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Sample records for actual clinical experience

  1. The Lived-Experience of Novice Nurse's Actualizing Clinical Reasoning in Academic Simulation

    ERIC Educational Resources Information Center

    Brinker, Mary Catherine

    2016-01-01

    The purpose of this existential-phenomenological study was to address the first-person perspective of what it is like to experience clinical reasoning during a simulation. It was not known how a novice nurse would describe the experience of actualizing clinical reasoning during the academic simulation experience. In order to maintain the…

  2. Clinical equipoise: actual or hypothetical disagreement?

    PubMed

    Gelfand, Scott

    2013-12-01

    In his influential 1987 essay, "Equipoise and The Ethics of Randomized Clinical Research," Benjamin Freedman argued that Charles Fried's theoretical equipoise requirement threatened clinical research because it was overwhelmingly fragile and rendered unethical too many randomized clinical trials. Freedman, therefore, proposed an alternative requirement, the clinical equipoise requirement, which is now considered to be the fundamental or guiding principle concerning the ethics of enrolling patients in randomized clinical trials. In this essay I argue that Freedman's clinical equipoise requirement is ambiguous and can be interpreted in (at least) two different ways. I furthermore claim that, ironically, the best interpretation of the clinical equipoise requirement opens Freedman to the same objection that he leveled against Fried twenty-five years ago; namely, that it (Freedman's clinical equipoise requirement) renders unethical too many randomized clinical trials.

  3. Actual Operation Simulation of RESSOX Ground Experiments

    DTIC Science & Technology

    2010-11-01

    One, every 30 s , we expect to receive orbit forecast information in the International Terrestrial Reference Frame (ITRF) for a duration of 3 minutes...values, every 30 s , RC will receive orbit estimation and forecast values in the International Terrestrial Reference Frame (ITRF) for a duration of 3...Fig. 3. System diagram of Experiment Two using QZSS. 30 s Orbit estimation values

  4. MLCMS Actual Use, Perceived Use, and Experiences of Use

    ERIC Educational Resources Information Center

    Asiimwe, Edgar Napoleon; Grönlund, Åke

    2015-01-01

    Mobile learning involves use of mobile devices to participate in learning activities. Most e-learning activities are available to participants through learning systems such as learning content management systems (LCMS). Due to certain challenges, LCMS are not equally accessible on all mobile devices. This study investigates actual use, perceived…

  5. Implementing a Clinical Experience for Student Trainers.

    ERIC Educational Resources Information Center

    Compton, Rod

    Clinical experiences offered to students preparing to become athletic trainers at East Carolina University (North Carolina) are diverse and multiple. The program acquaints students with actual medical practices in sports medicine by allowing them to observe experienced trainers and doctors at work as well as providing opportunities for practical…

  6. Does medical students’ clinical performance affect their actual performance during medical internship?

    PubMed Central

    Han, Eui-Ryoung; Chung, Eun-Kyung

    2016-01-01

    INTRODUCTION This study examines the relationship between the clinical performance of medical students and their performance as doctors during their internships. METHODS This retrospective study involved 63 applicants of a residency programme conducted at Chonnam National University Hospital, South Korea, in November 2012. We compared the performance of the applicants during their internship with their clinical performance during their fourth year of medical school. The performance of the applicants as interns was periodically evaluated by the faculty of each department, while their clinical performance as fourth-year medical students was assessed using the Clinical Performance Examination (CPX) and the Objective Structured Clinical Examination (OSCE). RESULTS The performance of the applicants as interns was positively correlated with their clinical performance as fourth-year medical students, as measured by the CPX and OSCE. The performance of the applicants as interns was moderately correlated with the patient-physician interaction items addressing communication and interpersonal skills in the CPX. CONCLUSION The clinical performance of medical students during their fourth year in medical school was related to their performance as medical interns. Medical students should be trained to develop good clinical skills through actual encounters with patients or simulated encounters using manikins, to enable them to become more competent doctors. PMID:26768172

  7. Optimal maintenance and consolidation therapy for multiple myeloma in actual clinical practice

    PubMed Central

    Lee, Ho Sup; Min, Chang-Ki

    2016-01-01

    Multiple myeloma is an incurable malignant plasma cell-originating cancer. Although its treatment outcomes have improved with the use of glucocorticoids, alkylating drugs, and novel agents, including proteasome inhibitors (bortezomib and carfilzomib) and immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide), relapse remains a serious problem. Strategies to improve outcomes following autologous stem cell transplantation and frontline treatments in non-transplant patients include consolidation to intensify therapy and improve the depth of response and maintenance therapy to achieve long-term disease control. Many clinical trials have reported increased progression-free and overall survival rates after consolidation and maintenance therapy. The role of consolidation/maintenance therapy has been assessed in patients eligible and ineligible for transplantation and is a valuable option in clinical trial settings. However, the decision to use consolidation and/or maintenance therapy needs to be guided by the individual patient situation in actual clinical practice. This review analyzes the currently available evidence from several reported clinical trials to determine the optimal consolidation and maintenance therapy in clinical practice. PMID:27604793

  8. Clinical experience with bemiparin.

    PubMed

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

    2010-12-14

    therapy, while bleeding complications over 3 months of therapy were similarly low. In a European study, acute treatment of DVT with bemiparin for one week followed by 12 weeks' secondary prevention with bemiparin (i.e. bemiparin/bemiparin) was associated with a cost saving of &U20AC;908 per patient compared with UFH/warfarin. Similarly, bemiparin/warfarin produced a cost saving of &U20AC;769 compared with UFH/warfarin. The savings were predominantly the result of reduced hospital stays during acute treatment with bemiparin. Bemiparin was also associated with increased quality-adjusted life expectancy. Observational studies in routine clinical practice demonstrated that outpatient treatment of acute VTE was as effective as inpatient treatment, but with lower costs, and bemiparin was as effective as vitamin K antagonists over 3 months for secondary prevention, with VTE recurrence rates of 0% and 0.3% over 3 months in separate studies. Bemiparin is thus an effective, well tolerated agent for thromboprophylaxis in surgery, and for the acute and long-term treatment of established VTE, having advantages over UFH and particular benefits as a result of initiating therapy postoperatively.

  9. Characteristics of Effective Clinical Teachers in Simulated Clinical Experiences Compared to Traditional Clinical Experiences

    ERIC Educational Resources Information Center

    Sieh-Bliss, Selina

    2014-01-01

    While there is evidence in the literature measuring effective clinical teacher characteristics in traditional experiences, little is known of effective characteristics expected from clinical teachers during simulated clinical experiences. This study examined which clinical teaching behaviors and characteristics are perceived by nursing students'…

  10. The Cleveland Clinic's magnet experience.

    PubMed

    Kuhar, Peggy A; Lewicki, Linda J; Modic, Mary Beth; Schaab, Debbie; Rump, Colleen; Bixler, Sarah

    2004-01-01

    The awarding of Magnet Status by the Magnet Nursing Services Recognition Program of the American Nursing Credentialing Center is acknowledged as the achievement of Excellence in Nursing. In this article, The Cleveland Clinic shares insights from its experience in becoming the 72nd Magnet hospital. Questions to ponder when conducting a readiness assessment before embarking on the Magnet journey, techniques to engage the staff in the application process, and writing and organizing tips are shared.

  11. Actual concepts in rhinosinusitis: a review of clinical presentations, inflammatory pathways, cytokine profiles, remodeling, and management.

    PubMed

    Eloy, Philippe; Poirrier, Anne Lise; De Dorlodot, Clotilde; Van Zele, Thibaut; Watelet, Jean Baptiste; Bertrand, Bernard

    2011-04-01

    Rhinosinusitis (RS) is a heterogeneous group of diseases. It is a significant and increasing health problem that affects about 15% of the population in Western countries. It has a substantial impact on patients' health-related quality of life and daily functioning and represents a huge financial burden to society and the health care system as a result of the direct and indirect costs. In addition, RS is not well-understood, and little is known about the etiology and pathophysiology. In the past decade, many papers have been published that have changed our understanding of RS. RS is commonly classified into acute and chronic RS based on symptom duration. In acute RS, an inflammatory reaction initiated by a viral infection characterizes most uncomplicated, mild to moderate cases. Therefore, the first line of treatment for these cases are intranasal steroids and not antibiotics. In severe and complicated cases, antibiotics combined with topical steroids remain the treatment of choice. On the other hand, chronic RS is actually subdivided into two distinct entities (chronic rhinosinusitis with and without polyps), as growing evidence indicates that these entities have specific inflammatory pathways and cytokine profiles. The authors review recent data regarding the clinical presentations, cytokine profiles, tissue remodeling, and modalities of treatment for each form of RS.

  12. Discrepancies between Official Science Curriculum and Actual Classroom Practice: The Nigerian Experience.

    ERIC Educational Resources Information Center

    Olorundare, Solomon A.

    1990-01-01

    This paper was based on an investigation of how an officially prescribed science curriculum was interpreted and translated by teachers into actual classroom practice in Nigerian primary schools. Mismatches between official and hidden curricula were rampant and often beyond teachers' control. The teacher's role was "policy broker," not…

  13. Management of Graves' disease: an overview and comparison of clinical practice guidelines with actual practice trends.

    PubMed

    Muldoon, Becky T; Mai, Vinh Q; Burch, Henry B

    2014-06-01

    Over the last century, much has been learned about the pathogenesis, manifestations, and management of Graves' disease leading to the establishment of evidence-based clinical practice guidelines. The joint clinical practice guidelines from the American Thyroid Association and the American Association of Clinical Endocrinologists give recommendations on both the diagnosis and treatment of hyperthyroidism. A survey of clinicians performed that same year, however, revealed that current practices diverge from these recently published guidelines in multiple areas. These differences will need to be assessed serially to determine the impact of the guidelines on future clinical practice and perhaps vice versa.

  14. Actual Texts, Possible Meanings: The Uses of Poetry and the Subjunctification of Experience

    ERIC Educational Resources Information Center

    Green, Andrew; Ellis, Viv; Simecek, Karen

    2016-01-01

    Jerome Bruner's experiment over 30 years ago suggested that imaginative literature had greater affordances for the "subjunctification" of experience by those who heard it read aloud than did transactional prose such as a news article. By "subjunctification", Bruner meant the capacity to use the resource (the short story, for…

  15. Hybrid quantitative simulation on the in-line phase-contrast x-ray imaging of three dimensional samples under actual clinic imaging parameters

    SciTech Connect

    Yu Hong; Han Shensheng; Ding Jianhui; Jiang Zhaoxia; Peng Weijun

    2009-07-06

    A hybrid model combining Monte Carlo method with diffraction theory of wave optics has been developed and applied to quantitatively simulate the in-line diffractive phase-contrast x-ray imaging of three dimensional tissue samples under actual clinic imaging parameters. The primary microcosmic interactions of medical-energy x-ray within matter including photoabsorption, Compton scattering, and coherent scattering, have been taken into account in the Monte Carlo simulation. A diffraction processing based on Fresnel diffraction theory is carried out to simulate the macroscopic diffraction effect. A comparison with experiment results has also been performed.

  16. [From the actual foreign experience in organization of functioning of day-hospital for children].

    PubMed

    2012-01-01

    The article deals with the issues of organization of functioning of day-hospital for children in particular foreign countries. The hospitals and medical centers of USA and Canada exemplify the positive experience of curative, rehabilitative and psychological care to children in daytime. The demand for effective medical service of this type by children and their parents is noted. The possibility of using this experience in Russian health care is discussed.

  17. Making the Difference for Teachers: The Field Experience in Actual Practice.

    ERIC Educational Resources Information Center

    Slick, Gloria Appelt, Ed.

    This is the third in a series of four books presenting a variety of field experience program models and philosophies that drive the programs provided to preservice teachers during their undergraduate teacher preparation. This publication explores the internal workings of the relationships and events that have an impact on all the persons involved…

  18. How Do Teachers' Intentions Influence What Teachers Actually Teach and What Students Experience?

    ERIC Educational Resources Information Center

    Thornton, Stephen J.

    This paper draws on a study of curriculum consonance (correspondence between teachers' goals, what ensues in the classroom, and what students learn) in three tenth-grade social studies classrooms. The three teachers had about the same number of years of teaching experience and educational attainment, and they were about the same age. The…

  19. Designing a Curriculum for Clinical Experiences

    ERIC Educational Resources Information Center

    Henning, John E.; Erb, Dorothy J.; Randles, Halle Schoener; Fults, Nanette; Webb, Kathy

    2016-01-01

    The purpose of this article is to describe a collaborative effort among five teacher preparation programs to create a conceptual tool designed to put clinical experiences at the center of our programs. The authors refer to the resulting product as a clinical curriculum. The clinical curriculum describes a developmental sequence of clinical…

  20. Would Socrates Have Actually Used the "Socratic Method" for Clinical Teaching?

    PubMed

    Stoddard, Hugh A; O'Dell, David V

    2016-09-01

    Medical students and residents are familiar with clinical teaching methods in which a faculty member poses a series of questions to them. This technique is often called the "Socratic method," but it is frequently perceived by learners as an attempt to demean them, a practice that is colloquially known as "pimping." The distinction between Socratic teaching and pimping lies in the perception of "psychological safety." Psychological safety allows learners to answer questions or ask for help without threats to their dignity or worthiness. In a psychologically safe clinical teaching context, learners recognize that questions posed by attending physicians probe their current understanding and guide them to expand their knowledge. In pimping, questions are posed to embarrass the learner and to reinforce the teacher's position of power over them. Absent a threat of disparagement or condemnation, learners are able to focus on building schema for knowledge, skills, and attitudes, rather than worrying about shielding their self-worth. This article presents the proper Socratic method, as intended by Socrates, and contrasts it with pimping. This perspective defines psychological safety as the pivotal factor distinguishing Socratic teaching from pimping, and establishes the foundation for empirical studies of these common practices in medical education.

  1. The feasibility of external blind DNA proficiency testing. II. Experience with actual blind tests.

    PubMed

    Peterson, Joseph L; Lin, George; Ho, Monica; Chen, Yingyu; Gaensslen, R E

    2003-01-01

    The background and goals of a national study to determine the feasibility of blind proficiency testing in U.S. forensic DNA laboratories are discussed. Part of the project involved designing and executing a series of fifteen blind proficiency tests. Execution included biological specimen donor recruitment and case evidence manufacturing. Simulated cases were submitted to DNA laboratories by law enforcement agencies and in some cases by other forensic-science laboratories. Replicate-manufactured evidence was submitted to reference laboratories to simulate the workings of a larger-scale program. Ten tests were straightforward, and essentially tested analytical ability. Five tests involved selecting on the basis of case facts appropriate bloodstains for typing from a bloodstain pattern. We describe in detail our experience in designing and conducting these blind proficiency test trials, and relate those experiences to the overall issue of blind proficiency testing as a quality-assurance tool in forensic DNA laboratories. In this feasibility test series, one blind test was detected by a laboratory, a second one was shown to the lab by law enforcement, and a third was never completed because of lapses in communication. Turnaround times were relatively fast in the independent/commercial labs and relatively slow in the larger public laboratories. Two cross-state case-to-case CODIS "hits" were "planted" among the first series of ten blind tests. One pair was detected. One member of the second pair went to a lab that was not CODIS-ready.

  2. Motor imagery of locomotion with an additional load: actual load experience does not affect differences between physical and mental durations.

    PubMed

    Munzert, Jörn; Blischke, Klaus; Krüger, Britta

    2015-03-01

    Motor imagery relies strongly on motor representations. Currently, it is widely accepted that both the imagery and execution of actions share the same neural representations (Jeannerod, Neuroimage 14:S103-S109, 2001). Comparing mental with actual movement durations opens a window through which to examine motor representations and how they relate to cognitive motor processes. The present experiment examined mental durations reported by participants standing upright who imagined walking either with or without an additional load while actually carrying or not carrying that same load. Results showed a robust effect of longer durations when imagining the additional load during mental walking, whereas physical walking with an additional load did not extend movement durations accordingly. However, experiencing an actual load during imagery did not influence mental durations substantially. This dissociation of load-related effects can be interpreted as being due to an interaction of motor processes and their cognitive representation along with a reduction in neural activity in vestibular and somatosensory areas during imagery of locomotion. It is argued that this effect might be specific to locomotion and not generalize to a broader range of movements.

  3. Implementation of the SSHAC Guidelines for Level 3 and 4 PSHAs - Experience Gained from Actual Applications

    USGS Publications Warehouse

    Hanks, Thomas C.; Abrahamson, Norm A.; Boore, David M.; Coppersmith, Kevin J.; Knepprath, Nichole E.

    2009-01-01

    In April 1997, after four years of deliberations, the Senior Seismic Hazard Analysis Committee released its report 'Recommendations for Probabilistic Seismic Hazard Analysis: Guidance on Uncertainty and Use of Experts' through the U.S. Nuclear Regulatory Commission as NUREG/CR-6372, hereafter SSHAC (1997). Known informally ever since as the 'SSHAC Guidelines', SSHAC (1997) addresses why and how multiple expert opinions - and the intrinsic uncertainties that attend them - should be used in Probabilistic Seismic Hazard Analyses (PSHA) for critical facilities such as commercial nuclear power plants. Ten years later, in September 2007, the U.S. Geological Survey (USGS) entered into a 13-month agreement with the U.S. Nuclear Regulatory Commission (NRC) titled 'Practical Procedures for Implementation of the SSHAC Guidelines and for Updating PSHAs'. The NRC was interested in understanding and documenting lessons learned from recent PSHAs conducted at the higher SSHAC Levels (3 and 4) and in gaining input from the seismic community for updating PSHAs as new information became available. This study increased in importance in anticipation of new applications for nuclear power facilities at both existing and new sites. The intent of this project was not to replace the SSHAC Guidelines but to supplement them with the experience gained from putting the SSHAC Guidelines to work in practical applications. During the course of this project, we also learned that updating PSHAs for existing nuclear power facilities involves very different issues from the implementation of the SSHAC Guidelines for new facilities. As such, we report our findings and recommendations from this study in two separate documents, this being the first. The SSHAC Guidelines were written without regard to whether the PSHAs to which they would be applied were site-specific or regional in scope. Most of the experience gained to date from high-level SSHAC studies has been for site-specific cases, although three

  4. Actual measurement, hygrothermal response experiment and growth prediction analysis of microbial contamination of central air conditioning system in Dalian, China

    PubMed Central

    Lv, Yang; Hu, Guangyao; Wang, Chunyang; Yuan, Wenjie; Wei, Shanshan; Gao, Jiaoqi; Wang, Boyuan; Song, Fangchao

    2017-01-01

    The microbial contamination of central air conditioning system is one of the important factors that affect the indoor air quality. Actual measurement and analysis were carried out on microbial contamination in central air conditioning system at a venue in Dalian, China. Illumina miseq method was used and three fungal samples of two units were analysed by high throughput sequencing. Results showed that the predominant fungus in air conditioning unit A and B were Candida spp. and Cladosporium spp., and two fungus were further used in the hygrothermal response experiment. Based on the data of Cladosporium in hygrothermal response experiment, this paper used the logistic equation and the Gompertz equation to fit the growth predictive model of Cladosporium genera in different temperature and relative humidity conditions, and the square root model was fitted based on the two environmental factors. In addition, the models were carried on the analysis to verify the accuracy and feasibility of the established model equation. PMID:28367963

  5. Clinical experience with CT colonography

    NASA Astrophysics Data System (ADS)

    Reed, Judd E.; Garry, John L.; Wilson, Lynn A.; Johnson, C. Daniel

    2000-04-01

    Since the introduction of Computed Tomographic Colonography (CTC) in 1995, many advances in computer equipment and software have become available. Despite these advances, the promise of colon cancer prevention has not been realized. A colorectal screening tool that performs at a high level, is acceptable to patients, and can be performed safely and at low cost holds promise of saving lives in the future. Our institution has performed over two hundred seventy five clinical CTC examinations. These scans, which each entail a supine and a prone acquisition, only differ from our research protocol in the necessity of an expeditious interpretation. Patients arrive for their CTC examination early in the morning following a period of fasting and bowel preparation. If a CTC examination has a positive finding, the patient is scheduled for colonoscopic polypectomy that same morning. To facilitate this, the patients are required to continue fasting until the CTC examination has been interpreted. It is therefore necessary to process the CTC examination very quickly to minimize patient discomfort. A positive CTC result occurred in fifteen percent of examinations. Among these positive results, the specificity has been in excess of ninety five percent. Additionally, life threatening extra-colonic lesions were discovered in two percent of the screened population.

  6. Clinical experience with nuclear pacemakers.

    PubMed

    Parsonnet, V; Myers, G H; Gilbert, L; Zucker, I R

    1975-12-01

    Approximately 1,400 nuclear pacemakers have been implanted in patients since April, 1970, without a single battery failure; 64 of these have been implanted at the Newark Beth Israel Medical Center. All except four of the 64 pulse generators were attached to transvenous electrodes, 39 to pacing wires already in place. Fifty-nine of the 64 units are in service and continue to function normally in a follow-up period of up to 2 years. In the total worldwide experience, 70 pacemakers are out of service, approximately half because of the patient's death, and the rest for infection or lead problems, and only three or four because of difficulties with components. The first 15 ARCO pacemakers implanted 2 years ago continue to function well. Of the 15 control pacemakers implanted at the same time, one unit has failed. We have concluded that a nuclear pacemaker should not be used in a patient with limited life expectancy or in an infant, but for the otherwise healthy young or middle-age individual, it should be the unit of choice.

  7. Experiences from a French-German project - on the integration of pupils in an actual space experiment

    NASA Astrophysics Data System (ADS)

    Horn, Eberhard R.; Dournon, Christian

    2007-09-01

    The German-French biological experiment AQUARIUS-XENO-PUS which flew on the French Soyuz taxi flight Andromède to the International Space Station ISS was extended by an outreach project. Pupils of class 10 to 12, age 16 to 18 years from Ulm/Germany and Tomblaine-Nancy/France were involved in this space experiment. They recorded swimming behavior of Xenopus laevis tadpoles by video. They used this as the 1gground control for similar observations in microgravity exposed tadpoles on the International Space Station, ISS. The pupils were instructed to perform all experimental steps following the protocol of the video recordings on ISS which were done by the French cosmonaut Claudie Haigneré. After the flight, they evaluated swimming activity of both ground controls and space animals using parameters such as type, velocity and acceleration of swimming, or the distribution patterns of tadpoles within the miniaquaria. The pupil project included theoretical components to introduce them to the field of gravitational biology. Nancy pupils established a homepage (www.xenope.com) about background and aim of their scientific project while Ulm pupils received an extended theoretical and practical education about gravity effects on biological systems, what gravity means for life on Earth, and about hardware used for biological research in Space. A feature of the project was the exchange of ideas between all pupils by internet and meetings which took place in Ulm (June 2001), Nancy (February 2002) and Paris (May 2002). Selected pupils presented the work at international conferences on Life Science Research in Space. The project lasted about 18 months; only 1 of 20 participants left the project after 6 months. - We consider our approach as a successful way to include high school students in space experiments on a cheap cost level and to bring the ideas of gravitational biology into curricula of European schools. The project also showed that personal engagement from the teachers

  8. The lived experience of clinical educators.

    PubMed

    Ferguson, D S

    1996-04-01

    This phenomenological study was undertaken to discover the everyday meanings which clinical educators of pre-registration Bachelor of Nursing students attached to their experiences as clinical educators. The researcher employed a qualitative design using audiotaped in-depth interviews with four registered nurses employed as clinical educators in four different schools of nursing in Victoria, Australia. Using hermeneutics, thematic analysis revealed five themes of meaning central to the lived experiences of clinical educators. They are:(a) being human, (b) having standards, (c) developing own teaching style, (d) learn as you go, and (e) not belonging. The first three themes are described in the literature on clinical education, however, the latter two are unique to this research. The results of this study indicate there is need for extensive preparation and on-going support of clinical educators. The researcher, who is respectful of the enormity of the task which educators face in preparing students for practice, speculates whether clinical educators are the vanguards of student learning in the clinical field. It is evident that the participants of this study did not possess many of the role requirements of clinical educators identified in the literature. Further studies are needed which explore the link between student learning and clinical educator support.

  9. Evidence supporting primary prevention of cardiovascular diseases with statins: Gaps between updated clinical results and actual practice.

    PubMed

    Bruckert, Eric; Ferrières, Jean

    2014-03-01

    The use of pharmacological lipid-lowering intervention in individuals with hypercholesterolaemia and known cardiovascular disease or diabetes/chronic kidney disease is well established. Current European Society of Cardiology guidelines recommend immediate initiation of drugs in adjunct to lifestyle intervention in these patients at high or very high cardiovascular risk. In these clinical settings, statins are generally chosen as the first-choice drug intervention, in consideration of the robust evidence showing a reduction in all-cause mortality and major adverse cardiac events (MACE). In contrast, primary prevention with statins, even in the subset of patients at high-risk of cardiovascular events, is not well implemented. This might be related to a lack of public awareness regarding the actual risk associated with prolonged exposure to high concentrations of low-density lipoprotein cholesterol (LDL-C) and uncertainties in the clinical evidence coming from the earliest trials in this patient subset. However, recent observational studies suggest that lowering LDL-C earlier in life and for a longer duration can substantially decrease the burden of cardiovascular disease and mortality. Moreover, results from recent well-conducted large meta-analyses of randomized clinical trials showed that primary prevention with statins reduced all-cause mortality by 14% and MACE by > 20% - findings similar to those observed for the use of statins in secondary prevention. Recently published American Heart Association/American College of Cardiology guidelines on the treatment of blood cholesterol emphasize that primary prevention using high-dose statins in individuals with LDL-C ≥ 190 mg/dL induces a benefit in atherosclerotic cardiovascular risk reduction that clearly exceeds the potential for adverse effects. We aim in this review to discuss the new data that advocate the use of statins in primary prevention earlier and more frequently, putting the efficacy evidence into

  10. Obstetrical staff nurses experiences of clinical learning.

    PubMed

    Veltri, Linda M

    2015-01-01

    The clinical learning experience is used in nursing programs of study worldwide to prepare nurses for professional practice. This study's purpose was to use Naturalistic Inquiry to understand the experiences of staff nurses in an obstetrical unit with undergraduate nursing students present for clinical learning. A convenience sample of 12 staff nurses, employed on a Family Birth Center, participated in semi-structured interviews. The constant comparative method as modified by Lincoln and Guba was used to analyze data. Five themes related to staff nurses experiences of clinical learning were identified: Giving and Receiving; Advancing Professionally and Personally; Balancing Act; Getting to Know and Working with You; and Past and Present. This research highlights staff nurses' experiences of clinical learning in undergraduate nursing education. Staff nurses exert a powerful, long lasting influence on students. A need exists to prepare and judiciously select nurses to work with students. Clinical agencies and universities can take joint responsibility providing tangible incentives, financial compensation, and recognition to all nurses working with nursing students.

  11. Improvements in and actual performance of the Plant Experiment Unit onboard Kibo, the Japanese experiment module on the international space station

    NASA Astrophysics Data System (ADS)

    Yano, Sachiko; Kasahara, Haruo; Masuda, Daisuke; Tanigaki, Fumiaki; Shimazu, Toru; Suzuki, Hiromi; Karahara, Ichirou; Soga, Kouichi; Hoson, Takayuki; Tayama, Ichiro; Tsuchiya, Yoshikazu; Kamisaka, Seiichiro

    2013-03-01

    In 2004, Japan Aerospace Exploration Agency developed the engineered model of the Plant Experiment Unit and the Cell Biology Experiment Facility. The Plant Experiment Unit was designed to be installed in the Cell Biology Experiment Facility and to support the seed-to-seed life cycle experiment of Arabidopsis plants in space in the project named Space Seed. Ground-based experiments to test the Plant Experiment Unit showed that the unit needed further improvement of a system to control the water content of a seedbed using an infrared moisture analyzer and that it was difficult to keep the relative humidity inside the Plant Experiment Unit between 70 and 80% because the Cell Biology Experiment Facility had neither a ventilation system nor a dehumidifying system. Therefore, excess moisture inside the Cell Biology Experiment Facility was removed with desiccant bags containing calcium chloride. Eight flight models of the Plant Experiment Unit in which dry Arabidopsis seeds were fixed to the seedbed with gum arabic were launched to the International Space Station in the space shuttle STS-128 (17A) on August 28, 2009. Plant Experiment Unit were installed in the Cell Biology Experiment Facility with desiccant boxes, and then the Space Seed experiment was started in the Japanese Experiment Module, named Kibo, which was part of the International Space Station, on September 10, 2009 by watering the seedbed and terminated 2 months later on November 11, 2009. On April 19, 2010, the Arabidopsis plants harvested in Kibo were retrieved and brought back to Earth by the space shuttle mission STS-131 (19A). The present paper describes the Space Seed experiment with particular reference to the development of the Plant Experiment Unit and its actual performance in Kibo onboard the International Space Station. Downlinked images from Kibo showed that the seeds had started germinating 3 days after the initial watering. The plants continued growing, producing rosette leaves, inflorescence

  12. Lessons Learned from Eight Years' Experience of Actual Operation, and Future Prospects of JMA Earthquake Early Warning System

    NASA Astrophysics Data System (ADS)

    Hoshiba, M.; Nishimae, Y.

    2015-12-01

    Since 2007, experiences of actual operation of EEW have been gained by the Japan Meteorological Agency (JMA). During this period, we have learned lessons from many M6- and M7-class earthquakes, and the Mw9.0 Tohoku earthquake. During the Mw9.0 Tohoku earthquake, JMA system functioned well: it issued a warning message more than 15 s before strong ground shaking in the Tohoku district (relatively near distance from the epicenter). However, it was not perfect: in addition to the problem of large extent of fault rupture, some false warning messages were issued due to the confusion of the system because of simultaneous multiple aftershocks which occurred at the wide rupture area. To address the problems, JMA will introduce two new methods into the operational system this year to start their tests, aiming at practical operation within a couple of years. One is Integrated Particle Filter (IPF) method, which is an integrated algorithm of multiple hypocenter determination techniques with Bayesian estimation, in which amplitude information is also used for hypocenter determination. The other is Propagation of Local Undamped Motion (PLUM) method, in which warning message is issued when strong ground shaking is detected at nearby stations around the target site (e.g., within 30 km). Here, hypocenter and magnitude are not required in PLUM. Aiming at application for several years later, we are investigating a new approach, in which current wavefield is estimated in real time, and then future wavefield is predicted time evolutionally from the current situation using physics of wave propagation. Here, hypocenter and magnitude are not necessarily required, but real-time observation of ground shaking is necessary. JMA also plans to predict long period ground motion (up to 8 s) with the EEW system for earthquake damage mitigation in high-rise buildings. Its test will start using the operational system in the near future.

  13. Nurses’ experiences of humour in clinical settings

    PubMed Central

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

    2015-01-01

    Background: Providing holistic nursing care when there is a shortage of personnel and equipment exposes nurses to stress and a higher risk of occupational burnout. Humour can promote nurses’ health and influence nursing care. The aim of this study was to describe nurses’ experiences of humour in clinical settings and factors affecting it. Methods: This qualitative study investigated nurses’ experiences of humour. Five hospitals affiliated to Tehran University of Medical Sciences provided the setting for this study. The participants comprised of 17 nurses with master’s and Baccalaureate degrees (BSN) in nursing. These nurses worked at educational hospitals affiliated to Tehran University of Medical Sciences and had minimum work experience of 12 months in various clinical wards. Nurses from all wards were invited to participate in this study. The data were collected through semi structure interviews using guides comprising probing questions. Telephonic interviews were used to further supplement the data. The data were analysed using conventional content analysis. Results: The data were classified into five themes including the dynamics of humour, condition enforcement, Risk making probability, Instrumental use and Change: opportunities and threats. Conclusion: Understanding nurses’ perceptions and experiences of humour helps identify its contributing factors and provides valuable guidelines for enhancing nurses and patients’ mental, emotional and physical health. Spreading a culture of humour through teaching methods can improve workplace cheerfulness and highlights the importance of humour in patient care in nurses and nursing students. PMID:26034735

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

    ERIC Educational Resources Information Center

    LaFauci, Frances F.

    2009-01-01

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

  15. Closed-loop neurostimulation: the clinical experience.

    PubMed

    Sun, Felice T; Morrell, Martha J

    2014-07-01

    Neurostimulation is now an established therapy for the treatment of movement disorders, pain, and epilepsy. While most neurostimulation systems available today provide stimulation in an open-loop manner (i.e., therapy is delivered according to preprogrammed settings and is unaffected by changes in the patient's clinical symptoms or in the underlying disease), closed-loop neurostimulation systems, which modulate or adapt therapy in response to physiological changes, may provide more effective and efficient therapy. At present, few such systems exist owing to the complexities of designing and implementing implantable closed-loop systems. This review focuses on the clinical experience of four implantable closed-loop neurostimulation systems: positional-adaptive spinal cord stimulation for treatment of pain, responsive cortical stimulation for treatment of epilepsy, closed-loop vagus nerve stimulation for treatment of epilepsy, and concurrent sensing and stimulation for treatment of Parkinson disease. The history that led to the development of the closed-loop systems, the sensing, detection, and stimulation technology that closes the loop, and the clinical experiences are presented.

  16. [Rationale for using nabumetone and clinical experience].

    PubMed

    Roth, S H

    2000-01-01

    Nabumetone's position as one of the most commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) in the world today is based upon over a decade of clinical experience. The popularity of this drug lies in both its unique pharmacokinetic profile and special safety features in pharmacodynamic terms. This nonacidic prodrug with an active 6-methoxy-2-naphthylacetic acid (6-MNA) metabolite has COX-2 preferential features and is also devoid of enterohepatic recirculation. It is felt that these characteristics have provided the basis for its unique long term tolerability, documented in various at-risk osteoarthritis and rheumatoid arthritis populations. The excellent tolerability of nabumetone and its 24-hour half-life, which provides the advantages of a once-daily dosage regimen, make it uniquely suitable for long term anti-inflammatory therapy in arthritis. The tolerability profile of nabumetone has also demonstrated clear cost-effectiveness advantages, as confirmed by comparative and epidemiological studies. Selective COX-2 NSAIDs are likely to prove more expensive because of the increasing costs and demands of clinical research prior to FDA approval. These higher costs may limit and influence patient access, depending on the healthcare delivery system, and many years of experience will be required to document the putative tolerability advantages of these newer COX-2 inhibitor agents. In the meantime, it is comforting that nabumetone has established such an advantageous tolerability profile together with acknowledged efficacy.

  17. Undergraduate clinical orthodontic experience: a discussion paper.

    PubMed

    Oliver, R; Hingston, E

    2006-08-01

    Undergraduate clinical orthodontic experience may be expressed in a variety of ways. The most common way (used, inter alia, in the DentEd school visits) is by number of curriculum hours. Other ways include the number of patients seen, or number of procedures carried out. Whilst any of these methods may allow comparison between cohorts of students within a school or between schools, none of them are suitable to determine how much experience is 'satisfactory', nor do they indicate what the student should know, understand, or be able to do, to be considered 'satisfactory', and hence fit to graduate. This situation may be addressed by the use of competences and/or learning outcomes, and in 2004 the Association for Dental Education in Europe (ADEE) adopted a document that contained one major competence and five supporting competences in orthodontics. This paper considers the shortcomings of conventional methods of recording orthodontic experience in relation to the acquisition of these competences, and some ways in which staff and students may assess competence.

  18. Clinical experience with ureteral metal stents

    PubMed Central

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

    2010-01-01

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

  19. Liposomal amphotericin B: clinical experience and perspectives.

    PubMed

    Gibbs, Winter J; Drew, Richard H; Perfect, John R

    2005-04-01

    While amphotericin B deoxycholate (Fungizone, Apothecon Pharmaceuticals) has been considered by many to be the gold standard for the treatment for numerous invasive fungal infections for over 45 years, toxicities associated with its use often necessitate treatment modification or discontinuation. Lipid-based formulations, including liposomal amphotericin B (AmBisome, Fujisawa Healthcare, Inc.), were developed to decrease many of these toxicities while retaining broad antifungal spectrum and potency of amphotericin B. In clinical trials, liposomal amphotericin B has demonstrated efficacy comparable to that of amphotericin B deoxycholate while reducing the incidence of treatment-related nephrotoxicity, electrolyte-wasting, and infusion-related reactions. In addition, recent clinical trials have also compared liposomal amphotericin B with other antifungal classes. Acquisition costs of liposomal amphotericin B are substantially higher than those of amphotericin B deoxycholate and other antifungals. While pharmacoeconomic analyses consider outcomes and other treatment-related costs, they have yet to clearly demonstrate the cost-effectiveness of liposomal amphotericin B when compared with amphotericin B deoxycholate or other antifungal agents. This review will focus primarily on recent liposomal amphotericin B experience and attempt to put its use into perspective considering other available antifungal agents.

  20. Johnson Space Center Flight Medicine Clinic Experience

    NASA Technical Reports Server (NTRS)

    Landry, Trela

    2006-01-01

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

  1. How do clinicians actually use the Diagnostic and Statistical Manual of Mental Disorders in clinical practice and why we need to know more.

    PubMed

    First, Michael B; Bhat, Venkat; Adler, David; Dixon, Lisa; Goldman, Beth; Koh, Steve; Levine, Bruce; Oslin, David; Siris, Sam

    2014-12-01

    The clinical use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is explicitly stated as a goal for both the DSM Fourth Edition and DSM Fifth Edition (DSM-5) revisions. Many uses assume a relatively faithful application of the DSM diagnostic definitions. However, studies demonstrate significant discrepancies between clinical psychiatric diagnoses with those made using structured interviews suggesting that clinicians do not systematically apply the diagnostic criteria. The limited information regarding how clinicians actually use the DSM raises important questions: a) How can the clinical use be improved without first having a baseline assessment? b) How can potentially significant shifts in practice patterns based on wording changes be assessed without knowing the extent to which the criteria are used as written? Given the American Psychiatric Association's plans for interim revisions to the DSM-5, the value of a detailed exploration of its actual use in clinical practice remains a significant ongoing concern and deserves further study including a number of survey and in vivo studies.

  2. ‘I am actually doing something to keep well. That feels really good’: Experiences of exercise within hospice care

    PubMed Central

    Turner, Karen; Tookman, Adrian; Bristowe, Katherine; Maddocks, Matthew

    2016-01-01

    Background: Patients with advanced cancer frequently experience functional impairment and reduced quality of life. Therapeutic exercise can provide benefit and be made accessible through the use of tailored programmes. Most studies examining exercise programmes for people with advanced cancer have used quantitative outcome measures and focussed on objective physical function, therefore offer a limited perspective on the experience of exercise participation. Methods: This qualitative study explored patients' experiences of an exercise programme within a palliative care setting. The interviews focussed on the perceived impact on all aspects of quality of life. Results: Nine people with advanced cancer, attending a hospice-based exercise programme, completed a one-to-one interview with a senior physiotherapist to explore the physical, emotional, and social impacts of their participation. Interviews were audiotaped, transcribed verbatim and analysed using interpretive phenomenological analysis. Patients reported an awareness of the positive physical, psychological, and social consequences of exercising. Their experiences reflected on all dimensions of quality of life, the impact of others and the sense of meaning gained through participation in exercise. Conclusion: Our findings highlight that exercise in palliative care should not be viewed solely a physical intervention, but one that has potential to enhance many aspects of patients' quality of life. PMID:27453639

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

    ERIC Educational Resources Information Center

    Zeanah, Charles H.

    2009-01-01

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

  4. [Enalapril-clinical experience in Bulgaria].

    PubMed

    Taseva, T

    2000-01-01

    The authors present the results of clinical trail about treatment of arterial hypertension with ENAP (Enalapril) fo KRKA in centers of Bulgaria. Enalapril is ACE-inhibitor usually administered orally once daily, decreases blood pressure by lowering peripheral vascular resistance without increasing heart rate or output. In this clinical trail are given results about blood pressure, heart rate and biochemical indexes. The most frequent adverse events--headache, dizziness, orthostatic effects, abdominal pain e.t.s. occurring in less than 10%. More important side effects like dry persistent cough occurring in 8.6%. The results of clinical trail define high efficacy and good tolerability of ENAP in the treatment of arterial hypertension.

  5. Ultrafast networks (ATM): first clinical experiences.

    PubMed

    Duerinckx, A J; Valentino, D J; Hayrapetian, A; Hagan, G; Grant, E G

    1996-06-01

    Ultrafast networks using asynchronous transfer mode (ATM) technology can provide the bandwidth and throughput that may be sufficient to satisfy the medical imaging community. Several trials are underway to assess the effect of ATM network capabilities on the clinical practice of radiology, by providing immediate interactive radiology consultations between subspecialists and general radiologists at affiliated academic institutions. The hardware to build such networks is now commercially available and its cost is decreasing steadily, but the monthly charges for ATM bandwidth use are still high. Nevertheless, given the tremendous increase in communication capability and data transfer rates possible with ATM networks, cost alone should not be the determining factor for selecting this technology. The ATM concept in general is first reviewed, followed by a description of early clinical ATM network installation in four medical environments worldwide. These medical clusters include: the UCLA affiliated hospitals (UCLA Medical Center, West LA VAMC and Olive-View UCLA Medical Center), the UCSF affiliated hospitals, Duke University Hospitals and a cluster of medical centers in Berlin which have all been connected via ATM networks. The use of ATM technology in these realistic clinical environments is discussed and evaluated for its potential impact on patient care and clinical teaching within radiology departments. From this preliminary study it is concluded that image communications over a regional PACS using an ATM network can allow interactive consultations between different subspecialist and general radiologists or other specialized radiologists spread over different medical centers.

  6. Clinical Engineering: Experiences of assisted professional practices

    NASA Astrophysics Data System (ADS)

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

    2007-11-01

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

  7. [Clinical experience with a new microfilled composite].

    PubMed

    Grandini, R; Pagavino, G; Nardi, P

    1990-02-01

    The authors have investigated a new material for esthetic restoration for front teeth. It is a microfilled heterogene composite (Helio Progress) with spheridal prepolymer. The clinical trials were realized in cavities III, IV an V, in anomal y teeth and resin ceramic (with a pretreatment with silane). The results after 18 months have demonstrated the better characteristics of this material in relation with foreknown ones.

  8. The clinical experience of acute cyanide poisoning.

    PubMed

    Yen, D; Tsai, J; Wang, L M; Kao, W F; Hu, S C; Lee, C H; Deng, J F

    1995-09-01

    The authors reviewed the clinical manifestations, complications, and the prognosis affected by Lilly Cyanide Antidote in 21 victims of acute cyanide poisoning over a 10-year period. The clinical signs and symptoms in cyanide poisoning are variable. Among 21 cases, loss of consciousness (15), metabolic acidosis (14), and cardiopulmonary failure (9) were the three leading manifestations of cyanide intoxication. Anoxic encephalopathy (6) was not uncommon in the severely intoxicated victims. Diabetes insipidus (1) or clinical signs and symptoms mimicking diabetes insipidus (3) may be an ominous sign to encephalopathy victims. The major cause of fatal cyanide poisoning is the intentional ingestion of cyanide compounds as part of a suicide attempt. Decrease of arteriovenous difference of O2 partial pressure may be a clue for the suspicion of cyanide intoxication. Although the authors cannot show a statistically significant difference (P = .47) for the Lilly cyanide antidote kit in terms of improving the survival rate for victims of cyanide poisoning, the antidote kit was always mandatory in our study in the cases of severely intoxicated victims who survived. Early diagnosis, prompt, intensive therapy with antidote, and supportive care are still the golden rules for the treatment of acute cyanide poisoning, whether in the ED or on the scene.

  9. Does Work Experience Actually Work?

    ERIC Educational Resources Information Center

    Field, John

    2012-01-01

    As unemployment levels rise, so education and training move into the policy spotlight. For the government, this is a very uncomfortable place to be right now. A number of large companies have withdrawn from the flagship Work Programme--under which jobseekers are invited to take up unpaid work placements of between two and eight weeks--amid…

  10. Experimental and clinical experience with distraction osteogenesis.

    PubMed

    Aronson, J

    1994-11-01

    G.A. Ilizarov's clinical insights and experimental biology have developed into what is known today as distraction osteogenesis. Initially used for the treatment of fractures and nonunions, his methods have proven successful for limb lengthening and bone transportation. A brief history of the development of distraction osteogenesis, definition of terms, methods, and monitoring techniques are described. The primary mechanism, intramembranous ossification, is direct bone formation in uniform gradients of mineralization from a central fibrous interzone. New bone is produced from the local host surfaces and quickly remodels to the equivalent macro and microstructure. Blood supply at the focus of distraction, dependency on a latency period, different rates, and rhythms of distraction are all tested and discussed. Data from experimental tibial lengthening in more than 125 animals (dogs, rabbits, and rats) show that distraction osteogenesis provides unlimited new bone formation that remodels at daily rates ranging from 200 to 400 microns. In over 100 clinical cases, patients ranging in age from 18 months to 49 years have regenerated bone at an average rate of 213 microns in adults and 385 microns in children. Approximately 10% of these cases required supplemental bone grafts. The article proposes that distraction osteogenesis might be successfully applied in craniofacial surgery.

  11. Paranasal sinus mucoceles: our clinical experiments

    PubMed Central

    Topdag, Murat; Iseri, Mete; Sari, Fatih; Erdogan, Selvet; Keskin, I Gurkan

    2015-01-01

    Objectives: We present the clinical and radiological features, treatment protocols, and medium-long-term results of our patients following surgery for paranasal sinus mucocele, along with a review of the relevant literature. Materials and methods: A total of 18 patients (11 women and 7 men) who underwent surgery for paranasal sinus mucocele at Kocaeli University Faculty of Medicine, Department of Otolaryngology, between 2006 and 2013 were examined retrospectively. The mean patient age was 41 (range 4-73). Demographic and radiological features, symptoms, treatment protocols, and postoperative outcomes were recorded. Results: The most frequently affected sinus was the maxillary sinus (n=9, 50%) followed by the frontal sinus (n=6, 33%) and sphenoidal sinus (n=3, 16%). The main symptom was headache. Endoscopic marsupialization of the mucocele was applied in all 18 patients, while frontal sinus exploration with the osteoplastic flap procedure was performed in one patient and the Caldwell-Luc operation was performed in another patient. The Caldwell-Luc procedure was subsequently required in one patient (6%) and endoscopic revision surgery was required in another patient (6%). Conclusion: Sinus mucocele that enlarges, eroding the surrounding bone tissue, and induces various clinical symptoms due to the impression of the expansile mass, is treated surgically, and must be planned carefully to prevent serious complications. PMID:26770462

  12. The experience of nursing students who make mistakes in clinical.

    PubMed

    Zieber, Mark Pijl; Williams, Beverley

    2015-05-07

    The experience of nursing students who make mistakes during clinical practice is poorly understood. The literature identifies clinical practice mistakes as a significant issue in nursing practice and education but there is very little research on the topic. This study used a grounded theory approach to explore the experience of undergraduate nursing students who had made at least one mistake in their clinical practice. What emerged is a theory that illuminates the process of how students move through the positive and negative elements of the mistake experience the core variable that emerged from the study was "living through the mistake experience." The mistake experience was clearly a traumatic process for nursing students and students reported feeling unprepared and lacking the capability to manage the mistake experience. A number of recommendations for nursing education are proposed.

  13. Clinical experience with Angiojet: a comprehensive review.

    PubMed

    Ierardi, A M; Xhepa, G; Piffaretti, G; Bacuzzi, A; Tozzi, M; Carbone, M; Barile, A; Squillaci, E; Fonio, P; Brunese, L; Carrafiello, G

    2015-12-01

    The development of various sophisticated mechanical thrombectomy devices and the amassed experience of physicians in minimal invasive therapy produced a paradigm shift in vascular access management toward percutaneous declotting procedures, using pharmaceutical thrombolysis, mechanical thrombectomy, balloon thrombectomy, and a combination of the above techniques. In this setting, in the last years, AngioJet™ (Possis, Minneapolis, MN, USA) rheolytic thrombectomy (RT) showed an increasing use in emergency and election patients. The purpose of this review is to present the current status of percutaneous rheolytic thrombectomy in different fields of applications.

  14. Clinical experience with peripheral excimer laser angioplasty

    NASA Astrophysics Data System (ADS)

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

    1993-06-01

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

  15. Clinical evaluation of terconazole. European experience.

    PubMed

    Hirsch, H A

    1989-08-01

    Terconazole is a new topical antifungal agent that differs structurally and functionally from the imidazoles. European clinical trials were conducted to determine (1) the lowest effective dose for a given treatment period, (2) which formulation should be tested further, and (3) how terconazole compares with other topical antifungal agents in terms of safety and efficacy. The results of dose-response studies demonstrated that 80- and 240-mg suppositories and 0.4% cream were the most effective formulations. Data from multicenter studies of pregnant and nonpregnant women in Belgium and Luxembourg indicate that the efficacy of terconazole cream is superior to that of miconazole nitrate cream and clotrimazole cream. Terconazole cream is also more effective than clotrimazole cream in terms of lower relapse rates.

  16. Clinical evaluation of terconazole. United states experience.

    PubMed

    Thomason, J L

    1989-08-01

    Terconazole is the first of a new class of antifungal agents, the triazoles. The results of numerous European studies have demonstrated the efficacy and safety of this agent in both cream and suppository form in the treatment of vulvovaginal candidiasis. Recently, results of short- and long-term analyses in the United States confirmed the efficacy and safety of 0.4% terconazole cream and 80-mg terconazole suppositories. In short-term evaluations (eight to ten days after therapy), 0.4% terconazole cream was as effective as 2.0% miconazole nitrate cream and significantly superior microbiologically in one study. The clinical cure rates with terconazole cream ranged from 87.3% to 95.5% and the microbiologic cure rates, from 76.9% to 91.1%. Thirty- to 35-day microbiologic relapse rates with terconazole cream ranged from 10.4% to 22.2%. In the short-term evaluations of vaginal suppositories the cure rates of 80-mg terconazole suppositories for three days were comparable to those of 100-mg miconazole nitrate suppositories for seven days. The clinical cure rates with 80-mg terconazole suppositories ranged from 90.0% to 92.2% and the microbiologic cure rates, from 80.4% to 85.0%. The 30- to 35-day microbiologic relapse rates of the 80-mg terconazole suppositories ranged from 20.0% to 28.1%. Terconazole cream and suppositories demonstrated an excellent safety profile in all the studies; no life-threatening side effects occurred with any of the regimens. The frequency of common side effects was similar with terconazole and miconazole nitrate formulations.

  17. The good clinical nursing educator and the baccalaureate nursing clinical experience: attributes and praxis.

    PubMed

    Hanson, Karla J; Stenvig, Thomas E

    2008-01-01

    Clinical education accounts for a significant portion of baccalaureate nursing (BSN) education. This study examined recent BSN program graduates' views about clinical nursing educator attributes that enhance the ability of the graduates to provide safe, effective patient care. In this descriptive study, 6 participants were interviewed using grounded theory techniques. The study framework blended the elements of cognitive field theory, the humanistic philosophy of teaching and learning, the gestalt theory of learning, and Hergenhahn's behavioral change model. Participants identified three attributes of a good clinical nursing educator: knowledge, interpersonal presentation, and teaching strategies. Analysis revealed that educator attributes and phases of the clinical experience process together form the foundation for clinical experience praxis. Educators can improve the clinical education experience by developing teaching strategies and evaluation tools that build on the positive attributes and phases of the clinical experience identified in this study.

  18. Differences in clinical experiences of ADN and BSN students.

    PubMed

    Oermann, M H

    1998-05-01

    Prior research has suggested that clinical experience for nursing students is stressful. Concern about making an error and harming the patient, limited knowledge and skills for practice, and difficulties in interacting with the teacher and others in the clinical setting are some of the stressors reported by students. Few studies have compared these stresses and the clinical experiences in general between students in associate degree (ADN) and baccalaureate (BSN) nursing programs. The purposes of this research were to compare the clinical experiences of ADN and BSN students at different levels in the programs and describe these experiences from the students' perspectives. As such, both quantitative and qualitative data were collected from 415 students in ADN and BSN programs in the Midwest. The ADN students reported significantly higher stress in clinical practice than BSN students (t = 2.16, p < .05). The stress experienced by ADN and BSN students in clinical practice increased as they progressed through the programs. The semester prior to graduation was the most stressful time in terms of clinical practice for both ADN and BSN students. The instructor was the predominant stressor reported by students in ADN programs across all levels of the curriculum. Among BSN students, the most prevalent stresses were coping with demands associated with patient care and the clinical teacher. The findings highlight the important role of the clinical faculty in both types of nursing programs.

  19. Immunoscintigraphic localization of inflammatory lesions: clinical experience.

    PubMed

    Seybold, K; Locher, J T; Coosemans, C; Andres, R Y; Schubiger, P A; Bläuenstein, P

    1988-01-01

    This clinical study was based on the experimental results reported in the two preceding papers, showing that the highly selective affinity of the 123I-anti-CEA monoclonal antibody 47 (123I-Mabgc) for human granulocytes makes this compound suitable for the immunoscintigraphic detection of inflammatory lesions. Forty five patients with suspected infections have been studied after infusion of 4 mCi (148 MBq) 123I-Mabgc corresponding to 120 micrograms labeled protein. No adverse reactions have been seen. Because of the high number of labeled cells, the quality of the images was excellent. SPECT was performed in 15 cases in order to define the extent of the lesion. Infectious foci were usually seen 3-5 h postinjection, but the unimpaired function of the granulocytes guarantees diagnostically relevant examinations over a much longer period of time. Scans were read as being negative if no pathological accumulation of activity was detected after 24 h. The new scanning method is technically easy to perform and provides distinct advantages over other techniques necessitating in vitro labeling of the white blood cells. Therefore, recommended indications are acute infections of unknown origin or extent, especially recurrent episodes of osteomyelitis and infections of joint prostheses.

  20. Clinical experience in appendiceal neuroendocrine neoplasms

    PubMed Central

    Ozcelik, Caglar K.; Bozdogan, Nazan; Dibekoglu, Cengiz

    2015-01-01

    Aim of the study To analyse the incidence of appendiceal neuroendocrine neoplasms in appendectomy specimens and establish the epidemiological and histopathological features, treatment, and clinical course. Material and methods Between 2004 and 2013, 975 patients who underwent appendectomy in Ankara Oncology Education and Research Hospital were retrospectively analysed. Results Neuroendocrine neoplasm was detected in the nine of 975 (0.9%) patients. Neuroendocrine neoplasms were diagnosed in eight patients by appendectomy, which was performed because of the prediagnosis of acute appendicitis, and in one patient by the suspicious mass detection during surgical procedures that were done in the appendix for a different reason. Eight of the patients’ tumours were in the tip of the appendix, and one of the patients’ tumours was at the base of appendix. Tumour size in 77.8% of patients was equal or less than 1 cm, in 22.2% patients it was 1–2 cm. There was tumour invasion in the muscularis propria layer in four patients, in the serosa layer in three patients, and in the deep mesoappendix in two patients. Patients were followed for a median of 78 months. In the follow-up of patients who were operated because of colon cancer, metachronous colon tumour evolved. This patient died due to progressive disease. Other patients are still disease-free. Conclusions The diagnosis of neuroendocrine neoplasm is often incidentally done after appendectomy. Tumour size is important in determining the extent of disease and in the selection of the surgical method during operation. PMID:26793027

  1. [Clinical experience of automated double filtration plasmapheresis].

