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Sample records for japanese clinical settings

  1. Dosage, effectiveness, and safety of sertraline treatment for posttraumatic stress disorder in a Japanese clinical setting: a retrospective study.

    PubMed

    Kamo, Toshiko; Maeda, Masaharu; Oe, Misari; Kato, Hiroshi; Shigemura, Jun; Kuribayashi, Kazuhiko; Hoshino, Yuko

    2016-12-07

    Many of the posttraumatic stress disorder (PTSD) treatment guidelines recognize the use of selective serotonin reuptake inhibitors as first-line pharmacological treatment. In Japan, there were no published studies investigating the effectiveness and safety of sertraline for PTSD in a clinical setting. We conducted a retrospective medical chart review of the dosage, effectiveness, and safety of sertraline for the PTSD treatment in Japan. Data were collected from medical charts of patients of PTSD, caused by various types of trauma, who were treated with sertraline between July 2006 and October 2012 during their regular clinical practice. To evaluate the effectiveness, the investigators retrospectively assessed the severity and improvement of the symptoms using the Clinical Global Impressions - Severity and the Clinical Global Impressions - Improvement. The study population was 122 Japanese patients aged ≥18 years with a diagnosis of PTSD who were treated with sertraline (median duration, 10.6 months). Doses ranged from 12.5 to 150 mg/day, mostly 25 and 50 mg/day. The median duration of observation was 10.8 months. Out of those, 50% of patients were regarded as responders by using the Clinical Global Impressions - Improvement at the end of sertraline treatment or the last observation. Two-thirds (65.6%) of patients improved in the severity of PTSD, as assessed by Clinical Global Impressions - Severity, whereas 32.8% showed no change, and 1.6% worsened. Subgroups analyses and logistic regression analyses suggested that the type of traumatic events was the factor with the highest influence on the response rate. The adverse events in this chart review were consistent with the known safety profile of sertraline. There were no reports of serious or severe adverse events considered to be related to sertraline. Our study suggested the effectiveness of sertraline for the treatment of PTSD in a Japanese clinical setting, and the obtained safety profile was

  2. A feasibility study of the clinical effectiveness and cost-effectiveness of individual cognitive behavioral therapy for panic disorder in a Japanese clinical setting: an uncontrolled pilot study.

    PubMed

    Seki, Yoichi; Nagata, Shinobu; Shibuya, Takayuki; Yoshinaga, Naoki; Yokoo, Mizue; Ibuki, Hanae; Minamitani, Noriko; Kusunoki, Muga; Inada, Yasushi; Kawasoe, Nobuko; Adachi, Soichiro; Yoshimura, Kensuke; Nakazato, Michiko; Iyo, Masaomi; Nakagawa, Akiko; Shimizu, Eiji

    2016-10-07

    In Japan, cognitive behavioral therapy (CBT) for panic disorder (PD) is not well established. Therefore, a feasibility study of the clinical effectiveness and cost-effectiveness of CBT for PD in a Japanese clinical setting is urgently required. This was a pilot uncontrolled trial and the intervention consisted of a 16-week CBT program. The primary outcome was Panic Disorder Severity Scale (PDSS) scores. Quality of life was assessed using the EuroQol's EQ-5D questionnaire. Assessments were conducted at baseline, 8 weeks, and at the end of the study. Fifteen subjects completed outcome measures at all assessment points. At post-CBT, the mean reduction in PDSS scores from baseline was -6.6 (95 % CI 3.80 to -9.40, p < 0.001) with a Cohen's d = 1.77 (95 % CI 0.88-2.55). Ten (66.7 %) participants achieved a 40 % or greater reduction in PDSS. By calculating areas under the curve for EQ-5D index changes, we estimated that patients gained a minimum of 0.102 QALYs per 1 year due to the CBT. This study demonstrated that individual CBT for PD may be useful in Japanese clinical settings but further randomized control trials are needed. UMIN-CTR UMIN000022693 (retrospectively registered).

  3. Exposure evaluation of adult male Japanese smokers switched to a heated cigarette in a controlled clinical setting.

    PubMed

    Sakaguchi, Chikako; Kakehi, Aoi; Minami, Naoki; Kikuchi, Akira; Futamura, Yasuyuki

    2014-08-01

    The objective of this clinical study was to investigate changes in levels of biomarkers of exposure (BOEs) in healthy Japanese male smokers who switched to a prototype heated cigarette (HC). This was a controlled, semi-randomized, open-label, residential study conducted in Japan. A total of 70 healthy Japanese male smokers were enrolled. Following enrollment, subjects smoked their usual brand of cigarette for 2days and were subsequently randomized either to an HC group or a 10mg tar conventional cigarette (CC10) group for four consecutive weeks. Levels of BOEs for ten selected cigarette smoke constituents (nicotine, carbon monoxide (CO), benzene, 1,3-butadiene, acrolein, hydrogen cyanide, crotonaldehyde, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone [NNK], pyrene, 4-aminobiphenyl), and urine mutagenicity were measured at several time points during the study period. At the end of the study period, except for blood carboxyhemoglobin, levels of BOEs for the other nine constituents and urine mutagenicity were significantly lower in the HC group compared to the CC10 group. These results suggest that exposure to most cigarette smoke constituents, except CO, can be reduced by switching from CC10 to HC.

  4. A preliminary study of individual cognitive behavior therapy for social anxiety disorder in Japanese clinical settings: a single-arm, uncontrolled trial

    PubMed Central

    2013-01-01

    Background Cognitive behavior therapy (CBT) is regarded as an effective treatment for social anxiety disorder (SAD) in Europe and North America. Individual CBT might be acceptable and effective for patients with SAD even in non-Western cultures; therefore, we conducted a feasibility study of individual CBT for SAD in Japanese clinical settings. We also examined the baseline predictors of outcomes associated with receiving CBT. Methods This single-arm trial employed a 14-week individual CBT intervention. The primary outcome was the self-rated Liebowitz Social Anxiety Scale, with secondary measurements of other social anxiety and depressive severity. Assessments were conducted at baseline, after a waiting period before CBT, during CBT, and after CBT. Results Of the 19 subjects screened, 15 were eligible for the study and completed the outcome measures at all assessment points. Receiving CBT led to significant improvements in primary and secondary SAD severity (ps < .001). The mean total score on the Liebowitz Social Anxiety Scale improved from 91.8 to 51.7 (before CBT to after CBT), and the within-group effect size at the end-point assessment was large (Cohen’s d = 1.71). After CBT, 73% of participants were judged to be treatment responders, and 40% met the criteria for remission. We found no significant baseline predictors of those outcomes. Conclusion Despite several limitations, our treatment—which comprises a 14-week, individual CBT program—seems feasible and may achieve favorable treatment outcomes for SAD in Japanese clinical settings. Further controlled trials are required in order to address the limitations of this study. Trial registration UMIN-CTR UMIN000005897 PMID:23448435

  5. Development of the Japanese Version of the Leeds Assessment of the Neuropathic Symptoms and Signs Pain Scale: Diagnostic Utility in a Clinical Setting.

    PubMed

    Isomura, Tatsuya; Sumitani, Masahiko; Matsudaira, Ko; Kawaguchi, Mika; Inoue, Reo; Hozumi, Jun; Tanaka, Takeyuki; Oshima, Hirofumi; Mori, Kanto; Taketomi, Shuji; Inui, Hiroshi; Tahara, Keitaro; Yamagami, Ryota; Hayakawa, Kazuhiro

    2017-07-01

    We aimed to assess the diagnostic utility of the linguistically validated Japanese version of the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS-J) as a screening tool for neuropathic pain in the clinical setting. Patients with neuropathic pain or nociceptive pain who were 20 to 85 years of age were included. Sensitivity and specificity using the original cutoff value of 12 were assessed to evaluate the diagnostic utility of the LANSS-J. Sensitivity and specificity with possible cutoff values were calculated, along with area under the receiver operating characteristic curve. We then evaluated agreement regarding assessment of the LANSS-J by two investigators. We used the intraclass correlation coefficient (ICC) for the total score and Cohen's kappa coefficient for each item. Data for patients with neuropathic pain (n = 30) and those with nociceptive pain (n = 29) were analyzed. With a cutoff of 12, the sensitivity was 63.3% (19/30) and the specificity 93.1% (27/29). Sensitivity improved substantially with a cutoff of ≤ 11 (≥ 83.3%, 25/30). High specificity (93.1%, 27/29) was sustained with a cutoff of 9 to 12. The ICC for the total score was 0.85, indicating sufficient agreement. Kappa coefficients ranged from 0.68 to 0.84. The LANSS-J is a valid screening tool for detecting neuropathic pain. Our results suggest that employing the original cutoff value provides high specificity, although a lower cutoff value of 10 or 11 (with its high specificity maintained) may be more beneficial when pain attributed to neuropathic mechanisms is suspected in Japanese patients. © 2016 World Institute of Pain.

  6. Differences in antimicrobial susceptibility breakpoints for Pseudomonas aeruginosa, isolated from blood cultures, set by the Clinical and Laboratory Standards Institute (CLSI) and the Japanese Society of Chemotherapy.

    PubMed

    Nakamura, Tatsuya; Shimizu, Chihiro; Kasahara, Mayumi; Nakata, Chiyo; Munakata, Machiko; Takahashi, Hakuo

    2007-02-01

    A study was made of the antimicrobial susceptibility to and efficacy of various kinds of antimicrobial agents against 179 strains of Pseudomonas aeruginosa that were isolated from blood cultures at Kansai Medical University Hospital from 1990 through 2004. The annual detection rate was highest in 1994, at 22 strains (6.5%). There were 9 multidrug resistant strains of Pseudomonas aeruginosa (5.0%). Among 14 antimicrobial agents tested for measurements, ciprofloxacin (CPFX) showed the best minimum inhibitory concentration (MIC) 50 value, of 0.25 microg/ml, followed by pazufloxacin (PZFX) and biapenem (BIPM), each at 0.5 microg/ml. When the period of 15 years was divided into three stages, the MIC50 value for each antimicrobial agent was highest in the middle stage (1995 to 1999). Assuming that the percentage of sensitive strains according to the breakpoints set by the Clinical and Laboratory Standards Institute (CLSI) represents the antimicrobial susceptibility rate, amikacin (AMK) showed the best value, of 85.5%. According to the sepsis breakpoint set by the Japanese Society of Chemotherapy (JSC), the efficacy of CPFX showed the highest rate (77.1%) of all the antimicrobial agents tested. Among beta-lactams, BIPM showed the highest efficacy rate, of 67.0%. When the efficacy rates were compared with each other, the difference in efficacy rate between the breakpoint set by the CLSI and the sepsis breakpoint set by the JSC was large for beta-lactams. Comparisons made based on the CLSI criteria showed no difference in cross-resistance rates between CPFX, meropenem (MEPM), and BIPM. However, when comparisons were made using the JSC sepsis breakpoint, MEPM showed a cross-resistance rate of 87.8%, while the rate for BIPM was lower, at 56.1%, with the chi2 test showing a significant difference, at P = 0.0014. In accordance with the pharmacokinetics/pharmacodynamics theory that has been advocated, breakpoints which are more suitable for the clinical setting in Japan should

  7. Reliability, validity, and responsiveness of the Japanese version of International Restless Legs Syndrome Study Group rating scale for restless legs syndrome in a clinical trial setting.

    PubMed

    Inoue, Yuichi; Oka, Yasunori; Kagimura, Tatsuo; Kuroda, Kenji; Hirata, Koichi

    2013-09-01

    This study was conducted to verify the reliability, validity, and responsiveness of the Japanese version of the International Restless Legs Syndrome Study Group Rating Scale for restless legs syndrome (J-IRLS) as a sub-study of a clinical trial of pramipexole against restless legs syndrome. After evaluating the test-retest reliability, concurrent validity and construct validity were analyzed. The responsiveness of J-IRLS was confirmed by evaluating the correlations between the changes in J-IRLS total score after treatment, Clinical Global Impression Improvement Scale (CGI-I), and Patient Global Impression. Test-retest reliability of J-IRLS was good (intra-class correlation coefficient, 0.877; 95% confidence interval, 0.802-0.925). The correlation coefficient of J-IRLS total score and CGI-S score for the first and second visit was 0.804 and 0.796, respectively (both P < 0.0001). Factor analysis of J-IRLS itemsalone identified a two-factor structure. Exploratory analysis on 10 items of J-IRLS together with the Japanese version of the Pittsburgh Sleep Quality Index revealed that several items on the Japanese version of the Pittsburgh Sleep Quality Index appeared as the third factor. The correlations of CGI-I and Patient Global Impression with change in J-IRLS total score after treatment were highly significant. Reliability, validity, and responsiveness of J-IRLS were considered adequate. The scale is highly applicable both for evaluating the severity of restless legs syndrome and for assessing drug efficacy. © 2013 The Authors. Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology.

  8. Telemedicine in clinical setting

    PubMed Central

    Zhang, Xiao-Ying; Zhang, Peiying

    2016-01-01

    The telemedicine department of a hospital is an emerging branch in upcoming hospitals and may become an essential component of every hospital. It basically utilizes the information technologies along with telecommunication systems in order to provide clinical care and assistance. Furthermore, the branch of telemedicine offers significant opportunities for the process of developmental freedom from illness, early death, and preventable diseases. It advances development by providing relevant drugs and the necessary care aimed to alleviate patient suffering. It is also beneficial for patients in rural remote areas who usually do not have adequate access to advanced hospitals. Telemedicine in these remote areas allows for timely treatment of emergency cases. Thus, it contributes towards remote emergency critical care in order to save lives in crucial cases. Additionally, the emerging advances have now enabled telemedicine to transfer large amounts of clinical informatics data including images, and test reports to the specifically specialized health professionals in some serious cases. However, as in the case of many emerging technologies, organizing information and understanding the field has significant challenges. The present review article aimed to discuss important aspects of the field with regard to the better management of patients in clinical settings. PMID:27703503

  9. Multiregional clinical trials: Japanese perspective on drug development strategy and sample size for Japanese subjects.

    PubMed

    Ando, Yuki; Uyama, Yoshiaki

    2012-09-01

    Multiregional clinical trials including Japanese subjects are playing a key role in new drug development in Japan. In addition to the consideration of differences in intrinsic and extrinsic ethnic factors, deciding the sample size of Japanese subjects is an important issue when a multiregional clinical trial is intended to be used for Japanese submission. Accumulated experience suggests that there are several points to consider, such as the basic principles described in the guidance document, drug development strategy, trial phase, and disease background. The difficulty of interpreting the results of Japanese trials should also be considered.

  10. Clinical evidence for Japanese population based on prospective studies--linking clinical trials and clinical practice.

    PubMed

    Ogawa, Hisao; Kojima, Sunao

    2009-10-01

    "Evidence-based medicine (EBM)" implies effective and high quality practice for patients based on well-grounded medical science. The success of clinical trials in Japan is essential to build original evidence specific for Japanese patients. Based on this concept, we have performed several large-scale clinical trials to provide EBM, including the Japanese Antiplatelets Myocardial Infarction Study [JAMIS; clinical improvement in acute myocardial infarction (AMI) patients with antiplatelet therapy], the Japanese beta-Blockers and Calcium Antagonists Myocardial Infarction (JBCMI; comparison of the effects of beta-blockers and calcium antagonists on cardiovascular events in post-AMI patients), a multicenter study for aggressive lipid-lowering strategy by HMG-CoA reductase inhibitors in patients with AMI (MUSASHI; effects of statin therapy on cardiovascular events in patients with AMI), and the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD trial; efficacy of low-dose aspirin therapy for primary prevention of atherosclerotic events in type 2 diabetic patients). The results of these prospective studies were directly linked with clinical practice. We have acquired the know-how of large-scale clinical trials; an important point is to have passion for "buildup evidence specific for the Japanese" and to recruit subjects for enrollment after explaining the significance of "clinical trials for the Japanese".

  11. [Evidence from large clinical trials for Japanese hypertensive patients].

    PubMed

    Okura, Takafumi; Higaki, Jitsuo

    2011-11-01

    Large-scale clinical trials for the hypertensive patients have been carried out in Japan. Double-blind, placebo-controlled large clinical trials in Europe and USA showed that antihypertensive drugs prevented cardiovascular disease. Recently large clinical trials carried out in Japan. These clinical trials have shown that the onset rate of the heart vascular disease in Japanese hypertensive patients, the factor which influenced the onset of the cardiovascular disease, and the suppressant effect of cardiovascular disease of different antihypertensive drug class.

  12. Clinical manifestations of Japanese encephalitis in southern Taiwan.

    PubMed

    Chen, Kuang Ming; Tsai, Hung Chin; Sy, Cheng Len; Lee, Susan Shin-Jung; Liu, Yung Ching; Wann, Shue Ren; Wang, Yung Hsing; Mai, Ming Hsin; Chen, Jei Kuang; Wu, Kuan Sheng; Chen, Yi Jan; Chen, Yao Shen

    2009-08-01

    Japanese encephalitis virus infection is a sporadic infectious disease in Taiwan. Despite progress in laboratory examinations and imaging studies, diagnosis of Japanese encephalitis remains underestimated. This study was conducted to identify clinical symptoms and laboratory findings that may assist in early identification of this disease. This retrospective study included all patients diagnosed with Japanese encephalitis at Kaohsiung Veterans General Hospital from January 2000 through December 2007. Epidemiologic data, predisposing factors, neurological and non-neurological signs and symptoms, laboratory data, and treatment were analyzed. Outcomes and neurological complications were evaluated. Eleven patients had Japanese encephalitis, and 10 had sufficient information for enrolment into the study. Nine patients presented with non-significant constitutional symptoms of fever, nausea, or headache. Other signs and symptoms included rhinorrhea, sore throat, abdominal pain, cough, myalgia, or arthralgia. Eight patients had lymphocytic pleocytosis with elevated protein and borderline low glucose levels in the cerebrospinal fluid. Leptomeningeal enhancement and low density lesions were the most common computed tomography findings. T2 hyperintensity lesions and leptomeningeal enhancement were seen in 5 patients. Two patients presenting with acute flaccid paralysis had high intensity lesions on the thalamus and basal ganglion. There were no correlations between clinical, laboratory, and imaging findings. None of the patients had neurological sequelae. Presentations, laboratory examination, and clinical signs are not specific for Japanese encephalitis. Sporadic cases are usually seen from May to August, which are associated with monsoon rains. Hence increased awareness of this disease is recommended during these periods.

  13. Teaching Reflective Care in Japanese Early Childhood Settings

    ERIC Educational Resources Information Center

    Hellman, Anette

    2016-01-01

    The purpose of this article is to explore the way preschool teachers teach reflective care in Japan. The article builds on a two-month ethnographic study conducted in Japanese kindergartens and nurseries among children aged 3-6 years. The data were analysed using concepts of age and gender. The results show that care in Japan, in contrast to…

  14. Teaching Reflective Care in Japanese Early Childhood Settings

    ERIC Educational Resources Information Center

    Hellman, Anette

    2016-01-01

    The purpose of this article is to explore the way preschool teachers teach reflective care in Japan. The article builds on a two-month ethnographic study conducted in Japanese kindergartens and nurseries among children aged 3-6 years. The data were analysed using concepts of age and gender. The results show that care in Japan, in contrast to…

  15. Current status of quality in Japanese clinical trials.

    PubMed

    Saito, Kazuyuki; Kodama, Yasuo; Ono, Shunsuke; Mutoh, Mizue; Kawashima, Susumu; Fujimura, Akio

    2005-08-01

    The changes in the quality of Japanese clinical trials were evaluated by comparing the results of Good Clinical Practice (GCP) audits conducted from April 1997 to March 2000 (fiscal year (FY) 1997-1999) with those from April 2001 to March 2002 (FY2001). During both of the periods inspections were undertaken by the Organization for Pharmaceutical Safety and Research (OPSR). The audit findings in the former period were based on the audits that covered 331 hospitals and 775 trials conducted under the old GCP guideline. The audits in the latter period targeted 147 hospitals and 238 trials conducted under the old or new GCP guideline. The total number of deficiencies detected by GCP audits in the former three-year period (FY 1997-1999) was 1529, and the corresponding number in the latter single year (FY 2001) was 912. Two remarkable changes in OPSR's findings were observed between FY 1997-1999 and FY 2001 as follows; the proportion of protocol deviations increased from 14.7% (225/1529) to 53.1% (484/912), while the proportion of errors in case report forms (CRFs) decreased from 43.6% (666/1529) to 15.4% (140/912). The new GCP guideline sets very high standards for a hospital's qualification: to have sufficient equipment and hospital resources, to have capacity for promptly responding to urgent trial-related problems, to have an IRB, and to have appropriate staff including clinical research coordinators (CRCs) assigned to the clinical trial. Our results suggest that the impact of the regulatory changes of applicable standard is large for a hospital's qualification for conducting clinical trials in Japan.

  16. [The newly certified 105 Japanese medical technologists in clinical microbiology].

    PubMed

    Kumasaka, Kazunari

    2002-05-01

    Interest in quality assurance(QA) in clinical laboratories in Japan has increased over the past 30 years. We have however been lagging behind countries such as the USA, Canada and the UK in QA of clinical microbiology. The main problem of QA in Japan is human resources. There are only about 400 laboratory physicians certified by the Japanese Society of Laboratory Medicine(JSLM). Almost no academics in microbiology are interested in QA and they mostly lack clinical competence. There is a small number of faculty positions, and promotions are mostly based on research productivity while medical graduates are increasingly drawn to bench work for basic, short-term research. The Japanese Society for Clinical Microbiology (JSCM) was established in 1990 in order to promote the development of clinical microbiology and its relevant fields in Japan. And 2001 was a milestone in sustained efforts of the JSLM to initiate qualifying examinations of medical technologists(MT) in clinical microbiology. 105 MT in clinical microbiology were newly certified by the Joint Committee of JSCM, JSLM, Japanese Association of Medical Technologists (JAMT) and College of Clinical Pathology of Japan(CCPJ). The certified MTs have appropriate educational background and are well motivated. With good on-the-job training, they are expected to perform effectively various tasks, including laboratory management. Recent radical changes in the health care delivery system have also had serious implications on laboratory services and QA of microbiological tests. The primary goal of the clinical microbiology laboratory is to provide accurate diagnostic testing and high-quality service at a low cost for its customers. It is believed that the Joint Committee and the newly certified MTs will contribute to narrowing the gap between Japan and other countries in clinical microbiology.

  17. Japanese clinical practice guidelines for congenital biliary dilatation.

    PubMed

    Ishibashi, Hiroki; Shimada, Mitsuo; Kamisawa, Terumi; Fujii, Hideki; Hamada, Yoshinori; Kubota, Masayuki; Urushihara, Naoto; Endo, Itaru; Nio, Masaki; Taguchi, Tomoaki; Ando, Hisami

    2017-01-01

    Until now, there have been no practical clinical guidelines for congenital biliary dilatation (CBD). In this review article, the Japanese Study Group on Congenital Biliary Dilatation (JSCBD) propose to establish clinical practice guidelines for CBD. Because the evidence-based literature is relatively small, we decided to create guidelines based on the consensus of experts, using the medical literature for reference. A total of 20 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs included the distinct aspects of CBD: (1) Concepts and Pathology (three CQs); (2) Diagnosis (six CQs); (3) Pancreaticobiliary Complications (three CQs); Treatments and Prognosis (eight CQs). Each statements and comments for CQs were made by the guidelines committee members. CQs were finally approved after review by members of the editorial committee and the guidelines evaluation board of CBD. These guidelines were created to provide assistance in the clinical practice of CBD management; their contents focus on clinical utility, and they include general information on CBD to make this disease more widely recognized. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  18. Clinical characteristics of Japanese patients with severe hypertriglyceridemia.

    PubMed

    Tada, Hayato; Kawashiri, Masa-Aki; Nakahashi, Takuya; Yagi, Kunimasa; Chujo, Daisuke; Ohbatake, Azusa; Mori, Yukiko; Mori, Shunsuke; Kometani, Mitsuhiro; Fujii, Hiroshi; Nohara, Atsushi; Inazu, Akihiro; Mabuchi, Hiroshi; Yamagishi, Masakazu; Hayashi, Kenshi

    2015-01-01

    Although of interest, few data exist on the clinical characteristics of Japanese patients with an extremely high triglyceride level (≥ 1000 mg/dL). We assessed the clinical characteristics of Japanese patients with an extremely high triglyceride level. We investigated the presence of coronary artery disease, history of pancreatitis, the presence of fatty liver, and the potential causes of elevated triglyceride in Japanese subjects with an extremely high level of fasting triglyceride (≥ 1000 mg/dL) among 70,368 subjects whose serum triglyceride was measured for any reason at Kanazawa University Hospital from April 2004 to March 2014. We identified 215 (0.31%) subjects (mean age, 46 years; male, 170, mean body mass index, 25 kg/m(2)) with severe hypertriglyceridemia. Among them, 4 (1.9%) subjects were classified as type I, 97 (45.1%) subjects were type IV, and 114 (53.0%) subjects were type V hyperlipidemia, according to Fredrickson's classification. Among 215 subjects, 116 subjects (54.0%) drank alcohol, 58 (27.0%) showed heavy intake (≥ 60 g/d), and 64 (29.8%) subjects had diabetes. In total, 59 (27.4%) subjects had transient severe hypertriglyceridemia caused by corticosteroids (N = 19), antidepressant (N = 18), l-asparaginase and steroids for acute lymphoid leukemia (N = 15), hormone replacement therapy for breast cancer (N = 9), β-blocker (N = 5), hypothyroidism (N = 4), pregnancy (N = 4), and panhypopituitarism (N = 2). As many as 119 (55.3%) subjects exhibited fatty liver. Moreover, 12 (5.6%) and 17 (7.9%) subjects had a history of pancreatitis and coronary artery disease, respectively. A variety of situations can cause severe hypertriglyceridemia. We suggest that potential secondary causes should be carefully assessed for such patients. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  19. Blood pressure differences between office and home settings among Japanese normotensive subjects and hypertensive patients.

    PubMed

    Mori, Hisao; Ukai, Hiroshi; Yamamoto, Hareaki; Yuasa, Shouhei; Suzuki, Yoshiro; Chin, Keiichi; Katsumata, Takuma; Umemura, Satoshi

    2017-03-01

    This study attempted to clarify the differences in blood pressure (BP) between the office (clinic) and home settings in patients with controlled, sustained, masked or white-coat hypertension. The following formula was used: office mean systolic BP (omSBP)-mean morning home SBP (mmhSBP)/office mean diastolic BP (omDBP)-mean morning home DBP (mmhDBP). The paired t-test was used for statistical analysis. The omSBP-mmhSBP/omDBP-mmhDBP calculation yielded the following results: among normotensive subjects, -1.1±11.2/-1.7±8.5 mm Hg (mean SBP and mean DBP were higher at home than in the office; n=451, P=0.038 in SBP, P=0.000 in DBP); in controlled hypertensive patients, -0.42±10.9/-2.2±8.2 mm Hg (n=1362, P=0.160 in SBP, P=0.000 in DBP); among sustained hypertensive patients, 5.6±14.7/0.048±9.9 mm Hg (n=1370, P=0.000 in SBP, P=0.857 in DBP); in masked hypertensive patients, -15.3±12.9/-9.3±9.5 mm Hg (n=1308, both P=0.000); and among white-coat hypertensive patients, 23.7±13.2/8.2±9.1 mm Hg (n=580, both P=0.000). Our results showed a difference of 5 mm Hg in SBP among sustained hypertensive patients, as recommended by the Japanese Society of Hypertension Guidelines for the Management of Hypertension; however, in other hypertensive patient types, the differences in SBP and DBP between office and home measurements differed by >5 mm Hg. Office and home BP measurements should be interpreted cautiously, keeping in mind the clinical setting.

  20. Gentamicin in the Clinical Setting

    ERIC Educational Resources Information Center

    Pillers, De-Ann M.; Schleiss, Mark R.

    2005-01-01

    Gentamicin is an aminoglycoside antibiotic that has been a mainstay in pediatric care for decades. Although new antibiotics are constantly under development, gentamicin continues to play an important role in clinical medicine. Although this may be surprising in the context of evidence of an association with hearing loss, both on a toxicity and a…

  1. [Malingering in the clinical setting].

    PubMed

    Spinetto, Marcela

    2005-01-01

    This article presents an overview of advances in the clinical and neuropsychological assessment of malingering, issues in diagnostic differential, neuropsychological and psychodynamic test methods, and special issues presented by medical - legal context, and other factors which may affect presentations. Cautions and recommendations for practice are presented.

  2. Gentamicin in the Clinical Setting

    ERIC Educational Resources Information Center

    Pillers, De-Ann M.; Schleiss, Mark R.

    2005-01-01

    Gentamicin is an aminoglycoside antibiotic that has been a mainstay in pediatric care for decades. Although new antibiotics are constantly under development, gentamicin continues to play an important role in clinical medicine. Although this may be surprising in the context of evidence of an association with hearing loss, both on a toxicity and a…

  3. Factors Affecting Professional Autonomy of Japanese Nurses Caring for Culturally and Linguistically Diverse Patients in a Hospital Setting in Japan.

    PubMed

    Kuwano, Noriko; Fukuda, Hiromi; Murashima, Sachiyo

    2016-11-01

    The study aimed to analyze the professional autonomy of Japanese nurses when caring for non-Japanese patients and to identify its contributing factors. A descriptive cross-sectional design was used. Participants included 238 clinical nurses working at 27 hospitals in Japan. The Intercultural Sensitivity Scale (Chen and Starosta), and the Scale for Professional Autonomy in Nursing (Kikuchi and Harada) were used to measure intercultural sensitivity and professional autonomy. Stepwise multiple regression analysis was used to identify the most significant factors affecting professional autonomy. Professional autonomy of Japanese nurses caring for non-Japanese patients was significantly lower than when caring for Japanese patients (142.84 vs. 172.85; p < .001). Contributing factors were intercultural sensitivity (p < .001), length of nurse experience (p < .05), and availability of interpretation service (p < .05). Incorporating transcultural nursing content into training programs in schools and hospitals could enhance professional autonomy of Japanese nurses by promoting intercultural sensitivity. © The Author(s) 2015.

  4. Effects of ward rotation on subsequent transition processes of Japanese clinical nurses.

    PubMed

    Fujino, Mitsuku; Nojima, Yoshiko

    2005-03-01

    The purpose of this study was to examine the experience of Japanese clinical nurses undertaking a ward rotation in a general hospital, and its effects on subsequent processes relating to: (i) perception of ward rotation; (ii) reactions to the ward transition process; and (iii) outcomes of ward rotation. In-depth interviews were conducted with 21 Japanese clinical nurses who had an average of 8.8 years (SD = 5.50) clinical experience. Findings indicated that participants experienced role overload, role incongruity and/or role underload, role overqualification, or role ambiguity in the new environment. These role stresses created critical emotional distress during the transition process. The high desire for career development facilitated the transition process, while lack of preparation inhibited the transition process. To facilitate smooth transition, well-prepared and structured supports based on reliable interpersonal relationships are necessary. The findings offer significant cues for effective ward rotation programs. The implication for nursing administrators is that appropriate ward rotations enhance confidence and promote effective role development in the new clinical setting.

  5. Clinical features of 405 Japanese patients with systemic sclerosis.

    PubMed

    Hashimoto, Atsushi; Endo, Hirahito; Kondo, Hirobumi; Hirohata, Shunsei

    2012-04-01

    We aimed to clarify the clinical features of Japanese patients with systemic sclerosis (SSc), especially with reference to organ involvement and autoantibodies. A cohort of 405 patients with SSc who attended our institution from 1973 to 2008 was identified retrospectively. Data on clinical features, including autoantibodies, organ involvement, and overlap of other connective tissue diseases, were obtained by following the medical records until 2009. The percentage of male patients during or after 1990 was greater than that before 1990 (3.9 vs. 10.6%, respectively). Limited cutaneous SSc (lSSc) was twice as frequent as diffuse cutaneous SSc (dSSc). About half of the patients had lung involvement (50.4%), while only 3.2% had scleroderma renal crisis. Male gender was associated with lung involvement, and dSSc was associated with most organ involvements except for pulmonary arterial hypertension (PAH). Anti-Scl-70 antibody was associated with lung or heart involvement, while anti-U1-RNP antibody was only associated with PAH. Conversely, patients with anti-centromere antibody had less organ involvement. SSc-Sjögren overlap syndrome was related to lSSc, further overlapping systemic lupus erythematosus (SLE), and less lung or heart involvement. In conclusion, these results not only confirmed previous reports but revealed several other findings, such as the increased proportion of male patients in recent years and the relationships between clinical features.

  6. Pathophysiology and Japanese clinical characteristics in Marfan syndrome.

    PubMed

    Fujita, Daishi; Takeda, Norifumi; Imai, Yasushi; Inuzuka, Ryo; Komuro, Issei; Hirata, Yasunobu

    2014-08-01

    Marfan syndrome is an autosomal dominant heritable disorder of the connective tissue, caused by mutations of the gene FBN1, which encodes fibrillin-1, a major component of the microfibrils of the extracellular matrix. Fibrillin-1 interacts with transforming growth factor-β (TGF-β), and dysregulated TGF-β signaling plays a major role in the development of connective tissue disease and familial aortic aneurysm and dissection, including Marfan syndrome. Losartan, an angiotensin II blocker, has the potential to reduce TGF-β signaling and is expected to be an additional therapeutic option. Clinical diagnosis is made using the Ghent nosology, which requires comprehensive patient assessment and has been proven to work well, but evaluation of some of the diagnostic criteria by a single physician is difficult and time-consuming. A Marfan clinic was established at the University of Tokyo Hospital in 2005, together with cardiologists, cardiac surgeons, pediatricians, orthopedists, and ophthalmologists in one place, for the purpose of speedy and accurate evaluation and diagnosis of Marfan syndrome. In this review, we discuss the recent progress in diagnosis and treatment of Marfan syndrome, and the characteristics of Japanese patients with Marfan syndrome.

  7. Eye trackers in an oculary clinical setting

    NASA Astrophysics Data System (ADS)

    Shahimin, Mizhanim M.; Shahimin, Mukhzeer M.

    2013-12-01

    Infrared eye tracker has been demonstrated to provide a more objective and quantitative results of the cover test measurement in eye care practices. This paper reviews the application of eye trackers in oculary clinical setting. It highlights the different types of eye movement recording system (EMRS) available, the advantages and disadvantages of each and their use in a clinical setting. This paper also discusses the parameters that can be derived from the EMRS and the significance of the parameters in a clinical interpretation. Using an eye tracker would make available to the clinician a simple system for making quantitative measurements when performing the cover test in an eye examination.

  8. Reliability of Japanese clinical trials estimated from GCP audit findings.

    PubMed

    Saito, K; Kodama, Y; Ono, S; Maida, C; Fujimura, A; Miyamoto, E

    2008-08-01

    To describe the reliability of Japanese clinical trials, we compared the results of a Good Clinical Practice (GCP) audit conducted between April 1997 and March 2000 (fiscal year (FY) 1997 - 1999) with those from April 2004 - March 2005 (FY2004). The number and proportion of various types of deficiencies described in GCP audit reports were compared between the 2 periods. The audit findings in the former period were based on official audits that covered 331 hospitals and 775 trials. The audits in the latter period targeted 114 hospitals and 189 trials. The inspection of former period was undertaken by the Organization for Pharmaceuticals Safety and Research (OPSR). On the other hand, the latter period was undertaken by the Pharmaceuticals and Medical Devices Agency (PMDA). The total number of deficiencies detected in GCP audits was 1,529 in the former 3-year period (FY1997 - 1999) and 819 in the latter period (FY2004). The total number of deficiencies detected and reported was more than 1.5-fold on an annual basis in the latter period. By category of deficiencies, the proportion of protocol deviations increased from 14.7 (225/1,529) to 45.7% (374/819), while the proportion of errors in case report forms (CRFs) decreased from 43.6 (666/ 1,529) to 27.1% (222/819). There were two remarkable changes in audit findings between FY1997 - 1999 and FY2004; the increase in the proportion of protocol deviations and the decrease in the proportion of CRF-related deficiencies. We think that in Japan the improvement of research environments is needed to provide reliable clinical data responsible for the regulatory standard of GCP.

  9. Japanese Society of Clinical Oncology clinical practice guidelines 2010 for antiemesis in oncology: executive summary.

    PubMed

    Takeuchi, Hideki; Saeki, Toshiaki; Aiba, Keisuke; Tamura, Kazuo; Aogi, Kenjiro; Eguchi, Kenji; Okita, Kenji; Kagami, Yoshikazu; Tanaka, Ryuhei; Nakagawa, Kazuhiko; Fujii, Hirofumi; Boku, Narikazu; Wada, Makoto; Akechi, Tatsuo; Udagawa, Yasuhiro; Okawa, Yutaka; Onozawa, Yusuke; Sasaki, Hidenori; Shima, Yasuo; Shimoyama, Naohito; Takeda, Masayuki; Nishidate, Toshihiko; Yamamoto, Akifumi; Ikeda, Tadashi; Hirata, Koichi

    2016-02-01

    The purpose of this article is to disseminate the standard of antiemetic therapy for Japanese clinical oncologists. On the basis of the Appraisal of Guidelines for Research and Evaluation II instrument, which reflects evidence-based clinical practice guidelines, a working group of the Japanese Society of Clinical Oncology (JSCO) reviewed clinical practice guidelines for antiemesis and performed a systematic review of evidence-based domestic practice guidelines for antiemetic therapy in Japan. In addition, because health-insurance systems in Japan are different from those in other countries, a consensus was reached regarding standard treatments for chemotherapy that induce nausea and vomiting. Current evidence was collected by use of MEDLINE, from materials from meetings of the American Society of Clinical Oncology National Comprehensive Cancer Network, and from European Society of Medical Oncology/Multinational Association of Supportive Care in Cancer guidelines for antiemesis. Initially, 21 clinical questions (CQ) were selected on the basis of CQs from other guidelines. Patients treated with highly emetic agents should receive a serotonin (5-hydroxytryptamine; 5HT3) receptor antagonist, dexamethasone, and a neurokinin 1 receptor antagonist. For patients with moderate emetic risk, 5HT3 receptor antagonists and dexamethasone were recommended, whereas for those receiving chemotherapy with low emetic risk dexamethasone only is recommended. Patients receiving high-emetic-risk radiation therapy should also receive a 5HT3 receptor antagonist. In this paper the 2010 JSCO clinical practice guidelines for antiemesis are presented in English; they reveal high concordance of Japanese medical circumstances with other antiemetic guidelines that are similarly based on evidence.

  10. Occult Hepatitis B (OBH) in Clinical Settings

    PubMed Central

    Alavian, Seyed Moayed; Miri, Seyed Mohammad; Hollinger, F. Blaine; Jazayeri, Seyed Mohammad

    2012-01-01

    Context Occult hepatitis B (OHB), or persistent HBV DNA in patients who are hepatitis B surface antigen (HBsAg) negative, is a recently recognized entity. In an attempt to summarize the issues, this review presents an overview of the current proposed hypothesis on the clinical relevance and also updates the knowledge on the classification of OHB in different clinical settings. Evidence Acquisition OHB could be found in different population and clinical backgrounds including: viral co-infections (with either human immunodeficiency or hepatitis C viruses), HBV chronic carriers, dialysis patients, transplantation settings and certain clinical situations (named in here: special clinical settings) with no apparent distinguishable clinical parameters. Results The exact magnitude, pathogenesis, and clinical relevance of OHB are unclear. Even the possible role exerted by this cryptic infection on liver disease outcome, and hepatocellular carcinoma development remains unknown. Conclusions Monitoring of Individuals with positive anti-HBc, mass immunization programs and improvement in diagnostic tools seem to be important to control the probability of transmission of HBV through cryptic HBV infection. PMID:23087749

  11. English for Content Instruction in a Japanese Higher Education Setting: Examining Challenges, Contradictions and Anomalies

    ERIC Educational Resources Information Center

    Toh, Glenn

    2014-01-01

    This article examines issues pertaining to content instruction in English in a Japanese higher education institution. It notes that Japan's economic success in the latter part of the twentieth century was achieved with Japanese as the medium of instruction and observes that in terms of ideology and cultural politics at least, there are inherent…

  12. Communication Characteristics of Asians in American Urban Settings: The Case of Honolulu Japanese.

    ERIC Educational Resources Information Center

    Ogawa, Dennis M.

    Traditional familialism as a basic antecedent for understanding Japanese-American communication in Honolulu is examined. The traditional Japanese extended family evolved from economic interdependencies in agricultural, rural communities. This familial communalism demanded that individualism be suppressed so that the needs of the corporate group…

  13. Physical Settings and Materials Recommended for Play Therapy with Japanese Children

    ERIC Educational Resources Information Center

    Ji, Yuanhong; Ramirez, Sylvia Z.; Kranz, Peter L.

    2008-01-01

    This article describes a number of important issues to consider in play therapy with Japanese children. They include the waiting room and playroom decor, toys, and other materials, as well as terminology that are commonly used in Japan. The layout of the small and large playrooms, use of the "Wa-Shitsu" (a traditional Japanese room…

  14. Physical Settings and Materials Recommended for Play Therapy with Japanese Children

    ERIC Educational Resources Information Center

    Ji, Yuanhong; Ramirez, Sylvia Z.; Kranz, Peter L.

    2008-01-01

    This article describes a number of important issues to consider in play therapy with Japanese children. They include the waiting room and playroom decor, toys, and other materials, as well as terminology that are commonly used in Japan. The layout of the small and large playrooms, use of the "Wa-Shitsu" (a traditional Japanese room…

  15. English for Content Instruction in a Japanese Higher Education Setting: Examining Challenges, Contradictions and Anomalies

    ERIC Educational Resources Information Center

    Toh, Glenn

    2014-01-01

    This article examines issues pertaining to content instruction in English in a Japanese higher education institution. It notes that Japan's economic success in the latter part of the twentieth century was achieved with Japanese as the medium of instruction and observes that in terms of ideology and cultural politics at least, there are inherent…

  16. [Clinical manifestations of ocular sarcoidosis in Japanese patients].

    PubMed

    Ohara, K

    1994-06-01

    Ocular sarcoidosis was found in 57.5 to 93.5% of Japanese patients with systemic sarcoidosis. Many studies reported a high female/male ratio with high percentage of patients at 20s and 50s in age in ocular sarcoidosis. A cardinal involvement was intraocular and manifested as uveitis. A combinations of granulomatous iritis, trabecular nodules, tent-like peripheral anterior synechia, snow-ball vitreous opacities, perivasculitis, and candle-wax or spotty chorioretinal exudates were characteristic and highly specific intraocular lesions. The lesions often lead ophthalmologists to systemic examinations. In suspects of ocular sarcoidosis who had no or sparse systemic findings, a diagnosis should remain tentative. Transbronchial lung biopsy showed non-caseating epithelioid granuloma in 37 of 60 patients with suspected ocular sarcoidosis who showed no bilateral hilar lymphadenopathy.

  17. Japanese Encephalitis—A Pathological and Clinical Perspective

    PubMed Central

    Ghosh, Debapriya; Basu, Anirban

    2009-01-01

    Japanese encephalitis (JE) is the leading form of viral encephalitis in Asia. It is caused by the JE virus (JEV), which belongs to the family Flaviviridae. JEV is endemic to many parts of Asia, where periodic outbreaks take hundreds of lives. Despite the catastrophes it causes, JE has remained a tropical disease uncommon in the West. With rapid globalization and climatic shift, JEV has started to emerge in areas where the threat was previously unknown. Scientific evidence predicts that JEV will soon become a global pathogen and cause of worldwide pandemics. Although some research documents JEV pathogenesis and drug discovery, worldwide awareness of the need for extensive research to deal with JE is still lacking. This review focuses on the exigency of developing a worldwide effort to acknowledge the prime importance of performing an extensive study of this thus far neglected tropical viral disease. This review also outlines the pathogenesis, the scientific efforts channeled into develop a therapy, and the outlook for a possible future breakthrough addressing this killer disease. PMID:19787040

  18. Timed Writing Practice for Japanese University Students in an EFL Setting.

    ERIC Educational Resources Information Center

    Kresovich, Brant M.

    1990-01-01

    Timed writing exercises used at the University of the Ryukyus (Japan) to help alleviate common problems in English second language writing are described. It is proposed that Japanese students have difficulty writing in English because of early training in the grammar-translation method, a lack of communication skills, the overuse of bilingual…

  19. Timed Writing Practice for Japanese University Students in an EFL Setting.

    ERIC Educational Resources Information Center

    Kresovich, Brant M.

    1990-01-01

    Timed writing exercises used at the University of the Ryukyus (Japan) to help alleviate common problems in English second language writing are described. It is proposed that Japanese students have difficulty writing in English because of early training in the grammar-translation method, a lack of communication skills, the overuse of bilingual…

  20. Genotype-phenotype correlation in Japanese patients with familial Mediterranean fever: differences in genotype and clinical features between Japanese and Mediterranean populations.

    PubMed

    Kishida, Dai; Nakamura, Akinori; Yazaki, Masahide; Tsuchiya-Suzuki, Ayako; Matsuda, Masayuki; Ikeda, Shu-ichi

    2014-09-27

    Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease characterized by recurrent self-limiting fever and serositis that mainly affects Mediterranean populations. Many patients with FMF have been reported in Japan due to increasing recognition of this condition and the availability of genetic analysis for the gene responsible, MEFV. The present study was performed to elucidate the clinical characteristics of Japanese FMF patients and to examine the precise genotype-phenotype correlation in a large cohort of Japanese FMF patients. We analyzed the MEFV genotypes and clinical manifestations in 116 patients clinically diagnosed as having FMF and with at least one mutation. The most frequent mutation in Japanese patients was E148Q (40.2%), followed by M694I (21.0%), L110P (18.8%), P369S (5.4%), and R408Q (5.4%). In contrast, common mutations seen in Mediterranean patients, such as M694V, V726A, and M680I, were not detected in this population. The clinical features with M694I were associated with more severe clinical course compared to those seen with E148Q. P369S/R408Q showed variable phenotypes with regard to both clinical manifestations and severity. Patients with M694I showed a very favorable response to colchicine therapy, while those with P369S and R408Q did not. Clinical features and efficacy of treatment in Japanese FMF patients vary widely according to the specific MEFV gene mutation, and therefore genetic analysis should be performed for diagnosis in cases of Japanese FMF.