    PubMed

    Lee, C T; Chuang, F R; Hsu, K T; Lam, K K; Liao, S C; Liu, C C; Chen, J B; Jang, S W; Chien, Y S; Pan, H H

    1996-12-01

    Double filtration plasmapheresis, one kind of fractionation plasmapheresis, was developed from membrane type plasmapheresis to remove only the pathogen and return the normal protein back to the patient. We started our automated double filtration plasmapheresis since December 1993. There were 13 patients who received one hundred treatments totally during one year period. And they are myasthenia gravis (8 patients); acute inflammatory demyelinating polyneuropathy (1 patient), multiple myeloma (1 patient); acquired factor VIII inhibitor (1 patient); autoimmune hemolytic anemia (1 patient); systemic lupus erythematous (1 patient). Technically double filtration plasmapheresis is easy to perform and time-saving. It also makes necessity of replacement fluid less frequent. Incidence of complication is rare, and this includes hypotension 2%, palpitation 1%, headache 1%, hemolysis 4%, air emboli 1%, high secondary pressure 2%, and no motality during our treatment. Clinical response is documented in cases of myasthenia gravis; acute inflammatory demyelinating polyneuropathy and acquired factor VIII inhibitor in our study. In conclusion, double filtration plasmapheresis is a time-saving, convenient, and safe therapeutic modality with rare complication. Because its effectiveness on limited kinds of diseases and costs relatively high price, thus plasmapheresis should be used in selected cases and treat aggressively if indicated.

  2. Cartap hydrochloride poisoning: A clinical experience

    PubMed Central

    Boorugu, Hari K.; Chrispal, Anugrah

    2012-01-01

    Cartap hydrochloride, a nereistoxin analog, is a commonly used low toxicity insecticide. We describe a patient who presented to the emergency department with alleged history of ingestion of Cartap hydrochloride as an act of deliberate self-harm. The patient was managed conservatively. To our knowledge this is the first case report of Cartap hydrochloride suicidal poisoning. Cartap toxicity has been considered to be minimal, but a number of animal models have shown significant neuromuscular toxicity resulting in respiratory failure. It is hypothesized that the primary effect of Cartap hydrochloride is through inhibition of the [3H]-ryanodine binding to the Ca2+ release channel in the sarcoplasmic reticulum in a dose-dependent manner and promotion of extracellular Ca2+ influx and induction of internal Ca2+ release. This results in tonic diaphragmatic contraction rather than paralysis. This is the basis of the clinical presentation of acute Cartap poisoning as well as the treatment with chelators namely British Anti Lewisite and sodium dimercaptopropane sulfonate. PMID:22557838

  3. Cartap hydrochloride poisoning: A clinical experience.

    PubMed

    Boorugu, Hari K; Chrispal, Anugrah

    2012-01-01

    Cartap hydrochloride, a nereistoxin analog, is a commonly used low toxicity insecticide. We describe a patient who presented to the emergency department with alleged history of ingestion of Cartap hydrochloride as an act of deliberate self-harm. The patient was managed conservatively. To our knowledge this is the first case report of Cartap hydrochloride suicidal poisoning. Cartap toxicity has been considered to be minimal, but a number of animal models have shown significant neuromuscular toxicity resulting in respiratory failure. It is hypothesized that the primary effect of Cartap hydrochloride is through inhibition of the [(3)H]-ryanodine binding to the Ca(2+) release channel in the sarcoplasmic reticulum in a dose-dependent manner and promotion of extracellular Ca(2+) influx and induction of internal Ca(2+) release. This results in tonic diaphragmatic contraction rather than paralysis. This is the basis of the clinical presentation of acute Cartap poisoning as well as the treatment with chelators namely British Anti Lewisite and sodium dimercaptopropane sulfonate.

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

    PubMed

    Akduman, B; Crawford, E D

    2001-12-01

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

  5. Tinnitus: clinical experience of the psychosomatic connection

    PubMed Central

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

    2014-01-01

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

  6. Clinical experience with cyanoacrylate tissue adhesive.

    PubMed

    Moschos, M; Droutsas, D; Boussalis, P; Tsioulias, G

    In this paper 385 cases treated with cyanoacrylate tissue adhesive during the years 1980-1995 are studied. The indications, outcomes and complications of cyanoacrylate adhesive are investigated and the results are analysed. It is encouraging that except for three cases of ocular hypotony and two cases of microbial infection no other complications occurred. Even in desperate cases with corneal perforation greater than 3 mm and ocular infection, enucleation was avoided. The early use of a bandage contact lens, inserted just after the glue application and the coverage with topical antibiotics switched every 15 days until the removal of the glue, may explain the small incidence of infection. Our experience from the use of cyanoacrylate tissue adhesive in cases with corneal perforation greater than 3 mm is very encouraging. In these cases a running 10.0 nylon suture was used to create a reticulum over the space of the corneal perforation upon which the glue was applied. The use of cyanoacrylate tissue adhesive offers to the clinician a safe technique for healing corneal wounds that avoids tectonic penetrating keratoplasty with its associated complications.

  7. Review article: clinical experience with Prometheus.

    PubMed

    Rifai, Kinan; Manns, Michael P

    2006-04-01

    Prometheus is a new extracorporeal liver support device which facilitates the combined removal of both albumin-bound and water-soluble toxins based upon the method of fractionated plasma separation and adsorption (FPSA). The pilot trial included 11 patients with acute-on-chronic liver failure and concomitant renal failure. Prometheus therapy was found to be safe except for a reversible decrease of blood pressure. In three patients, clotting of the secondary system occurred. Prometheus treatment significantly improved blood levels of protein-bound (conjugated bilirubin, bile acids, ammonia) and water-soluble (creatinine, urea) substances. Thus, Prometheus might be a new therapeutic option in patients with severe hepatorenal syndrome. Furthermore, there is some preliminary experience with Prometheus in the treatment of refractory cholestatic pruritus and in successful bridging to liver transplantation. In order to compare extraction capacities of Prometheus and the molecular adsorbent recirculating system (MARS), five patients were crossover-treated with both systems. Prometheus resulted in significantly higher reduction ratios of bilirubin, ammonia and urea. Another study closely monitored whether the device causes an unselective removal. Neither important cytokines nor coagulation factors were found to be removed. In conclusion, Prometheus seems to be a new therapeutic option in artificial liver support. A significant improvement of the biochemical milieu was already observed after two treatments. The potential to remove protein-bound and water-soluble substances has been shown without signs of a significant unselective removal.

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

    ERIC Educational Resources Information Center

    Schilling, Jim

    2011-01-01

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

  9. Subjective experiences in psychotic disorders: diagnostic value and clinical correlates.

    PubMed

    Peralta, V; Cuesta, M J

    1998-01-01

    This study evaluated the prevalence and clinical correlates of abnormal subjective experiences across functional psychotic disorders. Patients were recruited from consecutive admissions with the following diagnoses; schizophrenia (n = 40), schizophreniform disorder (n = 40), schizoaffective disorder (n = 21), mood disorder (n = 18), brief reactive psychosis (n = 15), and atypical psychosis (n = 16). Subjective experiences were assessed using the Frankfurt Complaint Questionnaire (FCQ), and the clinical status was assessed with the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS) and the Manual for the Assessment and Documentation of Psychopathology (AMDP). Neither the FCQ total score nor individual subjective experiences displayed significant differences across diagnoses. When the clinical predictors of subjective experiences were studied by multiple regression analyses, a different pattern resulted for individual psychotic disorders. In schizophrenic patients, subjective experiences were predicted by female gender, euphoria, lack of insight, greater illness severity, and more positive symptoms. The only predictors of subjective experiences in the schizophreniform disorder group were the negative symptoms. Within the affective disorders group, subjective experiences had no clinical predictors.

  10. Clinicians' experiences with the fragile X clinical and research consortium.

    PubMed

    Liu, Jessica A; Hagerman, Randi J; Miller, Robert M; Craft, Lisa T; Finucane, Brenda; Tartaglia, Nicole; Berry-Kravis, Elizabeth M; Sherman, Stephanie L; Kidd, Sharon A; Cohen, Jeffrey

    2016-12-01

    The objectives of the study were to assess the attitudes and experiences of clinicians involved in a consortium of clinics serving people with fragile X-associated disorders to gauge satisfaction with the consortium and its efforts to improve quality of life for patients and the community. An internet survey was sent to 26 fragile X (FX) clinic directors participating in the Fragile X Clinical and Research Consortium (FXCRC). Respondents were asked to complete 19 questions on consortium performance and outcomes relevant for their own clinic. The response rate was 84% (22/26), with two surveys providing incomplete data. Assistance with clinic establishment, opportunities for research collaborations, and access to colleagues and information were highly valued. Approximately 76% of clinicians reported improvements in patient care and 60% reported an increase in patient services. There was a 57% increase in participation in a FX-related clinical trial among clinics since joining the FXCRC (24% vs. 81%). Overall, respondents reported primarily positive experiences from participation in the FXCRC. Common suggestions for improvement included additional financial support and increased utilization of collected patient data for research purposes. Additionally, a Clinic Services Checklist was administered annually to examine changes in services offered over time. There were several important changes regarding the provision of services by clinics, often with multiple clinics changing with respect to a service. In conclusion, the FXCRC has led to the establishment and sustainment of fragile X clinics in the U.S., fostered cooperation among fragile X clinicians, and provided clinics with a platform to share recommendations and best practices to maximize quality of life for their patients and the overall fragile X community. The results from the survey and checklist also provide suggestions to strengthen the FXCRC and enhance future collaborations among FXCRC members. © 2016

  11. Nursing Students' Clinical Experience With Death: A Pilot Study.

    PubMed

    Heise, Barbara A; Gilpin, Laura C

    2016-01-01

    Although debriefing in simulation settings is routine in nursing education, debriefing does not routinely take place in clinical settings with nursing students after a patient has died. This pilot study sought to explore nursing students' perceptions of their first experience with the death of a patient. Students reported emotional distress and feelings of inadequacy with regard to communicating with and supporting the family of the dying patient. Only half the students sampled reported debriefing by their clinical instructor or staff. Nurse educators must include debriefing and student support following a patient death in the clinical setting.

  12. Some experience in an area health authority child health clinic.

    PubMed Central

    Illingworth, R S

    1979-01-01

    Three years' experience as a doctor taking two clinics a week in an area health authority child health clinic was reviewed. A wide range of clinical conditions was seen, including: problems associated with feeding in breast- and bottle-fed infants; minor developmental abnormalities (mental, behavioural, and physical); surgical and orthopaedic conditions requiring treatment; medical conditions, mainly respiratory and alimentary infections, skin conditions, and problems of over-treatment for minor ailments; and minor genetic abnormalities. Mothers asked for advice on a wide range of topics, risks and benefits of immunisation being the most common. The clinic doctor needs a wide experience in paediatrics to deal with such problems. It is suggested that all lecturers in child health and paediatric and senior registrars should take one clinic a week for six months, and all medical students should attend some clinics as part of their paediatric training. Health visitors have an important role in helping the clinic doctor, but their training should be more realistic and appropriate facilities should be provided to keep them up to date in their work. PMID:86374

  13. Dental Students' Clinical Expectations and Experiences Treating Persons with Disabilities.

    PubMed

    Perusini, Darsi J; Llacuachaqui, Marcia; Sigal, Michael J; Dempster, Laura J

    2016-03-01

    Persons with disabilities (PWDs) have a disproportionate level of dental disease relative to the general population. Access to care is a cause along with dentists' willingness to treat PWDs. The aim of this study was to investigate the expectations and experiences of dental students in providing treatment to these patients in a hospital-based dental clinic for PWDs. Senior dental students at the Faculty of Dentistry, University of Toronto (n=92) were surveyed prior to (Phase I) and at the end of (Phase II) mandatory clinical rotations at the Mount Sinai Hospital's Dentistry Clinic for Persons with Special Needs. Response rates were 88% for Phase I and 58% for Phase II. Before the rotations, 70% of the respondents reported little or no experience with PWDs, and 46% said they did not feel comfortable providing basic dental treatment to PWDs. However, in Phase II, significantly more students reported being comfortable than in Phase I (p=0.001). Overall, the majority of respondents (Phase I 95%; Phase II 98%) indicated they would at least attempt to provide basic dental care to PWDs after graduation. The majority also identified the opportunity to provide care and interact with PWDs as the most enjoyable aspect of their experience at the clinic. They reported that the experience helped reduce their concerns about treating PWDs including being more realistic about the time required and ideal quality of the treatment they could provide. These results suggest that their experience in the clinic significantly increased students' comfort in treating PWDs. The respondents expressed a willingness to treat PWDs once graduated and generally identified their experience as being more positive than their expectations.

  14. Providing premedical students with quality clinical and research experience

    PubMed Central

    Davis, James; Anderson, Maggie; Stankevitz, Kristen

    2014-01-01

    Undergraduate premedical students face a prodigious decision as they work to determine whether to pursue a profession in medicine. Experience in clinical medicine and research is essential to inform students what it might be like to be a physician. Undergraduates, however, face a number of obstacles to obtaining the kind of quality clinical and research experience needed to best inform them on this decision. Growing regulations designed to protect patient confidentiality, though undeniably important, pose a barrier to students seeking patient contact. Traditional passive physician shadowing often does not provide ample opportunities for one-on-one patient interaction or problem solving. Finally, research opportunities available to students typically are not associated with clinical work and therefore do not provide an experiential model of how empirical evidence informs medical practice. This report provides a description of the University of Wisconsin Tobacco Science Scholars Program, a pilot program designed to grapple with some of these barriers. The program provides supervision for students so that they might fulfill institutional requirements required for patient contact, provides an active model of clinical patient interaction and problem solving, and provides access to research that is integrated into the student’s clinical experience so the student might better understand the nature of research-based evidence in medicine. Program details and limitations are discussed. PMID:24734413

  15. A solo hospital librarian's experience in clinical informatics.

    PubMed

    Miles, Alisha

    2015-01-01

    This column reviews some of a solo librarian's experiences that led to involvement with the hospital Clinical Informatics Team. This included work on the electronic health record (EHR), computerized physician order entry (CPOE) system, development of order sets, and participation in the Physician Technology Committee.

  16. Time Keeps on Ticking: The Experience of Clinical Judgment

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  17. Enrichment of the Educational Psychology Curriculum through Clinical Experiences.

    ERIC Educational Resources Information Center

    Shaker, Paul; Ullrich, Walter

    An educational psychology curriculum for preservice teachers that attempts to overcome some of the shortcomings of most such curricula while providing clinical experience is described. The curriculum is based on three major propositions: (1) preservice teachers must acquire psychologically informed inquiry skills and a general understanding of…

  18. Teachers' Clinical Experiences and Attitudes toward Technology Inclusion

    ERIC Educational Resources Information Center

    Paganelli, Andrea Lynch

    2010-01-01

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

  19. Designing Nursing Simulation Clinical Experiences to Promote Critical Inquiry

    ERIC Educational Resources Information Center

    Beattie, Bev; Koroll, Donna; Price, Susan

    2010-01-01

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

  20. Nursing students' experiences with incivility in clinical education.

    PubMed

    Anthony, Maureen; Yastik, Joanne

    2011-03-01

    This qualitative study aimed to explore the experiences of nursing students as targets of incivility in clinical settings, to describe their perceptions of specific uncivil and favorable behaviors by nurses, and to examine how nursing students think schools of nursing should address incivility in clinical settings. Four focus groups were conducted comprising 21 prelicensure nursing students. Data were collected with semi-structured interviews. Uncivil behaviors fell into three themes: exclusionary, hostile or rude, and dismissive. Positive experiences occurred when students felt included by the staff nurses in patient care. Schools of nursing should prepare students through discussion. Our research suggests that incivility occurs in clinical education. Further research on a larger scale is needed to provide qualitative and generalizable findings. All health care team members, including students, should be educated about the organization's code of conduct.

  1. Challenging clinical learning environments: experiences of undergraduate nursing students.

    PubMed

    O'Mara, Linda; McDonald, Jane; Gillespie, Mary; Brown, Helen; Miles, Lynn

    2014-03-01

    Clinical learning is an essential component of becoming a nurse. However at times, students report experiencing challenging clinical learning environments (CCLE), raising questions regarding the nature of a challenging clinical learning environment, its impact on students' learning and how students might respond within a CCLE. Using an Interpretive Descriptive study design, researchers held focus groups with 54 students from two Canadian sites, who self-identified as having experienced a CCLE. Students defined a CCLE as affected by relationships in the clinical area and by the context of their learning experiences. CCLE decreased students' learning opportunities and impacted on them as persons. As students determined which relationships were challenging, they tapped other resources and they used strategies to rebuilt, reframe, redirect and/or retreat relative to the specific challenge. Relationships also acted as buffers to unsupportive practice cultures. Implications for practice and research are addressed.

  2. [One-stop outpatient cardiology clinics: 10 years' experience].

    PubMed

    Falces, Carlos; Sadurní, Josep; Monell, Joan; Andrea, Rut; Ylla, Miquel; Moleiro, Angels; Cantillo, Jordi

    2008-05-01

    A one-stop outpatient cardiology clinic was set up at the Vic General Hospital in Spain in 1996. The aims were to provide patients with a rapid response, and to ensure that, on the same day, they saw a specialist and were referred for any relevant investigations required, primarily echocardiography, exercise testing, and Holter monitoring. We report experience from 10 years of follow-up, involving 19,515 consultations. The mean waiting time for a consultation was 3 days. We analyzed the reasons for the consultations, the investigations carried out, and the reductions in follow-up visits and hospital admissions. Primary care physicians' level of satisfaction was increased by this approach. The one-stop clinic proved feasible in clinical practice and proved robust during the follow-up period. This clinical model was beneficial for patients, was highly acceptable to primary care physicians, reduced the need for patients to contact the hospital, and, possibly, reduced hospital admissions.

  3. A curriculum model for an integrated senior year clinical experience.

    PubMed

    Wukasch, R N; Blue, C L; Overbay, J

    2000-01-01

    Transformations in the delivery of health care from hospital to community have brought about many changes in nursing practice. These, in turn, have necessitated alterations in the education of nursing students, the curricula, and clinical experiences. Confident that nursing is an independent practice, exclusive of the health care setting, our faculty decided to direct our teaching efforts to reflect changes in health care delivery. We restructured our baccalaureate nursing program's senior level clinical education experience to prepare students to meet the needs of the clients we serve--the community--and the demands of professional nursing education. In doing so, we have supported Ryan's definition of community, which includes "all settings where consumers seek health care" (1, p. 140). In response to the recommendation by the pew health professions commission for new models of content integration "between education and the highly managed and integrated systems of care" (2, p. 51), a decision was made to merge three senior level clinical courses--pediatrics, public health, and nursing leadership and management--into one integrated experience. This process required an examination of collective values and beliefs with respect to course content and learning experiences. The challenge was to examine "sacred cows" and eliminate redundancies and replication of learning activities.

  4. Interprofessional student experiences on the HAVEN free clinic leadership board.

    PubMed

    Scott, Elizabeth Anne; Swartz, Martha K

    2015-01-01

    In this study, we examined the experiences of students serving on the leadership board of HAVEN - the student-run free clinic of the Yale University health professional schools. Open-ended responses were collected from 18 of the 28 members of the 2011-2012 leadership board through an online survey. Students reported an overall positive experience participating on the board and valued the opportunity to be part of a committed community creating change. The majority of students reported that their time as a board member had improved their attitude towards interprofessional collaboration (78%) and had also fostered their leadership skills (67%). Around two thirds (67%) reported that their experience had positively impacted their future career plans, either reinforcing their desire to work with underserved populations or encouraging them to pursue leadership roles. Based on these data, it is suggested that the HAVEN Free Clinic offers a useful opportunity for students to experience the demands of clinical care leadership while working together in an interprofessional context.

  5. Seven years experience with a computerized diabetes clinic database.

    PubMed

    Flack, J R

    1995-01-01

    With the emergence of information technology applications in medicine, a computerized medical record system that could be used to : (1) maintain patients' clinical records over time, (2) communicate with referring practitioners, and (3) form the basis of a potential research database of information, was sought. In 1987, we developed such a clinical database to register patients attending our busy Diabetes Clinic, now seeing in excess of 300 new referrals and, on average, 3,000 clinic visits per year. Baseline demographic data, clinical history, and examination and investigation results are recorded. We also record diabetes therapy and other medication dosage and changes, monitor follow-up, assess health outcome information (such as stroke or amputation), and generate results, summaries, and reports to referring practitioners and other health professionals. We now have almost seven years of experience using the system. Initially established on a single PC with paper-based data collection and subsequent data entry (running as a DOS application), it is now established on a PC Local Area Network [LAN] with terminals in the clinic consultation rooms enabling direct data entry and allowing patients to view their results in graphic form on screen. From its inception, the Diabetes Clinic Database System has maintained patient demographic and clinical data (which facilitates efficient clinic management) with patient clinic lists and adhesive address labels generated from appropriate menus. Batch mode processing produces daily work sheets which facilitate the running of clinics as well as ad hoc, daily, and weekly reports for all patients (as required). This expedites correspondence with referring doctors. A quality assurance report to the clinic doctor highlights missing clinical information which must be obtained in order to ensure data completeness. The initial system was relatively inefficient in that it required data entry following patient consultation and provided no

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

    PubMed

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

    2003-04-01

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

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

    PubMed Central

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

    2012-01-01

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

  8. Hospice clinical experiences for nursing students: living to the fullest.

    PubMed

    Spicer, Sherri; Heller, Rebecca; Troth, Sarah

    2015-01-01

    Preparing future nurses to provide appropriate care for patients and their families at the end of life can be a formidable challenge for nurse educators. Most nursing schools thread end-of-life concepts throughout the curriculum. Grand Canyon University includes a 40-hour hospice clinical as a component of a home healthcare practicum. Students' weekly written reflections reveal the depth of affective learning that occurs during this experience. Article includes hospice materials and resources.

  9. The usefulness of systematic reviews of animal experiments for the design of preclinical and clinical studies.

    PubMed

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

    2014-01-01

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

  10. Exploring clinical nursing experiences: listening to student nurses.

    PubMed

    Pearcey, Patricia; Draper, Peter

    2008-07-01

    Student nurses spend one half of their educational programme in the clinical area. The success of an educationally sound clinical placement is crucial to forming a professional nursing identity that will encompass the seen and 'unseen' aspects of the nurses' role. The aim of this study was to explore the clinical nursing environment through the perceptions of first year student nurses. Semi-structured interviews were used to collect data from 12 student nurses who each had four weeks clinical experience, representing 21 wards and five hospitals. Results suggest that these student nurses were disillusioned with the reality of clinical nursing and that their expectations of nursing were not realised. They perceived that paperwork, completing tasks and meeting targets were dominant features of nursing work at the expense of patient contact and communication. A majority indicated that nursing was not as caring as they expected and vowed to hold on to their personal values of caring about patients and forming communicative, interpersonal relationships with them.

  11. My personal experiences at the BEST Medical Center: A day in the clinic-the morning.

    PubMed

    Cohen, Philip R; Kurzrock, Razelle

    2016-01-01

    Dr. Ida Lystic is a gastroenterologist who trained at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center, after having completed her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School). She accepted a faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. Dr. Lystic shares her experiences on a typical morning in gastroenterology clinic. Although her clinic start date was delayed by 2 months after becoming sick following a mandatory flu shot and having to complete more than 70 hours of compliance training modules, she is now familiar with the BEST system. Clinic scheduling priorities include ensuring that the staff can eat lunch together and depart at 5:00 pm. It is a continual challenge to find time to complete the electronic medical record after BEST changed from the SIMPLE (Succinct Input Making Patients Lives Electronic) system to LEGEND (referred to as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues). To maintain clinic punctuality, a compliance spreadsheet is e-mailed monthly to the Wait Time Committee. Their most recent corrective action plan for tardy physicians included placing egg timers on the doors and having nurses interrupt visits that exceed the allotted time. Administrative decisions have resulted in downsizing personnel. Patients are required to schedule their own tests and procedures and follow-up appointments-causing low patient satisfaction scores; however, the money saved lead to a large year-end bonus for the vice president of BEST Efficiency, who holds "providers" accountable for the poor patient experience. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes are based on actual events.

  12. Application of optimal design methodologies in clinical pharmacology experiments.

    PubMed

    Ogungbenro, Kayode; Dokoumetzidis, Aristides; Aarons, Leon

    2009-01-01

    Pharmacokinetics and pharmacodynamics data are often analysed by mixed-effects modelling techniques (also known as population analysis), which has become a standard tool in the pharmaceutical industries for drug development. The last 10 years has witnessed considerable interest in the application of experimental design theories to population pharmacokinetic and pharmacodynamic experiments. Design of population pharmacokinetic experiments involves selection and a careful balance of a number of design factors. Optimal design theory uses prior information about the model and parameter estimates to optimize a function of the Fisher information matrix to obtain the best combination of the design factors. This paper provides a review of the different approaches that have been described in the literature for optimal design of population pharmacokinetic and pharmacodynamic experiments. It describes options that are available and highlights some of the issues that could be of concern as regards practical application. It also discusses areas of application of optimal design theories in clinical pharmacology experiments. It is expected that as the awareness about the benefits of this approach increases, more people will embrace it and ultimately will lead to more efficient population pharmacokinetic and pharmacodynamic experiments and can also help to reduce both cost and time during drug development.

  13. The effect of communicating the genetic risk of cardiometabolic disorders on motivation and actual engagement in preventative lifestyle modification and clinical outcome: a systematic review and meta-analysis of randomised controlled trials.

    PubMed

    Li, Sherly X; Ye, Zheng; Whelan, Kevin; Truby, Helen

    2016-09-01

    Genetic risk prediction of chronic conditions including obesity, diabetes and CVD currently has limited predictive power but its potential to engage healthy behaviour change has been of immense research interest. We aimed to understand whether the latter is indeed true by conducting a systematic review and meta-analysis investigating whether genetic risk communication affects motivation and actual behaviour change towards preventative lifestyle modification. We included all randomised controlled trials (RCT) since 2003 investigating the impact of genetic risk communication on health behaviour to prevent cardiometabolic disease, without restrictions on age, duration of intervention or language. We conducted random-effects meta-analyses for perceived motivation for behaviour change and clinical changes (weight loss) and a narrative analysis for other outcomes. Within the thirteen studies reviewed, five were vignette studies (hypothetical RCT) and seven were clinical RCT. There was no consistent effect of genetic risk on actual motivation for weight loss, perceived motivation for dietary change (control v. genetic risk group standardised mean difference (smd) -0·15; 95 % CI -1·03, 0·73, P=0·74) or actual change in dietary behaviour. Similar results were observed for actual weight loss (control v. high genetic risk SMD 0·29 kg; 95 % CI -0·74, 1·31, P=0·58). This review found no clear or consistent evidence that genetic risk communication alone either raises motivation or translates into actual change in dietary intake or physical activity to reduce the risk of cardiometabolic disorders in adults. Of thirteen studies, eight were at high or unclear risk of bias. Additional larger-scale, high-quality clinical RCT are warranted.

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

    PubMed Central

    Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

    2015-01-01

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

  15. Investigator experiences with financial conflicts of interest in clinical trials

    PubMed Central

    2011-01-01

    Background Financial conflicts of interest (fCOI) can introduce actions that bias clinical trial results and reduce their objectivity. We obtained information from investigators about adherence to practices that minimize the introduction of such bias in their clinical trials experience. Methods Email survey of clinical trial investigators from Canadian sites to learn about adherence to practices that help maintain research independence across all stages of trial preparation, conduct, and dissemination. The main outcome was the proportion of investigators that reported full adherence to preferred trial practices for all of their trials conducted from 2001-2006, stratified by funding source. Results 844 investigators responded (76%) and 732 (66%) provided useful information. Full adherence to preferred clinical trial practices was highest for institutional review of signed contracts and budgets (82% and 75% of investigators respectively). Lower rates of full adherence were reported for the other two practices in the trial preparation stage (avoidance of confidentiality clauses, 12%; trial registration after 2005, 39%). Lower rates of full adherence were reported for 7 practices in the trial conduct (35% to 43%) and dissemination (53% to 64%) stages, particularly in industry funded trials. 269 investigators personally experienced (n = 85) or witnessed (n = 236) a fCOI; over 70% of these situations related to industry trials. Conclusion Full adherence to practices designed to promote the objectivity of research varied across trial stages and was low overall, particularly for industry funded trials. PMID:21226951

  16. Clinical education experiences: perceptions of student registered nurse anesthetists.

    PubMed

    Elisha, Sass; Rutledge, Dana N

    2011-08-01

    The purpose of this study was to describe the experiences and attitudes of student registered nurse anesthetists (SRNAs) related to clinical instruction. This descriptive study used a cross-sectional survey method with a regionally stratified randomly selected sample of SRNA members from the American Association of Nurse Anesthetists data bank. A total of 2,673 SRNAs were invited by email to respond to an online, 54-item questionnaire; 696 SRNAs participated. Verbal abuse was reported by almost 70% of SRNA participants, but fewer experienced sexual harassment (13%), physical abuse (14%), or racial discrimination (72%). However, SRNAs reported that their Certified Registered Nurse Anesthetist (CRNA) preceptors most often served as positive role models. These SRNAs found CRNA preceptors, unique cases, reading, and clinical lectures more helpful to their clinical learning compared with grand rounds, surgeons, and anesthesiology residents. The SRNAs' perceptions of the ideal behavioral characteristics for CRNA preceptors included calmness during stressful events, use of nonthreatening communication, clear communication, and encouraging independent decision making. The educational process for nurse anesthetists is continually evolving and improving. Study findings offer insights that may assist in improvements in the clinical component of SRNA education.

  17. [The clinical experience with MARS and Prometheus procedures].

    PubMed

    Hydzik, Piotr; Gawlikowski, Tomasz; Ciszowski, Krzysztof; Sułlek, Monika

    2007-01-01

    Based on the hypothesis, that extracorporeal removal of endo- and egzogenic substances should be beneficial to the clinical course of the patient in liver failure or poisoned, treatment systems were evaluatedbased on the two concepts: (1) blood dialysis against albumin dialysate--Molecular Adsorbent Recirculating System (MARS), Single Pass Albumin Dialysis (SPAD), Continuous Veno-Venous Haemodiafiltration (CWHDF); (2) selective albumin filtration and adsorption combined with haemodialysis--Fractioned Plasma Separation and Adsorption-Prometheus. We present our own experiences with MARS and Prometheus procedures between 2003-2006 years.

  18. Experience of isolated sleep paralysis in clinical practice in Nigeria.

    PubMed

    Ohaeri, J U

    1992-06-01

    The supernatural fears associated with the experience of isolated sleep paralysis in the culture of developing countries is sometimes associated with the evolution of somatic symptoms of psychological origin in patients predisposed to neurotic illness. Patients rarely spontaneously volunteer these fears and doctors pay them scant attention. Illustrative case histories that demonstrate the dynamics of the clinical presentation, as well as the treatment approach, are highlighted. It is hoped that doctors in general medical practice and in psychological medicine in developing countries where belief in supernatural causation of illness is rife will consider these factors in order to provide more effective treatment.

  19. Aggregate/community-centered undergraduate community health nursing clinical experience.

    PubMed

    Flick, L H; Reese, C; Harris, A

    1996-02-01

    Debate continues about the appropriateness of clinical experiences targeting aggregates in undergraduate community health nursing education. This paper describes a practical model to teach, through experience, the concepts of aggregate/community-centered practice at the baccalaureate level. As a voluntary alternative to the usual community assessment paper, groups of students worked in partnership with community groups to define health needs and to address one need. Sequential student groups focused the assessment and implemented a plan. The required time for each project varied. One project is described to illustrate the model. While independent community-centered practice is not expected of the B.S.N. graduate, the model described here develops comprehension of the concepts and process of such practice.

  20. Initial clinical experience with the Baylor-Nikkiso centrifugal pump.

    PubMed

    Ohtsubo, S; Naito, K; Matsuura, M; Kawahito, K; Shimono, T; Makinouchi, K; Tasai, K; Ohara, Y; Damm, G; Glueck, J

    1995-07-01

    Recently, a newly developed centrifugal pump, the Baylor-Nikkiso pump, was approved for clinical use in the United States. This pump is the most compact centrifugal pump with a priming volume of only 25 ml. Although it is small, this pump can provide a flow of 4 L/min against a total pressure head of 300 mm Hg at 3,000 rpm. In vitro and in vivo validation of the Baylor-Nikkiso pump has proved that this pump could effectively reduce blood trauma even under high total head pressure. In addition, 48-h durability tests with biventricular bypass using calves verified the reliability of shaft sealing and antithrombogenicity. Clinical trials of the Baylor-Nikkiso pumps have been initiated in our department. This pump provides flows of 60-70 ml/kg/min with stable hemodynamic conditions. No leakage of thrombus formation was observed. The results of the initial clinical experience of the Baylor-Nikkiso pump suggest that it is suitable for cardiopulmonary bypass surgery.

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

    PubMed Central

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

    2013-01-01

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

  2. Molding of the regenerate in mandibular distraction: clinical experience.

    PubMed

    McCarthy, Joseph G; Hopper, Richard A; Hollier, Larry H; Peltomaki, Timo; Katzen, Timothy; Grayson, Barry H

    2003-10-01

    Initial clinical experience with distraction osteogenesis has demonstrated the risk of developing postdistraction malocclusion that requires secondary orthodontic correction. In addition, optimal mandibular form is not always achieved. Both animal studies and preliminary clinical investigations have suggested that the regenerate can be successfully "molded" during active mandibular distraction. The authors have applied this concept clinically to obtain a more desirable occlusal relationship in a group of mandibular distraction patients. Eleven patients are described in whom angulation of the distraction device or intermaxillary/interdental elastics were employed to mold the regenerate. Two representative case studies are provided to illustrate the principles. When using elastic traction to close an anterior open bite, care must be taken that extrusion of individual teeth is minimized by distributing the force over the entire dental arch, especially the basilar portions of the jaws. The authors demonstrate that molding of the regenerate can be successfully accomplished not only during device activation but also early in the consolidation period. The outer limit of the time window in which molding is effective remains to be defined.

  3. Clinicians’ experiences of becoming a clinical manager: a qualitative study

    PubMed Central

    2012-01-01

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

  4. Managing medical images and clinical information: InCor's experience.

    PubMed

    Furuie, Sergio S; Rebelo, Marina S; Moreno, Ramon A; Santos, Marcelo; Bertozzo, Nivaldo; Motta, Gustavo H M B; Pires, Fabio A; Gutierrez, Marco A

    2007-01-01

    Patients usually get medical assistance in several clinics and hospitals during their lifetime, archiving vital information in a dispersed way. Clearly, a proper patient care should take into account that information in order to check for incompatibilities, avoid unnecessary exams, and get relevant clinical history. The Heart Institute (InCor) of São Paulo, Brazil, has been committed to the goal of integrating all exams and clinical information within the institution and other hospitals. Since InCor is one of the six institutes of the University of São Paulo Medical School and each institute has its own information system, exchanging information among the institutes is also a very important aspect that has been considered. In the last few years, a system for transmission, archiving, retrieval, processing, and visualization of medical images integrated with a hospital information system has been successfully created and constitutes the InCor's electronic patient record (EPR). This work describes the experience in the effort to develop a functional and comprehensive EPR, which includes laboratory exams, images (static, dynamic, and three dimensional), clinical reports, documents, and even real-time vital signals. A security policy based on a contextual role-based access control model was implemented to regulate user's access to EPR. Currently, more than 10 TB of digital imaging and communications in medicine (DICOM) images have been stored using the proposed architecture and the EPR stores daily more than 11 GB of integrated data. The proposed storage subsystem allows 6 months of visibility for rapid retrieval and more than two years for automatic retrieval using a jukebox. This paper addresses also a prototype for the integration of distributed and heterogeneous EPR.

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

    PubMed

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

    2011-07-01

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

  6. Implementing security in computer based patient records clinical experiences.

    PubMed

    Iversen, K R; Heimly, V; Lundgren, T I

    1995-01-01

    In Norway, organizational changes in hospitals and a stronger focus on patient safety have changed the way of organizing and managing paper based patient records. Hospital-wide patient records tend to replace department based records. Since not only clinicians, but also other non-medical staff have access to the paper records, they also have easy access to all the information which is available on a specific patient; such a system has obvious 'side effects' on privacy and security. Computer based patient records (CPRs) can provide the solution to this apparent paradox if the complex aspects of security, privacy, effectiveness, and user friendliness are focused on jointly from the outset in designing such systems. Clinical experiences in Norway show that it is possible to design patient record systems that provide a very useful tool for clinicians and other health care personnel (HCP) while fully complying with comprehensive security and privacy requirements.

  7. Prescribing exercise training in pulmonary rehabilitation: a clinical experience.

    PubMed

    Bernard, S; Ribeiro, F; Maltais, F; Saey, D

    2014-01-01

    Built around exercise training, pulmonary rehabilitation (PR) is a multidisciplinary, evidence-based, comprehensive approach to working with the patient as a whole and not just the pulmonary component of the disease. Integrated into the individualized treatment, this intervention aims to reduce symptoms, optimize functional status, increase participation in daily life, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease. Although there are many other components that should be considered to manage the impairment and symptom burden, supervised exercise training is considered the cornerstone of effective pulmonary rehabilitation. This paper addresses our clinical experience at Institut universitaire de cardiologie et de pneumologie de Québec to assess and manage exercise training in line with the current recommendations and guidelines surrounding PR.

  8. Junior nursing students' experiences of vertical violence during clinical rotations.

    PubMed

    Thomas, Sandra P; Burk, Renee

    2009-01-01

    Horizontal violence is a form of workplace violence, a phenomenon that is prevalent in the nursing profession. Research has revealed a variety of negative peer-to-peer behaviors that lower morale and lead to turnover. However, little research has been conducted on "eating our young" (violence occurring between individuals with unequal power, such as staff nurse and student). We propose "vertical violence" as the appropriate term when abusive registered nurse (RN) behavior is directed towards students. We report a content analysis of stories written by junior nursing students about incidents of injustice perpetrated by staff RNs during their clinical experiences. Four levels of injustice were described. Nursing leadership, both in hospitals and educational institutions, must become engaged in efforts to eradicate vertical violence towards students.

  9. Clinical experiences with microwave thermal ablation of lung malignancies.

    PubMed

    Sidoff, Luby; Dupuy, Damian E

    2017-02-01

    Approximately 30% of early stage lung cancer patients are not surgical candidates due to medical co-morbidities, poor cardiopulmonary function and advanced age. These patients are traditionally offered chemotherapy and radiation, which have shown relatively modest improvements in mortality. For over a decade, percutaneous image-guided ablation has emerged as a safe, cost-effective, minimally invasive treatment alternative for patients who would otherwise not qualify for surgery. Although radiofrequency ablation (RFA) is currently the most extensively studied and widely utilised technique in the treatment of lung malignancies, there is a growing body of evidence that microwave ablation (MWA) has several unique benefits over RFA and cryoablation in the lung. This article reviews our institution's clinical experiences in the treatment of lung malignancies with MWA including patient selection, procedural technique, imaging follow-up, treatment outcomes and comparison of ablation techniques.

  10. Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties

    PubMed Central

    Li, Tse Yan; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

    2015-01-01

    Background Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students’ acquisition of clinical competence. Objective This study aimed to understand the experience of undergraduate students across clinical disciplines—medicine, dentistry, and nursing—in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Methods Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong—Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Results Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Conclusions Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students

  11. Questioning Skills Demonstrated by Approved Clinical Instructors During Clinical Field Experiences

    PubMed Central

    Barnum, Mary G

    2008-01-01

    Context: The current trend in athletic training clinical education places greater emphasis on the quality of interactions occurring between Approved Clinical Instructors (ACIs) and athletic training students (ATSs). Among other attributes, the ability of ACIs to facilitate and direct quality clinical learning experiences may be influenced by the skill with which the ACI is able to use selected teaching strategies. Objective: To gain insight into ACIs' use of questioning as a specific teaching strategy during the clinical education experiences of undergraduate ATSs. Design: Qualitative case study design involving initial and stimulated-recall interviews, prolonged field observations, and audio recording of ACI-ATS interactions. Setting: The primary athletic training facility at one athletic training education program accredited by the Commission on Accreditation of Athletic Training Education. Patients or Other Participants: The 8 ACI participants included 3 full-time athletic training education program faculty members and 5 graduate-level assistants. The 24 ATS participants included 1 senior, 17 juniors, and 6 sophomores. Data Collection and Analysis: Transcribed data collected from 8 initial interviews, 23 field observations, 23 audio-recorded ACI-ATS interactions and 54 stimulated-recall interviews were analyzed through microscopic, open, and axial coding, as well as coding for process. The cognition level of questions posed by ACIs was analyzed according to Sellappah and colleagues' Question Classification Framework. Results: The ACI participants posed 712 questions during the 23 observation periods. Of the total questions, 70.37% were classified as low-level cognitive questions and 17.00% as high-level cognitive questions. The remaining 12.64% were classified as other. Conclusions: Although all ACIs used questioning during clinical instruction, 2 distinct questioning patterns were identified: strategic questioning and nonstrategic questioning. The way ACIs

  12. The initial Trinidad experience with Cine MRI in clinical cardiology.

    PubMed

    Thomas, C N; Maharaj, P; Bodapati, S; John, R; Rahaman, R; Henry, R; Brann, S

    2002-03-01

    We describe the initial Trinidad experience with Magnetic Resonance Imaging (MRI) and Cine MRI as a diagnostic tool in clinical cardiology. Six patients from the following categories were referred for Cine MRI evaluation: congenital heart disease, valvular heart disease, aortic diseases, cardiomyopathy and intracardiac mass. All patients underwent echocardiography. MRI and Cine MRI were performed on all patients using a Siemens Magnetom 1.0 Tesla MR system at MRI Trinidad and Tobago Ltd. Selected patients underwent Angiography and/or computed tomography (CT) scanning. Clinical data and images of the six patients evaluated are described. MRI and Cine MRI provided excellent anatomical and functional details of the heart and aorta in five patients with dissection of the aorta, aneurysm of the ascending aorta, suspected left ventricular apical thrombus, infiltrative cardiomyopathy and arrhythmogenic right ventricular dysplasia. Technical difficulty was experienced with one patient who had a congenital defect (common atrium). In this study, Cine MRI provided excellent images in all but one patient. This new noninvasive technique enhanced diagnostic capabilities and facilitated management in patients with certain cardiovascular diseases.

  13. Clinical experience with heat sterilization for reprocessing dialyzers.

    PubMed

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

    1992-01-01

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

  14. Dasatinib first-line: Multicentric Italian experience outside clinical trials.

    PubMed

    Breccia, Massimo; Stagno, Fabio; Luciano, Luigiana; Abruzzese, Elisabetta; Annunziata, Mario; D'Adda, Mariella; Maggi, Alessandro; Sgherza, Nicola; Russo-Rossi, Antonella; Pregno, Patrizia; Castagnetti, Fausto; Iurlo, Alessandra; Latagliata, Roberto; Cedrone, Michele; Di Renzo, Nicola; Sorà, Federica; Rege-Cambrin, Giovanna; La Nasa, Giorgio; Scortechini, Anna Rita; Greco, Giovanna; Franceschini, Luca; Sica, Simona; Bocchia, Monica; Crugnola, Monica; Orlandi, Esther; Guarini, Attilio; Specchia, Giorgina; Rosti, Gianantonio; Saglio, Giuseppe; Alimena, Giuliana

    2016-01-01

    Dasatinib was approved for the treatment of chronic phase (CP) chronic myeloid leukemia (CML) patients in first line therapy based on the demonstration of efficacy and safety reported in patients enrolled in clinical trials. We describe a multicentric Italian "real-life" experience of dasatinib used as frontline treatment outside clinical trials. One hundred and nine patients (median age 54 years) were treated from January 2012 to December 2013. Increased incidence of high risk patients were detected according to stratification (26% according to Sokal score, 19% according to Euro score and 16% according to EUTOS) when compared to company sponsored studies. Median time from diagnosis to start of dasatinib was 18 days. Ten patients received unscheduled starting dose (6 patients 50mg and 4 patients 80 mg QD), whereas 99 patients started with 100mg QD. At 3 months, 92% of patients achieved a BCR-ABL ratio less than 10%. At 6 months, the rate of CCyR was 91% and the rate of MR3 was 40%, with 8% of the patients reaching MR4.5. Ninety-three patients were evaluable at 12 months: the rate of MR3 was 62%, with MR4.5 being achieved by 19% of the patients. At a median follow-up of 12 months, 27 patients (24.7%) were receiving the drug at reduced dose. Two patients (1.8%) experienced a lymphoid blast crisis and the overall incidence of resistance was 8%. As regards safety, the major side effects recorded were thrombocytopenia, neutropenia and pleural effusions, which occurred in 22%, 10% and 8% of patients, respectively. Present results, achieved in a large cohort of patients treated outside clinical trials, further confirm the efficacy and safety of dasatinib as firstline treatment in CML.

  15. "We actually care and we want to make the parks better": A qualitative study of youth experiences and perceptions after conducting park audits.

    PubMed

    Gallerani, David G; Besenyi, Gina M; Wilhelm Stanis, Sonja A; Kaczynski, Andrew T

    2017-02-01

    This study explored youths' experiences and perceptions about community engagement as a result of participating in a community-based data collection project using paper and mobile technology park environmental audit tools. In July 2014, youth (ages 11-18, n=50) were recruited to participate in nine focus groups after auditing two parks each using paper, electronic, or both versions of the Community Park Audit Tool in Greenville County, SC. The focus groups explored the youths' experiences participating in the project, changes as a result of participation, suggested uses of park audit data collected, and who should use the tools. Four themes emerged related to youths' project participation experiences: two positive (fun and new experiences) and two negative (uncomfortable/unsafe and travel issues). Changes described as a result of participating in the project fell into four themes: increased awareness, motivation for further action, physical activity benefits, and no change. Additionally, youth had numerous suggestions for utilizing the data collected that were coded into six themes: maintenance & aesthetics, feature/amenity addition, online park information, park rating/review system, fundraising, and organizing community projects. Finally, six themes emerged regarding who the youth felt could use the tools: frequent park visitors, community groups/organizations, parks and recreation professionals, adults, youth, and everyone. This study revealed a wealth of information about youth experiences conducting park audits for community health promotion. Understanding youth attitudes and preferences can help advance youth empowerment and civic engagement efforts to promote individual and community health.

  16. The Course of Actualization

    ERIC Educational Resources Information Center

    De Smet, Hendrik

    2012-01-01

    Actualization is traditionally seen as the process following syntactic reanalysis whereby an item's new syntactic status manifests itself in new syntactic behavior. The process is gradual in that some new uses of the reanalyzed item appear earlier or more readily than others. This article accounts for the order in which new uses appear during…

  17. Combination Therapy for Acne Scarring: Personal Experience and Clinical Suggestions.

    PubMed

    Kroepfl, Lucija; Emer, Jason J

    2016-11-01

    Acne is one of the most prevalent skin conditions seen by dermatologists. The cosmetic sequelae of severe acne, including scarring and pigmentation, have a profound psychological impact on those in icted. Topical (eg, retinoids, antibiotics, dapsone, hydroxyacids) and oral treatments (eg, antibiotics and/or spironolactone) are often bene cial to control acne or in the instance of oral isotretinoin use, rid the acne permanently; however, these treatments have very little affect on the ultimate cosmetic outcome of the acne scarring and skin texture that results. Given the variety of scar types that can form and the variability of responses seen in various skin types and textures, treatment options are vast without appropriate guidelines for pathways that dictate best timing, combinations, and options in given clinical scenarios. Current treatment options include solo or combina- tions of energy-based (eg, laser, radiofrequency), chemical-based (eg, peels, TCA cross), surgical-based options (eg, subcision, punch excision), microneedling, and llers and/or fat injections. Most recently, fractional radiofrequency-based treatments have been used to improve acne scarring with less reported downtime as compared to lasers or chemical peels and the ability to treat darker or sensitive skin types with less risk of scarring or hyperpigmentation. In severe cystic ares, scarring treatments are often postposed till the acne is under control and in many instances this can limit the dermatologists ability to affect future cosmetic treatments. Based on personal experience of various clinical scenarios in a busy laser practice that treats a signi cant number of patients with acne scarring, fractional radiofrequency is an excellent choice for treating all forms of acne scars with minimal risk to patients, even those on concurrent treatments such as isotretinoin. Additionally, fractional radiofrequency can be used in combination with all other treatment options to speed the time to

  18. "We're Not Slaves--We Are Actually the Future!" A Follow-up Study of Apprentices' Experiences in the Norwegian Hospitality Industry

    ERIC Educational Resources Information Center

    Bakkevig Dagsland, Åse Helene; Mykletun, Reidar Johan; Einarsen, Ståle

    2015-01-01

    This study addresses the socialisation processes taking place during the apprenticeship period within the hospitality industry, searching for explanations of drop-out and early staff turnover in the personal, social and educational experiences of the apprentices during their organisational socialisation process and vocational training. Data were…

  19. "They're Too Focused on Being Progressive to Actually Be Progressive": Understanding the Lived Experience of Progressivism at a Liberal Arts College

    ERIC Educational Resources Information Center

    Lane, Amy; Fraser, Abigail; Eathorne, Jamie; Lawrence, Roxann; Meyer, Kylie; Morton, Brittany; Sullivan, Sarah

    2015-01-01

    This article investigates to what extent students' experiences at a small liberal arts college reflect the institutional commitment to progressive thinking and practice. Through in-depth interviews across two studies carried out in 2012 and 2014, the authors found students reported that they felt institutional-level multicultural programming can…

  20. [Implementation of Guidelines on Conflict of Interest in Clinical Research of the Japanese Society of Psychiatry and Neurology: actual status and future perspectives].

    PubMed

    Mikuni, Masahiko; Kurihara, Chieko; Miyaoka, Hitoshi

    2014-01-01

    In May 2011, the Japanese Society of Psychiatry and Neurology released their Guidelines on Conflict of Interest (COI) in Clinical Research and detailed regulations. These guidelines cover clinical research, although each committee of the society may have a policy to cover basic research as well as clinical research. The COI Committee implemented the guidelines, including a one-year trial period. According to the guidelines, members of the society have to disclose their COIs at the time of presentations, manuscript submissions, and publications; the board and committees members have to submit their COIs to the president of the society. During the trial period, the latter was limited to the four committees involved in the development of the guidelines: Conflict of Interest; Pharmaceutical Affairs; Research Ethics; and Editorial Committees. The COI Committee reviewed the COIs submitted by the board and committee members. The COI Committee found that, among the 382 board and committee members, 298 were without COI; 31 COIs were regarded by one committee member as not necessary to be circulated to all the attending members (total of these 2 categories: 329, 87%); 31 COIs (8%) were regarded as necessary to be circulated; and 18 cases (4.7%) were problematic: not submitted or explicit rejection of submission. Considering the seriousness of scientific misconduct by a researcher in another disease area who resigned his professorship and is now under investigation, we should further discuss the implementation of our COI guidelines.

  1. Centralization of a regional clinical microbiology service: The Calgary experience.

    PubMed

    Church, D L; Hall, P

    1999-11-01

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

  2. Centralization of a regional clinical microbiology service: The Calgary experience

    PubMed Central

    Church, Deirdre L; Hall, Paula

    1999-01-01

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

  3. Clinical experience of baclofen in alcohol dependence: A chart review

    PubMed Central

    Rozatkar, Abhijit R.; Kapoor, Abhishek; Sidana, Ajeet; Chavan, Bir Singh

    2016-01-01

    Introduction: Craving is recognized as a formidable barrier in the management of patients with alcohol dependence. Among pharmacological agents that have been used in experimental studies for reduction in craving, baclofen appears to have a significant advantage over other agents. Methodology: The study is retrospective chart review of patients (n = 113) who have been treated with baclofen for alcohol dependence in a tertiary hospital of North India. Baseline assessments included sociodemography, motivation, quantity-frequency of alcohol use, and other alcohol-related clinical parameters. Weekly assessments, for a period of 4 weeks, were extracted from records which included dose of baclofen, craving intensity, and alcohol consumption. Results: The study sample was predominantly male, mean age of 41.49 (±9.75) years, most having a family history of substance use (70.97%), and many reporting binge use pattern in last year (49.46%). Baseline assessment revealed 48.7% of the sample was in precontemplation phase for alcohol use and 70% reported severe and persistent craving. This persistent craving was reported by only 15% of the sample by the end of 4 weeks treatment with baclofen (20–40 mg/day). Thirty-four percent of patients reported continued problematic use of alcohol by the end of 4 weeks. Conclusion: Our clinical experience suggests that baclofen reduces craving and alcohol consumption including in those with poor motivation. The drug causes few side effects and does not add to the intoxication effect of alcohol. Considering that baclofen is safe in those with liver cirrhosis and reduces withdrawal symptoms due to alcohol, a controlled trial comparing it with standard treatment is required. PMID:28163402

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

    ERIC Educational Resources Information Center

    Cole, Beverley; Wessel, Jean

    2008-01-01

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

  5. [Gluten--mechanisms of intolerance, symptoms and treatment possibilities of IgE-related allergy for gluten in the light of actual clinical and immunological studies].

    PubMed

    Obtułowicz, Krystyna; Waga, Jacek; Dyga, Wojciech

    2015-01-01

    Gluten is the product of a chemical bond of wheat prolamin proteins (glia- dins and glutenins) in an aqueous me- dium. IgE mediated gluten allergy can be induced either by gluten as an in- gredient in foods or wheat prolamines present in the air. The aim of the study was clinical analysis of 13 patients, who demonstrated elevated levels of gluten specific IgE and identification of the most allergenic protein fractions from several samples of wheat using serum of examined subjects. Clinical analysis showed the occupational allergy to gluten in the form of rhinitis, asthma and airborne dermatistis in 9 subjects, whose symptoms disappeared during isolation from occupational exposure despite the use of a normal diet. In case of 4 patients with severe forms of chronic urticaria and atopic dermatitis, who are also allergic to grass pollen at the same time, the introduction of a gluten-free diet resulted in improvement of health conditions. The study of wheat protein fractions revealed a significant polymorphism dependent on the wheat sample. In the protein fractions, low and high molecular glutenin fractions, and alpha, beta, gamma, and omega-gliadins were separated. It has been shown that the strongest immunogenic effect causes omega-5 gliadin fraction. The removal of this fraction resulted in reduction of skin reactivity evaluated by skin prick test in the studied patients.

  6. Clinical Experiences with the Scapular Fascial Free Flap

    PubMed Central

    Park, Il Ho; Chang, Yong Joon; Kim, Jae Hyun

    2016-01-01

    Background The goal of reconstruction is to provide coverage of exposed vital structures with well-vascularized tissue for optimal restoration of form and function. Here, we present our clinical experience with the use of the scapular fascial free flap to correct facial asymmetry and to reconstruct soft tissue defects of the extremities. Methods We used a scapular fascial free flap in 12 cases for soft tissue coverage of the extremities or facial soft tissue augmentation. Results The flaps ranged in size from 3×12 to 13×23 cm. No cases of total loss of the flap occurred. Partial loss of the flap occurred in 1 patient, who was treated with a turnover flap using the adjacent scapular fascial flap and a skin graft. Partial loss of the skin graft occurred in 4 patients due to infection or hematoma beneath the graft, and these patients underwent another skin graft. Four cases of seroma at the donor site occurred, and these cases were treated with conservative management or capsulectomy and quilting sutures. Conclusions The scapular fascial free flap has many advantages, including a durable surface for restoration of form and contours, a large size with a constant pedicle, adequate surface for tendon gliding, and minimal donor-site scarring. We conclude that despite the occurrence of a small number of complications, the scapular fascial free flap should be considered to be a viable option for soft tissue coverage of the extremities and facial soft tissue augmentation. PMID:27689051

  7. Management of laryngeal radionecrosis: Animal and clinical experience

    SciTech Connect

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

    1989-05-01

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

  8. Biological wound dressings sterilized with gamma radiation: Mexican clinical experience

    NASA Astrophysics Data System (ADS)

    Martínez-Pardo, M. E.; Ley-Chávez, E.; Reyes-Frías, M. L.; Rodríguez-Ferreyra, P.; Vázquez-Maya, L.; Salazar, M. A.