  1. Frequency and Clinical Implication of the R450H Mutation in the Thyrotropin Receptor Gene in the Japanese Population Detected by Smart Amplification Process 2

    PubMed Central

    Yanagawa, Yoshimaro; Aoki, Tomoyuki; Morimura, Tadashi; Araki, Osamu; Kimura, Takao; Ogiwara, Takayuki; Kotajima, Nobuo; Yanagawa, Masumi; Murakami, Masami

    2014-01-01

    In Japanese pediatric patients with thyrotropin (TSH) resistance, the R450H mutation in TSH receptor gene (TSHR) is occasionally observed. We studied the frequency and clinical implication of the R450H mutation in TSHR in the general population of Japanese adults using smart amplification process 2 (SmartAmp2). We designed SmartAmp2 primer sets to detect this mutation using a drop of whole blood. We analyzed thyroid function, antithyroid antibodies, and this mutation in 429 Japanese participants who had not been found to have thyroid disease. Two cases without antithyroid antibodies were heterozygous for the R450H mutation in TSHR. Thus, the prevalence of this mutation was 0.47% in the general population and 0.63% among those without antithyroid antibodies. Their serum TSH concentrations were higher than the average TSH concentration not only in subjects without antithyroid antibodies but also in those with antithyroid antibodies. The R450H mutation in TSHR is relatively common in the Japanese population and potentially affects thyroid function. The present study demonstrates that the SmartAmp2 method is useful to detect the R450H mutation in TSHR, which is one of the common causes of TSH resistance in the Japanese population. PMID:24895636

  2. Clinical Characteristics of Stenotrophomonas maltophilia Bacteremia: A Regional Report and a Review of a Japanese Case Series

    PubMed Central

    Ebara, Hirotaka; Hagiya, Hideharu; Haruki, Yuto; Kondo, Eisei; Otsuka, Fumio

    2017-01-01

    Objective Stenotrophomonas maltophilia is an emerging nosocomial pathogen that causes fatal infections in critically ill or immunocompromised patients. S. maltophilia bacteremia (SMB) is a rare condition, and its clinical characteristics in Japanese settings are not well known. Methods The medical charts of patients with SMB were retrospectively reviewed at two medical facilities (Okayama University Hospital and Tsuyama Chuo Hospital) for seven years. The data were analyzed along with those previously reported from other Japanese facilities. Result A total of 181 patients (110 men and 71 women) were evaluated. The major underlying diseases included hematologic malignancy (36.5%), solid organ malignancy (25.4%), and neutropenia (31.5%). The recent use of carbapenem was seen in 56.9% of the cases in total, and more than one-third of the patients in our hospitals were treated with carbapenem at the onset of SMB. Of 28 (63.6%) of 44 cases treated for S. maltophilia, those who did not survive were more likely to have been treated with broad-spectrum antibiotics. A multivariate analysis revealed that a higher updated Charlson Comorbidity Index [odds ratio (95% confidence interval), 1.75 (1.11-2.75); p=0.015] and intubation [odds ratio (95% confidence interval), 12.6 (1.62-97.9); p=0.016] were associated with mortality in our cases. Pathogens were often resistant to ceftazidime but susceptible to minocycline, trimethoprim/sulfamethoxazole, and fluoroquinolones. The overall mortality rates within 30 and 90 days were 37.5% and 62.5%, respectively. Conclusion The clinical characteristics of SMB in Japanese cases were similar to those reported from other countries. Clinicians should be aware that breakthrough infection by S. maltophilia may occur during administration of carbapenem. PMID:28090041

  3. Comparison of performance of the 2016 ACR-EULAR classification criteria for primary Sjögren's syndrome with other sets of criteria in Japanese patients.

    PubMed

    Tsuboi, Hiroto; Hagiwara, Shinya; Asashima, Hiromitsu; Takahashi, Hiroyuki; Hirota, Tomoya; Noma, Hisashi; Umehara, Hisanori; Kawakami, Atsushi; Nakamura, Hideki; Sano, Hajime; Tsubota, Kazuo; Ogawa, Yoko; Takamura, Etsuko; Saito, Ichiro; Inoue, Hiroko; Nakamura, Seiji; Moriyama, Masafumi; Takeuchi, Tsutomu; Tanaka, Yoshiya; Hirata, Shintaro; Mimori, Tsuneyo; Matsumoto, Isao; Sumida, Takayuki

    2017-03-22

    To compare the performance of the new 2016 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria for primary Sjögren's syndrome (SS) with 1999 revised Japanese Ministry of Health criteria for diagnosis of SS (JPN), 2002 American-European Consensus Group classification criteria for SS (AECG) and 2012 ACR classification criteria for SS (ACR) in Japanese patients. The study subjects were 499 patients with primary SS (pSS) or suspected pSS who were followed up in June 2012 at 10 hospitals in Japan. All patients had been assessed for all four criteria of JPN (pathology, oral, ocular, anti-SS-A/SS-B antibodies). The clinical diagnosis by the physician in charge was set as the 'gold standard'. pSS was diagnosed in 302 patients and ruled out in 197 patients by the physician in charge. The sensitivity of the ACR-EULAR criteria in the diagnosis of pSS (95.4%) was higher than those of the JPN, AECG and ACR (82.1%, 89.4% and 79.1%, respectively), while the specificity of the ACR-EULAR (72.1%) was lower than those of the three sets (90.9%, 84.3% and 84.8%, respectively). The differences of sensitivities and specificities between the ACR-EULAR and other three sets of criteria were statistically significant (p<0.001). Eight out of 302 patients with pSS and 11 cases out of 197 non-pSS cases satisfied only the ACR-EULAR criteria, compared with none of the other three sets. The ACR-EULAR criteria had significantly higher sensitivity and lower specificity in diagnosis of pSS, compared with the currently available three sets of criteria. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Multigene sets for clinical application in glioma.

    PubMed

    de Groot, John F; Sulman, Erik P; Aldape, Kenneth D

    2011-04-01

    Diffuse gliomas are a heterogeneous group of malignancies with highly variable outcomes, and diagnosis is largely based on histologic appearance. Tumor classification according to cell type and grade provides some prognostic information. However, significant clinical and biologic heterogeneity exists in glioma, even after accounting for known clinicopathologic variables. Significant advances in knowledge of the molecular genetics of brain tumors have occurred in the past decade, largely because of the availability of high-throughput profiling techniques, including new sequencing methodologies and multidimensional profiling by The Cancer Genome Atlas project. The large amount of data generated from these efforts has enabled the identification of prognostic and predictive factors and helped to identify pathways driving tumor growth. Implementing these signatures into the clinic to personalize therapy presents a new challenge. Identification of relevant biomarkers, especially when coupled with clinical trials of newer targeted therapies, will enable better patient stratification and individualization of treatment for patients with glioma.

  5. Boundary crossings and violations in clinical settings.

    PubMed

    Aravind, V K; Krishnaram, V D; Thasneem, Z

    2012-01-01

    Principles of beneficence, autonomy, and nonmaleficence, compassion along with fiduciary partnership are the core concepts in the doctor-patient relationship in therapeutic settings. There are varieties of reasons for boundary problems. Physicians ignorance, exploitative character, emotional vulnerability moral weakness and similar factors may pave the way for boundary issues resulting in nonsexual or sexual boundary crossings and violations.

  6. Boundary Crossings and Violations in Clinical Settings

    PubMed Central

    Aravind, V. K.; Krishnaram, V. D.; Thasneem, Z.

    2012-01-01

    Principles of beneficence, autonomy, and nonmaleficence, compassion along with fiduciary partnership are the core concepts in the doctor-patient relationship in therapeutic settings. There are varieties of reasons for boundary problems. Physicians ignorance, exploitative character, emotional vulnerability moral weakness and similar factors may pave the way for boundary issues resulting in nonsexual or sexual boundary crossings and violations. PMID:22661802

  7. Estimated number of siblings in Japanese families with multiple birth children using two sets of census data: 1990 and 1995.

    PubMed

    Imaizumi, Yoko; Nishida, Etsuo

    2011-04-01

    The purpose of this study was to estimate the number of siblings in each Japanese family with multiple birth children using two sets of census data, from 1990 and 1995. The mean number of siblings for singletons was 2.3 in 1990 (2.4 in 1995), 2.9 (2.9) for one set of twins, 4.6 (4.5) for two sets of twins, and 3.5 (3.3) for one set of triplets. For birth order of multiples, the highest mean sibling number was 4.4 for one set of twins (the middle), 7.5 for two sets of twins (the middle-middle), and 4.3 for one set of triplets (the last). The mean sibling number was slightly higher for like-sexed twins and triplets than in unlike-sexed twins and triplets. The mean sibling number was highest in the Okinawa District, among nine districts (0.4 for singletons, 0.6 for one set of twins, 1.0 for two sets of twins and 0.6 for triplets). The current study of the number of siblings in each family with multiple birth children will help provide data for designing programs to help support multiple-birth families. The method of using census data on multiple births might result in a system to analyze nationwide data on multiple birth children if there is no national registry of multiple births after live births in any country.

  8. 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.

  9. 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.

  10. Testing visual function in the clinical setting.

    PubMed

    Westheimer, Gerald

    2010-07-01

    The explosive growth of automatic examination of the eye, in particular for determining refractive corrections, invites an analysis of the strengths and limitations of these devices and their role in clinical decisions. Subjective refraction procedures are based on a patient's visual responses and these embrace many levels of additional optical and neural processing and factors involving the higher-order nervous system and perception. Because the ultimate mission is the maintenance and improvement of a patient's visual experiences, the optometric examination necessarily extends beyond the employment of automatic devices and therefore, should include engaging the patients in tests of their visual functions.

  11. Clinical Anatomy of the Liver: Review of the 19th Meeting of the Japanese Research Society of Clinical Anatomy

    PubMed Central

    Sakamoto, Yoshihiro; Kokudo, Norihiro; Kawaguchi, Yoshikuni; Akita, Keiichi

    2017-01-01

    Precise clinical knowledge of liver anatomy is required to safely perform a hepatectomy, for both open and laparoscopic surgery. At the 19th meeting of the Japanese Research Society of Clinical Anatomy (JRSCA), we conducted special symposia on essential issues of liver surgery, such as the history of hepatic segmentation, the glissonean pedicle approach, application of 3-D imaging simulation and fluorescent imaging using indocyanine green solution, a variety of segmentectomies including caudate lobectomy, the associating liver partition and portal vein embolization for stage hepatectomy and harvesting liver grafts for living donor liver transplantation. The present review article provides useful information for liver surgeons and anatomic researchers. PMID:28275581

  12. Validation of the "Activity and participation" component of ICF Core Sets for stroke patients in Japanese rehabilitation wards

    PubMed

    Kinoshita, Shoji; Abo, Masahiro; Miyamura, Kohei; Okamoto, Takatsugu; Kakuda, Wataru; Kimura, Ikuo; Urabe, Hiroshi

    2016-10-12

    To validate the International Classification of Functioning, Disability and Health (ICF) Core Set for stroke in the assessment of functional status and disability in Japanese stroke patients. The study included stroke patients admitted to the Kaifukuki (convalescent) rehabilitation wards. The comprehensive ICF Core Set for neurological conditions for post-acute care and the ICF rehabilitation set were evaluated with qualifiers assessed by the physiatrists at admission. The "activity and participation" (d) component was divided to sub-components (cognition-related activity, motor-related activity and participation). The correlations between numbers of problem categories in the entire "d" component and these sub-components in each ICF Core Set and the Functional Independence Measure (FIM) score were assessed using Spearman's correlation coefficient. A total of 117 post-stroke patients (mean age 70.1 ± 14.2 years, 53 women) were included. Correlation analysis identified significant and strong correlations between the values of the entire "d" component and sub-components (cognition-related activity and motor-related activity) of the 2 ICF Core Sets and FIM score. A significant, but weak, correlation between FIM and the participation sub-component was identified. The "d" component of these 2 ICF Core Sets reflects functional status and disability and could be a valid measure in post-acute stroke patients in the rehabilitation setting.

  13. Staff Training in a Clinical Setting. Volume II, Number 4.

    ERIC Educational Resources Information Center

    Bangs, Tina E.

    Provided is the script for a presentation of 16 slides on staff training, orientation, and role in a clinical setting providing educational programs for the preschool and primary grade handicapped child. The sixteen slide commentaries cover an introduction to principles and implementation of a staff training program in a clinical setting, staff…

  14. Clinical evaluation of body fat percentage in 11,833 Japanese measured by air displacement plethysmograph.

    PubMed

    Miyatake, Nobuyuki; Takenami, Sumiko; Kawasaki, Yuriko; Kunihashi, Yumiko; Nishikawa, Hidetaka; Numata, Takeyuki

    2005-07-01

    Body fat percentage is commonly used for assessing body composition. We investigated the body fat percentage in Japanese subjects measured by air displacement plethysmograph (ADP) termed BOD POD. Cross-sectional clinical investigation study. We used data of 11,833 Japanese subjects aged 20-79 years [body mass index (BMI): 23.2+/-3.7 kg/m2]. Body fat percentage was evaluated by BOD POD. Anthropometric parameters such as height, weight, BMI, waist circumference and hip circumference were also measured. Mean values of body fat percentage measured by BOD POD were 24.5+/-6.6% in men and 31.1+/-7.1% in women, mean values were also calculated as classified into aged groups in normal weight subjects. Body fat percentage was significantly correlated with BMI and 25.1% of men and 34.6% of women corresponded to 25 kg/m2 in BMI. Mean value of body fat percentage in normal weight Japanese subjects was revealed. In addition, the level of 25% in men and 35% in women corresponded to 25 kg/m2 of BMI.

  15. The Vidian Canal: Radiological Features in Japanese Population and Clinical Implications

    PubMed Central

    MATO, David; YOKOTA, Hajime; HIRONO, Seiichiro; MARTINO, Juan; SAEKI, Naokatsu

    2015-01-01

    The vidian canal (VC), a bony tunnel in which the vidian artery and nerve pass, has been widely known as an important landmark to identify the anterior genu of the petrous carotid artery (AGPCA) especially during lateral extended endoscopic endonasal approachs (LEEEAs). The objectives of this study in the Japanese population are to describe the radiological anatomic features and relationships between VC and its surrounding structures, and discuss the clinical implications. We studied 231 high-resolution computed tomography (CT) scans with a slice thickness of 0.5 mm. All the patients had known sellar or parasellar pathologies but without any involvement of VC. The following VC-related parameters were examined: its length, relationship to AGPCA, course from the pterygopalatine fossa to the carotid canal, its position relative to the medial pterygoid plate and pneumatization pattern of the sphenoid sinus. Mean length of VC is 14.6 mm. There is more tendency of straight-running VC compared to other populations. VC locates infero-lateral to AGPCA in all the cases. The protrusion of VC and the paraclival carotid artery to the sphenoid sinus, as well as well-pneumatization of the sinus is also observed more frequently in almost a half of the population. Surgeons who perform LEEEAs in Japanese patients must know these anatomical features. The characteristics particular to Japanese populations may facilitate better identification of VC and exposure to AGPCA intraoperatively. PMID:25744352

  16. Cooperation between Japanese and Cambodian Dietitians in Setting up a Hospital Diet Management System.

    PubMed

    Ly, Koung Ry; Saito, Shino; Kusama, Kaoru

    2015-01-01

    Cambodia faces a considerably high percentage of the stunted under 5 (Unicef, 2014). Despite the National Nutrition Strategy Launched by the Ministry of Health in cooperation with development partners, nutrition improvement projects have not always been effective. It is generally said these issues are addressed in many other developing nations, and the literature largely documented that successful nutrition programmes are community-based programmes because of their sustainability and the intensive communications between health workers and beneficiaries. Learning from the past experiences, the Foundation for International Development/Relief organized a project team with a Cambodian dietitian and an experienced Japanese dietitian to implement a hospital diet programme for children from April 2006 to March 2014 in the National Pediatric Hospital (NPH) in Cambodia. The project has two objectives: establishing a hospital diet management system, and developing the capacity of NPH staff. Hospital food menus were created paying particular attention to Cambodian culture, eating habits and accessibility to the ingredients for the purpose of continuous supply. We have also put emphasis on the communication between dietitians and family members of the children to let them understand the importance of a nutritious diet. After 8 y of project implementation, the hospital diet management system was established providing 7 types of menu with nutritious diets. The final evaluation of the project showed that NPH staff have the intention to continue hospital food supply with their acquired knowledge and capacity. In practice, a Cambodian dietitian currently takes the initiative for a continuous nutritional diet in NPH. The key to this success is the collaboration between Japanese dietitians with experience and Cambodian dietitians with knowledge of Cambodian eating habits. Taking our experience into account, it is highly recommended to educate Cambodian dietitians, as they are

  17. Measuring venous insufficiency objectively in the clinical setting.

    PubMed

    Kelechi, Teresa J; Bonham, Phyllis A

    2008-09-01

    The purpose of this article is to propose a screening procedure to assess venous insufficiency with a hand-held photoplethysmography (PPG) instrument in the clinical setting. PPG is noninvasive technology that is used as part of venous assessment of the lower extremities. Although duplex ultrasound remains the industry gold standard for assessment, there are many situations in which access or expertise is not available. The measurement of venous refill time with PPG, one measure of venous insufficiency, is becoming increasingly more prevalent in research settings; however, PPG is underused in clinical settings. Rapid venous refill time clinical settings as a screening mechanism may provide useful data to augment diagnostic and therapeutic decision making. Future research is needed to establish a best-practice guideline for venous assessment in clinical settings to validate using PPG.

  18. Driving clinical study efficiency by using a productivity breakdown model: comparative evaluation of a global clinical study and a similar Japanese study.

    PubMed

    Takahashi, K; Sengoku, S; Kimura, H

    2011-02-01

    A fundamental management imperative of pharmaceutical companies is to contain surging costs of developing and launching drugs globally. Clinical studies are a research and development (R&D) cost driver. The objective of this study was to develop a productivity breakdown model, or a key performance indicator (KPI) tree, for an entire clinical study and to use it to compare a global clinical study with a similar Japanese study. We, thereby, hope to identify means of improving study productivity. We developed the new clinical study productivity breakdown model, covering operational aspects and cost factors. Elements for improving clinical study productivity were assessed from a management viewpoint by comparing empirical tracking data from a global clinical study with a Japanese study with similar protocols. The following unique and material differences, beyond simple international difference in cost of living, that could affect the efficiency of future clinical trials were identified: (i) more frequent site visits in the Japanese study, (ii) head counts at the Japanese study sites more than double those of the global study and (iii) a shorter enrollment time window of about a third that of the global study at the Japanese study sites. We identified major differences in the performance of the two studies. These findings demonstrate the potential of the KPI tree for improving clinical study productivity. Trade-offs, such as those between reduction in head count at study sites and expansion of the enrollment time window, must be considered carefully. © 2010 Blackwell Publishing Ltd.

  19. Significance of Kampo, Japanese traditional medicine, in the treatment of obesity: basic and clinical evidence.

    PubMed

    Yamakawa, Jun-Ichi; Moriya, Junji; Takeuchi, Kenji; Nakatou, Mio; Motoo, Yoshiharu; Kobayashi, Junji

    2013-01-01

    The cause of obesity includes genetic and environmental factors, including cytokines derived from adipocytes (adipo-cytokines). Although drug therapy is available for obesity, it is highly risky. Our main focus in this review is on the traditional form of Japanese medicine, Kampo, in the treated of obesity. Two Kampo formulas, that is, bofutsushosan () and boiogito (), are covered by the national health insurance in Japan for the treatment of obesity. Various issues related to their action mechanisms remain unsolved. Considering these, we described the results of basic experiments and presented clinical evidence and case reports on osteoarthritis as examples of clinical application of their two Kampo medicine. Traditional medicine is used not only for treatment but also for prevention. In clinical practice, it is of great importance to prove the efficacy of combinations of traditional medicine and Western medicine and the utility of traditional medicine in the attenuation of adverse effects of Western medicine.

  20. [Clinical and pathophysiological features of Japanese patients with type 2 diabetes mellitus and their risk factors for diabetic complication].

    PubMed

    Sone, Hirohito

    2015-12-01

    The pathophysiological backgrounds as well as clinical phenotypes of Japanese or East Asian patients with type 2 diabetes are quite different from those in Western countries. According to results of East Asian large-scale studies such as the Japan Diabetes Complications Study (JDCS), which is a representative cohort of Japanese patients with type 2 diabetes, Japanese patients had a much lower body mass index and lower incidence of coronary heart disease compared with Caucasian diabetic patients. Other differences between Japanese and Caucasian patients with type 2 diabetes could be found in risk factors such as fruit intake on retinopathy and significance of triglycerides, or the effects of moderate alcohol drinking on cardiovascular disease. These results demonstrated a necessity of ethnic group-specific risk evaluations and care of type 2 diabetes and its complications.

  1. Clinical implications of the coronary artery calcium score in Japanese patients.

    PubMed

    Yamamoto, Hideya; Kitagawa, Toshiro; Kihara, Yasuki

    2014-01-01

    Coronary artery calcification (CAC) is a well-established surrogate marker of the total burden of coronary atherosclerosis. The CAC score, as measured on coronary computed tomography (CT), is associated with the prevalence of coronary artery disease (CAD) as well as cardiovascular morbidity and mortality. The CAC score is used to reclassify coronary risks in asymptomatic individuals with intermediate risks. However, there are few clinical data regarding the usefulness of the CAC score for identifying high-risk Japanese patients. In this review article, we describe our previous studies of the prognostic value of the CAC score in patients with proven or suspected CAD. In addition, we reanalyzed our previous data for 723 patients with suspected CAD and found both all-cause and cardiovascular disease mortality to be significantly higher among the patients with a CAC score of ≥100 than among those with a CAC score of <100. Several studies from Japan have also shown that the CAC score is associated with the prevalence of obstructive CAD, as demonstrated on invasive coronary angiography or stress myocardial perfusion imaging. Furthermore, the CAC score provides useful information for performing coronary CT angiography, as asymptomatic patients without CAC are expected to have favorable outcomes. In contrast, the diagnostic accuracy is decreased in patients with a high CAC score (>400 or 600). In conclusion, the CAC score may have useful clinical applications in symptomatic and asymptomatic Japanese individuals. However, further studies are required to evaluate the prognostic value of this parameter for predicting cardiovascular morbidity and mortality in population-based analyses of asymptomatic Japanese subjects.

  2. 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…

  3. Historical chronology of basic and clinical research in diabetic nephropathy and contributions of Japanese scientists.

    PubMed

    Wada, Jun; Makino, Hirofumi

    2009-10-01

    The most problematic issue in clinical nephrology worldwide is the relentless and progressive increase in patients with end-stage renal disease (ESRD). Diabetic nephropathy has considerable impact on society in the areas of public health and social economy; many scientists are involved in research for the elucidation of the pathogenesis of diabetic nephropathy and for the prevention and cure of the disease. In contrast, diabetic nephropathy was a neglected or ignored disease in the historical era, and few dedicated physicians recognized the disease process of diabetic nephropathy. In this review, we look back on the history of basic and clinical research on diabetic nephropathy and survey the recent progress of the research, especially focusing on the contribution of Japanese scientists.

  4. Clinical characteristics of exudative age-related macular degeneration in Japanese patients.

    PubMed

    Maruko, Ichiro; Iida, Tomohiro; Saito, Masaaki; Nagayama, Dai; Saito, Kuniharu

    2007-07-01

    To clarify the clinical characteristics of exudative age-related macular degeneration (AMD) in Japanese patients. Retrospective, observational, consecutive case series. Two hundred and eighty-nine patients with neovascular AMD were examined. The authors classified the patients into three subtypes of neovascular AMD: polypoidal choroidal vasculopathy (PCV), retinal angiomatous proliferation (RAP), and typical AMD. One hundred and fifty-eight patients (54.7%) were diagnosed with PCV and 102 patients (35.3%) with typical AMD. RAP was observed in 13 patients (4.5%). In 16 patients (5.5%), one eye had PCV and the other eye had typical AMD. Most patients with PCV and typical AMD had unilateral disease (81.6% and 94.1%, respectively) with a male preponderance (77.8% and 71.6%, respectively). Nine of 13 patients with RAP were female (69.2%). Patients with RAP were older (mean, 80.3 years for men and 75.3 years for women) than patients with other subtypes. Serous and hemorrhagic pigment epithelial detachment developed in 69 patients (43.7%) with PCV, 22 patients (21.6%) with typical AMD, and nine patients (69.2%) with RAP. In the patients with unilateral disease in each subtype, large drusen in the unaffected eye were seen in 24.0% with PCV, 30.2% with typical AMD, and 77.8% with RAP. Neovascular AMD in Japanese patients has different demographic features compared with that in White patients. In Japanese patients, there is a preponderance of PCV, male gender, unilaterality, and absence of drusen in the second eye, with the exception of RAP.

  5. [Clinical effects of Lactobacillus acidophilus strain L-55-contained yogurt on symptoms of Japanese cedar pollen allergy].

    PubMed

    Kimura, Goro; Akagi, Hirofumi; Okada, Chiharu; Hirano, Atsushi; Amano, Yoshimi; Ohmura, Etsuko; Nakashige, Yoshito; Sunada, Yosuke; Fujii, Yusuke; Nakamura, Syoji; Soda, Ryo; Takahashi, Kiyoshi

    2012-05-01

    It has been reported that oral administration of Lactobacillus acidophilus strain L-55 (L-55) suppressed nasal symptom and antigen-specific IgE induced by antigen challenge in mice. We investigated clinical effects of L-55-contained yogurt on symptoms and IgE production in the patients with Japanese cedar pollinosis. The study was performed as a randomized double blind placebo-controlled trial. L-55-contained yogurt (L-55 yogurt) or placebo yogurt was started to administer to each subject from 4 weeks prior to the onset of Japanese cedar pollen release for total 13 weeks. The mean value of symptom score and symptom medication score were lower in L-55 yogurt group compared with placebo yogurt group during 5th week to 9th week from the first week of Japanese cedar pollination. Especially, in medicated subjects, total symptom score and throat symptom score were significantly lower in L-55 yogurt group compared with placebo yogurt group at 5th and 4th week from the first week of Japanese cedar pollination, respectively. Moreover, in medicated subjects, change ratio of serum total IgE was significantly lower in L-55 yogurt group compared with placebo yogurt group at 1st week from the first week of Japanese cedar pollination. Intake of L-55 during Japanese cedar pollinating season may be effective in alleviating the allergic symptoms related to Japanese cedar pollinosis. From these finding, it was suggested that L-55 is a possible candidate as a complementary medicine for Japanese cedar pollinosis.

  6. A national evaluation of specialists' clinics in primary care settings.

    PubMed Central

    Bowling, A; Bond, M

    2001-01-01

    BACKGROUND: Encouraged by the increased purchasing power of general practitioners (GPs), specialist-run clinics in general practice and community health care settings (known as specialist outreach clinics) have increased rapidly across England. The activities of local commissioning schemes within primary care groups are likely to accelerate this trend. AIM: To evaluate the costs, processes, and benefits of specialists' outreach clinics held in GPs' surgeries, compared with hospital outpatient clinics. DESIGN OF STUDY: A case-referent (comparative) study comparing the characteristics of outreach clinics (cases) with matched outpatient control clinics. SETTING: Thirty-eight outreach clinics, compared with 38 matched outpatient clinics as controls, covering 14 hospital trust areas across England. METHOD: Self-administered questionnaires were given to patients in both clinic settings. These covered processes, satisfaction, personal costs, and health status, with postal follow-up at six months to assess health outcomes. Self-administered questionnaires were also given to the specialists and GPs whose clinics were included in the study (individual patient clinical sheet and an attitude questionnaire), practice managers, and trust accountants (process and costs questionnaire). Evaluation of the costs, processes, and benefits of specialist outreach clinics versus hospital outpatient clinics was carried out by comparing questionnaire responses. RESULTS: In comparison with outpatients, outreach clinic patients spent less time on the waiting lists for appointments to see the specialist, they had shorter waiting times in clinics, fewer follow-up appointments, and were more likely to be completely discharged after the sampled attendance. Outreach patients were more satisfied than outpatients with the range of clinic process items asked about. Most doctors felt that the outreach clinic was 'worthwhile'. While patients' personal costs were lower in outreach than in outpatients

  7. Safety and efficacy of sorafenib in Japanese patients with hepatocellular carcinoma in clinical practice: a subgroup analysis of GIDEON.

    PubMed

    Kudo, Masatoshi; Ikeda, Masafumi; Takayama, Tadatoshi; Numata, Kazushi; Izumi, Namiki; Furuse, Junji; Okusaka, Takuji; Kadoya, Masumi; Yamashita, Satoshi; Ito, Yuichiro; Kokudo, Norihiro

    2016-12-01

    GIDEON was a prospective, global, non-interventional study evaluating the safety of sorafenib in patients with unresectable hepatocellular carcinoma in real-world practice. The aim of this subgroup analysis was to assess the safety and efficacy of sorafenib as used by Japanese patients. In Japan, 508 patients were valid for safety analysis. Efficacy and safety were evaluated by the Child-Pugh score. The number of patients with Child-Pugh A and B was 432 (85.0 %) and 58 (11.4 %), respectively. The median overall survival time and time to progression in patients with Child-Pugh A and Child-Pugh B were 17.4 and 4.9 months, 3.7 and 2.3 months, respectively. The most common drug-related adverse events (AEs) included hand-foot skin reaction (47.8 %), diarrhea (35.8 %) and hypertension (24.2 %). The incidences of all or drug-related AEs were similar between patients with Child-Pugh A and B. However, all or drug-related serious AEs, AEs resulting in permanent discontinuation of sorafenib and deaths were observed more frequently in patients with Child-Pugh B compared with Child-Pugh A. Duration of treatment tended to be shorter as the Child-Pugh score worsened. Sorafenib was well tolerated by Japanese HCC patients in clinical settings. Patients with Child-Pugh B had shorter duration of treatment and higher incidence of SAEs. It is important to carefully evaluate patients' conditions and assess the benefit and risk before making a decision to treat patients with sorafenib.

  8. A national evaluation of specialists' clinics in primary care settings.

    PubMed

    Bowling, A; Bond, M

    2001-04-01

    Encouraged by the increased purchasing power of general practitioners (GPs), specialist-run clinics in general practice and community health care settings (known as specialist outreach clinics) have increased rapidly across England. The activities of local commissioning schemes within primary care groups are likely to accelerate this trend. To evaluate the costs, processes, and benefits of specialists' outreach clinics held in GPs' surgeries, compared with hospital outpatient clinics. A case-referent (comparative) study comparing the characteristics of outreach clinics (cases) with matched outpatient control clinics. Thirty-eight outreach clinics, compared with 38 matched outpatient clinics as controls, covering 14 hospital trust areas across England. Self-administered questionnaires were given to patients in both clinic settings. These covered processes, satisfaction, personal costs, and health status, with postal follow-up at six months to assess health outcomes. Self-administered questionnaires were also given to the specialists and GPs whose clinics were included in the study (individual patient clinical sheet and an attitude questionnaire), practice managers, and trust accountants (process and costs questionnaire). Evaluation of the costs, processes, and benefits of specialist outreach clinics versus hospital outpatient clinics was carried out by comparing questionnaire responses. In comparison with outpatients, outreach clinic patients spent less time on the waiting lists for appointments to see the specialist, they had shorter waiting times in clinics, fewer follow-up appointments, and were more likely to be completely discharged after the sampled attendance. Outreach patients were more satisfied than outpatients with the range of clinic process items asked about. Most doctors felt that the outreach clinic was 'worthwhile'. While patients' personal costs were lower in outreach than in outpatients clinics, NHS costs were more expensive per patient in outreach

  9. The Geriatric Minimum Data Set for clinical trials (GMDS).

    PubMed

    Abellan Van Kan, G; Sinclair, A; Andrieu, S; Olde Rikkert, M; Gambassi, G; Vellas, B

    2008-03-01

    To overcome the weak evidence base coming from often poor and insufficient clinical research in older people, a minimum data set to achieve harmonisation is highly advisable. This will lead to uniform nomenclature and to the standardisation of the assessment tools. Our primary objective was to develop a Geriatric Minimum Data Set (GMDS) for clinical research. Investigators from 33 leading Research Centres in Europe (selected based on pre-defined criteria), agreed to establish GerontoNet, a network for research collaboration. Following a systematic review of literature performed before the meeting, the expert panel identified 79 functional, cognitive, nutritional and social statements. Of the initial 79 statements, 49 were found appropriate for a GMDS. After an additional stage of evaluation, a 25-item data set was proposed as the minimum set of information to be included in any future clinical trial involving older people. The GMDS covers 7 domains: general information including data on clinical diagnosis and medication use (5 items), functional performance (5 items), cognitive and emotional status (4 items), cardiovascular risk profile (3 items), nutritional status (3 items), biochemical parameters (1 set and 1 item), and social status (3 items). The proposed GMDS provides an enhanced opportunity for research in elderly populations with appropriate outcome measures, and would greatly facilitate meta-analysis of relevant clinical trials.

  10. [Dietary reference intakes of trace elements for Japanese and problems in clinical fields].

    PubMed

    Inoue, Yoshifumi

    2016-07-01

    In the dietary reference intakes, EAR(estimated average requirement), RDA(recommended dietary allowance), AL(adequate intake), DG(tentative dietary goal for preventing life style related diseases) and UL(tolerable upper intake level) of eight types of trace elements (iron: Fe, zinc: Zn, copper: Cu, manganese: Mn, iodine: I, selenium: Se, chromium: Cr, molybdenum: Mo) have been set. However, in the meals of hospitals, only iron of which has been taken into account. The content of these trace elements in the enteral nutrient released after 2000 was determined by considering the content of dietary reference intakes of trace elements for Japanese and considered so not fall into deficiency. However, enteral nutrient must be used considering the content of Zn, Cu and the Zn/Cu ratio, the selenium content, and the route of administration, in order to avoid falling into deficiency.

  11. Incidence of dizziness and vertigo in Japanese primary care clinic patients with lifestyle-related diseases: an observational study

    PubMed Central

    Wada, Masaoki; Takeshima, Taro; Nakamura, Yosikazu; Nagasaka, Shoichiro; Kamesaki, Toyomi; Oki, Hiroshi; Kajii, Eiji

    2015-01-01

    Objective Dizziness and vertigo are highly prevalent symptoms among patients presenting at primary care clinics, and peripheral vestibular disorder (PVD) is their most frequent cause. However, the incidence of PVD has not been well documented. This study aimed to investigate the incidence of dizziness, vertigo, and PVD among patients presenting at a primary care clinic. Design This was an observational study. Setting and participants Between November 2011 and March 2013, we observed 393 patients, all at least 20 years old, who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for at least 6 months at a primary clinic (Oki Clinic) in Japan. Outcome The main outcome of interest was new incidence of dizziness, vertigo, and PVD events. During the 1-year follow-up period, the otorhinolaryngologist diagnosed and reported new PVD events. Results The mean age of the 393 participants at entry was 65.5 years. Of the study participants, 12.7%, 82.4%, and 92.6% had diabetes mellitus, hypertension, and dyslipidemia, respectively. We followed up all the participants (100%). During the 662.5 person-years of follow-up, 121 cases of dizziness or vertigo (dizziness/vertigo) and 76 cases of PVD were observed. The incidence of dizziness/vertigo and PVD was 194.7 (95% confidence interval: 161.6–232.6) per 1,000 person-years and 115.7 (95% confidence interval: 92.2–142.6) per 1,000 person-years, respectively. There were 61 cases of acute peripheral vestibulopathy, 12 of benign paroxysmal positional vertigo, and three of Meniere’s disease among the 76 PVD patients. Conclusion We reported the incidence of dizziness/vertigo among Japanese primary care clinic patients, which was higher than that usually observed in the general population. Furthermore, we described the incidence of PVD and found that it was a major cause of dizziness/vertigo. PMID:25931828

  12. Clinical characteristics of Japanese patients with axial spondyloarthritis, and short-term efficacy of adalimumab.

    PubMed

    Otsuka, Akiyo; Morita, Mitsuhiro; Yamada, Harumoto

    2015-11-01

    Ankylosing spondylitis (AS) is rarer in Japan than in Europe, probably because the European criteria, not well known by Japanese general physicians, regard AS as a progressive stage of axial spondyloarthritis (SpA). HLA-B27 is an important diagnostic marker of SpA; however, the incidence of the HLA-B27 allele is as low as 0.4 % in Japan. For Japanese SpA patients, other HLA alleles and clinical findings are required for earlier definitive diagnosis, for determining appropriate treatment timing, and for disease monitoring. We investigated the HLA-B alleles of 36 patients clinically diagnosed with SpA. For 8 axial SpA patients we evaluated the short-term efficacy of subcutaneous adalimumab injections (40 mg every other week for ≥11 months). Treatment efficacy was evaluated by use of the Bath Ankylosing Spondylitis Activity Index (BASDAI) score, and serum TNF-α and IL-6 levels were measured pre and post-treatment. Among the 36 Japanese SpA patients, the HLA-B27 allele occurred infrequently (5.6 %) whereas the HLA-B44 and 61 alleles were the most frequently detected (25.0 %). We also detected severe bamboo spine on radiography in the absence of the HLA-B27 allele. All 8 patients with axial SpA experienced significant symptom improvement after adalimumab treatment; the HLA-B27 allele was absent from these patients. Serum TNF-α and IL-6 levels were elevated in cases with remarkable inflammatory pain and high disease activity. These cytokines decreased after therapy, however. Most patients with normal cytokine levels at baseline retained these low levels. The findings reveal the short-term efficacy of adalimumab. The remarkably low incidence of HLA-B27 among our patients indicates that HLA-B distribution is different from that in other countries. Serum TNF-α and IL-6 levels were not effective as biomarkers for cases without high disease activity, and further research with larger samples is needed. The efficacy of TNF blockers, however, suggested a potential localized

  13. Where Realities Confront Ideals: The Personal, Professional, Philosophical and Political in the Teaching of Academic English in a Japanese Setting

    ERIC Educational Resources Information Center

    Toh, Glenn

    2013-01-01

    In recent years, Japanese universities have sought to have a greater number of faculty courses taught in English, where traditionally Japanese has been the medium of instruction. This article begins with an overview of the literature discussing Japan's responses to the spread of English, and philosophies and ideologies influencing the…

  14. Where Realities Confront Ideals: The Personal, Professional, Philosophical and Political in the Teaching of Academic English in a Japanese Setting

    ERIC Educational Resources Information Center

    Toh, Glenn

    2013-01-01

    In recent years, Japanese universities have sought to have a greater number of faculty courses taught in English, where traditionally Japanese has been the medium of instruction. This article begins with an overview of the literature discussing Japan's responses to the spread of English, and philosophies and ideologies influencing the…

  15. How Cultural Traits Influence the Way Japanese and Americans Interact with Each Other in a Business Setting.

    ERIC Educational Resources Information Center

    Kumayama, A.

    An examination of the different cultural traits, values, and business strategies of Americans and Japanese through simulation and role-playing is presented. A Japanese player and an American player, when presented with scripts, have a business conversation about a hypothetical business venture, and then discuss the interaction in interviews. The…

  16. Molecular and Clinical Studies in 138 Japanese Patients with Silver-Russell Syndrome

    PubMed Central

    Fuke, Tomoko; Mizuno, Seiji; Nagai, Toshiro; Hasegawa, Tomonobu; Horikawa, Reiko; Miyoshi, Yoko; Muroya, Koji; Kondoh, Tatsuro; Numakura, Chikahiko; Sato, Seiji; Nakabayashi, Kazuhiko; Tayama, Chiharu; Hata, Kenichiro; Sano, Shinichiro; Matsubara, Keiko; Kagami, Masayo; Yamazawa, Kazuki; Ogata, Tsutomu

    2013-01-01

    Background Recent studies have revealed relative frequency and characteristic phenotype of two major causative factors for Silver-Russell syndrome (SRS), i.e. epimutation of the H19-differentially methylated region (DMR) and uniparental maternal disomy 7 (upd(7)mat), as well as multilocus methylation abnormalities and positive correlation between methylation index and body and placental sizes in H19-DMR epimutation. Furthermore, rare genomic alterations have been found in a few of patients with idiopathic SRS. Here, we performed molecular and clinical findings in 138 Japanese SRS patients, and examined these matters. Methodology/Principal Findings We identified H19-DMR epimutation in cases 1–43 (group 1), upd(7)mat in cases 44–52 (group 2), and neither H19-DMR epimutation nor upd(7)mat in cases 53–138 (group 3). Multilocus analysis revealed hyper- or hypomethylated DMRs in 2.4% of examined DMRs in group 1; in particular, an extremely hypomethylated ARHI-DMR was identified in case 13. Oligonucleotide array comparative genomic hybridization identified a ∼3.86 Mb deletion at chromosome 17q24 in case 73. Epigenotype-phenotype analysis revealed that group 1 had more reduced birth length and weight, more preserved birth occipitofrontal circumference (OFC), more frequent body asymmetry and brachydactyly, and less frequent speech delay than group 2. The degree of placental hypoplasia was similar between the two groups. In group 1, the methylation index for the H19-DMR was positively correlated with birth length and weight, present height and weight, and placental weight, but with neither birth nor present OFC. Conclusions/Significance The results are grossly consistent with the previously reported data, although the frequency of epimutations is lower in the Japanese SRS patients than in the Western European SRS patients. Furthermore, the results provide useful information regarding placental hypoplasia in SRS, clinical phenotypes of the hypomethylated ARHI-DMR, and

  17. Molecular and clinical studies in 138 Japanese patients with Silver-Russell syndrome.

    PubMed

    Fuke, Tomoko; Mizuno, Seiji; Nagai, Toshiro; Hasegawa, Tomonobu; Horikawa, Reiko; Miyoshi, Yoko; Muroya, Koji; Kondoh, Tatsuro; Numakura, Chikahiko; Sato, Seiji; Nakabayashi, Kazuhiko; Tayama, Chiharu; Hata, Kenichiro; Sano, Shinichiro; Matsubara, Keiko; Kagami, Masayo; Yamazawa, Kazuki; Ogata, Tsutomu

    2013-01-01

    Recent studies have revealed relative frequency and characteristic phenotype of two major causative factors for Silver-Russell syndrome (SRS), i.e. epimutation of the H19-differentially methylated region (DMR) and uniparental maternal disomy 7 (upd(7)mat), as well as multilocus methylation abnormalities and positive correlation between methylation index and body and placental sizes in H19-DMR epimutation. Furthermore, rare genomic alterations have been found in a few of patients with idiopathic SRS. Here, we performed molecular and clinical findings in 138 Japanese SRS patients, and examined these matters. We identified H19-DMR epimutation in cases 1-43 (group 1), upd(7)mat in cases 44-52 (group 2), and neither H19-DMR epimutation nor upd(7)mat in cases 53-138 (group 3). Multilocus analysis revealed hyper- or hypomethylated DMRs in 2.4% of examined DMRs in group 1; in particular, an extremely hypomethylated ARHI-DMR was identified in case 13. Oligonucleotide array comparative genomic hybridization identified a ∼3.86 Mb deletion at chromosome 17q24 in case 73. Epigenotype-phenotype analysis revealed that group 1 had more reduced birth length and weight, more preserved birth occipitofrontal circumference (OFC), more frequent body asymmetry and brachydactyly, and less frequent speech delay than group 2. The degree of placental hypoplasia was similar between the two groups. In group 1, the methylation index for the H19-DMR was positively correlated with birth length and weight, present height and weight, and placental weight, but with neither birth nor present OFC. The results are grossly consistent with the previously reported data, although the frequency of epimutations is lower in the Japanese SRS patients than in the Western European SRS patients. Furthermore, the results provide useful information regarding placental hypoplasia in SRS, clinical phenotypes of the hypomethylated ARHI-DMR, and underlying causative factors for idiopathic SRS.

  18. Nursing staff perceptions of student contributions in clinical settings.

    PubMed

    Slaughter-Smith, Cheryl; Helms, Jennifer E; Burris, Rebecca

    2012-01-01

    Because nursing is a practice discipline, students are placed in clinical settings to collaborate with professional nurses in caring for patients. This descriptive study aimed to explore the benefits and limitations of undergraduate nursing students in the clinical setting. A 54-item instrument, Nursing Students' Contributions to Clinical Agencies, was used to collect data from staff nurses (N = 84) at three hospitals. The instrument also provided space for participants to share qualitative data, which revealed perceptions with which staff nurses were likely to agree and three key themes: Eager to Learn, Willing to Help, and Serving Their Time. The major implication for students is that they are often judged on their assertiveness skills and should offer assistance so they appear eager to learn. Faculty must ascertain that students understand their objectives for the clinical rotation and share those objectives with the staff nurses to enhance their learning experience. Copyright 2012, SLACK Incorporated.

  19. Clinical investigation of set-shifting subtypes in anorexia nervosa.

    PubMed

    Abbate-Daga, Giovanni; Buzzichelli, Sara; Marzola, Enrica; Amianto, Federico; Fassino, Secondo

    2014-11-30

    While evidence continues to accumulate on the relevance of cognitive inflexibility in anorexia nervosa (AN), its clinical correlates remain unclear. We aimed at examining the relationship between set-shifting and clinical variables (i.e., eating psychopathology, depression, and personality) in AN. Ninety-four individuals affected by AN and 59 healthy controls (HC) were recruited. All participants were assessed using: Eating Disorders Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and Wisconsin Card Sorting Test (WCST). The AN group scored worse than HCs on set-shifting. According to their neuropsychological performances, AN patients were split into two groups corresponding to poor (N=30) and intact (N=64) set-shifting subtypes. Interoceptive awareness, impulse regulation, and maturity fears on the EDI-2 and depression on the BDI differed across all groups (HC, intact, and poor set-shifting subtype). Self-directedness on the TCI differed significantly among all groups. Cooperativeness and reward dependence differed instead only between HC and AN poor set-shifting subtype. After controlling for depression, only interoceptive awareness remained significant with reward dependence showing a trend towards statistical significance. These findings suggest that multiple clinical variables may be correlated with set-shifting performances in AN. The factors contributing to impaired cognitive inflexibility could be more complex than heretofore generally considered.

  20. Assessment of Japanese stimulant control law offenders using the Addiction Severity Index--Japanese version: comparison with patients in treatment settings.

    PubMed

    Watanabe, Takashi; Ogai, Yasukazu; Koga, Takehiro; Senoo, Eiichi; Nakamura, Kazuhiko; Mori, Norio; Ikeda, Kazutaka

    2009-12-01

    The present study assessed problems in Japanese prisoners (inmates) who abused methamphetamine. Fifty-two male inmates were assessed in 2005-2007 using the Addiction Severity Index-Japanese version and compared with 55 male methamphetamine abusers in hospitals and recovery centers. The chi(2) and Mann-Whitney-Wilcoxon tests showed that the inmates had a significantly lower education level, more frequently had full-time jobs, had more experience living with a sexual partner, and more frequently had a history of juvenile delinquency and criminal records than patients. Although psychiatric symptoms, such as depression, anxiety, and hallucinations, were not common among inmates, suicidal behavior and trouble controlling violence were common in both groups.

  1. Research setting versus clinic setting: Which produces better outcomes in cognitive therapy for depression?

    PubMed Central

    Gibbons, Carly R.; Stirman, Shannon Wiltsey; DeRubeis, Robert J.; Newman, Cory F.; Beck, Aaron T.

    2012-01-01

    Objective To compare the outcomes of cognitive therapy for depression under controlled and clinically representative conditions, while holding several therapist and clinical assessment factors constant. Method Treatment outcomes for a sample of 23 adults with a primary diagnosis of Major Depressive Disorder who received cognitive therapy in an outpatient clinic were compared with outcomes of 18 clients who were treated in the cognitive therapy condition of a large, multi-site randomized clinical trial of treatments for depression. All participants had been treated by one of two therapists who served as clinicians in both settings. Individuals in the two samples were diagnostically and demographically similar (approximately 50% Female, 83% White). A variety of client characteristics, assessed prior to treatment, as well as the outcomes of treatment, were examined. Results Significantly superior treatment outcomes were observed in the individuals treated in the research study, relative to clients in the outpatient clinic, and the difference was not accounted for by intake characteristics. Individuals treated by the therapists in the RCT experienced almost three times as much improvement in depressive symptoms as clients seen in the outpatient setting. Conclusions If replicated, the findings suggest that differences exist between treatment outcomes in research and outpatient settings and that these differences may not simply be due to therapist experience and training, or differences in patient populations. Future research should further examine the impact of fidelity monitoring, treatment expectation and motivation, and the duration and timing of treatment protocols on clinical outcomes. PMID:23710102

  2. A one-year longitudinal study of English and Japanese vowel production by Japanese adults and children in an English-speaking setting.