    2007-11-01

    Biological wound dressings sterilized with gamma radiation, such as amnion and pig skin, are a reality in Mexico. These tissues are currently processed in the tissue bank and sterilized in the Gamma Industrial Irradiation Plant; both facilities belong to the Instituto Nacional de Investigaciones Nucleares (ININ) (National Institute of Nuclear Research). With the strong support of the International Atomic Energy Agency, the bank was established at the ININ and the Mexican Ministry of Health issued its sanitary license on July 7, 1999. The Quality Management System of the bank was certified by ISO 9001:2000 on August 1, 2003; the scope of the system is "Research, Development and Processing of Biological Tissues Sterilized with Gamma Radiation". At present, more than 150 patients from 16 hospitals have been successfully treated with these tissues. This paper presents a brief description of the tissue processing, as well as the present Mexican clinical experience with children and adult patients who underwent medical treatment with radiosterilized amnion and pig skin, used as biological wound dressings on burns and ocular surface disorders.

  9. Health promotion initiatives: An experience of a Well Women's Clinic

    PubMed Central

    Dudeja, Puja; Singh, Amarjeet; Jindal, A.K.

    2013-01-01

    Background Army Medical Corps provides comprehensive health care services to troops and their dependents. This approach is in consonance with the concept of Health Promoting Hospitals (HPH) initiative introduced by WHO in 1986. However, the concept is still at an infancy stage in civil health care system in India. This article describes the experiences and advantages of establishing a Well Women's Clinic (WWC) in a station of North India. Methods A system analysis approach was followed for analyzing input, process and output of the WWC during 2007–2009. Inputs included manpower and material i.e public health expert, non medical attendant and a nursing officer charts, poster, models, Television with Compact Disc (CD) player and CDs etc. Health promotion activities were conducted in the form of lectures, demonstrations, workshops, training, screening of movies, quiz, essay writing and declamation contests etc. Results Overall 385 lectures, 12 competitions, 07 training capsules were conducted. Coverage of target population was 92%. First aid training workshop trained 300 women. Six percent of the counseled women opted for tubectomy. Twelve new cases of diabetes and four new cases of hypertension were detected through screening. Seventy-two women were referred for dental treatment after a dental screening camp. Conclusion Establishment of WWC using HPH approach was quite cost effective. PMID:24623950

  10. The Use of Harmonic Scalpels in Thyroidectomies: Clinical Experiences

    PubMed Central

    Basoglu, Mahmut; Ozturk, Gurkan; Atamanalp, S. Selcuk; Aydinli, Bulent; Yildirgan, M. Ilhan; Oren, Durkaya

    2008-01-01

    Objective: Many studies have been conducted to investigate the efficacy of harmonic scalpels in thyroidectomies. Here, we present our clinical experiences with the instrument. Materials and Methods: The study was conducted at the General Surgery Department of the Ataturk University School of Medicine between January 2005 and July 2008. It was a prospective, randomized, controlled study. Patients with benign nodular goiter (BNG) were included in the study and randomly divided into three groups. The first group consisted of 47 patients, the second group consisted of 57 patients, and the third group consisted of 41 patients. Patients in the first group underwent the classical thyroidectomy. Those in the second group had only the superior thyroid arteries and veins ligated (with silk or polyglactin), while the other vascular structures were divided using a harmonic scalpel. In the third group, all arteries and veins of the thyroid gland were divided using a harmonic scalpel. In each group, mean operation time, amount of bleeding, amount of postoperative drainage, and other postoperative complications were recorded. Results: Operation time was significantly lower for patients in the third group. The degree of bleeding and postoperative drainage was lower in the second and third groups with respect to the first group. There was no significant difference among the groups in terms of the development of transient hypocalcemia or voice impairment. Conclusion: We conclude that the use of harmonic scalpels for a thyroidectomy is safe, shortens operative time, and decreases intraoperative bleeding. PMID:25610032

  11. Guidelines for Clinical Experiences in Health Occupations Education. Information Series: Report No. 12.

    ERIC Educational Resources Information Center

    Walters, Norma J., Ed.; Johnson, Lois H., Ed.

    This manual is intended to assist health occupations education (HOE) teachers in planning clinical experiences for their students. Addressed in the individual sections of the guide are the following topics: the purpose, philosophy, and legal aspects of clinical experiences in HOE; the HOE clinical structure (teacher qualifications, the role of the…

  12. How do patients actually experience and use art in hospitals? The significance of interaction: a user-oriented experimental case study

    PubMed Central

    Nielsen, Stine L.; Fich, Lars B.; Roessler, Kirsten K.; Mullins, Michael F.

    2017-01-01

    ABSTRACT This article aims to understand patient wellbeing and satisfaction and to qualify the current guidelines for the application of art in hospitals. Employing anthropological methods, we focus on the interactional aspects of art in health interventions. A user-oriented study ranked 20 paintings, followed by an experiment using paintings in the dayroom of five medical wards. Fieldwork was done over a two-week period. During the first week, dayrooms were configured without the presence of art and in the second week were configured with the artworks. Semi-structured interviews, observation, participant observation and informal conversation were carried out and were informed by thermal cameras, which monitored the usage, patient occupation and flow in two of the dayrooms. The study shows that art contributes to creating an environment and atmosphere where patients can feel safe, socialize, maintain a connection to the world outside the hospital and support their identity. We conclude that the presence of visual art in hospitals contributes to health outcomes by improving patient satisfaction as an extended form of health care. The article draws attention to further research perspectives and methods associated with the development of art in hospitals.

  13. [Stuttering and Tourette's syndrome: a short tutorial and account of a four years experience in a stuttering clinic constriction of the vocal tract].

    PubMed

    Monfrais-Pfauwadel, M C

    2004-01-01

    The author presents a short tutorial of Gilles de la Tourette's syndrome followed by a state of the art of review of the clinical links between stuttering and the different kinds of Tourette and tics disorders. The author relates her own experience of working for four consecutive years at the new stuttering diagnostic center at the "Hôpital Européen Georges Pompidou ". The article ends with a practical review of the actual therapies available when such a diagnosis is made.

  14. LEWY BODY DEMENTIA: THE CAREGIVER EXPERIENCE OF CLINICAL CARE

    PubMed Central

    Galvin, James E.; Duda, John E.; Kaufer, Daniel I.; Lippa, Carol F.; Taylor, Angela; Zarit, Steven H.

    2010-01-01

    BACKGROUND Lewy body dementia (LBD) is the second most common cause of dementia, however, little is known about how the clinical diagnosis of LBD is obtained in the community or the caregiver experience while seeking the diagnosis. METHODS The Lewy Body Dementia Association (www.LBDA.org) conducted a web-based survey of 962 caregivers over a 6-month period. RESULTS The mean age of respondents was 55.9y; 88% were female and 64% had daily contact with patients. The mean age of LBD patients was 75.4y; 62% were male and 46% lived with a caregiver. The most common presentation of symptoms as reported by LBD caregivers was cognitive (48%), motor (39%) or both (13%). The first diagnoses given to the patients were Parkinson disease or other movement disorder (39%), Alzheimer disease or other cognitive disorder (36%), or mental illness (24%). Fifty percent of patients saw >3 doctors for more than 10 visits over the course of 1 year before an LBD diagnosis was established. Neurologists diagnosed most cases (62%), while primary care-providers diagnosed only 6% of cases. No differences were found between the presentation of disease and the number of physicians, number of office visits, length of time to establish diagnosis, or type of doctor who finally made an LBD diagnosis. Caregivers viewed physicians as knowledgeable about disease manifestations and treatment options, but not about disease course/prognosis and available community resources and referrals. CONCLUSIONS These data highlight a need for increasing physician awareness and knowledge of LBD, which will facilitate accurate diagnosis and treatment. Community resources such as the Lewy Body Dementia Association may serve this end, while also providing practical information and support for caregivers. PMID:20434939

  15. Vinflunine in the treatment of advanced urothelial cancer: clinical evidence and experience

    PubMed Central

    Gerullis, Holger; Wawroschek, Friedhelm; Köhne, Claus-Henning; Ecke, Thorsten Holger

    2016-01-01

    Vinflunine (VFL) has been approved in Europe for second-line treatment of metastatic and advanced urothelial cancer after failure of platin-containing therapy. Since approval, the drug has been investigated in few clinical trials. Most of the currently available reports describe experiences with VFL in a daily clinical setting. This review gives a short overview on clinical experiences and clinical trials involving VFL since the approval of this drug in 2009. PMID:28042310

  16. Impact of Simulation and Clinical Experience on Self-efficacy in Nursing Students: Intervention Study.

    PubMed

    Kimhi, Einat; Reishtein, Judith L; Cohen, Miri; Friger, Michael; Hurvitz, Nancy; Avraham, Rinat

    2016-01-01

    This study compared the effect of simulation and clinical experience timing on self-confidence/self-efficacy for the nursing process. Using a randomized, double-crossover design, self-efficacy was measured 3 times. Although self-efficacy was significantly higher at time 1 for students who had clinical experience, there was no difference between the groups at the end of the course (time 2). Thus, simulation increased self-confidence/self-efficacy equivalently if placed either before or after clinical experience.

  17. Experience with a Family-Practice-Resident-Directed Obstetrical Clinic.

    ERIC Educational Resources Information Center

    Hunter, Jerry L.; Snyder, Frank

    1980-01-01

    At Toledo Hospital, family practice residents have assumed responsibility for the normal obstetrics clinic. Specialty consultations are provided by the hospital's obstetrics residency program. A medical audit of the clinic indicates that the family practice residents obtained consultations and made referrals at the appropriate times. (JMD)

  18. Table Clinics: A Valuable Learning Experience for Allied Health Students.

    ERIC Educational Resources Information Center

    Melton, Jimmie H.

    Table clinics, or short oral presentations on techniques related to some phase of research, diagnosis, or treatment, can be used to enrich allied health education. To present a table clinic, students must choose a topic which lends itself to a 5- to 7-minute presentation and which imparts knowledge that participants can take back to their…

  19. A dedicated undergraduate gynaecology teaching clinic: The Keele experience.

    PubMed

    Katali, Hamza Mahamadu; Parry-Smith, William Rhys; Eliot, Rees L; O'Mahony, Fidelma

    2016-01-01

    Much discussion in the literature centres on how best to teach medical students the intricacies of gynaecological assessment and the subsequent formulation of a management plan. At Keele University skills are initially developed in a simulated setting and then transferred to the workplace where students continue to develop their skills. A dedicated undergraduate gynaecology teaching clinic has been developed and comprises of 2-3 students and a tutor. All 38 students rotating through the department between January and June 2013 were invited to complete an anonymous questionnaire to evaluate this clinic and 36 (95%) of them responded. Respondents felt significantly more comfortable taking a gynaecology history, ensuring privacy during examination and formulating a management plan post-clinic (all p < 0.001), with female students feeling significantly more comfortable than their male counterparts (p = 0.04). The use of this clinic shows great promise to help students learn an unfamiliar and challenging skill.

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

    ERIC Educational Resources Information Center

    Chenail, Ronald J.

    2011-01-01

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

  1. Preclinical and clinical experience with a viscoelastic total disc replacement

    PubMed Central

    Rischke, Burkhard; Ross, Raymond S.; Jollenbeck, Boris A.; Zimmers, Kari B.; Defibaugh, Neal D.

    2011-01-01

    Background The purpose of this study is to describe the mechanical durability and the clinical and radiographic outcomes of a viscoelastic total disc replacement (VTDR). The human intervertebral disc is a complex, viscoelastic structure, permitting and constraining motion in 3 axes, thus providing stability. The ideal disc replacement should be viscoelastic and deformable in all directions, and it should restore disc height and angle. Methods Mechanical testing was conducted to validate the durability of the VTDR, and a clinical study was conducted to evaluate safety and performance. Fifty patients with single-level, symptomatic lumbar degenerative disc disease at L4-5 or L5-S1 were enrolled in a clinical trial at 3 European sites. Patients were assessed clinically and radiographically for 2 years by the Oswestry Disability Index (ODI), a visual analog scale (VAS), and independent radiographic analyses. Results The VTDR showed a fatigue life in excess of 50 million cycles (50-year equivalent) and a physiologically appropriate level of stiffness, motion, geometry, and viscoelasticity. We enrolled 28 men and 22 women in the clinical study, with a mean age of 40 years. Independent quantitative radiographic assessment indicated that the VTDR restored and maintained disc height and lordosis while providing physiologic motion. Mean ODI scores decreased from 48% preoperatively to 23% at 2 years’ follow-up. Mean VAS low-back pain scores decreased from 7.1 cm to 2.9 cm. Median scores indicated that half of the patient population had ODI scores below 10% and VAS low-back pain scores below 0.95 cm at 2 years. Conclusions The VTDR has excellent durability and performs clinically and radiographically as intended for the treatment of symptomatic lumbar degenerative disc disease. Clinical Relevance The VTDR is intended to restore healthy anatomic properties and stability characteristics to the spinal segment. This study is the first to evaluate a VTDR in a 50-patient

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

    PubMed

    Curnow, R T

    1997-01-01

    The class I IgG receptor (Fc gamma RI or CD64 receptor), which is present on key cytotoxic effector cells, has been shown to initiate the destruction of tumor cells in vitro and has been hypothesized to play a role in the destruction of antibody-coated cells such as platelets in idiopathic thrombocytopenia purpura (ITP). This overview summarizes the clinical experience with CD64-directed immunotherapy in cancer patients with the bispecific antibodies MDX-447 [humanized Fab anti-CD64 x humanized Fab anti-(epidermal growth factor receptor, EGFR)] and MDX-H210 (humanized Fab anti-DC64 x Fab anti-HER2/neu), and with the anti-CD64 monoclonal antibody (mAB) MDX-33 (H22) in the modulation of monocyte CD64 in vivo. In an ongoing phase I/II open-label trial with progressive dose escalation (1-15 mg/m2), patients with treatment refractory EGFR-positive cancers (renal cell carcinoma (RCC), head and neck, bladder, ovarian, prostate cancer and skin cancer) are treated weekly with intravenous MDX-447, with and without granulocyte-colony-stimulating factor (G-CSF). MDX-447 has been found to be immunologically active at all doses, binding to circulating monocytes and neutrophils (when given with G-CSF), causing monocytopenia and stimulating increases in circulating plasma cytokines. MDX-447 is well tolerated, the primary toxicities being fever, chills, blood pressure lability, and pain/ myalgias. Of 36 patients evaluable for response, 9 have experienced stable disease of 3-6 month's duration. The optimal dose and the maximal tolerated dose (MTD) have yet to be defined; dose escalation continues to define better the dose, toxicity, and the potential therapeutic role of this bispecific antibody. Three MDX-H210 phase II trials are currently in progress, all using the intravenous dose of 15 mg/m2 given with granulocyte/macrophage (GM-CSF). These consist of one trial each in the treatment of RCC patients, patients with prostate cancer, and colorectal cancer patients, all of whom have

  3. Evaluating Perceptions of Culminating Clinical Education Experiences of Senior Athletic Training Students

    ERIC Educational Resources Information Center

    Aronson, Patricia A.; Bowman, Thomas G.; Mazerolle, Stephanie M.

    2015-01-01

    Context: The perceptions of athletic training students (ATSs) regarding their clinical education experiences are not fully understood. It is important to investigate ATS perceptions of clinical education to allow athletic training educators to provide educational experiences that will maximize learning. Objective: To determine what ATSs value…

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

    ERIC Educational Resources Information Center

    Duxbury, Mark

    2004-01-01

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

  5. Sporotrichosis in childhood: clinical and therapeutic experience in 25 patients.

    PubMed

    Bonifaz, Alexandro; Saúl, Amado; Paredes-Solis, Vanessa; Fierro, Leonel; Rosales, Alejandra; Palacios, Carolina; Araiza, Javier

    2007-01-01

    Sporotrichosis in an uncommon mycoses in childhood and is generally associated with injuries received as a consequence of farm work. We undertook a retrospective study of sporotrichosis in children and adolescents seen over a 10-year period, focusing on their clinical, epidemiologic, and mycologic features as well as treatment. We included 25 children with a mean age of 9.3 years. Most of those affected were schoolchildren (84%) from rural areas. The main clinical variety of sporotrichosis seen was the lymphocutaneous form (64%), followed by the fixed cutaneous form (36%), and one instance of the disseminated cutaneous form. Most lesions were located on the upper limbs (40%) and the face (36%). Sporothrix schenckii was isolated in all patients and 24 of 25 had a positive sporotrichin skin test. Nineteen patients were treated and cured clinically and mycologically with potassium iodide, three were cured with itraconazole and one with heat therapy.

  6. Clinical Experience of the Klippel-Trenaunay Syndrome

    PubMed Central

    Sung, Hyung Min; Lee, Seok Jong; Lee, Jong Min; Huh, Seung; Lee, Jeong Woo; Choi, Kang Young; Yang, Jung Dug; Cho, Byung Chae

    2015-01-01

    Background The Klippel-Trenaunay syndrome (KTS) is characterized by three clinical features, namely cutaneous capillary malformations, venous malformations, and soft tissue and/or bony hypertrophy of the extremities. The varied manifestations are attributed to the unpredictable clinical nature and prognosis of the syndrome. To elucidate the clinical characteristics of this disease, we reviewed a relatively large number of KTS patients who presented to our vascular anomalies center. Methods We conducted a retrospective study with 19 patients who were diagnosed with KTS and treated in our vascular anomalies clinic between 2003 and 2014, and examined their demographic characteristics, their clinical features, and the treatments administered. Results The sex distribution was balanced, with 9 (47%) males and 10 (53%) females. The mean follow-up period was 4.1 years (range, 7 months-9 years). Most of the patients received conservative treatments such as medication or physiotherapy. Compression therapies such as wearing of elastic garments/bandages were also administered, and surgical interventions were considered only when the patients became excessively symptomatic. Other treatments included laser therapy and sclerotherapy, and all the treatments were adjusted according to each case, tailored to the conditions of the individual patients. Conclusions KTS is an extremely rare, multifactorial disorder that induces widely varied symptoms. Because of this unique feature, plastic surgeons, when not careful, tend to attach a one-sided importance to typical symptoms such as limb hypertrophy or capillary malformation and thus overlook other symptoms and clinical features. KTS can be suspected in all infants who show capillary malformations or limb hypertrophy and require a multi-disciplinary approach for comprehensive management. PMID:26430625

  7. Necrotizing Craniocervical Soft Tissue Infections: Clinical Experience and Personal Considerations

    PubMed Central

    Lenzi, Riccardo; Castelnuovo, Paolo; Dallan, Iacopo

    2012-01-01

    Necrotizing cervical soft tissue infections (NCSTIs) are devastating uncommon clinical entities that are often life threatening. We report two patients suffering from NCSTI and treated at our institution. Diagnosis of NCSTI has been confirmed histologically and surgically. Both patients were managed with very aggressive treatment (medical and surgical) and survived with minimal morbidity. Early diagnosis and aggressive, multimodality treatment can reduce mortality and morbidity rates. Thoracic and mediastinal involvement requires appropriate management. A strong clinical suspicion remains one of the most important aspects of the management of such shattering conditions. PMID:23304596

  8. The ethics of nursing student international clinical experiences.

    PubMed

    Levi, Amy

    2009-01-01

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

  9. Clinical microbiology quality assurance program: a Taiwan experience.

    PubMed

    Tsai, W C; Wu, J L; Luh, K T

    1995-05-01

    Quality assurance programs have been established during the last two decades in developed countries to promote high quality performance in clinical laboratories. In Taiwan, such a program for clinical microbiology laboratories has been in place since July 1987. It has been supported by the Department of Health, Executive Yuan, R.O.C. and was set up by the authors. The manpower status, facilities and equipment, and performance of clinical laboratories were investigated during the first year and standards of laboratory quality were recommended. Since then, under a continuing education program, we have conducted seminars, symposia, workshops, short-courses or panel discussions approximately 4 times a year. There have been about 150 participants per session and they have come from local hospitals (primary care hospitals), regional hospitals (secondary care hospitals) and medical centers (tertiary care hospitals). Proficiency test specimens or external unknown specimens were sent to all the laboratories twice a year and approximately 3 specimens were used each time for the evaluation of each laboratory's diagnostic capability and quality of service. Results indicated that there were tremendous improvements in the quality of laboratory performance. At the same time, several laboratory manuals describing the methods of quality control of clinical specimens, test procedures, media and reagents, personnel management and a compilation of reports etc. were published as guidelines of basic requirements for each level of the laboratories. For local hospital laboratories in remote areas, several regional hospitals or medical centers with high quality laboratories were selected to serve as back-ups. Our evaluation has shown that the performance and quality of service provided by most clinical microbiology laboratories in Taiwan have now reached nearly the level of those found in the so-called "developed countries".

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

    PubMed

    Karlberg, A T

    1988-01-01

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

  11. PACS archive upgrade and data migration: clinical experiences

    NASA Astrophysics Data System (ADS)

    Liu, Brent J.; Documet, Luis; Sarti, Dennis A.; Huang, H. K.; Donnelly, John

    2002-05-01

    Saint John's Health Center PACS data volumes have increased dramatically since the hospital became filmless in April of 1999. This is due in part of continuous image accumulation, and the integration of a new multi-slice detector CT scanner into PACS. The original PACS archive would not be able to handle the distribution and archiving load and capacity in the near future. Furthermore, there is no secondary copy backup of all the archived PACS image data for disaster recovery purposes. The purpose of this paper is to present a clinical and technical process template to upgrade and expand the PACS archive, migrate existing PACs image data to the new archive, and provide a back-up and disaster recovery function not currently available. Discussion of the technical and clinical pitfalls and challenges involved in this process will be presented as well. The server hardware configuration was upgraded and a secondary backup implemented for disaster recovery. The upgrade includes new software versions, database reconfiguration, and installation of a new tape jukebox to replace the current MOD jukebox. Upon completion, all PACS image data from the original MOD jukebox was migrated to the new tape jukebox and verified. The migration was performed during clinical operation continuously in the background. Once the data migration was completed the MOD jukebox was removed. All newly acquired PACS exams are now archived to the new tape jukebox. All PACs image data residing on the original MOD jukebox have been successfully migrated into the new archive. In addition, a secondary backup of all PACS image data has been implemented for disaster recovery and has been verified using disaster scenario testing. No PACS image data was lost during the entire process and there was very little clinical impact during the entire upgrade and data migration. Some of the pitfalls and challenges during this upgrade process included hardware reconfiguration for the original archive server, clinical

  12. Patient flow improvement for an ophthalmic specialist outpatient clinic with aid of discrete event simulation and design of experiment.

    PubMed

    Pan, Chong; Zhang, Dali; Kon, Audrey Wan Mei; Wai, Charity Sue Lea; Ang, Woo Boon

    2015-06-01

    Continuous improvement in process efficiency for specialist outpatient clinic (SOC) systems is increasingly being demanded due to the growth of the patient population in Singapore. In this paper, we propose a discrete event simulation (DES) model to represent the patient and information flow in an ophthalmic SOC system in the Singapore National Eye Centre (SNEC). Different improvement strategies to reduce the turnaround time for patients in the SOC were proposed and evaluated with the aid of the DES model and the Design of Experiment (DOE). Two strategies for better patient appointment scheduling and one strategy for dilation-free examination are estimated to have a significant impact on turnaround time for patients. One of the improvement strategies has been implemented in the actual SOC system in the SNEC with promising improvement reported.

  13. [Clinical experience of usage of neurostimulator in regionar anesthesia].

    PubMed

    Rudenko, M I; Kolobaeva, E G

    2006-09-01

    The elaboration of more reliable and simple methods of transmitted and plexus anestesias has provided a wide clinical usage of regionar anestesia (RA) during the operations on extremities. The creation of devices to identificate (locate) nerval bearer and plexes was also an important factor for increasing quantity of RA. For such identification we use the portable "Innervator 232" neurostimulator manufactured by "Fisher & Paykel Ltd.", New Zealand. Successful conduction of transmitted and plexus anesthesia depends a lot on anesthesiologist's knowledge of anatomy-topography location of nerval bearer and plexes, precise fulfillment of anesthesia, manual capabilities of physician and obtaining a paresthesia or muscular contraction during the identification of nerval bearer with the help of neurostimulator. RA is secure, effective, and provides less risk for a patient. With neurostimulation the amount of successful anesthesias increases up to 98%. The neurostimulator is easy to use, clinically effective in emergency and planned surgeries for identification of nerval bearer and plexes.

  14. Clinical Aspects of Cerebral Venous Thrombosis: Experiences in Two Institutions

    PubMed Central

    Rim, Hyun Taek; Jun, Hyo Sub; Ahn, Jun Hyong; Kim, Ji Hee; Oh, Jae Keun; Song, Joon Ho; Cho, Byung Moon

    2016-01-01

    Objective Cerebral venous thrombosis (CVT) is a rare condition for which few clinical reviews have been conducted in Korea. Our aim was to investigate, risk factors, clinical presentations/courses, and outcomes of 22 patients treated for CVT at two centers. Materials and Methods A retrospective analysis was conducted, selecting 22 patients diagnosed with and treated for CVT at two patient care centers over a 10-year period (January 1, 2004 to August 31, 2015). Patient data, pathogenetic concerns (laboratory findings), risk factors, locations, symptoms, treatments, and clinical outcomes were reviewed. Results Mean patient age at diagnosis was 54.41 ± 16.19. Patients most often presented with headache (40%), followed by seizure (27%) and altered mental status (18%). Focal motor deficits (5%), visual symptoms (5%), and dysarthria (5%) were less common. Important predisposing factors in CVT included prothrombotic conditions (35%), infections (14%), hyperthyroidism (18%), trauma (14%), and malignancy (4%). By location, 9 patients (40%) experienced thrombosis of superior sagittal sinus predominantly, with involvement of transverse sinus in 20 (90%), sigmoid sinus in 12 (40%), and the deep venous system in 5 (23%). Treatment generally consisted of anticoagulants (63%) or antiplatelet (23%) drugs, but surgical decompression was considered if warranted (14%). Medical therapy in CVT yields good functional outcomes. Conclusion Mean age of patients with CVT in our study exceeded that reported in Europe or in America and had difference in risk factors. Functional outcomes are good with use of antithrombotic medication, whether or not hemorrhagic infarction is evident. PMID:27847760

  15. Laboratory and clinical experience with neodymium:YAG laser prostatectomy

    NASA Astrophysics Data System (ADS)

    Kabalin, John N.

    1996-05-01

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

  16. Clinical experience with trimegestone as a new progestin in HRT.

    PubMed

    Grubb, Gary; Spielmann, Daniele; Pickar, James; Constantine, Ginger

    2003-11-01

    Trimegestone (TMG) is a novel, 19-norpregnane progestin, which demonstrates endometrial selectivity with a reduced progestin-related side effect profile when compared to several other currently marketed progestins. TMG has been studied in combination with 17beta-estradiol (17beta-E2) and conjugated equine estrogens (CEE). TMG-containing HRT agents were effective in relieving vasomotor symptoms and providing protection from endometrial hyperplasia with < or =1% hyperplasia. In clinical trials with sequential regimens, TMG provided predictable withdrawal bleeding associated with a low incidence of irregular and prolonged bleeding. Clinical studies of continuous combined regimens of estrogen/TMG combinations demonstrated high levels of amenorrhea. Both 17beta-E2 and CEE/TMG combinations have shown improved bone mineral density and quality-of-life assessments. Both continuous combined and sequential regimens of 17beta-E2/TMG and CEE/TMG have a favorable clinical profile. TMG provides an important new option for the treatment of postmenopausal symptoms and the prevention of osteoporosis.

  17. Discordance between presumed standard of care and actual clinical practice: the example of rubber dam use during root canal treatment in the National Dental Practice-Based Research Network

    PubMed Central

    Gilbert, Gregg H; Riley, Joseph L; Eleazer, Paul D; Benjamin, Paul L; Funkhouser, Ellen

    2015-01-01

    Objectives Use of a rubber dam during root canal treatment is considered the standard of care because it enhances patient safety and optimises the odds of successful treatment. Nonetheless, not all dentists use a rubber dam, creating disconnect between presumed standard of care and what is actually done in clinical practice. Little is known about dentists’ attitudes towards use of the rubber dam in their practices. The objectives were to: (1) quantify these attitudes and (2) test the hypothesis that specific attitudes are significantly associated with rubber dam use. Setting National Dental Practice-Based Research Network (NationalDentalPBRN.org). Participants 1490 network dentists. Outcome measures Dentists completed a questionnaire about their attitudes towards rubber dam use during root canal treatment. Three attitude scales comprised 33 items that used a 5-point ordinal scale to measure beliefs about effectiveness, inconvenience, ease of placement, comparison to other isolation techniques and patient factors. Factor analysis, cluster analysis and multivariable logistic regression analysed the relationship between attitudes and rubber dam use. Results All items had responses at each point on the 5-point scale, with an overall pattern of substantial variation across dentists. Five attitudinal factors (rubber dam effectiveness; inconvenient/time-consuming; ease of placement; effectiveness compared to Isolite; patient factors) and 4 clusters of practitioners were identified. Each factor and cluster was independently and strongly associated with rubber dam use. Conclusions General dentists have substantial variation in attitudes about rubber dam use. Beliefs that rubber dam use is not effective, inconvenient, time-consuming, not easy to place or affected by patient factors, were independently and significantly associated with lower rubber dam use. These attitudes explain why there is substantial discordance between presumed standard of care and actual practice

  18. Co-Learning: Maximizing Learning in Clinical Experiences

    ERIC Educational Resources Information Center

    Merk, Hillary; Waggoner, Jacqueline; Carroll, James

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    PubMed

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

    2014-08-01

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

  1. Three years of clinical experiences on excimer laser angioplasty

    NASA Astrophysics Data System (ADS)

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

    1992-08-01

    Our experience on excimer laser angioplasty in peripheral arteries is reported. During three years 34 patients were treated with improved techniques, following the evolution of the laser and of the delivery systems. Encouraging results in the laser stand alone technique allowed us to reduce the association with balloon dilatation to a limited number of cases.

  2. "Playing" at Leadership: Clinical Experiences for Professional Development.

    ERIC Educational Resources Information Center

    Tucker-Ladd, Patricia R.

    1990-01-01

    The required educational administration internship at Eastern Illinois University is a rigorous program designed to promote professional development through structures integrating play or a playful attitude into its work-related elements. These structures allow interns opportunities to initiate and think clearly, experience solidarity in work…

  3. Clinical spectrum of hypopituitarism in India: A single center experience

    PubMed Central

    Gundgurthi, Abhay; Garg, M. K.; Bhardwaj, Reena; Brar, Karninder S.; Kharb, Sandeep; Pandit, Aditi

    2012-01-01

    Objectives: There is paucity of information regarding clinical profile of hypopituitarism from India. We report the clinical profile of hypopituitarism from a tertiary center in North India. Materials and Methods: This study was carried out in patients attending our endocrine center between January 2010 and December 2011. All new patients were studied prospectively and those registered before January 2010 retrospectively. Relevant clinical, hormonal, and imaging data were collected. Dynamic testing for pituitary functions was carried out as necessary. Hormonal deficiencies were defined as per prevailing recommendations. Results: This study included 113 subjects. The mean age was 38.6 ± 17.8 years (range, 4 – 76 years). There were 78 (69%) males and 35 females (31%). There were 22 subjects aged ≤18 years (childhood and adolescence) and 91 adults (>18 years). Visual disturbances were the most common presenting complaint (33%), though headache was the most common symptom (81%). Fifteen percent presented with pituitary apoplexy. Tumors comprised of 84% of cases. Hypogonadism (97%) was the most common abnormality seen followed by hypothyroidism (83.2%), hypoadrenalism (79.6%), growth hormone deficiency (88.1% of the 42 patients tested), and diabetes insipidus (13.3%). Panhypopituitarism was seen in 104 (92%) patients. There were no cases of hypopituitarism secondary to traumatic brain injury, subarachnoid hemorrhage, central nervous system infections, or cranial irradiation to extrasellar tumors. Conclusion: The most common cause of hypopituitarism at tertiary care center is pituitary tumors and the commonest presenting complaint is visual symptoms. Panhypopituitarism is present in 92% cases. PMID:23087868

  4. Clinical Experiences of Uncommon Motor Neuron Disease: Hirayama Disease

    PubMed Central

    Lee, Kyoung Hee; Choi, Dae Seob; Lee, Young Suk

    2016-01-01

    Hirayama disease, juvenile muscular atrophy of the distal upper limb, is a rare disease predominantly affecting the anterior horn cells of the cervical spinal cord in young men. This cervical myelopathy is associated with neck flexion. It should be suspected in young male patients with a chronic history of weakness and atrophy involving the upper extremities followed by clinical stability in few years. Herein, we report 2 cases of Hirayama disease on emphasis of diagnostic approach and describe the pathognomonic findings at flexion magnetic resonance imaging. PMID:27800001

  5. [Animal experimental and clinical experiences with carbon polymer stomas].

    PubMed

    Harzmann, R; Bichler, K H; Kieninger, G; Haumer, M; Ideler, V

    1978-07-01

    Biocarbon implants consist of 99.9% pure carbon and are characterized by chemical inactivity and good tissue compatibility. Biocarbon was used for subfascial implantations, as well as coecostomies, ileostomies and cystostomie on mongrel dogs. The most important clinical results was the good healing over of the material without adverse reaction. The cystostomies showed only a very slight tendency to form incrustations. Drainage was watertight without signs of leakage. The satisfying results with two patients who were provided with a cystostoma are reported and further uses of the procedure, such as ureterocutaneostomy, iliac and colonic conduit, are discussed.

  6. Langerhans cell histiocytosis: clinical experience with 124 patients.

    PubMed

    Rivera-Luna, R; Martinez-Guerra, G; Altamirano-Alvarez, E; Martinez-Avalos, A; Cardenas-Cardoz, R; Ayon-Cardenas, A; Ruiz-Maldonado, R; Lopez-Corella, E

    1988-08-01

    We cared for 124 pediatric patients with a histologic diagnosis of Langerhans' cell histiocytosis (histiocytosis X) over a period of 14 years. Clinical, laboratory, and radiographic findings were analyzed. The most frequent manifestations were bone lesions, lymph node involvement, and skin infiltration. Liver disease was noted in 50% of patients and lung disease in 23%; hematologic changes were also frequent. Dysfunction and involvement of these three organ systems, plus age of onset, distinguished the group of patients with the highest mortality. All patients with generalized disease or organ dysfunction were treated with systemic chemotherapy. The actuarial survival curve at 10 years was 63%.

  7. A Comparison of a Traditional Clinical Experience to a Precepted Clinical Experience for Baccalaureate-Seeking Nursing Students in Their Second Semester

    PubMed Central

    Ownby, Kristin; Schumann, Renae; Dune, Linda; Kohne, David

    2012-01-01

    The shortage of nursing faculty has contributed greatly to the nursing workforce shortage, with many schools turning away qualified applicants because there are not enough faculty to teach. Despite the faculty shortage, schools are required to admit more students to alleviate the nursing shortage. Clinical groups in which preceptors are responsible for student learning extend faculty resources. Purpose. To determine the effectiveness of an alternative clinical experience (preceptorship). Methods. quasi-experimental, randomized, longitudinal design. Students were randomized to either the traditional or precepted clinical group. The clinical experience was a total of 12 weeks. Groups were compared according to several variables including second semester exam scores, HESI scores, and quality and timeliness of clinical paperwork. Sample. Over a two-year period, seventy-one undergraduate nursing students in the second semester medical-surgical nursing course participated. 36 were randomized to the experimental group. The preceptors were baccalaureate-prepared nurses who have been practicing for at least one year. Setting. Two hospitals located in the Texas Medical Center. Statistical Analysis. Descriptive statistics and independent t-test. Results. There was no difference between the groups on the variables of interest. Conclusion. Students in the precepted clinical group perform as well as those in a traditional clinical group. PMID:22577535

  8. Clinical Experiences Are Not Predictive of Outcomes on the NATABOC Examination

    PubMed Central

    Turocy, Paula Sammarone; Comfort, Ronald E.; Perrin, David H.; Gieck, Joe H.

    2000-01-01

    Objective: To determine the efficacy of the National Athletic Trainers' Association Board of Certification (NATABOC) clinical experience requirements and individual student characteristics to predict candidate outcomes on the NATABOC certification examination. Design and Setting: For all subjects, we gathered survey information and examination scores. The survey information included age, sex, route to certification, previous athletic training and allied health experience, and clinical education experiences. Subjects: A total of 269 subjects, 22.25% of all first-time candidates for the June and November 1993 NATABOC examinations, were included in this study. Measurements: Data were analyzed for standard descriptive statistics and parametric linear regression and correlational relationships. Results: Total clinical hours, high-risk sport experiences, and previous athletic training experience were not predictive of examination outcomes. Although our results indicated a relationship between previous allied health experience and both outcome on the written section of the examination and age and outcome on the oral/practical section, these characteristics also were not predictive of examination outcomes. Conclusions: Gaining clinical experience hours in excess of 400 hours beyond the 800-or 1500-hour requirement may yield no greater benefit for an entry-level professional than less time. The quality, rather than the quantity, of clinical experiences should be evaluated. More emphasis should be placed on the achievement of an entry level of clinical competency, rather than on total hour collection. Also, because high-risk sport experiences did not predict outcomes on the NATABOC examination, the emphasis of clinical education should be on students' receiving a more structured clinical experience, in which they are progressively required to assume greater responsibilities integrating both cognitive and psychomotor skills, while working under the supervision of a certified

  9. Clinical experience of esophageal perforation occurring with endoscopic submucosal dissection.

    PubMed

    Sato, H; Inoue, H; Ikeda, H; Grace R Santi, E; Yoshida, A; Onimaru, M; Kudo, S

    2014-01-01

    Esophageal perforation occurring during or after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is a rare, but serious complication. However, reports of its characteristics, including endoscopic imaging and management, have not been fully detailed. To analyze and report the clinical presentation and management of esophageal perforations occurred during or after EMR/ESD. Four hundred seventy-two esophageal neoplasms in 368 patients were treated (171 EMR; ESD 306) at Northern Yokohama Hospital from 2003 to 2012. Esophageal perforation occurred in a total of seven (1.9%) patients, all of whom were male and had undergone ESD. The etiology of perforation was: three (42.9%) intraoperative; three (42.9%) balloon dilatation for stricture prevention; one (14.2%) due to food bolus impaction. All cases were managed non-operatively based on the comprehensive assessment of clinical severity, extent of the injury, and the time interval from perforation to treatment onset. Conservative management included (i) bed rest and continuous monitoring to determine the need for operative intervention; (ii) fasting and intravenous fluid infusion/ tube feeding; and (iii) intravenous antibiotics. All defects closed spontaneously, save one case where closure was achieved by endoscopic clipping. Surgery was not required. Conservative management for esophageal perforation during advanced endoscopic resection is may be possible when there is no delay in diagnosis or treatment. Decision-making should be governed purely by multidisciplinary discussion.

  10. Clinical trials of live oral rotavirus vaccines: the Finnish experience.

    PubMed

    Vesikari, T

    1993-01-01

    Live oral candidate rotavirus vaccines of bovine (RIT 4237) or rhesus (RRV-1) origin and reassortants of RRV-1 expressing human serotype 1 (DxRRV) or serotype 2 (DS1xRRV) VP7 protein were evaluated for clinical efficacy in young children in successive trials from 1983 to 1989. In each study, the vaccinations were given before a rotavirus epidemic season and the follow-up of vaccinees covered two rotavirus epidemic seasons lasting up to 2-3 years of age. Serotype 1 rotavirus was predominant in each season. Protection rates against all rotavirus-associated diarrhoea ranged from 0 to 67% but were higher, up to 100%, against more severe rotavirus disease. All tested vaccines also showed efficacy for diarrhoea not apparently associated with rotavirus; therefore the clinical benefit of the vaccinations was greater than could be deduced from efficacy rates for rotavirus-associated diarrhoea alone. Each of the candidate vaccines could significantly reduce severe diarrhoea in Finnish children in the first 2 to 3 years of life. For optimal efficacy, the vaccines should be administered in the autumn before the regular epidemic season of rotavirus.

  11. Group Counseling for Self-Actualization.

    ERIC Educational Resources Information Center

    Streich, William H.; Keeler, Douglas J.

    Self-concept, creativity, growth orientation, an integrated value system, and receptiveness to new experiences are considered to be crucial variables to the self-actualization process. A regular, year-long group counseling program was conducted with 85 randomly selected gifted secondary students in the Farmington, Connecticut Public Schools. A…

  12. Patient experience of source isolation: lessons for clinical practice.

    PubMed

    Barratt, Ruth Linda; Shaban, Ramon; Moyle, Wendy

    2011-10-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is now the leading antimicrobial-resistant organism of concern to clinicians worldwide. Preventing and controlling the increase and spread of MRSA within the health-care environment is therefore an important function of the infection control team. The prevention and control of MRSA requires strict use of both Standard and Additional Precautions, which include good hand hygiene practices, judicious antimicrobial prescribing, and source isolation. While few would dispute the need for these precautions for preventing the spread of MRSA and other infections, their use may result in adverse physical and psychological effects for the patient. In an age of quality and safety of health care, ensuring infection control practice such as source isolation and contact precautions adhere to fundamental human rights is paramount. This paper presents a review of the literature on the patient experience of source isolation for MRSA or other infectious diseases. The review yielded five major interconnected themes: (1) psychological effects of isolation; (2) coping with isolation; (3) social isolation; (4) communication and information provision; and (5) physical environment and quality of care. It found that the experience of isolation by patients has both negative and positive elements. Isolation may result in detrimental psychological effects including anxiety, stress and depression, but may also result in the patient receiving less or substandard care. However, patients may also benefit from the quietness and privacy of single rooms. Nurses and other healthcare workers must look for ways to improve the experience of isolation and contact precautions of patients in source isolation. Opportunities exist in particular in improving the environment and the patient's self-control of the situation and in providing adequate information.

  13. Early Clinical Experience With Argon Ion Laser Endarterectomy

    NASA Astrophysics Data System (ADS)

    Eugene, John; Baribeau, Yvon; Ott, Richard A.; McColgan, Stephen J.; Berns, Michael W.

    1989-09-01

    This report describes our progress in the development of argon ion laser endarterectomy for arteriosclerotic cardiovascular disease. Nine patients underwent 10 vascular reconstructions for claudication (6), rest pain (1), and gangrene (2). There was 1 aortoiliac endarterectomy, 6 superficial femoral artery endarterectomies, 1 profunda femoris endarterectomy and 2 popliteal endarterectomies. The reconstructions were 6 cm to 60 cm in length. The operations were performed using low power argon ion laser radiation, 1.0 W. All patients experienced symptomatic relief and had palpable pulses postoperatively. There were no perforations and there were no injuries to surrounding tissues from laser radiation. Surgical complications occurred and these were technical problems that should be eliminated from the operation with further developments. The early clinical results show that laser endarterectomy can be performed for peripheral vascular reconstruction using low power argon ion laser radiation.

  14. Clinical experiences with Creutzfeldt-Jakob disease: three case studies.

    PubMed

    Szucs, Anna; Várallyay, Péter; Osztie, Eva; Papp, Erzsébet; Sólyom, András; Finta, Lehel; Varga, Dániel; Barcs, Gábor; Holló, András; Kamondi, Anita

    2012-11-30

    The clinical picture, electroencephalographic, imaging and cerebrospinal fluid parameters as well as the molecular background of Creutzfeldt-Jakob disease have been well explored. The diagnostic criteria, offering clinicians a fair chance to identify these patients in vivo, have recently been updated. However, the diagnosis is still a challenge in everyday neurological routine. We report on three of our Creutzfeldt-Jakob patients for calling attention to the classical and the recently defined features of the disease. We conclude that based on the rapidly progressing neuropsychiatric syndrome Creutzfeldt-Jakob disease may be suspected; follow-up EEG may reveal the typical (pseudo)-periodic pattern with progressive deterioration of the background activity. In addition, diffusion-weighted brain MRI imaging (DWI) has high diagnostic value. Detection of 14-3-3 protein in the cerebrospinal fluid supports the in vivo diagnosis.

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

    PubMed Central

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

    1976-01-01

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

  16. [Clinical experiences with a gestodene containing oral contraceptive (femoden)].

    PubMed

    Gimes, G; Valent, S

    1998-09-01

    In order to reduce the side-effects (blood-lipid alterations, androgen effects etc.) new gestogens were introduced, while the ethinyl-estradiol component of the pill was unchanged. Authors report about clinical trial on monophasic oral contraceptive containing 0.030 mg ethinyl-estradiol and 0.075 mg gestodene. In a follow up of 92 women, in 1740 cycles no pregnancy and no cardivascular or thromboembolic complication was observed. The frequency of bleeding disorders was below 10% already in the first cycle. The quantity of withdrawal bleeding, as well the frequency of breakthrough bleeding and spotting decreased during the treatment. Significant alteration in body weight or blood pressure did not occur. Femoden containing third generation gestogen has an excellent cycle control and good patient compliance.

  17. [Experience in thyroglossal duct pathology: clinical case series].

    PubMed

    Cieri, Patricio; Udaquiola, Julia E; Calello, Santiago E; Libero, Daniel H

    2016-10-01

    The thyroglossal duct cyst pathology represents the second cause of bening cervical anomalies in childhood. Diagnosis is mainly clinical. Sistrunk (1920) proposed a surgical technique that is still considered the gold standard for definitive treatment of this condition. A retrospective study was made including patients who underwent surgery for thyroglossal duct cyst pathology in our department between June 2008 and August 2015. In this period, we performed 54 procedures in 45 patients (39 primary cases). Median age was 4.7 years; 14/39 patients (31.1%) had pre-operative infection. All patients were studied with neck ultrasound. A Sistrunk's procedure was performed in all cases. The global recurrence rate was 17.8% (8/45).

  18. What do medical students learn from early clinical experiences (ECE)?

    PubMed

    Lie, Désirée; Boker, John; Gutierrez, David; Prislin, Michael

    2006-08-01

    What are the common learning themes perceived by medical students during ECE with varying practice settings and patient profiles? Retrospective qualitative and quantitative analyses of structured descriptive reports completed by one class (n = 92) for 895 observed patient encounters identified common learning themes. Identified themes were examined by practice setting and patient characteristics. Student response rates were 85 to 94% across settings. Fifty-five percent of ECE were in outpatient settings. Chief complaints were predominantly medical (67%); only 20% represented psychosocial and 8% preventive care, respectively (5% were ambiguous). The five most common learning themes (out of 13 themes coded) were communication (>50%), procedures/time management, cross-cultural issues, feeling useful as a student, and presenting medical problems. Cross-cultural issues were addressed mainly in community settings. Negative learning occurred only rarely (<3%). Student observations from ECE can be used by course managers to design effective early clinical exposures to address specific course learning objectives.

  19. Clinical experience with aurora kinase inhibitors: a review.

    PubMed

    Boss, David S; Beijnen, Jos H; Schellens, Jan H M

    2009-08-01

    The aurora kinase family of serine/threonine kinases comprises three members, designated auroras A, B, and C. Auroras A and B are essential components of the mitotic pathway, ensuring proper chromosome assembly, formation of the mitotic spindle, and cytokinesis. The role of aurora C is less clear. Overexpression of aurora A and B has been observed in several tumor types, and has been linked with a poor prognosis of cancer patients. Several small molecules targeting aurora kinases A and B or both have been evaluated preclinically and in early phase I trials. In this review we aim to summarize the most recent advances in the development of aurora kinase inhibitors, with a focus on the clinical data.

  20. Complications of Zygomatic Implants: Our Clinical Experience with 4 Cases

    PubMed Central

    Tzerbos, Fotios; Theologie-Lygidakis, Nadia; Fakitsas, Dimitrios; Fakitsas, Ioannis

    2016-01-01

    Zygomatic implants have been used for rehabilitation of the edentulous atrophic maxilla as an alternative to bone grafting for almost two decades resulting in satisfactory clinical outcomes. However, the patients with edentulous atrophic maxilla treated using this technique may present serious complications that could put the prosthetic restoration at risk. Four cases are reported in this paper, one case with a cutaneous fistula in the left zygomatic-orbital area caused by aseptic necrosis at the apical part of the implant, which was treated with the surgical removal of this part, a second case with loss of the right zygomatic implant due to failure of osseointegration and two cases of periimplantitis that resulted in partial and complete removal of the implant, respectively. All patients who had complications were treated without compromising the restoration which remained functional after appropriately modified treatment. PMID:27847399

  1. Japanese experience with clinical trials of fast neutrons

    SciTech Connect

    Tsunemoto, H.; Arai, T.; Morita, S.; Ishikawa, T.; Aoki, Y.; Takada, N.; Kamata, S.

    1982-12-01

    Between November, 1975 and November, 1981, 825 patients were treated with 30 MeV (d-Be) neutrons at the National Institute of Radiological Sciences, Chiba. At the Institute of Medical Science, Tokyo, 302 patients were referred to the Radiation Therapy department and were treated with 16 MeV (d-Be) neutrons. The emphasis of these clinical trials with fast neutrons was placed on the estimation of the effect of fast neutrons for locally advanced cancers or radioresistant cancers, and on evaluation of the rate of complication of normal tissues following irradiation with fast neutrons. Results were evaluated for patients with previously untreated cancer; local control of the tumor was observed in 59.1%. Complications requiring medical care developed in only 32 patients. Late reaction of soft tissue seemed to be more severe than that observed with photon beams. The results also suggest that for carcinoma of the larynx, esophagus, uterine cervix, Pancoast's tumor of the lung and osteosarcoma, fast neutrons were considered to be effectively applied in this randomized clinical trial. For carcinoma of the larynx, a fast neutron boost was effectively delivered, although an interstitial implant was necessarily combined with fast neutrons for carcinoma of the tongue. The cumulative survival rate of the patients with carcinoma of the esophagus treated with fast neutrons of 26% compared to the survival rate of 10.5% obtained using photons. The results also indicate that local control and relief of the symptom related to Pancoast's tumor of the lung seemed to be better with neutrons than with photons. For patients suffering from osteosarcoma, the surgical procedures preserving the function of the leg and arm were studied according to the better local control rate of the tumor following fast neutron beam therapy.

  2. Clinical manifestations and outcomes of pulmonary aspergillosis: experience from Pakistan

    PubMed Central

    Iqbal, Nousheen; Irfan, Muhammad; Zubairi, Ali Bin Sarwar; Jabeen, Kauser; Awan, Safia; Khan, Javaid A

    2016-01-01

    Introduction Pulmonary aspergillosis has variable course of illness, severity and outcomes depending on underlying conditions. There is limited data available on the clinical manifestations and outcome of pulmonary aspergillosis from Pakistan. Methods To determine the clinical manifestations and outcome of pulmonary aspergillosis in a tertiary care hospital a retrospective study was conducted from 2004 to 2014 in patients admitted with pulmonary aspergillosis at the Aga Khan University Hospital Karachi, Pakistan. Results Of the 280 cases with provisional diagnosis of aspergillosis 69 met the inclusion criteria. The mean age was 45±15.7 years, 48 (69.6%) were men and 21 (30.4%) had diabetes mellitus (DM). The average length of hospital stay (LOS) was 10.61±9.08 days. Aspergillus fumigatus was the most common (42.0%), followed by Aspergillus flavus (28.9%). More than one-third of patients previously had tuberculosis (TB) (39.13%). The commonest pulmonary manifestation was chronic pulmonary aspergillosis (CPA) 47 (68.1%) followed by invasive pulmonary aspergillosis (IPA) 12 (17.4%) and subacute invasive aspergillosis (SAIA) 8 (11.6%). Surgical excision was performed in 28 patients (40.57%). Intensive care unit admission was required for 18 patients (26.08%). Case fatality rate was 14/69 (20.3%). DM, mean LOS and hypoxic respiratory failure were identified as independent risk factors of mortality on multivariate analysis. Conclusion A. fumigatus was the most frequent species found especially in patients with prior TB. CPA was the commonest pulmonary manifestation seen as post TB sequel. Diabetes, hypoxic respiratory failure and increased LOS were independent predictors of poor outcomes. Overall patients had good outcome with CPA compared with SAIA and IPA. PMID:28074136

  3. Japanese experience with clinical trails of fast neutrons

    SciTech Connect

    Tsunemoto, H.; Arai, T.; Morita, S.; Ishikawa, T.; Aoki, Y.; Takada, N.; Kamata, S.

    1982-12-01

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

  4. Clinical experience with a computerized record and verify system.

    PubMed

    Podmaniczky, K C; Mohan, R; Kutcher, G J; Kestler, C; Vikram, B

    1985-08-01

    To improve the quality of patient care by detecting and preventing many types of treatment mistakes, we have implemented a computerized system for recording and verifying external beam radiation treatments on our therapy machines. It inhibits the radiation beam if treatment machine settings do not agree with prescribed values to within maximum permissible deviations (tolerances). The tolerances are determined from experience and adjusted when necessary to make the system more effective and less susceptible to "false alarms." The system uses a common data base for all treatment machines. As a result, it permits statistical analysis and generation of reports based on data encompassing the entire patient population as well as verification of treatments of patients transferred from one machine to another. Reports of verification failures reveal patterns of mistakes. Knowing these, attempts can be made to reduce the frequency of verification failures. "Significant" mistakes that were prevented are extracted by treatment planning personnel from these reports. Analysis of data indicates a rate of approximately 150 "significant" mistakes detected and prevented per machine per year, representing 1.0% of all fields treated. We present and discuss our experiences with the system and with the frequency, patterns, and significance of verification failures. We selected a few of the patients for whose treatments significant set-up mistakes were made, and were detected and prevented by the Record and Verify System. We include discussions of the overall effect these mistakes would have had on dose distribution had they not been prevented.

  5. 42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... center. (3) A pancreas transplant center is not required to comply with the clinical experience... pancreas transplants performed at the center. (4) A center that is requesting initial Medicare approval...

  6. 42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... center. (3) A pancreas transplant center is not required to comply with the clinical experience... pancreas transplants performed at the center. (4) A center that is requesting initial Medicare approval...