    PubMed

    Oh, Grace E; Guion-Anderson, Susan; Aoyama, Katsura; Flege, James E; Akahane-Yamada, Reiko; Yamada, Tsuneo

    2011-04-01

    The effect of age of acquisition on first- and second-language vowel production was investigated. Eight English vowels were produced by Native Japanese (NJ) adults and children as well as by age-matched Native English (NE) adults and children. Productions were recorded shortly after the NJ participants' arrival in the USA and then one year later. In agreement with previous investigations [Aoyama, et al., J. Phon. 32, 233-250 (2004)], children were able to learn more, leading to higher accuracy than adults in a year's time. Based on the spectral quality and duration comparisons, NJ adults had more accurate production at Time 1, but showed no improvement over time. The NJ children's productions, however, showed significant differences from the NE children's for English "new" vowels /ɪ/, /ε/, /ɑ/, /ʌ/ and /ʊ/ at Time 1, but produced all eight vowels in a native-like manner at Time 2. An examination of NJ speakers' productions of Japanese /i/, /a/, /u/ over time revealed significant changes for the NJ Child Group only. Japanese /i/ and /a/ showed changes in production that can be related to second language (L2) learning. The results suggest that L2 vowel production is affected importantly by age of acquisition and that there is a dynamic interaction, whereby the first and second language vowels affect each other.

  3. A one-year longitudinal study of English and Japanese vowel production by Japanese adults and children in an English-speaking setting

    PubMed Central

    Oh, Grace E.; Guion-Anderson, Susan; Aoyama, Katsura; Flege, James E.; Akahane-Yamada, Reiko; Yamada, Tsuneo

    2011-01-01

    The effect of age of acquisition on first- and second-language vowel production was investigated. Eight English vowels were produced by Native Japanese (NJ) adults and children as well as by age-matched Native English (NE) adults and children. Productions were recorded shortly after the NJ participants’ arrival in the USA and then one year later. In agreement with previous investigations [Aoyama, et al., J. Phon. 32, 233–250 (2004)], children were able to learn more, leading to higher accuracy than adults in a year’s time. Based on the spectral quality and duration comparisons, NJ adults had more accurate production at Time 1, but showed no improvement over time. The NJ children’s productions, however, showed significant differences from the NE children’s for English “new” vowels /ɪ/, /ε/, /ɑ/, /ʌ/ and /ʊ/ at Time 1, but produced all eight vowels in a native-like manner at Time 2. An examination of NJ speakers’ productions of Japanese /i/, /a/, /u/ over time revealed significant changes for the NJ Child Group only. Japanese /i/ and /a/ showed changes in production that can be related to second language (L2) learning. The results suggest that L2 vowel production is affected importantly by age of acquisition and that there is a dynamic interaction, whereby the first and second language vowels affect each other. PMID:21603058

  4. Ethics consultation and empathy : finding the balance in clinical settings.

    PubMed

    Bruns, Florian; Frewer, Andreas

    2011-12-01

    There is no doubt that emotions have an important effect on practices of moral reasoning such as clinical ethics consultation. Empathy is not only a basic human emotion but also an important and learnable skill for health care professionals. A basic amount of empathy is essential both in patient care and in clinical ethics consultation. This article debates the "adequate dose" of empathy in ethics consultations in clinical settings and tries to identify possible situations within the process of consultation in which this crucial feeling is at risk.

  5. Screening for pre-clinical disability in different residential settings.

    PubMed

    Gibson, Kate; Day, Lesley; Hill, Keith D; Jolley, Damien; Newstead, Stuart; Cicuttini, Flavia; Segal, Leonie; Flicker, Leon

    2010-08-03

    Preventing disability and offering effective interventions to older people during early decline in function is most likely to be effective if those most at risk of progressive disablement are able to be identified. Similarly the ability to easily identify a group with similar functional profile from disparate sectors of the community is of significant benefit to researchers. This study aimed to (1) describe the use of a pre-clinical disability screening tool to select a functionally comparable group of older men and women with early functional limitation from different settings, and (2) explore factors associated with function and disability. Self-reported function and disability measured with the Late-Life Function and Disability Instrument along with a range of physical performance measurements were compared across residential settings and gender in a sample of 471 trial participants identified as pre-clinically disabled after being screened with the Fried pre-clinical disability tool. Factors that might lie on the pathway to progressive disablement were identified using multiple linear regression analysis. We found that a sample population, screened for pre-clinical disability, had a functional status and disability profile reflecting early functional limitation, regardless of residential setting or gender. Statistical models identified a range of factors associated with function and disability which explained a greater degree of the variation in function, than disability. We selected a group of people with a comparable function and disability profile, consistent with the pre-clinical stage of disability, from a sample of older Australian men and women from different residential settings using the Fried pre-clinical disability screening tool. The results suggest that the screening tool can be used with greater confidence for research, clinical and population health purposes. Further research is required to examine the validity of the tool. These findings offer

  6. Clinical presentation and outcome of avoidant/restrictive food intake disorder in a Japanese sample.

    PubMed

    Nakai, Yoshikatsu; Nin, Kazuko; Noma, Shun'ichi; Hamagaki, Seiji; Takagi, Ryuro; Teramukai, Satoshi; Wonderlich, Stephen A

    2017-01-01

    We conducted a study of the clinical presentation and outcome in patients with avoidant/restrictive food intake disorder (ARFID), aged 15-40years, and compared this group to an anorexia nervosa (AN) group in a Japanese sample. A retrospective chart review was completed on 245 patients with feeding and eating disorders (FEDs), analyzing prevalence, clinical presentation, psychopathological properties, and outcomes. Using the DSM-5 criteria, 27 (11.0%) out of the 245 patients with a FED met the criteria for ARFID at entry. All patients with ARFID were women. In terms of eating disorder symptoms, all patients with ARFID had restrictive eating related to emotional problems and/or gastrointestinal symptoms. However, none of the ARFID patients reported food avoidance related to sensory characteristics or functional dysphagia. Additionally, none of them exhibited binge eating or purging behaviors, and none of them reported excessive exercise. The ARFID group had a significantly shorter duration of illness, lower rates of admission history, and less severe psychopathology than the AN group. The ARFID group reported significantly better outcome results than the AN group. These results suggest that patients with ARFID in this study were clinically distinct from those with AN and somewhat different from pediatric patients with ARFID in previous studies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Significance of Kampo, Japanese Traditional Medicine, in the Treatment of Obesity: Basic and Clinical Evidence

    PubMed Central

    Yamakawa, Jun-ichi; Moriya, Junji; Takeuchi, Kenji; Nakatou, Mio; Motoo, Yoshiharu; Kobayashi, Junji

    2013-01-01

    The cause of obesity includes genetic and environmental factors, including cytokines derived from adipocytes (adipo-cytokines). Although drug therapy is available for obesity, it is highly risky. Our main focus in this review is on the traditional form of Japanese medicine, Kampo, in the treated of obesity. Two Kampo formulas, that is, bofutsushosan (防風通聖散) and boiogito (防己黄耆湯), are covered by the national health insurance in Japan for the treatment of obesity. Various issues related to their action mechanisms remain unsolved. Considering these, we described the results of basic experiments and presented clinical evidence and case reports on osteoarthritis as examples of clinical application of their two Kampo medicine. Traditional medicine is used not only for treatment but also for prevention. In clinical practice, it is of great importance to prove the efficacy of combinations of traditional medicine and Western medicine and the utility of traditional medicine in the attenuation of adverse effects of Western medicine. PMID:23662155

  8. Doctoral Clinical Geropsychology Training in a Primary Care Setting

    ERIC Educational Resources Information Center

    Zweig, Richard A.; Siegel, Lawrence; Hahn, Steven; Kuslansky, Gail; Byrne, Kathy; Fyffe, Denise; Passman, Vicki; Stewart, Douglas; Hinrichsen, Gregory

    2005-01-01

    Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica,…

  9. Collaborative learning in gerontological clinical settings: The students' perspective.

    PubMed

    Suikkala, Arja; Kivelä, Eeva; Käyhkö, Pirjo

    2016-03-01

    This study deals with student nurses' experiences of collaborative learning in gerontological clinical settings where aged people are involved as age-experts in students' learning processes. The data were collected in 2012 using the contents of students' reflective writing assignments concerning elderly persons' life history interviews and the students' own assessments of their learning experiences in authentic elder care settings. The results, analyzed using qualitative content analysis, revealed mostly positive learning experiences. Interaction and collaborative learning activities in genuine gerontological clinical settings contributed to the students' understanding of the multiple age-related and disease-specific challenges as well as the issues of functional decline that aged patients face. Three types of factors influenced the students' collaborative learning experiences in gerontological clinical settings: student-related, patient-related and learning environment-related factors. According to the results, theoretical studies in combination with collaboration, in an authentic clinical environment, by student nurses, elderly patients, representatives of the elder care staff and nurse educators provide a feasible method for helping students transform their experiences with patients into actual skills. Their awareness of and sensitivity to the needs of the elderly increase as they learn.

  10. Effectiveness of Child Psychoanalytic Psychotherapy in a Clinical Outpatient Setting

    ERIC Educational Resources Information Center

    Deakin, Elisabeth Kuhn; Tiellet Nunes, Maria Lucia

    2009-01-01

    The objective of this study was to evaluate the outcome of child psychoanalytic psychotherapy in a clinical outpatient setting in a city in southern Brazil. Three psychological tests (Rorschach, Bender and WISC III) were administered to 23 children, aged 6-11 years old, and the Child Behaviour Check List (CBCL) was completed by the parents. All…

  11. An Introductory Clinical Course--Orientation to Patient Care Settings.

    ERIC Educational Resources Information Center

    Bober, Kenneth F.; And Others

    1982-01-01

    A second-year clinical course composed of weekly observation sessions of interactions between patients and health care professionals in a variety of health care settings within a hospital is described. Weekly discussion sessions summarize the observations and introduce such topics as communication skills, patients' rights, patient relationships,…

  12. Doctoral Clinical Geropsychology Training in a Primary Care Setting

    ERIC Educational Resources Information Center

    Zweig, Richard A.; Siegel, Lawrence; Hahn, Steven; Kuslansky, Gail; Byrne, Kathy; Fyffe, Denise; Passman, Vicki; Stewart, Douglas; Hinrichsen, Gregory

    2005-01-01

    Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica,…

  13. Effectiveness of Child Psychoanalytic Psychotherapy in a Clinical Outpatient Setting

    ERIC Educational Resources Information Center

    Deakin, Elisabeth Kuhn; Tiellet Nunes, Maria Lucia

    2009-01-01

    The objective of this study was to evaluate the outcome of child psychoanalytic psychotherapy in a clinical outpatient setting in a city in southern Brazil. Three psychological tests (Rorschach, Bender and WISC III) were administered to 23 children, aged 6-11 years old, and the Child Behaviour Check List (CBCL) was completed by the parents. All…

  14. Caring in nursing education: reducing anxiety in the clinical setting.

    PubMed

    Audet, M C

    1995-01-01

    It has been well-documented that the clinical experience is one of the most anxiety-producing aspects of nursing education. When feelings of anxiety become severe, they present a clear threat to the student's success in the program. This article explores the role of "caring" in nursing education as a means of reducing student anxiety. Caring, described at length by Jean Watson, has become one of the most popular trends in the education of young nurses. When caring behaviors are demonstrated in a meaningful way by clinical instructors, the student may experience a sense of comfort and belonging, which may in turn be effective in reducing anxiety and enabling the student to successfully complete a clinical rotation. The aim of this article is to inspire nurses, not only those in the educational setting but in all settings and at all levels of their careers, to reconsider the effects and benefits of displaying a caring attitude.

  15. Clinical utility of erlotinib for the treatment of non-small-cell lung cancer in Japanese patients: current evidence

    PubMed Central

    Togashi, Yosuke; Hayashi, Hidetoshi; Nakagawa, Kazuhiko; Nishio, Kazuto

    2014-01-01

    Gefitinib, an epidermal growth factor tyrosine kinase inhibitor (EGFR-TKI), has been approved in Japan for the treatment of patients with advanced non-small-cell lung cancer (NSCLC) based on Phase II clinical trials since 2002. Erlotinib, another EGFR-TKI, was also approved a few years thereafter. In 2004, activating mutations in the EGFR gene were discovered to be a predictive biomarker for EGFR-TKI treatment, and gefitinib, which is not effective for patients with EGFR wild-type NSCLC, has since been used only in patients with EGFR-mutated NSCLC. In contrast, erlotinib is potentially effective for the treatment of EGFR wild-type NSCLC. Similar to gefitinib, erlotinib is also effective for EGFR-mutated NSCLC and has been used as an initial treatment for patients with advanced EGFR-mutated NSCLC. Both gefitinib and erlotinib can be used in a Japanese clinical setting. The approved daily dose of erlotinib (150 mg) is equal to the maximum tolerated dose of erlotinib. In contrast, the daily dose of gefitinib has been set at 250 mg, which is approximately one-third of the maximum tolerated dose of gefitinib. Accordingly, a higher serum concentration can be achieved using erlotinib, compared with gefitinib. This advantage can be applied to the treatment of central nervous system metastases (brain metastasis and carcinomatous meningitis), the treatment of which is complicated by the difficulty drugs have penetrating the blood–brain barrier. Although patients with EGFR-mutated NSCLC respond dramatically to EGFR-TKIs, some patients have a poor response and the majority eventually undergo disease progression. To overcome such resistance, several novel treatment strategies, such as combination therapy and next-generation EGFR-TKIs, have been attempted. PMID:25114510

  16. Opinions on Kampo and reasons for using it – results from a cross-sectional survey in three Japanese clinics

    PubMed Central

    2013-01-01

    Background Traditional Japanese Medicine (Kampo) is often used in Japan, but very little data on its users are available. We investigated who uses Kampo, the reasons and opinions for its use. Methods Questionnaire survey in three Japanese outpatient clinics offering Kampo in different settings: Kampo only, Kampo and traditional Chinese medicine, Kampo and Western medicine. Before seeing the doctor, patients were asked about socio-demographic data, medical history, experience with Kampo, general health-related opinions and behaviours, opinions about Western medicine and Kampo, and reasons for Kampo utilization. Descriptive statistics and predictors for Kampo use were calculated. Results A total of 354 questionnaires were completed. Participants were 50.97 ± 15.60 (mean ± SD) years of age, 68% were female. Of all patients, 73% (n = 202) were using Kampo currently and 84% (297) had taken Kampo before. Questions on general health-related opinions and behaviour revealed a strong environmental awareness. The most frequent indications for earlier Kampo use were: common cold (36%), gastrointestinal complaints (30%), oversensitivity to cold (“Hi’e-sho”; 29%), stress/anxiety (21%), and shoulder stiffness (20%). Kampo users suffered more often from chronic illnesses (OR 2.88 [1.48-5.58]). Beliefs in underlying philosophy (Wu Xing (adjusted OR 3.08, [1.11-8.55]), Ying and Yang (OR 2.57 [1.15-5.73], a holistic way of seeing the patient (OR 2.17 [1.53-3.08]), and in Kampo efficacy (OR 2.62 [1.66-4.13]) were positively associated with Kampo use. So was, interestingly, conviction of the efficacy of Western medicine (OR 1.87 [1.28-2.74]). Half of the patients had a general preference for a combination of Kampo and Western treatment. Conclusions Most patients visiting a clinic that also provided Kampo had previous experience with Kampo. Usage was associated with beliefs in philosophical Kampo concepts and its efficacy. PMID:23680097

  17. Nationwide surveillance of bacterial respiratory pathogens conducted by the surveillance committee of Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology in 2010: General view of the pathogens' antibacterial susceptibility.

    PubMed

    Yanagihara, Katsunori; Kadota, Junichi; Aoki, Nobuki; Matsumoto, Tetsuya; Yoshida, Masaki; Yagisawa, Morimasa; Oguri, Toyoko; Sato, Junko; Ogasawara, Kazuhiko; Wakamura, Tomotaro; Sunakawa, Keisuke; Watanabe, Akira; Iwata, Satoshi; Kaku, Mitsuo; Hanaki, Hideaki; Ohsaki, Yoshinobu; Watari, Tomohisa; Toyoshima, Eri; Takeuchi, Kenichi; Shiokoshi, Mayumi; Takeda, Hiroaki; Miki, Makoto; Kumagai, Toshio; Nakanowatari, Susumu; Takahashi, Hiroshi; Utagawa, Mutsuko; Nishiya, Hajime; Kawakami, Sayoko; Kobayashi, Nobuyuki; Takasaki, Jin; Mezaki, Kazuhisa; Konosaki, Hisami; Aoki, Yasuko; Yamamoto, Yumiko; Shoji, Michi; Goto, Hajime; Saraya, Takeshi; Kurai, Daisuke; Okazaki, Mitsuhiro; Niki, Yoshihito; Yoshida, Koichiro; Kawana, Akihiko; Saionji, Katsu; Fujikura, Yuji; Miyazawa, Naoki; Kudo, Makoto; Sato, Yoshimi; Yamamoto, Masaki; Yoshida, Takashi; Nakamura, Masahiko; Tsukada, Hiroki; Imai, Yumiko; Tsukada, Ayami; Kawasaki, Satoshi; Honma, Yasuo; Yamamoto, Toshinobu; Ban, Nobuyoshi; Mikamo, Hiroshige; Sawamura, Haruki; Miyara, Takayuki; Toda, Hirofumi; Sato, Kaori; Nakamura, Tadahiro; Fujikawa, Yasunori; Mitsuno, Noriko; Mikasa, Keiichi; Kasahara, Kei; Sano, Reiko; Sugimoto, Keisuke; Asari, Seishi; Nishi, Isao; Toyokawa, Masahiro; Miyashita, Naoyuki; Koguchi, Yutaka; Kusano, Nobuchika; Mihara, Eiichirou; Kuwabara, Masao; Watanabe, Yaeko; Kawasaki, Yuji; Takeda, Kenichi; Tokuyasu, Hirokazu; Masui, Kayoko; Negayama, Kiyoshi; Hiramatsu, Kazufumi; Aoki, Yosuke; Fukuoka, Mami; Magarifuchi, Hiroki; Nagasawa, Zenzo; Suga, Moritaka; Muranaka, Hiroyuki; Morinaga, Yoshitomo; Honda, Junichi; Fujita, Masaki

    2015-06-01

    The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from patients in Japan, was conducted by Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases and Japanese Society for Clinical Microbiology in 2010. The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period from January and April 2010 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical and Laboratory Standard Institutes using maximum 45 antibacterial agents. Susceptibility testing was evaluable with 954 strains (206 Staphylococcus aureus, 189 Streptococcus pneumoniae, 4 Streptococcus pyogenes, 182 Haemophilus influenzae, 74 Moraxella catarrhalis, 139 Klebsiella pneumoniae and 160 Pseudomonas aeruginosa). Ratio of methicillin-resistant S. aureus was as high as 50.5%, and those of penicillin-intermediate and -resistant S. pneumoniae were 1.1% and 0.0%, respectively. Among H. influenzae, 17.6% of them were found to be β-lactamase-non-producing ampicillin (ABPC)-intermediately resistant, 33.5% to be β-lactamase-non-producing ABPC-resistant and 11.0% to be β-lactamase-producing ABPC-resistant strains. Extended spectrum β-lactamase-producing K. pneumoniae and multi-drug resistant P. aeruginosa with metallo β-lactamase were 2.9% and 0.6%, respectively. Continuous national surveillance of antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis.

  18. Comprehensive analysis of clinical development and regulatory submission promotion schemes for oncologic drugs as the Japanese national projects.

    PubMed

    Nagai, Sumimasa; Ozawa, Keiya

    2016-12-01

    To reduce the delay in marketing authorization of drugs in Japan, four Japanese national projects were instituted. We examined all oncologic drugs for adult patients approved or discussed through these schemes, for the first time. All the data are publicly available. In total, 197 applications/demands (181 indications and 16 dosages/uses) were collected. As of December 31, 2015, 64 indications and 10 dosages/uses were approved as off-label drugs through these schemes without conducting additional registration trials in Japan. Furthermore, 46 indications and two dosages/uses were approved after registration trials in Japan requested by the national scheme councils. Regarding the following 23 indications of the 197 applications/demands, registration trials in Japan were commenced after the national scheme council's request: 17 hematological malignancies and six orphan solid tumors. Moreover, 54 indications and three dosages/uses, for which demands were submitted, were regarded as not a high medical priority by the national scheme council. Regarding two hematological malignancy indications, the dosage approved in foreign countries was intolerable for the Japanese patients in Japanese registration trials and this stopped the clinical development in Japan. Our analysis showed that 110 indications and 12 dosages/uses were approved in Japan through these schemes. These national projects have provided numerous therapeutic options for Japanese patients and may be meaningful for promoting clinical development and regulatory approval especially in orphan diseases in countries other than Japan.

  19. Prognostic stratification of patients with vasospastic angina: a comprehensive clinical risk score developed by the Japanese Coronary Spasm Association.

    PubMed

    Takagi, Yusuke; Takahashi, Jun; Yasuda, Satoshi; Miyata, Satoshi; Tsunoda, Ryusuke; Ogata, Yasuhiro; Seki, Atsushi; Sumiyoshi, Tetsuya; Matsui, Motoyuki; Goto, Toshikazu; Tanabe, Yasuhiko; Sueda, Shozo; Sato, Toshiaki; Ogawa, Satoshi; Kubo, Norifumi; Momomura, Shin-Ichi; Ogawa, Hisao; Shimokawa, Hiroaki

    2013-09-24

    The present study aimed to develop a comprehensive clinical risk score for vasospastic angina (VSA) patients. Previous studies demonstrated various prognostic factors of future adverse events in VSA patients. However, to apply these prognostic factors in clinical practice, the assessment of their accumulation in individual patients is important. The patient database of the multicenter registry study by the Japanese Coronary Spasm Association (JCSA) (n = 1,429; median 66 years; median follow-up 32 months) was utilized for score derivation. Multivariable Cox proportional hazard model selected 7 predictors of major adverse cardiac events (MACE). The integer score was assigned to each predictors proportional to their respective adjusted hazard ratio; history of out-of-hospital cardiac arrest (4 points), smoking, angina at rest alone, organic coronary stenosis, multivessel spasm (2 points each), ST-segment elevation during angina, and beta-blocker use (1 point each). According to the total score in individual patients, 3 risk strata were defined; low (score 0 to 2, n = 598), intermediate (score 3 to 5, n = 639) and high (score 6 or more, n = 192). The incidences of MACE in the low-, intermediate-, and high-risk patients were 2.5%, 7.0%, and 13.0%, respectively (p < 0.001). The Cox model for MACE between the 3 risk strata also showed prognostic utility of the scoring system in various clinical subgroups. The average prediction rate of the scoring system in the internal training and validation sets were 86.6% and 86.5%, respectively. We developed a novel scoring system, the JCSA risk score, which may provide the comprehensive risk assessment and prognostic stratification for VSA patients. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. [Proposal for improving EQA programs in clinical microbiology by the Japanese Association of Medical Technologists].

    PubMed

    Inuzuka, Kazuhisa

    2005-04-01

    External quality assessment (EQA) programs have been conducted by the Japanese Association of Medical Technologists (JAMT) since 1989. The nationwide EQA programs have provided feedback for improving clinical tests quality in individual laboratories. The participating laboratories have been expected to process the survey samples according to their usual practice for patient specimens. However, many problems relating to the EQA programs in clinical microbiology have been raised. Dishonesty in the responses, survey samples being handled in a manner that improves assessment results, surveys depending on volunteers because of time and cost limitations were some of the initial problems. In addition, the criteria used to evaluate the results were poorly understood, so that neither examiners not participants were clear as to how the evaluation worked. And finally, the nationwide EQA programs can detect only gross errors and use invalid methods for evaluating routine performances. They have been measuring only a few steps in specimens processing. To assess overall laboratory competence, other methods are needed. It is time to reform the JAMT nationwide EQA program to initiate real proficiency testing and to this end it is necessary to increase collaboration between JAMT and the regional associations of medical technologists, so that the improved testing program can be properly administered.

  1. Bortezomib therapy-related lung disease in Japanese patients with multiple myeloma: incidence, mortality and clinical characterization.

    PubMed

    Yoshizawa, Kazutake; Mukai, Harumi Y; Miyazawa, Michiko; Miyao, Makiko; Ogawa, Yoshimasa; Ohyashiki, Kazuma; Katoh, Takao; Kusumoto, Masahiko; Gemma, Akihiko; Sakai, Fumikazu; Sugiyama, Yukihiko; Hatake, Kiyohiko; Fukuda, Yuh; Kudoh, Shoji

    2014-02-01

    Because of the potentially high mortality rate (6.5%) associated with bortezomib-induced lung disease (BILD) in Japanese patients with relapsed or refractory multiple myeloma, we evaluated the incidence, mortality and clinical features of BILD in a Japanese population. This study was conducted under the Risk Minimization Action Plan (RMAP), which was collaboratively developed by the pharmaceutical industry and public health authority. The RMAP consisted of an intensive dissemination of risk information and a recommended countermeasure to health-care professionals. All patients treated with bortezomib were consecutively registered in the study within 1 year and monitored for emerging BILD. Of the 1010 patients registered, 45 (4.5%) developed BILD, 5 (0.50%) of whom had fatal cases. The median time to BILD onset from the first bortezomib dose was 14.5 days, and most of the patients responded well to corticosteroid therapy. A retrospective review by the Lung Injury Medical Expert Panel revealed that the types with capillary leak syndrome and hypoxia without infiltrative shadows were uniquely and frequently observed in patients with BILD compared with those with conditions associated with other molecular-targeted anticancer drugs. The incidence rate of BILD in Japan remains high compared with that reported in other countries, but the incidence and mortality rates are lower than expected before the introduction of bortezomib in Japan. This study describes the radiographic pattern and clinical characterization of BILD in the Japanese population. The RMAP seemed clinically effective in minimizing the BILD risk among our Japanese population. © 2013 Janssen Pharmaceutical K.K. Cancer Science published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Cancer Association.

  2. Temple syndrome: comprehensive molecular and clinical findings in 32 Japanese patients.

    PubMed

    Kagami, Masayo; Nagasaki, Keisuke; Kosaki, Rika; Horikawa, Reiko; Naiki, Yasuhiro; Saitoh, Shinji; Tajima, Toshihiro; Yorifuji, Tohru; Numakura, Chikahiko; Mizuno, Seiji; Nakamura, Akie; Matsubara, Keiko; Fukami, Maki; Ogata, Tsutomu

    2017-06-22

    PurposeTemple syndrome (TS14) is a rare imprinting disorder caused by aberrations at the 14q32.2 imprinted region. Here, we report comprehensive molecular and clinical findings in 32 Japanese patients with TS14.MethodsWe performed molecular studies for TS14 in 356 patients with variable phenotypes, and clinical studies in all TS14 patients, including 13 previously reported.ResultsWe identified 19 new patients with TS14, and the total of 32 patients was made up of 23 patients with maternal uniparental disomy (UPD(14)mat), six patients with epimutations, and three patients with microdeletions. Clinical studies revealed both Prader-Willi syndrome (PWS)-like marked hypotonia and Silver-Russell syndrome (SRS)-like phenotype in 50% of patients, PWS-like hypotonia alone in 20% of patients, SRS-like phenotype alone in 20% of patients, and nonsyndromic growth failure in the remaining 10% of patients in infancy, and gonadotropin-dependent precocious puberty in 76% of patients who were pubescent or older.ConclusionThese results suggest that TS14 is not only a genetically diagnosed entity but also a clinically recognizable disorder. Genetic testing for TS14 should be considered in patients with growth failure plus both PWS-like hypotonia and SRS-like phenotypes in infancy, and/or precocious puberty, as well as a familial history of Kagami-Ogata syndrome due to maternal microdeletion at 14q32.2.Genetics in Medicine advance online publication, 22 June 2017; doi:10.1038/gim.2017.53.

  3. Challenges Associated With Using Large Data Sets for Quality Assessment and Research in Clinical Settings

    PubMed Central

    Cohen, Bevin; Vawdrey, David K.; Liu, Jianfang; Caplan, David; Furuya, E. Yoko; Mis, Frederick W.; Larson, Elaine

    2015-01-01

    The rapidly expanding use of electronic records in health-care settings is generating unprecedented quantities of data available for clinical, epidemiological, and cost-effectiveness research. Several challenges are associated with using these data for clinical research, including issues surrounding access and information security, poor data quality, inconsistency of data within and across institutions, and a paucity of staff with expertise to manage and manipulate large clinical data sets. In this article, we describe our experience with assembling a data-mart and conducting clinical research using electronic data from four facilities within a single hospital network in New York City. We culled data from several electronic sources, including the institution’s admission-discharge-transfer system, cost accounting system, electronic health record, clinical data warehouse, and departmental records. The final data-mart contained information for more than 760,000 discharges occurring from 2006 through 2012. Using categories identified by the National Institutes of Health Big Data to Knowledge initiative as a framework, we outlined challenges encountered during the development and use of a domain-specific data-mart and recommend approaches to overcome these challenges. PMID:26351216

  4. Challenges Associated With Using Large Data Sets for Quality Assessment and Research in Clinical Settings.

    PubMed

    Cohen, Bevin; Vawdrey, David K; Liu, Jianfang; Caplan, David; Furuya, E Yoko; Mis, Frederick W; Larson, Elaine

    2015-08-01

    The rapidly expanding use of electronic records in health-care settings is generating unprecedented quantities of data available for clinical, epidemiological, and cost-effectiveness research. Several challenges are associated with using these data for clinical research, including issues surrounding access and information security, poor data quality, inconsistency of data within and across institutions, and a paucity of staff with expertise to manage and manipulate large clinical data sets. In this article, we describe our experience with assembling a data-mart and conducting clinical research using electronic data from four facilities within a single hospital network in New York City. We culled data from several electronic sources, including the institution's admission-discharge-transfer system, cost accounting system, electronic health record, clinical data warehouse, and departmental records. The final data-mart contained information for more than 760,000 discharges occurring from 2006 through 2012. Using categories identified by the National Institutes of Health Big Data to Knowledge initiative as a framework, we outlined challenges encountered during the development and use of a domain-specific data-mart and recommend approaches to overcome these challenges.

  5. Towards a national clinical minimum data set for general surgery.

    PubMed

    Prytherch, D R; Sirl, J S; Weaver, P C; Schmidt, P; Higgins, B; Sutton, G L

    2003-10-01

    Measurement and comparison of surgical performance is accepted as necessary and inevitable. Risk-stratified (case-mix adjusted) models of clinical outcomes form a metric with which to assess performance, but require accurate data. Collecting such data in the clinical environment is time consuming and difficult. This study aimed to construct effective models, for operative and non-operative admissions, from routine clinical data residing in hospital computers, so minimizing data collection and quality problems, and facilitating national implementation. Data for 3181 non-operative emergency, 5039 elective and 3043 emergency operative admissions for the 2 years beginning 1 August 1997 were used to generate logistic regression equations for risk of death, which were applied prospectively to the following 3 years' data. The models use urea, haemoglobin, white blood cell count, sodium, potassium, age on admission, sex, British United Provident Association (BUPA) Operative Severity Score (for operative admissions) and, implicitly, mode of admission and mortality at discharge. All three models successfully stratified risk into five or more bands. Effective models of mortality, applicable to all general surgical admissions, can be constructed from existing routine clinical data, largely obtained from a single venesection. The data set is a candidate national clinical minimum data set. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  6. Comparative genetic characterization of Enteroaggregative Escherichia coli strains recovered from clinical and non-clinical settings

    PubMed Central

    Zhang, Rong; Gu, Dan-xia; Huang, Yong-lu; Chan, Edward Wai-Chi; Chen, Gong-Xiang; Chen, Sheng

    2016-01-01

    The origin of pathogenic Enteroaggregative Escherichia coli (EAEC), a major causative agent of childhood diarrhea worldwide, remains ill-defined. The objective of this study was to determine the relative prevalence of EAEC in clinical and non-clinical sources and compare their genetic characteristics in order to identify strains that rarely and commonly cause human diarrhea. The virulence gene astA was commonly detectable in both clinical and non-clinical EAEC, while clinical isolates, but not the non-clinical strains, were consistently found to harbor other virulence factors such as aap (32%), aatA (18%) and aggR (11%). MLST analysis revealed the extremely high diversity of EAEC ST types, which can be grouped into three categories including: (i) non-clinical EAEC that rarely cause human infections; (ii) virulent strains recoverable in diarrhea patients that are also commonly found in the non-clinical sources; (iii) organisms causing human infections but rarely recoverable in the non-clinical setting. In addition, the high resistance in these EAEC isolates in particular resistance to fluoroquinolones and cephalosporins raised a huge concern for clinical EAEC infection control. The data from this study suggests that EAEC strains were diversely distributed in non-clinical and clinical setting and some of the clinical isolates may originate from the non-clinical setting. PMID:27062991

  7. Clinical characteristics of patients with gender identity disorder at a Japanese gender identity disorder clinic.

    PubMed

    Okabe, Nobuyuki; Sato, Toshiki; Matsumoto, Yosuke; Ido, Yumiko; Terada, Seishi; Kuroda, Shigetoshi

    2008-01-15

    The aim of this study was to examine the clinical characteristics of patients with gender identity disorder (GID) at a GID clinic in Japan. A total of 603 consecutive patients were evaluated at the GID clinic using clinical information and results of physical and neurological examinations. Using DSM-IV criteria, 579 patients (96.0%) were diagnosed with GID. Four patients were excluded for transvestic fetishism, eight for homosexuality, five for schizophrenia, three for personality disorders, and four for other psychiatric disorders. Among the GID patients, 349 (60.3%) were the female-to-male (FTM) type, and 230 (39.7%) were the male-to-female (MTF) type. Almost all FTM-type GID patients started to feel discomfort with their sex before puberty and were sexually attracted to females. The proportion of FTM patients who had experienced marriage as a female was very low, and very few had children. Therefore, FTM-type GID patients seem to be highly homogeneous. On the other hand, various patterns of age at onset and sexual attraction existed among MTF patients. Among the MTF-type GID patients, 28.3% had married as males and 18.7% had sired children. Thus, MTF-type GID patients seem to be more heterogeneous.

  8. Improving Laboratory and Clinical Hematology Services in Resource Limited Settings.

    PubMed

    Allen, Angela; Allen, Stephen; Olivieri, Nancy

    2016-04-01

    The difficulties in establishing and delivering reliable clinical hematology and laboratory services in resource-limited settings are well recognized. However, much can be achieved by better use of existing resources through a concerted quality improvement approach. The recommendations of this article are based in part upon work in the thalassemias, inherited disorders of hemoglobin that are widely prevalent in Asia, which may serve as a model that is applicable to other common, chronic disorders in resource-poor settings. Available resources are highlighted and recommendations made regarding approaches to improving services. Over the last few years, a number of low and middle-income countries, obtaining support from appropriate governmental sources, have identified and overcome difficulties and significantly improved clinical services for patients with thalassemia.

  9. Estimating the re-identification risk of clinical data sets

    PubMed Central

    2012-01-01

    Background De-identification is a common way to protect patient privacy when disclosing clinical data for secondary purposes, such as research. One type of attack that de-identification protects against is linking the disclosed patient data with public and semi-public registries. Uniqueness is a commonly used measure of re-identification risk under this attack. If uniqueness can be measured accurately then the risk from this kind of attack can be managed. In practice, it is often not possible to measure uniqueness directly, therefore it must be estimated. Methods We evaluated the accuracy of uniqueness estimators on clinically relevant data sets. Four candidate estimators were identified because they were evaluated in the past and found to have good accuracy or because they were new and not evaluated comparatively before: the Zayatz estimator, slide negative binomial estimator, Pitman’s estimator, and mu-argus. A Monte Carlo simulation was performed to evaluate the uniqueness estimators on six clinically relevant data sets. We varied the sampling fraction and the uniqueness in the population (the value being estimated). The median relative error and inter-quartile range of the uniqueness estimates was measured across 1000 runs. Results There was no single estimator that performed well across all of the conditions. We developed a decision rule which selected between the Pitman, slide negative binomial and Zayatz estimators depending on the sampling fraction and the difference between estimates. This decision rule had the best consistent median relative error across multiple conditions and data sets. Conclusion This study identified an accurate decision rule that can be used by health privacy researchers and disclosure control professionals to estimate uniqueness in clinical data sets. The decision rule provides a reliable way to measure re-identification risk. PMID:22776564

  10. Developing core outcome sets for clinical trials: issues to consider.

    PubMed

    Williamson, Paula R; Altman, Douglas G; Blazeby, Jane M; Clarke, Mike; Devane, Declan; Gargon, Elizabeth; Tugwell, Peter

    2012-08-06

    The selection of appropriate outcomes or domains is crucial when designing clinical trials in order to compare directly the effects of different interventions in ways that minimize bias. If the findings are to influence policy and practice then the chosen outcomes need to be relevant and important to key stakeholders including patients and the public, health care professionals and others making decisions about health care. There is a growing recognition that insufficient attention has been paid to the outcomes measured in clinical trials. These issues could be addressed through the development and use of an agreed standardized collection of outcomes, known as a core outcome set, which should be measured and reported, as a minimum, in all trials for a specific clinical area. Accumulating work in this area has identified the need for general guidance on the development of core outcome sets. Key issues to consider in the development of a core outcome set include its scope, the stakeholder groups to involve, choice of consensus method and the achievement of a consensus.

  11. Manual linear movements to assess spasticity in a clinical setting.

    PubMed

    Marinelli, Lucio; Trompetto, Carlo; Mori, Laura; Vigo, Gabriele; Traverso, Elisabetta; Colombano, Federica; Abbruzzese, Giovanni

    2013-01-01

    In a clinical setting, where motor-driven systems are not readily available, the major difficulty in the assessment of the stretch reflex lies in the control of passive limb displacement velocity. A potential approach to this problem arises from the use of manual sinusoidal movements (made by continuous alternating flexions and extensions) paced by an external stimulus. Unfortunately, there are conditions in which sinusoidal movements induce interfering phenomena such as the shortening reaction or postactivation depression. In the present paper, a novel manual method to control the velocity of passive linear movements is described and the results obtained from both healthy subjects and spastic patients are reported. This method is based on the synchronisation of movements with tones played by a metronome at different speeds. In a first set of experiments performed in healthy subjects, we demonstrated consistent control of velocity during passive limb movements using this method. Four joints usually examined during muscle tone assessment were tested: wrist, elbow, knee and ankle joints. Following this, we conducted a longitudinal assessment of the stretch reflex amplitude in wrist flexor muscles in patients with spasticity treated with botulinum toxin type A. The evaluators were not only able to vary the movement velocity based on the metronome speed, but also could reproduce the respective speeds two weeks later, despite the changing degree of hypertonia. This method is easy to perform in a clinical setting and hardware requirements are minimal, making it an attractive and robust procedure for the widespread clinical assessment of reflex hypertonia.

  12. Experience with alendronate treatment for 7 years among Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures.

    PubMed

    Iwamoto, Jun; Uzawa, Mitsuyoshi

    2016-01-01

    A retrospective study was performed to evaluate the outcome of alendronate treatment for 7 years among Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures. Thirty-five Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures (mean age at baseline 58.2 years) who had been treated with alendronate for over 7 years in our outpatient clinic were analyzed. The lumbar spine or total hip bone mineral density (BMD) was measured using dual energy X-ray absorptiometry; the urinary levels of cross-linked N-terminal telopeptides of type I collagen (NTX) and the serum levels of alkaline phosphatase (ALP) were monitored; the incidence of fractures during the 7-year treatment period was then assessed. The urinary NTX and serum ALP levels decreased (-46.1% at 3 months and -21.1% at 7 years, respectively) and the lumbar spine and total hip BMD increased (+14.2 and +10.1% at 7 years, respectively), compared with the baseline values. Four patients (11.4%) experienced vertebral fractures, and one patient (2.9%) experienced a nonvertebral fracture. No serious adverse events were observed, including osteonecrosis of the jaw or atypical femoral fractures. These results suggested that alendronate suppressed bone turnover and increased the lumbar spine and total hip BMD from the baseline values over the course of the 7-year treatment period without causing any severe adverse events in Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures.

  13. Order sets utilization in a clinical order entry system.

    PubMed

    Cowden, Daniel; Barbacioru, Catalin; Kahwash, Eiad; Saltz, Joel

    2003-01-01

    An order set is a predefined template that has been utilized in the standard care of hospitals for many years. While in the past, it took the form of pen and paper, today, it is, indeed, electronic. Within order sets are distinct ordering patterns that may yield fruitful results for clinicians and informaticians, alike. Protocols like there electronic counterpart, order sets, provide an 'indication' identifying the clinical scenario of the patient's condition when the ordering event occurred. This 'indication' is rarely captured by individual orders, and provides difficult challenges to developers of information systems. While mandating an 'indication' be entered for every medication or lab order makes the job much more tasking on the physician provider, it is appealing to researchers and accountants. We have attempted to bypasses that consideration by identifying ordering patterns that predict diagnostic related codes (DRGs) and diagnostic codes which would greatly facilitate the information gathering process and still provide a flexible and user friendly physician interface.

  14. Bridge to the future: nontraditional clinical settings, concepts and issues.

    PubMed

    Faller, H S; Dowell, M A; Jackson, M A

    1995-11-01

    Healthcare restructuring in the wake of healthcare reform places greater emphasis on primary healthcare. Clinical education in acute care settings and existing community health agencies are not compatible with teaching basic concepts, principles and skills fundamental to nursing. Problems of clients in acute care settings are too complex and clients in the community are often too dispersed for necessary faculty support and supervision of beginning nursing students. Nontraditional learning settings offer the baccalaureate student the opportunity to practice fundamental skills of care and address professional skills of negotiation, assertiveness, organization, collaboration and leadership. An overview of faculty designed clinical learning experiences in nontraditional sites such as McDonald's restaurants, inner city churches, YWCA's, the campus community and homes are presented. The legal, ethical and academic issues associated with nontraditional learning settings are discussed in relation to individual empowerment, decision making and evaluation. Implications for the future address the role of the students and faculty as they interact with the community in which they live and practice.

  15. Etiological Spectrum of Clinically Diagnosed Japanese Encephalitis Cases Reported in Guizhou Province, China, in 2006 ▿

    PubMed Central

    Xufang, Ye; Huanyu, Wang; Shihong, Fu; Xiaoyan, Gao; Shuye, Zhao; Chunting, Liu; Minghua, Li; Yougang, Zhai; Guodong, Liang

    2010-01-01

    The proportion of laboratory-confirmed Japanese encephalitis (JE) virus (JEV) infections was compared to the number of JE cases reported on the basis of seasonality and the clinical symptoms of hospitalized patients in Guizhou Province, China, between April and November 2006. Of the 1,837 patients with reported JE, 1,382 patients in nine prefectures were investigated. JE was confirmed in 1,210 of 1,382 (87.6%) patients by a JEV-specific immunoglobulin M (IgM) antibody-capture enzyme-linked immunosorbent assay (MAC-ELISA), heminested reverse transcriptase PCR, and virus isolation. Two strains of JEV belonging to genotype 1 were isolated. Other viral pathogens responsible for encephalitis, including echovirus, mumps virus, herpes simplex virus, and cytomegalovirus, were identified in 67 of 172 (38.9%) JE-negative cases. On the basis of the distribution of the laboratory-confirmed JE cases from different hospitals according to the Chinese administrative division, which included hospitals at the provincial, city, county, and township levels, county hospitals detected the highest number of JE cases (81.8%), whereas township hospitals detected the smallest number of JE cases (1.4%). Provincial and city hospitals had the highest and lowest rates of accuracy of providing a clinical diagnosis of JE, as confirmed by laboratory testing (91.8% and 76.7%, respectively). This study demonstrates that laboratory confirmation improves the accuracy of diagnosis of JE and that an enhanced laboratory capacity is critical for JE surveillance as well as the identification of other pathogens that cause encephalitic syndromes with clinical symptoms similar to those caused by JEV infection. PMID:20147638

  16. [Teaching methods for clinical settings: a literature review].

    PubMed

    Brugnolli, Anna; Benaglio, Carla

    2017-01-01

    . Teaching Methods for clinical settings: a review. The teaching process during internship requires several methods to promote the acquisition of more complex technical skills such as relational, decisional and planning abilities. To describe effective teaching methods to promote the learning of relational, decisional and planning skills. A literature review of the teaching methods that have proven most effective, most appreciated by students, and most frequently used in Italian nursing schools. Clinical teaching is a central element to transform clinical experiences during internship in professional competences. The students are gradually brought to become more independent, because they are offered opportunities to practice in real contexts, to receive feedback, to have positive role models, to become more autonomous: all elements that facilitate and potentiate learning. Clinical teaching should be based on a variety of methods. The students value a gradual progression both in clinical experiences and teaching strategies from more supervised methods to methods more oriented towards reflecting on clinical practice and self-directed learning.

  17. Teaching About Health Care Disparities in the Clinical Setting

    PubMed Central

    Fernandez, Leonor; Irby, David M.; Harleman, Elizabeth; Fernandez, Alicia

    2010-01-01

    Clinical teachers often observe interactions that may contribute to health care disparities, yet may hesitate to teach about them. A pedagogical model could help faculty structure teaching about health care disparities in the clinical setting, but to our knowledge, none have been adapted for this purpose. In this paper, we adapt an established model, Time-Effective Strategies for Teaching (TEST), to the teaching of health care disparities. We use several case scenarios to illustrate the core components of the model: diagnose the learner, teach rapidly to the learner’s need, and provide feedback. The TEST model is straightforward, easy to use, and enables the incorporation of teaching about health care disparities into routine clinical teaching. PMID:20352501

  18. Randomized clinical trial comparing 5% and 1% topical minoxidil for the treatment of androgenetic alopecia in Japanese men.

    PubMed

    Tsuboi, Ryoji; Arano, Osamu; Nishikawa, Tooru; Yamada, Hidekazu; Katsuoka, Kensei

    2009-08-01

    Minoxidil is efficacious in inducing hair growth in patients with androgenetic alopecia by inducing hair follicles to undergo transition from the early to late anagen phase. Although the efficacy of 1% topical minoxidil has been confirmed in Japan, no controlled study of 5% topical minoxidil has been conducted using male Japanese subjects. The objective of this trial was to verify the superiority in clinical efficacy of 5% topical minoxidil to 1% topical minoxidil in a double-blind controlled study with male, Japanese androgenetic alopecia patients as the subjects. The trial included 300 Japanese male patients aged 20 years or older with androgenetic alopecia who were administered either 5% topical minoxidil (n = 150) or 1% topical minoxidil (n = 150) for 24 weeks. The mean change from the baseline in non-vellus hair/cm(2), the primary efficacy variable, was 26.4 (n = 142) in the 5% topical minoxidil group and 21.2 (n = 144) in the 1% topical minoxidil group at 16 weeks, the main time point for the evaluation. The difference between the groups was significant (P = 0.020). The incidence of adverse events was 8.7% (13/150) in the 5% group and 5.3% (8/150) in the 1% group, with no significant difference between the groups (chi(2)-test: P = 0.258). Our findings confirmed the superiority of 5% topical minoxidil to 1% topical minoxidil in treating Japanese men with androgenetic alopecia.

  19. Clinical productivity of primary care nurse practitioners in ambulatory settings.

    PubMed

    Xue, Ying; Tuttle, Jane

    Nurse practitioners are increasingly being integrated into primary care delivery to help meet the growing demand for primary care. It is therefore important to understand nurse practitioners' productivity in primary care practice. We examined nurse practitioners' clinical productivity in regard to number of patients seen per week, whether they had a patient panel, and patient panel size. We further investigated practice characteristics associated with their clinical productivity. We conducted cross-sectional analysis of the 2012 National Sample Survey of Nurse Practitioners. The sample included full-time primary care nurse practitioners in ambulatory settings. Multivariable survey regression analyses were performed to examine the relationship between practice characteristics and nurse practitioners' clinical productivity. Primary care nurse practitioners in ambulatory settings saw an average of 80 patients per week (95% confidence interval [CI]: 79-82), and 64% of them had their own patient panel. The average patient panel size was 567 (95% CI: 522-612). Nurse practitioners who had their own patient panel spent a similar percent of time on patient care and documentation as those who did not. However, those with a patient panel were more likely to provide a range of clinical services to most patients. Nurse practitioners' clinical productivity was associated with several modifiable practice characteristics such as practice autonomy and billing and payment policies. The estimated number of patients seen in a typical week by nurse practitioners is comparable to that by primary care physicians reported in the literature. However, they had a significantly smaller patient panel. Nurse practitioners' clinical productivity can be further improved. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Clinical features and outcomes of 139 Japanese patients with Hodgkin lymphoma.

    PubMed

    Makita, Shinichi; Maruyama, Dai; Maeshima, Akiko Miyagi; Taniguchi, Hirokazu; Miyamoto, Ken-Ichi; Kitahara, Hideaki; Fukuhara, Suguru; Munakata, Wataru; Kobayashi, Yukio; Itami, Jun; Tobinai, Kensei

    2016-08-01

    Hodgkin lymphoma (HL) is a rare subtype of malignant lymphoma in Japan, and there are few reports of HL in Japan in recent years. We retrospectively analyzed the clinical features of 139 patients with HL who were diagnosed and treated at our institution between 1997 and 2011. The median age at diagnosis was 34 years with 83 male. Of these patients, 83 (60 %) were early stage and 56 (40 %) were advanced-stage. Seventy-three patients (88 %) with early stage disease received ABVd followed by irradiation. All of the 56 advanced-stage patients received chemotherapy, mainly ABVd. The 5-year progression-free survival (PFS) rates and overall survival rates were 90 and 94 % in patients with early stage disease, and 71 and 90 % in those with advanced-stage disease. The PFS of patients with advanced-stage disease was significantly lower than those with early stage (p = 0.014). In conclusion, the outcomes of Japanese patients with HL in recent years were not improved as compared with the results of previous reports. We confirmed that patients with advanced-stage disease have lower PFS than those with early stage disease. Prospective studies are needed to establish novel treatment strategies to improve the outcome of HL patients, especially those with advanced disease.

  1. Recent Clinical Characteristics of Labors Using Three Japanese Systems of Midwife-Led Primary Delivery Care

    PubMed Central

    Suzuki, Shunji

    2016-01-01

    Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care. PMID:27034827

  2. The Japanese Postmarketing Adverse Event Relief System: A Confluence of Regulatory Science, the Legal System, and Clinical Pharmacology.

    PubMed

    Tominaga, T; Miyazaki, S; Oniyama, Y; Weber, A D; Kondo, T

    2016-10-13

    The Japanese Postmarketing Relief System provides for compensation to patients with adverse reactions, based on the acknowledgment that unpredicted adverse events occur inevitably once a drug is marketed. The system also provides new knowledge about the benefit-risk profile of a drug that may be incorporated into product labeling. The system relies on causality assessments that are based on sound clinical pharmacology principles. The system may serve as a model for other countries' healthcare systems.

  3. Diagnosis of MS: a comparison of three different clinical settings.

    PubMed

    Porter, B; Keenan, E; Record, E; Thompson, A J

    2003-10-01

    In order to compare a newly established diagnostic clinic with two existing clinical settings in the management of the diagnostic phase of multiple sclerosis (MS), a retrospective audit was performed over a 12-month period comparing the length of time, adherence to recently published standards and price charged in diagnosing MS in three different clinical diagnostic settings operating within the same hospital: a specifically designed demyelinating disease diagnostic clinic (DDC), a general neurology clinic (GNC) and an inpatient investigation unit (IIU). An audit tool was created to measure the standards advocated by the UK MS Society on management of the diagnostic phase of MS. The costing tool was the price charged to health authorities. A randomized retrospective case note and referral letter review method was used. The entry criterion was a confirmed diagnosis of MS documented in the medical notes following investigation during the period April 1999-April 2001. The time between referral and first appointment favoured the DDC with a mean time of 5.9 weeks, compared to 7.7 weeks for the GNC and 10.0 weeks for the IIU. The mean times between the first appointment and receipt of results were 4.7 weeks (DDC), 18.8 weeks (GNC) and 21.2 weeks (IIU). Prices ranged from pounds sterling 395-pounds sterling 790 (DDC), pounds sterling 95-pounds sterling 380 (GNC) and pounds sterling 1940-pounds sterling 2700 (IIU). This study suggests that the UK MS Society standards are achievable in most areas without excessive additional costs and provides evidence that the DDC offers a better service than other existing models.

  4. Doctoral clinical geropsychology training in a primary care setting.

    PubMed

    Zweig, Richard A; Siegel, Lawrence; Hahn, Steven; Kuslansky, Gail; Byrne, Kathy; Fyffe, Denise; Passman, Vicki; Stewart, Douglas; Hinrichsen, Gregory A

    2005-01-01

    Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica, to clinical psychology doctoral students within a large urban professional psychology program. In an innovative effort to provide the most disadvantaged elderly with comprehensive mental health treatment and maximize trainee exposure to an interdisciplinary treatment model, the program also pairs selected doctoral psychology trainees with medical residents to optimize integrated mental health service delivery for primary care elderly. The program has the following core objectives: (1) Infuse the mental health and aging knowledge base into the regular graduate curriculum; (2) Provide interdisciplinary training in geropsychological diagnostic and consultative services within an urban primary care setting; (3) Provide interdisciplinary training in the practice of psychological and neuropsychological evaluation of elderly; (4) Provide training in geropsychological psychotherapeutic intervention, including individual, couples/family, and brief/psycho-educational therapies with outpatient older adults. These objectives are achieved by pooling the resources of a graduate school of psychology, a local public hospital, and an academic medical center to achieve educational and clinical service goals.

  5. Synthesis of clinical prediction models under different sets of covariates with one individual patient data.

    PubMed

    Yoneoka, Daisuke; Henmi, Masayuki; Sawada, Norie; Inoue, Manami

    2015-11-19

    Recently, increased development of clinical prediction models has been reported in the medical literature. However, evidence synthesis methodologies for these prediction models have not been sufficiently studied, especially for practical situations such as a meta-analyses where only aggregated summaries of important predictors are available. Also, in general, the covariate sets involved in the prediction models are not common across studies. As in ordinary model misspecification problems, dropping relevant covariates would raise potentially serious biases to the prediction models, and consequently to the synthesized results. We developed synthesizing methods for logistic clinical prediction models with possibly different sets of covariates. In order to aggregate the regression coefficient estimates from different prediction models, we adopted a generalized least squares approach with non-linear terms (a sort of generalization of multivariate meta-analysis). Firstly, we evaluated omitted variable biases in this approach. Then, under an assumption of homogeneity of studies, we developed bias-corrected estimating procedures for regression coefficients of the synthesized prediction models. Numerical evaluations with simulations showed that our approach resulted in smaller biases and more precise estimates compared with conventional methods, which use only studies with common covariates or which utilize a mean imputation method for omitted coefficients. These methods were also applied to a series of Japanese epidemiologic studies on the incidence of a stroke. Our proposed methods adequately correct the biases due to different sets of covariates between studies, and would provide precise estimates compared with the conventional approach. If the assumption of homogeneity within studies is plausible, this methodology would be useful for incorporating prior published information into the construction of new prediction models.

  6. Short-term operational evaluation of a group-parenting program for Japanese mothers with poor psychological status: adopting a Canadian program into the Asian public service setting.

    PubMed

    Goto, Aya; Yabe, Junko; Sasaki, Hitomi; Yasumura, Seiji

    2010-07-01

    Although parenting practices differ across various sociocultural settings, scientific research on parenting intervention in Asia is scarce. We adopted a Canadian multilanguage group-based parenting program (Nobody's Perfect) into the Japanese public health service setting and evaluated its impact. Our program was feasible as a public service; was well-accepted among the participants with low psychological status, many of whom were first-time mothers; and had a potential positive impact on the mood of mothers and the self-evaluation of their abilities in society. Our results may facilitate and provide direction for similar research in Asia.

  7. Bortezomib therapy-related lung disease in Japanese patients with multiple myeloma: Incidence, mortality and clinical characterization

    PubMed Central

    Yoshizawa, Kazutake; Mukai, Harumi Y; Miyazawa, Michiko; Miyao, Makiko; Ogawa, Yoshimasa; Ohyashiki, Kazuma; Katoh, Takao; Kusumoto, Masahiko; Gemma, Akihiko; Sakai, Fumikazu; Sugiyama, Yukihiko; Hatake, Kiyohiko; Fukuda, Yuh; Kudoh, Shoji

    2014-01-01

    Because of the potentially high mortality rate (6.5%) associated with bortezomib-induced lung disease (BILD) in Japanese patients with relapsed or refractory multiple myeloma, we evaluated the incidence, mortality and clinical features of BILD in a Japanese population. This study was conducted under the Risk Minimization Action Plan (RMAP), which was collaboratively developed by the pharmaceutical industry and public health authority. The RMAP consisted of an intensive dissemination of risk information and a recommended countermeasure to health-care professionals. All patients treated with bortezomib were consecutively registered in the study within 1 year and monitored for emerging BILD. Of the 1010 patients registered, 45 (4.5%) developed BILD, 5 (0.50%) of whom had fatal cases. The median time to BILD onset from the first bortezomib dose was 14.5 days, and most of the patients responded well to corticosteroid therapy. A retrospective review by the Lung Injury Medical Expert Panel revealed that the types with capillary leak syndrome and hypoxia without infiltrative shadows were uniquely and frequently observed in patients with BILD compared with those with conditions associated with other molecular-targeted anticancer drugs. The incidence rate of BILD in Japan remains high compared with that reported in other countries, but the incidence and mortality rates are lower than expected before the introduction of bortezomib in Japan. This study describes the radiographic pattern and clinical characterization of BILD in the Japanese population. The RMAP seemed clinically effective in minimizing the BILD risk among our Japanese population. PMID:24329927

  8. [Comparison of clinical efficacy and cost-quality of antihistamines in early treatment for Japanese cedar pollinosis].

    PubMed

    Kakutani, Chieko; Ogino, Satoshi; Ikeda, Hiroki; Enomoto, Tadao

    2006-05-01

    Japanese cedar pollinosis (JCP) affects more than 16% of the Japanese population. The estimated direct and indirect costs for this disease totaled 286 billion yen in 1998. In JCP therapy, antihistamines are first line agents. It is well known that starting treatment for JCP with antihistamines before initial day of the pollen scattering can relieve nasal symptom severity during pollen season. The aim of this study is to assess the clinical efficacy and cost-quality of 7 major second-generation antihistamines in early treatment for Japanese cedar pollinosis (JCP). Patients were randomly selected from 16 ENT clinical sites in Osaka and Wakayama between February 24 and March 8, 2003 (peak pollen season). Effectiveness was assessed using patient'ratings of nasal and ocular symptoms and overall assessment in their condition compared to previous season ones. Costs include direct costs of the drugs used for treatment to JCP from January to March. One hundred seventy-five patients who were treated with antihistamine monotherapy (azelastine: n=15, cetirizine: n=15, ebastine: n=36, epinastine: n=16, fexofenadine: n=16, loratadine: n=60, oxatomide: n=17) and 510 non-treatment patients were evaluated. Among 8 groups, there were significant differences in sneezing, rhinorrhea, ocular itching and overall health condition. However, among 7 monotherapy groups, there were no differences in each symptom or the overall assessment. In cost-quality analysis, there were significant differences in a cost for each effective patient (defined as those with improvement in their overall condition) among 7 drugs. The top three cost-efficacious drugs resulted in azelastine, loratadine and fexofenadine. These results show that there were no significant differences in clinical efficacy in early treatment for JCP among 7 antihistamines. But Japanese National Health Insurance drug price scheme led to significant differences in cost-quality.

  9. The feasibility and validity of the comprehensive ICF core set for stroke in Chinese clinical settings.

    PubMed

    Wang, Pu; Li, Huagang; Guo, Yi; Xie, Yuxiao; Ge, Ruidong; Qiu, Zhuoying

    2014-02-01

    To inspect the feasibility and content validity of the comprehensive International Classification of Functioning, Disability and Health (ICF) core set for stroke by describing relevant aspects of functioning, disability and environmental factors affected in Chinese patients post stroke. Multicentre, cross-sectional study. Department of rehabilitation medicine. The content validity was evaluated using frequency and percentage of 208 patients with a mean age of 60 years post stroke in China. Aspects of body function and structure, activity and participation, and environmental factors in the comprehensive ICF core set for stroke. Six ICF categories of body function were identified as a problem in over 90% (n = 187) of the patients (functions of the cardiovascular system and neuromusculoskeletal and movement-related functions). Impairments of brain, upper and lower extremity were identified as a problem in over 50% (n = 104) of the patients. Four ICF categories of activities and participation were documented as a problem in 100% (n = 208) of the patients (domestic and civic life). In environmental factors, nine ICF categories were documented as barriers by more than 10% (n = 20) and fewer than 50% (n = 104) of the patients (products and technology, physical geography, societal attitudes, services, systems and polices). Six ICF categories were identified as facilitators in over 90% (n = 187) of the patients (support and relationships and attitudes). The findings suggest that it is feasible to apply the comprehensive ICF core set for stroke in the Chinese clinical setting, after the appropriate reduction of some categories according to Chinese patients' characteristics and culture.

  10. The impact of hypnotic suggestibility in clinical care settings

    PubMed Central

    Montgomery, Guy H.; Schnur, Julie B.; David, Daniel

    2013-01-01

    Hypnotic suggestibility has been described as a powerful predictor of outcomes associated with hypnotic interventions. However, there have been no systematic approaches to quantifying this effect across the literature. The present meta-analysis evaluates the magnitude of the effect of hypnotic suggestibility on hypnotic outcomes in clinical settings. PsycINFO and PubMed were searched from their inception through July 2009. Thirty-four effects from ten studies and 283 participants are reported. Results revealed a statistically significant overall effect size in the small to medium range (r = 0.24; 95% Confidence Interval = −0.28 to 0.75), indicating that greater hypnotic suggestibility led to greater effects of hypnosis interventions. Hypnotic suggestibility accounted for 6% of the variance in outcomes. Smaller sample size studies, use of the SHCS, and pediatric samples tended to result in larger effect sizes. Results question the usefulness of assessing hypnotic suggestibility in clinical contexts. PMID:21644122

  11. Identifying Problematic Segmental Features to Acquire Comprehensible Pronunciation in EFL Settings: The Case of Japanese Learners of English

    ERIC Educational Resources Information Center

    Saito, Kazuya

    2011-01-01

    The present study examines how to identify problematic pronunciation features for particular EFL learners, namely native Japanese speakers (NJs) learning English, to acquire comprehensible pronunciation, and tests the appropriateness of the selection. The study comprises two phases. In the identification phase, eight English-specific segmentals,…

  12. Adaptation of Clinical Prediction Models for Application in Local Settings

    PubMed Central

    Kappen, Teus H.; Vergouwe, Yvonne; van Klei, Wilton A.; van Wolfswinkel, Leo; Kalkman, Cor J.

    2012-01-01

    Background. When planning to use a validated prediction model in new patients, adequate performance is not guaranteed. For example, changes in clinical practice over time or a different case mix than the original validation population may result in inaccurate risk predictions. Objective. To demonstrate how clinical information can direct updating a prediction model and development of a strategy for handling missing predictor values in clinical practice. Methods. A previously derived and validated prediction model for postoperative nausea and vomiting was updated using a data set of 1847 patients. The update consisted of 1) changing the definition of an existing predictor, 2) reestimating the regression coefficient of a predictor, and 3) adding a new predictor to the model. The updated model was then validated in a new series of 3822 patients. Furthermore, several imputation models were considered to handle real-time missing values, so that possible missing predictor values could be anticipated during actual model use. Results. Differences in clinical practice between our local population and the original derivation population guided the update strategy of the prediction model. The predictive accuracy of the updated model was better (c statistic, 0.68; calibration slope, 1.0) than the original model (c statistic, 0.62; calibration slope, 0.57). Inclusion of logistical variables in the imputation models, besides observed patient characteristics, contributed to a strategy to deal with missing predictor values at the time of risk calculation. Conclusions. Extensive knowledge of local, clinical processes provides crucial information to guide the process of adapting a prediction model to new clinical practices. PMID:22427369

  13. Adaptation of clinical prediction models for application in local settings.

    PubMed

    Kappen, Teus H; Vergouwe, Yvonne; van Klei, Wilton A; van Wolfswinkel, Leo; Kalkman, Cor J; Moons, Karel G M

    2012-01-01

    When planning to use a validated prediction model in new patients, adequate performance is not guaranteed. For example, changes in clinical practice over time or a different case mix than the original validation population may result in inaccurate risk predictions. To demonstrate how clinical information can direct updating a prediction model and development of a strategy for handling missing predictor values in clinical practice. A previously derived and validated prediction model for postoperative nausea and vomiting was updated using a data set of 1847 patients. The update consisted of 1) changing the definition of an existing predictor, 2) reestimating the regression coefficient of a predictor, and 3) adding a new predictor to the model. The updated model was then validated in a new series of 3822 patients. Furthermore, several imputation models were considered to handle real-time missing values, so that possible missing predictor values could be anticipated during actual model use. Differences in clinical practice between our local population and the original derivation population guided the update strategy of the prediction model. The predictive accuracy of the updated model was better (c statistic, 0.68; calibration slope, 1.0) than the original model (c statistic, 0.62; calibration slope, 0.57). Inclusion of logistical variables in the imputation models, besides observed patient characteristics, contributed to a strategy to deal with missing predictor values at the time of risk calculation. Extensive knowledge of local, clinical processes provides crucial information to guide the process of adapting a prediction model to new clinical practices.

  14. Pharmacokinetics, efficacy and safety profiles of etanercept monotherapy in Japanese patients with rheumatoid arthritis: review of seven clinical trials

    PubMed Central

    Miyasaka, Nobuyuki; Kawai, Shinichi; Yuasa, Hirotoshi; Yamashita, Noriaki; Sugiyama, Noriko; Wagerle, Lorin Craig; Vlahos, Bonnie; Wajdula, Joseph

    2015-01-01

    Conventional synthetic disease-modifying anti-rheumatic drugs, including methotrexate, may not be tolerated by all patients with rheumatoid arthritis (RA), and limited international data for etanercept (ETN) monotherapy are available. The aim of this review was to summarize the clinical program for ETN monotherapy in Japanese patients with RA, which has included a pharmacokinetic study, clinical trials for registration, long-term studies, and once-weekly dosing studies. Pharmacokinetic results showed that serum concentrations of ETN were linear with dose levels and were similar to other international studies. Across interventional studies, 652 Japanese patients with active RA were treated with ETN. In the registration studies, ETN treatment led to consistent improvement in American College of Rheumatology 20/50/70 scores, European League Against Rheumatism Good Response, Disease Activity Score 28 erythrocyte sedimentation rate remission, and Health Assessment Questionnaire disability index. In the long-term studies, efficacy was maintained for up to 180 weeks. Similar results were seen in the once-weekly studies. Across the studies, more than 870 patient-years of exposure to ETN were recorded. Discontinuations owing to lack of efficacy or adverse events were modest and no new safety signals were recorded. These studies demonstrated that ETN monotherapy is efficacious and well-tolerated in Japanese patients with RA. PMID:24842477

  15. Story of a Mediation in the Clinical Setting.

    PubMed

    Morreim, Haavi

    2016-01-01

    Conflicts in the clinical setting can spiral downward with remarkable speed, as parties become ever more incensed and entrenched in their positions. Productive conversations seem unlikely at best. Nevertheless, such situations can sometimes be turned into collaborative problem solving with equally remarkable speed. For this to happen, those providing conflict-resolution services such as mediation need to bring, not just a set of skills, but also some key norms: the process must be voluntary for all; the mediator must abjure giving advice or taking sides, and must honor the privacy of privately offered thoughts. This article describes a conflict that had reached the point of a hospital's requesting judicial coercion. However, a conflict-resolution process was then initiated that, in the end, led to amicable resolution and mended relationships, obviating the need for court orders. This article describes that conflict and the resolution process in detail, along the way annotating specific strategies that are often highly effective. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

  16. Integrative Nursing: Application of Principles Across Clinical Settings

    PubMed Central

    Kreitzer, Mary Jo

    2015-01-01

    While the essence of nursing has long been whole person (body, mind, and spirit) and whole system-focused, in reality the contemporary practice of nursing in many settings around the globe has become increasingly fragmented and de-stabilized. Nursing shortages in many parts of the world are significant, and hierarchies and bureaucracies often remove nurses from the point of care, be that the bedside, home, or clinic, replacing them with less skilled workers and filling their time with documentation and other administrative tasks. Integrative nursing is a framework for providing whole person/whole system care that is relationship-based and person-centered and focuses on improving the health and wellbeing of caregivers as well as those they serve. It is aligned with what is being called the “triple aim” in the United States—an effort focused on improving the patient experience (quality and satisfaction), improving the health of populations, and reducing the cost of care. The principles of integrative nursing offer clear and specific guidance that can shape and impact patient care in all clinical settings. PMID:25973268

  17. Current status of achieving blood pressure target and its clinical correlates in Japanese type 2 diabetes.

    PubMed

    Yokoyama, Hiroki; Araki, Shin-Ichi; Kawai, Koichi; Hirao, Koichi; Kurihara, Yoshio; Seino, Hiroaki; Takamura, Hiroshi; Sugimoto, Hidekatsu; Okada, Akira; Maegawa, Hiroshi

    2017-07-21

    To investigate the current status of achieved blood pressure levels in association with the number of antihypertensive drug classes as of 2013, and to explore the clinical correlates with achievement of target blood pressure in a large-scale cohort of Japanese subjects with type 2 diabetes. A nationwide survey was conducted including 12,811 subjects with type 2 diabetes. Subjects were divided by achieved blood pressure, <130/80 or 140/90 mmHg, and the number of drug classes taken. The percentages achieving a blood pressure of <130/80 or 140/90 mmHg were 52.0% and 86.1%, respectively. The prevalence of hypertension, if defined as ≥130/80 mmHg or treated, became 67.9%. Among subjects taking antihypertensive drugs, a blood pressure of <130/80 or <140/90 mmHg was 46.7% and 83.2%, respectively. The percentages of <130/80 mmHg were 55.9% without drugs, 47.1% on 1, 42.5% on 2, 47.2% on 3, and 56.8% on ≥4 drugs, respectively. The most prescribed drugs were renin-angiotensin system inhibitors, followed by calcium channel blockers, diuretics, and β-blockers. The multiple logistic regression analysis indicated that a blood pressure <130/80 mmHg was associated with lower values in age, body mass index, albuminuria, and glomerular filtration rate, higher proportions on targets for HbA1C and lipids, and less retinopathy. In type 2 diabetes, hypertension is common and only 52% achieved <130/80 mmHg, indicating a difficulty in blood pressure lowering. This was correlated with difficulties in glycemic and lipid management, obesity, and vascular complications, implying these clustering to be a serious problem. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  18. Clinical Characteristics of Severe Japanese Encephalitis: A Case Series from South Korea.

    PubMed

    Sunwoo, Jun-Sang; Lee, Soon-Tae; Jung, Keun-Hwa; Park, Kyung-Il; Moon, Jangsup; Jung, Ki-Young; Kim, Manho; Lee, Sang Kun; Chu, Kon

    2017-08-01

    Japanese encephalitis (JE) virus is a major cause of devastating viral encephalitis, especially in Asia. Although a successful vaccination program led to its near-elimination over three decades in South Korea, the incidence of JE has increased since 2010. The present study investigated the clinical manifestations, laboratory findings, and factors affecting neurological outcomes of reemerging JE. We retrospectively reviewed medical records of laboratory-confirmed JE patients who presented with acute encephalitis syndrome at three tertiary hospitals between 2010 and 2015. A total of 17 patients with JE were identified. Their median age was 51 years, and 10 (58.5%) were men. The most common symptoms and signs were fever (94.1%), altered consciousness (94.1%), and headache (80.2%). Hyporeflexia (47.1%), seizures (35.2%), abnormal brainstem reflex (23.5%), and flaccid weakness (17.6%) were also noted. Brain imaging revealed thalamic lesions in all patients, with the hippocampus, midbrain, basal ganglia, and cerebral cortex affected to varying degrees. Sixteen patients (94.1%) required management in the intensive care unit with mechanical ventilation due to neurological deterioration. At the time of discharge, 11 (64.7%) had poor recovery, defined as Glasgow coma scale scores of less than 8, and remained ventilator dependent. Comparison between the two outcome groups indicated that midbrain involvement (P = 0.028) and rapid deterioration (P = 0.005) were associated with severe neurological sequelae. Given that JE is a vaccine-preventable disease, vaccination for adults should be considered in response to the reemergence of JE.

  19. Identification of Paecilomyces variotii in clinical samples and settings.

    PubMed

    Houbraken, Jos; Verweij, Paul E; Rijs, Anthonius J M M; Borman, Andrew M; Samson, Robert A

    2010-08-01

    Paecilomyces variotii is a commonly occurring species in air and food, but it is also associated with many types of human infections and is among the emerging causative agents of opportunistic mycoses in immunocompromised hosts. Paecilomyces can cause hyalohyphomycosis, and two species, Paecilomyces lilacinus and P. variotii, are the most frequently encountered organisms. In the present study, a set of 34 clinical isolates morphologically identified as P. variotii or P. lilacinus were formally identified by sequencing intergenic transcribed spacer regions 1 and 2 (including 5.8S rDNA) and a part of the beta-tubulin gene. Three isolates were identified as P. lilacinus, and five of the presumptive P. variotii isolates did not belong to the genus Paecilomyces but were identified as Talaromyces eburneus (anamorph, Geosmithia argillacea) or Hamigera avellanea (anamorph, Merimbla ingelheimense). Applying the most recent taxonomy, we found that the clinical P. variotii isolates could be identified as P. variotii sensu stricto (14 strains), P. formosus (11 strains), and P. dactylethromorphus (1 strain). These data indicate that P. formosus occurs in clinical samples as commonly as P. variotii. Susceptibility tests showed that the antifungal susceptibility profiles of P. variotii, P. formosus, and P. dactylethromorphus are similar and that all strains tested were susceptible to amphotericin B in vitro. P. lilanicus, T. eburneus, and H. avellanea had different susceptibility profiles; and flucytosine and voriconazole were the least active of the antifungal drugs tested against these species. Our results indicate that correct species identification is important to help guide appropriate antifungal therapy.

  20. Modeling decision support rule interactions in a clinical setting.

    PubMed

    Sordo, Margarita; Rocha, Beatriz H; Morales, Alfredo A; Maviglia, Saverio M; Oglio, Elisa Dell'Oglio; Fairbanks, Amanda; Aroy, Teal; Dubois, David; Bouyer-Ferullo, Sharon; Rocha, Roberto A

    2013-01-01

    Traditionally, rule interactions are handled at implementation time through rule task properties that control the order in which rules are executed. By doing so, knowledge about the behavior and interactions of decision rules is not captured at modeling time. We argue that this is important knowledge that should be integrated in the modeling phase. In this project, we build upon current work on a conceptual schema to represent clinical knowledge for decision support in the form of if then rules. This schema currently captures provenance of the clinical content, context where such content is actionable (i.e. constraints) and the logic of the rule itself. For this project, we borrowed concepts from both the Semantic Web (i.e., Ontologies) and Complex Adaptive Systems (CAS), to explore a conceptual approach for modeling rule interactions in an enterprise-wide clinical setting. We expect that a more comprehensive modeling will facilitate knowledge authoring, editing and update; foster consistency in rules implementation and maintenance; and develop authoritative knowledge repositories to promote quality, safety and efficacy of healthcare.

  1. Revealing the hidden agency of children in a clinical setting.

    PubMed

    Dedding, Christine; Reis, Ria; Wolf, Bart; Hardon, Anita

    2015-12-01

    Interactions with children in clinical settings are often criticized because parents and medical professionals speak for children rather than to them. Such approaches do not take the agency of children into account. First, to examine how children enact agency in a clinical encounter and draw lessons from this to improve health-care practices for children and, second, to explain how looking at agency might help to move the participation agenda forwards. A qualitative study incorporating a range of methods, including participant observation, interviews and focus group discussions. Three hospitals in the Netherlands. Children with diabetes type 1, between 8 and 12 years (n = 30), parents (n = 22) and medical professionals (n = 16). Children do not simply accept the recurrent health education from medical professionals. Instead, they attribute their own personal meaning to their disease and treatment. Drawing from their years of experience with the disease and health care and the image of a passive and vulnerable child, they actively find ways to balance personal goals with medically defined goals. Efforts to facilitate child participation should be based on insights into the ways in which children enact agency in the clinical encounter. Our data show that children already participate in health care and that their enactment of agency is based on a practical logic. Understanding of children's current participation and agency is needed to more successfully attune their treatment to their daily lives with diabetes. This is crucial for the success of treatment and the well-being of children. © 2014 John Wiley & Sons Ltd.

  2. Clinical and Genetic Characteristics of Japanese Patients with Age-Related Macular Degeneration and Pseudodrusen.

    PubMed

    Elfandi, Sufian; Ooto, Sotaro; Ueda-Arakawa, Naoko; Takahashi, Ayako; Yoshikawa, Munemitsu; Nakanishi, Hideo; Tamura, Hiroshi; Oishi, Akio; Yamashiro, Kenji; Yoshimura, Nagahisa

    2016-10-01

    To investigate differences in clinical characteristics and genotype distribution in Japanese patients with age-related macular degeneration (AMD) and pseudodrusen using multimodal imaging. Retrospective, observational case series. A total of 101 patients (101 eyes) with AMD and pseudodrusen. Patients underwent complete ophthalmologic examination, including color fundus photography, infrared reflectance (IR) imaging, fundus autofluorescence, confocal blue reflectance, fluorescein and indocyanine green (ICG) angiography, and spectral-domain optical coherence tomography (SD OCT). Pseudodrusen subtype was identified with multiple imaging techniques. Patients were genotyped to identify major single nucleotide polymorphisms associated with AMD (CFH Y402, CFH I62V, and ARMS2 A69S). Clinical characteristics and genetic distributions of patients with pseudodrusen. At least 1 imaging technique identified dot pseudodrusen in all 101 eyes and ribbon pseudodrusen in 53 eyes (52.5%). Forty-eight eyes (47.5%) had only dot pseudodrusen, but no eyes had only ribbon pseudodrusen or midperipheral drusen. Forty-five of 49 bilateral cases (91.8%) had the same pseudodrusen subtype in both eyes. Pseudodrusen subtype did not change during the observation period in 100 eyes (99.0%), but dot-dominant type changed to dot-ribbon type in 1 eye (1.0%). The dot and ribbon subtypes were detected in 84 (83.1%) and 51 (96.2%) eyes, respectively, using color fundus photographs. Detection sensitivity of dot pseudodrusen was high for IR (97.0%), confocal blue reflectance (95.1%), fundus autofluorescence (93.1%), and ICG (100%) imaging. Detection sensitivity for ribbon pseudodrusen was high for color fundus photography (96.2%), confocal blue reflectance (94.3%), and fundus autofluorescence (90.6%), but not for IR imaging and ICG angiography. Risk allele frequency of the CFH I62V polymorphism was 79.8% and 67.0% in patients with dot-dominant and dot-ribbon pseudodrusen, respectively (P = 0.053). The

  3. Virtual patients to explore and develop clinical case summary statement skills amongst Japanese resident physicians: a mixed methods study.

    PubMed

    Heist, Brian S; Kishida, Naoki; Deshpande, Gautam; Hamaguchi, Sugihiro; Kobayashi, Hiroyuki

    2016-02-01

    In Western clinical training, formulation of a summary statement (SS) is a core exercise for articulation, evaluation, and improvement of clinical reasoning (CR). In Japanese clinical training, structured guidance in developing CR, including opportunity for SS practice, is uncommon, and the present status of case summarization skills is unclear. We used Virtual Patients (VPs) to explore Japanese junior residents' SS styles and the effectiveness of VPs on improving SS quality. All first-year junior resident physicians at 4 residency programs (n = 54) were assigned randomized sequences of 5 VP modules, rolled out at 6 day intervals. During each module, participants free-texted a case summary and then reviewed a model summary. Thematic analysis was used to identify SS styles and each SS was categorized accordingly. Frequency of SS styles, and SS CR quality determined by 1) an internally developed Key Feature rubric and 2) demonstration of semantic qualification, were compared across modules. Four SS styles were identified: numbered features matched to differential diagnoses, differential diagnoses with supportive comments, feature listing, and narrative summarization. From module #1 to #5, significant increases in the narrative summarization SS style (p = 0.016), SS CR quality score (p = 0.021) and percentage of semantically driven SS (p = 0.003) were observed. Our study of Japanese junior residents identified distinct clinical case summary statement styles, and observed adoption of the narrative summarization style and improvement in the CR quality of summary statements during a series of VP cases.

  4. Impact of clinical preventive services in the ambulatory setting

    PubMed Central

    Ogola, Gerald; Mercer, Quay; Fong, Jaclyn; DeVol, Edward; Couch, Carl E.; Ballard, David J.

    2008-01-01

    Indicators of the performance of clinical preventive services (CPS) have been adopted in the ambulatory setting to improve quality of care. The impact of CPS was evaluated in a network of 49 primary care practices providing care to an estimated 245,000 adults in the Dallas–Fort Worth area through a sample chart review to determine delivery of recommended evidence-based CPS combined with medical literature estimates of the effectiveness of CPS. In this population in 2005, CPS were estimated to have prevented 36 deaths and 97 incident cases of cancer; 420 coronary heart disease events (including 66 sudden deaths) and 118 strokes; 816 cases of influenza and pneumonia (including 24 hospital admissions); and 87 osteoporosis-related fractures. Thus, CPS have substantial benefits in preventing deaths and illness episodes. PMID:18628969

  5. Clinical and molecular analysis of GM2 gangliosidosis in two apparent littermate kittens of the Japanese domestic cat.

    PubMed

    Hasegawa, Daisuke; Yamato, Osamu; Kobayashi, Masanori; Fujita, Michio; Nakamura, Shinichiro; Takahashi, Kimimasa; Satoh, Hiroyuki; Shoda, Toru; Hayashi, Daisuke; Yamasaki, Masahiro; Maede, Yoshimitsu; Arai, Toshiro; Orima, Hiromitsu

    2007-06-01

    This case report documents clinical and molecular findings in two littermate kittens of the Japanese domestic cat with GM2 gangliosidosis variant 0. Analysis included detailed physical, magnetic resonance imaging, biochemical, pathological and genetic examinations. At first, these littermate kittens showed typical cerebellar signs at approximately 2 months of age. About 2 months later, they progressively showed other neurological signs and subsequently died at about 7 months of age. Magnetic resonance imaging just before the death showed an enlarged ventricular system, T1 hyperintensity in the internal capsule, and T2 hyperintensity in the white matter of the whole brain. Histological findings suggested a type of lysosomal storage disease. Biochemical studies demonstrated that the kittens were affected with GM2 gangliosidosis variant 0, and a DNA assay finally demonstrated that these animals were homozygous for the mutation, which the authors had identified in a different family of the Japanese domestic cat. The findings in the present cases provide useful information about GM2 gangliosidosis variant 0 in Japanese domestic cats.

  6. Care mapping in clinical neuroscience settings: Cognitive impairment and dependency.

    PubMed

    Leigh, Andrew James; O'Hanlon, Katie; Sheldrick, Russell; Surr, Claire; Hare, Dougal Julian

    2015-01-01

    Person-centred care can improve the well-being of patients and is therefore a key driver in healthcare developments in the UK. The current study aims to investigate the complex relationship between cognitive impairment, dependency and well-being in people with a wide range of acquired brain and spinal injuries. Sixty-five participants, with varied acquired brain and spinal injuries, were selected by convenience sampling from six inpatient clinical neuroscience settings. Participants were observed using Dementia Care Mapping - Neurorehabilitation (DCM-NR) and categorised based on severity of cognitive impairment. A significant difference in the behaviours participants engaged in, their well-being and dependency was found between the severe cognitive impairment group and the mild, moderate or no cognitive impairment groups. Dependency and cognitive impairment accounted for 23.9% of the variance in well-ill-being scores and 17.2% of the variance in potential for positive engagement. The current study highlights the impact of severe cognitive impairment and dependency on the behaviours patients engaged in and their well-being. It also affirms the utility of DCM-NR in providing insights into patient experience. Consideration is given to developing DCM-NR as a process that may improve person-centred care in neuroscience settings.

  7. A study on task-analysis of clinical pathologists as medical consultants in Nihon University Hospital--a Japanese perspective by comparison with current status in the USA.

    PubMed

    Kumasaka, K; Yanai, M; Hosokawa, N; Iwasaki, Y; Hoshino, T; Arashima, Y; Hayashi, K; Murakami, J; Tsuchiya, T; Kawano, K

    2000-07-01

    To identify our role and the customers' satisfaction, the on-call consultation service records of the Department of Clinical Pathology, Nihon University School of Medicine, Itabashi Hospital (NUIH), were analyzed. Between 1995 and 1998, 1,789 consultation services were recorded, and approximately 40% were from physicians, and 50% were from medical technologists. During office hours, many physicians made contact with us at the office of clinical pathology, the clinical laboratory and other places in the hospital by various means. They asked us to interpret multidisciplinary laboratory data, and to provide the specific information that might affect clinical management. Medical technologists asked for clinical information of patients with extreme measured values and requested that we contact with physicians. In contrast, on weekends/holidays or after routine working hours, physicians sometimes requested non-automated laboratory tests such as peripheral blood smears/bone marrow smears or Gram stains. The major contents of our responses to medical technologists were concerned with blood banking and handling of instruments not to be operated in routine work. These results reconfirm that we are still required to have clinical competence for common laboratory procedures and to have the capability of interpretation of multidisciplinary laboratory data in the university hospital. Traditionally, most Japanese clinical pathologists have been focused their attention on bench work in research laboratories. However, the present study shows that the clinical pathologists need to bridge the real gap between laboratory technology and patient care. Our on-call service system can enhance the education of clinical pathologists, and improve not only laboratory quality assurance but also patient care. In addition, in response to a need for customer access to this service with a shortage of clinical pathologists, a more effective method would be to set up a proactive systemic approach in

  8. Applying Organ Clearance Concepts in a Clinical Setting

    PubMed Central

    2008-01-01

    Objective To teach doctor of pharmacy (PharmD) students how to apply organ clearance concepts in a clinical setting in order to optimize dose management, select the right drug product, and promote better patient-centered care practices. Design A student-focused 5-hour topic entitled "Organ Clearance Concepts: Modeling and Clinical Applications" was developed and delivered to second-year PharmD students. Active-learning techniques, such as reading assignments and thought-provoking questions, and collaborative learning techniques, such as small groups, were used. Student learning was assessed using application cards and a minute paper. Assessment Overall student responses to topic presentation were overwhelmingly positive. The teaching strategies here discussed allowed students to play an active role in their own learning process and provided the necessary connection to keep them motivated, as mentioned in the application cards and minute paper assessments. Students scored an average of 88% on the examination given at the end of the course. Conclusion By incorporating active-learning and collaborative-learning techniques in presenting material on organ clearance concept, students gained a more thorough knowledge of dose management and drug-drug interactions than if the concepts had been presented using a traditional lecture format. This knowledge will help students in solving critical patient situations in a real-world context. PMID:19214275

  9. Utilization of lean management principles in the ambulatory clinic setting.

    PubMed

    Casey, Jessica T; Brinton, Thomas S; Gonzalez, Chris M

    2009-03-01

    The principles of 'lean management' have permeated many sectors of today's business world, secondary to the success of the Toyota Production System. This management method enables workers to eliminate mistakes, reduce delays, lower costs, and improve the overall quality of the product or service they deliver. These lean management principles can be applied to health care. Their implementation within the ambulatory care setting is predicated on the continuous identification and elimination of waste within the process. The key concepts of flow time, inventory and throughput are utilized to improve the flow of patients through the clinic, and to identify points that slow this process -- so-called bottlenecks. Nonessential activities are shifted away from bottlenecks (i.e. the physician), and extra work capacity is generated from existing resources, rather than being added. The additional work capacity facilitates a more efficient response to variability, which in turn results in cost savings, more time for the physician to interact with patients, and faster completion of patient visits. Finally, application of the lean management principle of 'just-in-time' management can eliminate excess clinic inventory, better synchronize office supply with patient demand, and reduce costs.

  10. A guideline for reporting results of statistical analysis in Japanese Journal of Clinical Oncology.

    PubMed

    Fukuda, H; Ohashi, Y

    1997-06-01

    The paper gives guidelines to authors on the use of statistics, including statistical considerations when designing studies. Information on this article plus a list of other recommended books is available on the World Wide Web (http:/(/)wwwinfo.ncc.go.jp/jjco/) in Japanese as well as English.

  11. Treatment guidelines in inflammatory bowel disease: the Japanese perspectives.

    PubMed

    Matsuoka, Katsuyoshi; Hibi, Toshifumi

    2013-01-01

    The number of inflammatory bowel disease patients has been increasing in Japan and the demand for clinical practical guidelines emerged. A set of clinical practice guidelines for ulcerative colitis and Crohn's disease were thus published in 2006 and 2011, respectively. Their English versions were then published in 2000 and 2012, respectively. These guidelines aim to provide appropriate clinical indicators to Japanese practitioners to improve the outcomes of inflammatory bowel disease patients. The guidelines are based on global literature-based evidence as well as evidence from Japan. The Japanese guidelines were developed based on the existing evidence with integration of the experts' consensus. The criteria for recommendation grade were also determined by the level of evidence as well as by the experts' consensus. It is a distinct feature of the Japanese guidelines to disclose this process explicitly. This recommendation rating is thus useful to fill the gap between evidence and daily clinical practice. Since the Japanese guidelines are primarily based on global literature-based evidence, most of the clinical indicators in them are consistent with those in other guidelines from the Western world. Meanwhile, there are some distinctly different statements in the Japanese guidelines reflecting Japanese standard clinical practice, evidence, and the opinions of Japanese experts.

  12. Undergraduate nursing students integrating health literacy in clinical settings.

    PubMed

    Zanchetta, Margareth; Taher, Yasmin; Fredericks, Suzanne; Waddell, Janice; Fine, Carol; Sales, Rona

    2013-09-01

    Analyzing students' performance and self-criticism of their roles in promoting health literacy can inform nursing education in a social environment that expects new graduates to be health promoters. The pilot study reported here aimed to a) analyze students' understanding of and sensitivity to issues of health literacy, (b) identify students' perceptions of structural, organizational, and political barriers to the promotion of health literacy in social and health care organizations, and (c) document students' suggestions for curriculum changes that would develop their skills and competencies as health-literacy promoters. A qualitative pilot study. A collaborative undergraduate nursing degree program in the metropolitan area of Toronto, Canada. Sixteen undergraduate, Year 4 nursing students. Signed informed consent was obtained from the participants. Participation was unpaid and voluntary. Recruitment was through an email invitation sent by the School of Nursing Student Affairs Coordinator. Three, one-time individual interviews and three focus groups were conducted. All were audio-recorded. Recordings were transcribed, and the transcriptions were coded using the qualitative software ATLAS ti 6.0. The interview data were submitted to thematic analysis. Additional data were gathered from the two-page self-assessments in students' academic portfolios. Sensitivity to health literacy was documented. Students performed best as health promoters in supportive teaching hospitals. Their performance was hindered by clinical settings unsupportive of health education, absence of role models, and insufficient theoretical preparation for health teaching. Students' sensitivity to their clients' diversity reportedly reinforced the interconnection, in multicultural healthcare settings, between health literacy and other social determinants of health and a growing demand for educating future nurses in expanding their role also as health promoters. Students recommended more socially

  13. The value of the Uniform Clinical Data Set System (UCDSS) in a hospital setting.

    PubMed

    Hartz, A J; Sigmann, P; Guse, C; Hagen, T C

    1994-03-01

    The Health Care Financing Administration designed the Uniform Clinical Data Set System (UCDSS) to help peer review organizations (PROs) identify problems with patient care. The system currently is being piloted in five states and may be used for the PRO review of Medicare patients from all states by January 1995. This study tested whether UCDSS could be used with modifications for effective internal hospital quality review. The UCDSS includes a computer program for collecting information from the medical record and 359 computerized algorithms that evaluate quality of care. For this study, 2,313 randomly chosen medical records from a tertiary care teaching hospital were abstracted with the UCDSS at the time of discharge. Cases flagged by the UCDSS algorithms as having potential quality-of-care problems were referred to a clinical reviewer to evaluate whether the flag was a true positive and to identify reasons for false-positive flags. The algorithms were modified based on this hospital's experience by adding the reasons for false-positive flags as exceptions to the algorithm rules. To abstract the data with the UCDSS required a median time of 45 minutes and a mean time of 55 minutes per medical record. The percentages of algorithm flags that were confirmed upon physician review to have a quality problem were estimated to be 21% for the UCDSS and 43% for the modified UCDSS. The confirmed problem rate varied substantially by algorithm. Confirmed problems were the source of numerous departmental and individual discussions and led to changes in five departmental procedures. Although the results of this study are preliminary and require further verification, they suggest that with modifications and careful attention to implementation, the UCDSS may be an expensive but potentially useful tool for in-hospital quality review. In-hospital employment of the UCDSS offers more opportunities for practical use of algorithms for continuous quality improvement rather than the

  14. Authorship ignorance: views of researchers in French clinical settings

    PubMed Central

    Pignatelli, B; Maisonneuve, H; Chapuis, F

    2005-01-01

    Objectives: To assess the knowledge and behaviour of researchers regarding criteria for authorship, and the practices of ghost and gift authorship. Design: Semidirective interviews of senior clinical researchers. Setting: University hospital. Participants: Thirty-nine main investigators of clinical research programmes. Main measurements: Awareness and use of International Committee of Medical Journal Editors (ICMJE) criteria for authorship, and perceptions about ghost and gift authorship. Results: A total of 48 protocols submitted by 42 principal investigators between 1994 and 1996 were identified. Thirty-nine investigators were contacted; 37 (one of whom delegated a co-author) were interviewed between May 2002 and March 2003. Two co-authors of two principal investigators were also interviewed. In all, 42 studies were represented. The interviews lasted for 40–90 minutes and were conducted with openness and respect for confidentiality. The choice of names of co-authors did not follow the ICMJE recommendations. Half of the respondents stated they were aware of criteria for authorship and knew of ICMJE, but most of them did not cite any of the ICMJE criteria among those they applied in deciding authorship. Most of them disagreed with the obligation to meet the three criteria justifying co-authorship because they found these too rigid and inapplicable. Gift authorship was a common practice; 59% of the respondents had been a recipient of gift authorship. Twenty-five (64%) were aware of ghost authorship and the majority considered it questionable and blameworthy. Conclusions: The ICMJE criteria were ignored by clinicians at a university hospital. Ghost and gift authorship were frequent among them. There is a need for French guidelines for authorship to be prepared and implemented. PMID:16199598

  15. Montelukast in the treatment of perennial allergic rhinitis in paediatric Japanese patients; an open-label clinical trial

    PubMed Central

    Okubo, Kimihiro; Inoue, Yoichi; Numaguchi, Hirotaka; Tanaka, Kumi; Saito, Itori; Oshima, Nobuyuki; Matsumoto, Yuki; Prohn, Marita; Mehta, Anish; Nishida, Chisato; Philip, George

    2016-01-01

    Abstract Background: This study was conducted to evaluate the safety and tolerability, and population pharmacokinetics (PPK) of montelukast as well as efficacy in the treatment of perennial allergic rhinitis (PAR) in paediatric Japanese patients aged between 1 and 15 years. Methods: In this multi-centre, open-label trial, 87 paediatric Japanese patients with PAR received montelukast 4 mg oral granules (OG) for 4 weeks (1–5-year-olds, N = 15), 4 mg OG for 12 weeks (1–5-year-olds, N = 36), 5 mg chewable tablets (CT) for 12 weeks (6–9-year-olds, N = 18), or 5 mg CT for12 weeks (10–15-year-olds, N = 18). Clinical exams and laboratory assessments were conducted at study visits, and adverse events (AE) were monitored throughout the study up to 14 days after the last visit. Population pharmacokinetic approach was used to estimate AUC0–∞, Cmax, Tmax and apparent elimination half-life in each age group. Efficacy was assessed based on global evaluations by the subject’s caregiver. Results: There were no serious AEs and one discontinuation due to an AE. The most common AEs in any of the treatment groups were nasopharyngitis, pharyngitis, and acute sinusitis. Montelukast exposure (AUC0–∞) was similar in the 1–5-year-old group and the 6–9-year-old group, but 19% lower in the 10–15-year-old group. Among all patients, the total proportion of patients whose global evaluation was “very much better” was 5.7% (week 2), 11.5% (week 4), and 16.9% (week 12) reflecting improvement in symptoms over time. Conclusion: Montelukast was generally well tolerated in Japanese children with PAR. AUC0–∞was similar in 1–5 and 6–9-year-olds, while a lower exposure was observed in the 10–15-year-old group likely due to differences in bodyweight. The exposure in Japanese paediatric patients was generally consistent with that in non-Japanese paediatric and adult patients. As assessed by the patients’ caregivers, montelukast also

  16. Feasibility of Applying the Extended ICF Core Set for Stroke to Clinical Settings in Rehabilitation: A Preliminary Study

    PubMed Central

    Han, Kyu Yong; Kim, Hyo Jong

    2015-01-01

    Objective To evaluate the potential feasibility of application of the extended International Classification of Functioning, Disability and Health (ICF) Core Set for stroke. Methods We retrospectively reviewed the medical records of 40 stroke outpatients (>6 months after onset) admitted to the Department of Rehabilitation Medicine for comprehensive rehabilitation. Clinical information of the patients were respectively evaluated to link to the 166 second-level categories of the extended ICF Core Set for stroke. Results Clinical information could be linked to 111 different ICF categories, 58 categories of the body functions component, eight categories of the body structures component, 38 categories of the activities and participation component, and seven categories of the environmental factors component. Conclusion The body functions component might be feasible for application of the extended ICF Core Set for stroke to clinical settings. The activities and participation component and environmental factors component may not be directly applied to clinical settings without additional evaluation tools including interview and questionnaire. PMID:25750873

  17. The clinical conscientiousness index: a valid tool for exploring professionalism in the clinical undergraduate setting.