  7. “The invisible”: Participant's experiences in clinical trials

    PubMed Central

    Nadimpally, Sarojini; Bhagianadh, Divya

    2017-01-01

    Background: The paper discussing the perspectives of clinical trial participants about the various aspects of CTs is based on the primary research conducted by Sama in 2012-13. Methodology: In-depth interviews were conducted with 36 CT participants from the states of New Delhi, Gujarat, Maharashtra and Andhra Pradesh. In addition to CT participants, other key informants including investigators, representatives of Contract Research Organizations (CROs), sponsor, Ethics Committee (EC) members etc. were also interviewed to develop a comprehensive understanding of the functioning of the CT sector. Findings and Discussion: The paper describes the perspectives of participants on the relevant aspects of recruitment into CTs, reasons for participation in CTs, informed consent, adverse events and compensation. The role played by the push and pull factors in recruitment, the information asymmetry, the power imbalance between the health-care provider and seeker, the role of sociocultural factors, etc., are explored in the paper. Combined with the insights from other stakeholders, the study gives an understanding about the chasm between regulations and realities in the Indian CT sector. Further, the paper briefly explores the recent changes and amendments in the laws governing the CT sector that is aimed at improving the conduct of CTs and uphold the rights of participants. Conclusion: Participants are the most important stakeholders in a CT setting. It is imperative that their voices are heard and their rights upheld for the ethical conduct of CTs. PMID:28194331

  8. Paradoxical vocal cord dysfunction: clinical experience and personal considerations.

    PubMed

    Nacci, A; Fattori, B; Ursino, F; Rocchi, V; Matteucci, F; Citi, C; Bruschini, L; Rognini, F; La Vela, R; Dallan, I

    2007-10-01

    Paradoxical vocal cord dysfunction is a nosographic entity that remains to be fully elucidated as far as concerns criteria required for diagnosis and underlying aetiopathogenesis. The disorder manifests with repeated episodes of acute dyspnoea associated with a series of symptoms that may include hoarseness, globus, chest pain and "shortness of breath". A retrospective analysis of cases with acute dyspnoea referred to our Department between June 2004 and June 2005 revealed 3 patients with paradoxical vocal cord dysfunction. In 2 of these 3 cases, concomitant psychiatric morbidity was observed and the third also presented gastro-oesophageal reflux. In one patient, the episodes of dyspnoea were triggered by inspiration of irritating substances. Diagnosis of the condition requires a high level of suspicion, which is confirmed by a laryngoscopic investigation that demonstrates hyperadduction of the true vocal cords and a reduction of at least 50% in the breathing space. From a therapeutic point of view, patients with paradoxical vocal cord dysfunction require, in our opinion, a multidisciplinary approach; in fact, only a team comprising otorhinolaryngologists, phoniatricians, pulmonologists, neurologists, allergologists, psychotherapists and speech therapists is capable of defining the appropriate treatment according to the clinical and psychological characteristics of each individual patient. Our results with speech therapy, focused on respiratory and speech retraining, are reported.

  9. Clinical experience with Nikkiso centrifugal pumps for extracorporeal circulation.

    PubMed

    Onoda, K; Kondo, C; Mizumoto, T; Kusagawa, H; Katayama, Y; Hayashi, T; Komada, T; Hirano, R; Miyamura, T; Tanaka, J

    1994-09-01

    A comparative study of a newly developed impeller-type centrifugal pump, Nikkiso HMS-15, was made to assess the effects on hemolysis, platelet function, and renal function for extracorporeal circulation (ECC) during open heart surgery. The Bio-pump (cone-type, Medtronic) and the roller pump were used as controls. The increase of serum hemoglobin level in the Nikkiso pump was significantly lower than that in the other pumps. The decrease of platelet counts was recognized after the initiation of ECC in the three pumps whereas the levels of platelet factor 4 and beta-thromboglobulin in the Nikkiso pump group increased by far less than in the other two groups. Moreover, renal function was better maintained in the Nikkiso pump group; in particular, a significantly higher urine output was recorded during ECC and for 1 h after the termination of ECC. The results of our clinical studies suggest that the Nikkiso centrifugal pump is suitable for ECC during open heart surgery.

  10. Clinical experience of ketogenic diet on children with refractory epilepsy.

    PubMed

    Mak, S C; Chi, C S; Wan, C J

    1999-01-01

    Thirteen children with refractory epilepsy received a ketogenic diet (medium chain triglyceride oil diet) as an alternative therapy since September 1997. Their seizure patterns included (1) generalized tonic-clonic seizures, (2) myoclonic seizures, (3) generalized tonic + atonic seizures, (4) complex partial seizures, (5) generalized clonic + atonic + myoclonic seizures, (6) head nodding + myoclonic + gelastic seizures, and (7) generalized tonic-clonic + myoclonic + atonic seizures. Major concerns emphasized on the efficacy and side effects of the diet. Clinical observation one month after the diet revealed that 53.8% of the patients had a > 75% reduction in seizure frequency and 76.9% of the patients had a > 50% reduction in seizure frequency. Six patients had some degrees of improvement in cognitive function and/ or school performances. The most common side effects were body weight loss (n = 6) and diarrhea (n = 5). Others included bad temper (n = 1), abdominal cramps (n = 2), nausea (n = 2), bad body smell (n = 1), and renal stones (n = 1). Even after discontinuation of the diet, 61.5% of patients still had a > 50% reduction in seizure frequency. We concluded that the ketogenic diet deserves a trial in children with refractory epilepsy.

  11. Defecography by digital radiography: experience in clinical practice*

    PubMed Central

    Gonçalves, Amanda Nogueira de Sá; Sala, Marco Aurélio Sousa; Bruno, Rodrigo Ciotola; Xavier, José Alberto Cunha; Indiani, João Mauricio Canavezi; Martin, Marcelo Fontalvo; Bruno, Paulo Maurício Chagas; Nacif, Marcelo Souto

    2016-01-01

    Objective The objective of this study was to profile patients who undergo defecography, by age and gender, as well as to describe the main imaging and diagnostic findings in this population. Materials and Methods This was a retrospective, descriptive study of 39 patients, conducted between January 2012 and February 2014. The patients were evaluated in terms of age, gender, and diagnosis. They were stratified by age, and continuous variables are expressed as mean ± standard deviation. All possible quantitative defecography variables were evaluated, including rectal evacuation, perineal descent, and measures of the anal canal. Results The majority (95%) of the patients were female. Patient ages ranged from 18 to 82 years (mean age, 52 ± 13 years): 10 patients were under 40 years of age; 18 were between 40 and 60 years of age; and 11 were over 60 years of age. All 39 of the patients evaluated had abnormal radiological findings. The most prevalent diagnoses were rectocele (in 77%) and enterocele (in 38%). Less prevalent diagnoses were vaginal prolapse, uterine prolapse, and Meckel's diverticulum (in 2%, for all). Conclusion Although defecography is performed more often in women, both genders can benefit from the test. Defecography can be performed in order to detect complex disorders such as uterine and rectal prolapse, as well as to detect basic clinical conditions such as rectocele or enterocele. PMID:28100932

  12. Autoimmune Hemolytic Anemia in Children: Mayo Clinic Experience.

    PubMed

    Sankaran, Janani; Rodriguez, Vilmarie; Jacob, Eapen K; Kreuter, Justin D; Go, Ronald S

    2016-04-01

    We studied 35 pediatric patients with autoimmune hemolytic anemia seen at Mayo Clinic from 1994 to 2014. The median age was 10.0 years and 65.7% were males. Most had warm antibodies (80.0%) and some secondary to viral (14.3%) or autoimmune disorders (31.4%). Seven (20.0%) patients presented with Evans syndrome, 3 of whom also had common variable immunodeficiency. The median hemoglobin at diagnosis was 6.1 g/dL and 62.8% patients required red cell transfusions. The severity of anemia was worse among children below 10 years (median 5.5 vs. 7.0 g/dL, P=0.01). Steroid was the initial treatment for 88.5% patients, with overall response rate of 82.7% (68.5% complete, 14.2% partial) and median response duration of 10.7 months (range, 0.2 to 129.7+ mo). After median follow-up of 26.6 months, 8 (22.8%) patients relapsed. Salvage treatments included splenectomy, intravenous immunoglobulin, rituximab, and mycophenolate mofetil. Infectious complications occurred in 9 (25.7%) patients and 1 patient died of cytomegalovirus infection. Four patients had cold agglutinin disease and 3 (75.0%) responded to steroids. Autoimmune hemolytic anemia is a rare disorder in pediatric population and most respond well to steroids regardless of the type of antibody. Infectious complications are common and screening for immunodeficiency is recommended among those with Evans syndrome.

  13. Abdominal Tuberculosis with an Acute Abdomen: Our Clinical Experience

    PubMed Central

    Dey, Ramprasad; Bhattacharya, Ujjwal

    2014-01-01

    Introduction: Tuberculosis is an important cause of morbidity in India. Abdominal Tuberculosis is a great mimicker and is difficult to diagnose. This prospective observational study is based on those patients who were diagnosed to be suffering from Abdominal Tuberculosis only after they presented with an acute abdomen. This study aims to document the nature of different types of acute presentation in Abdominal Tuberculosis according to involved sites and surgical pathology. The study also discusses the indications and extent of surgical intervention. Materials and Methods: Seventy new cases of Abdominal Tuberculosis (out of 718 cases of acute abdomen) were diagnosed and treated over a period of three years in the surgical ward of Calcutta National Medical College. Macroscopic appearance of abdominal tissues during surgery suggested the diagnosis of tuberculosis. The diagnosis was confirmed by histopathology and tissue culture. All patients were subsequently treated with a full course of antitubercular drugs (ATD). Results: The clinical presentations of acute abdomen included acute intestinal obstruction, perforative peritonitis and acute appendicitis etc. Terminal ileum and ileocaecal region were predominantly involved. The most common pathology was intestinal stricture with or without perforation. Most of the patients (approx 78.5%) required emergency surgery as a therapeutic intervention. A two-stage procedure was preferred in peritonitis and sepsis. Most of the remaining patients (12.8%) required surgery after initial conservative treatment for the first few days. Undiagnosed Abdominal Tuberculosis represents a notable percentage (10%) of patients who present with an acute abdomen as a surgical emergency. Conclusion: Abdominal Tuberculosis is very difficult to diagnose and diagnosis is often delayed till an acute abdomen is presented with. Almost all patients needed surgical intervention. Irrespective of surgery, all patients of abdominal tuberculosis require a

  14. Adult Intussusception: Clinical Experience from a Single Center.

    PubMed

    Ozogul, Bunyami; Kisaoglu, Abdullah; Ozturk, Gurkan; Atamanalp, Sabri Selcuk; Yıldırgan, Mehmet İlhan; Aköz, Ayhan; Aydinli, Bulent

    2015-12-01

    Though frequently observed in children, intussusception is a rare state in adults. The treatment of intussusception in adults is different. In this trial, we have presented intussusception cases in adults that were treated and followed up in our department. The records of 31 adult intussusception cases surgically treated in our department between January 1993 and July 2012 were evaluated retrospectively. Among the 31 adult cases of intussusception that were treated during a period of 19 years, 10 were men, and 21 were women. The mean age was determined as 39.7 ± 5.3. The presentation symptom was abdominal pain in all the patients. Failure to pass gas or feces was observed in 23 patients (74.2 %); nausea and vomiting, in 22 patients (70.9 %); hematochezia, in 16 patients (51.6 %); and weight loss, in 3 patients (9.6 %). The mean duration of symptoms was 4.8 days. Abdominal tenderness was found in all the patients. Muscular defense and rebound tenderness were determined in 13 patients (41.9 %). Findings of intussusception were found in 80.9 % of patients examined by abdominal ultrasonography and in 63.1 % of cases examined by computerized tomography. Resection of the intussuscepted bowel segment was performed in 87 % of the patients. In conclusion, intussusception in adults is a rare clinical entity. Intussusception should be considered in the differential diagnosis in patients presenting with spasmodic abdominal pain, especially in cases with intestinal obstruction. The recommended surgical method is en bloc resection of the intussuscepted segment in cases suspected to carry a risk of malignancy.

  15. Clinical experience with ceramics in total hip replacement.

    PubMed

    Oonishi, H; Wakitani, S; Murata, N; Saito, M; Imoto, K; Kim, S; Matsuura, M

    2000-10-01

    As part of a search for better articulation in total hip prostheses, the decrease in the thickness of the socket in different total hip prostheses was measured in vivo. The wear rates of (1) RCH 1000 (molecular weight, 10(6)) socket gamma-irradiated with 100 Mrad articulating with a crude COP (stainless steel containing 20% cobalt and 0.01% phosphorous) metal femoral head; (2) RCH 1000 socket nonirradiated articulating with a crude COP femoral head; (3) RCH 1000 socket irradiated with 100 Mrad articulating with an alumina femoral head; (4) ultra high molecular weight polyethylene (molecular weight, 5-6 x 10(6)) socket articulating with an alumina femoral head; and (5) ultrahigh molecular weight polyethylene socket articulating with a stainless steel femoral head (T-28) were 0.06, 0.30, 0.06, 0.1 and 0.25 mm/year, respectively, in the authors' clinical cases. Alumina femoral heads were effective in decreasing wear of the polyethylene socket. However, the wear rates of gamma-irradiated sockets articulating with alumina and with metal femoral heads wear very low and were not different from each other. Regarding the relationship between wear rate and the thickness of the ultra high molecular weight polyethylene socket articulating with a 28 mm alumina femoral head, on radiographs, average wear rates of socket thicknesses of 7, 8, 9, 10 and 11 mm were 0.14, 0.15, 0.12, 0.06, and 0.08 mm/year, respectively. On measuring retrieved prostheses, average wear rates of 7, 8, 9 and 11 mm thickness sockets were 0.2, 0.19, 0.14, and 0.1 mm/year, respectively. The wear of sockets has been proven to be minimal in alumina femoral heads articulating with ultrahigh molecular weight polyethylene sockets thicker than 10 mm.

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

    SciTech Connect

    Koyfman, Shlomo A.; Tendulkar, Rahul D.; Chao, Samuel T.

    2010-10-01

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

  17. Clinical experience with ultrasound guided angioplasty for vascular access

    PubMed Central

    Cho, Seong; Lee, Yu-Ji; Kim, Sung-Rok

    2017-01-01

    Background The use of ultrasound guided percutaneous transluminal angioplasty (UG-PTA), which use ultrasound as an imaging modality, is an evolving strategy. But, in Korea, this method is rarely used. We report our experiences with UG-PTA with respect to technical success rates and complication rates compared to conventional PTA (C-PTA), performed between 2010 and 2015 at Samsung Changwon Hospital, Korea. Methods In our series, 53 cases of UG-PTA and 90 cases of C-PTA were reviewed, respectively. Cases of central vein stenosis, cephalic arch stenosis, arterial stenosis and thrombosis were excluded. However, cases of juxta-anastomotic stenosis and outflow vein stenosis were included. Results Technical success was achieved in 96.2% (51 of 53) of cases in the UG-PTA group and in 93.3% (84 of 90) of cases in the C-PTA group, respectively (P = 0.710). Technical failure was experienced in a total 8 cases (UG-PTA group: 2/53, 3.8%; C-PTA group: 6/90, 6.7%). No differences were observed in complications. Conclusion Duplex ultrasound-guided angioplasty for dialysis access in the outpatient setting is feasible, safe, and effective for peripheral venous stenotic lesions. It offers many advantages over conventional angiographic procedures, and, in the future, it has great potential to play a significant role in the management of these challenging patients. PMID:28393000

  18. Experiences with array-based sequence capture; toward clinical applications

    PubMed Central

    Almomani, Rowida; van der Heijden, Jaap; Ariyurek, Yavuz; Lai, Yuching; Bakker, Egbert; van Galen, Michiel; Breuning, Martijn H; den Dunnen, Johan T

    2011-01-01

    Although sequencing of a human genome gradually becomes an option, zooming in on the region of interest remains attractive and cost saving. We performed array-based sequence capture using 385K Roche NimbleGen, Inc. arrays to zoom in on the protein-coding and immediate intron-flanking sequences of 112 genes, potentially involved in mental retardation and congenital malformation. Captured material was sequenced using Illumina technology. A data analysis pipeline was built that detects sequence variants, positions them in relation to the gene, checks for presence in databases (eg, db single-nucleotide polymorphism (SNP)) and predicts the potential consequences at the level of RNA splicing and protein translation. In the samples analyzed, all known variants were reliably detected, including pathogenic variants from control cases and SNPs derived from array experiments. Although overall coverage varied considerably, it was reproducible per region and facilitated the detection of large deletions and duplications (copy number variations), including a partial deletion in the B3GALTL gene from a patient sample. For ultimate diagnostic application, overall results need to be improved. Future arrays should contain probes from both DNA strands, and to obtain a more even coverage, one could add fewer probes from densely and more probes from sparsely covered regions. PMID:21102627

  19. Clinical review: The Israeli experience: conventional terrorism and critical care

    PubMed Central

    Aschkenasy-Steuer, Gabriella; Shamir, Micha; Rivkind, Avraham; Mosheiff, Rami; Shushan, Yigal; Rosenthal, Guy; Mintz, Yoav; Weissman, Charles; Sprung, Charles L; Weiss, Yoram G

    2005-01-01

    Over the past four years there have been 93 multiple-casualty terrorist attacks in Israel, 33 of them in Jerusalem. The Hadassah-Hebrew University Medical Center is the only Level I trauma center in Jerusalem and has therefore gained important experience in caring for critically injured patients. To do so we have developed a highly flexible operational system for managing the general intensive care unit (GICU). The focus of this review will be on the organizational steps needed to provide operational flexibility, emphasizing the importance of forward deployment of intensive care unit personnel to the trauma bay and emergency room and the existence of a chain of command to limit chaos. A retrospective review of the hospital's response to multiple-casualty terror incidents occurring between 1 October 2000 and 1 September 2004 was performed. Information was assembled from the medical center's trauma registry and from GICU patient admission and discharge records. Patients are described with regard to the severity and type of injury. The organizational work within intensive care is described. Finally, specific issues related to the diagnosis and management of lung, brain, orthopedic and abdominal injuries, caused by bomb blast events associated with shrapnel, are described. This review emphasizes the importance of a multidisciplinary team approach in caring for these patients. PMID:16277738

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

    PubMed

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

    1998-03-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Gordon, Michael; Russo, Kate

    2009-01-01

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

  4. Role of Clinical Education Experiences on Athletic Training Students' Development of Professional Commitment

    ERIC Educational Resources Information Center

    Mazerolle, Stephanie M.; Dodge, Thomas

    2015-01-01

    Context: Limited evidence exists on the role clinical education can play in the development of athletic training student commitment for the profession. Objective: Investigating the role clinical education experiences play on the development of passion for athletic training. Design: Exploratory qualitative study. Setting: Athletic training…

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

    ERIC Educational Resources Information Center

    Nelson, Lori A.

    2011-01-01

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

  6. The Impact of Clinical Experiences from Athletic Training Student and Preceptor Perspectives

    ERIC Educational Resources Information Center

    Benes, Sarah S.; Mazerolle, Stephanie M.; Bowman, Thomas G.

    2014-01-01

    Context: Clinical education is an integral part of athletic training programs. This is where students should develop their professional identities and become socialized into the profession. Understanding the student and preceptor perspectives of the impact that clinical experiences have on students can provide valuable insight into this aspect of…

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Neill, Jane; Taylor, Kerry

    2002-01-01

    Two urban Australian nursing students' stories of their experiences in clinical placements in rural and Aboriginal communities indicate their interest in and enthusiasm for returning to rural nursing after graduation. Unfortunately, many urban students are disadvantaged financially by the added expense of their rural clinical rotation. Assisting…

  9. [Application of portfolio in teaching dermatology clinic: an experience in teaching of medicine].

    PubMed

    de Cabalier, M E; Chalub, D M

    2009-01-01

    We present a learning experience conducted in the Chair of Dermatology Clinic of the Faculty of Medical Sciences, National University of Cordoba in the context of curriculum change. For comprehension,present a theoretical framework and practical from the conceptualization of the "portfolio" teaching and its role teaching and learning paradigms sustained constructivist medical education. The portfolio Teach-ing is not a collection of papers, but a coherent set of experiences led thoughtful learning between teachers and students. This resource allows to account for the "qualitative achievements" of students from their work produced, sorted and evaluated in a carefully planned sequence of experiences and case Dermatology Clinic. To introduce the teaching portfolio, the planned new student grouping shapes and a sequence of learning experiences for the construction of this resource, namely: "The development of theoretical material iconographic resources and working guidelines for students. "The clinical reasoning on a case or laboratory experience-Clinical case Discussion and bibliography. -The development of records to from observation of patients. "The study of clinical cases: diagnosis and evolution of clinical cases. Interconsultations-Registration and referrals. "The magazine room and sharing experiences. In each of these, production, tutorial feedback Team teaching and assessment tasks allowed assessment approach to learning and improving he achievements of the students to the approval of the subject.

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

    PubMed Central

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

    2014-01-01

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

  11. Self-Actualization Effects Of A Marathon Growth Group

    ERIC Educational Resources Information Center

    Jones, Dorothy S.; Medvene, Arnold M.

    1975-01-01

    This study examined the effects of a marathon group experience on university student's level of self-actualization two days and six weeks after the experience. Gains in self-actualization as a result of marathon group participation depended upon an individual's level of ego strength upon entering the group. (Author)

  12. Dosimetric evaluation of whole-breast radiation therapy: Clinical experience

    SciTech Connect

    Osei, Ernest; Darko, Johnson; Fleck, Andre; White, Jana; Kiciak, Alexander; Redekop, Rachel; Gopaul, Darin

    2015-01-01

    Radiation therapy of the intact breast is the standard therapy for preventing local recurrence of early-stage breast cancer following breast conservation surgery. To improve patient standard of care, there is a need to define a consistent and transparent treatment path for all patients that reduces significance variations in the acceptability of treatment plans. There is lack of consistency among institutions or individuals about what is considered an acceptable treatment plan: target coverage vis-à-vis dose to organs at risk (OAR). Clinical trials usually resolve these issues, as the criteria for an acceptable plan within the trial (target coverage and doses to OAR) are well defined. We developed an institutional criterion for accepting breast treatment plans in 2006 after analyzing treatment data of approximately 200 patients. The purpose of this article is to report on the dosimetric review of 623 patients treated in the last 18 months to evaluate the effectiveness of the previously developed plan acceptability criteria and any possible changes necessary to further improve patient care. The mean patient age is 61.6 years (range: 25.2 to 93.0 years). The mean breast separation for all the patients is 21.0 cm (range: 12.4 to 34.9 cm), and the mean planning target volume (PTV-eval) (breast volume for evaluation) is 884.0 cm{sup 3} (range: 73.6 to 3684.6 cm{sup 3}). Overall, 314 (50.4%) patients had the disease in the left breast and 309 (49.6%) had it in the right breast. A total of 147 (23.6%) patients were treated using the deep inspiration breath-hold (DIBH) technique. The mean normalized PTV-eval receiving at least 92% (V{sub 92%} {sub PD}) and 95% (V{sub 95%} {sub PD}) of the prescribed dose (PD) are more than 99% and 97%, respectively, for all patients. The mean normalized PTV-eval receiving at least 105% (V{sub 105%} {sub PD}) of the PD is less than 1% for all groups. The mean homogeneity index (HI), uniformity index (UI), and conformity index (CI) for the

  13. The Lived Experience and Training Needs of Librarians Serving at the Clinical Point-of-Care.

    PubMed

    Lyon, Jennifer A; Kuntz, Gretchen M; Edwards, Mary E; Butson, Linda C; Auten, Beth

    2015-01-01

    This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n = 21), interviews (n = 2), and an online survey (n = 167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly affective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians' perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics.

  14. The Lived Experience and Training Needs of Librarians Serving at the Clinical Point-of-Care

    PubMed Central

    Kuntz, Gretchen M.; Edwards, Mary E.; Butson, Linda C.; Auten, Beth

    2016-01-01

    This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n=21), interviews (n=2), and an online survey (n=167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly effective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians’ perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics. PMID:26211792

  15. Experience of Adjunct Novice Clinical Nursing Faculty: An Interpretive Case Study

    ERIC Educational Resources Information Center

    Mann, Carol

    2013-01-01

    The purpose of this qualitative interpretive case study was to describe the experience of adjunct novice clinical nursing faculty who has less than three years teaching experience or feels novice in this setting. The nursing shortage in the United States is well documented and is forecasted to have significant impacts on the health care delivery…

  16. A Mandala: A Diagram of the Clinical Education Experience in Athletic Training

    ERIC Educational Resources Information Center

    Cernohous, Steve; West, Sharon

    2007-01-01

    Objective: The objective of this paper is to present the practical use of a Mandala that: 1) provides opportunities for athletic training students to explore, reflect on and appreciate their clinical experiences; 2) provides educators with a model to understand and value athletic training student experiences; 3) organizes and captures factors and…

  17. What Students Really Learn: Contrasting Medical and Nursing Students' Experiences of the Clinical Learning Environment

    ERIC Educational Resources Information Center

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

    2015-01-01

    This paper explores and contrasts undergraduate medical and nursing students' experiences of the clinical learning environment. Using a sociocultural perspective of learning and an interpretative approach, 15 in-depth interviews with medical and nursing students were analysed with content analysis. Students' experiences are described using a…

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  19. [Zhu Lian's characteristics and experiences in clinical practice of acupuncture and moxibustion].

    PubMed

    Wei, Li fu; Pan, Xiaoria; Liu, Bing; Yue, Jin; Zhang, Lijian

    2015-01-01

    This paper aims at discussing the clinical characteristics and experiences of ZHU Lian, the renowned contemporary acupuncture master from the following three aspects: "characteristics of clinical manipulations and techniques", "thoughts on diagnosis and treatment" and "examples of clinical cases". The study has shown that ZHU Lian invented the slow insertion technique by rotating needle and the embedding needle technique, improved moxibustion technique with moxa roll and proposed the three keys on the treatment with acupuncture and moxibustion, as well as discovered new acupoints for treatment. The pioneering and distinguished achievements she con tributed play the great demonstrating and driving role in the development of clinical study and practice of acupuncture and moxibustion.

  20. Clinical Boot Camp: An Innovative Simulation Experience to Prepare Nursing Students for Obstetric and Pediatric Clinicals.

    PubMed

    Hogewood, Connie; Smith, Tedra; Etheridge, Sherita; Britt, Sylvia

    2015-01-01

    Obstetric and pediatric patients require unique specialized care not included in traditional adult health education. To prepare nursing students for clinical rotations beginning the second week of class, faculty developed an innovative one-day simulation seminar, the OB/PEDS Boot Camp, in which groups of students rotated through six stations of obstetric and pediatric simulation exercises. This article provides insight on the development and implementation of the OB/PEDS Boot Camp.

  1. CLINICAL EXPERIENCE AND IMPACT OF A COMMUNITY-LED VOLUNTEER ATMOSPHERIC HAZE CLINIC IN SINGAPORE.

    PubMed

    Yeo, Benson; Liew, Choon Fong; Oon, Hazel H

    2014-11-01

    The Pollutant Standards Index reached a life-threatening level of 401 in Singapore on 21 June 2013. Grassroot leaders in Ulu Pandan Constituency conducted the first community-led free atmospheric Haze Clinic from 25 June 2013 to 11 July 2013 to provide accessible medical assessment for affected community members. This provided insight into the common conditions afflicting that community during the haze period while allaying public anxiety. Seventy-two consultations were conducted over the 3 week period, of which 26 (36.1%) were haze related, 18 (25%) were possibly haze related and 28 (38.9%) were non-haze related. The majority of haze-related complaints were respiratory, eye and skin-related. During a haze crisis, such adhoc community-led clinics may help alleviate the surge in patients seen at emergency departments and public primary health clinics. Many of the patients seen were from low income families and a significant number (38.9%) sought help for non-haze related medical conditions.

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2015-08-01

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

  4. Use of Tablet Computers to Promote Physical Therapy Students' Engagement in Knowledge Translation During Clinical Experiences

    PubMed Central

    Loeb, Kathryn; Barbosa, Sabrina; Jiang, Fei; Lee, Karin T.

    2016-01-01

    Background and Purpose: Physical therapists strive to integrate research into daily practice. The tablet computer is a potentially transformational tool for accessing information within the clinical practice environment. The purpose of this study was to measure and describe patterns of tablet computer use among physical therapy students during clinical rotation experiences. Methods: Doctor of physical therapy students (n = 13 users) tracked their use of tablet computers (iPad), loaded with commercially available apps, during 16 clinical experiences (6-16 weeks in duration). Results: The tablets were used on 70% of 691 clinic days, averaging 1.3 uses per day. Information seeking represented 48% of uses; 33% of those were foreground searches for research articles and syntheses and 66% were for background medical information. Other common uses included patient education (19%), medical record documentation (13%), and professional communication (9%). The most frequently used app was Safari, the preloaded web browser (representing 281 [36.5%] incidents of use). Users accessed 56 total apps to support clinical practice. Discussion and Conclusions: Physical therapy students successfully integrated use of a tablet computer into their clinical experiences including regular activities of information seeking. Our findings suggest that the tablet computer represents a potentially transformational tool for promoting knowledge translation in the clinical practice environment. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A127). PMID:26945431

  5. Whiteheadian Actual Entitities and String Theory

    NASA Astrophysics Data System (ADS)

    Bracken, Joseph A.

    2012-06-01

    In the philosophy of Alfred North Whitehead, the ultimate units of reality are actual entities, momentary self-constituting subjects of experience which are too small to be sensibly perceived. Their combination into "societies" with a "common element of form" produces the organisms and inanimate things of ordinary sense experience. According to the proponents of string theory, tiny vibrating strings are the ultimate constituents of physical reality which in harmonious combination yield perceptible entities at the macroscopic level of physical reality. Given that the number of Whiteheadian actual entities and of individual strings within string theory are beyond reckoning at any given moment, could they be two ways to describe the same non-verifiable foundational reality? For example, if one could establish that the "superject" or objective pattern of self- constitution of an actual entity vibrates at a specific frequency, its affinity with the individual strings of string theory would be striking. Likewise, if one were to claim that the size and complexity of Whiteheadian 'societies" require different space-time parameters for the dynamic interrelationship of constituent actual entities, would that at least partially account for the assumption of 10 or even 26 instead of just 3 dimensions within string theory? The overall conclusion of this article is that, if a suitably revised understanding of Whiteheadian metaphysics were seen as compatible with the philosophical implications of string theory, their combination into a single world view would strengthen the plausibility of both schemes taken separately. Key words: actual entities, subject/superjects, vibrating strings, structured fields of activity, multi-dimensional physical reality.

  6. In utero Repair of Myelomeningocele: Rationale, Initial Clinical Experience and a Randomized Controlled Prospective Clinical Trial

    PubMed Central

    Danzer, Enrico; Flake, Alan W.

    2008-01-01

    Myelomeningocele (MMC), one of the most common congenital malformations, can result in severe lifelong disabilities, including paraplegia, hydrocephalus, Arnold-Chiari II malformation, incontinence, sexual dysfunction, skeletal deformations, and mental impairment. MMC was the first nonlethal anomaly to be treated by fetal surgery. Studies in animals provide compelling evidence that the primary cause of the neurological deficit associated with MMC is not simply incomplete neurulation but rather chronic mechanical injury and amniotic-fluid-induced chemical trauma that progressively damage the exposed neural tissue during gestation. Initial results suggest that the surgical repair of MMC before 25 weeks of gestation may preserve neurological function, reverse the hindbrain herniation of the Arnold-Chiari II malformation, and obviate the need for postnatal placement of a ventriculoperitoneal shunt. As it is currently unknown whether fetal surgery for MMC is truly beneficial compared to standard postnatal care, a randomized, controlled clinical trial has been initiated within the United States. PMID:22479081

  7. Incidence, clinical features and para-clinical findings of achalasia in Algeria: Experience of 25 years

    PubMed Central

    Tebaibia, Amar; Boudjella, Mohammed Amine; Boutarene, Djamel; Benmediouni, Farouk; Brahimi, Hakim; Oumnia, Nadia

    2016-01-01

    AIM To investigate the incidence of achalasia in Algeria and to determine its clinical and para-clinical profile. To evaluate the impact of continuing medical education (CME) on the incidence of this disease. METHODS From 1990 to 2014, 1256 patients with achalasia were enrolled in this prospective study. A campaign of CME on diagnosis involving different regions of the country was conducted between 1999 and 2003. Annual incidence and prevalence were calculated by relating the number of diagnosed cases to 105 inhabitants. Each patient completed a standardized questionnaire, and underwent upper endoscopy, barium swallow and esophageal manometry. We systematically looked for Allgrove syndrome and familial achalasia. RESULTS The mean annual incidence raised from 0.04 (95%CI: 0.028-0.052) during the 1990s to 0.27/105 inhabitants/year (95%CI: 0.215-0.321) during the 2000s. The incidence of the disease was two and half times higher in the north and the center compared to the south of the country. One-hundred-and-twenty-nine (10%) were children and 97 (7.7%) had Allgrove syndrome. Familial achalasia was noted in 18 different families. Patients had dysphagia (99%), regurgitation (83%), chest pain (51%), heartburn 24.5% and weight loss (70%). The lower esophageal sphincter was hypertensive in 53% and hypotensive in 0.6%. CONCLUSION The mean incidence of achalasia in Algeria is at least 0.27/105 inhabitants. A good impact on the incidence of CME was noted. A gradient of incidence between different regions of the country was found. This variability is probably related to genetic and environmental factors. The discovery of an infantile achalasia must lead to looking for Allgrove syndrome and similar cases in the family. PMID:27784974

  8. Predoctoral Dental Students' Perceptions of Dental Implant Training: Effect of Preclinical Simulation and Clinical Experience.

    PubMed

    Prasad, Soni; Bansal, Naveen

    2017-04-01

    The aims of this study were to assess 1) differences in perceptions of dental implant training between dental students who received didactic training alone (control group) and those who received didactic plus simulation training (test group); 2) differences in response between students with and without clinical experience in implant dentistry; and 3) the interaction effect of simulation training and clinical experience on students' satisfaction. A survey was distributed to the control group in 2014 and to the test group in 2015; both groups were at the same U.S. dental school. Data were collected on confidence levels with various implant restorative procedures along with overall satisfaction and number of implant restorations performed by each student. The response rate was 78.7% in the control group and 81.3% in the test group. In the control group, 85.7% of students reported being satisfied with implant training compared to 90.8% of students in the test group. The interaction effect of simulation training and clinical experience on overall student satisfaction was OR=1.5 at 95% CI: 0.8, 3.0. The students who had clinical experience with implant restorative procedures had significantly greater satisfaction than those who did not (OR=4.8, 95% CI: 2.1, 11.1, p<0.01). This study found that both the simulation and clinical experience affected these students' confidence and satisfaction levels with implant education: they were almost five times more satisfied with implant training when clinical experience in implant restorative procedures was a part of their implant education.

  9. Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences

    PubMed Central

    Pfeiffer, Yvonne; Taxis, Katja

    2016-01-01

    Background Double-checking is widely recommended as an essential method to prevent medication errors. However, prior research has shown that the concept of double-checking is not clearly defined, and that little is known about actual practice in oncology, for example, what kind of checking procedures are applied. Objective To study the practice of different double-checking procedures in chemotherapy administration and to explore nurses' experiences, for example, how often they actually find errors using a certain procedure. General evaluations regarding double-checking, for example, frequency of interruptions during and caused by a check, or what is regarded as its essential feature was assessed. Methods In a cross-sectional survey, qualified nurses working in oncology departments of 3 hospitals were asked to rate 5 different scenarios of double-checking procedures regarding dimensions such as frequency of use in practice and appropriateness to prevent medication errors; they were also asked general questions about double-checking. Results Overall, 274 nurses (70% response rate) participated in the survey. The procedure of jointly double-checking (read-read back) was most commonly used (69% of respondents) and rated as very appropriate to prevent medication errors. Jointly checking medication was seen as the essential characteristic of double-checking—more frequently than ‘carrying out checks independently’ (54% vs 24%). Most nurses (78%) found the frequency of double-checking in their department appropriate. Being interrupted in one's own current activity for supporting a double-check was reported to occur frequently. Regression analysis revealed a strong preference towards checks that are currently implemented at the responders' workplace. Conclusions Double-checking is well regarded by oncology nurses as a procedure to help prevent errors, with jointly checking being used most frequently. Our results show that the notion of independent checking needs to be

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

    PubMed Central

    Wańkowicz, Zofia

    2013-01-01

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

  11. The role of technological progress vs. accidental discoveries and clinical experience.

    PubMed

    Wańkowicz, Zofia

    2013-11-13

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

  12. A Decade of Experience in Creating and Maintaining Data Elements for Structured Clinical Documentation in EHRs.

    PubMed

    Zhou, Li; Collins, Sarah; Morgan, Stephen J; Zafar, Neelam; Gesner, Emily J; Fehrenbach, Martin; Rocha, Roberto A

    2016-01-01

    Structured clinical documentation is an important component of electronic health records (EHRs) and plays an important role in clinical care, administrative functions, and research activities. Clinical data elements serve as basic building blocks for composing the templates used for generating clinical documents (such as notes and forms). We present our experience in creating and maintaining data elements for three different EHRs (one home-grown and two commercial systems) across different clinical settings, using flowsheet data elements as examples in our case studies. We identified basic but important challenges (including naming convention, links to standard terminologies, and versioning and change management) and possible solutions to address them. We also discussed more complicated challenges regarding governance, documentation vs. structured data capture, pre-coordination vs. post-coordination, reference information models, as well as monitoring, communication and training.

  13. A Decade of Experience in Creating and Maintaining Data Elements for Structured Clinical Documentation in EHRs

    PubMed Central

    Zhou, Li; Collins, Sarah; Morgan, Stephen J.; Zafar, Neelam; Gesner, Emily J.; Fehrenbach, Martin; Rocha, Roberto A.

    2016-01-01

    Structured clinical documentation is an important component of electronic health records (EHRs) and plays an important role in clinical care, administrative functions, and research activities. Clinical data elements serve as basic building blocks for composing the templates used for generating clinical documents (such as notes and forms). We present our experience in creating and maintaining data elements for three different EHRs (one home-grown and two commercial systems) across different clinical settings, using flowsheet data elements as examples in our case studies. We identified basic but important challenges (including naming convention, links to standard terminologies, and versioning and change management) and possible solutions to address them. We also discussed more complicated challenges regarding governance, documentation vs. structured data capture, pre-coordination vs. post-coordination, reference information models, as well as monitoring, communication and training. PMID:28269927

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

    PubMed Central

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

    1998-01-01

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

  15. Use of the experience sampling method in the context of clinical trials

    PubMed Central

    Verhagen, Simone J W; Hasmi, Laila; Drukker, Marjan; van Os, J; Delespaul, Philippe A E G

    2016-01-01

    Objective The experience sampling method (ESM) is a structured diary technique to appraise subjective experiences in daily life. It is applied in psychiatric patients, as well as in patients with somatic illness. Despite the potential of ESM assessment, the improved logistics and its increased administration in research, its use in clinical trials remains limited. This paper introduces ESM for clinical trials in psychiatry and beyond. Methods ESM is an ecologically valid method that yields a comprehensive view of an individual's daily life. It allows the assessment of various constructs (eg, quality of life, psychopathology) and psychological mechanisms (eg, stress-sensitivity, coping). These constructs are difficult to assess using cross-sectional questionnaires. ESM can be applied in treatment monitoring, as an ecological momentary intervention, in clinical trials, or in single case clinical trials. Technological advances (eg, smartphone applications) make its implementation easier. Results Advantages of ESM are highlighted and disadvantages are discussed. Furthermore, the ecological nature of ESM data and its consequences are explored, including the potential pitfalls of ambiguously formulated research questions and the specificities of ESM in statistical analyses. The last section focuses on ESM in relation to clinical trials and discusses its future use in optimising clinical decision-making. Conclusions ESM can be a valuable asset in clinical trial research and should be used more often to study the benefits of treatment in psychiatry and somatic health. PMID:27443678

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

    PubMed

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

    2013-03-04

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

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

    SciTech Connect

    Mailli, Leto Filippiadis, Dimitrios K.; Brountzos, Elias N.; Alexopoulou, Efthymia; Kelekis, Nikolaos; Kelekis, Alexios

    2013-02-15

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

  18. Appraisals and Responses to Experimental Symptom Analogues in Clinical and Nonclinical Individuals With Psychotic Experiences

    PubMed Central

    Ward, Thomas A.; Gaynor, Keith J.; Hunter, Mike D.; Woodruff, Peter W. R.; Garety, Philippa A.; Peters, Emmanuelle R.

    2014-01-01

    Objective: Cognitive models of psychosis suggest that anomalous experiences alone do not always lead to clinical psychosis, with appraisals and responses to experiences being central to understanding the transition to “need for care”. Methods: The appraisals and response styles of Clinical (C; n = 28) and Nonclinical (NC; n = 34) individuals with psychotic experiences were compared following experimental analogues of thought interference (Cards Task) and auditory hallucinations (Virtual Acoustic Space Paradigm). Results: The groups were matched in terms of their psychotic experiences. As predicted, the C group scored higher than the NC group on maladaptive appraisals following both tasks, rated the experience as more personally significant, and was more likely to incorporate the experimental setup into their ongoing experiences. The C group also appraised the Cards Task as more salient, distressing, and threatening; this group scored higher on maladaptive—and lower on adaptive—response styles, than the NC group on both tasks. Conclusions: The findings are consistent with cognitive models of psychosis, with maladaptive appraisals and response styles characterizing the C group only. Clinical applications of both tasks are suggested to facilitate the identification and modification of maladaptive appraisals. PMID:23858493

  19. An Exploration of Dental Students' Assumptions About Community-Based Clinical Experiences.

    PubMed

    Major, Nicole; McQuistan, Michelle R

    2016-03-01

    The aim of this study was to ascertain which assumptions dental students recalled feeling prior to beginning community-based clinical experiences and whether those assumptions were fulfilled or challenged. All fourth-year students at the University of Iowa College of Dentistry & Dental Clinics participate in community-based clinical experiences. At the completion of their rotations, they write a guided reflection paper detailing the assumptions they had prior to beginning their rotations and assessing the accuracy of their assumptions. For this qualitative descriptive study, the 218 papers from three classes (2011-13) were analyzed for common themes. The results showed that the students had a variety of assumptions about their rotations. They were apprehensive about working with challenging patients, performing procedures for which they had minimal experience, and working too slowly. In contrast, they looked forward to improving their clinical and patient management skills and knowledge. Other assumptions involved the site (e.g., the equipment/facility would be outdated; protocols/procedures would be similar to the dental school's). Upon reflection, students reported experiences that both fulfilled and challenged their assumptions. Some continued to feel apprehensive about treating certain patient populations, while others found it easier than anticipated. Students were able to treat multiple patients per day, which led to increased speed and patient management skills. However, some reported challenges with time management. Similarly, students were surprised to discover some clinics were new/updated although some had limited instruments and materials. Based on this study's findings about students' recalled assumptions and reflective experiences, educators should consider assessing and addressing their students' assumptions prior to beginning community-based dental education experiences.

  20. Women’s Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study

    PubMed Central

    Bilardi, Jade; Walker, Sandra; McNair, Ruth; Mooney-Somers, Julie; Temple-Smith, Meredith; Bellhouse, Clare; Fairley, Christopher; Chen, Marcus; Bradshaw, Catriona

    2016-01-01

    Background Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women’s recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV. Methods A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews. Results The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women’s frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching. Conclusion In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors. PMID:27010725

  1. Linguistic Theory and Actual Language.

    ERIC Educational Resources Information Center

    Segerdahl, Par

    1995-01-01

    Examines Noam Chomsky's (1957) discussion of "grammaticalness" and the role of linguistics in the "correct" way of speaking and writing. It is argued that the concern of linguistics with the tools of grammar has resulted in confusion, with the tools becoming mixed up with the actual language, thereby becoming the central…

  2. School Guidance Counselors' Perceptions of Actual and Preferred Job Duties

    ERIC Educational Resources Information Center

    Edwards, John Dexter

    2010-01-01

    The purpose of this study was to provide process data for school counselors, administrators, and the public, regarding school counselors' actual roles within the guidance counselor preferred job duties and actual job duties. In addition, factors including National Certification or no National Certification, years of counseling experience, and…

  3. Commissioning and initial experience with the first clinical gantry-mounted proton therapy system.

    PubMed

    Zhao, Tianyu; Sun, Baozhou; Grantham, Kevin; Rankine, Leith; Cai, Bin; Goddu, Sreekrishna M; Santanam, Lakshmi; Knutson, Nels; Zhang, Tiezhi; Reilly, Michael; Bottani, Beth; Bradley, Jeffrey; Mutic, Sasa; Klein, Eric E

    2016-03-08

    The purpose of this study is to describe the comprehensive commissioning process and initial clinical experience of the Mevion S250 proton therapy system, a gantry-mounted, single-room proton therapy platform clinically implemented in the S. Lee Kling Proton Therapy Center at Barnes-Jewish Hospital in St. Louis, MO, USA. The Mevion S250 system integrates a compact synchrocyclotron with a C-inner gantry, an image guidance system and a 6D robotic couch into a beam delivery platform. We present our commissioning process and initial clinical experience, including i) CT calibration; ii) beam data acquisition and machine characteristics; iii) dosimetric commissioning of the treatment planning system; iv) validation through the Imaging and Radiation Oncology Core credentialing process, including irradiations on the spine, prostate, brain, and lung phantoms; v) evaluation of localization accuracy of the image guidance system; and vi) initial clinical experience. Clinically, the system operates well and has provided an excellent platform for the treatment of diseases with protons.

  4. Perceptions of Co-Teaching in the Clinical Experience: How Well Is It Working?

    ERIC Educational Resources Information Center

    Kinne, Lenore J.; Ryan, Carol; Faulkner, Shawn A.

    2016-01-01

    This study examined the perceptions of teacher candidates, cooperating teachers, and university supervisors in the first year of state-mandated co-teaching in the clinical experience. Study results suggest the need (a) to emphasize the importance of the teacher candidate exerting leadership, (b) to develop and communicate specific criteria for…

  5. Why Clinical Experience and Mentoring Are Replacing Student Teaching on the Best Campuses. A White Paper

    ERIC Educational Resources Information Center

    Fraser, James W.; Watson, Audra M.

    2014-01-01

    Woodrow Wilson Senior Fellow James W. Fraser and Audra Watson, the Foundation's Director of Mentoring and Induction Strategy, take a look at emerging trends in clinical preparation for new teachers. This new white paper is based on experience with the Woodrow Wilson Teaching Fellowships, and includes observations from some of the colleges and…

  6. Instant Experience in Clinical Trials: A Computer-Aided Simulation Technique

    ERIC Educational Resources Information Center

    Simpson, Michael A.

    1976-01-01

    Describes "Instant Experience," a simulation and game method in which students are given information about a promising new drug and asked to design a protocol for a clinical trial of the drug. Evaluation of a trial workshop showed positive response to the method. Educational goals to be achieved through its use are noted. (JT)

  7. Preservice Teachers' Reflection on Clinical Experiences: A Comparison of Blog and Final Paper Assignments

    ERIC Educational Resources Information Center

    Harland, Darci J.; Wondra, Joshua D.

    2011-01-01

    This study focused on the depth of reflection in the writing of preservice teachers who completed end-of-the-semester reflective papers or reflective blogs for undergraduate education courses associated with clinical experiences. Coders rated the depth of reflection as one of four categories: non-reflection, understanding, reflection, or critical…

  8. Using a Web-Based Database to Record and Monitor Athletic Training Students' Clinical Experiences

    ERIC Educational Resources Information Center

    Brown, Kirk W.; Williams, Lisa; Janicki, Thomas

    2008-01-01

    Objective: The purpose of this article is to introduce a documentation recording system employing the Microsoft Structured Query Language (MS-SQL) database used by the Athletic Training Education Program (ATEP) for recording and monitoring of athletic training student (ATS) clinical experiences and hours. Background: Monitoring ATSs clinical…

  9. Evaluation of Nontraditional Age Learners' Experiences in Internet-Based Clinical Social Work Courses

    ERIC Educational Resources Information Center

    Swanke, Jayme; Zeman, Laura Dreuth

    2015-01-01

    This study involves an evaluation of online learners' experiences with two Internet-based clinical social work courses. The evaluation sought to discover whether there were differences in learning between traditional (under 25 years old) and nontraditional age learners (25 years and over) who completed the asynchronous online course. The study…

  10. Management Development in Health Care: Exploring the Experiences of Clinical Nurse Managers

    ERIC Educational Resources Information Center

    Purcell, Laura; Milner, Brigid

    2005-01-01

    Purpose--The purpose of this paper is to investigate the dramatic reforms in the health service in recent years. Design/methodology/approach--Examines management development in health care, and explores the experiences of clinical nurse managers. Findings--Duplication of agencies and multiplication of roles have led to tensions in terms of both…

  11. Experiences of Master's Students Regarding Clinical Supervision in an Applied Psychology Programme in South Africa

    ERIC Educational Resources Information Center

    Nel, Lindi; Fouche, Paul

    2017-01-01

    This study explored and described the experiences regarding clinical supervision of master's students in professional psychology programmes in South Africa. Four participants were purposively selected from four different universities. The participants engaged in reflective writings and in-depth interviews over a one-year span. Data were analysed…

  12. A Collective Self-Study to Improve Program Coherence of Clinical Experiences

    ERIC Educational Resources Information Center

    Samaras, Anastasia P.; Frank, Toya Jones; Williams, Monique Apollon; Christopher, Emily; Rodick, William Harry, III.

    2016-01-01

    Student feedback collected through program evaluation of secondary education licensure and Master's program clinical experiences prompted us to conduct a collective self-study. We used a reflective framework for analysis and discussion of the shifts students in our courses made as they progressed from observers to practicing teachers. Along with…

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  14. Social justice as a framework for undergraduate community health clinical experiences in the United States.

    PubMed

    Boutain, Doris M

    2008-01-01

    Educating future registered nurses for social justice is an urgent, yet complex undertaking in undergraduate education. Although the need for social justice education is often highlighted, few articles describe practical teaching strategies for ensuring that undertaking. The purpose of this article is to illustrate how a curricular focus on social justice framed and supported the development of a clinical evaluation tool for undergraduate community health clinical experiences. First, social justice is defined and its relationship to baccalaureate nursing education explained. Then a description is provided of how social justice was highlighted in the vision, curriculum, and community health clinical evaluation tool of a College of Nursing. The article subsequently showcases the content and evaluation of students' journal entries about social justice. The development of the social justice component presented in this article may be useful to nurse educators striving to match theory and practice in the evaluation of social justice in students' community health experience.

  15. Comprehensive experiment-clinical biochemistry: determination of blood glucose and triglycerides in normal and diabetic rats.

    PubMed

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

    2015-01-01

    For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a standard clinical biochemistry exercise. The students are not only exposed to techniques and equipment but are also inspired to think more about the biochemical mechanisms of diseases. When linked with lecture topics about the metabolism of carbohydrates and lipids, the students obtain a better understanding of the relevance of abnormal metabolism in relation to diseases. Such understanding provides a solid foundation for the medical students' future research and for other clinical applications.

  16. The effect of clinical experience on cue trading for the /r-w/ contrast.

    PubMed

    Wolfe, Virginia; Martin, David; Borton, Thomas; Youngblood, Heather Conner

    2003-05-01

    Although the ability of clinicians to perceptually process speech sound productions is a key ingredient in the evaluation and remediation of articulatory disorders, very little attention has been given to this important skill. This study explored the potential of a perceptual task, known as cue trading, to assess perceptual skill among students with varying clinical experience. A cue-trading paradigm for the /r-w/ contrast was used in which a temporal-spectral cue on F2 was balanced against a spectral cue on F3. Results indicated a trading relationship for all students. However, students without clinical experience demonstrated reduced sensitivity to the acoustic cues for /w/ and identification functions that were less clearly separated compared to students with clinical experience. Furthermore, the magnitude of the difference between functions (the trading relationship) was significantly smaller for students without practicum experience: They showed weaker phonetic percepts for /r/ and /w/ than did the students with practicum experience. Preliminary results suggest that a task based on cue trading could be useful in assessing perceptual sensitivity to the acoustic cues representative of misarticulated /r/.

  17. Neoadjuvant Treatment in Rectal Cancer: Actual Status

    PubMed Central

    Garajová, Ingrid; Di Girolamo, Stefania; de Rosa, Francesco; Corbelli, Jody; Agostini, Valentina; Biasco, Guido; Brandi, Giovanni

    2011-01-01

    Neoadjuvant (preoperative) concomitant chemoradiotherapy (CRT) has become a standard treatment of locally advanced rectal adenocarcinomas. The clinical stages II (cT3-4, N0, M0) and III (cT1-4, N+, M0) according to International Union Against Cancer (IUCC) are concerned. It can reduce tumor volume and subsequently lead to an increase in complete resections (R0 resections), shows less toxicity, and improves local control rate. The aim of this review is to summarize actual approaches, main problems, and discrepancies in the treatment of locally advanced rectal adenocarcinomas. PMID:22295206

  18. Selection responses for clinical mastitis and protein yield in two Norwegian dairy cattle selection experiments.

    PubMed

    Heringstad, B; Klemetsdal, G; Steine, T

    2003-09-01

    Inferences from two dairy cattle selection experiments, in which sires were selected from external sources, were drawn by using an animal model to analyze data from the entire population. The first selection experiment was carried out in the period from 1978 to 1989 and included groups selected for high milk production (HMP) and low milk production (LMP). Each year, the highest ranking proven sires for milk production, from the most recent group of Norwegian Dairy Cattle (NRF) test bulls, were selected and mated to the cows in the HMP group. A group of sires with low milk production indices from progeny testing in 1978 and 1979 were used as sires in the LMP group during the entire experiment. The second selection experiment, which started in 1989, included one high protein yield (HPY) group and one low clinical mastitis (LCM) group. The highest ranking proven NRF sires for protein yield and mastitis resistance were selected each year from the most recent group of progeny tested bulls and used as sires in the HPY and LCM groups, respectively. Genetic trends for protein yield were positive (as expected) for HMP and HPY cows, and negative for LMP and LCM cows. Estimates of annual genetic trends for clinical mastitis were +0.23, -0.02, +0.04, and -0.91% per year for HMP, LMP, HPY, and LCM cows, respectively. The difference in genetic trend of clinical mastitis between HMP and HPY groups, both selected for increased milk production, reflects the gradual change in the NRF breeding objective towards more weight on health relative to milk over the last 20 yr. After four cow generations, the genetic difference in mastitis between HMP and LMP group cows was 3.1% clinical mastitis, a correlated response to selection for increased milk production. The genetic difference between LCM and HPY cows of 8.6% clinical mastitis after three cow generations is mainly a result of direct selection against clinical mastitis in the LCM group. In the NRF population, an approximately flat

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

    PubMed Central

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

    2015-01-01

    Background: Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. Materials and Methods: This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability). Results: Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient's welfare, poor preparation, lack of motivation, ethical problems), factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system's monitoring, bad planning and inadequate resource). Conclusion: Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching. PMID:26109975

  20. Creating an assistive technology clinic: the experience of the Johns Hopkins AT clinic for patients with ALS.

    PubMed

    Casey, Kelly Showalter

    2011-01-01

    For persons with Amyotrophic Lateral Sclerosis (ALS), comprehensive multidisciplinary care can effectively improve overall quality of life from diagnosis to end of life [16]. Considering the rapidly progressive loss in overall function experienced by persons with ALS, it is essential to provide comprehensive multidisciplinary care, including Assistive Technology (AT) services, in an effective and efficient manner. AT is an important adjunctive therapy for people with neurological disability. For people with complex conditions, access to a comprehensive AT clinic can be the best way to access these tools. Unfortunately, few medical centers have invested in AT clinics, and managers may not understand how to go about developing AT resources at their facility. This article chronicles the step-by-step development of The Johns Hopkins Assistive Technology Clinic for persons with ALS. It offers background evidence, the process of program development, and insight into the experience of professional accountability of one occupational therapist turned AT Director. It also details descriptions of the stakeholders and their roles in the development process, funding and ethical considerations, and barriers to implementation. It is hoped that this may provide guidance for teams who may wish to build AT facilities in their own practice settings.