    PubMed

    Kelly, Martina; O'Flynn, Siun; McLachlan, John; Sawdon, Marina A

    2012-09-01

    The need to develop effective tools to measure professionalism continues to challenge medical educators; thus, as a follow-up to a recent examination of the "Conscientiousness Index" (CI, a novel measure of one facet of professionalism) in one setting with preclinical medical students, the authors aimed to investigate the validity of the CI as a proxy measure of professionalism in a different context and in the clinical phase of undergraduate medical education. In academic year 2009-2010, the authors collected data similar to those collected for the original preclinical study. In an effort to create a Clinical Conscientiousness Index (CCI) score, they collected the following information on 124 third-year medical students completing their clinical rotations: attendance, timeliness of assessment submissions, and completion of rotation evaluations. Then, they compared the resultant CCI scores with faculty views on professionalism and with formal assessments of students' professionalism (i.e., their portfolios and objective structured clinical examinations [OSCEs]). The authors demonstrate significant correlations between CCI scores and faculty views on professionalism (rS = 0.3; P = .001), and between CCI scores and OSCE score (rS = 0.237; P = .008), but not between CCI scores and portfolio assessment (rS = 0.084; P = .354). The authors also present relationships between CCI scores and demographics. The CCI is a practical, valid proxy measure of professionalism, achieving good correlation with faculty views on professionalism and clinical competency examinations, but not portfolio assessment, in one clinical undergraduate setting.

  18. Japanese nationwide surveillance in 2011 of antibacterial susceptibility patterns of clinical isolates from complicated urinary tract infection cases.

    PubMed

    Ishikawa, Kiyohito; Hamasuna, Ryoichi; Uehara, Shinya; Yasuda, Mitsuru; Yamamoto, Shingo; Hayami, Hiroshi; Takahashi, Satoshi; Matsumoto, Tetsuro; Minamitani, Shinichi; Kadota, Jun-ichi; Iwata, Satoshi; Kaku, Mitsuo; Watanabe, Akira; Sunakawa, Keisuke; Sato, Junko; Hanaki, Hideaki; Tsukamoto, Taiji; Kiyota, Hiroshi; Egawa, Shin; Deguchi, Takashi; Matsumoto, Minori; Tanaka, Kazushi; Arakawa, Soichi; Fujisawa, Masato; Kumon, Hiromi; Kobayashi, Kanao; Matsubara, Akio; Wakeda, Hironobu; Amemoto, Yoshinosuke; Onodera, Shoichi; Goto, Hirokazu; Komeda, Hisao; Yamashita, Masuo; Takenaka, Tadasu; Fujimoto, Yoshinori; Tsugawa, Masaya; Takahashi, Yoshito; Maeda, Hiroshi; Onishi, Hiroyuki; Ishitoya, Satoshi; Nishimura, Kazuo; Mitsumori, Kenji; Ito, Toru; Togo, Yoshikazu; Nakamura, Ichiro; Ito, Noriyuki; Kanamaru, Sojun; Hirose, Takaoki; Muranaka, Takashi; Yamada, Daisuke; Ishihara, Satoshi; Oka, Hiroya; Inatomi, Hisato; Matsui, Takashi; Kobuke, Makoto; Kunishima, Yasuharu; Kimura, Takahiro; Ichikawa, Takaharu; Kagara, Ichiro; Matsukawa, Masanori; Takahashi, Koichi; Mita, Koji; Kato, Masao; Okumura, Kazuhiro; Kawanishi, Hiroaki; Hashimura, Takayuki; Aoyama, Teruyoshi; Shigeta, Masanobu; Koda, Shuntaro; Taguchi, Keisuke; Matsuda, Yohei

    2015-09-01

    To investigate antimicrobial susceptibility patterns of various bacterial pathogens isolated from complicated urinary tract infection (UTI) cases, the Japanese Society of Chemotherapy, the Japanese Association of Infectious Disease, and the Japanese Society of Clinical Microbiology conducted the second nationwide surveillance from January to September 2011. With the cooperation of 42 medical institutions throughout Japan, 1036 strains belonging to 8 clinically relevant bacterial species were collected. Among methicillin-resistant Staphylococcus aureus (MRSA) strain, the vancomycin (VCM) MIC for 5.5% (3/55) of the strains was 2 μg/mL. Ampicillin, VCM, and linezolid were relatively active against 209 Enterococcus faecalis strains. The proportion of fluoroquinolone (FQ)-resistant strains was >20%. The MIC90 of FQs against the 382 Escherichia coli strains was 2-64 mg/L and the proportion resistant to FQs was approximately 30%. However, susceptibility of E. coli to sitafloxacin was still high (MIC90 = 2 mg/L). Fifty-eight (15.2%) of 382 E. coli, 6 (4.5%) of 132 Klebsiella pneumoniae, 1 (2.4%) of 41 Klebsiella oxytoca and 4 (6.8%) of 59 Proteus mirabilis strains were suspected of producing extended-spectrum beta-lactamase. Of 93 Pseudomonas aeruginosa strains, the proportions resistant to imipenem, amikacin, and ciprofloxacin were 21.5%, 4.3%, and 20.4%, respectively. Four strains (4.3%) were found to be multidrug-resistant. In complicated UTI cases, all of MRSA and E. faecalis were susceptible to all anti-MRSA agents. Sitafloxacin was active against other FQ-resistant E. coli strains. The isolation of extended-spectrum beta-lactamase-producing and multidrug-resistant strains increased.

  19. The Brøset Violence Checklist: clinical utility in a secure psychiatric intensive care setting.

    PubMed

    Clarke, D E; Brown, A-M; Griffith, P

    2010-09-01

    Violence towards health-care workers, especially in areas such as mental health/psychiatry, has become increasingly common, with nursing staff suggesting that a fear of violence from their patients may affect the quality of care they provide. Structured clinical tools have the potential to assist health-care providers in identifying patients who have the potential to become violent or aggressive. The Brøset Violence Checklist (BVC), a six-item instrument that uses the presence or absence of three patient characteristics and three patient behaviours to predict the potential for violence within a subsequent 24-h period, was trialled for 3 months on an 11-bed secure psychiatric intensive care unit. Despite the belief on the part of some nurses that decisions related to risk for violence and aggression rely heavily on intuition, there was widespread acceptance of the tool. During the trial, use of seclusion decreased suggesting that staff were able to intervene before seclusion was necessary. The tool has since been implemented as a routine part of patient care on two units in a 92-bed psychiatric centre. Five-year follow-up data and implications for practice are presented.

  20. The Japanese containerless experiments

    NASA Technical Reports Server (NTRS)

    Azuma, Hisao

    1990-01-01

    There are three sets of Japanese containerless experiments. The first is Drop dynamics research. It consists of acoustic levitation and large amplitude drop oscillation. The second is Optical materials processing in an acoustic levitation furnace. And the third is Electrostatic levitator development by two different Japanese companies.

  1. Prevalence of Sarcopenia and Associated Outcomes in the Clinical Setting.

    PubMed

    Peterson, Sarah J; Braunschweig, Carol A

    2016-02-01

    Sarcopenia refers to age-associated decrease in muscle mass and function. The condition was originally described in the elderly, but emerging evidence suggests that it is also a concern among the chronically ill nonelderly. Currently there are a number of definitions for diagnosing sarcopenia; however, in the clinical setting, abdominal computed tomography (CT) scans completed for diagnostic purposes can be utilized to identify CT-defined sarcopenia. Recent studies suggest that prevalence of CT-defined sarcopenia is high among chronically ill patients, ranging from 15%-50% in patients with cancer, 30%-45% with liver failure, and 60%-70% for critically ill patients in the intensive care unit. Depleted muscle mass is associated with infectious complications, prolonged duration of mechanical ventilation, longer hospitalization, greater need for rehabilitation care after hospital discharge, and higher mortality. In consideration of the growing population of older adults with multiple comorbidities, more research is needed to identify sarcopenia and develop interventions that are directed at attenuating or reversal muscle loss.

  2. Mutation Profile of B-Raf Gene Analyzed by fully Automated System and Clinical Features in Japanese Melanoma Patients.

    PubMed

    Ide, Masaru; Koba, Shinichi; Sueoka-Aragane, Naoko; Sato, Akemi; Nagano, Yuri; Inoue, Takuya; Misago, Noriyuki; Narisawa, Yutaka; Kimura, Shinya; Sueoka, Eisaburo

    2017-01-01

    BRAF gene mutations have been observed in 30-50 % of malignant melanoma patients. Recent development of therapeutic intervention using BRAF inhibitors requires an accurate and rapid detection system for BRAF mutations. In addition, the clinical characteristics of the melanoma associated with BRAF mutations in Japanese patients have not been investigated on a large scale evaluation. We recently established quenching probe system (QP) for detection of an activating BRAF mutation, V600E and evaluated 113 melanoma samples diagnosed in Saga University Hospital from 1982 to 2011. The QP system includes fully automated genotyping, based on analysis of the probe DNA melting curve, which binds the target mutated site using a fluorescent guanine quenched probe. BRAF mutations were detected in 54 of 115 (47 %) including 51 of V600E and 3 of V600 K in Japanese melanoma cases. Among clinical subtypes of melanoma, nodular melanoma showed high frequency (12 of 15; 80 %) of mutation followed by superficial spreading melanoma (13 of 26; 50 %). The QP system is a simple and sensitive method to determine BRAF V600E mutation, and will be useful tool for patient-oriented therapy with BRAF inhibitors.

  3. Being a mindful clinical teacher: can mindfulness enhance education in a clinical setting?

    PubMed

    Dobkin, Patricia L; Laliberté, Vincent

    2014-04-01

    Mindfulness may be viewed as a vehicle to promote the healer's role in medicine. This role addresses the way in which a medical practitioner interacts with patients. The aim of this article is to highlight how mindful qualities may also enhance teaching in clinical settings. Challenges to being a mindful clinical teacher are presented along with creative ways to accommodate them. Residents play an important role in training medical students. Examples of how mindfulness influenced a psychiatric resident's teaching experiences are presented to illustrate the concepts discussed herein. The dimension of "being" in medicine, based on the humanist philosophy of Dr Karl Jaspers, is provided as a framework for this article.

  4. A prototype model using clinical document architecture (CDA) with a Japanese local standard : designing and implementing a referral letter system.

    PubMed

    Yong, Huang; Jinqiu, Guo; Ohta, Yoshio

    2008-02-01

    Since clinical document architecture (CDA) became an American National Standards Institute (ANSI)-approved health level seven (HL7) Standard, many countries have begun making an effort to make local standards conform to CDA. In order to make CDA compatible with the many different local standards existing in different countries, we designed a prototype model using HL7 CDA R2 with medical markup language (MML), a Japanese medical data exchange standard. Furthermore, a referral letter system based on this model was developed. Archetypes were used to express medical concepts in a formal manner and to make 2 different standards work collaboratively. We share herein the experience gathered in designing and implementing a referral letter system based on HL7 CDA, Release 2 (CDA R2). We also outline the challenges encountered in our project and the opportunities to widen the scope of this approach to other clinical documents.

  5. Clinical and immunological studies for 105 Japanese seropositive patients of epidermolysis bullosa acquisita examined at Kurume University.

    PubMed

    Hashimoto, Takashi; Jin, Zhexiong; Ishii, Norito

    2016-08-01

    Using our serological diagnostic criteria, we selected 105 Japanese patients with epidermolysis bullosa acquisita (EBA), an autoimmune bullous disease (AIBD) reacting with type VII collagen, from our cohort of 5063 AIBD patients. We examined the patients clinically and immunologically. We found diversity of clinical manifestations in both cutaneous and oral mucosal lesions and a high rate of inflammatory-type EBA patients in Japan. Common treatments were systemic steroids, followed by immunosuppressives, DDS, tetracycline/minocycline and colchicine. Immunological studies revealed that indirect immunofluorescence of 1M-NaCl-split skin, immunoblotting of dermal extract, and type VII collagen ELISA were sensitive methods, with possible multiplicity of circulating autoantibodies against other basement membrane autoantigens. The present study analyzed the largest cohort of EBA patients, confirming the scarcity of EBA (only 105 of the 5063 AIBD patients), and showed that the three serological tests are useful for the diagnosis of EBA.

  6. Effects of HLA-DRB1 alleles on susceptibility and clinical manifestations in Japanese patients with adult onset Still's disease.

    PubMed

    Asano, Tomoyuki; Furukawa, Hiroshi; Sato, Shuzo; Yashiro, Makiko; Kobayashi, Hiroko; Watanabe, Hiroshi; Suzuki, Eiji; Ito, Tomoyuki; Ubara, Yoshifumi; Kobayashi, Daisuke; Iwanaga, Nozomi; Izumi, Yasumori; Fujikawa, Keita; Yamasaki, Satoshi; Nakamura, Tadashi; Koga, Tomohiro; Shimizu, Toshimasa; Umeda, Masataka; Nonaka, Fumiaki; Yasunami, Michio; Ueki, Yukitaka; Eguchi, Katsumi; Tsuchiya, Naoyuki; Tohma, Shigeto; Yoshiura, Koh-Ichiro; Ohira, Hiromasa; Kawakami, Atsushi; Migita, Kiyoshi

    2017-09-12

    HLA-DRB1 alleles are major determinants of genetic predisposition to rheumatic diseases. We assessed whether DRB1 alleles are associated with susceptibility to particular clinical features of adult onset Still's disease (AOSD) in a Japanese population by determining the DRB1 allele distributions. DRB1 genotyping of 96 patients with AOSD and 1,026 healthy controls was performed. Genomic DNA samples from the AOSD patients were also genotyped for MEFV exons 1, 2, 3, and 10 by direct sequencing. In Japanese patients with AOSD, we observed a predisposing association of DRB1*15:01 (p = 8.60 × 10(-6), corrected p (Pc) = 0.0002, odds ratio (OR) = 3.04, 95% confidence interval (95% CI) = 1.91-4.84) and DR5 serological group (p = 0.0006, OR = 2.39, 95% CI = 1.49-3.83) and a protective association of DRB1*09:01 (p = 0.0004, Pc = 0.0110, OR = 0.34, 95% CI = 0.18-0.66) with AOSD, and amino acid residues 86 and 98 of the DRβ chain were protectively associated with AOSD. MEFV variants were identified in 49 patients with AOSD (56.3%). The predisposing effect of DR5 was confirmed only in patients with AOSD who had MEFV variants and not in those without MEFV variants. Additionally, DR5 in patients with AOSD are associated with macrophage activation syndrome (MAS) and steroid pulse therapy. The DRB1*15:01 and DR5 are both associated with AOSD susceptibility in Japanese subjects. A protective association between the DRB1*09:01 allele and AOSD was also observed in these patients. Our data also highlight the effects of DRB1 alleles in susceptibility to AOSD.

  7. Decaying relevance of clinical data towards future decisions in data-driven inpatient clinical order sets.

    PubMed

    Chen, Jonathan H; Alagappan, Muthuraman; Goldstein, Mary K; Asch, Steven M; Altman, Russ B

    2017-06-01

    Determine how varying longitudinal historical training data can impact prediction of future clinical decisions. Estimate the "decay rate" of clinical data source relevance. We trained a clinical order recommender system, analogous to Netflix or Amazon's "Customers who bought A also bought B..." product recommenders, based on a tertiary academic hospital's structured electronic health record data. We used this system to predict future (2013) admission orders based on different subsets of historical training data (2009 through 2012), relative to existing human-authored order sets. Predicting future (2013) inpatient orders is more accurate with models trained on just one month of recent (2012) data than with 12 months of older (2009) data (ROC AUC 0.91 vs. 0.88, precision 27% vs. 22%, recall 52% vs. 43%, all P<10(-10)). Algorithmically learned models from even the older (2009) data was still more effective than existing human-authored order sets (ROC AUC 0.81, precision 16% recall 35%). Training with more longitudinal data (2009-2012) was no better than using only the most recent (2012) data, unless applying a decaying weighting scheme with a "half-life" of data relevance about 4 months. Clinical practice patterns (automatically) learned from electronic health record data can vary substantially across years. Gold standards for clinical decision support are elusive moving targets, reinforcing the need for automated methods that can adapt to evolving information. Prioritizing small amounts of recent data is more effective than using larger amounts of older data towards future clinical predictions. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  8. Cost of Dry Eye Treatment in an Asian Clinic Setting

    PubMed Central

    Waduthantri, Samanthila; Yong, Siew Sian; Tan, Chien Hua; Shen, Liang; Lee, Man Xin; Nagarajan, Sangeetha; Hla, Mynt Htoon; Tong, Louis

    2012-01-01

    Objectives To estimate the cost and patterns of expenditure of dry eye treatment. Methodology We retrieved data on the type and cost of dry eye treatment in Singapore National Eye Centre from pharmacy and clinic inventory databases over a 2 year period (2008–2009) retrospectively. According to the type of treatment, data were sorted into 7 groups; meibomien gland disease (MGD) treatment, preservative free lubricant eye drops, preserved lubricant eye drops, lubricant ointments and gels, cyclosporine eye drops, oral supplements and non-pharmacological treatments/procedures. Each recorded entry was considered as one patient episode (PE). Comparisons in each group between two years were carried out using Pearson Chi-Square test. Significance level was set at alpha  = 0.05. Results Cost data from 54,052 patients were available for analysis. Total number of recorded PEs was 132,758. Total annual expenditure on dry eye treatment for year 2008 and 2009 were US$1,509,372.20 and US$1,520,797.80 respectively. Total expenditure per PE in year 2008 and 2009 were US$22.11 and US$23.59 respectively. From 2008 to 2009, there was a 0.8% increase in total annual expenditure and 6.69% increase in expenditure per PE. Pharmacological treatment attributes to 99.2% of the total expenditure with lubricants accounting for 79.3% of the total pharmacological treatment expenditure. Total number of units purchased in preservative free lubricants, cyclosporine eye drops and MGD therapy have increased significantly (p<0.001) whereas number of units purchased in preserved lubricants and ointments/gels have reduced significantly (p<0.001) from 2008 to 2009. Conclusion Dry Eye imposes a significant direct burden to health care expenditure even without considering indirect costs. Health care planners should be aware that these direct costs appear to increase over the time and more so for particular types of medications. Given the limitations of socio-economic data, true societal costs of Dry

  9. Setting up a clinical psychology service for commercial sex workers.

    PubMed

    Stevenson, Clare; Petrak, Jenny

    2007-04-01

    The objective of this study was to provide what we believe to be the first report of the establishment of a clinical psychology service to provide accessible psychological assessment, intervention and crisis support, integrated within an existing East London sexual health clinical and outreach service for commercial sex workers (CSWs). Data are presented on referral patterns, demographics, presenting issues to clinical psychology, interventions and outcomes for the first year of the service. Women presented with a range of psychosocial needs. Psychological interventions included direct therapy, signposting to other services and consultation with staff. We concluded that this flexible model of service provision improves access to mental health services within the context of a specialist sexual health and outreach service for CSWs. The provision of a named, female clinical psychologist who provides both the clinical sessions and attends outreach has been an important factor in developing trust and familiarity, leading to better uptake of the clinical psychology service.

  10. Effects of cognitive stimulation therapy Japanese version (CST-J) for people with dementia: a single-blind, controlled clinical trial.

    PubMed

    Yamanaka, Katsuo; Kawano, Yoshiyuki; Noguchi, Dai; Nakaaki, Shutaro; Watanabe, Norio; Amano, Takashi; Spector, Aimee

    2013-01-01

    Cognitive stimulation therapy (CST) has shown to have significant benefits in improving the cognitive function and quality of life (QOL) in people with mild-to-moderate dementia in a UK randomized controlled trial (RCT). We developed and examined the Japanese version of group CST (CST-J) in a single-blind, controlled clinical trial. CST-J consisting of 14 sessions was administered to a treatment group (n = 26) twice a week for 7 weeks. The treatment group was compared with a control group (n = 30). Based on single-blindness, cognition was evaluated by a researcher, and QOL and mood were rated by the participants themselves. Additionally, QOL and mood of participants were rated by care workers who were not blind but who observed them most directly in their daily life (important for social validity). A linear mixed model was used for analyses of cognition and QOL. There were significant improvements in cognition [COGNISTAT (Neurobehavioral Cognitive Status Examination) and MMSE (Mini-Mental State Examination)] for the treatment group compared with the control group (p < 0.01). Regarding QOL, the EQ-5D was significant (p = 0.019) and the QoL-AD (Quality of Life - Alzheimer's Disease) showed a positive trend (p = 0.06) when rated by care workers, although not when rated by the participants themselves. Using a nonparametrical analysis, there were significant improvements in the face scale for mood when rated by both the participants (p < 0.01) and the care workers (p = 0.017). The CST-J shows promising improvements in cognition, mood, and aspects of QOL for people with dementia in Japanese care settings. A large RCT is now needed.

  11. Effects of cognitive stimulation therapy Japanese version (CST-J) for people with dementia: a single-blind, controlled clinical trial

    PubMed Central

    Yamanaka, Katsuo; Kawano, Yoshiyuki; Noguchi, Dai; Nakaaki, Shutaro; Watanabe, Norio; Amano, Takashi; Spector, Aimee

    2013-01-01

    Objectives Cognitive stimulation therapy (CST) has shown to have significant benefits in improving the cognitive function and quality of life (QOL) in people with mild-to-moderate dementia in a UK randomized controlled trial (RCT). We developed and examined the Japanese version of group CST (CST-J) in a single-blind, controlled clinical trial. Method CST-J consisting of 14 sessions was administered to a treatment group (n = 26) twice a week for 7 weeks. The treatment group was compared with a control group (n = 30). Based on single-blindness, cognition was evaluated by a researcher, and QOL and mood were rated by the participants themselves. Additionally, QOL and mood of participants were rated by care workers who were not blind but who observed them most directly in their daily life (important for social validity). Results A linear mixed model was used for analyses of cognition and QOL. There were significant improvements in cognition [COGNISTAT (Neurobehavioral Cognitive Status Examination) and MMSE (Mini-Mental State Examination)] for the treatment group compared with the control group (p < 0.01). Regarding QOL, the EQ-5D was significant (p = 0.019) and the QoL-AD (Quality of Life – Alzheimer's Disease) showed a positive trend (p = 0.06) when rated by care workers, although not when rated by the participants themselves. Using a nonparametrical analysis, there were significant improvements in the face scale for mood when rated by both the participants (p < 0.01) and the care workers (p = 0.017). Conclusion The CST-J shows promising improvements in cognition, mood, and aspects of QOL for people with dementia in Japanese care settings. A large RCT is now needed. PMID:23550665

  12. Perceptions of Anatomy: Critical Components in the Clinical Setting

    ERIC Educational Resources Information Center

    Lazarus, Michelle D.; Chinchilli, Vernon M.; Leong, Shou Ling; Kauffman, Gordon L., Jr.

    2012-01-01

    The evolution in undergraduate medical school curricula has significantly impacted anatomy education. This study investigated the perceived role of clinical anatomy and evaluated perceptions of medical students' ability to apply anatomical knowledge in the clinic. The aim of this study was to develop a framework to enhance anatomical educational…

  13. Perceptions of Anatomy: Critical Components in the Clinical Setting

    ERIC Educational Resources Information Center

    Lazarus, Michelle D.; Chinchilli, Vernon M.; Leong, Shou Ling; Kauffman, Gordon L., Jr.

    2012-01-01

    The evolution in undergraduate medical school curricula has significantly impacted anatomy education. This study investigated the perceived role of clinical anatomy and evaluated perceptions of medical students' ability to apply anatomical knowledge in the clinic. The aim of this study was to develop a framework to enhance anatomical educational…

  14. PSYCHOLOGY IN COMMUNITY SETTINGS--CLINICAL, EDUCATIONAL, VOCATIONAL, SOCIAL ASPECTS.

    ERIC Educational Resources Information Center

    SARASON, SEYMOUR B.; AND OTHERS

    IN THIS DESCRIPTION OF THE PSYCHOEDUCATIONAL CLINIC IN THE DEPARTMENT OF PSYCHOLOGY AT YALE UNIVERSITY, THE CLINIC'S HISTORICAL AND PROFESSIONAL ORIGINS ARE REVIEWED, AND ITS RELATIONSHIP TO THE SCHOOLS THAT IT SERVES DISCUSSED. SPECIFIC TOPICS CONSIDERED ARE (1) THE APPROACH TO THE SCHOOLS, (2) TEACHING IS A LONELY PROFESSION, (3) HELPING TO…

  15. Evaluation of factors affecting continuous performance test identical pairs version score of schizophrenic patients in a Japanese clinical sample.

    PubMed

    Koide, Takayoshi; Aleksic, Branko; Kikuchi, Tsutomu; Banno, Masahiro; Kohmura, Kunihiro; Adachi, Yasunori; Kawano, Naoko; Iidaka, Tetsuya; Ozaki, Norio

    2012-01-01

    Aim. Cognitive impairment in schizophrenia strongly relates to social outcome and is a good candidate for endophenotypes. When we accurately measure drug efficacy or effects of genes or variants relevant to schizophrenia on cognitive impairment, clinical factors that can affect scores on cognitive tests, such as age and severity of symptoms, should be considered. To elucidate the effect of clinical factors, we conducted multiple regression analysis using scores of the Continuous Performance Test Identical Pairs Version (CPT-IP), which is often used to measure attention/vigilance in schizophrenia. Methods. We conducted the CPT-IP (4-4 digit) and examined clinical information (sex, age, education years, onset age, duration of illness, chlorpromazine-equivalent dose, and Positive and Negative Symptom Scale (PANSS) scores) in 126 schizophrenia patients in Japanese population. Multiple regression analysis was used to evaluate the effect of clinical factors. Results. Age, chlorpromazine-equivalent dose, and PANSS-negative symptom score were associated with mean d' score in patients. These three clinical factors explained about 28% of the variance in mean d' score. Conclusions. As conclusion, CPT-IP score in schizophrenia patients is influenced by age, chlorpromazine-equivalent dose and PANSS negative symptom score.

  16. Placing wireless tablets in clinical settings for patient education

    PubMed Central

    Stribling, Judy C.; Richardson, Joshua E.

    2016-01-01

    Objective The authors explored the feasibility and possible benefit of tablet-based educational materials for patients in clinic waiting areas. Methods We distributed eight tablets preloaded with diagnosis-relevant information in two clinic waiting areas. Patients were surveyed about satisfaction, usability, and effects on learning. Technical issues were resolved. Results Thirty-seven of forty patients completed the survey. On average, the patients were satisfied in all categories. Conclusions Placing tablet-based educational materials in clinic waiting areas is relatively easy to implement. Patients using tablets reported satisfaction across three domains: usability, education, and satisfaction. PMID:27076806

  17. Clinical radiographic features of the wrist without osteoarthritis and its relations to age and sex in Japanese.

    PubMed

    Katayama, Takeshi; Ono, Hiroshi; Furuta, Kazuhiko; Akahane, Manabu; Omokawa, Shohei

    2015-01-01

    The purpose of this study was to identify a clinical radiographic features containing the measurements of carpal alignment, configuration, and joint space width of the wrist without osteoarthritis (OA) in Japanese. We also aimed to analyse age-related correlations in these parameters with reference to the difference between men and women. A total of 184 cases were analysed to establish the following relations: (1) Sex-related differences in the morphology and joint space width of the wrist without OA; (2) correlation coefficient between these parameters and age according to sex. This study suggests that carpal height ratio (CHR) was higher in men than in women. Also the ulnar variance (UV) increased and the radial inclination (RI) decreased with age in both men and women, and the volar tilt (VT) decreased with age in women.

  18. Analysis of hip geometry by clinical CT for the assessment of hip fracture risk in elderly Japanese women.

    PubMed

    Ito, Masako; Wakao, Norimitsu; Hida, Tetsuro; Matsui, Yasumoto; Abe, Yasue; Aoyagi, Kiyoshi; Uetani, Masataka; Harada, Atsushi

    2010-02-01

    Two case-control studies were designed to investigate the contribution of the geometry and bone mineral density (BMD) of the proximal femur to bone strength in Japanese elderly women. We also investigated whether clinical CT is useful to assess the risk of hip fracture. Subjects in the neck fracture study included 20 Japanese women with neck fracture (age: mean+/-SD; 80.1+/-4.5 years old) and 20 age-matched control women (79.2+/-2.6 years old). Subjects in the trochanteric fracture study included 16 Japanese women with trochanteric fracture (82.6+/-5.0 years old) and 16 age-matched control women (80.8+/-3.8 years old). CT examination of the proximal femur was performed between the date of admission and the date of surgery. The CT scanners used were an Aquillion 16 (Toshiba) and Somatom 64 (Siemens); the scanning conditions including spatial resolution and scanning energy were adjusted, and the same type of reference phantom containing hydroxyapatite was used. QCT PRO software (Mindways) was used to analyze data for BMD, geometry, and biomechanical parameters. Both the neck and trochanteric fracture cases had significantly lower total and cortical BMD, a significantly smaller cortical cross-sectional area (CSA), and a larger trabecular CSA. Both had significantly thinner cortex and smaller distance to center of bone mass, and women with trochanteric fracture had a significantly smaller cortical perimeter in the cross-sectional femoral neck. Women with neck fracture had a longer hip axis length (HAL) and women with trochanteric fracture had a significantly larger neck-shaft angle (NSA). Both groups had significantly lower cross-sectional moment of inertia (CSMI), and only women with neck fracture had a significantly higher buckling ratio (BR) compared to their respective controls. According to the multiple logistic regression analysis, women with neck fracture had a significantly longer HAL, lower CSMI, and higher BR, and women with trochanteric fracture had a

  19. [Gender difference of clinical features in Japanese patients with alcoholic liver cirrhosis].

    PubMed

    Kawashima, Osamu; Ohata, Mitsuru; Sakamoto, Kazuhiko; Hashimoto, Kenichi; Nakajima, Hisato; Yamauchi, Masayoshi

    2003-02-01

    Gender difference of alcohol intake and laboratory data was investigated in 165 Japanese patients with alcoholic liver cirrhosis. Mean age of first drinking and habitual drinking were higher in female. Duration of drinking was shorter in female. Although cumulative alcohol intake was larger in male, mean daily alcohol intake did not differ in both gender. Moreover, daily alcohol intake adjusted to body weight was significantly larger in female. Body mass index, serum levels of total protein, albumin and cholinesterase were significantly decreased in female. Platelet counts on admission did not differ in both gender. However, it was significantly increased in female after one month abstinence. C reactive protein, ammonia and serum levels of total bilirubin were significantly higher in female as compared to male. In conclusion, female alcoholics seems to progress to liver cirrhosis earlier because of high daily alcohol intake adjusted to body weight, poor nutritional condition and inflammation caused by endotoxin.

  20. Diabetes prevention information in Japanese magazines with the largest print runs. Content analysis using clinical guidelines as a standard.

    PubMed

    Noda, Emi; Mifune, Taka; Nakayama, Takeo

    2013-01-01

    To characterize information on diabetes prevention appearing in Japanese general health magazines and to examine the agreement of the content with that in clinical practice guidelines for the treatment of diabetes in Japan. We used the Japanese magazines' databases provided by the Media Research Center and selected magazines with large print runs published in 2006. Two medical professionals independently conducted content analysis based on items in the diabetes prevention guidelines. The number of pages for each item and agreement with the information in the guidelines were determined. We found 63 issues of magazines amounting to 8,982 pages; 484 pages included diabetes prevention related content. For 23 items included in the diabetes prevention guidelines, overall agreement of information printed in the magazines with that in the guidelines was 64.5% (471 out of 730). The number of times these items were referred to in the magazines varied widely, from 247 times for food items to 0 times for items on screening for pregnancy-induced diabetes, dyslipidemia, and hypertension. Among the 20 items that were referred to at least once, 18 items showed more than 90% agreement with the guidelines. However, there was poor agreement for information on vegetable oil (2/14, 14%) and for specific foods (5/247, 2%). For the fatty acids category, "fat" was not mentioned in the guidelines; however, the term frequently appeared in magazines. "Uncertainty" was never mentioned in magazines for specific food items. The diabetes prevention related content in the health magazines differed from that defined in clinical practice guidelines. Most information in the magazines agreed with the guidelines, however some items were referred to inappropriately. To disseminate correct information to the public on diabetes prevention, health professionals and the media must collaborate.

  1. Linezolid minimum inhibitory concentration (MIC) creep in methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates at a single Japanese center.

    PubMed

    Miyazaki, Motoyasu; Nagata, Nobuhiko; Miyazaki, Hiroyuki; Matsuo, Koichi; Takata, Tohru; Tanihara, Shinichi; Kamimura, Hidetoshi

    2014-01-01

    The aim of this study was to evaluate whether linezolid minimum inhibitory concentration (MIC) creep occurred in Staphylococcus aureus clinical isolates, including methicillin-resistant S. aureus (MRSA), over a recent 5-year period at a single Japanese center. A total of 453 MRSA and 195 methicillin-susceptible S. aureus (MSSA) isolates recovered from inpatients from April 1, 2008 to March 31, 2013 were analyzed. The MIC of linezolid was determined by automated Vitek-2 system. The modal MIC, MIC range, MIC50 and MIC90 (MICs required to inhibit the growth of 50% and 90% of organisms, respectively), geometric mean MIC and percentages of susceptible and resistant isolates were evaluated for each fiscal year. None of the S. aureus isolates were resistant to linezolid. Isolates with an MIC of >1 µg/mL were more common in the MSSA samples than in the MRSA samples (91.3% versus 38.2%, p<0.001). The linezolid geometric mean MIC increased by 0.403 µg/mL (from 1.178 in 2008 to 1.582 in 2012) in the MRSA isolates (p=0.006, r(2)=0.945 according to a linear regression analysis) over the 5-year period; however, no increase was observed in the MSSA isolates. The frequency of MRSA isolates with an MIC of 1 µg/mL decreased (from 76.3% in 2008 to 35.4% in 2012) and the isolates with MICs of >1 µg/mL increased over time (from 23.7% in 2008 to 64.6% in 2012). This report demonstrates the occurrence of linezolid MIC creep, as determined using the geometric mean MIC, in MRSA clinical isolates at a single Japanese center.

  2. Clinical significance of visceral adiposity assessed by computed tomography: A Japanese perspective

    PubMed Central

    Ryo, Miwa; Kishida, Ken; Nakamura, Tadashi; Yoshizumi, Tohru; Funahashi, Tohru; Shimomura, Iichiro

    2014-01-01

    Abdominal obesity, rather than total amount of fat, is linked to obesity-related disorders. Visceral adiposity is an important component of obesity-related disorders in Japanese individuals with a mild degree of adiposity compared with Western subjects. In 1983, our group reported techniques for body fat analysis using computed tomography (CT) and established the concept of visceral fat obesity in which intra-abdominal fat accumulation is an important factor in the development of obesity-related complications, such as diabetes, lipid disorders, hypertension and atherosclerosis. Our group also established ideal imaging conditions for determining abdominal fat area at the umbilical level CT scan. Visceral fat area (VFA) measured in a single slice at L4 level correlated significantly with the total abdominal visceral fat volume measured on multislice CT scan. In a large-scale study of a Japanese population, the mean number of obesity-related cardiovascular risk factors (hypertension, low high-density lipoprotein cholesterolemia and/or hypertriglyceridemia, and hyperglycemia) was greater than 1.0 at 100 cm2 of VFA, irrespective of gender, age and body mass index. Our group also demonstrated that reduction of visceral fat accumulation subsequent to voluntary lifestyle modification, “Hokenshido”, correlated with a decrease in the number of obesity-related cardiovascular risk factors. It is important to select the most appropriate subjects from the general population (e.g., non-obese subjects with a cluster of risk factors for the metabolic syndrome) that are most suitable for body weight reduction, with the goal of preventing atherosclerotic cardiovascular diseases. PMID:25071881

  3. [Performance neutrophil gelatinase-associated lipocalin in clinical settings].

    PubMed

    Gala-Bładzińska, Agnieszka; Kuzniewski, Marek

    2013-01-01

    Acute kidney injury (AKI) is largely asymptomatic, and establishing the diagnosis in thisin creasingly common disorder currently hinges on functional biomarkers such as serum creatinine. Early neutrophil gelatinase-associated lipocalin (NGAL) measurements can identify patients with sub-clinical AKI who have an increased risk of adverse outcomes, even in the absence of diagnostic increases in serum creatinine. NGAL is emerging as an excellent biomarker in the urine and plasma, for the early prediction of AKI, for monitoring clinical trials in AKI, and for the prognosis of AKI in several common clinical scenarios. Also numerous studies have also demonstrated that NGAL may be a potential biomarker for the diagnosis, prediction, prevention, and prognosis of non-AKI diseases such as chronic kidney diseases, vascular disorders, cancer, preeclampsia, and allergies. The current status of the most promising of novel biomarkers in medicin as NGAL is appraised in this review.

  4. Best Practices in Assessment for School and Clinical Settings.

    ERIC Educational Resources Information Center

    Vance, H. Booney, Ed.

    This book is designed to provide insight into the ways in which psychologists conduct psychoeducational assessments in a variety of settings. Each contributed chapter gives a detailed and practical discussion of a particular assessment instrument or strategy along with a detailed case study. Chapters have the following titles and authors:…

  5. Clinical Guide to Music Therapy in Physical Rehabilitation Settings

    ERIC Educational Resources Information Center

    Wong, Elizabeth

    2004-01-01

    Elizabeth Wong, MT-BC presents tools and information designed to arm the entry-level music therapist (or an experienced MT-BC new to rehabilitation settings) with basic knowledge and materials to develop or work in a music therapy program treating people with stroke, brain injury, and those who are ventilator dependent. Ms. Wong offers goals and…

  6. Clinical Guide to Music Therapy in Physical Rehabilitation Settings

    ERIC Educational Resources Information Center

    Wong, Elizabeth

    2004-01-01

    Elizabeth Wong, MT-BC presents tools and information designed to arm the entry-level music therapist (or an experienced MT-BC new to rehabilitation settings) with basic knowledge and materials to develop or work in a music therapy program treating people with stroke, brain injury, and those who are ventilator dependent. Ms. Wong offers goals and…

  7. Exploring ward nurses' perceptions of continuing education in clinical settings.

    PubMed

    Govranos, Melissa; Newton, Jennifer M

    2014-04-01

    Health care systems demand that nurses are flexible skilful workers who maintain currency and competency in order to deliver safe effective patient centered care. Nurses must continually build best practice into their care and acquire lifelong learning. Often this learning is acquired within the work environment and is facilitated by the clinical nurse educator. Understanding clinical nurses' values and needs of continuing education is necessary to ensure appropriate education service delivery and thus enhance patient care. To explore clinical ward-based nurses' values and perceptions towards continuing education and what factors impact on continuing education in the ward. A case study approach was utilized. A major teaching hospital in Melbourne, Australia. A range of clinical nursing staff (n=23). Four focus groups and six semi-structured individual interviews were undertaken. Focus group interviews explored participants' values and perceptions on continuing education through a values clarification tool. Thematic analysis of interviews was undertaken to identify themes and cluster data. Three central themes: 'culture and attitudes', 'what is learning?' and 'being there-being seen', emerged reflecting staffs' values and perceptions of education and learning in the workplace. Multiple factors influence ward nurses' ability and motivation to incorporate lifelong learning into their practice. Despite variance in nurses' values and perceptions of CE in clinical environments, CE was perceived as important. Nurses yearned for changes to facilitate lifelong learning and cultivate a learning culture. Clinical nurse educators need to be cognizant of adult learners' characteristics such as values, beliefs, needs and potential barriers, to effectively facilitate support in a challenging and complex learning environment. Organizational support is essential so ward managers in conjunction with educational departments can promote and sustain continuing education, lifelong

  8. Chairside Assisting Skill Evaluation (CASE). Clinical Setting. Health Manpower References.

    ERIC Educational Resources Information Center

    Innovative Programming Systems, Minneapolis, Minn.

    These checklists are designed for use during the dental assistant student's extramural clinical experience assignment. Checklists test students on their knowledge of terminology, equipment, procedures, and patient relations. Objectives are listed outline style with columns to check progress during a first and a second evaluation. Areas included…

  9. Pediatric Headache and Epilepsy Comorbidity in the Pragmatic Clinical Setting.

    PubMed

    Papavasiliou, Antigone S; Bregianni, Marianna; Nikaina, Irene; Kotsalis, Charalambos; Paraskevoulakos, Evangelos; Bazigou, Helen

    2016-04-01

    Demographic and clinical data were collected from three cross-sectional samples, from the headache and epilepsy clinics according to respective protocols. During structured interviews, we examined the co-occurrence of headaches and epilepsy in children and their families: (1) 172 children from the headache clinic, were questioned for the number and type of epileptic seizures and epilepsy diagnosis. (2) Around 70 children from the epilepsy clinic for the frequency and type of headaches and headache syndrome diagnosis. (3) A total of 149 parents of children with benign childhood epilepsy with centro-temporal spikes (BCECTS) and childhood absence epilepsy (CAE), for the relative frequency of headaches in first- and second-degree relatives. Out of 172, 84 (48.8%) children with headache had a migraine and 60 (34.9%) had tension headaches; 3 children (1.7%) had epilepsy or unprovoked seizures. Migraine and epilepsy, co-occurred in 2/84 (2.3%). Eight out of 70 patients with epilepsy had headaches (11.4%); none had migraine. Around 43% of patients with BCECTS or CAE had a family history of headache, more prevalent in first-degree relatives of children with BCECTS than CAE. Contrary to existing literature, migraine and epilepsy, co-occurred infrequently in these highly selected samples. Family history of headache was frequent in patients with BCECTS and CAE, without any significant difference between the two. Georg Thieme Verlag KG Stuttgart · New York.

  10. Chairside Assisting Skill Evaluation (CASE). Clinical Setting. Health Manpower References.

    ERIC Educational Resources Information Center

    Innovative Programming Systems, Minneapolis, Minn.

    These checklists are designed for use during the dental assistant student's extramural clinical experience assignment. Checklists test students on their knowledge of terminology, equipment, procedures, and patient relations. Objectives are listed outline style with columns to check progress during a first and a second evaluation. Areas included…

  11. Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics:Randomized Clinical Trial

    PubMed Central

    Naik, Aanand D.; Palmer, Nynikka; Petersen, Nancy J.; Street, Richard L.; Rao, Radha; Suarez-Almazor, Maria; Haidet, Paul

    2011-01-01

    Background Diabetes group clinics can effectively control hypertension, but data to support glycemic control is equivocal. This study evaluated the comparative effectiveness of two diabetes group clinic interventions on glycosolated hemoglobin (HbA1c) levels in primary care. Methods Participants (n = 87) were recruited from a diabetes registry of a single regional VA medical center to participate in an open, randomized comparative effectiveness study. Two primary care based diabetes group interventions of three months duration were compared. Empowering Patients in Care (EPIC) was a clinician-led, patient-centered group clinic consisting of four sessions on setting self-management action plans (diet, exercise, home monitoring, medications, etc.) and communicating about progress with action plans. The comparison intervention consisted of group education sessions with a diabetes educator and dietician followed by an additional visit with one’s primary care provider. HbA1c levels were compared post-intervention and at one-year follow-up. Results Participants in the EPIC intervention had significantly greater improvements in HbA1c levels immediately following the active intervention (8.86 to 8.04 vs. 8.74 to 8.70, mean [SD] between-group difference 0.67±1.3, P=.03) and these differences persisted at 1 year follow-up (.59±1.4, P=.05). A repeated measures analysis using all study time points found a significant time-by-treatment interaction effect on HbA1c levels favoring the EPIC intervention (F(2,85) =3.55, P= .03). The effect of the time-by-treatment interaction appears to be partially mediated by diabetes self-efficacy (F(1,85) =10.39, P= .002). Conclusions Primary care based diabetes group clinics that include structured goal-setting approaches to self-management can significantly improve HbA1c levels post-intervention and maintain improvements for 1-year. Trial registration ClinicalTrials.gov Identifier: NCT00481286 PMID:21403042

  12. Nurse awareness of clinical research: a survey in a Japanese University Hospital

    PubMed Central

    2014-01-01

    Background Clinical research plays an important role in establishing new treatments and improving the quality of medical practice. Since the introduction of the concept of clinical research coordinators (CRC) in Japan, investigators and CRC work as a clinical research team that coordinates with other professionals in clinical trials leading to drug approval (registration trials). Although clinical nurses collaborate with clinical research teams, extended clinical research teams that include clinical nurses may contribute to the ethical and scientific pursuit of clinical research. Methods As knowledge of clinical research is essential for establishing an extended clinical research team, we used questionnaires to survey the knowledge of clinical nurses at Tokushima University Hospital. Five-point and two-point scales were used. Questions as for various experiences were also included and the relationship between awareness and experiences were analyzed. Results Among the 597 nurses at Tokushima University Hospital, 453 (75.9%) responded to the questionnaires. In Japan, registration trials are regulated by pharmaceutical affairs laws, whereas other types of investigator-initiated research (clinical research) are conducted based on ethical guidelines outlined by the ministries of Japan. Approximately 90% of respondents were aware of registration trials and clinical research, but less than 40% of the nurses were aware of their difference. In clinical research terminology, most respondents were aware of informed consent and related issues, but ≤50% were aware of other things, such as the Declaration of Helsinki, ethical guidelines, Good Clinical Practice, institutional review boards, and ethics committees. We found no specific tendency in the relationship between awareness and past experiences, such as nursing patients who were participating in registration trials and/or clinical research or taking a part in research involving patients as a nursing student or a nurse

  13. [Reflecting on a religious conversion event in a clinical setting].