  1. Belongingness: a montage of nursing students' stories of their clinical placement experiences.

    PubMed

    Levett-Jones, Tracy; Lathlean, Judith; McMillan, Margaret; Higgins, Isabel

    2007-04-01

    The psychological and social sciences literature is replete with assertions that human beings are fundamentally and pervasively motivated by the need to belong. This paper reports on some of the findings from the qualitative phase of a mixed-method, multi-site study that explored nursing students' experience of belongingness while on clinical placements. Students from Australia and the United Kingdom were interviewed to identify factors that impact upon and are consequences of belongingness. A montage of participants' stories is used to illustrate some of the key features of clinical workplaces that are conducive to the development of belongingness. Contextual factors and interpersonal dynamics were seen to have a significant bearing on students' experiences. Clinical leaders/managers who were welcoming, accepting and supportive, and nursing staff who were inclusive and encouraging, facilitated students' perception of being valued and respected as members of the nursing team. Additionally, the provision of consistent, quality mentorship was identified as important to students' feelings of connectedness and fit. The experience of belongingness, in turn, enhanced students' potential for learning and influenced their future career decisions. Alternatively, alienation resulted from unreceptive and unwelcoming clinical environments and from the dissonance created when students' personal and professional values did not articulate with those evident in practice environments. Consequently, distress, detachment and disengagement occurred and students' capacity and motivation for learning was negatively impacted.

  2. International student nurses' experiences of clinical practice in the Finnish health care system.

    PubMed

    Mattila, Lea-Riitta; Pitkäjärvi, Marianne; Eriksson, Elina

    2010-05-01

    The purpose of this qualitative study was to describe international student nurses' experiences of their clinical practice in the Finnish health care system. The data were collected by semi-structured interviews. Fourteen international student nurses of African and Asian origin were interviewed, and the data were then analysed by qualitative content analysis. The results indicated that appreciative orientation, sense of belonging to the team, enhancing independent working, growing towards professionalism and working as a member of the team were descriptions of positive experiences. Descriptions of negative experiences were related to restricted learning and compromised human dignity, which lead to negative feelings of being an outsider, decreased self-esteem, sense of giving up and anticipation of difficulties. Despite the small sample size, the results indicate a need to develop clinical practice arrangements when the language of the learning environment is other than that of the student nurse. As the number of international students has increased in the Finnish health care sector and in nursing education, it is important to recognise the factors related to positive and negative experiences in clinical practice.

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

    PubMed

    Langer, Alvaro I; Cangas, Adolfo J; Serper, Mark

    2011-02-01

    Numerous studies have found that hallucinatory experiences occur in the general population. But to date, few studies have been conducted to compare clinical and nonclinical groups across a broad array of clinical symptoms that may co-occur with hallucinations. Likewise, hallucination-like experiences are measured as a multidimensional construct, with clinical and subclinical components related to vivid daydreams, intrusive thoughts, perceptual disturbance, and clinical hallucinatory experiences. Nevertheless, these individual subcomponents have not been examined across a broad spectrum of clinically disordered and nonclinical groups. The goal of the present study was to analyze the differences and similarities in the distribution of responses to hallucination-like experience in clinical and nonclinical populations and to determine the relation of these hallucination-like experiences with various clinical symptoms. These groups included patients with schizophrenia, non-psychotic clinically disordered patients, and a group of individuals with no psychiatric diagnoses. The results revealed that hallucination-like experiences are related to various clinical symptoms across diverse groups of individuals. Regression analysis found that the Psychoticism dimension of the Symptom Check List (SCL-90-R) was the most important predictor of hallucination-like experiences. Additionally, increased auditory and visual hallucination was the only subcomponent that differentiated schizophrenic patients from other groups. This distribution of responses in the dimensions of hallucination-like experiences suggests that not all the dimensions are characteristic of people hearing voices. Vivid daydreams, intrusive thoughts, and auditory distortions and visual perceptual distortions may represent a state of general vulnerability that does not denote a specific risk for clinical hallucinations. Overall, these results support the notion that hallucination-like experiences are closer to a

  4. Systematic reviews of animal experiments demonstrate poor human clinical and toxicological utility.

    PubMed

    Knight, Andrew

    2007-12-01

    The assumption that animal models are reasonably predictive of human outcomes provides the basis for their widespread use in toxicity testing and in biomedical research aimed at developing cures for human diseases. To investigate the validity of this assumption, the comprehensive Scopus biomedical bibliographic databases were searched for published systematic reviews of the human clinical or toxicological utility of animal experiments. In 20 reviews in which clinical utility was examined, the authors concluded that animal models were either significantly useful in contributing to the development of clinical interventions, or were substantially consistent with clinical outcomes, in only two cases, one of which was contentious. These included reviews of the clinical utility of experiments expected by ethics committees to lead to medical advances, of highly-cited experiments published in major journals, and of chimpanzee experiments--those involving the species considered most likely to be predictive of human outcomes. Seven additional reviews failed to clearly demonstrate utility in predicting human toxicological outcomes, such as carcinogenicity and teratogenicity. Consequently, animal data may not generally be assumed to be substantially useful for these purposes. Possible causes include interspecies differences, the distortion of outcomes arising from experimental environments and protocols, and the poor methodological quality of many animal experiments, which was evident in at least 11 reviews. No reviews existed in which the majority of animal experiments were of good methodological quality. Whilst the effects of some of these problems might be minimised with concerted effort (given their widespread prevalence), the limitations resulting from interspecies differences are likely to be technically and theoretically impossible to overcome. Non-animal models are generally required to pass formal scientific validation prior to their regulatory acceptance. In contrast

  5. Self-Actualization in a Marathon Growth Group: Do the Strong Get Stronger?

    ERIC Educational Resources Information Center

    Kimball, Ronald; Gelso, Charles J.

    1974-01-01

    This study examined the effects of a weekend marathon on the level of self-actualization of college students and the relationship between ego strength and extent of change in self-actualization. The group experience did increase self-actualization, but participants' initial level of ego strength was unrelated to changes in self-actualization.…

  6. Experimenting Clinical Pathways in General Practice: a Focus Group Investigation with Italian General Practitioners

    PubMed Central

    Zannini, Lucia; Cattaneo, Cesarina; Peduzzi, Paolo; Lopiccoli, Silvia; Auxilia, Francesco

    2012-01-01

    Background Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners’ (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment. Acknowledgments the Authors thank Dr. AP. Cantù and Dr D. Cereda who participated in the two focus groups as observers. PMID:25181354

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

    PubMed

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

    2012-08-01

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

  8. Clinical hypnosis with a Little League baseball population: performance enhancement and resolving traumatic experiences.

    PubMed

    Iglesias, Alex; Iglesias, Adam

    2011-01-01

    A model for the use of clinical hypnosis with a Little League population was proposed and outlined with dual emphasis: performance enhancement and resolving traumatic experiences. The Performance Enhancement Training Model was developed to enhance performance with this non-patient population. It employed clinical hypnosis to bring to fruition recommendations made by coaches to enhance players' batting proficiency. The second emphasis of the proposed model focused on the resolution of involuntary maladaptive habits secondary to a traumatic experience that impede or compromise optimum performance. Included in this category were detrimental defensive habits "at the plate" after a beaming by a pitch and detrimental defensive habits "on the field" after being hit by a batted ball.

  9. [Clinical experience of Qin's eight scalp needles for treatment of Parkinson's disease].

    PubMed

    Dong, Jun; Cui, Hua-Shun

    2014-05-01

    The eight scalp needles, founded by Professor QIN Liang-fu, and its clinical experience for treatment of Parkinson's disease (PD) are introduced. Based on his years of clinical experience, it is proposed by Professor QIN that the Governor Vessel is mainly for miscellaneous disease and disease of limbs. Combined with distribution of cephalic motor region and meridian, an acupuncture treatment plan that is full of innovativeness is proposed, which is called Qin's eight scalp needles. It includes bilateral Fengchi (GB 20), Shuaigu (GB 8), Toulinqi (GB 15) as well as Yintang (GV 29) and Baihui (GV 20), mainly for treatment of nervous system diseases, such as PD and multiple sclerosis and so on. Besides, some outpatient cases are introduced to explain that eight scalp needle could alleviate the progression of PD, improve patients' motor, cognitive and affective disorders, reduce the suffering of patients, and improve the patient's quality of life.

  10. Animal experiments scrutinised: systematic reviews demonstrate poor human clinical and toxicological utility.

    PubMed

    Knight, Andrew

    2007-01-01

    The assumption that animal models are reasonably predictive of human outcomes provides the basis for their widespread use in toxicity testing and in biomedical research aimed at developing cures for human diseases. To investigate the validity of this assumption, the comprehensive "Scopus" biomedical bibliographic databases were searched for published systematic reviews of the human clinical or toxicological utility of animal experiments. Of 20 reviews examining clinical utility, authors concluded that the animal models were substantially consistent with or useful in advancing clinical outcomes in only two cases, and the conclusion in one case was contentious. Included were reviews of the clinical utility of experiments expected by ethics committees to lead to medical advances, of highly-cited experiments published in major journals, and of chimpanzee experiments - the species most likely to be predictive of human outcomes. Seven additional reviews failed to clearly demonstrate utility in predicting human toxicological outcomes such as carcinogenicity and teratogenicity. Consequently, animal data may not generally be assumed to be substantially useful for these purposes. Possible causes include interspecies differences, the distortion of experimental outcomes arising from experimental environments and protocols, and the poor methodological quality of many animal experiments evident in at least 11 reviews. No reviews existed in which a majority of animal experiments were of good quality. While the latter problems might be minimised with concerted effort, given their widespread nature, the interspecies limitations are likely to be technically and theoretically impossible to overcome. Yet, unlike non-animal models, animal models are not normally subjected to formal scientific validation. Instead of simply assuming they are predictive of human outcomes, the consistent application of formal validation studies to all test models is clearly warranted, regardless of their

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

    PubMed

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

    2014-10-20

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

  12. Seeing Students Squirm: Nursing Students’ Experiences of Bullying Behaviors During Clinical Rotations

    PubMed Central

    Smith, Carolyn R.; Gillespie, Gordon Lee; Brown, Kathryn C.; Grubb, Paula L.

    2016-01-01

    Background Bullying remains a troubling problem in the nursing profession. Nursing students may encounter bullying behavior in clinical settings. However nursing students may not be adequately prepared to recognize and handle bullying behavior when it occurs. The purpose of this study was to gain greater understanding of nursing students’ experiences of bullying behaviors in the clinical setting. Method Using a descriptive qualitative approach, eight focus groups were held with 56 undergraduate baccalaureate nursing students from four college campuses. Focus group data were coded and analyzed for themes. Results Four categories of themes were identified: bullying behaviors, rationale for bullying, response to bullying, and recommendations to address bullying. Each category and its corresponding themes are presented. Conclusion Interventions for nurse educators to address bullying of nursing students in clinical settings are presented. PMID:27560118

  13. Early experiences in evolving an enterprise-wide information model for laboratory and clinical observations.

    PubMed

    Chen, Elizabeth S; Zhou, Li; Kashyap, Vipul; Schaeffer, Molly; Dykes, Patricia C; Goldberg, Howard S

    2008-11-06

    As Electronic Healthcare Records become more prevalent, there is an increasing need to ensure unambiguous data capture, interpretation, and exchange within and across heterogeneous applications. To address this need, a common, uniform, and comprehensive approach for representing clinical information is essential. At Partners HealthCare System, we are investigating the development and implementation of enterprise-wide information models to specify the representation of clinical information to support semantic interoperability. This paper summarizes our early experiences in: (1) defining a process for information model development, (2) reviewing and comparing existing healthcare information models, (3) identifying requirements for representation of laboratory and clinical observations, and (4) exploring linkages to existing terminology and data standards. These initial findings provide insight to the various challenges ahead and guidance on next steps for adoption of information models at our organization.

  14. From clinical experience to a model for the human fascial system.

    PubMed

    Day, Julie Ann; Copetti, Lorenzo; Rucli, Giorgio

    2012-07-01

    Studies of fascial anatomy, histology, and physiology are changing comprehension of the role of fascia in many body functions. In the light of these studies, evidence-based models of the human fascial system that provide immediate clinical applications for manual therapists working with movement dysfunctions and pain are necessarily evolving. This paper presents an overview of one proposed biomechanical model and discusses some of its underlying hypotheses. Developed initially from extensive review of anatomical texts and clinical experience, subsequent anatomical dissections, histological, biomechanical, and some clinical studies have investigated this model. These studies are discussed, also in reference to other contemporary musculoskeletal research. This model for the human fascial system could represent new perspectives for clinicians and researchers regarding the functional integration of fascia within the musculoskeletal system.

  15. Young People's Experiences of Participation in Clinical Trials: Reasons for Taking Part.

    PubMed

    Luchtenberg, Malou; Maeckelberghe, Els; Locock, Louise; Powell, Lesley; Verhagen, A A Eduard

    2015-01-01

    Given the lack of knowledge about safety and efficacy of many treatments for children, pediatric clinical trials are important, but recruitment for pediatric research is difficult. Little is known about children's perspective on participating in trials. The purpose of this study was to understand the experiences and motivations of young people who took part in clinical trials. This is a qualitative interview study of 25 young people aged 10-23 who were invited to take part in clinical trials. Interviews were audio or video recorded and analyzed using framework analysis. Young peoples' motivations were both personal benefit and helping others. Both incentives appeared to be more complex than expected. We introduce the terms "network of exchange" and "intergenerational solidarity" to describe these motivations. To improve recruitment, professionals should be more open about research opportunities, provide better information, and give young people feedback after the trial has ended.

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

    PubMed Central

    Bouras-vallianatos, Petros

    2014-01-01

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

  17. The clinical nurse leader in the perioperative setting: a preceptor experience.

    PubMed

    Wesolowski, Michael S; Casey, Gwendolyn L; Berry, Shirley J; Gannon, Jane

    2014-07-01

    The U.S. Veterans Administration (VA) has implemented the clinical nurse leader (CNL) role nationwide. Nursing leaders at the Malcolm Randall VA Medical Center in Gainesville, Florida, implemented the development of the CNL role in the perioperative setting during the summer of 2012. The perioperative department developed the position in partnership with the University of Florida College of Nursing, Gainesville, Florida. The team developed a description of the roles and experiences of the preceptors, the clinical nurse leader resident, and the University of Florida faculty member. The clinical nurse leader resident's successes and the positive outcomes, such as improved patient outcomes, experienced by the perioperative department demonstrated the importance of the CNL role.

  18. Experience from two decades of the Cambridge Rapid Access Neurology Clinic.

    PubMed

    Axinte, Laura T; Fiddes, Barnaby D; Donaghy, Alastair; Whyte, Adam; Allen, Chris; Sawcer, Stephen J; Adam, Robert J; Stacpoole, Sybil R L

    2015-10-01

    We report on the evolution of the rapid access neurology clinic (established in 1995) at Addenbrooke's Hospital, Cambridge. Annualised attendance data demonstrate an ever increasing demand, with primary headache disorders now accounting for more than 40% of referrals. Secondary causes of headache (including intracranial tumours, idiopathic intracranial hypertension, carotid or vertebral artery dissection and subdural haematomas) remain infrequent. In all such cases, there were additional diagnostic clues. The number of patients referred with problems related to chronic neurological diseases has fallen considerably, reflecting the roles of specialist nurses and clinics. Imaging investigation of choice shifted from computerised tomography scan (45 to 16%) towards magnetic resonance imaging (17 to 47%). Management is increasingly on an outpatient basis, often without the need for a follow-up appointment. The experience presented here should inform further development of rapid access neurology clinics across the UK and suggests the need for acute headache services, in line with those for transient ischaemic attack and first seizure.

  19. Clinical evaluation of music perception, appraisal and experience in cochlear implant users

    PubMed Central

    Drennan, Ward. R.; Oleson, Jacob J.; Gfeller, Kate; Crosson, Jillian; Driscoll, Virginia D.; Won, Jong Ho; Anderson, Elizabeth S.; Rubinstein, Jay T.

    2014-01-01

    Objectives The objectives were to evaluate the relationships among music perception, appraisal, and experience in cochlear implant users in multiple clinical settings and to examine the viability of two assessments designed for clinical use. Design Background questionnaires (IMBQ) were administered by audiologists in 14 clinics in the United States and Canada. The CAMP included tests of pitch-direction discrimination, and melody and timbre recognition. The IMBQ queried users on prior musical involvement, music listening habits pre and post implant, and music appraisals. Study sample One-hundred forty-five users of Advanced Bionics and Cochlear Ltd cochlear implants. Results Performance on pitch direction discrimination, melody recognition, and timbre recognition tests were consistent with previous studies with smaller cohorts, as well as with more extensive protocols conducted in other centers. Relationships between perceptual accuracy and music enjoyment were weak, suggesting that perception and appraisal are relatively independent for CI users. Conclusions Perceptual abilities as measured by the CAMP had little to no relationship with music appraisals and little relationship with musical experience. The CAMP and IMBQ are feasible for routine clinical use, providing results consistent with previous thorough laboratory-based investigations. PMID:25177899

  20. Transforming Experience: The Potential of Augmented Reality and Virtual Reality for Enhancing Personal and Clinical Change

    PubMed Central

    Riva, Giuseppe; Baños, Rosa M.; Botella, Cristina; Mantovani, Fabrizia; Gaggioli, Andrea

    2016-01-01

    During life, many personal changes occur. These include changing house, school, work, and even friends and partners. However, the daily experience shows clearly that, in some situations, subjects are unable to change even if they want to. The recent advances in psychology and neuroscience are now providing a better view of personal change, the change affecting our assumptive world: (a) the focus of personal change is reducing the distance between self and reality (conflict); (b) this reduction is achieved through (1) an intense focus on the particular experience creating the conflict or (2) an internal or external reorganization of this experience; (c) personal change requires a progression through a series of different stages that however happen in discontinuous and non-linear ways; and (d) clinical psychology is often used to facilitate personal change when subjects are unable to move forward. Starting from these premises, the aim of this paper is to review the potential of virtuality for enhancing the processes of personal and clinical change. First, the paper focuses on the two leading virtual technologies – augmented reality (AR) and virtual reality (VR) – exploring their current uses in behavioral health and the outcomes of the 28 available systematic reviews and meta-analyses. Then the paper discusses the added value provided by VR and AR in transforming our external experience by focusing on the high level of personal efficacy and self-reflectiveness generated by their sense of presence and emotional engagement. Finally, it outlines the potential future use of virtuality for transforming our inner experience by structuring, altering, and/or replacing our bodily self-consciousness. The final outcome may be a new generation of transformative experiences that provide knowledge that is epistemically inaccessible to the individual until he or she has that experience, while at the same time transforming the individual’s worldview. PMID:27746747

  1. Transforming Experience: The Potential of Augmented Reality and Virtual Reality for Enhancing Personal and Clinical Change.

    PubMed

    Riva, Giuseppe; Baños, Rosa M; Botella, Cristina; Mantovani, Fabrizia; Gaggioli, Andrea

    2016-01-01

    During life, many personal changes occur. These include changing house, school, work, and even friends and partners. However, the daily experience shows clearly that, in some situations, subjects are unable to change even if they want to. The recent advances in psychology and neuroscience are now providing a better view of personal change, the change affecting our assumptive world: (a) the focus of personal change is reducing the distance between self and reality (conflict); (b) this reduction is achieved through (1) an intense focus on the particular experience creating the conflict or (2) an internal or external reorganization of this experience; (c) personal change requires a progression through a series of different stages that however happen in discontinuous and non-linear ways; and (d) clinical psychology is often used to facilitate personal change when subjects are unable to move forward. Starting from these premises, the aim of this paper is to review the potential of virtuality for enhancing the processes of personal and clinical change. First, the paper focuses on the two leading virtual technologies - augmented reality (AR) and virtual reality (VR) - exploring their current uses in behavioral health and the outcomes of the 28 available systematic reviews and meta-analyses. Then the paper discusses the added value provided by VR and AR in transforming our external experience by focusing on the high level of personal efficacy and self-reflectiveness generated by their sense of presence and emotional engagement. Finally, it outlines the potential future use of virtuality for transforming our inner experience by structuring, altering, and/or replacing our bodily self-consciousness. The final outcome may be a new generation of transformative experiences that provide knowledge that is epistemically inaccessible to the individual until he or she has that experience, while at the same time transforming the individual's worldview.

  2. How People Actually Use Thermostats

    SciTech Connect

    Meier, Alan; Aragon, Cecilia; Hurwitz, Becky; Mujumdar, Dhawal; Peffer, Therese; Perry, Daniel; Pritoni, Marco

    2010-08-15

    Residential thermostats have been a key element in controlling heating and cooling systems for over sixty years. However, today's modern programmable thermostats (PTs) are complicated and difficult for users to understand, leading to errors in operation and wasted energy. Four separate tests of usability were conducted in preparation for a larger study. These tests included personal interviews, an on-line survey, photographing actual thermostat settings, and measurements of ability to accomplish four tasks related to effective use of a PT. The interviews revealed that many occupants used the PT as an on-off switch and most demonstrated little knowledge of how to operate it. The on-line survey found that 89% of the respondents rarely or never used the PT to set a weekday or weekend program. The photographic survey (in low income homes) found that only 30% of the PTs were actually programmed. In the usability test, we found that we could quantify the difference in usability of two PTs as measured in time to accomplish tasks. Users accomplished the tasks in consistently shorter times with the touchscreen unit than with buttons. None of these studies are representative of the entire population of users but, together, they illustrate the importance of improving user interfaces in PTs.

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    PubMed Central

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

    2011-01-01

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

  5. The first clinical experience on efficacy of topical flutamide on melasma compared with topical hydroquinone: a randomized clinical trial

    PubMed Central

    Adalatkhah, Hassan; Sadeghi-Bazargani, Homayoun

    2015-01-01

    Background Treatment of melasma is unsatisfactory most of the times. Hormonal role is shown to exist in pathogenesis of the melasma, and sex-hormone related drugs may have an effect on melasma. Aim To investigate efficacy of 1% flutamide cream versus 4% hydroquinone cream on melasma. Methods In a parallel randomized clinical trial, 74 women with melasma were allocated to receive a sunscreen along with 4% hydroquinone cream or 1% flutamide cream. Melasma Area and Severity Index (MASI), mexameter melanin assay, and patient satisfaction were investigated. Results Mean age of the participants was 33.8 years. Mean length of time suffering from Melasma was 96.3 months. The subjects reported in average 1.1 hours per day of exposure to sunlight. Mean standardized total patient satisfaction score was 28.8 (standard deviation [SD] 17.2) in flutamide group patients versus 18 (SD 15.5) in control group (P<0.01). Regardless of treatment group, the skin darkness assessed upon MASI scales was reduced over the treatment course (P<0.001). Using mixed effects, longitudinal modeling showed better treatment efficacy based on MASI scale for flutamide group compared to the hydroquinone group (P<0.05). However, longitudinal analysis of mexameter scores did not reveal any significant difference in melanin measurements between flutamide and hydroquinone. Conclusion Topical flutamide appeared as effective as topical hydroquinone in treating melasma using mexameter assessment but with a better MASI improvement trend and higher patient satisfaction in flutamide treatment versus topical hydroquinone. As the present study is possibly the first clinical experience on efficacy of topical flutamide on melasma, it would be quite unreasonable to recommend clinical use of it before future studies replicate the results on its efficacy and safety. PMID:26345129

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

    PubMed

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

    2014-01-01

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

  7. [Professor WU Xu's clinical experiences on acupuncture for acute upper abdominal pain].

    PubMed

    Wu, Xiao-Liang; Lu, Bin; Sun, Jian-Hua; Ai, Bing-Wei; Bao, Chao; Wu, Wen-Zhong; Li, Jian-Bing; Liu, Lan-Ying; Wu, Wen-Yun; Pei, Li-Xia; Zhou, Jun-Ling; Li, Yan-Cai; Qin, Shan

    2014-03-01

    The clinical experiences and proven cases of distinguished doctor of TCM, professor WU Xu, on acupuncture for acute upper abdominal pain is introduced. Professor WU's manipulation characteristics of acupuncture for acute upper abdominal pain, including acute cholecystitis, kidney stone, acute stomach pain, are one-hand shape but both hands in nature, moving like Tai Chi, force on the tip of needle, movement of qi mainly. The main technique posture is one-hand holding needle with middle finger for pressing, the needle is hold by thumb and index finger, and is assisted by middle finger. The special acupuncture experience of emergency is treatment according to syndrome differentiation, combination of acupuncture and moxibustion, selecting acupoint based on experience, blood-letting acupuncture therapy and so on.

  8. Self-Actualization in a Marathon Growth Group: Do the Strong Get Stronger?

    ERIC Educational Resources Information Center

    Kimball, Ronald; Gelso, Charles J.

    This study examined the effects of a weekend marathon on the level of self-actualization of college students one and four weeks following their group experience. It also studied the relationship between ego strength and extent of change in self-actualization during a marathon. Generally, the group experience did increase self-actualization and the…

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

    PubMed

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

    2015-02-01

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

  10. Clinical experience and skills of physicians in hospital cardiac arrest teams in Denmark: a nationwide study

    PubMed Central

    Lauridsen, Kasper G; Schmidt, Anders S; Caap, Philip; Aagaard, Rasmus; Løfgren, Bo

    2017-01-01

    Background The quality of in-hospital resuscitation is poor and may be affected by the clinical experience and cardiopulmonary resuscitation (CPR) training. This study aimed to investigate the clinical experience, self-perceived skills, CPR training and knowledge of the guidelines on when to abandon resuscitation among physicians of cardiac arrest teams. Methods We performed a nationwide cross-sectional study in Denmark. Telephone interviews were conducted with physicians in the cardiac arrest teams in public somatic hospitals using a structured questionnaire. Results In total, 93 physicians (53% male) from 45 hospitals participated in the study. Median age was 34 (interquartile range: 30–39) years. Respondents were medical students working as locum physicians (5%), physicians in training (79%) and consultants (16%), and the median postgraduate clinical experience was 48 (19–87) months. Most respondents (92%) felt confident in treating a cardiac arrest, while fewer respondents felt confident in performing intubation (41%) and focused cardiac ultrasound (39%) during cardiac arrest. Median time since last CPR training was 4 (2–10) months, and 48% had attended a European Resuscitation Council (ERC) Advanced Life Support course. The majority (84%) felt confident in terminating resuscitation; however, only 9% were able to state the ERC guidelines on when to abandon resuscitation. Conclusion Physicians of Danish cardiac arrest teams are often inexperienced and do not feel competent performing important clinical skills during resuscitation. Less than half have attended an ERC Advanced Life Support course, and only very few physicians know the ERC guidelines on when to abandon resuscitation. PMID:28331374

  11. Application of modeling and simulation to a long-term clinical trial: a direct comparison of simulated data and data actually observed in Japanese osteoporosis patients following 3-year ibandronate treatment.

    PubMed

    Nakai, Kiyohiko; Iida, Satofumi; Tobinai, Masato; Hashimoto, Junko; Kawanishi, Takehiko

    2015-03-01

    Ibandronate, a nitrogen-containing bisphosphonate, is a bone resorption inhibitor widely used to prevent and treat osteoporosis. To optimize the design for a long-term clinical study of ibandronate, modeling and simulation (M&S) was performed based on the result of population pharmacodynamic analysis using the data of a short-term clinical study. A population pharmacodynamic model was constructed by the urinary C-terminal telopeptide of type I collagen (uCTx) and the lumbar spine bone mineral density (BMD) data obtained in clinical studies, including a phase II study of Japanese osteoporosis patients treated with ibandronate for 6 months. Changes in BMD over a period of 3 years were simulated from the population pharmacodynamic parameters of the patients in this phase II study. The relationship between uCTx and BMD was well described by this modeling. The functions of disease progression and supplemental treatment were incorporated into the model to simulate a long-term clinical study with high accuracy. A long-term clinical study with a 3-year treatment was conducted after this M&S. The percentage change from baseline in observed BMD values were found to be similar to the prospectively simulated values. This study showed that M&S could be a useful and powerful tool for designing and conducting long-term clinical studies when carried out in the following sequence: (1) conduct a short-term clinical study; (2) perform M&S; and (3) conduct the long-term clinical study. Application of this procedure to various other treatment agents will establish the usefulness of M&S for long-term clinical studies and bring further efficiencies to drug development.

  12. Haemophilia in a real-world setting: the value of clinical experience in data collection.

    PubMed

    Dolan, Gerry; Iorio, Alfonso; Jokela, Vuokko; Juusola, Kristian; Lassila, Riitta

    2016-02-01

    At the 8th Annual Congress of the European Association for Haemophilia and Allied Disorders (EAHAD) held in Helsinki, Finland, in February 2015, Pfizer sponsored a satellite symposium entitled: 'Haemophilia in a real-world setting: The value of clinical experience in data collection' Co-chaired by Riitta Lassila (Helsinki University Central Hospital, Helsinki, Finland) and Gerry Dolan (Guy's and St Thomas' Hospital, London, UK); the symposium provided an opportunity to explore the practical value of real-world data in informing clinical decision-making. Gerry Dolan provided an introduction to the symposium by describing what is meant by real-world data (RWD), stressing the role RWD can play in optimising patient outcomes in haemophilia and highlighting the responsibility of all stakeholders to collaborate in continuous data collection. Kristian Juusola (Oulu University Hospital, Oulu, Finland) then provided personal experience as a haemophilia nurse around patient views on adherence to treatment regimes, and how collecting insights into real-world use of treatment can shape approaches to improving adherence. The importance of elucidating pharmacokinetic parameters in a real-world setting was then explored by Vuokko Jokela (Helsinki University, Helsinki, Finland). Finally, Alfonso Iorio (McMaster University, Hamilton, Ontario, Canada) highlighted the importance of quality data collection in translating clinical reality into scientific advances.

  13. Does reflective web-based discussion strengthen nursing students' learning experiences during clinical training?

    PubMed

    Mettiäinen, Sari; Vähämaa, Kristiina

    2013-09-01

    The aim of this research was to study how a web-based discussion forum can be used as a supervision tool during nursing students' clinical training. The study emphasises peer support and its importance for the students. The empirical research was carried out at a Finnish university of applied sciences. 25 nursing students took part in web-based discussion during their eight-week clinical training period. All in all, 395 comments were submitted. The material was analysed by using categorisation and a thematic analysis process. Finally, the results were reported using a modified Salmon's (2002) 5-stage model of Teaching and Learning On-line and Mezirow's (1981) levels of reflection. The students motivated each other by sharing their feelings and experiences. They noticed the value of peer support and started to learn from each other as well. By reflecting on their experiences, the students progressed in their learning process and at the same time advanced their reflective thinking process. This combination of theoretical knowledge and practice, based on the students' needs and interests, could lead to a deeper understanding which could also result in better clinical skills. This method offers the lecturers the possibility to support and follow the professional growth process in a new evidence-based manner.

  14. Vertigo in childhood: proposal for a diagnostic algorithm based upon clinical experience.

    PubMed

    Casani, A P; Dallan, I; Navari, E; Sellari Franceschini, S; Cerchiai, N

    2015-06-01

    The aim of this paper is to analyse, after clinical experience with a series of patients with established diagnoses and review of the literature, all relevant anamnestic features in order to build a simple diagnostic algorithm for vertigo in childhood. This study is a retrospective chart review. A series of 37 children underwent complete clinical and instrumental vestibular examination. Only neurological disorders or genetic diseases represented exclusion criteria. All diagnoses were reviewed after applying the most recent diagnostic guidelines. In our experience, the most common aetiology for dizziness is vestibular migraine (38%), followed by acute labyrinthitis/neuritis (16%) and somatoform vertigo (16%). Benign paroxysmal vertigo was diagnosed in 4 patients (11%) and paroxysmal torticollis was diagnosed in a 1-year-old child. In 8% (3 patients) of cases, the dizziness had a post-traumatic origin: 1 canalolithiasis of the posterior semicircular canal and 2 labyrinthine concussions, respectively. Menière's disease was diagnosed in 2 cases. A bilateral vestibular failure of unknown origin caused chronic dizziness in 1 patient. In conclusion, this algorithm could represent a good tool for guiding clinical suspicion to correct diagnostic assessment in dizzy children where no neurological findings are detectable. The algorithm has just a few simple steps, based mainly on two aspects to be investigated early: temporal features of vertigo and presence of hearing impairment. A different algorithm has been proposed for cases in which a traumatic origin is suspected.

  15. Management of genital herpes by genitourinary physicians: does experience or doctor's gender influence clinical management?

    PubMed Central

    Russell, J M; Cracknell, M; Barton, S E; Catalan, J

    1993-01-01

    OBJECTIVE--To determine the variation in management of genital herpes by genitourinary physicians, and whether their duration of experience or gender influence their clinical management. METHODS--A postal questionnaire was sent to UK consultant genitourinary physicians with detailed questions about management of primary and recurrent herpes. The gender and duration of genitourinary medicine experience of the physicians were also recorded. RESULTS--One hundred and eighty two questionnaires were sent, 112 (62%) returned. Eighty-one (72%) physicians treat all patients with primary genital herpes, but physicians with more than 20 years experience were significantly (p < 0.05) more likely to treat only "severe" primary attacks. Most experienced physicians were also most likely (p < 0.05) to prescribe topical acyclovir. Prescription of suppressive acyclovir was also influenced by the experience of the physician, the least experienced physicians being more likely to prescribe to patients who were HIV antibody positive or to those entering new relationships, whereas the more experienced prescribed to those patients who were particularly anxious (p < 0.05 for each of these). Male physicians were significantly more likely to agree with the proposition that men cope better with genital herpes (54%) than female physicians (24%, p < 0.01). CONCLUSION--The response to the questionnaire illustrates that management of genital herpes is influenced by the duration of the physicians clinical experience. Gender of the physician may have an indirect role to play as we have shown that physicians differ in their perception of how the sexes cope with genital herpes. PMID:8509090

  16. Clinical experiences with an ASP model backup archive for PACS images

    NASA Astrophysics Data System (ADS)

    Liu, Brent J.; Cao, Fei; Documet, Luis; Huang, H. K.; Muldoon, Jean

    2003-05-01

    Last year we presented a Fault-Tolerant Backup Archive using an Application Service Provider (ASP) model for disaster recovery. The purpose of this paper is to update and provide clinical experiences related towards implementing the ASP model archive solution for short-term backup of clinical PACS image data as well as possible applications other than disaster recovery. The ASP backup archive provides instantaneous, automatic backup of acquired PACS image data and instantaneous recovery of stored PACS image data all at a low operational cost and with little human intervention. This solution can be used for a variety of scheduled and unscheduled downtimes that occur on the main PACS archive. A backup archive server with hierarchical storage was implemented offsite from the main PACS archive location. Clinical data from a hospital PACS is sent to this ASP storage server in parallel to the exams being archived in the main server. Initially, connectivity between the main archive and the ASP storage server is established via a T-1 connection. In the future, other more cost-effective means of connectivity will be researched such as the Internet 2. We have integrated the ASP model backup archive with a clinical PACS at Saint John's Health Center and has been operational for over 6 months. Pitfalls encountered during integration with a live clinical PACS and the impact to clinical workflow will be discussed. In addition, estimations of the cost of establishing such a solution as well as the cost charged to the users will be included. Clinical downtime scenarios, such as a scheduled mandatory downtime and an unscheduled downtime due to a disaster event to the main archive, were simulated and the PACS exams were sent successfully from the offsite ASP storage server back to the hospital PACS in less than 1 day. The ASP backup archive was able to recover PACS image data for comparison studies with no complex operational procedures. Furthermore, no image data loss was

  17. Clinical and Histopathological Diagnosis of Glomus Tumor: An Institutional Experience of 138 Cases

    PubMed Central

    Mravic, Marco; LaChaud, Gregory; Nguyen, Alan; Scott, Michelle A.; Dry, Sarah M.; James, Aaron W.

    2015-01-01

    Background Glomus tumors are relatively uncommon subcentimeteric benign perivascular neoplasms usually located on the fingers. With their blue-red color and common subungual location, they are commonly confused for vascular or melanocytic lesions. To date there is no comprehensive review of an institutional experience with glomus tumors. Methods A 14-year retrospective review of all cases within University of California, Los Angeles, with either a clinical or pathological diagnosis of glomus tumor was performed. Data obtained included demographic information, tumor description, pathological diagnoses, immunohistochemical studies, radiographic and treatment information, and clinical course. Rates of concordance between clinical and pathological diagnoses and an evaluation of overlap with other entities were assessed. Results Clinical diagnosis of glomus tumor showed concordance with a histopathological diagnosis (45.4% of cases). The most common alternate clinical diagnoses included lipoma, cyst, or angioma. A pathological diagnosis of glomus tumor was most common in the fourth to seventh decades of life. The most common presentation was a subcentimeter lesion on the digit. Deep-seated tumors had a strikingly increased risk for malignancy (33%). Radiological studies were not relied on frequently (18.2% of cases). Immunohistochemical analysis showed diffuse αSMA and MSA expression in nearly all cases (99% and 95%, respectively), with focal to diffuse CD34 immunostaining in 32% of cases. Discussion Our study illustrates trends in the clinical versus pathologic diagnoses of glomus tumor, common competing diagnoses, a difference in demographics than is commonly reported (older age groups most commonly affected), and important differences in the use adjunctive diagnostic tools including radiology and immunohistochemistry. PMID:25614464

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

    PubMed

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

    2015-04-30

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

  19. Pegylated liposomal doxorubicin and immunomodulatory drug combinations in multiple myeloma: rationale and clinical experience.

    PubMed

    Chanan-Khan, Asher Alban; Lee, Kelvin

    2007-04-01

    The availability of new agents for multiple myeloma (MM) provides an opportunity to further improve response rates through the development of new combination regimens. Such new agents include pegylated liposomal doxorubicin (PLD) and the immunomodulatory drugs thalidomide and lenalidomide, all of which have demonstrated efficacy and safety in the treatment of newly diagnosed and relapsed/refractory MM. Based on their complementary mechanisms of action and nonoverlapping toxicity profiles, PLD and the immunomodulatory drugs might provide incremental benefits when used in combined treatment regimens. Thus, they have been evaluated in clinical studies that combine PLD/vincristine/dexamethasone and thalidomide (DVd-T) or PLD/vincristine/dexamethasone and lenalidomide (DVd-R) as well as in a study combining bortezomib with PLD and thalidomide. Results of all these studies have included high overall response rates, with improved rates of complete/near complete response compared with similar regimens that do not include chemotherapy (ie, immunomodulatory drugs plus dexamethasone). This article provides the clinical rationale for the use of PLD in combination with immunomodulatory drugs to treat patients with MM and summarizes the clinical experience with these combinations to date. Notably, the early phase I/II study results have been sufficiently encouraging to warrant further investigation in additional large-scale, phase II/III studies. Future clinical trials should focus on determining the optimal dose and schedule for each of these agents when used in combination and whether the addition of other new agents provides an additional response benefit.

  20. WE-G-BRC-00: Experiences with TG100 in Clinical Use.

    PubMed

    Kim, Grace Gwe-Ya

    2016-06-01

    Failure Mode and Effects Analysis (FMEA) originated as an industrial engineering technique used for risk management and safety improvement of complex processes. In the context of radiotherapy, the AAPM Task Group 100 advocates FMEA as the framework of choice for establishing clinical quality management protocols. However, there is concern that widespread adoption of FMEA in radiation oncology will be hampered by the perception that implementation of the tool will have a steep learning curve, be extremely time consuming and labor intensive, and require additional resources. To overcome these preconceptions and facilitate the introduction of the tool into clinical practice, the medical physics community must be educated in the use of this tool and the ease in which it can be implemented. Organizations with experience in FMEA should share their knowledge with others in order to increase the implementation, effectiveness and productivity of the tool. This session will include a brief, general introduction to FMEA followed by a focus on practical aspects of implementing FMEA for specific clinical procedures including HDR brachytherapy, physics plan review and radiosurgery. A description of common equipment and devices used in these procedures and how to characterize new devices for safe use in patient treatments will be presented. This will be followed by a discussion of how to customize FMEA techniques and templates to one's own clinic. Finally, cases of common failure modes for specific procedures (described previously) will be shown and recommended intervention methodologies and outcomes reviewed.

  1. Implementation of Electronic Checklists in an Oncology Medical Record: Initial Clinical Experience

    PubMed Central

    Albuquerque, Kevin V.; Miller, Alexis A.; Roeske, John C.

    2011-01-01

    Purpose: The quality of any medical treatment depends on the accurate processing of multiple complex components of information, with proper delivery to the patient. This is true for radiation oncology, in which treatment delivery is as complex as a surgical procedure but more dependent on hardware and software technology. Uncorrected errors, even if small or infrequent, can result in catastrophic consequences for the patient. We developed electronic checklists (ECLs) within the oncology electronic medical record (EMR) and evaluated their use and report on our initial clinical experience. Methods: Using the Mosaiq EMR, we developed checklists within the clinical assessment section. These checklists are based on the process flow of information from one group to another within the clinic and enable the processing, confirmation, and documentation of relevant patient information before the delivery of radiation therapy. The clinical use of the ECL was documented by means of a customized report. Results: Use of ECL has reduced the number of times that physicians were called to the treatment unit. In particular, the ECL has ensured that therapists have a better understanding of the treatment plan before the initiation of treatment. An evaluation of ECL compliance showed that, with additional staff training, > 94% of the records were completed. Conclusion: The ECL can be used to ensure standardization of procedures and documentation that the pretreatment checks have been performed before patient treatment. We believe that the implementation of ECLs will improve patient safety and reduce the likelihood of treatment errors. PMID:22043184

  2. Practical guide for implementing hybrid PET/MR clinical service: lessons learned from our experience

    PubMed Central

    Parikh, Nainesh; Friedman, Kent P.; Shah, Shetal N.; Chandarana, Hersh

    2015-01-01

    Positron emission tomography (PET) and magnetic resonance imaging, until recently, have been performed on separate PET and MR systems with varying temporal delay between the two acquisitions. The interpretation of these two separately acquired studies requires cognitive fusion by radiologists/nuclear medicine physicians or dedicated and challenging post-processing. Recent advances in hardware and software with introduction of hybrid PET/MR systems have made it possible to acquire the PET and MR images simultaneously or near simultaneously. This review article serves as a road-map for clinical implementation of hybrid PET/MR systems and briefly discusses hardware systems, the personnel needs, safety and quality issues, and reimbursement topics based on experience at NYU Langone Medical Center and Cleveland Clinic. PMID:25985966

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

    PubMed

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

    2005-11-01

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

  4. Family Nursing Therapeutic Conversations in Heart Failure Outpatient Clinics in Denmark: Nurses' Experiences.

    PubMed

    Voltelen, Barbara; Konradsen, Hanne; Østergaard, Birte

    2016-05-01

    As part of the Heart Failure Family Trial presently being conducted in Denmark, this qualitative process evaluation explored the perceptions of seven practicing cardiac nurses who offered family nursing therapeutic conversations (FNTC) to families in three heart failure outpatient clinics. FNTC were guided by the Calgary Family Assessment and Intervention Models. Data consisted of 34 case reports written by the nurses which documented the use of FNTC, including family responses to the FNTC. A focus group interview with the six of the nurses about their experience of offering FNTC was also conducted. Content analysis was performed using a combined deductive and inductive process. Nurses reported developing a distinct, closer, and more constructive relationship with the patients and their families and reported FNTC increased family bonding and strengthened family relationships. The nurses considered FNTC to be feasible interventions in the routine care provided in heart failure outpatient clinics.

  5. [Extrinsic allergic alveolitis. Clinical experience at the Instituto National de Enfermedades Respiratorias (INER)].

    PubMed

    Chapela-Mendoza, R; Selman-Lama, M

    1999-01-01

    Extrinsic allergic alveolitis is an interstitial lung disease caused by exposure to a variety of inhaled antigens. In Mexico, the most frequent form is due to the inhalation of avian antigens, markedly pigeon proteins. Depending on type and time exposure, the disease presents different clinical forms usually characterized by progressive dyspnea, ground glass or reticulonodular images on chest x rays, a restrictive functional pattern, rest hypoxemia worsening with exercise, and increase of T lymphocytes in bronchoalveolar lavage with an inversion in the helper/suppressor ratio. In this paper, we discuss a 15-year experience with this pathological problem in Mexico, emphasizing the differences with this disorder in Caucasian populations. Generally, our patients display a chronic form of the disease, which evolves to fibrosis in about one-half of the patients. In this sense, the diagnostic, prognostic, and therapeutic focusing exhibit different elements, and thus the development of clinical and basic research is strongly required.

  6. Vonoprazan-based therapy for Helicobacter pylori eradication: experience and clinical evidence

    PubMed Central

    Akazawa, Yuko; Fukuda, Daisuke; Fukuda, Yutaka

    2016-01-01

    Stable suppression of gastric acid secretion is a crucial factor in Helicobacter pylori eradication. Vonoprazan is a potassium-competitive acid blocker recently approved for use in Japan. As vonoprazan has a long duration of action and causes rapid and strong inhibition of gastric acid secretion, it has gained clinical attention for treating erosive oesophagitis, peptic ulcers, and H. pylori infection. In this review, we discuss the recent knowledge regarding the safety and efficacy of vonoprazan, focusing on its use in H. pylori eradication. The latest literature and our clinical experience have shown that vonoprazan-based therapies have satisfactory eradication rates. Additionally, vonoprazan-based therapies are associated with similar rates of adverse events as standard triple therapies with conventional proton-pump inhibitors. PMID:27803739

  7. Reflective Prompts to Guide Termination of the Psychiatric Clinical Student Nursing Experience.

    PubMed

    Hubbard, Grace B

    2016-04-01

    The average length of stay on psychiatric inpatient units has decreased in the past 40 years from 24.9 to 7.2 days. Inpatient psychiatric nurses are challenged to meet the standards and scope of practice despite the changing circumstances of their work environment. The amount of time student nurses spend with a given patient has been affected by changes in acute psychiatric inpatient care and decreased length of stay; however, opportunities exist for effective termination of the nurse-client relationship. Facilitation of students' awareness and understanding of the dynamics inherent in the termination process is an important teaching task for psychiatric nursing clinical instructors. In the current article, a clinically focused learning activity using structured prompts to guide and promote psychiatric nursing students' experiences with the process of termination is described and teaching strategies are discussed.

  8. Tracking Patient Encounters and Clinical Skills to Determine Competency in Ambulatory Care Advanced Pharmacy Practice Experiences

    PubMed Central

    Pereira, Chrystian R.; Harris, Ila M.; Moon, Jean Y.; Westberg, Sarah M.; Kolar, Claire

    2016-01-01

    Objective. To determine if the amount of exposure to patient encounters and clinical skills correlates to student clinical competency on ambulatory care advanced pharmacy practice experiences (APPEs). Design. Students in ambulatory care APPEs tracked the number of patients encountered by medical condition and the number of patient care skills performed. At the end of the APPE, preceptors evaluated students’ competency for each medical condition and skill, referencing the Dreyfus model for skill acquisition. Assessment. Data was collected from September 2012 through August 2014. Forty-six responses from a student tracking tool were matched to preceptor ratings. Students rated as competent saw more patients and performed more skills overall. Preceptors noted minimal impact on workload. Conclusions. Increased exposure to patient encounters and skills performed had a positive association with higher Dreyfus stage, which may represent a starting point in the conversation for more thoughtful design of ambulatory care APPEs. PMID:26941440

  9. Taken-for-granted assumptions about the clinical experience of newly graduated registered nurses from their pre-registration paid employment: A narrative inquiry.

    PubMed

    Law, Yee-Shui Bernice; Chan, E Angela

    2016-09-01

    Paid employment within clinical setting, such as externships for undergraduate student, are used locally and globally to better prepare and retain new graduates for actual practice and facilitate their transition into becoming registered nurses. However, the influence of paid employment on the post-registration experience of such nurses remains unclear. Through the use of narrative inquiry, this study explores how the experience of pre-registration paid employment shapes the post-registration experience of newly graduated registered nurses. Repeated individual interviews were conducted with 18 new graduates, and focus group interviews were conducted with 11 preceptors and 10 stakeholders recruited from 8 public hospitals in Hong Kong. The data were subjected to narrative and paradigmatic analyses. Taken-for-granted assumptions about the knowledge and performance of graduates who worked in the same unit for their undergraduate paid work experience were uncovered. These assumptions affected the quantity and quality of support and time that other senior nurses provided to these graduates for their further development into competent nurses and patient advocates, which could have implications for patient safety. It is our hope that this narrative inquiry will heighten awareness of taken-for-granted assumptions, so as to help graduates transition to their new role and provide quality patient care.

  10. Risk communication in clinical trials: A cognitive experiment and a survey

    PubMed Central

    2010-01-01

    Background A Royal Statistical Society Working Party recently recommended that "Greater use should be made of numerical, as opposed to verbal, descriptions of risk" in first-in-man clinical trials. This echoed the view of many clinicians and psychologists about risk communication. As the clinical trial industry expands rapidly across the globe, it is important to understand risk communication in Asian countries. Methods We conducted a cognitive experiment about participation in a hypothetical clinical trial of a pain relief medication and a survey in cancer and arthritis patients in Singapore. In part 1 of the experiment, the patients received information about the risk of side effects in one of three formats (frequency, percentage and verbal descriptor) and in one of two sequences (from least to most severe and from most to least severe), and were asked about their willingness to participate. In part 2, the patients received information about the risk in all three formats, in the same sequence, and were again asked about their willingness to participate. A survey of preference for risk presentation methods and usage of verbal descriptors immediately followed. Results Willingness to participate and the likelihood of changing one's decision were not affected by the risk presentation methods. Most patients indicated a preference for the frequency format, but patients with primary school or no formal education were indifferent. While the patients used the verbal descriptors "very common", "common" and "very rare" in ways similar to the European Commission's Guidelines, their usage of the descriptors "uncommon" and "rare" was substantially different from the EU's. Conclusion In this sample of Asian cancer and arthritis patients, risk presentation format had no impact on willingness to participate in a clinical trial. However, there is a clear preference for the frequency format. The lay use of verbal descriptors was substantially different from the EU's. PMID:20868525

  11. Senior dental students' experience with Cariogram in a pediatric dentistry clinic.

    PubMed

    Gonzalez, Cesar D; Okunseri, Christopher

    2010-02-01

    The study objective was to assess predoctoral dental students' experience with a caries risk assessment computer program in the pediatric dentistry clinic at Marquette University School of Dentistry. In 2005, spring semester sophomore dental students (class of 2008) were introduced to the caries risk assessment computer program "Cariogram." The students received a fifty-minute lecture on caries risk assessment and a demonstration on how to use Cariogram in the clinic. After two years of clinical exposure to Cariogram, sixty-six out of eighty senior dental students completed an anonymous eleven-item questionnaire on their experience with the tool. Each item on the questionnaire was scored on a five-point Likert scale with the exception of two questions. Full- and part-time faculty members in the pediatric dentistry clinic were involved in teaching and supervising students in the use of Cariogram for caries risk assessment after their training and calibration. Forty-five percent of the students who participated in the study agreed that Cariogram was easy to understand, and 18 percent disagreed. Thirty-six percent felt that it was easy to apply, and 25 percent reported that it was useful in determining caries preventive procedures. The students reported that 60 percent of full-time and 33 percent of part-time faculty were knowledgeable about Cariogram use. A majority of the students felt that Cariogram was not easy to understand, and eighty-two percent of them reported that they would not be using Cariogram in their private offices. Future studies should explore reasons why students do not feel inclined to use Cariogram as a caries risk assessment tool in their private practices even after being exposed to the tool in dental school.

  12. Vas deferens occlusion by percutaneous injection of polyurethane elastomer plugs: clinical experience and reversibility.

    PubMed

    Zhao, S C

    1990-05-01

    A non-incision method of vas occlusion based on the percutaneous injection of polyurethane elastomer solution to form plugs is described. The results are based on clinical experience in 12,000 men in which only 56 cases of minor complications were recorded. Follow-up of 500 men for up to 3 years demonstrated an azoospermia rate of 98%. Plugs have been removed from 86 men and, to date, 51 have made their wives pregnant. In those from which the plugs have been removed for more than 1 year (n = 31), the pregnancy rate is 100%.

  13. Clinical experience with a high-performance ATM-connected DICOM archive for cardiology

    NASA Astrophysics Data System (ADS)

    Solomon, Harry P.

    1997-05-01

    A system to archive large image sets, such as cardiac cine runs, with near realtime response must address several functional and performance issues, including efficient use of a high performance network connection with standard protocols, an architecture which effectively integrates both short- and long-term mass storage devices, and a flexible data management policy which allows optimization of image distribution and retrieval strategies based on modality and site-specific operational use. Clinical experience with such as archive has allowed evaluation of these systems issues and refinement of a traffic model for cardiac angiography.

  14. [Lumbar puncture training using simulation-based educational strategies: Experience in a clinical pediatric residency].

    PubMed

    Vassallo, Juan C; Gouguenheim, Bárbara; Ghiglione, Analía; Bravo, Nélida; Prudencio, Carla I; Villois, Florencia; Abadie, Yamila; Zubieta, Ana; Golini, Carol; Villar, Victoria; Rodríguez, Susana P

    2015-12-01

    Pediatricians should acquire multiple skills during their professional training, including procedural skills. Skill acquisition requires knowledge on theoretical bases, direct observation and, lastly, supervised repetitive practice. Training using simulators allows to learn procedures in a controlled setting, ensuring patients' safety, integrating this as a learning stage prior to the actual contact with patients. Here we report on the teaching experience of a simulated lumbar puncture procedure. Training was provided to 112 first year pediatric residents who entered Hospital Prof. Dr. Juan P. Garrahan in the 2013-2014 period. Educational contents included communication with parents regarding the procedure, material preparation, compliance with biosafety standards, sepsis and general patient care, puncture and subsequent cerebrospinal fluid collection, and specimen collection. Strategies included, in a sequential order, the introduction of theoretical aspects using the bibliography and audiovisual resources available at the hospital's online campus and subsequent practice of lumbar puncture in a 3-month-old infant phantom on a lateral recumbent position that allowed to make a puncture and collect cerebrospinal fluid. At each training session, the level of confidence was measured before and after the procedure, and a checklist was developed to verify an adequate compliance with each step of the procedure. The simulated lumbar puncture training model has been introduced as an educational strategy of our Pediatric Residency Program.

  15. [New bone distraction device for induced osteogenesis of the mandible. Experience with 126 clinical cases].

    PubMed

    Fuente del Campo, A

    2000-01-01

    In this paper, the author describes the distraction devise designed and developed by the author to perform the procedure of inducted bone generation or "bone distraction". The characteristics, principles, and advantages of this device are also described in comparison with other more expensive devices. The author's clinic experience using this device: 126 patients with a maximum follow-up of 54/12 years and an average bone distraction of 31 mm. The procedure was done on patients from 8/12 to 38 years of age. Bone distraction is a good option for early reconstruction of craniofacial skeletal defects, eliminating the need for bone grafts, maxillo-mandibular fixation, and other more aggressive and complex procedures. The results obtained with this distractor show that it is a stable, precise, and useful device. Its low cost and the simplicity of the technique make it very accessible to every surgeon with some experience in bone surgery and craniofacial or othognatic surgery.

  16. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy.