    PubMed

    Binkowski, Gabriel; Baubet, Thierry

    2016-01-01

    What should be the clinical approach to the event represented by a religious conversion, adherence or attraction to extreme groups and ideas? It requires a conceptual analysis, an ethical and epistemological approach at the centre of social situations presenting a high level of ambiguity, tinged even with a certain sense of unreality, as is being experienced in France. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Bioethics for clinicians: 25. Teaching bioethics in the clinical setting

    PubMed Central

    McKneally, Martin F.; Singer, Peter A.

    2001-01-01

    BIOETHICS IS NOW TAUGHT IN EVERY CANADIAN MEDICAL SCHOOL. Canada needs a cadre of teachers who can help clinicians learn bioethics. Our purpose is to encourage clinician teachers to accept this important responsibility and to provide practical advice about teaching bioethics to clinicians as an integral part of good clinical medicine. We use 5 questions to focus the discussion: Why should I teach? What should I teach? How should I teach? How should I evaluate? How should I learn? PMID:11338804

  15. A Spectrum of Clinical Presentations in Seven Japanese Patients with Vitamin D Deficiency

    PubMed Central

    Kubota, Takuo; Kotani, Tomoo; Miyoshi, Yoko; Santo, Yoko; Hirai, Haruhiko; Namba, Noriyuki; Shima, Masaaki; Shimizu, Kazuo; Nakajima, Shigeo; Ozono, Keiichi

    2006-01-01

    Recently, the reemergence of vitamin D deficiency in developed countries has been pointed out. Vitamin D deficiency is diagnosed based on the serum 25-hydroxyvitamin D (25OHD) level. However, its normal range is still controversial, making the diagnosis of vitamin D deficiency difficult. Here, we present seven Japanese patients diagnosed with vitamin D deficiency. Three patients complained of leg bowing, and the other four of tetany. The patients with leg bowing were toddlers. Radiographic surveys demonstrated evidence of rickets. Laboratory findings showed decreased levels of serum inorganic phosphorus and increased levels of alkaline phosphatase (ALP) and intact-parathyroid hormone (iPTH). The serum levels of 25OHD were relatively low, ranging from 13 to 15.2 ng/ml. Of the patients with tetany, three were young infants. Laboratory findings showed decreased levels of serum calcium and increased levels of ALP and iPTH. The serum levels of 25OHD were markedly decreased (below 8 ng/ml). Thus, these results indicate that relatively low levels of 25OHD can cause rickets, a symptom of vitamin D deficiency, and that clinicians should therefore carefully evaluate the levels of 25OHD. PMID:24790316

  16. Differences in the clinical course of 516 Japanese patients with upper gastrointestinal bleeding between weekday and weekend admissions.

    PubMed

    Fujita, Minoru; Manabe, Noriaki; Murao, Takahisa; Osawa, Motoyasu; Hirai, Shinsuke; Fukushima, Shinya; Shogen, Yo; Nakato, Rui; Ishii, Manabu; Matsumoto, Hiroshi; Hata, Jiro; Shiotani, Akiko

    2017-09-19

    Patients suspected of having upper gastrointestinal bleeding (UGIB) admitted during the weekend tend to have a poor outcome in western countries. However, no Japanese studies have been reported on this matter. We aimed to evaluate differences in the clinical course of patients with UGIB between weekday and weekend admissions in Japan. Medical records of patients who had undergone emergency endoscopy for UGIB were retrospectively reviewed. The severity of UGIB was evaluated using the Glasgow-Blatchford (GB) and AIMS65 score. Patients in whom UGIB was stopped and showed improved iron deficiency anemia after admission were considered as having a good clinical course. We reviewed 516 consecutive patients and divided them into two groups: Group A (daytime admission on a weekday: 234 patients) and Group B (nighttime or weekend admission: 282 patients). There was no significant difference in GB and AIM65 scores between the Groups. The proportions of patients with good clinical course were not significantly different between groups (A, 67.5% and B, 67.0%; p = .90). However, patients in Group B underwent hemostatic treatments more frequently compared with those in Group A (58.5% vs 47.4%, p = .012). Multivariate analysis showed that taking acid suppressants, no need for blood transfusions, use of hemostatic treatments, and GB score <12 were associated with a good clinical course. There were no significant differences in the clinical outcomes of patients with UGIB admitted during daytime on weekdays and those admitted at nighttime or weekends partly owing to the sufficient performance of endoscopic hemostatic treatments.

  17. An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.

    PubMed

    Hack, Nawaz; Fayad, Sarah M; Monari, Erin H; Akbar, Umer; Hardwick, Angela; Rodriguez, Ramon L; Malaty, Irene A; Romrell, Janet; Shukla, Aparna A Wagle; McFarland, Nikolaus; Ward, Herbert E; Okun, Michael S

    2014-01-01

    To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD). The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy. There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15), disease duration of 17-240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = -0.36, p<0.01) and H&Y score (r = -0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r = 0.21, p>0.05). This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.

  18. Ongoing evaluation of PACS in a clinical setting

    NASA Astrophysics Data System (ADS)

    Trefler, Martin; Russell, Edward

    1992-05-01

    The radiology department of Jackson Memorial Hospital processes 255,000 clinical examinations each year -- 65,000 of which are portable x rays. Film transportation and loss are major obstacles to the smooth operation of this department. To assist in the solution of these problems we have designed and begun the piecemeal installation of a clinical PACS. This system is based on a platform of IBM RISC/6000 computers and software developed by Genesys Corporation. The initial installation involved the digitization of the portable x rays from three ICUs. The images (in the form of a matrix of 2048 X 1648 pixels) are then entered into the network and can be viewed simultaneously in the radiology department and in the ICU. The second phase of installation, involving the images from two CT scanners and two MRI scanners is currently underway. We have evaluated the system from several standpoints. The first is user acceptance. The users are the radiologists who must make the diagnosis at the workstation and the referring physicians who need the diagnosis quickly but also require the image. The radiologists must be comfortable with their diagnosis based on the images presented at the two viewer workstation. This is compared to the use of a multiviewer which presents many radiographs simultaneously. The second parameter for evaluation involves the impact on patient care in terms of the time elapsed between the taking of the radiograph and the presentation to the physician of the image and the diagnosis.

  19. Neuroimaging in Parkinson disease: from research setting to clinical practice.

    PubMed

    Politis, Marios

    2014-12-01

    Over the past three decades, neuroimaging studies-including structural, functional and molecular modalities-have provided invaluable insights into the mechanisms underlying Parkinson disease (PD). Observations from multimodal neuroimaging techniques have indicated changes in brain structure and metabolic activity, and an array of neurochemical changes that affect receptor sites and neurotransmitter systems. Characterization of the neurobiological alterations that lead to phenotypic heterogeneity in patients with PD has considerably aided the in vivo investigation of aetiology and pathophysiology, and the identification of novel targets for pharmacological or surgical treatments, including cell therapy. Although PD is now considered to be very complex, no neuroimaging modalities are specifically recommended for routine use in clinical practice. However, conventional MRI and dopamine transporter imaging are commonly used as adjuvant tools in the differential diagnosis between PD and nondegenerative causes of parkinsonism. First-line neuroimaging tools that could have an impact on patient prognosis and treatment strategies remain elusive. This Review discusses the lessons learnt from decades of neuroimaging research in PD, and the promising new approaches with potential applicability to clinical practice.

  20. Things Japanese.

    ERIC Educational Resources Information Center

    Shigeta, Jessie M.

    Presented in this booklet are brief descriptions of items and activities that are symbolic of Japanese culture. Some of the items and activities described include Japanese musical instruments and records, toys and crafts, traditional clothing and accessories, and food utensils. Several recipes for Japanese dishes are provided. Lists of pertinent…

  1. The clinical safety, biodistribution and internal radiation dosimetry of flutemetamol (¹⁸F) injection in healthy Japanese adult volunteers.

    PubMed

    Senda, Michio; Brooks, David J; Farrar, Gill; Somer, Edward J; Paterson, Carolyn L; Sasaki, Masahiro; McParland, Brian J

    2015-08-01

    The Phase I safety, biodistribution and internal radiation dosimetry study in adult healthy Japanese males of flutemetamol ((18)F) injection, an in vivo β-amyloid imaging agent, is reported and compared with previously obtained Caucasian data. Whole-body PET scans of 6 healthy volunteers (age 51.8-61.7 years) were acquired approximately 4 h post-injection (administered activity 102-160 MBq). Venous blood sampling determined (18)F activity concentrations in whole blood and plasma and high-performance liquid chromatography (HPLC) established the percentages of parent [(18)F]flutemetamol and its metabolites. Voided urine activity was recorded. The decay-corrected and normalised (18)F activity of 14 source organ regions as a function of time was entered into the OLINDA/EXM software to calculate the internal radiation dosimetry and effective dose of each subject following the MIRD schema. The pharmacokinetics, biodistribution and dosimetry profiles were compared to data obtained from a cohort of healthy Caucasian adult volunteers from a previous Phase I study of [(18)F]flutemetamol. Flutemetamol ((18)F) injection was well tolerated. The highest mean initial uptakes were measured in the liver (15.2%), lungs (10.2%) and brain (6.6%). The highest mean radiation absorbed doses were received by the gallbladder wall (366 μGy/MBq), upper large intestine (138 μGy/MBq) and small intestine (121 μGy/MBq). The mean effective dose was 34.9 μSv/MBq. HPLC analysis demonstrated that at 5-min post-injection about 75% of plasma (18)F radioactivity was in the form of parent [(18)F]flutemetamol, reducing to 8 and 2% at 25 and 90 min, respectively, giving rise to less lipophilic (18)F-labelled metabolites. Comparisons with the Caucasian cohort showed no differences that could be regarded as clinically significant. The clinical safety of [(18)F]flutemetamol demonstrated no differences of clinical significance in the pharmacokinetics, biodistribution and internal radiation dosimetry

  2. Test set readings predict clinical performance to a limited extent: preliminary findings

    NASA Astrophysics Data System (ADS)

    Soh, BaoLin P.; Lee, Warwick M.; Kench, Peter L.; Reed, Warren M.; McEntee, Mark F.; Brennan, Patrick C.

    2013-03-01

    Aim: To investigate the level of agreement between test sets and actual clinical reading Background: The performance of screen readers in detecting breast cancer is being assessed in some countries by using mammographic test sets. However, previous studies have provided little evidence that performance assessed by test sets strongly correlate to performance in clinical reading. Methods: Five clinicians from BreastScreen New South Wales participated in this study. Each clinician was asked to read 200 de-identified mammographic examinations gathered from their own case history within the BreastScreen NSW Digital Imaging Library. All test sets were designed with specific proportions of true positive, true negative, false positive and false negative examinations from the previous actual clinical reads of each reader. A prior mammogram examination for comparison (when available) was also provided for each case. Results: Preliminary analyses have shown that there is a moderate level of agreement (Kappa 0.42-0.56, p < 0.001) between laboratory test sets and actual clinical reading. In addition, a mean increase of 38% in sensitivity in the laboratory test sets as compared to their actual clinical readings was demonstrated. Specificity is similar between the laboratory test sets and actual clinical reading. Conclusion: This study demonstrated a moderate level of agreement between actual clinical reading and test set reading, which suggests that test sets have a role in reflecting clinical performance.

  3. Transitioning Pharmacogenomics into the Clinical Setting: Training Future Pharmacists

    PubMed Central

    Frick, Amber; Benton, Cristina S.; Scolaro, Kelly L.; McLaughlin, Jacqueline E.; Bradley, Courtney L.; Suzuki, Oscar T.; Wang, Nan; Wiltshire, Tim

    2016-01-01

    Pharmacogenomics, once hailed as a futuristic approach to pharmacotherapy, has transitioned to clinical implementation. Although logistic and economic limitations to clinical pharmacogenomics are being superseded by external measures such as preemptive genotyping, implementation by clinicians has met resistance, partly due to a lack of education. Pharmacists, with extensive training in pharmacology and pharmacotherapy and accessibility to patients, are ideally suited to champion clinical pharmacogenomics. This study aimed to analyze the outcomes of an innovative pharmacogenomic teaching approach. Second-year student pharmacists enrolled in a required, 15-week pharmaceutical care lab course in 2015 completed educational activities including lectures and small group work focusing on practical pharmacogenomics. Reflecting the current landscape of direct-to-consumer (DTC) genomic testing, students were offered 23andMe genotyping. Students completed surveys regarding their attitudes and confidence on pharmacogenomics prior to and following the educational intervention. Paired pre- and post-intervention responses were analyzed with McNemar's test for binary comparisons and the Wilcoxon signed-rank test for Likert items. Responses between genotyped and non-genotyped students were analyzed with Fisher's exact test for binary comparisons and the Mann-Whitney U-test for Likert items. Responses were analyzed for all student pharmacists who voluntarily completed the pre-intervention survey (N = 121, 83% response) and for student pharmacists who completed both pre- and post-intervention surveys (N = 39, 27% response). Of those who completed both pre- and post-intervention surveys, 59% obtained genotyping. Student pharmacists demonstrated a significant increase in their knowledge of pharmacogenomic resources (17.9 vs. 56.4%, p < 0.0001) and confidence in applying pharmacogenomic information to manage patients' drug therapy (28.2 vs. 48.7%, p = 0.01), particularly if the student

  4. Japanese encephalitis

    PubMed Central

    Yun, Sang-Im; Lee, Young-Min

    2014-01-01

    Japanese encephalitis (JE) is an infectious disease of the central nervous system caused by Japanese encephalitis virus (JEV), a zoonotic mosquito-borne flavivirus. JEV is prevalent in much of Asia and the Western Pacific, with over 4 billion people living at risk of infection. In the absence of antiviral intervention, vaccination is the only strategy to develop long-term sustainable protection against JEV infection. Over the past half-century, a mouse brain-derived inactivated vaccine has been used internationally for active immunization. To date, however, JEV is still a clinically important, emerging, and re-emerging human pathogen of global significance. In recent years, production of the mouse brain-derived vaccine has been discontinued, but 3 new cell culture-derived vaccines are available in various parts of the world. Here we review current aspects of JEV biology, summarize the 4 types of JEV vaccine, and discuss the potential of an infectious JEV cDNA technology for future vaccine development. PMID:24161909

  5. Japanese encephalitis.

    PubMed

    Morita, K; Nabeshima, T; Buerano, C C

    2015-08-01

    Japanese encephalitis (JE) is an inflammation of the central nervous system in humans and animals, specifically horses and cattle. The disease, which can sometimes be fatal, is caused by the flavivirus Japanese encephalitis virus (JEV), of which there are five genotypes (genotypes 1, 2, 3, 4 and 5). The transmission cycle of the virus involves pigs and wild birds as virus amplifiers and mosquitoes as vectors for transferring the virus between amplifying hosts and to dead- end hosts, i.e. humans, horses and cattle. In horses and cattle the disease is usually asymptomatic, but when clinical signs do occur they include fever, decreased appetite, frothing at the mouth, rigidity of the legs and recumbency, and neurological signs, such as convulsive fits, circling, marked depression and disordered consciousness. In pigs, it can cause abortion and stillbirths. At present, the virus is detected in a wide area covering eastern and southern Asia, Indonesia, northern Australia, Papua New Guinea and Pakistan. JEV RNA has also been detected in Italy, first in dead birds in 1997 and 2000 and then in mosquitoes in 2010. Genotype shift, i.e. a change of genotype from genotype 3 to genotype 1, has occurred in some countries, namely Japan, South Korea, Chinese Taipei and Vietnam. Laboratory methods are available for confirming the causative agent of the disease. There are control measures to prevent or minimise infection and, among them, vaccination is one of the most important and one which should be adopted in endemic and epidemic areas.

  6. Understanding dyslexia and nurse education in the clinical setting.

    PubMed

    Sanderson-Mann, Jo; McCandless, Fiona

    2006-05-01

    Clinical practice and dyslexia is becoming an important topic with the introduction of disability legislation and changes in nursing school entrance requirements. This paper considers the issues surrounding nursing and dyslexia, drawing on the available evidence. Firstly, the strengths dyslexics can bring to nursing are considered, along with difficulties they can experience, although the evidence is limited, with papers being anecdotal or speculative at times. The attitudes of institutions and healthcare professionals towards dyslexia are also addressed, along with what they can do to support dyslexic nurses and student nurses. Strategies for individual students are also suggested, which nursing educators could encourage students to use. Finally, the issue of disclosure is discussed, and suggested reasons why some dyslexic students choose not to disclose.

  7. Pattern of astigmatism in a clinical setting in Maldives.

    PubMed

    Marasini, Sanjay

    2016-01-01

    Patterns of refractive errors have never been reported in Maldives. This study aims to dissect astigmatism and provide a general view in context of this island country. A clinic based cross sectional study was designed with 277 patients, aged ≥3.5 years and with a primary astigmatism of ≥-1.00 diopters (D). They underwent complete eye examination and a vector analysis was done. Mean age was 28.58 (SD 19.15) years. Astigmatic magnitude depended on age (p<0.05) but not on gender (p>0.05). Severity of visual impairment after refractive correction was very less, with only 2.2% having visual acuity ≤6/60. Mean spherical, spherical equivalent and astigmatic refraction were -1.35 (SD 2.94 D), -2.40 (SD 3.04) and -2.12 (SD 1.11 D), respectively. Between fellow eyes, refractive and corneal astigmatism highly correlated (0.83 and 0.73). Fifty eyes (18.1%) had an astigmatic error of ≥-3.00 D which peaked in the second and third decades of life (p<0.0001) and was corneal in origin (p<0.0001). Internal J45 and J0 tended to be more negative with increasing age, showing a trend toward against the rule astigmatism. Correlation between corneal and refractive J0 and J45 were 0.88 and 0.62 (p<0.0001). With the rule astigmatism was more common followed by against the rule and oblique. In conclusion, this study inferred that among patients with relatively higher magnitude of astigmatism attending to the clinics in Maldives, younger patients are affected more, which could possibly link to the environment, genetics and nutrition. The probable association between nutrition and astigmatism needs to be investigated to fill the gap in literature. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  8. Evaluation of a novel electronic genetic screening and clinical decision support tool in prenatal clinical settings.

    PubMed

    Edelman, Emily A; Lin, Bruce K; Doksum, Teresa; Drohan, Brian; Edelson, Vaughn; Dolan, Siobhan M; Hughes, Kevin; O'Leary, James; Vasquez, Lisa; Copeland, Sara; Galvin, Shelley L; DeGroat, Nicole; Pardanani, Setul; Gregory Feero, W; Adams, Claire; Jones, Renee; Scott, Joan

    2014-07-01

    "The Pregnancy and Health Profile" (PHP) is a free prenatal genetic screening and clinical decision support (CDS) software tool for prenatal providers. PHP collects family health history (FHH) during intake and provides point-of-care risk assessment for providers and education for patients. This pilot study evaluated patient and provider responses to PHP and effects of using PHP in practice. PHP was implemented in four clinics. Surveys assessed provider confidence and knowledge and patient and provider satisfaction with PHP. Data on the implementation process were obtained through semi-structured interviews with administrators. Quantitative survey data were analyzed using Chi square test, Fisher's exact test, paired t tests, and multivariate logistic regression. Open-ended survey questions and interviews were analyzed using qualitative thematic analysis. Of the 83% (513/618) of patients that provided feedback, 97% felt PHP was easy to use and 98% easy to understand. Thirty percent (21/71) of participating physicians completed both pre- and post-implementation feedback surveys [13 obstetricians (OBs) and 8 family medicine physicians (FPs)]. Confidence in managing genetic risks significantly improved for OBs on 2/6 measures (p values ≤0.001) but not for FPs. Physician knowledge did not significantly change. Providers reported value in added patient engagement and reported mixed feedback about the CDS report. We identified key steps, resources, and staff support required to implement PHP in a clinical setting. To our knowledge, this study is the first to report on the integration of patient-completed, electronically captured and CDS-enabled FHH software into primary prenatal practice. PHP is acceptable to patients and providers. Key to successful implementation in the future will be customization options and interoperability with electronic health records.

  9. Japanese language and Japanese science

    NASA Astrophysics Data System (ADS)

    Tanikawa, Kiyotaka

    2003-08-01

    Japanese mathematical scientists including astronomers, physicists, and mathematicians obtain ideas in Japanese, discuss their problems in Japanese, and arrive at conclusions in Japanese, and yet they write their results in foreign languages such as English. This uncomfortable situation has continued for nearly one hundred years and has had serious effects on Japanese science. In this short report, the author discusses and analyses these effects. In order to put Japanese science on a sound basis, the author proposes to increase the number of articles, reviews and textbooks in Japanese, first by translation and second by the voluntary efforts of scientists themselves. As centers devoted to this activity, the author proposes to construct "Airborne Libraries" which are maintained and accumulate in an electronic form the scientific documents written in Japanese.

  10. Consultation clinics for complementary and alternative medicine at Japanese university hospitals: An analysis at Tokushima University Hospital

    PubMed Central

    YANAGAWA, HIROAKI; TERAO, JUNJI; TAKEDA, EIJI; TAKAISHI, YOSHIHISA; KASHIWADA, YOSHIKI; KAWAZOE, KAZUYOSHI; FUSHITANI, SHUJI; TSUCHIYA, KOICHIRO; YAMAUCHI, AIKO; SATO, CHIHO; IRAHARA, MINORU

    2010-01-01

    Here, we report on a Consultation Clinic for Complementary and Alternative Medicine (CAM) which we established at Tokushima University Hospital in July of 2007 with the aim of providing person-to-person information on CAM, though not CAM therapy itself. In December of 2008, we received 55 applications for consultation, 37% concerning health foods, 37% Japanese herbal medicine (Kampo), and 26% various other topics. The consultants (nutritionists and pharmacists) communicated individually with 38 applicants; malignancies (26%) and cardiovascular disease (24%) were the main underlying concerns. To promote the quality of consultation, data was collected by means of focus group interviews concerning the perspective of the consultants. Safe and effective use of CAM requires a network of communication linking individuals, consultation teams, physicians, primary care institutions and university hospitals. To advance this goal, we plan to broaden the efforts described herein. Our findings indicate that the specific role of the consultation clinic in promoting the scientific use of CAM merits further study. PMID:22993564

  11. Clinical Implication of Plasma Hydrogen Sulfide Levels in Japanese Patients with Type 2 Diabetes

    PubMed Central

    Suzuki, Kunihiro; Sagara, Masaaki; Aoki, Chie; Tanaka, Seiichi; Aso, Yoshimasa

    2017-01-01

    Objective The goal of the present study was to investigate the plasma hydrogen sulfide (H2S) levels in patients with type 2 diabetes, as the plasma H2S levels in Japanese patients with type 2 diabetes remain unclear. Methods The plasma H2S levels were measured in 154 outpatients with type 2 diabetes and 66 outpatients without diabetes. All blood samples were collected in the outpatient department from 09:00 to 10:00. The patients had fasted from 21:00 the previous evening and had not consumed alcohol or caffeine or smoked until sample collection. The plasma H2S levels were measured using the methylene blue assay. The plasma H2S levels were determined in triplicate, and the average concentrations were calculated against a calibration curve of sodium sulfide. Results The patients with type 2 diabetes showed a progressive reduction in the plasma H2S levels (45.1±15.5 μM versus 54.0±26.4 μM, p<0.05), which paralleled poor glycemic control. There was a significant correlation between a reduction in the plasma H2S levels and the HbA1c levels (β=-0.505, p<0.01), Furthermore, a reduction in the plasma H2S levels was found to be related to a history of cardiovascular diseases in patients with type 2 diabetes (39.9±13.8 μM versus 47.5±15.9 μM, p<0.01). Conclusion Collectively, the plasma H2S levels were reduced in patients with type 2 diabetes, which may have implications in the pathophysiology of cardiovascular disease in diabetic patients. The trial was registered with the University Hospital Medical Information Network (UMIN no. #000020549). PMID:28049995

  12. Clinical evaluation of a new bleaching product "Polanight" in a Japanese population.

    PubMed

    Tsubura, Shuichi; Yamaguchi, Ryuji

    2005-09-01

    Home bleaching techniques have been applied as a safe and effective bleaching procedure. Many manufacturers are now marketing home tooth-bleaching products. The purpose of this study was to compare a new bleaching product, Polanight (PN) with a widely used home bleaching product, Opalescence (OP). Fifty-eight healthy Japanese volunteers of both sexes (18 to 47 years of age) were selected. Using a simultaneous split-mouth protocol, custom-made trays with PN and OP were applied to the maxillary right anterior teeth and left anterior teeth, respectively. The shades of the maxillary canine teeth were measured with a portable chromameter (Shade Eye Ex) at the first examination and at 4 weeks (after 2-week bleaching and 2-week rest). Tooth shade changes were analyzed using the Commission Internationale d'Eclairage (CIE) Lab units. Means of whiteness-blackness difference (DeltaL*), redness-greenness difference (Deltaa*), and yellowness-blueness difference (Deltab*) were 4.00, -1.28 and -7.53 for PN, and 2.54, -0.99, and -5.56 for OP, respectively. Means of color difference (DeltaE*) were 9.23 and 7.78 for PN and OP, respectively. Treatment with either agent demonstrated significant bleaching effects produced by the treatment. The new product, PN, showed significant differences in DeltaL* (P < 0.05) and Deltab* (P < 0.005), but not in the redness-greenness (a*) value when compared with OP. Bleaching with PN was considered more effective than that with OP in the young patient group and in the women.

  13. [A proposal by the Japanese Pharmacopoeia for a method to set an endotoxin limit for parenteral drugs to be tested].

    PubMed

    Ogawa, Y

    1997-01-01

    The Bacterial Endotoxins Test has been extensively revised in the JP 13. In addition to the limit test with gelation, adopted in the JP 12, quantitative methods using gel-clot, turbidimetric and chromogenic techniques have been adopted in the JP 13. As for the endotoxin limit for monographs, it was specified for Water for Injection alone in the JP 12. Since the issue of the JP 13 Supplement is under consideration, the possibility of replacing the Pyrogen Test (which is required for some main products in the current JP 13 monographs) with the Bacterial Endotoxins Test is now being discussed. For international harmonization of the Bacterial Endotoxins Test, it seems to be preferable to follow (if acceptable) the FDA method that was established in 1987 to set an endotoxin limit for products intended for parenteral use. This would then be followed by both the USP and EP. Thereby a draft for the Method to set the Endotoxin Limit, which is to be described in the Information chapter of the JP 13 Supplement, is being prepared. This report details an explanation of the draft, the definition of the endotoxin unit (EU) and its defined process, and the compliance with the replacement of the Pyrogen Test by the Bacterial Endotoxins Test, etc.

  14. Applications of CYP450 testing in the clinical setting.

    PubMed

    Samer, C F; Lorenzini, K Ing; Rollason, V; Daali, Y; Desmeules, J A

    2013-06-01

    Interindividual variability in drug response is a major clinical problem. Polymedication and genetic polymorphisms modulating drug-metabolising enzyme activities (cytochromes P450, CYP) are identified sources of variability in drug responses. We present here the relevant data on the clinical impact of the major CYP polymorphisms (CYP2D6, CYP2C19 and CYP2C9) on drug therapy where genotyping and phenotyping may be considered, and the guidelines developed when available. CYP2D6 is responsible for the oxidative metabolism of up to 25% of commonly prescribed drugs such as antidepressants, antipsychotics, opioids, antiarrythmics and tamoxifen. The ultrarapid metaboliser (UM) phenotype is recognised as a cause of therapeutic inefficacy of antidepressant, whereas an increased risk of toxicity has been reported in poor metabolisers (PMs) with several psychotropics (desipramine, venlafaxine, amitriptyline, haloperidol). CYP2D6 polymorphism influences the analgesic response to prodrug opioids (codeine, tramadol and oxycodone). In PMs for CYP2D6, reduced analgesic effects have been observed, whereas in UMs cases of life-threatening toxicity have been reported with tramadol and codeine. CYP2D6 PM phenotype has been associated with an increased risk of toxicity of metoprolol, timolol, carvedilol and propafenone. Although conflicting results have been reported regarding the association between CYP2D6 genotype and tamoxifen effects, CYP2D6 genotyping may be useful in selecting adjuvant hormonal therapy in postmenopausal women. CYP2C19 is responsible for metabolising clopidogrel, proton pump inhibitors (PPIs) and some antidepressants. Carriers of CYP2C19 variant alleles exhibit a reduced capacity to produce the active metabolite of clopidogrel, and are at increased risk of adverse cardiovascular events. For PPIs, it has been shown that the mean intragastric pH values and the Helicobacter pylori eradication rates were higher in carriers of CYP2C19 variant alleles. CYP2C19 is

  15. Pattern of astigmatism in a clinical setting in Maldives☆

    PubMed Central

    Marasini, Sanjay

    2015-01-01

    Background Patterns of refractive errors have never been reported in Maldives. This study aims to dissect astigmatism and provide a general view in context of this island country. Methods A clinic based cross sectional study was designed with 277 patients, aged ≥3.5 years and with a primary astigmatism of ≥−1.00 diopters (D). They underwent complete eye examination and a vector analysis was done. Results Mean age was 28.58 (SD 19.15) years. Astigmatic magnitude depended on age (p < 0.05) but not on gender (p > 0.05). Severity of visual impairment after refractive correction was very less, with only 2.2% having visual acuity ≤6/60. Mean spherical, spherical equivalent and astigmatic refraction were −1.35 (SD 2.94 D), −2.40 (SD 3.04) and −2.12 (SD 1.11 D), respectively. Between fellow eyes, refractive and corneal astigmatism highly correlated (0.83 and 0.73). Fifty eyes (18.1%) had an astigmatic error of ≥−3.00 D which peaked in the second and third decades of life (p < 0.0001) and was corneal in origin (p < 0.0001). Internal J45 and J0 tended to be more negative with increasing age, showing a trend toward against the rule astigmatism. Correlation between corneal and refractive J0 and J45 were 0.88 and 0.62 (p < 0.0001). With the rule astigmatism was more common followed by against the rule and oblique. Conclusion In conclusion, this study inferred that among patients with relatively higher magnitude of astigmatism attending to the clinics in Maldives, younger patients are affected more, which could possibly link to the environment, genetics and nutrition. The probable association between nutrition and astigmatism needs to be investigated to fill the gap in literature. PMID:25800279

  16. Clinical Phenotype Classifications Based on Static Varus Alignment and Varus Thrust in Japanese Patients With Medial Knee Osteoarthritis

    PubMed Central

    Iijima, Hirotaka; Fukutani, Naoto; Fukumoto, Takahiko; Uritani, Daisuke; Kaneda, Eishi; Ota, Kazuo; Kuroki, Hiroshi; Matsuda, Shuichi

    2015-01-01

    Objective To investigate the association between knee pain during gait and 4 clinical phenotypes based on static varus alignment and varus thrust in patients with medial knee osteoarthritis (OA). Methods Patients in an orthopedic clinic (n = 266) diagnosed as having knee OA (Kellgren/Lawrence [K/L] grade ≥1) were divided into 4 phenotype groups according to the presence or absence of static varus alignment and varus thrust (dynamic varus): no varus (n = 173), dynamic varus (n = 17), static varus (n = 50), and static varus + dynamic varus (n = 26). The knee range of motion, spatiotemporal gait parameters, visual analog scale scores for knee pain, and scores on the Japanese Knee Osteoarthritis Measure were used to assess clinical outcomes. Multiple logistic regression analyses identified the relationship between knee pain during gait and the 4 phenotypes, adjusted for possible risk factors, including age, sex, body mass index, K/L grade, and gait velocity. Results Multiple logistic regression analysis showed that varus thrust without varus alignment was associated with knee pain during gait (odds ratio [OR] 3.30, 95% confidence interval [95% CI] 1.08–12.4), and that varus thrust combined with varus alignment was strongly associated with knee pain during gait (OR 17.1, 95% CI 3.19–320.0). Sensitivity analyses applying alternative cutoff values for defining static varus alignment showed comparable results. Conclusion Varus thrust with or without static varus alignment was associated with the occurrence of knee pain during gait. Tailored interventions based on individual malalignment phenotypes may improve clinical outcomes in patients with knee OA. PMID:26017348

  17. Statistical principles underlying analytic goal-setting in clinical chemistry.

    PubMed

    Harris, E K

    1979-08-01

    The Survey programs of the College of American Pathologists (CAP) have assessed current levels of analytic variance in many biochemical measurements, and a number of clinical chemists have proposed analytic goals. The practical importance of further reductions in analytic variance depends on the specific use of the laboratory test. Three general areas of application are described: 1) surveying a population to detect disease, 2) determining whether a particular individual's level of a given analyte is above or below a predefined alarm point, 3) monitoring an individual over a period of time to detect trends. Within each of these different contests, statistical methods are proposed for judging the practical effect of improvements in current levels of analytic precision, taking into account recent estimates of biological variation within the average individual and between individuals. As might be expected, reductions in analytic variance have greatest impact in those applications where biological variance is minimal. Such reductions will generally have little effect on the efficiency of a population survey but may be extremely valuable in decision-making concerning a particular hospital patient.

  18. Nursing students' perceptions of their clinical learning environment in placements outside traditional hospital settings

    PubMed Central

    Bjørk, Ida T; Berntsen, Karin; Brynildsen, Grethe; Hestetun, Margrete

    2014-01-01

    Aims and objectives To explore students' opinions of the learning environment during clinical placement in settings outside traditional hospital settings. Background Clinical placement experiences may influence positively on nursing students attitudes towards the clinical setting in question. Most studies exploring the quality of clinical placements have targeted students' experience in hospital settings. The number of studies exploring students' experiences of the learning environment in healthcare settings outside of the hospital venue does not match the growing importance of such settings in the delivery of health care, nor the growing number of nurses needed in these venues. Design A survey design was used. Method The Clinical Learning Environment Inventory was administered to two cohorts of undergraduate nursing students (n = 184) after clinical placement in mental health care, home care and nursing home care. Results Nursing students' overall contentment with the learning environment was quite similar across all three placement areas. Students in mental health care had significantly higher scores on the subscale individualisation, and older students had significantly higher scores on the total scale. Compared with other studies where the Clinical Learning Environment Inventory has been used, the students' total scores in this study are similar or higher than scores in studies including students from hospital settings. Conclusion Results from this study negate the negative views on clinical placements outside the hospital setting, especially those related to placements in nursing homes and mental healthcare settings. Relevance to clinical practice Students' experience of the learning environment during placements in mental health care, home care and nursing homes indicates the relevance of clinical education in settings outside the hospital setting. PMID:24460862

  19. Japanese Competitiveness and Japanese Management.

    ERIC Educational Resources Information Center

    Minabe, Shigeo

    1986-01-01

    Analyzes and compares Japanese and American industrial policy and labor practices. Proposes that certain aspects of the Japanese system be adapted by American businesses for purpose of increasing international competitiveness. Proposes specific actions and plans for both the Japanese and American systems. (ML)

  20. Peer Assisted Learning in the Clinical Setting: An Activity Systems Analysis

    ERIC Educational Resources Information Center

    Bennett, Deirdre; O'Flynn, Siun; Kelly, Martina

    2015-01-01

    Peer assisted learning (PAL) is a common feature of medical education. Understanding of PAL has been based on processes and outcomes in controlled settings, such as clinical skills labs. PAL in the clinical setting, a complex learning environment, requires fresh evaluation. Socio-cultural theory is proposed as a means to understand educational…

  1. Concurrent Parent and Child Group Outcomes for Child Externalizing Disorders: Generalizability to Typical Clinical Settings

    ERIC Educational Resources Information Center

    Listug-Lunde, Lori; Bredemeier, Keith; Tynan, Douglas

    2005-01-01

    Parent behavior management and child social skills training programs have demonstrated efficacy in clinical research settings and are highly efficient treatment modalities. Few studies have examined their effectiveness and efficiency within the typical clinical setting. The current paper examines the use of a concurrent parent behavior management…

  2. Peer Assisted Learning in the Clinical Setting: An Activity Systems Analysis

    ERIC Educational Resources Information Center

    Bennett, Deirdre; O'Flynn, Siun; Kelly, Martina

    2015-01-01

    Peer assisted learning (PAL) is a common feature of medical education. Understanding of PAL has been based on processes and outcomes in controlled settings, such as clinical skills labs. PAL in the clinical setting, a complex learning environment, requires fresh evaluation. Socio-cultural theory is proposed as a means to understand educational…

  3. Fast and robust clinical triple-region image segmentation using one level set function.

    PubMed

    Li, Shuo; Fevens, Thomas; Krzyzak, Adam; Jin, Chao; Li, Song

    2006-01-01

    This paper proposes a novel method for clinical triple-region image segmentation using a single level set function. Triple-region image segmentation finds wide application in the computer aided X-ray, CT, MRI and ultrasound image analysis and diagnosis. Usually multiple level set functions are used consecutively or simultaneously to segment triple-region medical images. These approaches are either time consuming or suffer from the convergence problems. With the new proposed triple-regions level set energy modelling, the triple-region segmentation is handled within the two region level set framework where only one single level set function needed. Since only a single level set function is used, the segmentation is much faster and more robust than using multiple level set functions. Adapted to the clinical setting, individual principal component analysis and a support vector machine classifier based clinical acceleration scheme are used to accelerate the segmentation. The clinical acceleration scheme takes the strengths of both machine learning and the level set method while limiting their weaknesses to achieve automatic and fast clinical segmentation. Both synthesized and practical images are used to test the proposed method. These results show that the proposed method is able to successfully segment the triple-region using a single level set function. Also this segmentation is very robust to the placement of initial contour. While still quickly converging to the final image, with the clinical acceleration scheme, our proposed method can be used during pre-processing for automatic computer aided diagnosis and surgery.

  4. Fluid therapy in the perioperative setting-a clinical review.

    PubMed

    Voldby, Anders Winther; Brandstrup, Birgitte

    2016-01-01

    Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well-being and muscular strength and to reduce insulin resistance. Hence, the intake of fluid (preferably containing carbohydrates) should be encouraged up to 2 h prior to surgery in order to avoid dehydration. Excessive intravenous fluid administration adds to tissue inflammation and edema formation, thereby compromising tissue healing. During major abdominal surgery a "zero-balance" intraoperative fluid strategy aims at avoiding fluid overload (and comparable to the so-called restrictive approach) as well as goal-directed fluid therapy (GDT). Both proved to significantly reduce postoperative complications when compared to "standard fluid therapy". Trials comparing "restrictive" or zero-balance and GDT have shown equal results, as long as fluid overload is avoided in the GDT group as well (categorized as "zero-balance GDT"). It is possible that high-risk surgical patients, such as those undergoing acute surgery, may benefit from the continuous monitoring of circulatory status that the GDT provides. Data on this group of patients is not available at present, but trials are ongoing. In elective surgery, the zero-balance approach has shown to reduce postoperative complications and is easily applied for most patients. It is less expensive and simpler than the zero-balance GDT approach and therefore recommended in this review. In outpatient surgery, 1-2 L of balanced crystalloids reduces postoperative nausea

  5. Validity of the Japanese version of functional assessment of cancer therapy-gastric (FACT-Ga) and its sensitivity to ascites volume change: a retrospective analysis of Japanese clinical trial participants.

    PubMed

    Maeda, Hiromichi; Sato, Maho; Kobayashi, Michiya; Takiguchi, Nobuhiro; Yoshikawa, Takaki; Yoshino, Shigefumi; Yoshida, Kazuhiro; Tsuburaya, Akira; Sakamoto, Junichi; Morita, Satoshi

    2016-11-01

    The functional assessment of cancer therapy-gastric (FACT-Ga) questionnaire was designed to evaluate quality of life (QOL) in patients with gastric cancer. We aimed to explore the reliability and validity of FACT-Ga in Japanese patients, and assess the sensitivity of the gastric cancer subscale for detecting changes in cancer-related variables over time. The Japanese version of FACT-Ga was used, and data were obtained from Japanese patients who participated in either of two clinical trials: treatment for advanced or recurrent gastric cancer with ascites (advanced-GC group), or adjuvant chemotherapy after curative resection of gastric cancer (adjuvant group). Psychometric data including data used to determine reliability, internal consistency, and clinical validity were analyzed. Clinical validity was evaluated by comparing subscale scores for patients in the two groups, and by comparing subscale scores for patients with different performance status scores. Correlation between gastric cancer subscale scores and gastric cancer-related variables was also examined. In addition, sensitivity of the gastric cancer subscale to changes in ascites volume, abdominal girth, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) was examined by evaluating their correlation in the advanced-GC group. We collected data on 156 patients (62 advanced-GC group patients and 94 adjuvant group patients). Response rates for the subscales were over 80 % at most time points for both the groups. Cronbach's coefficient alpha revealed good internal consistency for each subscale. At baseline, the adjuvant group had higher QOL scores than the advanced-GC group (P < 0.05), and QOL scores for patients with different performance status scores differed significantly. Changes in gastric cancer subscale scores showed statistically significant correlation with changes in ascites volume (Spearman's rank correlation coefficient, 0.5; P < 0.05). FACT-Ga is reliable and clinically valid

  6. Usage of multilingual mobile translation applications in clinical settings.

    PubMed

    Albrecht, Urs-Vito; Behrends, Marianne; Schmeer, Regina; Matthies, Herbert K; von Jan, Ute

    2013-04-23

    perceived as easy-to-use (36/39, median=6, IQR=3) and there were no obvious problems with the usability of the device (36/39, median=6, IQR=2). The discrepancy between the expert ratings for xprompt (collected from the App Store and online) and the opinions of the study's participants can probably be explained by the differing approaches of the two user groups. The experts had clear expectations, whereas, without a more thorough introduction, our study participants perceived using the app as too time consuming in relation to the expected benefit. The introduction of such tools in today's busy care settings should therefore be more carefully planned to heighten acceptance of new tools. Still, the low return rate of the questionnaires only allows for speculations on the data, and further research is necessary. This study was approved by the local institutional review board (IRB), Trial ID number: 1145-2011.

  7. Usage of Multilingual Mobile Translation Applications in Clinical Settings

    PubMed Central

    2013-01-01

    /39, median=4, IQR=2.5), although the app was perceived as easy-to-use (36/39, median=6, IQR=3) and there were no obvious problems with the usability of the device (36/39, median=6, IQR=2). Conclusions The discrepancy between the expert ratings for xprompt (collected from the App Store and online) and the opinions of the study’s participants can probably be explained by the differing approaches of the two user groups. The experts had clear expectations, whereas, without a more thorough introduction, our study participants perceived using the app as too time consuming in relation to the expected benefit. The introduction of such tools in today’s busy care settings should therefore be more carefully planned to heighten acceptance of new tools. Still, the low return rate of the questionnaires only allows for speculations on the data, and further research is necessary. Trial Registration This study was approved by the local institutional review board (IRB), Trial ID number: 1145-2011. PMID:25100677

  8. A cross-sectional survey of policies guiding second stage labor in urban Japanese hospitals, clinics and midwifery birth centers.

    PubMed

    Baba, Kaori; Kataoka, Yaeko; Nakayama, Kaori; Yaju, Yukari; Horiuchi, Shigeko; Eto, Hiromi

    2016-02-24

    The Japan Academy of Midwifery developed and disseminated the '2012 Evidence-based Guidelines for Midwifery Care (Guidelines for Midwives)' for low-risk births to achieve a more uniform standard of care during childbirth in Japan. The objective of this study was to cross-sectional survey policy implementation regarding care during the second stage of labor at Japanese hospitals, clinics, and midwifery birth centers, and to compare those policies with the recommendations in Guidelines for Midwives. This study was conducted in the four major urbanized areas (e.g. Tokyo) of the Kanto region of Japan. Respondents were chiefs of the institutions (obstetricians/midwives), nurse administrators (including midwives) of the obstetrical departments, or other nurse/midwives who were well versed in the routine care of the targeted institutions. The Guidelines implementation questionnaire comprised 12 items. Data was collected from October 2010 to July 2011. The overall response was 255 of the 684 institutions (37%). Of the total responses 46% were hospitals, 26% were clinics and 28% were midwifery birth centers. Few institutions reported perineal massage education for 'almost all cases'. Using 'active birth' were all midwifery birth centers, 56% hospitals and 32% clinics. Few institutions used water births. The majority of hospitals (73%) and clinics (80%) but a minority (39%) of midwifery birth centers reported 'not implemented' about applying warm compress to the perineum. Few midwifery birth centers (10%) and more hospitals (38%) and clinics (50%) had a policy for valsalva as routine care. Many hospitals (90%) and clinics (88%) and fewer midwifery birth centers (54%) offered hands-on technique to provide perineal support during birth. A majority of institutions used antiseptic solution for perineal disinfection. Few institutions routinely used episiotomies for multiparas, however routine use for primiparas was slightly more in hospitals (21%) and clinics (25%). All

  9. Development and Validation of a Clinical Prediction Rule for Bacteremia among Maintenance Hemodialysis Patients in Outpatient Settings

    PubMed Central

    Sasaki, Sho; Hasegawa, Takeshi; Kawarazaki, Hiroo; Nomura, Atsushi; Uchida, Daisuke; Imaizumi, Takahiro; Furusho, Masahide; Nishiwaki, Hiroki; Fukuma, Shingo; Shibagaki, Yugo; Fukuhara, Shunichi

    2017-01-01

    Background To our knowledge, no reliable clinical prediction rule (CPR) for identifying bacteremia in hemodialysis (HD) patients has been established. The aim of this study was to develop a CPR for bacteremia in maintenance HD patients visiting the outpatient department. Methods This multicenter cohort study involved consecutive maintenance HD patients who visited the outpatient clinic or emergency room of seven Japanese institutions between August 2011 and July 2013. The outcome measure was bacteremia diagnosed based on the results of blood cultures. The candidate predictors for bacteremia were extracted through a literature review. A CPR for bacteremia was developed using a coefficient-based multivariable logistic regression scoring method, and calibration was performed. The test performance was then assessed for the CPR. Results Of 507 patients eligible for the study, we analyzed the 293 with a complete dataset for candidate predictors. Of these 293 patients, 48 (16.4%) were diagnosed with bacteremia. At the conclusion of the deviation process, body temperature ≥ 38.3°C, heart rate ≥ 125 /min, C-reactive protein ≥ 10 mg/dL, alkaline phosphatase >360 IU/L, and no prior antibiotics use within the past week were retained and scored. The CPR had a good fit for the model on calibration. The AUC of the CPR was 0.76, and for score CPR ≥ 2, the sensitivity and specificity were 89.6% and 51.4%, respectively. Conclusions We established a simple CPR for bacteremia in maintenance HD patients using routinely obtained clinical information in an outpatient setting. This model may facilitate more appropriate clinical decision making. PMID:28081211

  10. Rare variants of small effect size in neuronal excitability genes influence clinical outcome in Japanese cases of SCN1A truncation-positive Dravet syndrome.

    PubMed

    Hammer, Michael F; Ishii, Atsushi; Johnstone, Laurel; Tchourbanov, Alexander; Lau, Branden; Sprissler, Ryan; Hallmark, Brian; Zhang, Miao; Zhou, Jin; Watkins, Joseph; Hirose, Shinichi

    2017-01-01

    Dravet syndrome (DS) is a rare, devastating form of childhood epilepsy that is often associated with mutations in the voltage-gated sodium channel gene, SCN1A. There is considerable variability in expressivity within families, as well as among individuals carrying the same primary mutation, suggesting that clinical outcome is modulated by variants at other genes. To identify modifier gene variants that contribute to clinical outcome, we sequenced the exomes of 22 individuals at both ends of a phenotype distribution (i.e., mild and severe cognitive condition). We controlled for variation associated with different mutation types by limiting inclusion to individuals with a de novo truncation mutation resulting in SCN1A haploinsufficiency. We performed tests aimed at identifying 1) single common variants that are enriched in either phenotypic group, 2) sets of common or rare variants aggregated in and around genes associated with clinical outcome, and 3) rare variants in 237 candidate genes associated with neuronal excitability. While our power to identify enrichment of a common variant in either phenotypic group is limited as a result of the rarity of mild phenotypes in individuals with SCN1A truncation variants, our top candidates did not map to functional regions of genes, or in genes that are known to be associated with neurological pathways. In contrast, we found a statistically-significant excess of rare variants predicted to be damaging and of small effect size in genes associated with neuronal excitability in severely affected individuals. A KCNQ2 variant previously associated with benign neonatal seizures is present in 3 of 12 individuals in the severe category. To compare our results with the healthy population, we performed a similar analysis on whole exome sequencing data from 70 Japanese individuals in the 1000 genomes project. Interestingly, the frequency of rare damaging variants in the same set of neuronal excitability genes in healthy individuals is

  11. Rare variants of small effect size in neuronal excitability genes influence clinical outcome in Japanese cases of SCN1A truncation-positive Dravet syndrome

    PubMed Central

    Ishii, Atsushi; Johnstone, Laurel; Tchourbanov, Alexander; Lau, Branden; Sprissler, Ryan; Hallmark, Brian; Zhang, Miao; Zhou, Jin; Watkins, Joseph; Hirose, Shinichi

    2017-01-01

    Dravet syndrome (DS) is a rare, devastating form of childhood epilepsy that is often associated with mutations in the voltage-gated sodium channel gene, SCN1A. There is considerable variability in expressivity within families, as well as among individuals carrying the same primary mutation, suggesting that clinical outcome is modulated by variants at other genes. To identify modifier gene variants that contribute to clinical outcome, we sequenced the exomes of 22 individuals at both ends of a phenotype distribution (i.e., mild and severe cognitive condition). We controlled for variation associated with different mutation types by limiting inclusion to individuals with a de novo truncation mutation resulting in SCN1A haploinsufficiency. We performed tests aimed at identifying 1) single common variants that are enriched in either phenotypic group, 2) sets of common or rare variants aggregated in and around genes associated with clinical outcome, and 3) rare variants in 237 candidate genes associated with neuronal excitability. While our power to identify enrichment of a common variant in either phenotypic group is limited as a result of the rarity of mild phenotypes in individuals with SCN1A truncation variants, our top candidates did not map to functional regions of genes, or in genes that are known to be associated with neurological pathways. In contrast, we found a statistically-significant excess of rare variants predicted to be damaging and of small effect size in genes associated with neuronal excitability in severely affected individuals. A KCNQ2 variant previously associated with benign neonatal seizures is present in 3 of 12 individuals in the severe category. To compare our results with the healthy population, we performed a similar analysis on whole exome sequencing data from 70 Japanese individuals in the 1000 genomes project. Interestingly, the frequency of rare damaging variants in the same set of neuronal excitability genes in healthy individuals is

  12. Clinical Instructor Characteristics, Behaviors and Skills in Allied Health Care Settings: A Literature Review

    ERIC Educational Resources Information Center

    Levy, Linda S.; Sexton, Patrick; Willeford, K. Sean; Barnum, Mary G.; Guyer, M. Susan; Gardner, Greg; Fincher, A. Louise

    2009-01-01

    The purpose of this literature review is to compare both clinical instructor and student perceptions of helpful and hindering clinical instructor characteristics, behaviors and skills in athletic training and allied health care settings. Clinical education in athletic training is similar to that of other allied health care professions. Clinical…

  13. "Perpetual Problem-Solving": An Ethnographic Study of Clinical Reasoning in a Therapeutic Recreation Setting.

    ERIC Educational Resources Information Center

    Hutchinson, Susan L.; LeBlanc, Adrienne; Booth, Rhonda

    2002-01-01

    Reviews literature on the concept and practice of clinical reasoning, presenting evidence of clinical reasoning in a therapeutic recreation setting. Data from observations of and interviews with recreation therapists and clients in a Canadian rehabilitation hospital provided evidence of therapists' clinical reasoning practices which supported the…

  14. "Perpetual Problem-Solving": An Ethnographic Study of Clinical Reasoning in a Therapeutic Recreation Setting.

    ERIC Educational Resources Information Center

    Hutchinson, Susan L.; LeBlanc, Adrienne; Booth, Rhonda

    2002-01-01

    Reviews literature on the concept and practice of clinical reasoning, presenting evidence of clinical reasoning in a therapeutic recreation setting. Data from observations of and interviews with recreation therapists and clients in a Canadian rehabilitation hospital provided evidence of therapists' clinical reasoning practices which supported the…

  15. Clinical Instructor Characteristics, Behaviors and Skills in Allied Health Care Settings: A Literature Review

    ERIC Educational Resources Information Center

    Levy, Linda S.; Sexton, Patrick; Willeford, K. Sean; Barnum, Mary G.; Guyer, M. Susan; Gardner, Greg; Fincher, A. Louise

    2009-01-01

    The purpose of this literature review is to compare both clinical instructor and student perceptions of helpful and hindering clinical instructor characteristics, behaviors and skills in athletic training and allied health care settings. Clinical education in athletic training is similar to that of other allied health care professions. Clinical…

  16. Safety and effectiveness of gemcitabine in 260 patients with biliary tract cancer in a Japanese clinical practice based on post-marketing surveillance in Japan.

    PubMed

    Okubo, Sumiko; Nishiuma, Shinichi; Kobayashi, Noriko; Taketsuna, Masanori; Taniai, Hisashi

    2012-11-01

    Gemcitabine was approved for the treatment of biliary tract cancer in 2006 in Japan. While biliary tract cancer is usually associated with patients 70 years of age or older and/or those who tend to have underlying liver dysfunction, data on this population were limited in the Japanese Phase II study of gemcitabine. Thus, further evaluation of safety and effectiveness in this population was planned. This special post-marketing surveillance was conducted as an observational study on the use of gemcitabine in a clinical practice setting. Gemcitabine-naïve patients with biliary tract cancer were enrolled from 2006 to 2008 and observed over 12 months; one or more doses of gemcitabine were administered during the period. Data such as patient background, treatment details, adverse events occurring during the observational period, laboratory values of liver enzyme and survival status were collected 3 and 12 months after the start of therapy. Of the 285 patients registered for the study, 260 were included in the analysis. The mean age was 66.9 years. There were 120 patients (46.2%) classified as elderly (70 years or older). Haematotoxicities were the most common adverse drug reactions. In the elderly and the non-elderly, adverse drug reactions (serious) occurred in 48.3% (20.8%) and 50.7% (12.9%), respectively. The overall estimated 1-year survival rate was 52.5% (95% confidence interval, 45.9-58.7%). In line with previous clinical and post-marketing studies conducted in Japan, the results of this study suggest that gemcitabine could be used safely and effectively for biliary tract cancer patients including the elderly.

  17. [Clinical features in fatal Spanish influenza: Japanese Army Hospital medical records investigation].

    PubMed

    Fujikura, Yuji; Kawana, Akihiko; Kato, Yasuyuki; Mizuno, Yasutaka; Kudo, Koichiro

    2010-03-01

    Pandemic influenza preparedness requires a thorough knowledge of past pandemics. Tokyo First Army Hospital medical records from January 1918 to December 1920 found recently included 132 consecutive records of those diagnosed with influenza. We report on the clinical features in 8 fatal cases. Inpatient mortality was found to be 6.1% (8/132). Cough was noted in 6 (75%) and thoracic rales in 8 (100%) on admission, mimicking pneumonia. Bloody sputum was noted in 5 (62.5%) and diarrhea in 4 (50%), with marked hemorrhagic and digestive symptoms, resembling highly pathogenic avian influenza. Clinical features may differ from seasonal influenza, making early detection and treatment essential especially in severe cases.

  18. Differences in Clinical and Pathological Features of Renal Cell Carcinoma Between Japanese Patients After Kidney Transplantation and Those on Hemodialysis.

    PubMed

    Takagi, Toshio; Kondo, Tsunenori; Okumi, Masayoshi; Ishida, Hideki; Tanabe, Kazunari

    2017-04-01

    We compared the clinical features, pathological features, and prognoses of patients with renal cell carcinoma (RCC) arising in the native kidney after kidney transplantation (RCC-transplant) or on hemodialysis (RCC-HD), and analyzed predictive factors for survival at a Japanese single institution. This cohort included 42 patients in the RCC-transplant group and 467 patients in the RCC-HD group. RCC-transplant patients were younger (53 years vs. 56 years, P = 0.0358) and had less frequent symptoms (12% vs. 27%, P = 0.0344) than RCC-HD patients. Although tumor size, tumor stage, and histological subtype were not significantly different, the RCC-transplant group had less frequent multifocal occurrences and ACDK. Overall 5-year survival (RCC-transplant, 80%; RCC-hemodialysis, 76%; P = 0.3217) and 5-year cancer-specific survival (CSS; RCC-transplant, 84%; RCC-hemodialysis, 89%; P = 0.8916) were not significantly different between the two groups. Tumor stage and grade were significant predictors for CSS. Although kidney transplantation and hemodialysis were not associated with CSS, tumor stage was an independent predictor of CSS.

  19. Clinical Features of Japanese Patients with Central Retinal Vein Occlusion Complicated by Normal-Tension Glaucoma: A Retrospective Study.

    PubMed

    Kida, Teruyo; Fukumoto, Masanori; Sato, Takaki; Oku, Hidehiro; Ikeda, Tsunehiko

    2017-01-01

    The association of central retinal vein occlusion (CRVO) with primary open-angle glaucoma (POAG) or ocular hypertension has been reported, and lowering intraocular pressure (IOP) helps to improve the retinal circulation in eyes with CRVO. However, the clinical features of CRVOs with normal-tension glaucoma (NTG) are not well known. Therefore, we investigated Japanese CRVO patients with NTG. We retrospectively investigated 234 CRVO patients over 5 years, with follow-ups of more than 12 months, and evaluated the prevalence of glaucoma. Of the 234 CRVO patients, 18 (7.7%) were diagnosed with NTGs (n = 10) or POAGs (n = 8). Seven POAG (87.5%) and 3 NTG (30%) patients had systemic hypertension. At the initial CRVO evaluation, 6 NTGs showed a significantly increased IOP; mean IOP was 13.3 mm Hg before CRVO, 16.2 mm Hg at CRVO, and 13.5 mm Hg at the final visit. The proportion of NTGs with systemic hypertension was low. IOP of NTG patients was significantly elevated at the initial CRVO evaluation, even in the presence of anti-glaucoma drugs. © 2017 S. Karger AG, Basel.

  20. Clinical characterization and identification of duplication breakpoints in a Japanese family with Xq28 duplication syndrome including MECP2.

    PubMed

    Fukushi, Daisuke; Yamada, Kenichiro; Nomura, Noriko; Naiki, Misako; Kimura, Reiko; Yamada, Yasukazu; Kumagai, Toshiyuki; Yamaguchi, Kumiko; Miyake, Yoshishige; Wakamatsu, Nobuaki

    2014-04-01

    Xq28 duplication syndrome including MECP2 is a neurodevelopmental disorder characterized by axial hypotonia at infancy, severe intellectual disability, developmental delay, mild characteristic facial appearance, epilepsy, regression, and recurrent infections in males. We identified a Japanese family of Xq28 duplications, in which the patients presented with cerebellar ataxia, severe constipation, and small feet, in addition to the common clinical features. The 488-kb duplication spanned from L1CAM to EMD and contained 17 genes, two pseudo genes, and three microRNA-coding genes. FISH and nucleotide sequence analyses demonstrated that the duplication was tandem and in a forward orientation, and the duplication breakpoints were located in AluSc at the EMD side, with a 32-bp deletion, and LTR50 at the L1CAM side, with "tc" and "gc" microhomologies at the duplication breakpoints, respectively. The duplicated segment was completely segregated from the grandmother to the patients. These results suggest that the duplication was generated by fork-stalling and template-switching at the AluSc and LTR50 sites. This is the first report to determine the size and nucleotide sequences of the duplicated segments at Xq28 of three generations of a family and provides the genotype-phenotype correlation of the patients harboring the specific duplicated segment.

  1. Clinical findings in Japanese children with obstructive sleep apnea syndrome: focus on dental findings.

    PubMed

    Kawashima, S; Niikuni, N; Lo, C H; Kohno, M; Nakajima, I; Akasaka, M

    1999-09-01

    We evaluated clinical findings including those on dentistry and in the oral cavity of children with obstructive sleep apnea syndrome (OSA). This study examined twenty-seven OSA children, who were advised by otolaryngologists to be admitted for closer examination and showed an apnea index (AI) of 5 or more on polysomnographs. Their clinical history was obtained from their mothers, and oral findings were also evaluated. The patient consisted of 15 males (56%) and 12 females (44%). The mean body mass index (BMI) was 16.0 +/- 3.0. Of the clinical findings related to sleeping and the duration of sleeping, snoring was the most frequently observed finding (100%). The mean duration of sleep, calculated from the time they went to bed (9.2 +/- 0.8 p.m.) and the time they got up (7.1 +/- 0.8 a.m.), was 9.9 +/- 1.0 hours. Of the clinical findings obtained during the daytime, hyponasal speech was the most frequently observed finding (74%). In terms of dentistry, oral breathing was the most frequently observed finding (89%). The mean duration of meals was 31.7 +/- 13.8 minutes. Results of oral examination revealed that Hellman's dental age was most frequently IIA. According to the standardized grading classification, grade I was observed in 7%, II in 63%, and grade III in 30% of subjects.

  2. A first-in-Asian phase 1 study to evaluate safety, pharmacokinetics and clinical activity of VS-6063, a focal adhesion kinase (FAK) inhibitor in Japanese patients with advanced solid tumors.

    PubMed

    Shimizu, Toshio; Fukuoka, Kazuya; Takeda, Masayuki; Iwasa, Tutomu; Yoshida, Takeshi; Horobin, Joanna; Keegan, Mitchell; Vaickus, Lou; Chavan, Ajit; Padval, Mahesh; Nakagawa, Kazuhiko

    2016-05-01

    VS-6063 (also known as defactinib or PF-04554878) is a second-generation inhibitor of focal adhesion kinase and proline-rich tyrosine kinase-2. This phase 1 study evaluated the safety and tolerability, pharmacokinetics, and clinical activity of VS-6063 in Japanese subjects with advanced solid tumor malignancies in a first-in-Asian study setting. VS-6063 was administered orally twice daily (b.i.d.) in 21-day cycles to cohorts of three subjects each with a standard 3 + 3 dose-escalation design until disease progression or unacceptable toxicity. Blood samples for pharmacokinetics were collected on Day 1 and 15. The assessments were performed using CTCAE v4.0 for adverse events (AEs), and the Response Evaluation Criteria In Solid Tumors, version v1.1 (RECIST v1.1) for tumor response. Nine patients were treated across three dose levels (200-600 mg BID). No dose-limiting toxicities were observed at any dose level. Most frequent treatment-related AEs were Grade 1/2 unconjugated hyperbilirubinemia, fatigue, decreased appetite, and diarrhea. Only one subject in the 200 mg BID cohort experienced reversible and transient Grade 3 unconjugated hyperbilirubinemia. PK analyses confirmed that the exposure at the recommended Phase 2 dose (RP2D) of 400 mg BID was comparable with exposures previously reported in non-Japanese subjects. Durable stable disease of approximately 24 weeks was confirmed in two subjects (malignant mesothelioma and rectal cancer). VS-6063 was well tolerated at all dose levels investigated in this first-in-Asian study. These data support the administration of VS-6063 to Japanese subjects at the RP2D in clinical trials involving solid tumor malignancies.

  3. The clinical outcome of pazopanib treatment in Japanese patients with relapsed soft tissue sarcoma: A Japanese Musculoskeletal Oncology Group (JMOG) study.

    PubMed

    Nakamura, Tomoki; Matsumine, Akihiko; Kawai, Akira; Araki, Nobuhito; Goto, Takahiro; Yonemoto, Tsukasa; Sugiura, Hideshi; Nishida, Yoshihiro; Hiraga, Hiroaki; Honoki, Kanya; Yasuda, Taketoshi; Boku, Shogen; Sudo, Akihiro; Ueda, Takafumi

    2016-05-01

    Because the efficacy and safety of pazopanib in Japanese patients with soft tissue sarcoma (STS) had not been evaluated previously in a large-scale cohort, the authors investigated the efficacy and safety of pazopanib in 156 Japanese patients with relapsed STS. This was a retrospective study based on the collection of real-life, postmarketing surveillance data. Patients received pazopanib with the objective of treating local recurrence (n = 20), metastasis (n = 104), and both (n = 32). The patient median age was 53.8 years. The primary objective of this study was to clarify the efficacy of pazopanib for patients with STS. The median treatment duration was 28.7 weeks, and the average dose intensity of pazopanib was 609 mg. Adverse events occurred in 127 patients (81.4%). In addition to the main common toxicities, such as hypertension and liver disorder, pneumothorax (n = 11) and thrombocytopenia (n = 16) also were observed. The median progression-free survival for all patients was 15.4 weeks. The median progression-free survival for patients with leiomyosarcoma, synovial sarcoma, undifferentiated pleomorphic sarcoma, and liposarcoma was 18.6 weeks, 16.4 weeks, 15.3 weeks, and 8 weeks, respectively. The median survival for all patients was 11.2 months. The median survival for patients with leiomyosarcoma, synovial sarcoma, undifferentiated pleomorphic sarcoma, and liposarcoma was 20.1 months, 10.6 months, 9.5 months, and 7.3 months, respectively. There were apparent differences in the efficacy of pazopanib treatment among histologic types of STS. Pazopanib treatment is a new treatment option; however, adverse events like pneumothorax and thrombocytopenia, which did not occur frequently in the PALETTE study (pazopanib for metastatic soft-tissue sarcoma), should be taken into consideration. Cancer 2016;122:1408-16. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. © 2016 The Authors. Cancer published by Wiley

  4. Comparison between cancer specialists and general physicians regarding the education of nurse practitioners in Japan: a postal survey of the Japanese Society of Clinical Oncology.

    PubMed

    Ishida, Yasushi; Hatao, Masahiko; Fukushima, Osamu; Mori, Michiko; Isozaki, Fumiko; Okuyama, Asako

    2013-10-01

    Japanese physicians' attitudes regarding the education of nurse practitioners (NPs) are not well described. A survey was mailed to 1,094 board members of the Japanese Society of Clinical Oncology (JSCO) and the Japanese Primary Care Association (JPCA), and the directors of the clinical training program for physicians. The physicians of JSCO were classified as the cancer specialist group, and both the board members of JPCA and the directors of the clinical training program for physicians constituted the general physician group. We compared the responses of cancer specialists and general physicians. The survey response rate was 25.9% (69 of 266) in the cancer specialist group and 19.4% (161 of 828) in the general physician group. The median age of respondents was 53 and 55 years, respectively, of which 84 and 79%, respectively, were men. We found that the percentages of respondents who considered NP education necessary were almost identical in the 2 groups (r = 0.898, p < 0.0001). Education items considered necessary for NPs by >80% respondents in both groups included many symptoms, emergency management, basic procedures, general screening, palliative care including management against adverse effects, health education, and communication. More cancer specialists than general physicians (p < 0.01) expected NPs to be educated in multidisciplinary practice and palliative care, including management against adverse effects. Our study suggests that cancer specialists expect NPs to provide symptom management and psychosocial support, clarify information, provide education, and work as a member of a multidisciplinary team.

  5. Correlation Between Screening Mammography Interpretive Performance on a Test Set and Performance in Clinical Practice.

    PubMed

    Miglioretti, Diana L; Ichikawa, Laura; Smith, Robert A; Buist, Diana S M; Carney, Patricia A; Geller, Berta; Monsees, Barbara; Onega, Tracy; Rosenberg, Robert; Sickles, Edward A; Yankaskas, Bonnie C; Kerlikowske, Karla

    2017-10-01

    Evidence is inconsistent about whether radiologists' interpretive performance on a screening mammography test set reflects their performance in clinical practice. This study aimed to estimate the correlation between test set and clinical performance and determine if the correlation is influenced by cancer prevalence or lesion difficulty in the test set. This institutional review board-approved study randomized 83 radiologists from six Breast Cancer Surveillance Consortium registries to assess one of four test sets of 109 screening mammograms each; 48 radiologists completed a fifth test set of 110 mammograms 2 years later. Test sets differed in number of cancer cases and difficulty of lesion detection. Test set sensitivity and specificity were estimated using woman-level and breast-level recall with cancer status and expert opinion as gold standards. Clinical performance was estimated using women-level recall with cancer status as the gold standard. Spearman rank correlations between test set and clinical performance with 95% confidence intervals (CI) were estimated. For test sets with fewer cancers (N = 15) that were more difficult to detect, correlations were weak to moderate for sensitivity (woman level = 0.46, 95% CI = 0.16, 0.69; breast level = 0.35, 95% CI = 0.03, 0.61) and weak for specificity (0.24, 95% CI = 0.01, 0.45) relative to expert recall. Correlations for test sets with more cancers (N = 30) were close to 0 and not statistically significant. Correlations between screening performance on a test set and performance in clinical practice are not strong. Test set performance more accurately reflects performance in clinical practice if cancer prevalence is low and lesions are challenging to detect. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  6. Relationship between self-assessment and clinical evaluation of dental plaque and gingival condition in Japanese adolescents.

    PubMed

    Shizuma, Y; Zaitsu, T; Ueno, M; Ohnuki, M; Kawaguchi, Y

    2017-04-23

    To apply a self-administered assessment form about dental plaque level and gingival condition to Japanese adolescents and to examine the extent to which they can evaluate their own dental plaque and gingivae by comparing with dentists' clinical evaluation. Participants were 151 senior high school students (adolescents) who observed their own mouths and recorded dental plaque seen on their 12 anterior teeth, and gingival inflammation condition of 10 anterior interdental papillae, on a self-assessment form. Dentists clinically evaluated dental plaque using the, modified Debris Index (modified DI) and gingival condition, modified PMA index (P-index). "Recognition score" of dental plaque and gingival condition was the total number of agreement between the adolescents' self-assessment and dentists' evaluation. Proportion of agreement on dental plaque between the adolescents' self-assessment and dentists' evaluation with modified DI was 37.4%, and agreement on modified DI score 1, 2 or 3 was significantly lower than that on score 0 (P<.01). Agreement on gingivae was 47.3% in total, and agreement was significantly lower on gingival condition with inflammation than gingivae without inflammation (P<.01). Recognition scores of dental plaque or gingival condition were significantly lower in adolescents with fair or poor modified DI or P-index than in those with good condition (P<.01). Most adolescents could not recognize their dental plaque and gingival condition. Adolescents with poorer dental plaque level or gingival condition had lower recognition scores compared to those with better oral health. Improving oral health self-assessment skills could help adolescents achieve better oral health. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Japanese sake yeast supplementation improves the quality of sleep: a double-blind randomised controlled clinical trial.

    PubMed

    Monoi, Noriyuki; Matsuno, Ayumi; Nagamori, Yuki; Kimura, Eriko; Nakamura, Yoshitaka; Oka, Kengo; Sano, Tomomi; Midorikawa, Tatsuyuki; Sugafuji, Toshihiro; Murakoshi, Michiaki; Uchiyama, Akira; Sugiyama, Keikichi; Nishino, Hoyoku; Urade, Yoshihiro

    2016-02-01

    Activation of adenosine A2a receptors in cerebral neurons induces sleep in various mammals. It was previously found that Japanese sake yeast enriched in adenosine analogues activates A2a receptors in vitro and induces sleep in mice. Here it is reported that sake yeast activated A2a receptors in a cultured human cell line and improved human sleep quality in a clinical trial. Sake yeast activated A2a receptors in HEK cells in a dose-dependent manner with an EC50 of 40 μg mL(-1), and the activation was attenuated almost completely by the A2a receptor antagonist ZM241385 with an IC50 of 73 nm. In a double-blind placebo-controlled crossover clinical study, 68 healthy participants ingested tablets containing either 500 mg of sake yeast powder or a placebo (cellulose) 1 h before sleep for 4 days. Electroencephalograms were recorded during sleep at home with a portable device for 4 week days. Electroencephalogram analyses revealed that sake yeast supplementation significantly (P = 0.03) increased delta power during the first cycle of slow-wave sleep by 110%, without changing other sleep parameters. Sake yeast supplementation also significantly increased growth hormone secretion in the urine on awakening by 137% from 3.17 ± 0.41 (placebo) to 4.33 ± 0.62 (sake yeast) pg mg(-1) creatinine (P = 0.03). Subjective sleepiness (P = 0.02) and fatigue (P = 0.06) in the morning were improved by sake yeast. Given these benefits and the absence of adverse effects during the study period, it was concluded that sake yeast supplementation is an effective and safe way to support daily high-quality, deep sleep. © 2015 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.

  8. CAsubtype: An R Package to Identify Gene Sets Predictive of Cancer Subtypes and Clinical Outcomes.

    PubMed

    Kong, Hualei; Tong, Pan; Zhao, Xiaodong; Sun, Jielin; Li, Hua

    2017-01-21

    In the past decade, molecular classification of cancer has gained high popularity owing to its high predictive power on clinical outcomes as compared with traditional methods commonly used in clinical practice. In particular, using gene expression profiles, recent studies have successfully identified a number of gene sets for the delineation of cancer subtypes that are associated with distinct prognosis. However, identification of such gene sets remains a laborious task due to the lack of tools with flexibility, integration and ease of use. To reduce the burden, we have developed an R package, CAsubtype, to efficiently identify gene sets predictive of cancer subtypes and clinical outcomes. By integrating more than 13,000 annotated gene sets, CAsubtype provides a comprehensive repertoire of candidates for new cancer subtype identification. For easy data access, CAsubtype further includes the gene expression and clinical data of more than 2000 cancer patients from TCGA. CAsubtype first employs principal component analysis to identify gene sets (from user-provided or package-integrated ones) with robust principal components representing significantly large variation between cancer samples. Based on these principal components, CAsubtype visualizes the sample distribution in low-dimensional space for better understanding of the distinction between samples and classifies samples into subgroups with prevalent clustering algorithms. Finally, CAsubtype performs survival analysis to compare the clinical outcomes between the identified subgroups, assessing their clinical value as potentially novel cancer subtypes. In conclusion, CAsubtype is a flexible and well-integrated tool in the R environment to identify gene sets for cancer subtype identification and clinical outcome prediction. Its simple R commands and comprehensive data sets enable efficient examination of the clinical value of any given gene set, thus facilitating hypothesis generating and testing in biological and

  9. Amebiasis in HIV-1-Infected Japanese Men: Clinical Features and Response to Therapy

    PubMed Central

    Watanabe, Koji; Gatanaga, Hiroyuki; Cadiz, Aleyla Escueta-de; Tanuma, Junko; Nozaki, Tomoyoshi; Oka, Shinichi

    2011-01-01

    Invasive amebic diseases caused by Entamoeba histolytica are increasing among men who have sex with men and co-infection of ameba and HIV-1 is an emerging problem in developed East Asian countries. To characterize the clinical and epidemiological features of invasive amebiasis in HIV-1 patients, the medical records of 170 co-infected cases were analyzed retrospectively, and E. histolytica genotype was assayed in 14 cases. In this series of HIV-1-infected patients, clinical presentation of invasive amebiasis was similar to that described in the normal host. High fever, leukocytosis and high CRP were associated with extraluminal amebic diseases. Two cases died from amebic colitis (resulting in intestinal perforation in one and gastrointestinal bleeding in one), and three cases died from causes unrelated to amebiasis. Treatment with metronidazole or tinidazole was successful in the other 165 cases. Luminal treatment was provided to 83 patients following metronidazole or tinidazole treatment. However, amebiasis recurred in 6 of these, a frequency similar to that seen in patients who did not receive luminal treatment. Recurrence was more frequent in HCV-antibody positive individuals and those who acquired syphilis during the follow-up period. Various genotypes of E. histolytica were identified in 14 patients but there was no correlation between genotype and clinical features. The outcome of metronidazole and tinidazole treatment of uncomplicated amebiasis was excellent even in HIV-1-infected individuals. Luminal treatment following metronidazole or tinidazole treatment does not reduce recurrence of amebiasis in high risk populations probably due to amebic re-infection. PMID:21931875

  10. The moral development of baccalaureate nursing students: understanding unethical behavior in classroom and clinical settings.

    PubMed

    Baxter, Pamela E; Boblin, Sheryl L

    2007-01-01

    Unethical behavior in both classroom and clinical settings is a concern for nurse educators and has the potential to greatly influence the quality of patient care. A review of the literature suggests that students may view unethical clinical behaviors as different from unethical classroom behaviors because they recognize that clinical behaviors may have a direct effect on patient care. An overview of three moral theories, proposed by Kohlberg, Gilligan, and Rest, provides insight into the reasons for unethical behavior. These theories provide the foundation for strategies nurse educators can use to help reduce unethical behavior in both classroom and clinical settings in an attempt to ensure quality patient care.

  11. Histologic and clinical response to varying density settings with a fractionally scanned carbon dioxide laser.

    PubMed

    Saluja, Raminder; Khoury, Jane; Detwiler, Susan P; Goldman, Mitchel P

    2009-01-01

    An evaluation of the histological and clinical response to varying density settings (-10%, 0, and 10% overlap) with a fractionally scanned CO2 laser. Clinical and histological study evaluating abdominoplasty excised tissue for depth of penetration and width of tissue ablated with varying density and energy settings utilizing a scanned microsecond pulsed CO2 laser. These parameters were correlated clinically with patients treated with similar density settings. Fifteen patients were enrolled with 5 patients in each group: group 1 (density 1 settings), group 2 (density 2 settings) and group 3 (density 3 settings). Histological differences of width and depth of tissue ablated with varying density settings and correlation with photodamage improvement clinically. Six samples of excised abdominoplasty tissue were treated with increased energy and density settings and were evaluated histologically. Clinically, 15 patients with photodamage to the face were randomized to receive a fractional CO2 laser treatment with density levels ranging from 1 to 3. Microarrays of tissue injury were visualized with multiple areas of superficial to full-thickness epidermal thermal damage. As energy increased (90 W to 100 W), the width of basophilic coagulation of the subepidermal collagen increased. Increased density paralleled increased depth of penetration of subepidermal coagulation. Patient assessment of discomfort, erythema, edema, and satisfaction with the procedure was proportional to increasing densities. A fractional CO2 laser produces photorejuvenation, erythema, edema and discomfort in proportion with the depth and extent of epidermal and subepidermal thermal damage.

  12. Clinical development and trial design of biosimilar products: a Japanese perspective.

    PubMed

    Nagasaki, Masayuki; Ando, Yuki

    2014-01-01

    In recent years, development of biosimilar products has attracted considerable attention. Because of the structural complexity of biologics, it is difficult to demonstrate that a biosimilar product is identical to the reference product. Therefore, for the development of biosimilar products, we need to adopt an approach that is different from generic product development. In this article, we discuss the guidelines for the development of biosimilar products along with the case examples of biosimilar product development in Japan. In addition, we discuss several issues of clinical trial design for demonstrating biosimilarity to a reference product.

  13. Clinical classification of 103 Japanese patients with Guillain-Barré syndrome.

    PubMed

    Br, Wakerley; Kokubun, N; Funakoshi, K; Nagashima, T; Hirata, K; Yuki, N

    2016-10-15

    Guillain-Barré syndrome (GBS) is the commonest cause of flaccid paralysis worldwide. Miller Fisher syndrome (MFS) is a variant of GBS characterized by ophthalmoplegia and ataxia. Together GBS and MFS form a continuum of discrete and overlapping subtypes, the frequency of which remains unknown. We retrospectively analysed the clinical features (antecedent symptoms, pattern of neurological weakness or ataxia, presence of hypersomnolence) of 103 patients at a single hospital in Japan. Patients were then classified according to new diagnostic criteria (Wakerley et al., 2014). Laboratory data (neurophysiology and anti-ganglioside antibody profiles) were also analysed. According to the new diagnostic criteria, the 103 patients could be classified as follows: classic GBS 73 (71%), pharyngeal-cervical-brachial weakness 2 (2%), acute pharyngeal weakness 0 (0%), paraparetic GBS 1 (1%), bifacial weakness with paraesthesias 1 (1%), polyneuritis cranialis 0 (0%), classic MFS 18 (17%), acute ophthalmoparesis 1 (1%), acute ptosis 0 (0%), acute mydriasis 0 (0%), acute ataxic neuropathy 1 (1%), Bickerstaff brainstem encephalitis 3 (3%), acute ataxic hypersomnolence 0 (0%), GBS and MFS overlap 1 (1%), GBS and Bickerstaff brainstem encephalitis overlap 1 (1%), MFS and pharyngeal-cervical-brachial weakness overlap 1 (1%). Application of the new clinical diagnostic criteria allowed accurate retrospective diagnosis and classification of GBS and MFS subtypes. Copyright © 2016. Published by Elsevier B.V.

  14. Demographic and clinical features of autoimmune thyroid disorder in Japanese patients with systemic sclerosis.

    PubMed

    Toki, Sayaka; Motegi, Sei-ichiro; Yamada, Kazuya; Uchiyama, Akihiko; Ishikawa, Osamu

    2014-12-01

    Autoimmune thyroid disorders (AITD) are characterized by the impairment of the thyroid gland as a result of systemic or organ-specific autoimmune disorders, and the presence of antithyroid autoantibodies, such as antithyroglobulin antibody (AbTg) and antithyroid peroxidase antibody (AbTPO). Several studies have reported the association of AITD with systemic sclerosis (SSc). However, none of those studies analyzed the association between AITD and skin sclerosis in SSc patients. The aim of this study was to examine the demographic and clinical features of SSc patients with AITD treated in our department. Of a total of 210 SSc patients, we identified 30 with AITD (14.3%), including 29 with Hashimoto's disease (13.8%) and one patient with Graves' disease (0.5%), indicating that hypothyroidism was more common among SSc patients with AITD. All patients with AITD were female, and anticentromere antibody positivity, the complication of Sjögren's syndrome, severe facial skin sclerosis and atrophy of the thyroid gland were significantly prevalent in SSc patients with AITD. SSc patients with such clinical features may be at high risk of AITD and require regular follow up of thyroid function including ultrasonography and the examination of serum hormone levels to start an early treatment.

  15. Generations and Identity: The Japanese American.

    ERIC Educational Resources Information Center

    Kitano, Harry H. L.

    The story of people of Japanese descent in the United States is told in its historic context. The Japanese came to America with cultural values that differed greatly from the mainstream U.S. society. They were also set apart by appearance. Conflict between Japan and the United States exacerbated the problems between the Japanese Americans and the…

  16. Generations and Identity: The Japanese American.

    ERIC Educational Resources Information Center

    Kitano, Harry H. L.

    The story of people of Japanese descent in the United States is told in its historic context. The Japanese came to America with cultural values that differed greatly from the mainstream U.S. society. They were also set apart by appearance. Conflict between Japan and the United States exacerbated the problems between the Japanese Americans and the…

  17. Challenges in adapting existing clinical natural language processing systems to multiple, diverse health care settings.

    PubMed

    Carrell, David S; Schoen, Robert E; Leffler, Daniel A; Morris, Michele; Rose, Sherri; Baer, Andrew; Crockett, Seth D; Gourevitch, Rebecca A; Dean, Katie M; Mehrotra, Ateev

    2017-09-01

    Widespread application of clinical natural language processing (NLP) systems requires taking existing NLP systems and adapting them to diverse and heterogeneous settings. We describe the challenges faced and lessons learned in adapting an existing NLP system for measuring colonoscopy quality. Colonoscopy and pathology reports from 4 settings during 2013-2015, varying by geographic location, practice type, compensation structure, and electronic health record. Though successful, adaptation required considerably more time and effort than anticipated. Typical NLP challenges in assembling corpora, diverse report structures, and idiosyncratic linguistic content were greatly magnified. Strategies for addressing adaptation challenges include assessing site-specific diversity, setting realistic timelines, leveraging local electronic health record expertise, and undertaking extensive iterative development. More research is needed on how to make it easier to adapt NLP systems to new clinical settings. A key challenge in widespread application of NLP is adapting existing systems to new clinical settings.

  18. The reasons for triple therapy in stable COPD patients in Japanese clinical practice

    PubMed Central

    Miyazaki, Masaki; Nakamura, Hidetoshi; Takahashi, Saeko; Chubachi, Shotaro; Sasaki, Mamoru; Haraguchi, Mizuha; Terai, Hideki; Ishii, Makoto; Fukunaga, Koichi; Tasaka, Sadatomo; Soejima, Kenzo; Asano, Koichiro; Betsuyaku, Tomoko

    2015-01-01

    Background Triple combination therapy involving long-acting muscarinic antagonists long-acting β2 agonists, and inhaled corticosteroids has recently become an option for maintenance treatment of COPD. Some add-on clinical trials have reported the benefits of these combinations. However, the process to step up to triple therapy varies for individual cases. Methods Keio University and affiliated hospitals conducted an observational COPD cohort study, recruiting patients diagnosed as having COPD by pulmonary physicians and those referred for investigation of possible COPD. Their prescription history and clinical course were retrospectively analyzed based on the physicians’ medical records and patient questionnaires. This study was registered with UMIN (UMIN000003470, April 10, 2010). Results A total of 95 of the 445 COPD patients (21%) were treated with inhaled corticosteroids/long-acting β2 agonists/long-acting muscarinic antagonists as maintenance therapy, including 12 in COPD Grade I, 31 in Grade II, 38 in Grade III, and 14 in Grade IV, based on the Global Initiative for Chronic Obstructive Lung Disease spirometric grading. For more than half of the patients on triple therapy, the treatment had been intensified due to unsatisfactory improvement of symptoms, and 32% were treated with triple therapy due to comorbid asthma. In contrast, there were COPD patients whose therapy was maintained after starting with triple therapy because of their serious conditions or concurrent exacerbation at diagnosis (8%). Conclusion Triple therapy was often prescribed in the real-life management of COPD, even in patients whose airflow limitation was not severe. To better control symptoms was the major reason for choosing triple therapy, regardless of the severity of COPD, in Japan. PMID:26082629

  19. Clinical characteristics of Japanese candidates for lung transplant for interstitial lung disease and risk factors for early death while on the waiting list.

    PubMed

    Higo, Hisao; Kurosaki, Takeshi; Ichihara, Eiki; Kubo, Toshio; Miyoshi, Kentaroh; Otani, Shinji; Sugimoto, Seiichiro; Yamane, Masaomi; Miyahara, Nobuaki; Kiura, Katsuyuki; Miyoshi, Shinichiro; Oto, Takahiro

    2017-07-01

    Lung transplants have produced very favorable outcomes for patients with interstitial lung disease (ILD) in Japan. However, because of the severe donor lung shortage, patients must wait approximately 2.5 years before they can undergo transplantation and many candidates die before allocation. We reveal the clinical characteristics of Japanese patients with ILD who are candidates for lung transplants and the risk factors for early death while on the waiting list. We retrospectively reviewed the clinical data of patients registered in the Japan Organ Transplant Network from Okayama University Hospital who are candidates for cadaveric lung transplants for ILD between 1999 and 2015. Fifty-three patients with ILD were included (24 patients with idiopathic pulmonary fibrosis and 29 others). They had severe pulmonary dysfunction and low exercise tolerability. The median waiting time for transplantation was 462 days, and 22 patients died before allocation. Patients who died before 462 days without undergoing transplantation had more severe dyspnea, shorter 6-minute walk distance (6MWD), and lower performance status than those who waited ≥462 days. Japanese candidates for cadaveric lung transplants for ILD have severe pulmonary dysfunction. Severe dyspnea, short 6MWD, and low performance status are risk factors for early death while on the waiting list. Copyright © 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  20. Doctors' use of mobile devices in the clinical setting: a mixed methods study.

    PubMed

    Nerminathan, Arany; Harrison, Amanda; Phelps, Megan; Scott, Karen M; Alexander, Shirley

    2017-03-01

    Mobile device use has become almost ubiquitous in daily life and therefore includes use by doctors in clinical settings. There has been little study as to the patterns of use and impact this has on doctors in the workplace and how negatively or positively it impacts at the point of care. To explore how doctors use mobile devices in the clinical setting and understand drivers for use. A mixed methods study was used with doctors in a paediatric and adult teaching hospital in 2013. A paper-based survey examined mobile device usage data by doctors in the clinical setting. Focus groups explored doctors' reasons for using or refraining from using mobile devices in the clinical setting, and their attitudes about others' use. The survey, completed by 109 doctors, showed that 91% owned a smartphone and 88% used their mobile devices frequently in the clinical setting. Trainees were more likely than consultants to use their mobile devices for learning and accessing information related to patient care, as well as for personal communication unrelated to work. Focus group data highlighted a range of factors that influenced doctors to use personal mobile devices in the clinical setting, including convenience for medical photography, and factors that limited use. Distraction in the clinical setting due to use of mobile devices was a key issue. Personal experience and confidence in using mobile devices affected their use, and was guided by role modelling and expectations within a medical team. Doctors use mobile devices to enhance efficiency in the workplace. In the current environment, doctors are making their own decisions based on balancing the risks and benefits of using mobile devices in the clinical setting. There is a need for guidelines around acceptable and ethical use that is patient-centred and that respects patient privacy. © 2016 Royal Australasian College of Physicians.

  1. Nurse Practitioner Perceptions of a Diabetes Risk Assessment Tool in the Retail Clinic Setting.

    PubMed

    Marjama, Kristen L; Oliver, JoAnn S; Hayes, Jennifer

    2016-10-01

    IN BRIEF This article describes a study to gain insight into the utility and perceived feasibility of the American Diabetes Association's Diabetes Risk Test (DRT) implemented by nurse practitioners (NPs) in the retail clinic setting. The DRT is intended for those without a known risk for diabetes. Researchers invited 1,097 NPs working in the retail clinics of a nationwide company to participate voluntarily in an online questionnaire. Of the 248 NPs who sent in complete responses, 114 (46%) indicated that they used the DRT in the clinic. Overall mean responses from these NPs indicated that they perceive the DRT as a feasible tool in the retail clinic setting. Use of the DRT or similar risk assessment tools in the retail clinic setting can aid in the identification of people at risk for type 2 diabetes.

  2. Ubiquitous information for ubiquitous computing: expressing clinical data sets with openEHR archetypes.

    PubMed

    Garde, Sebastian; Hovenga, Evelyn; Buck, Jasmin; Knaup, Petra

    2006-01-01

    Ubiquitous computing requires ubiquitous access to information and knowledge. With the release of openEHR Version 1.0 there is a common model available to solve some of the problems related to accessing information and knowledge by improving semantic interoperability between clinical systems. Considerable work has been undertaken by various bodies to standardise Clinical Data Sets. Notwithstanding their value, several problems remain unsolved with Clinical Data Sets without the use of a common model underpinning them. This paper outlines these problems like incompatible basic data types and overlapping and incompatible definitions of clinical content. A solution to this based on openEHR archetypes is motivated and an approach to transform existing Clinical Data Sets into archetypes is presented. To avoid significant overlaps and unnecessary effort during archetype development, archetype development needs to be coordinated nationwide and beyond and also across the various health professions in a formalized process.

  3. Impact of clinic follow-up visits on body weight control in people with prediabetes or diabetes mellitus: Japanese nonelderly cohort study.

    PubMed

    Ono, Sachiko; Ono, Yosuke; Matsui, Hiroki; Yasunaga, Hideo

    2017-09-01

    Body weight control is considered essential for the management of diabetes mellitus. Clinicians have an important role in educating and guiding patients with diabetes to control their body weight. The aim of the present study was to clarify if clinic visits influenced body weight control of people with prediabetes or diabetes mellitus. To examine whether individuals with diabetes mellitus who visit clinics show better weight control. We used a large Japanese database (Japan Medical Data Center, Tokyo, Japan) of screening for lifestyle disease linked with administrative claim data to retrospectively identify people with prediabetes or diabetes mellitus based on their fasting plasma glucose and glycated haemoglobin (HbA1c) concentration. We collected data on their baseline characteristics (including age, sex, body mass index and disease history) and their lifestyles. We used propensity-score inverse probability of treatment weighted generalized estimating equations to examine the association between clinic visits and change in body mass index. Between 2013 and 2014, we identified 11004 individuals with prediabetes or diabetes. The proportions visiting clinics after the first diagnosis made at screening was 27.8%. Clinic visit was significantly associated with lower body mass index after adjustment for baseline patient characteristics a year after first screening (-0.17 kg/m2; 95% confidence interval, -0.22 to -0.12). In Japanese people found to have prediabetes or diabetes during an annual health screen, those who visited clinics after their first diagnosis were likely to have better body weight control.

  4. Clinical code set engineering for reusing EHR data for research: A review.

    PubMed

    Williams, Richard; Kontopantelis, Evangelos; Buchan, Iain; Peek, Niels

    2017-06-01

    The construction of reliable, reusable clinical code sets is essential when re-using Electronic Health Record (EHR) data for research. Yet code set definitions are rarely transparent and their sharing is almost non-existent. There is a lack of methodological standards for the management (construction, sharing, revision and reuse) of clinical code sets which needs to be addressed to ensure the reliability and credibility of studies which use code sets. To review methodological literature on the management of sets of clinical codes used in research on clinical databases and to provide a list of best practice recommendations for future studies and software tools. We performed an exhaustive search for methodological papers about clinical code set engineering for re-using EHR data in research. This was supplemented with papers identified by snowball sampling. In addition, a list of e-phenotyping systems was constructed by merging references from several systematic reviews on this topic, and the processes adopted by those systems for code set management was reviewed. Thirty methodological papers were reviewed. Common approaches included: creating an initial list of synonyms for the condition of interest (n=20); making use of the hierarchical nature of coding terminologies during searching (n=23); reviewing sets with clinician input (n=20); and reusing and updating an existing code set (n=20). Several open source software tools (n=3) were discovered. There is a need for software tools that enable users to easily and quickly create, revise, extend, review and share code sets and we provide a list of recommendations for their design and implementation. Research re-using EHR data could be improved through the further development, more widespread use and routine reporting of the methods by which clinical codes were selected. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  5. Does sensitivity measured from screening test-sets predict clinical performance?