    PubMed Central

    Sosa, J A; Bowman, H M; Tielsch, J M; Powe, N R; Gordon, T A; Udelsman, R

    1998-01-01

    OBJECTIVE: To determine whether individual surgeon experience is associated with improved short-term clinical and economic outcomes for patients with benign and malignant thyroid disease who underwent thyroid procedures in Maryland between 1991 and 1996. SUMMARY BACKGROUND DATA: There is a prevailing belief that surgeon experience affects patient outcomes in endocrine surgery, but there is a paucity of objective evidence outside of clinical series published by experienced surgeons that supports this view. METHODS: A cross-sectional analysis of all patients who underwent thyroidectomy in Maryland between 1991 and 1996 was conducted using a computerized statewide hospital discharge data base. Surgeons were categorized by volume of thyroidectomies over the 6-year study period: A (1 to 9 cases), B (10 to 29 cases), C (30 to 100 cases), and D (>100 cases). Multivariate regression was used to assess the relation between surgeon caseload and in-hospital complications, length of stay, and total hospital charges, adjusting for case mix and hospital volume. RESULTS: The highest-volume surgeons (group D) performed the greatest proportion of total thyroidectomies among the 5860 discharges, and they were more likely to operate on patients with cancer. After adjusting for case mix and hospital volume, highest-volume surgeons had the shortest length of stay (1.4 days vs. 1.7 days for groups B and C and 1.9 days for group A) and the lowest complication rate (5.1 % vs. 6.1% for groups B and C and 8.6% for group A). Length of stay and complications were more determined by surgeon experience than hospital volume, which had no consistent association with outcomes. CONCLUSIONS: Individual surgeon experience is significantly associated with complication rates and length of stay for thyroidectomy. PMID:9742915

  17. Drug administration in animal studies of cardiac arrest does not reflect human clinical experience

    PubMed Central

    Reynolds, Joshua C.; Rittenberger, Jon C.; Menegazzi, James J.

    2007-01-01

    Introduction To date, there is no evidence showing a benefit from any advanced cardiac life support (ACLS) medication in out-of-hospital cardiac arrest (OOHCA), despite animal data to the contrary. One explanation may be a difference in the time to first drug administration. Our previous work has shown the mean time to first drug administration in clinical trials is 19.4 minutes. We hypothesized that the average time to drug administration in large animal experiments occurs earlier than in OOHCA clinical trials. Methods We conducted a literature review between 1990 and 2006 in MEDLINE using the following MeSH headings: swine, dogs, resuscitation, heart arrest, EMS, EMT, ambulance, ventricular fibrillation, drug therapy, epinephrine, vasopressin, amiodarone, lidocaine, magnesium, and sodium bicarbonate. We reviewed the abstracts of 331 studies and 197 full manuscripts. Exclusion criteria included: non-peer reviewed, all without primary animal data, and traumatic models. From these, we identified 119 papers that contained unique information on time to medication administration. The data are reported as mean, ranges, and 95% confidence intervals. Mean time to first drug administration in animal laboratory studies and clinical trials was compared with a t-test. Regression analysis was performed to determine if time to drug predicted ROSC. Results Mean time to first drug administration in 2378 animals was 9.5 minutes (range 3.0–28.0; 95% CI around mean 2.78, 16.22). This is less than the time reported in clinical trials (19.4 min, p<0.001). Time to drug predicted ROSC (Odds Ratio 0.844; 95% CI 0.738, 0.966). Conclusion Shorter drug delivery time in animal models of cardiac arrest may be one reason for the failure of animal studies to translate successfully into the clinical arena. PMID:17360097

  18. The actual goals of geoethics

    NASA Astrophysics Data System (ADS)

    Nemec, Vaclav

    2014-05-01

    The most actual goals of geoethics have been formulated as results of the International Conference on Geoethics (October 2013) held at the geoethics birth-place Pribram (Czech Republic): In the sphere of education and public enlightenment an appropriate needed minimum know how of Earth sciences should be intensively promoted together with cultivating ethical way of thinking and acting for the sustainable well-being of the society. The actual activities of the Intergovernmental Panel of Climate Changes are not sustainable with the existing knowledge of the Earth sciences (as presented in the results of the 33rd and 34th International Geological Congresses). This knowledge should be incorporated into any further work of the IPCC. In the sphere of legislation in a large international co-operation following steps are needed: - to re-formulate the term of a "false alarm" and its legal consequences, - to demand very consequently the needed evaluation of existing risks, - to solve problems of rights of individuals and minorities in cases of the optimum use of mineral resources and of the optimum protection of the local population against emergency dangers and disasters; common good (well-being) must be considered as the priority when solving ethical dilemmas. The precaution principle should be applied in any decision making process. Earth scientists presenting their expert opinions are not exempted from civil, administrative or even criminal liabilities. Details must be established by national law and jurisprudence. The well known case of the L'Aquila earthquake (2009) should serve as a serious warning because of the proven misuse of geoethics for protecting top Italian seismologists responsible and sentenced for their inadequate superficial behaviour causing lot of human victims. Another recent scandal with the Himalayan fossil fraud will be also documented. A support is needed for any effort to analyze and to disclose the problems of the deformation of the contemporary

  19. Association between self-efficacy, career interest and rural career intent in Australian medical students with rural clinical school experience

    PubMed Central

    Isaac, Vivian; Walters, Lucie; McLachlan, Craig S

    2015-01-01

    Objectives To investigate medical student's self-efficacy at the time of finishing their rural clinical school (RCS) placement and factors associated with self-efficacy. Secondary aims are to explore whether interest levels or self-efficacy are associated with rural or remote career intentions. Design, setting and participants A cross-sectional study of medical students who had completed their RCS term in 17 Australian universities. Data were derived from the 2013 Federation of Rural Australian Medical Educators (FRAME) evaluation survey. Questionnaire responses were analysed from 653 medical students from regional Australia. All 732 students who completed their RCS term in 2013 were invited to participate. Primary and secondary outcome measures Rural self-efficacy: Six questions to measure self-efficacy beliefs in rural medical practice, based on the sources of self-efficacy described by Bandura. Rural career intention: Students were asked to identify their preferred location for future practice. The options were, Capital or Major City; Inner regional city or large town; Smaller town and very remote area. Results Questionnaire responses were analysed from 653 medical students from regional Australia (response rate 89.2%). 83.8% of all students recalled an increase in their interest levels for rural medicine as a result of their RCS experience. Actual career intention to work in a regional area or rural area was 60.2%. Bivariate analyses showed female gender (p=0.003), rural background (p<0.001), an RCS preference for clinical training (p<0.001) and general practice intentions (p=0.004) were factors associated with higher levels of self-efficacy. Logistic regression analyses showed that self-efficacy was independently associated with increased interest in rural medicine (OR 1.4 (95% CI 1.3 to 1.5)) and rural career intent (OR 1.2 (95% CI 1.1 to 1.3)). (Model included gender, rural background, preference for RCS, generalist intent, rural practice interest and self

  20. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study

    PubMed Central

    Phillips, Cameron J; Marshall, Andrea P; Chaves, Nadia J; Jankelowitz, Stacey K; Lin, Ivan B; Loy, Clement T; Rees, Gwyneth; Sakzewski, Leanne; Thomas, Susie; To, The-Phung; Wilkinson, Shelley A; Michie, Susan

    2015-01-01

    Background The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF. PMID:25834455

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

    PubMed Central

    Park, Taeyeol; Lee, Sanghun

    2016-01-01

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

  2. The logic of turmoil: some epistemological and clinical considerations on emotional experience and the infinite.

    PubMed

    Bria, Pietro; Lombardi, Riccardo

    2008-08-01

    The idea of the infinite has its origins in the very beginnings of western philosophy and was developed significantly by modern philosophers such as Galileo and Leibniz. Freud discovered the Unconscious which does not respect the laws of classical logic, flouting its fundamental principle of non-contradiction. This opened the way to a new epistemology in which classical logic coexists with an aberrant logic of infinite affects. Matte Blanco reorganized this Freudian revolution in logic and introduced the concept of bi-logic, which is an intermingling of symmetric and Aristotelic logics. The authors explore some epistemological and clinical aspects of the functioning of the deep unconscious where the emergence of infinity threatens to overwhelm the containing function of thought, connecting this topic to some of Bion's propositions. They then suggest that bodily experiences can be considered a prime source of the logic of turmoil, and link a psychoanalytic consideration of the infinite to the mind-body relation. Emotional catastrophe is seen both as a defect-a breakdown of the unfolding function which translates unconscious material into conscious experience-and as the consequence of affective bodily pressures. These pressures function in turn as symmetrizing or infinitizing operators. Two clinical vignettes are presented to exemplify the hypotheses.

  3. Learning from clinical placement experience: Analysing nursing students' final reflections in a digital storytelling activity.

    PubMed

    Paliadelis, Penny; Wood, Pamela

    2016-09-01

    This paper reports on the learning potential of a reflective activity undertaken by final year nursing students, in which they were asked to recount two meaningful events that occurred during their clinical placements over the duration of their 3-year nursing degree program and reflect on how these events contributed to their learning to become beginning level Registered Nurses (RNs). This descriptive qualitative study gathered narratives from 92 students as individual postings in an online forum created within the University's learning management system. An analysis of the students' reflections are the focus of this paper particularly in relation to the value of reflecting on the identified events. Four themes emerged that clearly highlight the way in which these students interpreted and learned from both positive and negative clinical experiences, their strong desire to fit into their new role and their ability to re-imagine how they might respond to clinical events when they become Registered Nurses. The findings of this study may contribute to developing nursing curricula that better prepares final year students for the realities of practice.

  4. Who benefits most from THC:CBD spray? Learning from clinical experience.

    PubMed

    Koehler, Jürgen

    2014-01-01

    Patients with multiple sclerosis (MS) represent a diverse and heterogeneous population varying in terms of disease type, its severity and variable progression/time-course, and with regard to the wide range of presenting symptoms. Consequently, detailed experience with individual patients is important to provide examples of therapy to specific patient types. In this article, real-life data from clinical practice showing specific aspects relating to use of 9-delta-tetrahydocannabinol and cannabidiol (THC:CBD) oromucosal spray (Sativex®) in patients with moderate to severe spasticity resistant to usual therapy will be presented. Three common clinical scenarios will be considered: MS patients with resistance to usual spasticity therapies; patients with impairment in MS spasticity symptoms; MS patients with relevant impairment in quality of life/activities of daily living (QoL/ADL). These case reports highlight the diverse nature of the MS spasticity population and they show the possible usefulness of THC:CBD oromucosal spray in individual patients with moderate to severe spasticity resistant to existing therapies, within the frame of use approved after large clinical trial results. Perhaps the most important finding is the possibility of obtaining relevant improvements in QoL/ADL in some patients with resistant MS spasticity, allowing them to engage back in physical and social activities.

  5. Running a postmortem service--a business case and clinical experience.

    PubMed

    Cohen, Marta C; Whitby, Elspeth; Fink, Michelle A; Collett, Jacquelene M; Offiah, Amaka C

    2015-04-01

    The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia.

  6. Experience with Clinically Diagnosed Down Syndrome Children Admitted with Diarrhea in an Urban Hospital in Bangladesh.

    PubMed

    Das, Rina; Sarker, Anupam; Saha, Haimanti; Bin Shahid, Abu Sadat Mohammad Sayeem; Shahunja, K M; Chisti, Mohammod Jobayer

    2015-01-01

    There is lack of information in the medical literature on clinically diagnosed Down syndrome children presenting with diarrhea. Our aim was to describe our experience with Down syndrome patients admitted with diarrhea by evaluating the factors associated with Down syndrome presenting with diarrheal illness. In this retrospective chart analysis, we enrolled all the diarrheal children aged 0-59 months admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), from March 2011 to February 2013. Down syndrome children with diarrhea constituted cases and randomly selected threefold diarrheal children without Down syndrome constituted controls. Among 8422 enrolled children 32 and 96 were the cases and the controls, respectively. Median age (months) of the cases and the controls was comparable (7.6 (4.0, 15.0) versus 9.0 (5.0, 16.8); p = 0.496). The cases more often presented with severe acute malnutrition, developmental delay, congenital heart disease, hypothyroidism, sepsis, hypocalcemia, developed hospital acquired infection (HAI) during hospitalization, and required prolonged stay at hospital compared to the controls (for all p < 0.05). Thus, diarrheal children with clinically diagnosed Down syndrome should be investigated for these simple clinical parameters for their prompt management that may prevent HAI and prolonged hospital stay.

  7. Assessing decentering: validation, psychometric properties, and clinical usefulness of the Experiences Questionnaire in a Spanish sample.

    PubMed

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

    2014-11-01

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

  8. Critical periods after stroke study: translating animal stroke recovery experiments into a clinical trial

    PubMed Central

    Dromerick, Alexander W.; Edwardson, Matthew A.; Edwards, Dorothy F.; Giannetti, Margot L.; Barth, Jessica; Brady, Kathaleen P.; Chan, Evan; Tan, Ming T.; Tamboli, Irfan; Chia, Ruth; Orquiza, Michael; Padilla, Robert M.; Cheema, Amrita K.; Mapstone, Mark E.; Fiandaca, Massimo S.; Federoff, Howard J.; Newport, Elissa L.

    2015-01-01

    Introduction: Seven hundred ninety-five thousand Americans will have a stroke this year, and half will have a chronic hemiparesis. Substantial animal literature suggests that the mammalian brain has much potential to recover from acute injury using mechanisms of neuroplasticity, and that these mechanisms can be accessed using training paradigms and neurotransmitter manipulation. However, most of these findings have not been tested or confirmed in the rehabilitation setting, in large part because of the challenges in translating a conceptually straightforward laboratory experiment into a meaningful and rigorous clinical trial in humans. Through presentation of methods for a Phase II trial, we discuss these issues and describe our approach. Methods: In rodents there is compelling evidence for timing effects in rehabilitation; motor training delivered at certain times after stroke may be more effective than the same training delivered earlier or later, suggesting that there is a critical or sensitive period for strongest rehabilitation training effects. If analogous critical/sensitive periods can be identified after human stroke, then existing clinical resources can be better utilized to promote recovery. The Critical Periods after Stroke Study (CPASS) is a phase II randomized, controlled trial designed to explore whether such a sensitive period exists. We will randomize 64 persons to receive an additional 20 h of upper extremity therapy either immediately upon rehab admission, 2–3 months after stroke onset, 6 months after onset, or to an observation-only control group. The primary outcome measure will be the Action Research Arm Test (ARAT) at 1 year. Blood will be drawn at up to 3 time points for later biomarker studies. Conclusion: CPASS is an example of the translation of rodent motor recovery experiments into the clinical setting; data obtained from this single site randomized controlled trial will be used to finalize the design of a Phase III trial. PMID

  9. SU-E-T-344: Validation and Clinical Experience of Eclipse Electron Monte Carlo Algorithm (EMC)

    SciTech Connect

    Pokharel, S; Rana, S

    2014-06-01

    Purpose: The purpose of this study is to validate Eclipse Electron Monte Carlo (Algorithm for routine clinical uses. Methods: The PTW inhomogeneity phantom (T40037) with different combination of heterogeneous slabs has been CT-scanned with Philips Brilliance 16 slice scanner. The phantom contains blocks of Rando Alderson materials mimicking lung, Polystyrene (Tissue), PTFE (Bone) and PMAA. The phantom has 30×30×2.5 cm base plate with 2cm recesses to insert inhomogeneity. The detector systems used in this study are diode, tlds and Gafchromic EBT2 films. The diode and tlds were included in CT scans. The CT sets are transferred to Eclipse treatment planning system. Several plans have been created with Eclipse Monte Carlo (EMC) algorithm 11.0.21. Measurements have been carried out in Varian TrueBeam machine for energy from 6–22mev. Results: The measured and calculated doses agreed very well for tissue like media. The agreement was reasonably okay for the presence of lung inhomogeneity. The point dose agreement was within 3.5% and Gamma passing rate at 3%/3mm was greater than 93% except for 6Mev(85%). The disagreement can reach as high as 10% in the presence of bone inhomogeneity. This is due to eclipse reporting dose to the medium as opposed to the dose to the water as in conventional calculation engines. Conclusion: Care must be taken when using Varian Eclipse EMC algorithm for dose calculation for routine clinical uses. The algorithm dose not report dose to water in which most of the clinical experiences are based on rather it just reports dose to medium directly. In the presence of inhomogeneity such as bone, the dose discrepancy can be as high as 10% or even more depending on the location of normalization point or volume. As Radiation oncology as an empirical science, care must be taken before using EMC reported monitor units for clinical uses.

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

    PubMed

    Lindop, E; Cannon, S

    2001-06-01

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

  11. Student Exposure to Actual Patients in the Classroom.

    ERIC Educational Resources Information Center

    Chisholm, Marie A.; McCall, Charles Y.; Francisco, George E., Jr.; Poirier, Sylvie

    1997-01-01

    Two clinical courses for first-year dental students were designed to develop students' interaction skills through actual patient case presentations and discussions and an interdisciplinary teaching approach. Results indicate students preferred the case presentations, with or without lecture, to the lecture-only approach and felt they learned more…

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

    PubMed

    Logan, Gemma

    2015-03-01

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

  13. Clinical experience in applying endoscopic Nd:YAG laser to treat 451 esophagostenotic cases

    NASA Astrophysics Data System (ADS)

    Wang, Rui-Zhong; Wang, Zhen-he; Lu, Kuang-sheng; Yang, Xiao-zhi; Lu, Bo-kao

    1991-07-01

    This paper is to report and analyze our clinical experience in ap].ying endosoopi. c Nd:YAG laser to treat 451 esophagostenoses (1197 peraon times) including all kinds of then. All kinds of esophagostexiosis were mainly characterized by having difficulties swallowing foods. Some of their esophagus were even oompletely obstructed and could not drink even a drop of water On the basis of experint&xts in animals, fresh organs of the body, we started to treat all kinds of esophagostenosis with endoscopio Nd:YAG laser in 1985. By the end of 1989, 451 patients bad been treated in our hospital. Boh the patients and we felt satisfactory with the results we gain.

  14. Clinical experience of Hokkaido University-PACS and FCR-angiography.

    PubMed

    Terae, S; Hawkin, S; Sato, Y; Kikuchi, Y; Abe, S; Miyasaka, K

    1994-05-01

    Three years' experience with Hokkaido University-PACS (HU-PACS) is reported. In particular, this paper describes the suitability of FCR-angiography for HU-PACS, which has been in clinical use since March 1991. Image quality of FCR-arteriograms was evaluated in the head-and-face region and the abdominal region independently. The image quality in both regions was excellent. Quality of transferred images to image workstation for HU-PACS with 10:1 data compression was also evaluated, and no appreciable image degradation or loss of information was found in the transferred images. There was no significant difference in the examination time required for one patient in abdominal angiography between conventional angiography and FCR-angiography. In summary, FCR-angiography is suitable for HU-PACS as its image acquisition modality.

  15. A qualitative study of patients' experiences of a nurse-led memory clinic.

    PubMed

    Stirling, Christine; Campbell, Briony; Bentley, Michael; Bucher, Hazel; Morrissey, Martin

    2016-01-01

    Little is known about patients' decision-making to attend a nurse-led memory clinic (NLMC) or of their experiences in the months following attendance. This paper reports qualitative follow-up data from 13 participants who attended a NLMC run by a Nurse Practitioner, and who were interviewed later in their own homes. Participants attended the NLMC seeking 'benchmarking' against the broader population or confirmation of diagnosis, with the Nurse Practitioner perceived as having more time to talk. Although we anticipated that participants would have changed some behaviours to incorporate 'brain health material', we found that the focus was on maintaining current capacity and lifestyle with most participants delaying planning and decisions about future lifestyle changes until 'necessary'. Understanding why people contact a NLMC and how their participation influences future planning can help us better target health care messages with the aim of improving health literacy.

  16. Patients' Perceptions and Experiences of Shared Decision-Making in Primary HIV Care Clinics.

    PubMed

    Fuller, Shannon M; Koester, Kimberly A; Guinness, Ryan R; Steward, Wayne T

    Shared decision-making (SDM) is considered best practice in health care. Prior studies have explored attitudes and barriers/facilitators to SDM, with few specific to HIV care. We interviewed 53 patients in HIV primary care clinics in California to understand the factors and situations that may promote or hinder engagement in SDM. Studies in other populations have found that patients' knowledge about their diseases and their trust in providers facilitated SDM. We found these features to be more nuanced for HIV. Perceptions of personal agency, knowledge about one's disease, and trust in provider were factors that could work for or against SDM. Overall, we found that participants described few experiences of SDM, especially among those with no comorbidities. Opportunities for SDM in routine HIV care (e.g., determining antiretroviral therapy) may arise infrequently because of treatment advances. These findings yield considerations for adapting SDM to fit the context of HIV care.

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

    NASA Astrophysics Data System (ADS)

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

    1995-05-01

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

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

    SciTech Connect

    Mackley, Heath B. . E-mail: hmackley@alumni.upenn.edu; Reddy, Chandana A. M.S.; Lee, S.-Y.; Harnisch, Gayle A.; Mayberg, Marc R.; Hamrahian, Amir H.; Suh, John H.

    2007-01-01

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

  19. Clinical experience with electroconvulsive therapy at the Instituto Mexicano de Psiquiatría.

    PubMed

    Sánchez de Carmona Luna Y Parra, M; Páez Agraz, F; Nicolini Sánchez, H

    1996-01-01

    Electroconvulsive therapy (ECT) is a useful option for the treatment of certain psychiatric illnesses. Its efficacy and few side effects make it an important therapeutic alternative in the management of the patient with major depression. This study describes the clinical experience with ECT at the Instituto Mexicano de Psiquiatría. We retrospectively evaluated the clinical records of patients treated with ECT during the period of April 1990 to June 1994. A total of 55 patients were included in the analysis, the mean age was 42.4 +/- 17.2 years old. Diagnostic categories treated were major depression (43.6%), non-affective psychotic disorders (30.9%), mania (12.7%) and other diagnoses (12.7%). A positive response to ECT was found in 74.5% of patients. Subjects with major depression and mania responded significantly better than the rest of the patients (p < 0.01). Psychotic depression was not a predictor of better response. Only 18.1% of subjects had minor complications, all transitory. ECT is a highly effective therapeutic option in the treatment of psychiatric illness, especially in major depression and mania. The use of ECT in a tertiary psychiatric unit in Mexico reflects similar results as described in the international literature.

  20. Isavuconazole: Pharmacology, Pharmacodynamics, and Current Clinical Experience with a New Triazole Antifungal Agent.

    PubMed

    Rybak, Jeffrey M; Marx, Kayleigh R; Nishimoto, Andrew T; Rogers, P David

    2015-11-01

    Coinciding with the continually increasing population of immunocompromised patients worldwide, the incidence of invasive fungal infections has grown over the past 4 decades. Unfortunately, infections caused by both yeasts such as Candida and molds such as Aspergillus or Mucorales remain associated with unacceptably high morbidity and mortality. In addition, the available antifungals with proven efficacy in the treatment of these infections remain severely limited. Although previously available second-generation triazole antifungals have significantly expanded the spectrum of the triazole antifungal class, these agents are laden with shortcomings in their safety profiles as well as formulation and pharmacokinetic challenges. Isavuconazole, administered as the prodrug isavuconazonium, is the latest second-generation triazole antifungal to receive U.S. Food and Drug Administration approval. Approved for the treatment of both invasive aspergillosis and invasive mucormycosis, and currently under investigation for the treatment of candidemia and invasive candidiasis, isavuconazole may have therapeutic advantages over its predecessors. With clinically relevant antifungal potency against a broad range of yeasts, dimorphic fungi, and molds, isavuconazole has a spectrum of activity reminiscent of the polyene amphotericin B. Moreover, clinical experience thus far has revealed isavuconazole to be associated with fewer toxicities than voriconazole, even when administered without therapeutic drug monitoring. These characteristics, in an agent available in both a highly bioavailable oral and a β-cyclodextrin-free intravenous formulation, will likely make isavuconazole a welcome addition to the triazole class of antifungals.

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

    SciTech Connect

    Irie, Toshiyuki

    2006-12-15

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

  2. Mustard gas: clinical, toxicological, and mutagenic aspects based on modern experience.

    PubMed

    Aasted, A; Darre, E; Wulf, H C

    1987-10-01

    Based on a study of the literature and our own experience treating fisherman poisoned by mustard gas, this article outlines the clinical effects, and toxicological and mutagenic properties of the agent. Mustards are very persistent chemical agents that easily penetrate clothing. Mustard gas usually causes clinical symptoms after the liquid penetrates the skin or the vapor is inhaled. Skin lesions are similar to first- or second-degree burns and usually heal spontaneously in 4 to 6 weeks. Eye symptoms are photophobia and reduced vision. Following inhalation of the agent, pulmonary edema and long-term dyspnea may be seen. As mustard gas is an alkylating substance, it is conceivable that the risk of developing cancer may be increased, as observed in people who were involved with the production of mustard gas and in animals exposed to the gas. Also, transient significantly increased sister chromatid exchange rates have been found in fishermen exposed to mustard gas. Patients exposed to mustard gas must be treated immediately after exposure. Treatment should consist of cleaning of the exposed skin and clothes with an antigas powder and water and soap. The skin lesions should be treated as burns. Eye lesions and respiratory problems should be treated symptomatically.

  3. Clinical and Neuroradiological Spectrum of Metronidazole Induced Encephalopathy: Our Experience and the Review of Literature

    PubMed Central

    Panwar, Ajay; Pandit, Alak; Das, Susanta Kumar; Joshi, Bhushan

    2016-01-01

    Metronidazole is an antimicrobial agent mainly used in the treatment of several protozoal and anaerobic infections, additionally, is often used in hepatic encephalopathy and Crohn disease. Apart from peripheral neuropathy, metronidazole can also cause symptoms of central nervous system dysfunction like ataxic gait, dysarthria, seizures, and encephalopathy which may result from both short term and chronic use of this drug and is collectively termed as “metronidazole induced encephalopathy”(MIE). Neuroimaging forms the backbone in clinching the diagnosis of this uncommon entity, especially in cases where there is high index of suspicion of intoxication. Although typical sites of involvement include cerebellum, brain stem and corpus callosum, however, lesions of other sites have also been reported. Once diagnosed, resolution of findings on Magnetic Resonance Imaging (MRI) of the Brain along with clinical improvement remains the mainstay of monitoring. Here we review the key clinical features and MRI findings of MIE as reported in medical literature. We also analyze implication of use of this drug in special situations like hepatic encephalopathy and brain abscess and discuss our experience regarding this entity. PMID:27504340

  4. Nursing students' experiences of ethical issues in clinical practice: A New Zealand study.

    PubMed

    Sinclair, J; Papps, E; Marshall, B

    2016-03-01

    Nursing students experience ethical problems in clinical practice in a different way from registered nurses. In order to develop ethical reasoning and competence in nursing students, nurse educators must recognise the unique issues students face. This research described the occurrence of ethical issues in clinical practice for 373 undergraduate nursing students who responded to a national questionnaire investigating the frequency of pre-determined ethical issues and the corresponding level of distress. Over two thirds of respondents experienced breaches of a patient's right to confidentiality, privacy, dignity or respect and 87% experienced unsafe working conditions. The most distressing issues were those that compromised patient safety, including unsafe healthcare practices, working conditions and suspected abuse or neglect. Themes that emerged from an open-ended question included lack of support and supervision, bullying and end of life issues. This research found the frequency at which ethical issues are experienced was highest in year three participants. However, the overall distress levels were lower for the majority of issues for those participants in the later part of their degree. Recommendations from this research include developing ethics education around the main concerns that students face in order to enhance students' understanding, resilience and ability to respond appropriately.

  5. Death in the clinic: Women's perceptions and experiences of discarding supernumerary IVF embryos.

    PubMed

    de Lacey, Sheryl

    2016-10-22

    Perspectives on the status of human embryos and whether they should be discarded differ globally. Some countries protect embryos in law while in other countries embryos 'die' or 'succumb' in assisted reproductive technology clinics on a daily basis. This study analyses interview data drawn from a larger qualitative study conducted in South Australia from 2004-2007. 21 women and 12 of 21 partners were interviewed about the decision they made to discard their embryos. The analysis reported here sought to examine the ways in which women constructed and experienced the decision to discard embryos. The article highlights the ways in which embryo discard is a contested discursive space. Embryo death is sequestered through their confinement in the laboratory and their invisibility to the naked eye. The clinic treated embryo discard as disposal of biological waste and failed to acknowledge the meaning of the event. By contrast women experienced emotional bereavement described as similar to early pregnancy loss, and described experiences of attachment and grief. For sensitive and compassionate care these differences in perceptions of embryo discard need to be addressed.

  6. Pre-clinical Experience with a Multi-Chordal Patch for Mitral Valve Repair.

    PubMed

    Chawla, Surendra K; Shi, Weiwei; McIver, Bryant V; Vinten-Johansen, Jakob; Frater, Robert W M; Padala, Muralidhar

    2016-04-01

    Surgical repair of flail mitral valve leaflets with neochordoplasty has good outcomes, but implementing it in anterior and bi-leaflet leaflet repair is challenging. Placing and sizing individual neochordae is time consuming and error prone, with persistent localized flail if performed incorrectly. In this study, we report our pre-clinical experience with a novel multi-chordal patch for mitral valve repair. The device was designed based on human cadaver hearts, and laser cut from expanded polytetrafluoroethylene. The prototypes were tested in: (stage 1) ex vivo hearts with leaflet flail (N = 6), (stage 2) acute swine induced with flail (N = 6), and (stage 3) two chronic swine survived to 23 and 120 days (N = 2). A2 and P2 prolapse were successfully repaired with coaptation length restored to 8.1 ± 2.2mm after posterior repair and to 10.2 ± 1.3mm after anterior repair in ex vivo hearts. In vivo, trace regurgitation was seen after repair with excellent patch durability, healing, and endothelialization at euthanasia. A new device for easier mitral repair is reported, with good early pre-clinical outcomes.

  7. Finnish physicians' experiences with computer-supported patient information exchange and communication in clinical work.

    PubMed

    Viitanen, Johanna; Nieminen, Marko; Hypponen, Hannele; Laaveri, Tinja

    2011-01-01

    Several researchers share the concern of healthcare information systems failing to support communication and collaboration in clinical practices. The objective of this paper is to investigate the current state of computer-supported patient information exchange and associated communication between clinicians. We report findings from a national survey on Finnish physicians? experiences with their currently used clinical information systems with regard to patient information documentation, retrieval, management and exchange-related tasks. The questionnaire study with 3929 physicians indicated the main concern being cross-organisational patient information delivery. In addition, physicians argued computer usage increasingly steals time and attention from caring activities and even disturbs physician?nurse collaboration. Problems in information management were particularly emphasised among those physicians working in hospitals and wards. The survey findings indicated that collaborative applications and mobile or wireless solutions have not been widely adapted in Finnish healthcare and suggested an urgent need for adopting appropriate information and communication technology applications to support information exchange and communication between physicians, and physicians and nurses.

  8. Results of 1 year of clinical experience with independent dose calculation software for VMAT fields

    PubMed Central

    Colodro, Juan Fernando Mata; Berna, Alfredo Serna; Puchades, Vicente Puchades; Amores, David Ramos; Baños, Miguel Alcaraz

    2014-01-01

    It is widely accepted that a redundant independent dose calculation (RIDC) must be included in any treatment planning verification procedure. Specifically, volumetric modulated arc therapy (VMAT) technique implies a comprehensive quality assurance (QA) program in which RIDC should be included. In this paper, the results obtained in 1 year of clinical experience are presented. Eclipse from Varian is the treatment planning system (TPS), here in use. RIDC were performed with the commercial software; Diamond® (PTW) which is capable of calculating VMAT fields. Once the plan is clinically accepted, it is exported via Digital Imaging and Communications in Medicine (DICOM) to RIDC, together with the body contour, and then a point dose calculation is performed, usually at the isocenter. A total of 459 plans were evaluated. The total average deviation was -0.3 ± 1.8% (one standard deviation (1SD)). For higher clearance the plans were grouped by location in: Prostate, pelvis, abdomen, chest, head and neck, brain, stereotactic radiosurgery, lung stereotactic body radiation therapy, and miscellaneous. The highest absolute deviation was -0.8 ± 1.5% corresponding to the prostate. A linear fit between doses calculated by RIDC and by TPS produced a correlation coefficient of 0.9991 and a slope of 1.0023. These results are very close to those obtained in the validation process. This agreement led us to consider this RIDC software as a valuable tool for QA in VMAT plans. PMID:25525309

  9. Results of 1 year of clinical experience with independent dose calculation software for VMAT fields.

    PubMed

    Colodro, Juan Fernando Mata; Berna, Alfredo Serna; Puchades, Vicente Puchades; Amores, David Ramos; Baños, Miguel Alcaraz

    2014-10-01

    It is widely accepted that a redundant independent dose calculation (RIDC) must be included in any treatment planning verification procedure. Specifically, volumetric modulated arc therapy (VMAT) technique implies a comprehensive quality assurance (QA) program in which RIDC should be included. In this paper, the results obtained in 1 year of clinical experience are presented. Eclipse from Varian is the treatment planning system (TPS), here in use. RIDC were performed with the commercial software; Diamond(®) (PTW) which is capable of calculating VMAT fields. Once the plan is clinically accepted, it is exported via Digital Imaging and Communications in Medicine (DICOM) to RIDC, together with the body contour, and then a point dose calculation is performed, usually at the isocenter. A total of 459 plans were evaluated. The total average deviation was -0.3 ± 1.8% (one standard deviation (1SD)). For higher clearance the plans were grouped by location in: Prostate, pelvis, abdomen, chest, head and neck, brain, stereotactic radiosurgery, lung stereotactic body radiation therapy, and miscellaneous. The highest absolute deviation was -0.8 ± 1.5% corresponding to the prostate. A linear fit between doses calculated by RIDC and by TPS produced a correlation coefficient of 0.9991 and a slope of 1.0023. These results are very close to those obtained in the validation process. This agreement led us to consider this RIDC software as a valuable tool for QA in VMAT plans.

  10. Experiences of Iranian Nurses that Intent to Leave the Clinical Nursing: a Content Analysis

    PubMed Central

    Valizadeh, Leila; Zamanzadeh, Vahid; Habibzadeh, Hosein; Alilu, Leyla; Gillespie, Mark; Shakibi, Ali

    2016-01-01

    Introduction: Despite the current shortage of nurses, it is important to know the reasons nurses want to leave the clinical setting. The purpose of this study was to explore the experiences of nurses who intend to leave clinical nursing. Methods: In a qualitative content analysis study, data obtained from 13 in-depth face-to-face semi-structured interviews with nurses working in hospitals affiliated to the Tabriz and Urmia University of Medical Sciences in Iran, selected through purposive sampling. A conventional content analysis was used for data analysis. Results: Four categories and eleven subcategories emerged during data analysis. The extracted categories and sub categories consisted of (I) Entry routes into nursing (implicitly entry, targeted entry), (II) Defects in dignity (lack of professional vision toward the nurses, social status of nurses), (III) Work in non-ideal working environment (lack of support, discrimination, conflict, lack of opportunities for advancement), and (IV) Dissatisfaction with working conditions (heavy workload, lack of power, unusual working hours). Conclusion: The findings of this qualitative study reflect professional turnover as a complex, ongoing, multidimensional process. By identifying the factors responsible, it could be possible to retain nurses in the field. PMID:27354981

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

    PubMed

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

    2014-03-01

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

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

    PubMed Central

    Žilina, Olga; Teek, Rita; Tammur, Pille; Kuuse, Kati; Yakoreva, Maria; Vaidla, Eve; Mölter-Väär, Triin; Reimand, Tiia; Kurg, Ants; Õunap, Katrin

    2014-01-01

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

  13. Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center

    PubMed Central

    Amerine, Lindsey B.; Chen, Sheh-Li; Luter, David N.; Arnall, Justin; Smith, Shayna; Roth, Mary T.; Rodgers, Philip T.; Williams, Dennis M.; Pinelli, Nicole R.

    2015-01-01

    Objective. To examine student outcomes associated with the Student Medication and Reconciliation Team (SMART) program, which was designed to provide second-year student pharmacists at the University of North Carolina (UNC) Eshelman School of Pharmacy direct patient care experience at UNC Medical Center. Design. Twenty-two second-year student pharmacists were randomly selected from volunteers, given program training, and scheduled for three 5-hour evening shifts in 2013-2014. Pre/post surveys and reflection statements were collected from 19 students. Data were analyzed with a mixed methods approach. Assessment. Survey results revealed an increase in student self-efficacy (p<0.05) and positive perceptions of SMART. Qualitative findings suggest the program provided opportunities for students to develop strategies for practice, promoted an appreciation for the various roles pharmacists play in health care, and fostered an appreciation for the complexity of real-world practice. Conclusion. Early clinical experiences can enhance student learning and development while fostering an appreciation for pharmacy practice. PMID:26839428

  14. Dental Students' Perceived Value of Peer-Mentoring Clinical Leadership Experiences.

    PubMed

    Sheridan, Rachel A; Hammaker, Daniel J; de Peralta, Tracy L; Fitzgerald, Mark

    2016-03-01

    This pilot study compared second- and fourth-year dental students' perceived values of newly implemented clinical leadership experiences (CLEs) at one U.S. dental school during the 2012-13 academic year. In the CLEs, fourth-year (D4) students mentored second-year (D2) dental students during faculty-supervised patient treatment. The two cohorts' perceived value of the experiences was measured with questionnaires consisting of five-point Likert scale questions and open text responses. Out of a total of 114 D2 and 109 D4 students, 46 D2 students and 35 D4 students participated (response rates of 40.4% and 32.1%, respectively). While responses from both cohorts showed they highly valued the CLEs, the D2s perceived greater value: 4.07 (0.53) v. 3.51 (0.95), p<0.003. Both cohorts reported feeling that D4s were prepared to mentor D2s, that the CLEs had educational benefits, and that the CLEs increased their comfort with peer communication. Theme analysis of open text questions revealed that the respondents perceived the D4s were more accessible than faculty and provided guidance and individual attention; the CLEs increased student comfort; the CLEs reinforced D4 skills, knowledge, and confidence; and the CLEs provided management, leadership, and collaborative work experience. Theme analysis also highlighted student concerns about a lack of program structure. Overall, the majority of both groups valued CLEs in their dental education. Particular advantages they perceived were increased comfort, guidance, and attention. Further program development should address student concerns. These results suggest that similar programs should be considered and/or expanded in other dental schools' curricula.

  15. Team-based learning, a learning strategy for clinical reasoning, in students with problem-based learning tutorial experiences.

    PubMed

    Okubo, Yumiko; Ishiguro, Naoko; Suganuma, Taiyo; Nishikawa, Toshio; Takubo, Toshio; Kojimahara, Noriko; Yago, Rie; Nunoda, Shinichi; Sugihara, Shigetaka; Yoshioka, Toshimasa

    2012-01-01

    Acquiring clinical reasoning skills in lectures may be difficult, but it can be learnt through problem-solving in the context of clinical practice. Problem finding and solving are skills required for clinical reasoning; however, students who underwent problem-based learning (PBL) still have difficulty in acquiring clinical reasoning skills. We hypothesized that team-based learning (TBL), a learning strategy that provides the opportunity to solve problems by repeatedly taking tests, can enhance the clinical reasoning ability in medical students with PBL experiences during the pre-clinical years. TBL courses were designed for 4(th) year students in a 6-year program in 2008, 2009, and 2010. TBL individual scores, consisting of a combination of individual and group tests, were compared with scores of several examinations including computer-based testing (CBT), an original examination assessing clinical reasoning ability (problem-solving ability test; P-SAT), term examinations, and Objective Structured Clinical Examination (OSCE). CBT, OSCE and P-SAT scores were compared with those of students who learned clinical reasoning only through PBL tutorials in 2005, 2006, and 2007 (non-TBL students). Individual TBL scores of students did not correlate with scores of any other examination. Assessments on clinical reasoning ability, such as CBT, OSCE, and P-SAT scores, were significantly higher in TBL students compared with non-TBL students. Students found TBL to be effective, particularly in areas of problem solving by both individuals and teams, and feedback from specialists. In conclusion, TBL for clinical reasoning is useful in improving clinical reasoning ability in students with PBL experiences with limited clinical exposure.

  16. Simulation-guided cardiac auscultation improves medical students' clinical skills: the Pavia pilot experience.

    PubMed

    Perlini, Stefano; Salinaro, Francesco; Santalucia, Paola; Musca, Francesco

    2014-03-01

    Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p < 0

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

    PubMed Central

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

    2012-01-01

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

  18. SU-E-J-181: Magnetic Resonance Image-Guided Radiation Therapy Workflow: Initial Clinical Experience

    SciTech Connect

    Green, O; Kashani, R; Santanam, L; Wooten, H; Li, H; Rodriguez, V; Hu, Y; Mutic, S; Hand, T; Victoria, J; Steele, C

    2014-06-01

    Purpose: The aims of this work are to describe the workflow and initial clinical experience treating patients with an MRI-guided radiotherapy (MRIGRT) system. Methods: Patient treatments with a novel MR-IGRT system started at our institution in mid-January. The system consists of an on-board 0.35-T MRI, with IMRT-capable delivery via doubly-focused MLCs on three {sup 60} Co heads. In addition to volumetric MR-imaging, real-time planar imaging is performed during treatment. So far, eleven patients started treatment (six finished), ranging from bladder to lung SBRT. While the system is capable of online adaptive radiotherapy and gating, a conventional workflow was used to start, consisting of volumetric imaging for patient setup using visible tumor, evaluation of tumor motion outside of PTV on cine images, and real-time imaging. Workflow times were collected and evaluated to increase efficiency and evaluate feasibility of adding the adaptive and gating features while maintaining a reasonable patient throughput. Results: For the first month, physicians attended every fraction to provide guidance on identifying the tumor and an acceptable level of positioning and anatomical deviation. Average total treatment times (including setup) were reduced from 55 to 45 min after physician presence was no longer required and the therapists had learned to align patients based on soft-tissue imaging. Presently, the source strengths were at half maximum (7.7K Ci each), therefore beam-on times will be reduced after source replacement. Current patient load is 10 per day, with increase to 25 anticipated in the near future. Conclusion: On-board, real-time MRI-guided RT has been incorporated into clinical use. Treatment times were kept to reasonable lengths while including volumetric imaging, previews of tumor movement, and physician evaluation. Workflow and timing is being continuously evaluated to increase efficiency. In near future, adaptive and gating capabilities of the system will

  19. Oseltamivir in seasonal, pandemic, and avian influenza: a comprehensive review of 10-years clinical experience.

    PubMed

    Smith, James R; Rayner, Craig R; Donner, Barbara; Wollenhaupt, Martina; Klumpp, Klaus; Dutkowski, Regina

    2011-11-01

    Oseltamivir (Tamiflu®; F. Hoffmann-La Roche Ltd, Basel, Switzerland) is an orally administered antiviral for the treatment and prevention of influenza A and B infections that is registered in more than 100 countries worldwide. More than 83 million patients have been exposed to the product since its introduction. Oseltamivir is recommended by the World Health Organization (WHO) for use in the clinical management of pandemic and seasonal influenza of varying severity, and as the primary antiviral agent for treatment of avian H5N1 influenza infection in humans. This article is a nonsystematic review of the experience gained from the first 10 years of using oseltamivir for influenza infections since its launch in early 2000, emphasizing recent advances in our understanding of the product and its clinical utility in five main areas. The article reviews the pharmacokinetics of oseltamivir and its active metabolite, oseltamivir carboxylate, including information on special populations such as children and elderly adults, and the co-administration of oseltamivir with other agents. This is followed by a summary of data on the effectiveness of oseltamivir treatment and prophylaxis in patients with all types of influenza, including pandemic (H1N1) 2009 and avian H5N1 influenza. The implications of changes in susceptibility of circulating influenza viruses to oseltamivir and other antiviral agents are also described, as is the emergence of antiviral resistance during and after the 2009 pandemic. The fourth main section deals with the safety profile of oseltamivir in standard and special patient populations, and reviews spontaneously reported adverse event data from the pandemic and pre-pandemic periods and the topical issue of neuropsychiatric adverse events. Finally, the article considers the pharmacoeconomics of oseltamivir in comparison with vaccination and usual care regimens, and as a component of pandemic influenza mitigation strategies.

  20. Intrauterine levonorgestrel delivery with frameless fibrous delivery system: review of clinical experience

    PubMed Central

    Wildemeersch, Dirk; Andrade, Amaury; Goldstuck, Norman D; Hasskamp, Thomas; Jackers, Geert

    2017-01-01

    The concept of using a frameless intrauterine device (IUD) instead of the conventional plastic framed IUD is not new. Frameless copper IUDs have been available since the late 1990s. They rely on an anchoring system to retain in the uterine cavity. The clinical experience with these IUDs suggests that frameless IUDs fit better as they are thin and, therefore, do not disturb or irritate the uterus. High tolerance and continuation rates have been achieved as complaints of pain are virtually nonexistent and the impact on menstrual blood loss is minimal. Conventional levonorgestrel-releasing intrauterine systems (LNG-IUSs) are very popular as they significantly reduce menstrual bleeding and provide highly effective contraception. However, continuation of use remains problematic, particularly in young users. Total or partial expulsion and displacement of the LNG-IUS also occur too often due to spatial incompatibility within a small uterine cavity, as strong uterine contractions originate, attempting to get rid of the bothersome IUD/IUS. If not expelled, embedment ensues, often leading to chronic pain and early removal of the IUD/IUS. Several studies conducted recently have requested attention to the relationship between the LNG-IUS and the endometrial cavity. Some authors have proposed to measure the cavity width prior to inserting an IUD, as many uterine cavities are much smaller than the currently existing LNG-IUSs. A frameless fibrous drug delivery system fits, in principle, in all uterine cavities and may therefore be preferable to framed drug delivery systems. This review examines the clinical performance, acceptability, and potential of the frameless LNG-IUS (FibroPlant®) when used for contraception, treatment of heavy menstrual bleeding, dysmenorrhea, and endometrial suppression in women using estrogen replacement therapy, endometrial hyperplasia, and other gynecological conditions. The review concludes that FibroPlant LNG-IUS offers unique advantages in reducing

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

    PubMed Central

    Steinke, Wolfgang; Zellweger, René

    2000-01-01

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

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

    PubMed Central

    2012-01-01

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

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

    PubMed Central

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

    2001-01-01

    This study presents our clinical experience with linezolid in 19 patients with serious resistant gram-positive infections enrolled as part of the compassionate study. In this prospective, non-randomized, noncomparative study, 19 patients were enrolled as part of the National Compassionate Study Protocol conducted by Pharmacia-Upjohn. At the time of this writing, these patients had not been published in the literature. All of the patients had to have documented evidence of serious gram-positive infections in normally sterile sites and should have been unable to tolerate available antimicrobial therapy or be unresponsive to available drugs. Clinical characteristics, laboratory values, and pharmacokinetic and pharmacodynamic parameters were obtained. Patients were followed both short-term and long-term after completion of therapy. Nineteen patients were enrolled: 13 females and 6 males. The average age was 63 years. The average length of therapy with linezolid was 22 days. Methicillin-resistant Staphylococcus aureus (MRSA) was treated in eight patients, methicillin-resistant Staphylococcus epidermidis (MRSE) in two patients, vancomycin-resistant Enterococcus faecium (VREF) in eight patients, and coagulase-negative Staphylococcus in two patients. Co-infecting organisms include Enterococcus species colonization in six patients, Pseudomonas species in one patient, Serratia marcenens in one patient, and Candida albicans in one patient. Sterile sites that were infected included bone and joint (wounds and septic joints) in six patients, gastrointestinal system (hepatobiliary, liver abscess, Crohn's) in five patients, genitourinary (kidney and urine) in two patients, blood in five patients, respiratory in one patient, and aortic valve in 1 patient. Linezolid was given at 600 mg IV every 12 hours with a mean length of therapy of 22 days. Surgical drainage was used in combination with linezolid in 11 of the patients. Seventy nine percent of these patients achieved clinical and

  4. Comparison of Primary Care Experiences in Village Clinics with Different Ownership Models in Guangdong Province, China

    PubMed Central

    Feng, Shanshan; Shi, Leiyu; Zeng, Jiazhi; Chen, Wen; Ling, Li

    2017-01-01

    Objectives In order to improve the quality of services at village clinics (VCs), which are important primary care service providers in rural China, the Chinese government has encouraged the township hospitals to own and manage VCs. There are currently three models of ownership and management of VCs: township hospital-owned and -managed (HVC), village committee-owned and -managed (VVC), and private-owned and -managed (PVC). This study aims to examine the association between these ownership models of VCs and patients' primary care experiences. Methods Villagers were selected by multistage stratified sampling and their experiences with primary care were measured using the Primary Care Assessment Tool—Adult Edition (PCAT-AS). Data were collected through face-to-face interviews and the questionnaires administered by investigators in the cross-sectional study from February to April 2015. The PCAT scores were compared among the three models by covariance analysis, and multiple linear regression was used to analyze factors associated with the PCAT total scores. Results A total of 1491 questionnaires were collected. After controlling for covariates, HVCs reported the highest PCAT scores and satisfaction rate. In terms of the domains, HVC reported the highest scores in the coordination and comprehensiveness domains, while PVC had the highest scores in the first contact-accessibility domain. Multivariate linear regression showed that HVC, married participants, aged 60 and older, satisfied with the services, receiving six or more visits, and those with medical expenditures over 20% of their total family expenditures, were also positively associated with better primary care quality. Conclusions This study demonstrates that villagers receiving medical care at HVCs perceived better primary care than those at PVCs and VVCs. In order to improve the quality of primary care at VCs, it is necessary to increase government subsidies for public service packages, tighten the township

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

    PubMed

    Dante, Angelo; Fabris, Stefano; Palese, Alvisa

    2015-01-01

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

  6. Impact of the University of Colorado's Advanced Clinical Training and Service (ACTS) Program on dental students' clinical experience and cognitive skills, 1994-2006.

    PubMed

    Berg, Rob; Call, Richard L; Maguire, Kerry; Berkey, Douglas B; Karshmer, Bernard A; Guyton, Brad; Tawara-Jones, Karen

    2010-04-01

    The University of Colorado Denver School of Dental Medicine has operated a community-based dental education program for all of its students since 1985. A database of student productivity has been maintained in a standardized format, capable of multiyear compilation, since 1994. This study utilizes twelve years of these data to profile the type and amount of clinical treatment that can be provided by a typical fourth-year dental student during a 100-day community-based training experience. Between 1994 and 2006, the school's 423 graduates provided a mean of 922 treatment procedures per student at a mean of 498 patient visits per student. During a typical four-week clinical affiliation, each student provided a mean of approximately twenty-seven restorations on permanent teeth, sixteen restorations on primary teeth, and twenty-four oral surgery procedures (extractions). Students also gained considerable experience in periodontics, fixed and removable prosthodontics, and endodontics. Self-assessed competency ratings tended to increase after completing the program, as did willingness to treat underserved populations after graduation. About 16 percent of graduates reported planning to practice in the public sector after completing dental school. A community-based experience such as this appears to offer an opportunity to substantially augment dental students' clinical training experiences.

  7. Health-Related Quality of Life in the Gender, Race, And Clinical Experience Trial

    PubMed Central

    Feinberg, Judith; Saag, Michael; Squires, Kathleen; Currier, Judith; Ryan, Robert; Coate, Bruce; Mrus, Joseph

    2011-01-01

    Background. We report health-related QoL (HRQoL) from GRACE (Gender, Race, And Clinical Experience) study by sex and race over 48 weeks. Methods. 429 treatment-experienced adults (HIV-1 RNA ≥ 1000 copies/mL) received darunavir/ritonavir 600/100 mg twice daily plus an appropriate background regimen. QoL was measured by the Functional Assessment of HIV Infection (FAHI) questionnaire. Results. 67% women and 77% men, including 67.4% black, 76.0% Hispanic, and 73.8% white patients, completed the trial. Baseline total FAHI scores were similar between sexes and races. Total FAHI of the entire population improved by Week 4 (P < .05); near-maximum changes obtained by Week 12 were maintained through Week 48. Women and black patients demonstrated larger improvements in total FAHI versus men, and Hispanic and white patients, respectively. Conclusion. HRQoL improved in all sex and racial/ethnic groups. Sex-based and race-based differences in improvements in FAHI subscales may provide insight into subtle differences of HIV-1 and treatment on HRQoL in different populations. PMID:21904672

  8. In vivo experiment leading to clinical application of an electrohydraulic ventricular assist device with magnetic coupling.

    PubMed

    Kim, W G; Choi, J S; Won, Y S; Jo, Y H; Park, S K; Chung, C I; Kim, J; Min, B G; Ahn, H; Rho, J R

    1999-01-01

    We developed an electrohydraulic ventricular assist device with magnetic coupling. The integrated system consists of a blood pump, a water conduit for pressure transmission, a bellows type pumping sac, an actuator for transforming the circular motion of a motor to the linear motion of a pusher plate attached to the pumping sac with magnetic coupling, and a controller. The purpose of the coupling was to prevent excessive sucking against the atrial wall. Number 21 Medtronic Hall (Irvine, CA) mechanical valves were used in the inflow and outflow ports of the blood pump. Maximum dynamic stroke volume was 48 ml, and against a mean afterload of 100 mm Hg, maximum pump output was 7 L/min. Chronic in vivo experiments were performed in three sheep, and during these evaluations the system showed no noticeable problems related to mechanical or electronic devices. When left atrial pressure decreased below 0 mm Hg, the magnetic coupling system decoupled the pumping sac and pusher plate with satisfactory reliability. The device was clinically applied in a postoperative patient with chronic dilating cardiomyopathy, and no significant device related problems ensued. These results prove that the electrohydraulic ventricular assist system with magnetic coupling is a suitable ventricular assist device.

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

    PubMed

    Logan, Gemma

    2015-03-01

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

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

    PubMed

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

    2012-12-01

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

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

    PubMed

    Li, Chuan-qi

    2010-02-01

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

  12. Designing new collaborative learning spaces in clinical environments: experiences from a children's hospital in Australia.

    PubMed

    Bines, Julie E; Jamieson, Peter

    2013-09-01

    Hospitals are complex places that provide a rich learning environment for students, staff, patients and their families, professional groups and the community. The "new" Royal Children's Hospital opened in late 2011. Its mission is focused on improving health and well-being of children and adolescents through leadership in healthcare, research and education. Addressing the need to create "responsive learning environments" aligned with the shift to student-centred pedagogy, two distinct learning environments were developed within the new Royal Children's Hospital; (i) a dedicated education precinct providing a suite of physical environments to promote a more active, collaborative and social learning experience for education and training programs conducted on the Royal Children's Hospital campus and (ii) a suite of learning spaces embedded within clinical areas so that learning becomes an integral part of the daily activities of this busy Hospital environment. The aim of this article is to present the overarching educational principles that lead the design of these learning spaces and describe the opportunities and obstacles encountered in the development of collaborative learning spaces within a large hospital development.

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

    PubMed

    Zhang, Shaodian; Elhadad, Noémie

    2013-12-01

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

  14. Basic research and 12 years of clinical experience in computer-assisted navigation technology: a review.

    PubMed

    Ewers, R; Schicho, K; Undt, G; Wanschitz, F; Truppe, M; Seemann, R; Wagner, A

    2005-01-01

    Computer-aided surgical navigation technology is commonly used in craniomaxillofacial surgery. It offers substantial improvement regarding esthetic and functional aspects in a range of surgical procedures. Based on augmented reality principles, where the real operative site is merged with computer generated graphic information, computer-aided navigation systems were employed, among other procedures, in dental implantology, arthroscopy of the temporomandibular joint, osteotomies, distraction osteogenesis, image guided biopsies and removals of foreign bodies. The decision to perform a procedure with or without computer-aided intraoperative navigation depends on the expected benefit to the procedure as well as on the technical expenditure necessary to achieve that goal. This paper comprises the experience gained in 12 years of research, development and routine clinical application. One hundred and fifty-eight operations with successful application of surgical navigation technology--divided into five groups--are evaluated regarding the criteria "medical benefit" and "technical expenditure" necessary to perform these procedures. Our results indicate that the medical benefit is likely to outweight the expenditure of technology with few exceptions (calvaria transplant, resection of the temporal bone, reconstruction of the orbital floor). Especially in dental implantology, specialized software reduces time and additional costs necessary to plan and perform procedures with computer-aided surgical navigation.

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

    PubMed

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

    2000-07-01

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

  16. Initial clinical experience using the EchoNavigator®-system during structural heart disease interventions

    PubMed Central

    Balzer, Jan; Zeus, Tobias; Hellhammer, Katharina; Veulemans, Verena; Eschenhagen, Silke; Kehmeier, Eva; Meyer, Christian; Rassaf, Tienush; Kelm, Malte

    2015-01-01

    AIM: To present our initial clinical experience using this innovative software solution for guidance of percutaneous structural heart disease interventions. METHODS: Left atrial appendage, atrial septal defect and paravalvular leak closure, transaortic valve repair and MitraClip® procedures were performed in the catheter laboratory under fluoroscopic and echocardiographic guidance. The two-dimensional and three-dimensional images generated by the transesophageal echocardiography probe were interfaced with the fluoroscopic images in real-time using the EchoNavigator®-system. RESULTS: The application of the novel image fusion technology was safe and led to a better appreciation of multimodality imaging guidance due to improved visualization of the complex relationship between catheter devices and anatomical structures. CONCLUSION: The EchoNavigator®-system is a feasible and safe tool for guidance of interventional procedures in structural heart disease. This innovative technology may improve confidence of interventional cardiologists in targeting and positioning interventional devices in order to increase safety, accuracy, and efficacy of percutaneous interventions in the catheter laboratory. PMID:26413233

  17. Turner syndrome: review of clinical, neuropsychiatric, and EEG status: an experience of tertiary center.

    PubMed

    Saad, Khaled; Abdelrahman, Ahmed A; Abdel-Raheem, Yasser F; Othman, Essam R; Badry, Reda; Othman, Hisham A K; Sobhy, Karema M

    2014-03-01

    We reviewed the clinical, neuropsychiatric, and EEG status of 53 turner syndrome (TS) females, aged 3-16 years, in Assiut university hospitals, Upper Egypt. The diagnosis and care of patients with TS in Egypt is still in the developing stage. Hence this study was undertaken to review the details of patients with TS with respect to the pattern of cognitive, psychiatric, and motor dysfunction. We aimed to provide a comprehensive data about the experience of our center comparable to previous studies, which have been published in this field. This will contribute to a better definition of the neuropsychiatric features that may be specific to TS that allows early and better detection and management of these cases. We found FSIQ and verbal IQ that seem to be at a nearly normal level and a decreased performance IQ. ADHD and autistic symptoms were found in 20.70 and 3.77 % of our cohort, respectively. The motor performance in TS was disturbed, with some neurological deficits present in 17 % (reduced muscle tone and reduced muscle power). In addition, females with TS in our study exhibit social and emotional problems, including anxiety (5.66 %) and depression (11.30 %). The EEG results revealed abnormalities in seven patients (13.20 %). One patient presenting with generalized tonic-clonic seizures showed generalized epileptiform activity, and six patients presenting with intellectual disabilities showed abnormal EEG background activity.

  18. Early clinical experience with a new preloaded one-piece intraocular lens in paediatric cataract surgery.

    PubMed

    Gosling, D B; Chan, T K J

    2016-09-01

    PurposeTo report the clinical experience of using the Tecnis PCB00 (Abbott Medical Optics, Santa Ana, CA, USA) preloaded one-piece intraocular lens (IOL) in the setting of a tertiary referral centre for paediatric cataract.MethodsA retrospective case note review of all paediatric cataract surgeries using the Tecnis PCB00 IOL, at a single UK paediatric ophthalmology department.ResultsNine eyes in seven patients received the IOL between December 2014 and January 2016. All patients underwent lens aspiration and insertion of the IOL 'in the bag.' The indications for surgery included developmental cataract (8/9) and traumatic cataract (1/9). Mean age at the time of surgery was 7 years (range 2-14). The median improvement in logMAR best-corrected visual acuity was 0.475 (range 0.250-1.500). The mean follow-up duration was 5 months (range 1-13). No operative or post-operative complications occurred as a result of using the device.ConclusionThe Tecnis PCB00 preloaded IOL appears to be a safe and effective device in treating paediatric cataract.

  19. Internet-based virtual classroom and educational management software enhance students' didactic and clinical experiences in perfusion education programs.

    PubMed

    Riley, Jeffrey B; Austin, Jon W; Holt, David W; Searles, Bruce E; Darling, Edward M

    2004-09-01

    A challenge faced by many university-based perfusion education (PE) programs is the need for student clinical rotations at hospital locations that are geographically disparate from the main educational campus. The problem has been addressed through the employment of distance-learning environments. The purpose of this educational study is to evaluate the effectiveness of this teaching model as it is applied to PE. Web-based virtual classroom (VC) environments and educational management system (EMS) software were implemented independently and as adjuncts to live, interactive Internet-based audio/video transmission from classroom to classroom in multiple university-based PE programs. These Internet environments have been used in a variety of ways including: 1) forum for communication between the university faculty, students, and preceptors at clinical sites, 2) didactic lectures from expert clinicians to students assigned to distant clinical sites, 3) small group problem-based-learning modules designed to enhance students analytical skills, and 4) conversion of traditional face-to-face lectures to asynchronous learning modules. Hypotheses and measures of student and faculty satisfaction, clinical experience, and learning outcomes are proposed, and some early student feedback was collected. For curricula that emphasize both didactic and clinical education, the use of Internet-based VC and EMS software provides significant advancements over traditional models. Recognized advantages include: 1) improved communications between the college faculty and the students and clinical preceptors, 2) enhanced access to a national network of clinical experts in specialized techniques, 3) expanded opportunity for student distant clinical rotations with continued didactic course work, and 4) improved continuity and consistency of clinical experiences between students through implementation of asynchronous learning modules. Students recognize the learning efficiency of on

  20. Actual questions raised by nanoparticle radiosensitization

    NASA Astrophysics Data System (ADS)

    Brun, Emilie; Sicard-Roselli, Cécile

    2016-11-01

    Radiosensitization by metallic nanoparticles (NP) has been explored for more than a decade with promising results in vitro and in cellulo reported in a vast number of publications. Yet, few clinical trials are on-going. This could be related to the lack of selectivity of NP leading to massive quantities to be injected to observe an effect but also to the higher degree of complexity than first thought leading to an absence of consensus probably caused by the lack of standardization in pre-clinical studies. Given the wide panel of NP used, in terms of core nature, size, coating, not to mention of cell lines and irradiation modalities, cross-comparison of data is not a walk in the park. But only a thorough examination could help identifying the key parameters and the possible mechanisms involved. This step is crucial as it should provide guidance for designing the most efficient combination NP/radiation and rationally establishing clinical protocols. In this review, we will combine and confront cellular radiosensitization results with in vitro and numerical experiments in order to give the more recent vision of this complex phenomenon. We decided to address a few hot topics such as the influence of the incident radiation energy, the localization of NP or the so-called ;biological; effect. We will highlight that among the barriers to break down, some are not restricted to the ;nano; community: an incontestable support could be offered by the ;radiation; community in the broadest sense.

  1. Hypnosis Training and Education: Experiences with a Norwegian One-Year Education Course in Clinical Hypnosis for Children and Adolescents.

    PubMed

    Lindheim, Maren Ø; Helgeland, Helene

    2017-01-01

    Although the efficacy of clinical hypnosis is well documented, its implementation in clinical practice is far from completed and there are few reports of systematic, professional training. This article gives a historical overview and description of a 1-year training program in clinical hypnosis which started in Norway in 2008 and has been held yearly since then. We describe the present education course with respect to aims, conceptual framework, structure, target groups, teaching themes, and experiences. The following factors have been considered of importance for the success of this program: The extent and duration of the course, the focus on demonstrations, experiential skill-building and exercises, and that the education is rooted in acknowledged clinical, academic, and educational environments. The participants' evaluations tell stories of mastery and positive experiences with hypnosis as a therapeutic tool in their clinical practice. However, many struggle to understand the various concepts of hypnosis, trance, and suggestions. Some find it hard to get started and challenging to integrate hypnosis in their clinical practice. Finally, some report scarce opportunities to apply their newly acquired skills at their work places and limited support by their leaders. The development of systematic, professional training programs as described in this article may be of importance for further implementation. However, this will also require that clinicians and leaders in universities and professional environments, and policymakers at higher levels, recognize clinical hypnosis as a valid and efficient choice of treatment. This must be reflected in dedicated efforts to ensure successful implementation in practice.

  2. A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting

    PubMed Central

    Rashid-Doubell, F; Mohamed, S; Elmusharaf, K; O'Neill, C S

    2016-01-01

    Objective The aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital. Design Interpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting. Setting and participants Senior medical students at an international medical school in the Middle East. Results Three main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside. Conclusions Mobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner. PMID:27142860

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

    PubMed

    2013-06-01

    risk of thrombosis. For patients undergoing surgery or other invasive procedures, clinical practice guidelines are primarily based on pharmacokinetic parameters and on extrapolation of data on vitamin K antagonists. The decision on whether or not to discontinue anticoagulation before the procedure mainly depends on the likely risk of bleeding. In patients at high risk of thrombosis, heparin can be proposed when the anticoagulant is withdrawn. In early 2013, difficulties in the management of bleeding and of situations in which there is a risk of bleeding weigh heavily in the balance of potential harm versus potential benefit of dabigatran, rivaroxaban and apixaban. When an oral anticoagulant is required, it is best to choose warfarin, a vitamin K antagonist, and the drug with which we have the most experience, except in those rare situations in which the INR cannot be maintained within the therapeutic range.

  4. Change in sweat chloride as a clinical end point in cystic fibrosis clinical trials: the ivacaftor experience.

    PubMed

    Durmowicz, Anthony G; Witzmann, Kimberly A; Rosebraugh, Curtis J; Chowdhury, Badrul A

    2013-01-01

    Cystic fibrosis (CF) is a life-shortening inherited disease caused by mutations in the CF transmembrane conductance regulator gene (CFTR), which encodes for the CF transmembrane conductance regulator (CFTR) ion channel that regulates chloride and water transport across the surface of epithelial cells. Ivacaftor, a drug recently approved by the US Food and Drug Administration, represents the first mutation-specific therapy for CF. It is a CFTR channel modulator and improves CFTR function in patients with CF who have a G551D mutation. A clinical trial performed to support ivacaftor dose selection demonstrated a dose-response relationship between improvement in FEV(1) and decrease in sweat chloride, a measure of CFTR function. Validation of such a relationship between FEV(1) and sweat chloride would facilitate development of new drugs that target the defective CFTR. Subsequently, in phase 3 studies, ivacaftor 150 mg bid resulted in significant improvements in FEV(1) (10%-12%) and reduction in sweat chloride (approximately 50 mmol/L). However, a decrease in sweat chloride did not correlate with improvement in FEV(1), nor did there appear to be a threshold level for change in sweat chloride above which an improvement in FEV(1) was apparent. The lack of correlation of sweat chloride with improvement in FEV(1) speaks to the multiplicity of factors, physiologic, environmental, and genetic, that likely modulate CF disease severity. Future clinical trials of drugs that are directed to the defective CFTR will need take into account the uncertainty of using even established measurements, such as sweat chloride, as clinical end points.

  5. Teacher Candidates' Experiences with Clinical Teaching in Reading Instruction: A Comparison between the Professional Development School Environment and the Non-Professional Development School Environment

    ERIC Educational Resources Information Center

    Hopper, Cynthia J.

    2016-01-01

    Teacher candidates experience a variety of school settings when enrolled in teacher education methods courses. Candidates report varied experiences when in public school classrooms. This dissertation investigated clinical experiences of teacher candidates when placed in two different environments for clinical teaching. The two environments were a…

  6. Promoting good clinical practices in the conduct of clinical trials: experiences in the Department of Veterans Affairs Cooperative Studies Program.

    PubMed

    Sather, Mike R; Raisch, Dennis W; Haakenson, Clair M; Buckelew, Julia M; Feussner, John R

    2003-10-01

    The ever-increasing concern for the welfare of volunteers participating in clinical trials and for the integrity of the data derived from those trials has generated the concept of Good Clinical Practice (GCP). The Veterans Affairs Cooperative Studies Program, in anticipation of the need to comply with GCP guidelines, developed a Site Monitoring and Review Team (SMART), which consists of a Good Clinical Practice Monitoring Group and a Good Clinical Practice Review Group. The review group conducted 335 site reviews from fiscal years (FY) 1999 through 2001 to assess and encourage adherence to GCP. Data from reviews were compared for two time periods, a 2-year implementation period (FYs 1999/2000, n=204) and a continuing follow-up period (FY 2001, n=131). Overall, high GCP adherence was exhibited by 11.3% (n=23) of study sites in FY 1999/2000 versus 20.6% (n=27) in FY 2001, average to good adherence was exhibited by 84.3% (n=172) in FY 1999/2000 versus 77.0% (n=101) in FY 2001, and below average adherence was exhibited by 4.4% (n=9) versus 1.5% (n=3) in these two periods. These changes were statistically significant by chi square analysis (p=0.029). Moreover, GCP adherence was assessed within eight GCP focus areas: patient informed consent, protocol adherence, safety monitoring, institutional review board interactions, regulatory document management, patient records in investigator file, drug/device accountability, and general site operations. Median assessment scores for all 62 GCP review elements improved from 0.82 to 0.89 (p<0.001). Median assessment scores for the 14 selected critical GCP items improved from 0.78 to 0.89 (p<0.001). Median scores for five of the eight GCP focus areas improved significantly (p<0.001) between the two time periods. These data suggest that the site-oriented activities of SMART combined with centralized quality assurance activities of the coordinating centers represent an integrated, versatile program to promote and assure GCP adherence

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

    PubMed Central

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

    2008-01-01

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

  8. Exploration of Nursing Faculty Members' Lived Experiences of Objective Structured Clinical Examination (OSCE) in Undergraduate Nursing Education

    ERIC Educational Resources Information Center

    Obizoba, Cordelia O.

    2014-01-01

    The purpose of this phenomenological study was to gain an understanding of nursing faculty members' lived experiences of Objective Structured Clinical Examination (OSCE) in undergraduate nursing education. As owners of their programs' curriculum, nursing faculties are charged with the responsibility of providing needed knowledge, skills, and…

  9. Consequences of Predicted or Actual Asteroid Impacts

    NASA Astrophysics Data System (ADS)

    Chapman, C. R.

    2003-12-01

    Earth impact by an asteroid could have enormous physical and environmental consequences. Impactors larger than 2 km diameter could be so destructive as to threaten civilization. Since such events greatly exceed any other natural or man-made catastrophe, much extrapolation is necessary just to understand environmental implications (e.g. sudden global cooling, tsunami magnitude, toxic effects). Responses of vital elements of the ecosystem (e.g. agriculture) and of human society to such an impact are conjectural. For instance, response to the Blackout of 2003 was restrained, but response to 9/11 terrorism was arguably exaggerated and dysfunctional; would society be fragile or robust in the face of global catastrophe? Even small impacts, or predictions of impacts (accurate or faulty), could generate disproportionate responses, especially if news media reports are hyped or inaccurate or if responsible entities (e.g. military organizations in regions of conflict) are inadequately aware of the phenomenology of small impacts. Asteroid impact is the one geophysical hazard of high potential consequence with which we, fortunately, have essentially no historical experience. It is thus important that decision makers familiarize themselves with the hazard and that society (perhaps using a formal procedure, like a National Academy of Sciences study) evaluate the priority of addressing the hazard by (a) further telescopic searches for dangerous but still-undiscovered asteroids and (b) development of mitigation strategies (including deflection of an oncoming asteroid and on- Earth civil defense). I exemplify these issues by discussing several representative cases that span the range of parameters. Many of the specific physical consequences of impact involve effects like those of other geophysical disasters (flood, fire, earthquake, etc.), but the psychological and sociological aspects of predicted and actual impacts are distinctive. Standard economic cost/benefit analyses may not

  10. The experience of bedaquiline implementation at a decentralised clinic in South Africa

    PubMed Central

    Cariem, R.; Cox, V.; de Azevedo, V.; Hughes, J.; Mohr, E.; Durán, L. Triviño; Ndjeka, N.

    2016-01-01

    Multidrug-resistant tuberculosis (MDR-TB) is a serious public health problem, but the new drugs bedaquiline (BDQ) and delamanid offer hope to improve outcomes and minimise toxicity. In Khayelitsha, South Africa, patients are routinely started on BDQ in the out-patient setting. This report from the field describes BDQ use in the out-patient setting at the Nolungile Clinic. The clinic staff overall report a positive experience using the drug. Challenges have been based largely on the logistics of drug supply and delivery. BDQ can be started successfully in the out-patient setting, and can be a positive experience for both patients and providers. La tuberculose multirésistante (TB-MDR) est un problème de santé publique grave, mais les nouveaux médicaments que sont la bédaquiline (BDQ) et le délamanide apportent un espoir d'améliorer les résultats tout en réduisant la toxicité. A Khayelitsha, Afrique du Sud, les patients démarrent leur traitement par BDQ en consultation externe en routine. Ce rapport du terrain décrit l'utilisation de la BDQ à la consultation externe du dispensaire Nolungile. Dans l'ensemble, le personnel du centre de santé exprime une expérience positive du médicament. Les défis ont surtout été liés à la logistique de l'approvisionnement et de la distribution du médicament. La BDQ peut être mise en route avec succès dans le cadre d'une consultation externe et peut constituer une expérience positive pour les patients et les prestataires de soins. La tuberculosis multirresistente (TB-MDR) representa un grave problema de salud pública, pero la utilización de nuevos medicamentos como la bedaquilina (BDQ) y el delamanid ofrece perspectivas de mejores desenlaces terapéuticos y disminución de la toxicidad asociada. En Khayelitsha, Suráfrica, se inicia de manera sistemática el tratamiento ambulatorio con BDQ. En el presente informe del terreno, se describe la utilización de BDQ en tratamiento antituberculoso ambulatorio en el

  11. The experience of bedaquiline implementation at a decentralised clinic in South Africa.

    PubMed

    Cariem, R; Cox, V; de Azevedo, V; Hughes, J; Mohr, E; Durán, L Triviño; Ndjeka, N; Furin, J

    2016-09-01

    Multidrug-resistant tuberculosis (MDR-TB) is a serious public health problem, but the new drugs bedaquiline (BDQ) and delamanid offer hope to improve outcomes and minimise toxicity. In Khayelitsha, South Africa, patients are routinely started on BDQ in the out-patient setting. This report from the field describes BDQ use in the out-patient setting at the Nolungile Clinic. The clinic staff overall report a positive experience using the drug. Challenges have been based largely on the logistics of drug supply and delivery. BDQ can be started successfully in the out-patient setting, and can be a positive experience for both patients and providers. La tuberculose multirésistante (TB-MDR) est un problème de santé publique grave, mais les nouveaux médicaments que sont la bédaquiline (BDQ) et le délamanide apportent un espoir d'améliorer les résultats tout en réduisant la toxicité. A Khayelitsha, Afrique du Sud, les patients démarrent leur traitement par BDQ en consultation externe en routine. Ce rapport du terrain décrit l'utilisation de la BDQ à la consultation externe du dispensaire Nolungile. Dans l'ensemble, le personnel du centre de santé exprime une expérience positive du médicament. Les défis ont surtout été liés à la logistique de l'approvisionnement et de la distribution du médicament. La BDQ peut être mise en route avec succès dans le cadre d'une consultation externe et peut constituer une expérience positive pour les patients et les prestataires de soins. La tuberculosis multirresistente (TB-MDR) representa un grave problema de salud pública, pero la utilización de nuevos medicamentos como la bedaquilina (BDQ) y el delamanid ofrece perspectivas de mejores desenlaces terapéuticos y disminución de la toxicidad asociada. En Khayelitsha, Suráfrica, se inicia de manera sistemática el tratamiento ambulatorio con BDQ. En el presente informe del terreno, se describe la utilización de BDQ en tratamiento antituberculoso ambulatorio en el

  12. The Medina Embolic Device: early clinical experience from a single center

    PubMed Central

    Aguilar Perez, Marta; Bhogal, Pervinder; Martinez Moreno, Rosa; Bäzner, Hansjörg; Ganslandt, Oliver; Henkes, Hans

    2017-01-01

    Objective To report our initial experience with the Medina Embolic Device (MED) in unruptured intracranial aneurysms either as sole treatment or in conjunction with additional devices. Methods 15 consecutive patients (6 women, 9 men) with unruptured aneurysms were treated between September 2015 and April 2016. The aneurysm fundus measured at least 5 mm. We evaluated the angiographic appearances of treated aneurysms at the end of the procedure and at follow-up, the clinical status, complications, and requirement for adjunctive devices. Results The MED was successfully deployed in all but one case and adjunctive devices were required in 10 cases. Aneurysm locations were middle cerebral artery bifurcation (n=3), internal carotid artery (ICA) bifurcation (n=1), supraclinoid ICA (n=5), posterior communicating artery (n=1), anterior communicating artery (n=2), cavernous ICA (n=2), distal basilar sidewall (n=1), basilar tip (n=1). Three patients had complications although none could be attributed to the MED. Immediate angiographic results were modified Raymond-Roy classification (mRRC) I=1, mRRC II=5, mRRC IIIa=3, mRRC IIIb=5, and one patient showed contrast stasis within the fundus of the aneurysm. Follow-up angiography was available in 11 patients, with four showing complete aneurysm exclusion, six with stable remnants and one patient with an enlarging neck remnant. Conclusions The MED represents a major step forward in the treatment of intracranial aneurysms. It can result in rapid exclusion of an aneurysm from the circulation and has a good safety profile. We believe that the true value of the MED will be in combining its use with adjunctive devices such as endoluminal flow diverters that will result in rapid aneurysmal exclusion. PMID:27484746

  13. Measurement of subvisible particulates in lyophilised Erwinia chrysanthemi L-asparaginase and relationship with clinical experience.

    PubMed

    Gervais, David; Corn, Tim; Downer, Andrew; Smith, Stuart; Jennings, Alan

    2014-07-01

    In order to generate further characterisation data for the lyophilised product Erwinia chrysanthemi L-asparaginase, reconstituted drug product (DP; marketed as Erwinase or Erwinaze) was analysed for subvisible (2-10 μm) particulate content using both the light obscuration (LO) method and the newer flow-imaging microscopy (FIM) technique. No correlation of subvisible particulate counts exists between FIM and LO nor do the counts correlate with activity at both release and on stability. The subvisible particulate content of lyophilised Erwinia L-asparaginase appears to be consistent and stable over time and in line with other parenteral biopharmaceutical products. The majority (ca. 75%) of subvisible particulates in L-asparaginase DP were at the low end of the measurement range by FIM (2-4 μm). In this size range, FIM was unable to definitively classify the particulates as either protein or non-protein. More sensitive measurement techniques would be needed to classify the particulates in lyophilised L-asparaginase into type (protein and non-protein), so the LO technique has been chosen for on-going DP analyses. E. chrysanthemi L-asparaginase has a lower rate of hypersensitivity compared with native Escherichia coli preparations, but a subset of patients develop hypersensitivity to the Erwinia enzyme. A DP lot that had subvisible particulate counts on the upper end of the measurement range by both LO and FIM had the same incidence of allergic hypersensitivity in clinical experience as lots at all levels of observed subvisible particulate content, suggesting that the presence of L-asparaginase subvisible particulates is not important with respect to allergic response.

  14. Posttransplant lymphoproliferative disorders in lung transplant patients: the Cleveland Clinic experience.

    PubMed

    Ramalingam, P; Rybicki, L; Smith, M D; Abrahams, N A; Tubbs, R R; Pettay, J; Farver, C F; Hsi, E D

    2002-06-01

    PTLD is a well-recognized complication of organ transplantation. Large series of heart, renal, and liver transplants have been examined for the incidence and behavior of PTLD. However, reports of the incidence and characteristics of PTLDs in lung transplant (LTx) patients are few. We report our experience with PTLDs in a large series of LTx recipients at a single institution and compare them to other solid organ transplant recipient PTLDs seen at our institution. Twenty-eight patients were found to have PTLD, of whom 8 were lung transplant recipients. We evaluated nine PTLD specimens from these 8 patients for their histology, immunophenotype (CD20, CD3, EBV-LMP1), EBER status by in situ hybridization, and clinical features. The incidence of PTLD was 3.3% (8/244 patients). The time to development of PTLD, after transplant, was short (median time, 7 mo). All were of B-cell lineage. Overall, EBV was demonstrated in 77.7% (7 of 9 specimens) of PTLDs. All specimens tested for clonality were found to be monoclonal. Five patients died, with a median time to death of only 4.6 months. PTLDs in LTx patients are EBV-associated B-cell, predominantly monoclonal lymphoid lesions similar to other solid organ transplant PTLDs. Compared with other solid organ transplant recipients with PTLD at our institution, PTLDs in LTx patients have a propensity to involve the transplanted organ (P =.001, Fisher's exact test), occur earlier after transplant (P =.003, Wilcoxon test), and have a shorter survival (P =.002, log rank test). Reasons for this may include the relatively higher level of immunosuppression required in these patients and limited options in decreasing it. Although the incidence is low, careful early monitoring of lung transplantation patients is warranted because of the poor prognosis of patients developing this complication.

  15. Effect of immersive workplace experience on undergraduate nurses' mental health clinical confidence.

    PubMed

    Patterson, Christopher; Moxham, Lorna; Taylor, Ellie K; Perlman, Dana; Brighton, Renee; Sumskis, Susan; Heffernan, Tim; Lee-Bates, Benjamin

    2017-02-03

    Preregistration education needs to ensure that student nurses are properly trained with the required skills and knowledge, and have the confidence to work with people who have a mental illness. With increased attention on non-traditional mental health clinical placements, further research is required to determine the effects of non-traditional mental health clinical placements on mental health clinical confidence. The aim of the present study was to investigate the impact of a non-traditional mental health clinical placement on mental health nursing clinical confidence compared to nursing students undergoing traditional clinical placements. Using the Mental Health Nursing Clinical Confidence Scale, the study investigated the relative effects of two placement programmes on the mental health clinical confidence of 79 nursing students. The two placement programmes included a non-traditional clinical placement of Recovery Camp and a comparison group that attended traditional clinical placements. Overall, the results indicated that, for both groups, mental health placement had a significant effect on improving mean mental health clinical confidence, both immediately upon conclusion of placement and at the 3-month follow up. Students who attended Recovery Camp reported a significant positive difference, compared to the comparison group, for ratings related to communicating effectively with clients with a mental illness, having a basic knowledge of antipsychotic medications and their side-effects, and providing client education regarding the effects and side-effects of medications. The findings suggest that a unique clinical placement, such as Recovery Camp, can improve and maintain facets of mental health clinical confidence for students of nursing.

  16. How can the research potential of the clinical quality databases be maximized? The Danish experience.

    PubMed

    Nørgaard, M; Johnsen, S P

    2016-02-01

    In Denmark, the need for monitoring of clinical quality and patient safety with feedback to the clinical, administrative and political systems has resulted in the establishment of a network of more than 60 publicly financed nationwide clinical quality databases. Although primarily devoted to monitoring and improving quality of care, the potential of these databases as data sources in clinical research is increasingly being recognized. In this review, we describe these databases focusing on their use as data sources for clinical research, including their strengths and weaknesses as well as future concerns and opportunities. The research potential of the clinical quality databases is substantial but has so far only been explored to a limited extent. Efforts related to technical, legal and financial challenges are needed in order to take full advantage of this potential.

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

    PubMed

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

    2016-07-01

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

  18. Does free pregnancy testing reduce service denial in family planning clinics? A cluster-randomized experiment in Zambia and Ghana

    PubMed Central

    Stanback, John; Vance, Gwyneth; Asare, Gloria; Kasonde, Prisca; Kafulubiti, Beatrice; Chen, Mario; Janowitz, Barbara

    2013-01-01

    ABSTRACT Background: In many countries, pregnancy tests are not freely available in family planning clinics. As a result, providers sometimes deny services to non-menstruating clients due to uncertainty about pregnancy. Few clients are actually pregnant, yet denied clients run the risk of becoming pregnant, and those sent to pharmacies pay inflated prices for inexpensive tests. To assess the programmatic effect of free pregnancy testing, we conducted cluster-randomized trials in Ghana and Zambia, assessing clients' uptake of contraception in family planning clinics. Methods: In each country, 5 clinics were randomized to intervention status and 5 to control. Service data from 2,028 new, non-menstruating clients in Zambia and 1,556 in Ghana were collected. Intervention clinics received supplies of pregnancy tests, and staff were instructed to use tests as needed to help exclude pregnancy. Control clinics received no intervention. The primary outcome was the proportion of non-menstruating clients denied an effective contraceptive method. Cost-effectiveness was also evaluated. Results: In Zambia, clients in intervention and control clinics faced a similar risk of service denial at baseline, 15% and 17%, respectively. At follow-up, denial remained unchanged at 17% in control clinics, but decreased significantly to 4% in intervention sites. Clients in Zambia were 4.4 (95% confidence interval [CI] = 1.3–14.4) times more likely to be denied a method in control sites versus intervention sites (P<.01). Results from Ghana were inconclusive. Cost of a “denial averted” in Zambia was estimated to be US$0.59. Interpretation: Zambia results suggest that availability of free pregnancy testing significantly reduced contraceptive service denial, although results from Ghana preclude an unqualified recommendation. Authors conclude that free pregnancy testing in family planning clinics may make strong public health sense in those developing countries where denial to non

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

    PubMed

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

    2014-04-01

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

  20. A meta-synthesis of behavioral outcomes from telemedicine clinical trials for type 2 diabetes and the Clinical User-Experience Evaluation (CUE).

    PubMed

    Jalil, Sakib; Myers, Trina; Atkinson, Ian

    2015-03-01

    A worldwide demographic shift is in progress and the aged population proportion is projected to more than double across the next four decades. Our current healthcare models may not be adequate to handle this shift in demography, which may have serious consequences for the ageing population who are more prone to chronic diseases. One proposed remediation is to provide in-home assisted healthcare with technology-intervened approaches. Telemedicine, telehealth, e-health are paradigms found in scientific literature that provide clinical treatment through a technology intervention. In evidence-based medical science, these technology interventions are evaluated through clinical trials, which are targeted to measure improvements in medical conditions and the treatment's cost effectiveness. However, effectiveness of a technology also depends on the interaction pattern between the technology and its' users, especially the patients. This paper presents (1) a meta-synthesis of clinical trials for technology-intervened treatments of type 2 diabetes and (2) the Clinical User-Experience Evaluation (CUE). CUE is a recommendation for future telemedicine clinical trials that focuses on the patient as the user from Human-Computer Interaction (HCI) perspective and was developed as part of this research. The clinical trials reviewed were interpreted from a technology perspective and the non-medical or non-biological improvements of the users (patients) rather than the medical outcome. Results show that technology-intervened treatments provide positive behavior changes among patients and are potentially highly beneficial for chronic illness management such as type 2 diabetes. The results from the CUE method show how it complements clinical trials to capture patients' interaction with a technology.

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

    ERIC Educational Resources Information Center

    Parkerson, George R., Jr.; And Others

    1984-01-01

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

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

    PubMed

    Lu, Hongyan; Maithus, Caroline

    2012-11-01

    Clinical tutors, referred to in the international literature as clinical supervisors, facilitators, mentors or instructors, are responsible for providing and supervising workplace learning opportunities for groups of Bachelor of Nursing (BN) students. They also play a key role in assessing students. The role modeling and support provided by both clinical tutors and registered nurses (RN) or nurse preceptors helps students become familiar with the language in which nursing work is realised. As BN student cohorts in New Zealand have become more diverse in terms of cultures, ethnicities and language backgrounds, clinical tutors have to directly facilitate the development of context-specific and client-focused communication skills for students who speak English as an additional language. We undertook a study which looked at the perceptions of new nursing graduates with English as an additional language (EAL) on the development of spoken language skills for the clinical workplace. As well as interviewing graduates, we spoke to four clinical tutors in order to elicit their views on the language development of EAL students in previous cohorts. This article reports on the themes which emerged from the interviews with the tutors. These include goal setting for communication, integrating students into nursing work, making assessment less stressful, and endorsing independent learning strategies. Based on their observations and on other published research we make some suggestions about ways both clinical tutors and EAL students within their teaching groups could be supported in the development of communication skills for clinical practice.

  3. Nursing Students' Perceptions of Satisfaction and Self-Confidence with Clinical Simulation Experience

    ERIC Educational Resources Information Center

    Omer, Tagwa

    2016-01-01

    Nursing and other health professionals are increasingly using simulation as a strategy and a tool for teaching and learning at all levels that need clinical training. Nursing education for decades used simulation as an integral part of nursing education. Recent studies indicated that simulation improves nursing knowledge, clinical practice,…

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

    SciTech Connect

    Gaona, Enrique; Enriquez, Jesus Gabriel Franco; Alfonso, Beatriz Y. Alvarez; Castellanos, Gustavo Casian

    2008-08-11

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

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

    PubMed Central

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

    2015-01-01

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

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

    SciTech Connect

    Moore, Kevin L.; Brame, R. Scott; Low, Daniel A.; Mutic, Sasa

    2011-10-01

    Purpose: To incorporate a quality control tool, according to previous planning experience and patient-specific anatomic information, into the intensity-modulated radiotherapy (IMRT) plan generation process and to determine whether the tool improved treatment plan quality. Methods and Materials: A retrospective study of 42 IMRT plans demonstrated a correlation between the fraction of organs at risk (OARs) overlapping the planning target volume and the mean dose. This yielded a model, predicted dose = prescription dose (0.2 + 0.8 [1 - exp(-3 overlapping planning target volume/volume of OAR)]), that predicted the achievable mean doses according to the planning target volume overlap/volume of OAR and the prescription dose. The model was incorporated into the planning process by way of a user-executable script that reported the predicted dose for any OAR. The script was introduced to clinicians engaged in IMRT planning and deployed thereafter. The script's effect was evaluated by tracking {delta} = (mean dose-predicted dose)/predicted dose, the fraction by which the mean dose exceeded the model. Results: All OARs under investigation (rectum and bladder in prostate cancer; parotid glands, esophagus, and larynx in head-and-neck cancer) exhibited both smaller {delta} and reduced variability after script implementation. These effects were substantial for the parotid glands, for which the previous {delta} = 0.28 {+-} 0.24 was reduced to {delta} = 0.13 {+-} 0.10. The clinical relevance was most evident in the subset of cases in which the parotid glands were potentially salvageable (predicted dose <30 Gy). Before script implementation, an average of 30.1 Gy was delivered to the salvageable cases, with an average predicted dose of 20.3 Gy. After implementation, an average of 18.7 Gy was delivered to salvageable cases, with an average predicted dose of 17.2 Gy. In the prostate cases, the rectum model excess was reduced from {delta} = 0.28 {+-} 0.20 to {delta} = 0.07 {+-} 0

  7. Initial clinical experience with a radiation oncology dedicated open 1.0T MR-simulation.

    PubMed

    Glide-Hurst, Carri K; Wen, Ning; Hearshen, David; Kim, Joshua; Pantelic, Milan; Zhao, Bo; Mancell, Tina; Levin, Kenneth; Movsas, Benjamin; Chetty, Indrin J; Siddiqui, M Salim

    2015-03-08

    The purpose of this study was to describe our experience with 1.0T MR-SIM including characterization, quality assurance (QA) program, and features necessary for treatment planning. Staffing, safety, and patient screening procedures were developed. Utilization of an external laser positioning system (ELPS) and MR-compatible couchtop were illustrated. Spatial and volumetric analyses were conducted between CT-SIM and MR-SIM using a stereotactic QA phantom with known landmarks and volumes. Magnetic field inhomogeneity was determined using phase difference analysis. System-related, in-plane distortion was evaluated and temporal changes were assessed. 3D distortion was characterized for regions of interest (ROIs) 5-20 cm away from isocenter. American College of Radiology (ACR) recommended tests and impact of ELPS on image quality were analyzed. Combined ultrashort echotime Dixon (UTE/Dixon) sequence was evaluated. Amplitude-triggered 4D MRI was implemented using a motion phantom (2-10 phases, ~ 2 cm excursion, 3-5 s periods) and a liver cancer patient. Duty cycle, acquisition time, and excursion were evaluated between maximum intensity projection (MIP) datasets. Less than 2% difference from expected was obtained between CT-SIM and MR-SIM volumes, with a mean distance of < 0.2 mm between landmarks. Magnetic field inhomogeneity was < 2 ppm. 2D distortion was < 2 mm over 28.6-33.6 mm of isocenter. Within 5 cm radius of isocenter, mean 3D geometric distortion was 0.59 ± 0.32 mm (maximum = 1.65 mm) and increased 10-15 cm from isocenter (mean = 1.57 ± 1.06 mm, maximum = 6.26 mm). ELPS interference was within the operating frequency of the scanner and was characterized by line patterns and a reduction in signal-to-noise ratio (4.6-12.6% for TE = 50-150 ms). Image quality checks were within ACR recommendations. UTE/Dixon sequences yielded detectability between bone and air. For 4D MRI, faster breathing periods had higher duty cycles than slow (50.4% (3 s) and 39.4% (5 s), p

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

    PubMed Central

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

    2002-01-01

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

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

    PubMed

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

    1995-03-01

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

  10. Sensory integration intervention: historical concepts, treatment strategies and clinical experiences in three patients with succinic semialdehyde dehydrogenase (SSADH) deficiency.

    PubMed

    Kratz, S V

    2009-06-01

    This paper is a review of clinical experiences providing developmental therapy services for three boys diagnosed with paediatric neurotransmitter disease. The clinical presentation of paediatric neurotransmitter diseases might parallel other diagnostic characteristics seen in a typical paediatric therapy clinic (i.e. hypotonia, motor and cognitive delays, coordination, expressive speech, and ocular motor difficulties.) From the clinical perspective of the author, sensory integrative function is but one aspect of a thorough evaluation and treatment plan for all patients. The manifestations of sensory integration dysfunction (SID), also known as sensory processing dysfunction (SPD), can occur alone or be concurrent with a variety of known medical, behavioural and neurological diagnoses. These manifestations of SPD can include, but are not limited to: hypotonia, hyperactivity, irritability, distractibility, attention difficulties, learning difficulties, clumsiness and incoordination, instability, poor motor skills, social-emotional difficulties, and behavioural problems. This paper summarizes the theory and practice applications of sensory integration. The author discusses clinical experiences providing occupational therapy services utilizing sensory integration methods and strategies with clients who were eventually diagnosed with SSADH deficiency.

  11. The impact of clinical experience with alcoholics on Brazilian nursing students' attitudes toward alcoholism and associated problems.

    PubMed

    de Vargas, Divane

    2013-01-01

    This quasiexperimental study assessed the impact of a clinical experience involving alcoholics on nursing students' attitudes. The study participants were 195 students at a large university-based nursing school in Brazil. They were divided into experimental and control groups. Individuals in the experimental group (n = 56) participated in 6 weeks of a clinical practicum at a specialized treatment service for addiction, during a course in psychiatric nursing. In the same period, the control group (n = 144) participated in a 6-week clinical practicum at a specialized mental health service that did not treat people with addiction. At the end of the theoretical course and clinical practica, both groups completed an attitude measurement scale. Data analysis, using analysis of variance, indicated a statistically significant difference in the overall score on the attitude scale between the experimental and control groups (p = .04), indicating that the experimental group participants' have more positive attitudes, perceptions, opinions, and feelings toward alcoholic individuals and working and relating to these patients. In conclusion, educational interventions that include clinical experience with alcoholics may be an effective teaching strategy that contributes to better skill preparation and more comfortable feelings for nurses intervening in problems related to the use and abuse of alcohol and other drugs.

  12. Sociodemographic, Socio-economic, Clinical and Behavioural Factors Modifying Experience and Prevalence of Dental Caries in the Permanent Dentition

    PubMed Central

    Herrera, MS; Medina-Solis, CE; Islas-Granillo, H; Lara-Carrillo, E; Scougall-Vilchis, RJ; Escoffié-Ramírez, M; la Rosa-Santillana, R De; Avila-Burgos, L

    2014-01-01

    ABSTRACT Objective: To identify the sociodemographic, socio-economic, clinical and behavioural factors that modify the experience of decayed, missing and filled teeth (DMFT) and caries prevalence in Nicaraguan children 9-12 years old. Subjects and Methods: We conducted a cross-sectional study in 800 school children 9-12 years old in the city of León, Nicaragua. The clinical oral examinations to identify caries experience were undertaken by two trained and certified examiners. Sociodemographic, socio-economic and behavioural data were collected using questionnaires. Negative binomial regression (NBR) and binary logistic regression (BLR) models were used to model caries experience and caries prevalence, respectively. Results: Mean DMFT index was 0.98 ± 1.74 and caries prevalence (DMFT > 0) was 37.9%. In the NBR model, the categories that increase the expected DMFT mean were: older age, female gender, presence of plaque, and if the school children received curative and curative/preventive dental care in the last year. In the BLR model, the odds of presenting with caries in the permanent dentition were increased in older children, those from large families, mothers with a positive dental attitude, and those school children who received curative and curative/preventive dental care in the last year. Conclusions: Using different models, we identified several sociodemographic, socio-economic, clinical and behavioural factors that modify the experience (NBR) and prevalence (BLR) of dental caries. PMID:25867561

  13. [The value of the triad: clinical examination, mammography and needle aspiration cytology in the diagnosis of breast carcinoma. Our experience].

    PubMed

    Cipolla, C; Amato, C; Di Lisi, G; Graceffa, G; Cassano, T; Salanitro, L; Bajardi, G; De Simone, G F; Barberi, G; Tomasino, R M

    1990-11-01

    Based on the authors' personal experience of the use of the triad, clinical examination, mammography and needle-aspiration cytology, in the strategic diagnosis of breast cancer, the paper emphasizes the importance of early diagnosis as the sole means of obtaining an improved outcome. Using this integrated methodology the authors have obtained a specificity of 99%, sensitivity of 97.8%, and a diagnostic accuracy and prognostic value for positive tests of 98%. In conclusion, the authors affirm that the comparative interpretation of clinical examination, mammography and cytology appears to be an extremely efficacious and reliable method for the diagnosis of the nature of breast nodules.

  14. Crossing over: The lived experiences of clinical laboratory science education teachers as they transition from traditional to online instruction

    NASA Astrophysics Data System (ADS)

    Veldkamp, Ruth B.

    A phenomenological study was undertaken to understand and describe the nature and meaning of the live experiences of faculty transition from traditional to teaching online clinical laboratory science courses. In order to gain insight into the lived experiences of faculty, in-depth interviews were conducted with 10 faculty members. The task of the researcher was to allow the participants to speak for themselves, and reveal the meaning of the experiences, rather than to discover causal connections or patterns of correlation. The key criterion in choosing purposeful sampling procedure was to obtain the deepest understanding possible of the lived experiences of faculty transitioning to online teaching, which were likely to be a rich source of the data of interest. Analyses of the interview text were based on three essential considerations. The three essential considerations were (a) the traditional role of the faculty, (b) factors affecting the changing role of the faculty, and (c) the effects of web-based technology on teaching role.

  15. A new parallel plate dialyser. III. Preliminary experience on clinical performance.

    PubMed

    Dawids, S; Vojnovic, S

    1977-01-01

    The clinical model of a new parallel plate dialyser with a membrane area of 0.96 m2 with cuprophane 150 PM has been tested in more than 2000 dialyses with good clinical results. The simple design permits an aseptic, semiautomatic assembly and makes cheap industrial production possible. Clinical clearance values for urea, creatinine and uric acid are presented as well as data for ultrafiltration, residual blood volume and rupture frequency. The specific efficiency per square meter has been found to be high.

  16. Safety profile of Cerebrolysin: clinical experience from dementia and stroke trials.

    PubMed

    Thome, J; Doppler, E

    2012-04-01

    The safety of Cerebrolysin has been shown through many years of clinical use, observations from postmarketing surveillance studies, and safety data from randomized, controlled clinical trials. The reported events showed that adverse reactions to Cerebrolysin were generally mild and transient. Most common adverse events included vertigo, agitation and feeling hot. In the controlled clinical trials analyzed for this report, the incidence of adverse events was similar in Cerebrolysin- and placebo-treated groups. Cerebrolysin seems to be safe when used in combination with recombinant tissue-type plasminogen activator or cholinesterase inhibitors such as donepezil or rivastigmine. To our knowledge, Cerebrolysin was not associated with major changes in vital signs or laboratory parameters.

  17. Integrating Course Work With Field Work Placements in Undergraduate Clinical Biofeedback.

    ERIC Educational Resources Information Center

    Motiff, James P.

    The three major aspects of the clinical biofeedback experience for undergraduates at Hope College, Holland, Michigan are presented in terms of the academic program, the actual clinical experience, and the procedures for becoming certified as a "biofeedback assistant." The academic program is detailed, including the requirements for…

  18. Realizing actual feedback control of complex network

    NASA Astrophysics Data System (ADS)

    Tu, Chengyi; Cheng, Yuhua

    2014-06-01

    In this paper, we present the concept of feedbackability and how to identify the Minimum Feedbackability Set of an arbitrary complex directed network. Furthermore, we design an estimator and a feedback controller accessing one MFS to realize actual feedback control, i.e. control the system to our desired state according to the estimated system internal state from the output of estimator. Last but not least, we perform numerical simulations of a small linear time-invariant dynamics network and a real simple food network to verify the theoretical results. The framework presented here could make an arbitrary complex directed network realize actual feedback control and deepen our understanding of complex systems.

  19. The Accreditation Experience of Clinical Laboratories and Blood Banks in Mexico.

    PubMed

    Quintana, Sandra

    2015-11-01

    The accreditation of clinical laboratories and blood banks based on ISO 15189 is now being consolidated in Mexico, and is coordinated by the Mexican accreditation entity innovative strategies, A.C. (ema) and supported by the activities of the committee of clinical laboratories and blood banks. The active participation in working groups formed by the technical committee of clinical laboratories and blood banks in specific areas, has contributed to the formulation of technical documents and criteria of evaluation that strengthen the current accreditation scheme. The national registry of evaluation (PNE) consists of technical experts and evaluators from different disciplines of clinical laboratory; the evaluators actively participate in accreditation assessment, with an ultimate goal to receive training and feedback for continuous improvement of its own performance.

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

    PubMed

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

    2013-01-01

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

  1. Use of accelerating clinical improvement in reorganization of care: the Dartmouth-Hitchcock Medical Center experience.

    PubMed

    Kobokovich, L J

    1997-01-01

    Accelerating clinical improvement is a unique strategic method for accelerating the rate and effectiveness of improvements in strategically important clinical services. It promotes real reduction in the cost of service while preserving the quality and value within the system. Based on the components of process, value, benchmarking, change, and learning, the method can be used in any system or setting to produce value-driven change. Accelerating clinical improvement is being used within the Obstetrical Department of Dartmouth-Hitchcock Medical Center to decrease postpartum length of stay for families with spontaneous vaginal delivery. Familiarity with the method led to additional and ongoing improvements in the system. This method is important for nurses because it is continuous, multidisciplinary, addresses values of concern to families and providers, and is easily incorporated by nurse providers in any clinical setting.

  2. The Accreditation Experience of Clinical Laboratories and Blood Banks in Mexico

    PubMed Central

    2015-01-01

    The accreditation of clinical laboratories and blood banks based on ISO 15189 is now being consolidated in Mexico, and is coordinated by the Mexican accreditation entity innovative strategies, A.C. (ema) and supported by the activities of the committee of clinical laboratories and blood banks. The active participation in working groups formed by the technical committee of clinical laboratories and blood banks in specific areas, has contributed to the formulation of technical documents and criteria of evaluation that strengthen the current accreditation scheme. The national registry of evaluation (PNE) consists of technical experts and evaluators from different disciplines of clinical laboratory; the evaluators actively participate in accreditation assessment, with an ultimate goal to receive training and feedback for continuous improvement of its own performance. PMID:27683498

  3. Liposomal Amphotericin B (AmBisome(®)): A Review of the Pharmacokinetics, Pharmacodynamics, Clinical Experience and Future Directions.

    PubMed

    Stone, Neil R H; Bicanic, Tihana; Salim, Rahuman; Hope, William

    2016-03-01

    Liposomal amphotericin B (AmBisome(®); LAmB) is a unique lipid formulation of amphotericin B. LAmB is a standard of care for a wide range of medically important opportunistic fungal pathogens. LAmB has a significantly improved toxicity profile compared with conventional amphotericin B deoxycholate (DAmB). Despite nearly 20 years of clinical use, the pharmacokinetics and pharmacodynamics of this agent, which differ considerably from DAmB, remain relatively poorly understood and underutilized in the clinical setting. The molecular pharmacology, preclinical and clinical pharmacokinetics, and clinical experience with LAmB for the most commonly encountered fungal pathogens are reviewed. In vitro, experimental animal models and human clinical trial data are summarized, and novel routes of administration and dosing schedules are discussed. LAmB is a formulation that results in reduced toxicity as compared with DAmB while retaining the antifungal effect of the active agent. Its long terminal half-life and retention in tissues suggest that single or intermittent dosing regimens are feasible, and these should be actively investigated in both preclinical models and in clinical trials. Significant gaps remain in knowledge of pharmacokinetics and pharmacodynamics in special populations such as neonates and children, pregnant women and obese patients.

  4. Liposomal Amphotericin B (AmBisome®): A review of the pharmacokinetics, pharmacodynamics, clinical experience and future directions

    PubMed Central

    Stone, Neil RH; Bicanic, Tihana; Salim, Rahuman; Hope, William

    2016-01-01

    Liposomal amphotericin B (AmBisome®; LAmB) is a unique lipid formulation of amphotericin B. LAmB is a standard of care for a wide range of medically important opportunistic fungal pathogens. LAmB has a significantly improved toxicity profile compared with conventional amphotericin B deoxycholate (DAmB). Despite nearly 20 years of clinical use, the pharmacokinetics and pharmacodynamics of this agent, which differ considerably from DAmB, remain relatively poorly understood and underutilized in the clinical setting. The molecular pharmacology, preclinical and clinical pharmacokinetics, and clinical experience with LAmB for the most commonly encountered fungal pathogens are reviewed. In vitro, experimental animal models and human clinical trial data are summarized, and novel routes of administration and dosing schedules are discussed. LAmB is a formulation that results in reduced toxicity as compared with DAmB while retaining the antifungal effect of the active agent. Its long terminal half-life and retention in tissues suggest that single or intermittent dosing regimens are feasible, and these should be actively investigated in both preclinical models and in clinical trials. Significant gaps remain in knowledge of pharmacokinetics and pharmacodynamics in special populations such as neonates and children, pregnant women and obese patients. PMID:26818726

  5. The role of ultrasound simulators in education: an investigation into sonography student experiences and clinical mentor perceptions

    PubMed Central

    2015-01-01

    Simulation as an effective pedagogy is gaining momentum at all levels of health care education. Limited research has been undertaken on the role of simulated learning in health care and further evaluation is needed to explore the quality of learning opportunities offered, and their effectiveness in the preparation of students for clinical practice. This study was undertaken to explore ways of integrating simulation-based learning into sonography training to enhance clinical preparation. A qualitative study was undertaken, using interviews to investigate the experiences of a group of sonography students after interacting with an ultrasound simulator. The perceptions of their clinical mentors on the effectiveness of this equipment to support the education and development of sonographers were also explored. The findings confirm that ultrasound simulators provide learning opportunities in an unpressurised environment, which reduces stress for the student and potential harm to patients. Busy clinical departments acknowledge the advantages of opportunities for students to acquire basic psychomotor skills in a classroom setting, thereby avoiding the inevitable reduction in patient throughput which results from clinical training. The limitations of simulation equipment to support the development of the full range of clinical skills required by sonographers were highlighted and suggestions made for more effective integration of simulation into the teaching and learning process. Ultrasound simulators have a role in sonography education, but continued research needs to be undertaken in order to develop appropriate strategies to support students, educators and mentors to effectively integrate this methodology. PMID:27433260

  6. Leadership experiences for baccalaureate nursing students: improving quality in a nurse-managed rural health clinic.

    PubMed

    Sherrod, Roy Ann; Morrison, Ruby Shaw

    2008-01-01

    Nurse educators need practical, effective methods to help nursing students understand the importance of quality improvement activities and their relationship to the financial viability of organizations. This article describes a project designed to provide students with an opportunity to apply quality improvement principles in a rural, nurse-managed clinic with the ultimate goal of improving potential reimbursement for services through improved documentation. Implications for students, nurse educators, and rural clinics are provided.

  7. Skill Learning Through Early Clinical Exposure: An Experience of Indian Medical School

    PubMed Central

    Jagzape, Arunita; Srivastava, Tripti; Gotarkar, Shashank

    2016-01-01

    Introduction Indian Medical curriculum being discipline based, there is a line of demarcation between preclinical and clinical subjects. The challenges in medical education include the methods that would enhance the clinical education quality; one such method been Early Clinical Exposure (ECE). ECE can help to instill the skill component of medical education in the first year students helping to minimize the line of demarcation. Hence this study was undertaken to assess the skill learning of students through early clinical exposure and to collate the perception of them. Materials and Methods: In the present study, students of 1st MBBS were exposed to ECE as an adjunct teaching method with preset modules. They were evaluated by Objectively Structured Clinical Examination (OSCE). Feedback was obtained from 1st MBBS and also from the same students after passing the 1st MBBS in 4th semester. Results Significant differences in pre and post OSCE scores were noted (p<0.0001). Seventy six percent students rated ECE as an excellent tool. Second year students also perceived ECE held in 1st year was helpful to correlate topics and increasing confidence. Conclusion ECE had an effective influence on learning as manifested in skills gained by the students and their perceptions of ECE being helpful prospectively in their routine clinical posting. PMID:26894088

  8. Clinical pharmacokinetic/pharmacodynamic and physiologically based pharmacokinetic modeling in new drug development: the capecitabine experience.

    PubMed

    Blesch, Karen S; Gieschke, Ronald; Tsukamoto, Yuko; Reigner, Bruno G; Burger, Hans U; Steimer, Jean-Louis

    2003-05-01

    Preclinical studies, along with Phase I, II, and III clinical trials demonstrate the pharmacokinetics, pharmacodynamics, safety and efficacy of a new drug under well controlled circumstances in relatively homogeneous populations. However, these types of studies generally do not answer important questions about variability in specific factors that predict pharmacokinetic and pharmacodynamic (PKPD) activity, in turn affecting safety and efficacy. Semi-physiological and clinical PKPD modeling and simulation offer the possibility of utilizing data obtained in the laboratory and the clinic to make accurate characterizations and predictions of PKPD activity in the target population, based on variability in predictive factors. Capecitabine is an orally administered pro-drug of 5-fluorouracil (5-FU), designed to exploit tissue-specific differences in metabolic enzyme activities in order to enhance efficacy and safety. It undergoes extensive metabolism in multiple physiologic compartments, and presents particular challenges for predicting pharmacokinetic and pharmacodynamic activity in humans. Clinical and physiologically based pharmacokinetic (PBPK) and pharmacodynamic models were developed to characterize the activity of capecitabine and its metabolites, and the clinical consequences under varying physiological conditions such as creatinine clearance or activity of key metabolic enzymes. The results of the modeling investigations were consistent with capecitabine's rational design as a triple pro-drug of 5-FU. This paper reviews and discusses the PKPD and PBPK modeling approaches used in capecitabine development to provide a more thorough understanding of what the key predictors of its PBPK activity are, and how variability in these predictors may affect its PKPD, and ultimately, clinical outcomes.

  9. Answering the question, "what is a clinical nurse leader?": transition experience of four direct-entry master's students.

    PubMed

    Bombard, Emily; Chapman, Kimberly; Doyle, Marcy; Wright, Danielle K; Shippee-Rice, Raelene V; Kasik, Dot Radius

    2010-01-01

    Understanding the experience of students learning the clinical nurse leader (CNL) role can be useful for faculty, preceptors, staff nurses, and interdisciplinary team members who guide them. This article analyzes the experience of four direct-entry master's students in the first cohort to complete the CNL curriculum and to sit for the pilot CNL certification examination. Using action research methodology, the students worked with the clinical immersion practicum faculty and a writing consultant to develop the study purpose, collect and analyze data, and prepare a manuscript. The main theme that emerged was, answering the question, "what is a CNL?" Subthemes supporting the main theme involved coming to the edge, trusting the process, rounding the corner, and valuing becoming. The analysis confirmed the value the CNL offers as a new vision to nursing education and practice. The students offered suggestions for the CNL curriculum and practicum.

  10. The Effects of Early Clinical Teaching Experiences on Pre-Service Teachers' Self-Efficacy

    ERIC Educational Resources Information Center

    Androzzi, Jared

    2011-01-01

    In-service teachers are often lack sufficient teaching experience (Block et al., 2010) that leads to being psychologically unprepared to confront many challenges in teaching. Providing ample experiences for Physical Education Teacher Education (PETE) students in a pedagogical setting parallel to that which they will one day teach (Kirk &…

  11. Expectations and experiences of investigators and parents involved in a clinical trial for Duchenne/Becker muscular dystrophy

    PubMed Central

    Peay, Holly L; Tibben, Aad; Fisher, Tyler; Brenna, Ethan; Biesecker, Barbara B

    2014-01-01

    Background The social context of rare disease research is changing, with increased community engagement around drug development and clinical trials. This engagement may benefit patients and families, but may also lead to heightened trial expectations and therapeutic misconception. Clinical investigators are also susceptible to harboring high expectations. Little is known about parental motivations and expectations for clinical trials for rare pediatric disorders. Purpose We describe the experience of parents and clinical investigators involved in a phase II clinical trial for Duchenne and Becker muscular dystrophy: their expectations, hopes, motivations, and reactions to the termination of the trial. Methods This qualitative study was based on interviews with clinical investigators and parents of sons with DBMD who participated in the phase IIa or IIb ataluren clinical trial in the United States. Interviews were transcribed and coded for thematic analysis. Results Participants were twelve parents of affected boys receiving active drug and nine clinical investigators. High trial expectations of direct benefit were reported by parents and many clinicians. Investigators described monitoring and managing parents’ expectations; several worried about their own involvement in increasing parents’ expectations. Most parents were able to differentiate their expectations from their optimistic hopes for a cure. Parents’ expectations arose from other parents, advocacy organizations, and the sponsor. All parents reported some degree of clinical benefit to their children. Secondary benefits were hopefulness and powerful feelings associated with active efforts to affect the disease course. Parents and clinical investigators reported strong, close relationships that were mutually important. Parents and clinicians felt valued by the sponsor for the majority of the trial. When the trial abruptly stopped, they described loss of engagement, distress, and feeling unprepared for

  12. Holmium:YAG laser coronary angioplasty: quantitative angiography and clinical results in a large experience of a single medical center

    NASA Astrophysics Data System (ADS)

    Topaz, On; Luxenberg, Michael; Schumacher, Audrey

    1994-07-01

    Clinical experience with the mid IR holmium:YAG laser in a single medical center (St. Paul Ramsey Medical Center, University of Minnesota Medical School, St. Paul, MN) includes 112 patients who underwent holmium laser coronary angioplasty. Utilizing a unique lasing technique; `pulse and retreat,' we applied this laser to thrombotic and nonthrombotic lesions in patients presenting with unstable angina, stable angina, and acute myocardial infarction. A very high clinical success and very low complication rates were achieved. Holmium:YAG laser is effective and safe therapy for patients with symptomatic coronary artery disease. Unlike excimer lasers, the clinical success, efficacy and safety of holmium laser angioplasty is not compromised when thrombus is present.

  13. Implementation of the exception from informed consent regulations in a large multicenter emergency clinical trials network: the RAMPART experience.

    PubMed

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

    2012-04-01

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

  14. Children's Rights and Self-Actualization Theory.

    ERIC Educational Resources Information Center

    Farmer, Rod

    1982-01-01

    Educators need to seriously reflect upon the concept of children's rights. Though the idea of children's rights has been debated numerous times, the idea remains vague and shapeless; however, Maslow's theory of self-actualization can provide the children's rights idea with a needed theoretical framework. (Author)

  15. Culture Studies and Self-Actualization Theory.

    ERIC Educational Resources Information Center

    Farmer, Rod

    1983-01-01

    True citizenship education is impossible unless students develop the habit of intelligently evaluating cultures. Abraham Maslow's theory of self-actualization, a theory of innate human needs and of human motivation, is a nonethnocentric tool which can be used by teachers and students to help them understand other cultures. (SR)

  16. Humanistic Education and Self-Actualization Theory.

    ERIC Educational Resources Information Center

    Farmer, Rod

    1984-01-01

    Stresses the need for theoretical justification for the development of humanistic education programs in today's schools. Explores Abraham Maslow's hierarchy of needs and theory of self-actualization. Argues that Maslow's theory may be the best available for educators concerned with educating the whole child. (JHZ)

  17. Developing Human Resources through Actualizing Human Potential

    ERIC Educational Resources Information Center

    Clarken, Rodney H.

    2012-01-01

    The key to human resource development is in actualizing individual and collective thinking, feeling and choosing potentials related to our minds, hearts and wills respectively. These capacities and faculties must be balanced and regulated according to the standards of truth, love and justice for individual, community and institutional development,…

  18. 50 CFR 253.16 - Actual cost.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 9 2011-10-01 2011-10-01 false Actual cost. 253.16 Section 253.16 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE AID TO FISHERIES FISHERIES ASSISTANCE PROGRAMS Fisheries Finance Program §...

  19. Experience with DICOM for the clinical specialties in the healthcare enterprise

    NASA Astrophysics Data System (ADS)

    Kuzmak, Peter M.; Dayhoff, Ruth E.

    2003-05-01

    DICOM is a success for radiology and cardiology and it is now beginning to be used for other clinical specialties. The US Department of Veterans Affairs has been instrumental in promoting this technological advancement. We have worked with a number of non-radiology imaging vendors over the past several years, encouraging them to support DICOM, providing requirement specifications, validating their implementations, installing their products, and integrating their systems with the VA healthcare enterprise. We require each new non-radiology vendor to support the DICOM Modality Worklist and Storage services, as specified in the IHE Technical Framework, and insist that they perform validation testing with us over the Internet before installing at a VA site. Three years ago we began working with commercial DICOM image acquisition applications in ophthalmology and endoscopy. Today we are interfacing with six vendors in ophthalmology, six in dental, and two in endoscopy. Getting imaging modality vendors to support DICOM is only part of the story, however. We have also developed the capabilities of the VistA hospital information system to properly handle DICOM interfaces to the different clinical specialties. The workflow in the clinical specialties is different than that of radiology, and is much more diverse. We designed the VistA DICOM image acquisition and display interface to use the generic order entry, result entry, result reporting, and appointment scheduling applications of our hospital information system, which are common to other hospital information systems, in order to maintain existing clinical workflow, minimize operational disruptions, simplify training, and win user acceptance. This software is now being field tested with dental and ophthalmology systems at a large number of VA medical centers. We have learned several things from this field test. The DICOM Modality Worklist and Storage services can be successfully used for image acquisition in the clinical

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    PubMed

    Miller, Wendy

    2014-01-01

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

  2. Quality management systems in ART: are they really needed? An Australian clinic's experience.

    PubMed

    Warnes, G M; Norman, R J

    2007-02-01

    As assisted reproductive technology (ART) expanded globally, several countries introduced prescribed requirements for treatment and monitoring of outcomes, as well as a licensing or accreditation requirement. While it is common for ART laboratories to be required to have an effective quality control system, the remainder of the clinic is often under less stringent regulation. Furthermore, when treatment conditions are prescribed, the standards tend to be conservative and clinics may choose to establish their own standards. Total quality management systems are now being used by an increasing number of ART clinics. In Australia and New Zealand, it is now a requirement to have a quality management system in order to be accredited and to help meet customer demand for improved delivery of ART services in these two countries.

  3. Establishing a clinical trials network in nephrology: experience of the Australasian Kidney Trials Network.

    PubMed

    Morrish, Alicia T; Hawley, Carmel M; Johnson, David W; Badve, Sunil V; Perkovic, Vlado; Reidlinger, Donna M; Cass, Alan

    2014-01-01

    Chronic kidney disease is a major public health problem globally. Despite this, there are fewer high-quality, high-impact clinical trials in nephrology than other internal medicine specialties, which has led to large gaps in evidence. To address this deficiency, the Australasian Kidney Trials Network, a Collaborative Research Group, was formed in 2005. Since then, the Network has provided infrastructure and expertise to conduct patient-focused high-quality, investigator-initiated clinical trials in nephrology. The Network has not only been successful in engaging the nephrology community in Australia and New Zealand but also in forming collaborations with leading researchers from other countries. This article describes the establishment, development, and functions of the Network. The article also discusses the current and future funding strategies to ensure uninterrupted conduct of much needed clinical trials in nephrology to improve the outcomes of patients affected by kidney diseases with cost-effective interventions.

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

    PubMed Central

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

    1993-01-01

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

  5. Biomechanical testing and clinical experience with the OMEGA-21 spinal fixation system.

    PubMed

    Cook, S D; Salkeld, S L; Whitecloud, T S; Barberá, J

    2001-05-01

    The role of spinal instrumentation is to provide mechanical stability, obtain and maintain anatomic alignment, and promote fusion. The American Society for Testing and Materials (ASTM) introduced guidelines and procedures so that biomechanical properties of different implant designs could be compared in a consistent manner. Combined with biomechanical analyses, clinical evaluation allows the safety and efficacy of a spinal implant system to be determined before construction. The objective of our study was to determine the biomechanical properties and clinical performance of the OMEGA-21 Spinal Fixation System. Static and dynamic (fatigue) biomechanical testing was performed per ASTM guidelines and recommendations on individual components and on the system assembled in a corpectomy model. Clinical and radiographic evaluation of 57 consecutive patients with indications for instrumented spinal arthrodesis of the lower dorsal lumbar and sacral segments of the spine was performed at a mean follow-up of 31.9 months. Static and fatigue testing revealed superior biomechanical properties of the individual components and of the assembled system. The mechanical-strength values of the system were comparable with maximum reported values for existing implant designs. At final clinical follow-up, 86% of patients obtained relief of their symptoms; 84% considered their clinical results to be excellent or good. Ninety-one percent of patients satisfied radiographic criteria for bony fusion. There were 5 implant-related complications: 2 misplaced screws (2 patients), local pain above the implant (2 patients), and 2 broken expansive screws (1 patient). Biomechanical and clinical results indicate that the OMEGA-21 system is feasible and performs well as a spinal instrumentation system for the lower dorsal, lumbar, and sacral spine.

  6. Clinical experience with array CGH: case presentations from nine months of practice.

    PubMed

    Poss, Alexis F; Goldenberg, Paula C; Rehder, Catherine W; Kearney, Hutton M; Melvin, Elizabeth C; Koeberl, Dwight D; McDonald, Marie T

    2006-10-01

    A total of 124 individuals were tested in the initial 9 months that array CGH technology was offered to clinical genetics patients. In 11 of these patients array CGH identified a previously unsuspected diagnosis. A suspected diagnosis was confirmed in three patients. A single case in this series proved to be a polymorphic copy number variant. This paper describes five of the patients with previously unsuspected diagnoses in detail. We suggest that array CGH is an improved tool ready for routine use in clinical genetics.

  7. World experience after more than a decade of clinical hand transplantation: update on the Innsbruck program.

    PubMed

    Hautz, Theresa; Engelhardt, Timm O; Weissenbacher, Annemarie; Kumnig, Martin; Zelger, Bettina; Rieger, Michael; Rumpold, Gerhard; Pierer, Gerhard; Ninkovic, Marina; Gabl, Markus; Piza-Katzer, Hildegunde; Pratschke, Johann; Margreiter, Raimund; Brandacher, Gerald; Schneeberger, Stefan

    2011-11-01

    Patients who have lost a hand or upper extremity face many challenges in everyday life. For some patients, reconstructive hand transplantation represents a reasonable option for anatomic reconstruction, restoring prehensile function with sensation and allowing them to regain daily living independence. The first clinical case of bilateral hand transplantation at University Hospital Innsbruck was realized on March 17th, 2000. A decade later, a total of 7 hands and forearms were transplanted in 4 patients. This article review the clinical courses of 3 bilateral hand transplant recipients and highlights psychological aspects on reconstructive hand transplantation with special regard to unilateral/bilateral transplantation.

  8. Cardioprotective effects of Aronia melanocarpa anthocynanins. From laboratory experiments to clinical practice.

    PubMed

    Parzonko, Andrzej; Naruszewicz, Marek

    2016-01-01

    The role of polyphenols in the cardiovascular diseases prevention is still a matter of scientific discussion. However, recent clinical studies indicate that intake of anthocyanins and in a lesser extent procyanidins can participate in prevention of hypertension and type 2 diabetes. Fruits of Aronia melanocarpa (chokeberry) are known to be a reach source of these polyphenols. Moreover, its extracts were shown to express strong antioxidant, antiinflammatory, vasorelaxant and antithrombotic properties. The aim of the review is to summarize the results of the hitherto research regarding the biological effects at the molecular and clinical level.

  9. Clinical, hormonal and radiological features of partial Sheehan's syndrome: an Indian experience.

    PubMed

    Laway, Bashir; Misgar, Raiz; Mir, Shahnaz; Wani, Arshad

    2016-04-01

    Objective The objective of this study was to describe clinical presentation, hormonal profile and imaging characteristics of 21 patients with partial Sheehan's syndrome. Subjects and methods This prospective study was carried out over a period of six years (2008-2013). The evaluation of patients included clinical assessment, hormone estimations and contrast enhanced magnetic resonance imaging of pituitary. Results We documented preservation of gonadotroph, corticotroph and lactotroph function in 71.4, 61.9, and 9.5% of patients respectively. Conclusion To conclude some of the pituitary functions can be preserved in Sheehan's syndrome and this has important implications from the treatment and long term morbidity point of view.

  10. The experiences of patients with Duchenne muscular dystrophy in facing and learning about their clinical conditions

    PubMed Central

    Fujino, Haruo; Iwata, Yuko; Saito, Toshio; Matsumura, Tsuyoshi; Fujimura, Harutoshi; Imura, Osamu

    2016-01-01

    Patients experience extreme difficulty when facing an intractable genetic disease. Herein, we examine the experiences of patients with Duchenne muscular dystrophy in facing and learning about their disease. A total of seven patients with Duchenne muscular dystrophy (age range: 20–48) participated. We conducted in-depth interviews with them about how they learned of their disease and how their feelings regarding the disease changed over time. Transcribed data were analysed using thematic analysis. The following themes emerged from this analysis: “experiences before receiving the diagnosis,” “experiences when they learned of their condition and progression of the disease,” “supports,” and “desired explanations.” Anxiety and worry were most pronounced when they had to transition to using wheelchairs or respirators due to disease progression; indeed, such transitions affect the patients psychological adjustment. In such times, support from significant others in their lives helped patients adjust. PMID:27712620

  11. Clinical and laboratory experience with heparin-impregnated silicone shunts for carotid endarterectomy.

    PubMed

    Piepgras, D G; Sundt, T M

    1976-11-01

    Our experience with use of a Silastic shunt for carotid endarterectomy is reviewed briefly, and the complication of shunt thrombosis despite intraoperative administration of heparin is noted. Of obvious importance are the reduction of blood flow and the possibility of embolization caused by accumulating thrombus. Shunt thrombosis has been abolished by the use of heparin-impregnated Silastic shunts. In experiments in dogs, such heparin-treated shunts showed greater thromboresistance than did untreated shunts.

  12. The role of the nurse teacher in clinical practice: an empirical study of Finnish student nurse experiences.

    PubMed

    Saarikoski, Mikko; Warne, Tony; Kaila, Päivi; Leino-Kilpi, Helena

    2009-08-01

    This paper focuses on the role of the nurse teacher (NT) in supporting student nurse education in clinical practice. The paper draws on the outcomes of a study aimed at exploring student nurse experiences of the pedagogical relationship with NTs during their clinical placements. The participants (N=549) were student nurses studying on pre-registration nursing programmes in Finland. Data were analysed using descriptive statistics, cross-tabulation and ANOVA. The study showed that the core aspect of NTs work in clinical practice revolved around the relationship between student, mentor and NT. Higher levels of satisfaction were experienced in direct proportion to the number of meetings held between the student and NT. However, whilst the importance of this relationship has been reported elsewhere, an additional aspect of this relationship emerged in the data analysis. Those NT who facilitated good face to face contact also used other methods to enhance the relationship, particularly e-mail, virtual learning environment and texting. This outcome suggests that NT's interpersonal and communicative skills are as important as their clinical knowledge and skills in promoting effective learning in the clinical practice area. The paper argues for such approaches to be utilised within the emergent opportunities afforded by new communication and educational technologies.

  13. Clinical Experience of Patients Receiving Doripenem-Containing Regimens for the Treatment of Healthcare-Associated Infections

    PubMed Central

    Chao, Chien-Ming; Chen, Chi-Chung; Huang, Hui-Ling; Chuang, Yin-Ching; Lai, Chih-Cheng; Tang, Hung-Jen

    2016-01-01

    In this study, we retrospectively reviewed the clinical experience of patients receiving doripenem-containing regimens for the treatment of healthcare-associated infections (HCAIs) in a tertiary care center and assessed the clinical usefulness of doripenem therapy in this clinical setting. In this retrospective study, the medical records of all adult patients who had ever received doripenem-containing therapy for the treatment of HCAIs were reviewed between September 1, 2012 and August 31, 2014, and the following data were extracted: age, gender, type of infection, disease severity, underlying comorbidities or conditions, and laboratory results. Additionally, we also extracted data regarding the rates of mortality and clinical and microbiological response. A total of 184 adult patients with HCAIs who had received doripenem-containing therapy were included in this study. Respiratory tract infections (n = 91, 49.5%) were the most common type of infection, followed by urinary tract infections, intra-abdominal infections and skin and soft tissue infections. The mean APACHE II score was 14.5. The rate of clinical success was 78.2%, and the overall in-hospital mortality rate was only 13.0%. Among patients, in-hospital mortality was independently and significantly associated with APACHE II score (odds ratio (OR), 1.2825; 95% CI, 1.1123–1.4788) and achieving clinical success (OR, 0.003; 95% CI, 0.0003–0.409). In conclusion, the overall in-hospital mortality rate was low and the clinical success rate was high among HCAI patients receiving doripenem treatment. These results suggest that doripenem may be judiciously used for the treatment of patients with HCAIs. PMID:27907197

  14. Assessment Experiences in the Workplace: A Comparative Study between Clinical Educators' and Their Students' Perceptions

    ERIC Educational Resources Information Center

    Trede, Franziska; Mischo-Kelling, Maria; Gasser, Eva Maria; Pulcini, Stefania

    2015-01-01

    With this paper, we contribute to the complex field of assessment of student learning in work placements. The complexity includes the dual role of clinical educators as mentors and assessors, students as pre-accredited practitioners and the diverse purposes of assessment. A philosophical hermeneutic approach was adopted to explore the perceptions…

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

    NASA Technical Reports Server (NTRS)

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

    1982-01-01

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

  16. Experiences with developing and implementing a virtual clinic for glaucoma care in an NHS setting

    PubMed Central

    Kotecha, Aachal; Baldwin, Alex; Brookes, John; Foster, Paul J

    2015-01-01

    Background This article describes the development of a virtual glaucoma clinic, whereby technicians collect information for remote review by a consultant specialist. Design and Methods This was a hospital-based service evaluation study. Patients suitable for the stable monitoring service (SMS) were low-risk patients with “suspect”, “early”-to-“moderate” glaucoma who were deemed stable by their consultant care team. Three technicians and one health care assistant ran the service. Patients underwent tests in a streamlined manner in a dedicated clinical facility, with virtual review of data by a consultant specialist through an electronic patient record. Main outcome measure Feasibility of developing a novel service within a UK National Health Service setting and improvement of patient journey time within the service were studied. Results Challenges to implementation of virtual clinic include staffing issues and use of information technology. Patient journey time within the SMS averaged 51 minutes, compared with 92 minutes in the glaucoma outpatient department. Patient satisfaction with the new service was high. Conclusion Implementing innovation into existing services of the National Health Service is challenging. However, the virtual clinic showed an improved patient journey time compared with that experienced within the general glaucoma outpatient department. There exists a discrepancy between patient management decisions of reviewers, suggesting that some may be more risk averse than others when managing patients seen within this model. Future work will assess the ability to detect progression of disease in this model compared with the general outpatient model of care. PMID:26508830

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

    ERIC Educational Resources Information Center

    Feil, Philip; Meeske, Jessica; Fortman, Jared

    1999-01-01

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

  18. Implementing an assessment-based communication skills training in pre-clinical phase: an IMU experience.

    PubMed

    Lukman, H; Beevi, Z; Mohamadou, G; Yeap, R

    2006-06-01

    This article describes the communication skills programme of the International Medical University, which adopts an integrated medical curriculum. The programme, implemented in February 2005, is based on a systematic framework aimed at teaching students basic interpersonal communication skills progressively and continuously throughout the pre-clinical phase.

  19. The Clinical Learning Environment: Improving the Education Experience and Patient Outcomes Within Magnet® Organizations.

    PubMed

    Chappell, Kathy

    2016-01-01

    Creating a safe and supportive clinical learning environment where students can learn collaboratively with each other and with practicing healthcare providers is the responsibility of Magnet® leaders. In this month's Magnet Perspectives, the Vice President of the ANCC Accreditation Program and Institute for Credentialing Research discusses the imperative for interprofessional learning environments.

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

    ERIC Educational Resources Information Center

    Hollister, William G.; And Others

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

  1. Changes in local clinical practice following an experiment in medical care: evaluation of evaluation.

    PubMed

    Adler, M W

    1978-06-01

    The changes in clinical practice following a randomised controlled trial of early discharge for inguinal hernia and varicose veins are reviewed. A significant reduction in mean length of stay was recorded in the study area between 1970 (the year before the start of the study) and 1975 (two complete years after the study). This change was not found in two adjacent health districts.

  2. Dementia in Urban Black Outpatients: Initial Experience at the Emory Satellite Clinics.

    ERIC Educational Resources Information Center

    Auchus, Alexander P.

    1997-01-01

    Describes the demographic features and clinical diagnoses in a sample of 58 demented urban black outpatients. Results indicate that probable Alzheimer's disease was the most common cause of dementia whereas probable vascular dementia was uncommon. A multiple etiology dementia was identified in more than one-third of the patients. (RJM)

  3. The role of analogy-guided learning experiences in enhancing students' clinical decision-making skills.

    PubMed

    Edelen, Bonnie Gilbert; Bell, Alexandra Alice

    2011-08-01

    The purpose of this study was to address the need for effective educational interventions to promote students' clinical decision making (CDM) within clinical practice environments. Researchers used a quasi-experimental, non-equivalent groups, posttest-only design to assess differences in CDM ability between intervention group students who participated in analogy-guided learning activities and control group students who participated in traditional activities. For the intervention, analogy-guided learning activities were incorporated into weekly group discussions, reflective journal writing, and questioning with clinical faculty. The researcher-designed Assessment of Clinical Decision Making Rubric was used to assess indicators of CDM ability in all students' reflective journal entries. Results indicated that the intervention group demonstrated significantly higher levels of CDM ability in their journals compared with the control group (ES(sm) = 0.52). Recommendations provide nurse educators with strategies to maximize students' development of CDM ability, better preparing students for the demands they face when they enter the profession.

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

    NASA Astrophysics Data System (ADS)

    Kuzmak, Peter M.; Dayhoff, Ruth E.

    2004-04-01

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

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

    ERIC Educational Resources Information Center

    Lee, Kyungjae

    2014-01-01

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

  6. Associations between adverse childhood experiences and clinical characteristics of eating disorders

    PubMed Central

    Guillaume, S.; Jaussent, I.; Maimoun, L.; Ryst, A.; Seneque, M.; Villain, L.; Hamroun, D.; Lefebvre, P.; Renard, E.; Courtet, Ph.

    2016-01-01

    Patients with eating disorders (EDs) frequently report a history of childhood trauma (CT). We investigated whether certain subtypes of CT are associated with more severe features of EDs, independently of psychiatric comorbidity, and whether they act additively. One hundred and ninety-two patients with DSM-V-defined EDs were consecutively recruited. Five clinical characteristics were assessed: restraint, eating, shape and weight concerns on the EDE-Q, and daily functioning. CT was assessed by the childhood traumatism questionnaire. The clinical features were associated with at least one CT subtype (emotional, sexual or physical abuse, emotional neglect). Multivariate analyses adjusted for lifetime comorbid psychiatric disorders revealed that emotional abuse independently predicted higher eating, shape and weight concerns and lower daily functioning, whereas sexual and physical abuse independently predicted higher eating concern. A dose-effect relationship characterised the number of CT subtypes and the severity of the clinical features, suggesting a consistent and partly independent association between CT and more severe clinical and functional characteristics in EDs. Emotional abuse seems to have the most specific impact on ED symptoms. Last, not all CT subtypes have the same impact but they do act additively. PMID:27804994

  7. Rett syndrome: long-term clinical follow-up experiences over four decades.

    PubMed

    Hagberg, Bengt

    2005-09-01

    Long-term clinical profiles of female patients with classic Rett syndrome are presented and exemplified by three cases, as experienced over four decades. Emphasized is the frequently surprisingly well-preserved eye contact and primitive memory, in contrast to a premature neuromuscular aging and often advanced peripheral atrophy, usually combined with dystonic-rigid signs that are predominantly right sided.

  8. Implementing specific oral tolerance induction to milk into routine clinical practice: experience from first 50 patients

    PubMed Central

    Luyt, David; Bravin, Kristian; Luyt, Jessica

    2014-01-01

    Background Although the natural history of cow’s milk allergy is to resolve during childhood or adolescence, a small but significant proportion of children will remain allergic. Specific oral tolerance induction to cow’s milk (CM-SOTI) provides a treatment option in these children with continuing allergy with high success rates. However current sentiment limits widespread availability as existing reports advise that it is too soon to translate CM-SOTI into routine clinical practice. Methods In January 2007 we implemented a slow up-dosing CM-SOTI program. Eligible subjects were identified at routine visits to our children’s allergy clinic. Persisting cow’s milk allergy was confirmed from recent contact symptoms or a positive baked milk challenge. As allergic symptoms are common during CM-SOTI, families were provided with ready dietetic access for advice on dosing and symptom treatment. Subjects were continuously monitored at subsequent clinic visits or telephonically, where no longer followed, for a median of 49 months. Results The first 50 subjects (35 males) treated ranged in age from 5.1 to 15.8 years (median 10.3 years). Full tolerance (250 mL) was achieved in 23 subjects, 9 without any symptoms, and a further 9 achieved partial tolerance with continued ingestion. Eighteen children failed to achieve any regular milk ingestion; 11 because of persistent or significant symptoms whilst 8 withdrew against medical advice. Allergic symptoms were predominantly mild to moderate in severity, although 2 cases needed treatment with inhaled salbutamol and a further 2 required intramuscular adrenaline. Clinical tolerance, both full and partial, persists beyond 5 years. Conclusion We have demonstrated that a CM-SOTI program can be successfully and safely implemented as routine clinical practice with acceptable compliance during prolonged home up-dosing, despite frequent allergic symptoms, and for up to 4 years after starting treatment. CM-SOTI can thus be put into

  9. Clinical, socio-demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a "need for care".

    PubMed

    Peters, Emmanuelle; Ward, Thomas; Jackson, Mike; Morgan, Craig; Charalambides, Monica; McGuire, Philip; Woodruff, Peter; Jacobsen, Pamela; Chadwick, Paul; Garety, Philippa A

    2016-02-01

    Individuals reporting persistent psychotic experiences (PEs) in the general population, but without a "need for care", are a unique group of particular importance in identifying risk and protective factors for psychosis. We compared people with persistent PEs and no "need for care" (non-clinical, N=92) with patients diagnosed with a psychotic disorder (clinical, N=84) and controls without PEs (N=83), in terms of their phenomenological, socio-demographic and psychological features. The 259 participants were recruited from one urban and one rural area in the UK, as part of the UNIQUE (Unusual Experiences Enquiry) study. Results showed that the non-clinical group experienced hallucinations in all modalities as well as first-rank symptoms, with an earlier age of onset than in the clinical group. Somatic/tactile hallucinations were more frequent than in the clinical group, while commenting and conversing voices were rare. Participants in the non-clinical group were differentiated from their clinical counterparts by being less paranoid and deluded, apart from ideas of reference, and having fewer cognitive difficulties and negative symptoms. Unlike the clinical group, they were characterized neither by low psychosocial functioning nor by social adversity. However, childhood trauma featured in both groups. They were similar to the controls in psychological characteristics: they did not report current emotional problems, had intact self-esteem, displayed healthy schemas about the self and others, showed high life satisfaction and well-being, and high mindfulness. These findings support biopsychosocial models postulating that environmental and psychological factors interact with biological processes in the aetiology of psychosis. While some PEs may be more malign than others, lower levels of social and environmental adversity, combined with protective factors such as intact IQ, spirituality, and psychological and emotional well-being, may reduce the likelihood of persistent

  10. Clinical experiences utilizing wireless remote control and an ASP model backup archive for a disaster recovery event

    NASA Astrophysics Data System (ADS)

    Liu, Brent J.; Documet, Luis; Documet, Jorge; Huang, H. K.; Muldoon, Jean

    2004-04-01

    An Application Service Provider (ASP) archive model for disaster recovery for Saint John"s Health Center (SJHC) clinical PACS data has been implemented using a Fault-Tolerant Archive Server at the Image Processing and Informatics Laboratory, Marina del Rey, CA (IPIL) since mid-2002. The purpose of this paper is to provide clinical experiences with the implementation of an ASP model backup archive in conjunction with handheld wireless technologies for a particular disaster recovery scenario, an earthquake, in which the local PACS archive and the hospital are destroyed and the patients are moved from one hospital to another. The three sites involved are: (1) SJHC, the simulated disaster site; (2) IPIL, the ASP backup archive site; and (3) University of California, Los Angeles Medical Center (UCLA), the relocated patient site. An ASP backup archive has been established at IPIL to receive clinical PACS images daily using a T1 line from SJHC for backup and disaster recovery storage. Procedures were established to test the network connectivity and data integrity on a regular basis. In a given disaster scenario where the local PACS archive has been destroyed and the patients need to be moved to a second hospital, a wireless handheld device such as a Personal Digital Assistant (PDA) can be utilized to route images to the second hospital site with a PACS and reviewed by radiologists. To simulate this disaster scenario, a wireless network was implemented within the clinical environment in all three sites: SJHC, IPIL, and UCLA. Upon executing the disaster scenario, the SJHC PACS archive server simulates a downtime disaster event. Using the PDA, the radiologist at UCLA can query the ASP backup archive server at IPIL for PACS images and route them directly to UCLA. Implementation experiences integrating this solution within the three clinical environments as well as the wireless performance are discussed. A clinical downtime disaster scenario was implemented and successfully

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

    NASA Astrophysics Data System (ADS)

    Kanou, Naoyuki; Sakuma, Kenji; Nakashima, Kenji

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

  12. Clinical profile of parkinsonian disorders in the tropics: Experience at Kano, northwestern Nigeria

    PubMed Central

    Femi, Owolabi Lukman; Ibrahim, A; Aliyu, S

    2012-01-01

    Background: No data exists on Parkinson's disease (PD) and secondary Parkinsonism in Northwestern Nigeria. This study was designed to create a database, document the clinical profile of PD in Kano, northwestern Nigerian, and compare this to prior observations within and outside Nigeria. Materials and Methods: A database was documented on prospective patients presenting consecutively to the Neurology out-patients clinic of the two tertiary health facilities in Kano northwestern Nigeria over a period of 4 years. Demographic and clinical data at presentation were documented for all patients. Cases were classified as PD or secondary Parkinsonism. The severity at presentation and at last visit was classified using the H and Y scale. Results: Over a period of 4 years, out 1153 a total of 96 patients comprising 74 males and 22 females were enrolled. Eighty (83.3%) of them had clinically diagnosed PD while 16 (16.7%) had clinical features compatible with secondary Parkinsonism. The mean age at onset of symptoms in the PD patients (mean 58.2 ± 6.72 yrs ) was more than in secondary Parkinsonism (mean 51.4 ± 10.04 and P = 0.001). There was male preponderance in both idiopathic Parkinsonism (PD) (m:f = 3.2:1) and secondary Parkinsonism (m:f = 4.3:1). Out of the patients with secondary Parkinsonism, 10 (62.5%) and 5 (31.3%) had vascular Parkinsonism and drug-induced Parkinsonism, respectively. Duration of symptoms prior to presentation ranged between 3 months and 16 years. The mean (SD) time interval from the onset of motor symptoms to diagnosis of PD was 3.6 ± 3.4 yrs and time interval for men and women (male 3.8 ± 3.7; female 2.8 ± 2.1; P = 0.249). Conclusions: Clinical profile of patients with PD and secondary Parkinsonism in Kano is similar to that from other populations within Nigeria and other developing countries. However, delayed presentation, less frequent family history, lower frequency of Young-onset PD as well as treatment challenges occasioned by poverty

  13. The Actual Apollo 13 Prime Crew

    NASA Technical Reports Server (NTRS)

    1970-01-01

    The actual Apollo 13 lunar landing mission prime crew from left to right are: Commander, James A. Lovell Jr., Command Module pilot, John L. Swigert Jr.and Lunar Module pilot, Fred W. Haise Jr. The original Command Module pilot for this mission was Thomas 'Ken' Mattingly Jr. but due to exposure to German measles he was replaced by his backup, Command Module pilot, John L. 'Jack' Swigert Jr.

  14. Gene therapy for the treatment of AIDS: animal models and human clinical experience.

    PubMed

    Amado, R G; Mitsuyasu, R T; Zack, J A

    1999-05-15

    Although antiretroviral drug therapy has had a significant impact on the natural history of HIV infection, complete virus eradication still remains an unattainable goal. Drug-mediated virological control only occurs transiently, in part as a result of the development of drug resistance. Gene therapy for the treatment of AIDS is a promising area of research that has as its goal the replacement of the HIV-infected cellular pool with cells engineered to resist virus replication. A variety of anti-HIV genes have been designed and tested in laboratory systems, and available results from pilot clinical trials demonstrate the safety and feasibility of this approach. Obstacles to effective application of this technology include partial protection of HIV resistance genes, lack of effective vectoring systems, and unregulated gene expression. Herein, we review recent advances in transduction methods, data from in vivo preclinical studies in relevant animal models, and emerging results derived from pilot clinical gene therapy studies.

  15. Between Clinic and Experiment: Wilder Penfield's Stimulation Reports and the Search for Mind, 1929-55.

    PubMed

    Guenther, Katja

    2016-01-01

    In medicine, the realm of the clinic and the realm of experimentation often overlap and conflict, and physicians have to develop practices to negotiate their differences. The work of Canadian neurosurgeon Wilder Penfield (1891-1976) is a case in point. Engaging closely with the nearly 5,000 pages of unpublished and hitherto unconsidered reports of electrical cortical stimulation that Penfield compiled between 1929 and 1955, I trace how Penfield's interest shifted from the production of hospital-based records designed to help him navigate the brains of individual patients to the construction of universal brain maps to aid his search for an ever-elusive "mind." Reading the developments of Penfield's operation records over time, I examine the particular ways in which Penfield straddled the individual and the universal while attempting to align his clinical and scientific interests, thereby exposing his techniques to standardize and normalize his brain maps.

  16. A review of the clinical experience in pulsed dose rate brachytherapy

    PubMed Central

    Balgobind, Brian V; Koedooder, Kees; Ordoñez Zúñiga, Diego; Dávila Fajardo, Raquel; Rasch, Coen R N

    2015-01-01

    Pulsed dose rate (PDR) brachytherapy is a treatment modality that combines physical advantages of high dose rate (HDR) brachytherapy with the radiobiological advantages of low dose rate brachytherapy. The aim of this review was to describe the effective clinical use of PDR brachytherapy worldwide in different tumour locations. We found 66 articles reporting on clinical PDR brachytherapy including the treatment procedure and outcome. Moreover, PDR brachytherapy has been applied in almost all tumour sites for which brachytherapy is indicated and with good local control and low toxicity. The main advantage of PDR is, because of the small pulse sizes used, the ability to spare normal tissue. In certain cases, HDR resembles PDR brachytherapy by the use of multifractionated low-fraction dose. PMID:26290399

  17. Historical and Clinical Experiences of Gene Therapy for Solid Cancers in China.

    PubMed

    Li, Bo; Gao, Ning; Zhang, Zhuang; Chen, Qian-Ming; Li, Long-Jiang; Li, Yi

    2017-02-24

    Based on the theoretical and clinical development of modern medicines, gene therapy has been a promising treatment strategy for cancer and other diseases. The practice of gene therapy is nearly 27 years old, since the first authorized gene transfer study took place at the National Institute of Health in 1989. However, gene therapy was not readily adopted worldwide, until recently. Several gene therapy clinical trials have been carried out in China since 1998, and medical research in China has flourished. In this report, we review the history of gene therapy in China, focusing on treatment protocol, the administration cycle, dosage calculation, and the evaluation of therapeutic effects, in order to provide more information for the additional development of this promising treatment strategy.

  18. Familial isolated pituitary adenomas experience at a single center: clinical importance of AIP mutation screening.

    PubMed

    Pinho, Leandro Kasuki Jomori de; Vieira Neto, Leonardo; Wildemberg, Luiz Eduardo Armondi; Moraes, Aline Barbosa; Takiya, Christina M; Frohman, Lawrence A; Korbonits, Márta; Gadelha, Mônica R

    2010-11-01

    We present four FIPA kindred discussing clinical and molecular data and emphasizing the differences regarding AIP status, as well as the importance of genetic screening. Family 1 consists of five patients harboring somatotropinomas with germline E24X mutation in AIP. In one of the patients, acromegaly was diagnosed through active screening, being cured by surgery. Families 2 and 3 are composed of two patients with non-functioning pituitary adenomas. Family 4 comprises patients harboring a prolactinoma and a somatotropinoma. No mutations in AIP were found in these families. No patient in Family 1 was controlled with octreotide treatment, while the acromegalic patient in Family 4 was controlled with octreotide LAR. In conclusion, FIPA is a heterogeneous condition, which may be associated with AIP mutation. Genomic and clinical screening is recommended in families with two or more members harboring pituitary adenomas, allowing early diagnosis and better outcome.

  19. Experience of de-identification system development for clinical research in tertiary hospital.

    PubMed

    Shin, Soo-Yong; Lyu, Yongman; Shin, Yongdon; Choi, Hyo Joung; Park, Jihyun; Kim, Woo-Sung; Lee, Jae Ho

    2013-01-01

    To protect patients' privacy and to improve the convenience of research, Asan Medical Center (AMC) has been developing a de-identification system for biomedical research, which mainly consists of three components: de-identification tool, search tool, and chart review tool. The de-identification tool can substitute a randomly assigned research ID for a hospital patient ID, remove the identifiers in the structured format, and mask them in the unstructured format, i.e., texts. The search tool can find the number of patients which satisfies given criteria. The chart review tool can provide de-identified patient's clinical data for review. We found that clinical data warehouse was essential for successful implementation of de-identification system, and this system should be tightly linked to an electronic institutional review board system for easy operation of honest brokers.

  20. Drug treatments for mastalgia: 17 years experience in the Cardiff Mastalgia Clinic.

    PubMed Central

    Gateley, C A; Miers, M; Mansel, R E; Hughes, L E

    1992-01-01

    Mastalgia commonly presents to medical practitioners. The majority of patients can be managed by exclusion of cancer and reassurance. In some the severity of pain affects the quality of life and drug treatment should be considered. Since its inception 324 patients with cyclical mastalgia and 90 with non-cyclical mastalgia have received a therapeutic trial of drug treatment in the Cardiff Mastalgia Clinic. Overall 92% of those with cyclical mastalgia and 64% with non-cyclical mastalgia obtained a clinically useful response to therapy. Danazol was the most effective drug, with bromocriptine and evening primrose oil having equivalent efficacy. Many fewer adverse events were complained of by patients treated with evening primrose oil than danazol or bromocriptine. PMID:1548647

  1. Historical and Clinical Experiences of Gene Therapy for Solid Cancers in China

    PubMed Central

    Li, Bo; Gao, Ning; Zhang, Zhuang; Chen, Qian-Ming; Li, Long-Jiang; Li, Yi

    2017-01-01

    Based on the theoretical and clinical development of modern medicines, gene therapy has been a promising treatment strategy for cancer and other diseases. The practice of gene therapy is nearly 27 years old, since the first authorized gene transfer study took place at the National Institute of Health in 1989. However, gene therapy was not readily adopted worldwide, until recently. Several gene therapy clinical trials have been carried out in China since 1998, and medical research in China has flourished. In this report, we review the history of gene therapy in China, focusing on treatment protocol, the administration cycle, dosage calculation, and the evaluation of therapeutic effects, in order to provide more information for the additional development of this promising treatment strategy. PMID:28245595

  2. A review of the clinical experience in pulsed dose rate brachytherapy.

    PubMed

    Balgobind, Brian V; Koedooder, Kees; Ordoñez Zúñiga, Diego; Dávila Fajardo, Raquel; Rasch, Coen R N; Pieters, Bradley R

    2015-01-01

    Pulsed dose rate (PDR) brachytherapy is a treatment modality that combines physical advantages of high dose rate (HDR) brachytherapy with the radiobiological advantages of low dose rate brachytherapy. The aim of this review was to describe the effective clinical use of PDR brachytherapy worldwide in different tumour locations. We found 66 articles reporting on clinical PDR brachytherapy including the treatment procedure and outcome. Moreover, PDR brachytherapy has been applied in almost all tumour sites for which brachytherapy is indicated and with good local control and low toxicity. The main advantage of PDR is, because of the small pulse sizes used, the ability to spare normal tissue. In certain cases, HDR resembles PDR brachytherapy by the use of multifractionated low-fraction dose.

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

    SciTech Connect

    Miller, Janine D.; Scull, Heather

    2007-11-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

    Miller, Janine D; Baron, Elma D; Scull, Heather; Hsia, Andrew; Berlin, Jeffrey C; McCormick, Thomas; Colussi, Valdir; Kenney, Malcolm E; Cooper, Kevin D; Oleinick, Nancy L

    2007-11-01

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

  6. SU-E-T-447: Electronic Brachytherapy (EBT) Treatment of Cervical Cancer - First Clinical Experience

    SciTech Connect

    Johnson, D; Johnson, M; Thompson, J; Ahmad, S; Chan, L; Hausen, H

    2014-06-01

    Purpose: To study the first trial patient in which an electronic brachytherapy (EBT) x-ray source is utilized for treatment of cervical cancer. Methods: During patient treatment, a miniaturized x-ray source was used in combination with a customized titanium tandem and ovoid applicator set. The semi-specialized source was modeled with formalisms outlined by AAMP Task Group 43. Multiple models were used to compensate for variable attenuation conditions as a function of source positions. Varian Brachyvision treatment planning software was utilized on CT data sets for dose calculations prior to treatment delivery. The dose was prescribed to “point A” as defined by American Brachytherapy society. Additional treatments plans were created from those clinically utilized in patient care and were recalculated for an existing Ir-192 source model. Dose volume histograms (DVH) and point dose calculations were compared between the modalities for the clinical condition present in patients treated with EBT. Results: Clinical treatment times, though longer than those typically experienced by Ir-192 users, were manageable. Instantaneous dose rates at personal positions within the treatment vault were lower than those measured during intra operative radiation therapy and breast EBT treatments. Due to lower average photon energy in EBT, dose gradients within the treatment plans were as expected steeper than those observed in Ir-192 based brachytherapy. DVH comparisons between Ir-192 and EBT treatments showed an expected decrease in the integral dose to normal tissues of interest for EBT. In comparing plans created for EBT delivery with those calculated for Ir-192, average dose values for EBT were more than 4%, 11%, and 9% lower at predefined bladder, rectum and “point B” positions, respectively. Conclusion: For the first time, we have demonstrated that the utilizing electronic brachytherapy system for tandem and ovoid based treatment of cancer of the cervix is feasible, and

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

    SciTech Connect

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

    1993-12-31

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

  8. Residency training programs in veterinary clinical pathology: a comparison of experiences at two institutions.

    PubMed

    Raskin, Rose E

    2007-01-01

    Two institutions with different residency training formats in clinical pathology are compared with respect to application procedures, learning and teaching opportunities, learning resources, research training, publication requirements, and assessment methods of the program and trainees. The University of Florida and Purdue University programs are both based on an emphasis in morphologic recognition and interpretation of disease processes as well as training in basic science and applied research principles. The progress of trainees through each program is carefully monitored to meet individual needs as well as to meet the training requirements to allow candidates to sit for the certifying examination in clinical pathology. Periodic mock board exams are a critical tool to assess trainee progress and learning. The differences in format focus on coursework and publication requirements as well as on program assessment tools. While one program provides training in the form of 75% clinical diagnostic service, the other uses a mixture of 50% coursework and 50% clinical diagnostic training. Despite the contrast between a pure residency training program and one combining residency training with an MS degree, both institutions provide a solid program structure, ample learning resources, and adequate faculty mentorship to produce a high pass rate of board-certified specialists, the major focus for both programs. Numbers of post-training employment positions for both institutions are similar for those selecting faculty positions at veterinary schools. During the period studied, however, the combined residency and MS graduate program at Purdue University produced more graduates employed in pharmaceutical and biotechnology companies, while the residency program at the University of Florida produced more graduates employed by diagnostic laboratories.

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

    PubMed Central

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

    1999-01-01

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

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

    PubMed

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

    2014-09-01

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

  11. Clinical experience with a decision support computer program using Bayes' theorem to diagnose chest pain patients.

    PubMed

    Aase, O

    1999-01-01

    A decision support computer program (DSP) was used by the emergency room physician as a diagnostic tool on patients admitted with acute chest pain to guide the referral of these patients either to the Coronary Care Unit (CCU) or general ward. The DSP used Bayes' theorem on 38 anamnestic and clinical variables to classify patients into one of nine diagnoses. During a six months trial period 32 physicians used the DSP to diagnose 493 patients admitted with acute chest pain. The physicians referred the patients to CCU or general ward based on their clinical judgements, the ECG findings and the diagnostic estimates given by the DSP. The program correctly diagnosed 150 (84%) of 178 patients with acute myocardial infarction and 63 of 112 patients with unstable angina. However, acute ischemic heart disease (acute myocardial infarction or unstable angina) was correctly classified by the DSP for 259 (89%) of 290 patients. By using the DSP, the number of patients unnecessarily referred to CCU was reduced from 35% to 19% and the number of patients in need of CCU observation misallocated to general ward was reduced from 13% to 10%. Thus, use of the DSP in the emergency room on easily available anamnestic and clinical variables may improve referrals to the CCU, optimize therapy and resource use.

  12. Denosumab treatment in the management of patients with advanced prostate cancer: clinical evidence and experience

    PubMed Central

    Hegemann, Miriam; Bedke, Jens; Stenzl, Arnulf; Todenhöfer, Tilman

    2017-01-01

    Osteoprotective therapies have become an essential component in the management of advanced prostate cancer (PC) patients as bone metastases (BMs) have a major impact on morbidity and mortality. Denosumab is a fully humanized antibody targeting the receptor activator of nuclear factor κB ligand (RANKL), which has been approved by the European Medicines Agency (EMA) in Europe and the United States (US) Food and Drug Administration (FDA) in the US for prevention of skeletal-related events (SREs) in patients with solid tumors and BMs, including PC. The clinical settings in which PC patients should be treated with denosumab are still discussed controversially. In a phase III study, denosumab significantly delayed SREs compared with zoledronic acid (ZA) in patients with metastatic castration-resistant PC (CRPC). In addition, denosumab showed superior effects on pain and health-related quality of life (QoL) in these patients. In patients with nonmetastatic CRPC, denosumab has been proven to significantly increase bone metastases-free survival. However, no significant benefits on cancer-specific and overall survival were observed and denosumab was not approved by the US FDA and EMA in this context. The effectiveness of denosumab in patients with castration-sensitive PC (CSPC) and BMs is also under discussion, as clinical trials with ZA in these patients have not shown significant benefits. Clinical data on the use of denosumab in CSPC are urgently needed. PMID:28392837

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

    PubMed

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

    2012-08-01

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

  14. Magnetic Resonance-Guided Percutaneous Cryoablation of Uterine Fibroids: Early Clinical Experiences

    SciTech Connect

    Sakuhara, Yusuke Shimizu, Tadashi; Kodama, Yoshihisa; Sawada, Akihiro; Endo, Hideho; Abo, Daisuke; Hasegawa, Tenshu; Miyasaka, Kazuo

    2006-08-15

    Purpose. Uterine fibroids (leiomyomas) are the most common tumors of the uterus. The present study evaluated the feasibility and effectiveness of magnetic resonance (MR)-guided percutaneous cryoablation for uterine fibroids as a minimally invasive treatment alternative. Methods. From August 2001 to June 2002, MR-guided percutaneous cryoablation was performed on seven uterine fibroids in 6 patients who displayed clinical symptoms related to tumors. Using a horizontal-type open MR system, cryoablation probes were percutaneously placed in fibroids. Fibroids were ablated, and the site and size of ice balls were monitored on MR imaging. Postoperatively, patients completed a questionnaire to assess changes in presenting clinical symptoms, and MR images were obtained for all patients at follow-up. Changes in clinical symptoms and tumor volume were evaluated in each patient. Results. All treated patients showed reductions in tumor size. Mean volume reduction rate was 40.3% at 6 weeks postoperatively, and 79.4% at 9-12 months. All patients reported fever after treatment. Surgical drainage was required for abscess in the probe channel in one patient, and transient liver damage occurred in another. Subjective symptoms improved in all patients except one who had multiple tumors, and no patient complained of new symptoms after cryoablation during follow-up. Conclusion. MR-guided percutaneous cryoablation represents a feasible and effective treatment for uterine fibroids.

  15. The Use of Behavioral Experiments to Modify Delusions and Paranoia: Clinical Guidelines and Recommendations

    ERIC Educational Resources Information Center

    Combs, Dennis R.; Tiegreen, Joshua; Nelson, Amelia

    2007-01-01

    Recently, there has been a renewed interested in the treatment of psychosis and it is now appears possible to modify specific symptoms of psychosis such as paranoia and delusions using methods derived from Cognitive-Behavioral Therapy. One specific technique that has received less attention is the use of behavioral experiments. In this paper, we…

  16. Identifying the Categories of Spiritual Experience Encountered by Therapists in Their Clinical Work

    ERIC Educational Resources Information Center

    Ross, Alistair

    2016-01-01

    Spirituality has replaced religion in popular culture and its presence is being felt in the therapeutic world. Using a questionnaire completed by 104 people utilising six descriptive definitions of spirituality and 36 categories of spiritual experience, three meta-themes of forms of spirituality emerged through a thematic analysis. These are…

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

    ERIC Educational Resources Information Center

    Hathorn, Donna; Machtmes, Krisanna; Tillman, Ken

    2009-01-01

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

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

    PubMed

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

    2014-08-01

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

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

    PubMed

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

    2005-12-01

    Safety, tolerability and efficacy profiles of interferon beta (IFNbeta) therapy in relapsing multiple sclerosis (MS) has been widely verified both in trial settings and in daily clinical practice. However, for a variable percentage of treated patients, it remains only partially effective. In this study, we reported the post-marketing experience of the efficacy of IFNbeta therapy for a large cohort of MS patients regularly attending the MS Outpatient Clinic of "La Sapienza University" in Rome. In this cohort we also sought clinical and paraclinical variables responsible for the clinical course of MS during IFNbeta therapy. Patients that received treatment with one of the IFNbeta formulations for at least 1 year were included. Clinical outcomes (i. e., relapses and disability score) were monitored throughout the entire study period. Magnetic resonance imaging (MRI) scans were performed twice for each subject: at baseline and after 1 year of therapy. The occurrence of more than one relapse during the study period or a sustained disability progression in the Expanded Disability Status Scale (EDSS) score were considered as criteria for the definition of suboptimal clinical response to IFNbeta therapy. During IFNbeta therapy (number of patients 242, mean length of treatment 4.3+/-2.3 years) a reduction in the annualised relapse rate of 59% (p<0.001) was observed. Eighty-six patients (35%) fulfilled the criterion for defining "suboptimal responder" on the basis of relapses, and 69 (28.5%) did the same on the basis of EDSS sustained progression. Twenty-seven (11.1%) patients showed both an EDSS progression and two or more relapses. The presence of T1-enhancing lesions and new T2 hyperintense lesions on the scan performed after the first year of therapy were the best MRI features associated with both the occurrence of relapses during the treatment period (OR for enhancing lesions and relapses 3.6; OR for new T2 lesion and relapses 2.8). The present post-marketing experience

  20. Connecting patients, researchers and clinical genetics services: the experiences of participants in the Australian Ovarian Cancer Study (AOCS).

    PubMed

    Crook, Ashley; Plunkett, Loren; Forrest, Laura E; Hallowell, Nina; Wake, Samantha; Alsop, Kathryn; Gleeson, Margaret; Bowtell, David; Mitchell, Gillian; Young, Mary-Anne

    2015-02-01

    Population-based genetic research may produce information that has clinical implications for participants and their family. Researchers notify participants or their next of kin (NoK) about the availability of genetic information via a notification letter; however, many subsequently do not contact a family cancer centre (FCC) to clarify their genetic status. Therefore, the purpose of this study was to examine research participants' experience of receiving a notification letter and the factors that influenced contact with an FCC. Twenty-five semi-structured interviews were conducted with research participants (n=10) or their NoK (n=15) who had received a notification letter following participation in the Australian Ovarian Cancer Study. There were a number of factors which impacted participants' access to genetic counselling at an FCC. Some participants had unmet information and support needs, which were addressed by their participation in this psychosocial interview study. Recruitment and participation in this study therefore inadvertently increased a number of participants' intention to contact an FCC. For others, participation in this study facilitated access to an FCC. Recommendations are proposed regarding future notification as well as implications for clinical practice. An approach that also provides opportunity to address research participants' support and informational needs before contacting a clinical genetics service as well as practical guidance for accessing genetic services would facilitate timely and smooth access for research participants who are interested in following up clinically relevant genetic test results.