    NASA Astrophysics Data System (ADS)

    Soh, BaoLin P.; Lee, Warwick B.; Mello-Thoms, Claudia R.; Tapia, Kriscia A.; Ryan, John; Hung, Wai Tak; Thompson, Graham J.; Heard, Rob; Brennan, Patrick C.

    2014-03-01

    Aim: To examine the relationship between sensitivity measured from the BREAST test-set and clinical performance. Background: Although the UK and Australia national breast screening programs have regarded PERFORMS and BREAST test-set strategies as possible methods of estimating readers' clinical efficacy, the relationship between test-set and real life performance results has never been satisfactorily understood. Methods: Forty-one radiologists from BreastScreen New South Wales participated in this study. Each reader interpreted a BREAST test-set which comprised sixty de-identified mammographic examinations sourced from the BreastScreen Digital Imaging Library. Spearman's rank correlation coefficient was used to compare the sensitivity measured from the BREAST test-set with screen readers' clinical audit data. Results: Results shown statistically significant positive moderate correlations between test-set sensitivity and each of the following metrics: rate of invasive cancer per 10 000 reads (r=0.495; p < 0.01); rate of small invasive cancer per 10 000 reads (r=0.546; p < 0.001); detection rate of all invasive cancers and DCIS per 10 000 reads (r=0.444; p < 0.01). Conclusion: Comparison between sensitivity measured from the BREAST test-set and real life detection rate demonstrated statistically significant positive moderate correlations which validated that such test-set strategies can reflect readers' clinical performance and be used as a quality assurance tool. The strength of correlation demonstrated in this study was higher than previously found by others.

  6. Efficacy and safety of diquafosol ophthalmic solution in patients with dry eye syndrome: a Japanese phase 2 clinical trial.

    PubMed

    Matsumoto, Yukihiro; Ohashi, Yuichi; Watanabe, Hitoshi; Tsubota, Kazuo

    2012-10-01

    To investigate the dose-dependent efficacy and safety of diquafosol ophthalmic solution for the treatment of dry eye syndrome. Randomized, double-masked, multicenter, parallel-group, placebo-controlled trial. A total of 286 Japanese patients with dry eye who were prescribed topical diquafosol (1%, n = 96; 3%, n = 96) or placebo ophthalmic solution (n = 94). After a washout period of 2 weeks, qualified subjects were randomized to receive a single drop of 1% or 3% diquafosol or placebo ophthalmic solutions 6 times per day for 6 weeks. The primary outcome measure was fluorescein corneal staining score assessment. The secondary outcome measures were Rose Bengal corneal and conjunctival staining scores, tear break-up time (BUT), and subjective symptom assessment. Safety measures were clinical blood and urine examination and recording of adverse events. Fluorescein corneal staining scores significantly improved with both 1% and 3% topical diquafosol compared with placebo at 4 weeks, respectively (P = 0.037, P = 0.002). There was a dose-dependent effect among the groups. Rose Bengal corneal and conjunctival staining scores also improved significantly with both 1% and 3% diquafosol compared with placebo (P = 0.007 and P = 0.004, respectively). Subjective dry eye symptom scores significantly improved with both diquafosol ophthalmic solutions (P ≤ 0.033), although there were no significant differences in BUT compared with placebo. No significant differences between the treatment groups were observed in relation to the occurrence of adverse events. Both 1% and 3% diquafosol ophthalmic solutions are considered effective and safe for the treatment of dry eye syndrome. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  7. Gender Differences in In-Hospital Clinical Outcomes after Percutaneous Coronary Interventions: An Insight from a Japanese Multicenter Registry

    PubMed Central

    Numasawa, Yohei; Kohsaka, Shun; Miyata, Hiroaki; Noma, Shigetaka; Suzuki, Masahiro; Ishikawa, Shiro; Nakamura, Iwao; Nishi, Yutaro; Ohki, Takahiro; Negishi, Koji; Takahashi, Toshiyuki; Fukuda, Keiichi

    2015-01-01

    Background Gender differences in clinical outcomes after percutaneous coronary intervention (PCI) among different age groups are controversial in the era of drug-eluting stents, especially among the Asian population who are at higher risk for bleeding complications. Methods and Results We analyzed data from 10,220 patients who underwent PCI procedures performed at 14 Japanese hospitals from September 2008 to April 2013. A total of 2,106 (20.6%) patients were women. Women were older (72.7±9.7 vs 66.6±10.8 years, p<0.001), and had a lower body mass index (23.4±4.0 vs 24.3±3.5, p<0.001), with a higher prevalence of hypertension (p<0.001), hyperlipidemia (p<0.001), insulin-dependent diabetes (p<0.001), renal failure (p<0.001), and heart failure (p<0.001) compared with men. Men tended to have more bifurcation lesions (p = 0.003) and chronic totally occluded lesions (p<0.001) than women. Crude overall complications (14.8% vs 9.5%, p<0.001) and the rate of bleeding complications (5.3% vs 2.8%, p<0.001) were significantly higher in women than in men. On multivariate analysis in the total cohort, female sex was an independent predictor of overall complications (OR, 1.47; 95% CI, 1.26–1.71; p<0.001) and bleeding complications (OR, 1.74; 95% CI, 1.36–2.24; p<0.001) after adjustment for confounding variables. A similar trend was observed across the middle-aged group (≥55 and <75 years) and old age group (≥75 years). Conclusions Women are at higher risk than men for post-procedural complications after PCI, regardless of age. PMID:25635905

  8. Clinical symptoms of FSSG in gastroesophageal reflux disease are critical for PPI treatment: Japanese multi-centers with 185 patients.

    PubMed

    Komatsu-Tanaka, Mio; Iwakiri, Ryuichi; Fujimoto, Kazuma; Fujiwara, Yasuhiro; Inamori, Masahiko; Tanaka, Junji; Shimatani, Tomohiko; Akiyama, Junichi; Ando, Takashi; Manabe, Noriaki; Kinjo, Fukunori; Deguchi, Ryuzo; Kusano, Motoyasu

    2012-11-01

    The main aim of this study was to determine whether questionnaire evaluations of clinical symptoms in gastroesophageal reflux disease were useful to assess proton pump inhibitor therapy. A total of 185 Japanese patients (men, 88; women, 97; age: 55.7 ± 16.1 years) with gastroesophageal reflux disease were enrolled. The patients were divided based on the frequency scale for symptoms of gastroesophageal reflux disease: severe symptoms with scores ≥8 and mild symptoms with scores ≤7. Quality of life was evaluated with the Medical Outcomes Study 8-Item Short-Form Health Survey. All patients were treated with a proton pump inhibitor, rabeprazole (10 mg/day), for 8 weeks. Patients were classified into four groups: reflux esophagitis with severe symptoms (n = 92, 49.7%); reflux esophagitis with mild symptoms (n = 17, 9.2%); non-erosive reflux disease with severe symptoms (n = 66, 35.7%); and non-erosive reflux disease with mild symptoms (n = 10, 5.4%). The dysmotility score was high in non-erosive reflux disease with severe symptoms compared with reflux esophagitis with severe symptoms (9.1 ± 0.5 vs 6.8 ± 0.5, P < 0.05). The symptom score and quality of life in the severe symptoms groups for both reflux esophagitis and non-erosive reflux disease were significantly improved by rabeprazole treatment. Only the reflux score was improved by rabeprazole in the reflux esophagitis with mild symptoms group; no therapeutic effect was observed for the non-erosive reflux disease with mild symptoms group. Low scores on the frequency scale for the symptoms of gastroesophageal reflux disease indicate poor responsiveness to proton pump inhibitor treatment, and high scores indicate good responsiveness. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.

  9. [Studies on preanalytical phase errors in clinical chemistry in the Japanese clinical laboratory--now and the future].

    PubMed

    Tomita, Akio; Kizawa, Senji

    2007-05-01

    The Sampling Conference for the prevention of preanalytical phase errors was first held at Fukushima in 1987. Since then, The Sampling Conference has been held in several areas in Japan. For the same purpose, we started the Tokai Sampling Conference in the Tokai area including Aichi, Shizuoka, Gifu and Mie prefectures in 1990, and discussed clinical errors in laboratory measurements caused by physiological variations in age, sex and the season, influence of food, exercise, posture and medication, effects of anticoagulants, sample storage conditions and so on. We have studied many preanalytical errors at these conferences. Moreover, additional problems have been revealed at the conferences. Safety and risk management to avoid needle sticks and Vacutainer-induced infections have been discussed, and this information is thought to be important not only for laboratory workers but also for patients.

  10. Metrics for assessing the quality of value sets in clinical quality measures

    PubMed Central

    Winnenburg, Rainer; Bodenreider, Olivier

    2013-01-01

    Objective: To assess the quality of value sets in clinical quality measures, both individually and as a population of value sets. Materials and methods: The concepts from a given value set are expected to be rooted by one or few ancestor concepts and the value set is expected to contain all the descendants of its root concepts and only these descendants. (1) We assessed the completeness and correctness of individual value sets by comparison to the extension derived from their roots. (2) We assessed the non-redundancy of value sets for the entire population of value sets (within a given code system) using the Jaccard similarity measure. Results: We demonstrated the utility of our approach on some cases of inconsistent value sets and produced a list of 58 potentially duplicate value sets from the current set of clinical quality measures for the 2014 Meaningful Use criteria. Conclusion: These metrics are easy to compute and provide compact indicators of the completeness, correctness, and non-redundancy of value sets. PMID:24551422

  11. Japanese Dent disease has a wider clinical spectrum than Dent disease in Europe/USA: genetic and clinical studies of 86 unrelated patients with low-molecular-weight proteinuria.

    PubMed

    Sekine, Takashi; Komoda, Fusako; Miura, Kenichiro; Takita, Junko; Shimadzu, Mitsunobu; Matsuyama, Takeshi; Ashida, Akira; Igarashi, Takashi

    2014-02-01

    Dent disease is an X-linked disorder characterized by low-molecular-weight (LMW) proteinuria, hypercalciuria, nephrocalcinosis, urolithiasis and renal dysfunction. Dent disease is caused by mutations in at least two genes, i.e. CLCN5 and OCRL1, and its genetic background and phenotypes are common among European countries and the USA. However, only few studies on Dent disease in Japan, which was originally called 'low-molecular-weight proteinuric disease', have been reported thus far. In this study, we analysed genetic background and clinical phenotype and laboratory data of 86 unrelated Japanese Dent disease patients. The results demonstrated that the genetic basis of Japanese Dent disease was nearly identical to those of Dent disease in other countries. Of 86 unrelated Japanese Dent patients, 61 possessed mutations in CLCN5 (Dent-1), of which 27 were novel mutations; 11 showed mutations in OCRL1 (Dent-2), six of which were novel, and the remaining 14 patients showed no mutations in CLCN5 or OCRL1 (Dent-NI). Despite the similarity in genetic background, hypercalciuria was detected in only 51%, rickets in 2% and nephrocalcinosis in 35%. Although the patients were relatively young, six patients (8%) showed apparent renal dysfunction. Japanese Dent disease has a wider clinical spectrum than Dent disease in Europe and the USA.

  12. Efficacy and safety of empagliflozin in Japanese patients with type 2 diabetes mellitus: A sub-analysis by body mass index and age of pooled data from three clinical trials.

    PubMed

    Shiba, Teruo; Ishii, So; Okamura, Tomoo; Mitsuyoshi, Rika; Pfarr, Egon; Koiwai, Kazuki

    2017-09-01

    To investigate the efficacy and safety of empagliflozin in subgroups based on body mass index (BMI) and age, using a pooled data set from Japanese patients with type 2 diabetes mellitus (T2DM). Pooled data from 1403 patients treated with empagliflozin at 10mg/day or 25mg/day in three clinical studies (≥52week treatment) were stratified by baseline BMI (<22, 22 to <25 and ≥25kg/m(2)) and baseline age (<50, 50 to <65 and ≥65years). Empagliflozin at 10mg/day and 25mg/day reduced mean glycated hemoglobin (HbA1c) (-0.77 to -0.87% and -0.76 to -0.97%, respectively), mean fasting plasma glucose (FPG) (-20.79 to -27.06mg/dL and -26.08 to -29.60mg/dL) and mean body weight (-3.4 to -4.7% and -3.7 to -4.7%) in all subgroups of baseline BMI and age, regardless of age and degree of obesity. Adverse events were observed in approximately 70-80% patients in BMI and age subgroups of both empagliflozin groups. No hypoglycemia requiring assistance was observed. Neither UTI nor genital infection rates differed markedly among the BMI and age subgroups. Volume depletion was increased in patients ≥65years of age as compared to younger patients. Empagliflozin was well tolerated and improved HbA1c, FPG and body weight in all BMI and age subgroups of Japanese patients with T2DM, regardless of age and degree of obesity. Empagliflozin is considered to be effective and well tolerated for treating a wide range of Japanese patients with T2DM. Study 1 (NCT01193218), Study 2 (NCT01289990) and Study 3 (NCT01368081). Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  13. Application of incremental change strategies in chiropractic and multidisciplinary clinical settings for quality improvement.

    PubMed

    Mootz, R D; Hansen, D T; Souza, T A; Triano, J J; Wiese, B C

    2000-01-01

    Care for low back pain remains a clinical enigma. Its high prevalence and cost to the system warrants attention for improvement. Although, no major recent clinical breakthroughs for resolving back pain have emerged, reducing unnecessary tests, eliminating useless or harmful practices, preventing care dependence, and enhancing coping skills can be useful goals for improving patient outcomes. Quality Improvement (QI) approaches can serve as bridge between clinical intuition and large scale science. Three chiropractic delivery settings including two teaching clinics and one large multidisciplinary spine care center incorporated QI approaches as part of an initiative to improve low back pain care. All clinics were able to implement sustainable process and outcomes improvements.

  14. OSCEs in Japanese postgraduate clinical training Hiroshima experience 2000-2009.

    PubMed

    Taguchi, N; Ogawa, T

    2010-11-01

    Hiroshima University Hospital used the Objective Structured Clinical Examination (OSCE) as a formative and summative assessment tool to evaluate trainees' competence. To reflect on Hiroshima University Hospital experience of OSCEs in postgraduate training in terms of OSCE structure and trainees' perception of the OSCE they attended. A total 27 OSCEs implemented in Hiroshima University Hospital from 2000 to 2009 were examined. The OSCE in postgraduate training, Hiroshima University Hospital, was influenced by many factors from organisational and pedagogical perspectives, and changed to meet social and curriculum needs. At each OSCE, all examinees were required to answer an anonymous questionnaire, which consisted of ten checklists, just after their experience of OSCE. Five hundred and forty trainees who attended each OSCE were required to answer a questionnaire and 510 were returned (94.4%). In the comparison between formative and summative OSCEs, the number of trainees who answered "the OSCE is meaningful" in formative OSCE was significantly higher than that in summative OSCE (P < 0.001). In the comparison between before and after the 2006/2007 academic year, trainees who indicated that OSCEs were meaningful increased after 2006/2007 (P < 0.05), and trainees who felt they were evaluated appropriately by these OSCEs increased after 2006/2007 (P < 0.01). Trainees viewed OSCEs positively and appreciated their effectiveness from a pedagogical perspective, and OSCE positively affected the trainees' approach to learning. A ten-year process of OSCE change has helped with educational reforms because of its adaptability. Flexible attitudes to change are necessary for stakeholders to achieve the desired reforms. © 2010 John Wiley & Sons A/S.

  15. Worldwide Lineages of Clinical Pneumococci in a Japanese Teaching Hospital Identified by DiversiLab System.

    PubMed

    Kashiwaya, Kiyoshi; Saga, Tomoo; Ishii, Yoshikazu; Sakata, Ryuji; Iwata, Morihiro; Yoshizawa, Sadako; Chang, Bin; Ohnishi, Makoto; Tateda, Kazuhiro

    2016-06-01

    Pneumococcal Molecular Epidemiology Network (PMEN) clones are representatives of worldwide-spreading pathogens. DiversiLab system, a repetitive PCR system, has been proposed as a less labor-and time-intensive genotyping platform alternative to conventional methods. However, the utility and analysis parameters of DiversiLab for identifying worldwide lineages was not established. To evaluate and optimize the performance of DiversiLab for identifying worldwide pneumococcal lineages, we examined 245 consecutive isolates of clinical Streptococcus pneumoniae from all age-group patients at a teaching hospital in Japan. The capsular swelling reaction of all isolates yielded 24 different serotypes. Intensive visual observation (VO) of DiversiLab band pattern difference divided all isolates into 73 clusters. Multilocus sequence typing (MLST) of representative 73 isolates from each VO cluster yielded 51 different STs. Among them, PMEN-related lineages accounted for 63% (46/73). Although the serotype of PMEN-related isolates was identical to that of the original PMEN clone in 70% (32/46), CC156-related PMEN lineages, namely Greece(6B)-22 and Colombia(23F)-26, harbored various capsular types discordant to the original PMEN clones. Regarding automated analysis, genotyping by extended Jaccard (XJ) with a 75% similarity index cutoff (SIC) showed the highest correlation with serotyping (adjusted Rand's coefficient, 0.528). Elevating the SIC for XJ to 85% increased the discriminatory power sufficient for distinguishing two major PMEN-related isolates of Taiwan(19F)-14 and Netherlands(3)-31. These results demonstrated a potential utility of DiversiLab for identifying worldwide lineage of pneumococcus. An optimized parameters of automated analysis should be useful especially for comparison for reference strains by "identification" function of DiversiLab.

  16. Clinical usefulness of ursodeoxycholic acid for Japanese patients with autoimmune hepatitis

    PubMed Central

    Torisu, Yuichi; Nakano, Masanori; Takano, Keiko; Nakagawa, Ryo; Saeki, Chisato; Hokari, Atsushi; Ishikawa, Tomohisa; Saruta, Masayuki; Zeniya, Mikio

    2017-01-01

    AIM To evaluate the therapeutic effects of ursodeoxycholic acid (UDCA) on autoimmune hepatitis (AIH). METHODS A total 136 patients who were diagnosed with AIH were included in our study. All of the patients underwent a liver biopsy, and had at least a probable diagnosis on the basis of either the revised scoring system or the simplified scores. Initial treatment included UDCA monotherapy (Group U, n = 48) and prednisolone (PSL) monotherapy (Group P, n = 88). Group U was further classified into two subgroups according to the effect of UDCA: Patients who had achieved remission induction with UDCA monotherapy and showed no sign of relapse (Subgroup U1, n = 34) and patients who additionally received PSL during follow-up (Subgroup U2, n = 14). We compared the clinical and histological findings between each groups, and investigated factors contributing to the response to UDCA monotherapy. RESULTS In Group U, 34 patients (71%) achieved and maintained remission over 49 (range: 8-90) mo (Subgroup U1) and 14 patients (29%) additionally received PSL (Subgroup U2) during follow-up. Two patients in Subgroup U2 achieved remission induction once but additionally required PSL administration because of relapse (15 and 35 mo after the start of treatment). The remaining 12 patients in Subgroup U2 failed to achieve remission induction during follow-up, and PSL was added during 7 (range: 2-18) mo. Compared with Subgroup U2, Subgroup U1 had significantly lower alanine aminotransferase (ALT) levels at onset (124 IU/L vs 262 IU/L, P = 0.023) and a significantly higher proportion of patients with mild inflammation (A1) on histological examination (70.6% vs 35.7%, P = 0.025). When multivariate analysis was performed to identify factors contributing to the response to UDCA monotherapy, only a serum ALT level of 200 IU/L or lower was found to be associated with a significant difference (P = 0.013). CONCLUSION To prevent adverse events related to corticosteroids, UDCA monotherapy for AIH needs

  17. Clinical significance of the mesorectal extension of rectal cancer: a Japanese multi-institutional study.

    PubMed

    Shirouzu, Kazuo; Akagi, Yoshito; Fujita, Shin; Ueno, Hideki; Takii, Yasumasa; Komori, Koji; Ito, Masaaki; Sugihara, Kenichi

    2011-04-01

    The aim of this study was to emphasize the importance of a subclassification in the TNM staging system of rectal cancer. The clinical significance of the mesorectal extension of rectal cancer is unclear. Data from 463 consecutive patients with stage IIa disease (T3N0) undergoing curative surgery at 28 institutes were analyzed. The measurement of the distance of the mesorectal extension (DME) was histologically evaluated. Risk factors for recurrence, for the optimal cutoff point of the DME, independent prognostic factors, and for survivals were studied using receiver operating characteristic curve and logistic and Cox regression analyses. Survivals were calculated using the Kaplan-Meier method. A value of 4 mm was determined as the optimal cutoff point. The patients were subdivided into 2 groups: DME ≤ 4 mm and DME > 4 mm at the optimal cutoff point. DME > 4 mm had the greatest impact on recurrence-free survival [P = 0.00023, hazard ratio (HR): 2.26, 95% confidence interval (95% CI): 1.465-3.492, L/U ratio: 0.420] and was an independent adverse prognostic factor (P = 0.00323, HR: 1.97, 95% CI: 1.254-3.091). The distant metastasis rate in DME > 4 mm was higher 16.7% than that in DME ≤ 4 mm (P = 0.00177, OR: 2.61, 95% CI: 1.430-4.761). The incidence of local recurrence was not influenced by DME. The recurrence-free 5-year survival rate in DME ≤ 4 mm was significantly better than that in DME > 4 mm (86.6% vs 71.3%, P = 0.00015, HR: 0.44, 95% CI: 0.286-0.683). The cancer-specific survival rate in DME ≤ 4 mm was also significantly better than that in DME > 4 mm (91.3% vs 82.2%, P = 0.000664, HR: 0.52, 95% CI: 0.325-0.843). A subclassification according to mesorectal extension based on a 4-mm cutoff point is needed for the TNM staging system. However, further prospective study is necessary to prove reproducibility and validity of the cutoff point.

  18. Molecular Characteristics of Extended-Spectrum β-Lactamases in Clinical Isolates from Escherichia coli at a Japanese Tertiary Hospital

    PubMed Central

    Endo, Shiro; Kanamori, Hajime; Inomata, Shinya; Kakuta, Risako; Ichimura, Sadahiro; Ogawa, Miho; Shimojima, Masahiro; Ishibashi, Noriomi; Aoyagi, Tetsuji; Hatta, Masumitsu; Gu, Yoshiaki; Yamada, Mitsuhiro; Tokuda, Koichi; Kunishima, Hiroyuki; Kitagawa, Miho; Hirakata, Yoichi; Kaku, Mitsuo

    2013-01-01

    The prevalence of ESBL has been increasing worldwide. In this study, we investigated the molecular characteristics of ESBL among clinical isolates of Escherichia coli from a Japanese tertiary hospital. A total of 71 consecutive and nonduplicate clinical isolates of ESBL-positive E. coli collected at Tohoku University Hospital between January 2008 and March 2011 were studied. The antimicrobial susceptibility profile of these strains was determined. PCR and sequencing were performed to identify genes for β-lactamase (blaTEM, blaSHV, blaOXA-1-like, and blaCTX-M) and plasmid-mediated quinolone resistance determinants (PMQR). The isolates were also analyzed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Of the 71 strains, 68 were positive for CTX-M, 28 were positive for TEM, four were positive for OXA-1, and one was positive for SHV. Sequencing revealed that CTX-M-14 was the most prevalent (31/71), followed by CTX-M-27 (21/71) and then CTX-M-15 (9/71). Of the 28 TEM-positive strains, one was TEM-10 and the rest were TEM-1. One SHV-positive strain was SHV-12. The 21 CTX-M-27-producing isolates were divided into 14 unique PFGE types, while the 9 CTX-M-15 producers were divided into 8 types. Based on MLST, 9 CTX-M-14 procedures, 19 CTX-M-27 procedures, and 8 CTX-M-15 producers belonged to ST131. Thirty-five (94.6%) of the 37 ST131 E. coli strains showed resistance to levofloxacin, which was a higher rate than among non-ST131 strains (63.6%). Among ESBL-producing isolates, one, two, and six possessed qnrB, qnrS, qepA, and aac(6′)-Ib-cr, respectively. Of the 6 isolates with aac(6′)-Ib-cr, 4 carried the CTX-M-15 gene. Our data suggest that CTX-M-15-producing E. coli ST131 has emerged as a worldwide pandemic clone, while CTX-M-27 (a variant of CTX-M-14) is also spreading among E. coli ST131 in Japan. PMID:23691204

  19. Molecular characteristics of extended-spectrum β-lactamases in clinical isolates from Escherichia coli at a Japanese tertiary hospital.

    PubMed

    Yano, Hisakazu; Uemura, Mina; Endo, Shiro; Kanamori, Hajime; Inomata, Shinya; Kakuta, Risako; Ichimura, Sadahiro; Ogawa, Miho; Shimojima, Masahiro; Ishibashi, Noriomi; Aoyagi, Tetsuji; Hatta, Masumitsu; Gu, Yoshiaki; Yamada, Mitsuhiro; Tokuda, Koichi; Kunishima, Hiroyuki; Kitagawa, Miho; Hirakata, Yoichi; Kaku, Mitsuo

    2013-01-01

    The prevalence of ESBL has been increasing worldwide. In this study, we investigated the molecular characteristics of ESBL among clinical isolates of Escherichia coli from a Japanese tertiary hospital. A total of 71 consecutive and nonduplicate clinical isolates of ESBL-positive E. coli collected at Tohoku University Hospital between January 2008 and March 2011 were studied. The antimicrobial susceptibility profile of these strains was determined. PCR and sequencing were performed to identify genes for β-lactamase (bla(TEM), bla(SHV), bla(OXA-1-like), and bla(CTX-M)) and plasmid-mediated quinolone resistance determinants (PMQR). The isolates were also analyzed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Of the 71 strains, 68 were positive for CTX-M, 28 were positive for TEM, four were positive for OXA-1, and one was positive for SHV. Sequencing revealed that CTX-M-14 was the most prevalent (31/71), followed by CTX-M-27 (21/71) and then CTX-M-15 (9/71). Of the 28 TEM-positive strains, one was TEM-10 and the rest were TEM-1. One SHV-positive strain was SHV-12. The 21 CTX-M-27-producing isolates were divided into 14 unique PFGE types, while the 9 CTX-M-15 producers were divided into 8 types. Based on MLST, 9 CTX-M-14 procedures, 19 CTX-M-27 procedures, and 8 CTX-M-15 producers belonged to ST131. Thirty-five (94.6%) of the 37 ST131 E. coli strains showed resistance to levofloxacin, which was a higher rate than among non-ST131 strains (63.6%). Among ESBL-producing isolates, one, two, and six possessed qnrB, qnrS, qepA, and aac(6')-Ib-cr, respectively. Of the 6 isolates with aac(6')-Ib-cr, 4 carried the CTX-M-15 gene. Our data suggest that CTX-M-15-producing E. coli ST131 has emerged as a worldwide pandemic clone, while CTX-M-27 (a variant of CTX-M-14) is also spreading among E. coli ST131 in Japan.

  20. Wolfram Syndrome in the Japanese Population; Molecular Analysis of WFS1 Gene and Characterization of Clinical Features

    PubMed Central

    Inoue, Hiroshi; Okuya, Shigeru; Ohta, Yasuharu; Akiyama, Masaru; Taguchi, Akihiko; Kora, Yukari; Okayama, Naoko; Yamada, Yuichiro; Wada, Yasuhiko; Amemiya, Shin; Sugihara, Shigetaka; Nakao, Yuzo; Oka, Yoshitomo; Tanizawa, Yukio

    2014-01-01

    Background Wolfram syndrome (WFS) is a recessive neurologic and endocrinologic degenerative disorder, and is also known as DIDMOAD (Diabetes Insipidus, early-onset Diabetes Mellitus, progressive Optic Atrophy and Deafness) syndrome. Most affected individuals carry recessive mutations in the Wolfram syndrome 1 gene (WFS1). However, the phenotypic pleiomorphism, rarity and molecular complexity of this disease complicate our efforts to understand WFS. To address this limitation, we aimed to describe complications and to elucidate the contributions of WFS1 mutations to clinical manifestations in Japanese patients with WFS. Methodology The minimal ascertainment criterion for diagnosing WFS was having both early onset diabetes mellitus and bilateral optic atrophy. Genetic analysis for WFS1 was performed by direct sequencing. Principal Findings Sixty-seven patients were identified nationally for a prevalence of one per 710,000, with 33 patients (49%) having all 4 components of DIDMOAD. In 40 subjects who agreed to participate in this investigation from 30 unrelated families, the earliest manifestation was DM at a median age of 8.7 years, followed by OA at a median age of 15.8 years. However, either OA or DI was the first diagnosed feature in 6 subjects. In 10, features other than DM predated OA. Twenty-seven patients (67.5%) had a broad spectrum of recessive mutations in WFS1. Two patients had mutations in only one allele. Eleven patients (27.5%) had intact WFS1 alleles. Ages at onset of both DM and OA in patients with recessive WFS1 mutations were indistinguishable from those in patients without WFS1 mutations. In the patients with predicted complete loss-of-function mutations, ages at the onsets of both DM and OA were significantly earlier than those in patients with predicted partial-loss-of function mutations. Conclusion/Significance This study emphasizes the clinical and genetic heterogeneity in patients with WFS. Genotype-phenotype correlations may exist in patients

  1. Consumer attitudes towards and satisfaction with emergency contraception counselling: experience from clinic and retail pharmacy settings.

    PubMed

    Ragland, Denise; Battle, Marlene; Kueter, Teddi J; Payakachat, Nalin

    2015-10-01

    To collectively assess consumer attitudes towards and satisfaction with emergency contraception (EC) counselling by student pharmacists in two different locations: an academic healthcare clinic and a retail pharmacy. EC counselling was provided by trained student pharmacists utilizing a standardized education toolkit. Participants were asked to rate the counselling at the end of the knowledge survey. In addition to descriptive statistics, we compared the self-reported attitudes and satisfaction with the counselling between the two sites. The majority of participants from both settings rated 'strongly agree' on the attitude and satisfaction statements for the EC counselling. Participants from the clinic setting rated higher in two of the four statements than the participants from the retail setting. Participants had positive attitudes towards and were highly satisfied with the EC counselling in both settings. EC counselling should be encouraged in practice settings. © 2014 Royal Pharmaceutical Society.

  2. The Semantics and Pragmatics of Japanese Focus Particles

    ERIC Educational Resources Information Center

    Hasegawa, Akio

    2011-01-01

    Japanese has a rich set of focus particles, several exclusive and additive particles, and, in addition, contrastive particles. This thesis provides a formal description of the meanings of Japanese focus particles and addresses two general questions: "What kinds concepts do Japanese focus particles express?" and "Why does Japanese have a larger…

  3. The Semantics and Pragmatics of Japanese Focus Particles

    ERIC Educational Resources Information Center

    Hasegawa, Akio

    2011-01-01

    Japanese has a rich set of focus particles, several exclusive and additive particles, and, in addition, contrastive particles. This thesis provides a formal description of the meanings of Japanese focus particles and addresses two general questions: "What kinds concepts do Japanese focus particles express?" and "Why does Japanese have a larger…

  4. Understanding facilitators and barriers to reengineering the clinical research enterprise in community-based practice settings.

    PubMed

    Kukafka, Rita; Allegrante, John P; Khan, Sharib; Bigger, J Thomas; Johnson, Stephen B

    2013-09-01

    Solutions are employed to support clinical research trial tasks in community-based practice settings. Using the IT Implementation Framework (ITIF), an integrative framework intended to guide the synthesis of theoretical perspectives for planning multi-level interventions to enhance IT use, we sought to understand the barriers and facilitators to clinical research in community-based practice settings preliminary to implementing new informatics solutions for improving clinical research infrastructure. The studies were conducted in practices within the Columbia University Clinical Trials Network. A mixed-method approach, including surveys, interviews, time-motion studies, and observations was used. The data collected, which incorporates predisposing, enabling, and reinforcing factors in IT use, were analyzed according to each phase of ITIF. Themes identified in the first phase of ITIF were 1) processes and tools to support clinical trial research and 2) clinical research peripheral to patient care processes. Not all of the problems under these themes were found to be amenable to IT solutions. Using the multi-level orientation of the ITIF, we set forth strategies beyond IT solutions that can have an impact on reengineering clinical research tasks in practice-based settings. Developing strategies to target enabling and reinforcing factors, which focus on organizational factors, and the motivation of the practice at large to use IT solutions to integrate clinical research tasks with patient care processes, is most challenging. The ITIF should be used to consider both IT and non-IT solutions concurrently for reengineering of clinical research in community-based practice settings.

  5. Predicting inpatient clinical order patterns with probabilistic topic models vs conventional order sets.

    PubMed

    Chen, Jonathan H; Goldstein, Mary K; Asch, Steven M; Mackey, Lester; Altman, Russ B

    2017-05-01

    Build probabilistic topic model representations of hospital admissions processes and compare the ability of such models to predict clinical order patterns as compared to preconstructed order sets. The authors evaluated the first 24 hours of structured electronic health record data for > 10 K inpatients. Drawing an analogy between structured items (e.g., clinical orders) to words in a text document, the authors performed latent Dirichlet allocation probabilistic topic modeling. These topic models use initial clinical information to predict clinical orders for a separate validation set of > 4 K patients. The authors evaluated these topic model-based predictions vs existing human-authored order sets by area under the receiver operating characteristic curve, precision, and recall for subsequent clinical orders. Existing order sets predict clinical orders used within 24 hours with area under the receiver operating characteristic curve 0.81, precision 16%, and recall 35%. This can be improved to 0.90, 24%, and 47% ( P  < 10 -20 ) by using probabilistic topic models to summarize clinical data into up to 32 topics. Many of these latent topics yield natural clinical interpretations (e.g., "critical care," "pneumonia," "neurologic evaluation"). Existing order sets tend to provide nonspecific, process-oriented aid, with usability limitations impairing more precise, patient-focused support. Algorithmic summarization has the potential to breach this usability barrier by automatically inferring patient context, but with potential tradeoffs in interpretability. Probabilistic topic modeling provides an automated approach to detect thematic trends in patient care and generate decision support content. A potential use case finds related clinical orders for decision support.

  6. Predicting inpatient clinical order patterns with probabilistic topic models vs conventional order sets

    PubMed Central

    Goldstein, Mary K; Asch, Steven M; Mackey, Lester; Altman, Russ B

    2017-01-01

    Objective: Build probabilistic topic model representations of hospital admissions processes and compare the ability of such models to predict clinical order patterns as compared to preconstructed order sets. Materials and Methods: The authors evaluated the first 24 hours of structured electronic health record data for > 10 K inpatients. Drawing an analogy between structured items (e.g., clinical orders) to words in a text document, the authors performed latent Dirichlet allocation probabilistic topic modeling. These topic models use initial clinical information to predict clinical orders for a separate validation set of > 4 K patients. The authors evaluated these topic model-based predictions vs existing human-authored order sets by area under the receiver operating characteristic curve, precision, and recall for subsequent clinical orders. Results: Existing order sets predict clinical orders used within 24 hours with area under the receiver operating characteristic curve 0.81, precision 16%, and recall 35%. This can be improved to 0.90, 24%, and 47% (P < 10−20) by using probabilistic topic models to summarize clinical data into up to 32 topics. Many of these latent topics yield natural clinical interpretations (e.g., “critical care,” “pneumonia,” “neurologic evaluation”). Discussion: Existing order sets tend to provide nonspecific, process-oriented aid, with usability limitations impairing more precise, patient-focused support. Algorithmic summarization has the potential to breach this usability barrier by automatically inferring patient context, but with potential tradeoffs in interpretability. Conclusion: Probabilistic topic modeling provides an automated approach to detect thematic trends in patient care and generate decision support content. A potential use case finds related clinical orders for decision support. PMID:27655861

  7. Traditional Japanese Kampo Medicine: Clinical Research between Modernity and Traditional Medicine—The State of Research and Methodological Suggestions for the Future

    PubMed Central

    Watanabe, Kenji; Matsuura, Keiko; Gao, Pengfei; Hottenbacher, Lydia; Tokunaga, Hideaki; Nishimura, Ko; Imazu, Yoshihiro; Reissenweber, Heidrun; Witt, Claudia M.

    2011-01-01

    The Japanese traditional herbal medicine, Kampo, has gradually reemerged and 148 different formulations (mainly herbal extracts) can be prescribed within the national health insurance system. The objective of this article is to introduce Kampo and to present information from previous clinical studies that tested Kampo formulae. In addition, suggestions on the design of future research will be stated. The literature search was based on a summary, up until January 2009, by the Japanese Society of Oriental Medicine and included only those trials which were also available in either Pubmed or ICHUSHI (Japan Medical Abstracts Society). We included 135 studies, half of these studies (n = 68) used a standard control and 28 a placebo control. Thirty-seven trials were published in English [all randomized controlled trials (RCTs)] and the remaining articles were in Japanese only. The sample size for most studies was small (two-third of the studies included less than 100 patients) and the overall methodological quality appeared to be low. None of the studies used Kampo diagnosis as the basis for the treatment. In order to evaluate Kampo as a whole treatment system, certain aspects should be taken into account while designing studies. RCTs are the appropriate study design to test efficacy or effectiveness; however, within the trial the treatment could be individualized according to the Kampo diagnosis. Kampo is a complex and individualized treatment with a long tradition, and it would be appropriate for further research on Kampo medicine to take this into account. PMID:21687585

  8. Introducing consultant outpatient clinics to community settings to improve access to paediatrics: an observational impact study.

    PubMed

    McLeod, Hugh; Heath, Gemma; Cameron, Elaine; Debelle, Geoff; Cummins, Carole

    2015-06-01

    In line with a national policy to move care 'closer to home', a specialist children's hospital in the National Health Service in England introduced consultant-led 'satellite' clinics to two community settings for general paediatric outpatient services. Objectives were to reduce non-attendance at appointments by providing care in more accessible locations and to create new physical clinic capacity. This study evaluated these satellite clinics to inform further development and identify lessons for stakeholders. Impact of the satellite clinics was assessed by comparing community versus hospital-based clinics across the following measures: (1) non-attendance rates and associated factors (including patient characteristics and travel distance) using a logistic regression model; (2) percentage of appointments booked within local catchment area; (3) contribution to total clinic capacity; (4) time allocated to clinics and appointments; and (5) clinic efficiency, defined as the ratio of income to staff-related costs. Satellite clinics did not increase attendance beyond their contribution to shorter travel distance, which was associated with higher attendance. Children living in the most-deprived areas were 1.8 times more likely to miss appointments compared with those from least-deprived areas. The satellite clinics' contribution to activity in catchment areas and to total capacity was small. However, one of the two satellite clinics was efficient compared with most hospital-based clinics. Outpatient clinics were relocated in pragmatically chosen community settings using a 'drag and drop' service model. Such clinics have potential to improve access to specialist paediatric healthcare, but do not provide a panacea. Work is required to improve attendance as part of wider efforts to support vulnerable families. Satellite clinics highlight how improved management could contribute to better use of existing capacity. Published by the BMJ Publishing Group Limited. For permission to

  9. Comparing Ease-of-Processing Values of the Same Set of Words for Native English Speakers and Japanese Learners of English

    ERIC Educational Resources Information Center

    Takashima, Hiroomi

    2009-01-01

    Ease of processing of 3,969 English words for native speakers and Japanese learners was investigated using lexical decision and naming latencies taken from the English Lexicon Project (Balota et al. The English Lexicon Project: A web-based repository of descriptive and behavioral measures for 40,481 English words and nonwords, 2002) and accuracy…

  10. Peer assisted learning in the clinical setting: an activity systems analysis.

    PubMed

    Bennett, Deirdre; O'Flynn, Siun; Kelly, Martina

    2015-08-01

    Peer assisted learning (PAL) is a common feature of medical education. Understanding of PAL has been based on processes and outcomes in controlled settings, such as clinical skills labs. PAL in the clinical setting, a complex learning environment, requires fresh evaluation. Socio-cultural theory is proposed as a means to understand educational interventions in ways that are practical and meaningful. We describe the evaluation of a PAL intervention, introduced to support students' transition into full time clinical attachments, using activity theory and activity systems analysis (ASA). Our research question was How does PAL transfer to the clinical environment? Junior students on their first clinical attachments undertook a weekly same-level, reciprocal PAL activity. Qualitative data was collected after each session, and focus groups (n = 3) were held on completion. Data was analysed using ASA. ASA revealed two competing activity systems on clinical attachment; Learning from Experts, which students saw as the primary function of the attachment and Learning with Peers, the PAL intervention. The latter took time from the first and was in tension with it. Tensions arose from student beliefs about how learning takes place in clinical settings, and the importance of social relationships, leading to variable engagement with PAL. Differing perspectives within the group were opportunities for expansive learning. PAL in the clinical environment presents challenges specific to that context. Using ASA helped to describe student activity on clinical attachment and to highlight tensions and contradictions relating PAL in that setting. Planning learning opportunities on clinical placements, must take account of how students learn in workplaces, and the complexity of the multiple competing activity systems related to learning and social activities.

  11. Upregulation of the oncoprotein SET determines poor clinical outcomes in hepatocellular carcinoma and shows therapeutic potential.

    PubMed

    Hung, M-H; Chen, Y-L; Chu, P-Y; Shih, C-T; Yu, H-C; Tai, W-T; Shiau, C-W; Chen, K-F

    2016-09-15

    The SET protein is a potent inhibitor of protein phosphatase 2A (PP2A). Here, we report the oncogenic role of SET in hepatocarcinogenesis, clinical aggressiveness and anti-hepatocellular carcinoma (HCC) therapeutics. By analyzing samples obtained from 147 HCC patients, we found that SET overexpression was detected specifically in 30.6% HCC tumor samples, and was significantly associated with worse clinical features and high p-Akt expression in HCC tumors. Co-expression of SET and Akt predicted shorter post-operative recurrence-free survival in this cohort (P=0.045). Furthermore, SET was significantly associated with cell growth and hepatosphere formation. To elucidate the anti-HCC potential of targeting SET, we generated a novel SET antagonist, EMQA (N(4)-(3-ethynylphenyl)-6,7-dimethoxy-N(2)-(4-phenoxyphenyl) quinazoline-2,4-diamine). EMQA enhanced PP2A activity via disrupting SET-PP2Ac (catalytic domain of PP2A) binding in HCC cells, which restored PP2A-mediated p-Akt downregulation and promoted HCC cell death. In HCC cells or recombinant proteins expressing the N- and C- truncated forms of SET, only the C-terminal SET was required for EMQA targeting. Furthermore, combining sorafenib and EMQA showed good synergism in inhibiting HCC survival. Our findings suggested the oncogenic role of SET and the adverse prognostic value of SET overexpression in HCC. This alteration defines a subgroup of HCC patients who could benefit from SET antagonists, such as EMQA.

  12. Challenges to student learning in the clinical setting: a qualitative descriptive study.

    PubMed

    Killam, Laura A; Heerschap, Corey

    2013-06-01

    Clinical education is used throughout nursing to promote competency. Although this experience can be rewarding, students may face a variety of challenges within this context. The purpose of this qualitative descriptive study is to explore senior nursing students' perceptions of challenges to learning within the clinical setting. Three interrelated themes emerged from the data: (a) internal reactions to external limitations; (b) barriers experienced within the clinical environment; and (c) ineffective programme organisation. Findings are meant to guide educators and policy makers during decision making. The goal is advancement towards making the clinical environment a superior form of nursing education. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Japanese encephalitis (JE). Part I: clinical profile of 1,282 adult acute cases of four epidemics.

    PubMed

    Sarkari, N B S; Thacker, A K; Barthwal, S P; Mishra, V K; Prapann, Shiv; Srivastava, Deepak; Sarkari, M

    2012-01-01

    Japanese encephalitis (JE) is numerically the most important global cause of encephalitis and so far confirmed to have caused major epidemics in India. Most of the reported studies have been in children. This largest study involving only adults, belonging to four epidemics, is being reported from Gorakhpur. The aim of this study is to detail the acute clinical profile (not viral) outcome and to classify the sequelae at discharge. This prospective study involved 1,282 adult patients initially diagnosed as JE admitted during the epidemics of 1978, 1980, 1988, and 1989, on identical clinical presentation and CSF examination. In the meantime, the diagnosis of JE was confirmed by serological and/or virological studies in only a representative number of samples (649 of 1,282 cases). Eighty-three left against medical advice (LAMA) at various stages, so 1,199 of 1,282 were available for the study. Peak incidence of [1,061 of 1,282 (83%)] of clinically suspected cases was from September 15 to November 2. Serum IgM and IgG were positive in high titers in 50.87% (330 of 649) and IgM positive in CSF in 88.75% (109 of 123) of the cases. JE virus could be isolated from CSF and brain tissue in 5 of 5 and 4 of 5 samples, respectively. Altered sensorium (AS) in (96%), convulsions (86%), and headache (85%) were the main symptoms for hospitalization by the third day of the onset. Other neurological features included hyperkinetic movements in 593 of 1,282 (46%)-choreoathetoid in 490 (83%) and bizarre, ill-defined in 103 (17%). The features of brain stem involvement consisted of opsoclonus (20%), gaze palsies (16%), and pupillary changes (48%) with waxing and waning character. Cerebellar signs were distinctly absent. Dystonia and decerebrate rigidity was observed in 43 and 6%, respectively, paralytic features in 17% and seizures in 30%. Many non-neurological features of prognostic importance included abnormal breathing patterns (ABP) (45%), pulmonary edema (PO) (33%), and upper

  14. Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education.

    PubMed

    Blomberg, Karin; Bisholt, Birgitta; Kullén Engström, Agneta; Ohlsson, Ulla; Sundler Johansson, Annelie; Gustafsson, Margareta

    2014-08-01

    To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. A cross-sectional study with evaluative design. Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support. © 2014 John Wiley & Sons Ltd.

  15. Clinical and no-clinical setting specificities in first session short-term psychotherapy psychodrama group.

    PubMed

    Drakulić, Aleksandra Mindoljević

    2011-03-01

    Modern history of short-term group psychotherapy dates back to the late 1950-ies. From then to present day, this psychotherapeutic method has been used in various forms, from dynamic-oriented to cognitive behavioural psychotherapies. Although it has always been considered rather controversial, due its cost-effectiveness, it has been capturing more and more popularity. This paper presents the specificities of first session short-term psychotherapy psychodrama group through session work with two examined groups: a group of 20 adult women who suffer from mild or moderate forms of unipolar depression and a group of 20 students of the School of Medicine in Zagreb without any psychiatric symptomatology. The results indicate the high importance of having structure in first psychodrama session, of relating it with the previously thoroughly conducted, initial, clinical, interviews, and of the clarity and focus in terms of determining the goals of therapy, especially in a clinical context. This study also confirmed assumptions regarding the need for different approaches of warming-up in psychodrama, both in the clinical and in non-clinical samples. A psychodrama psychotherapist should have good time managing skills and capability to convert the time available into an opportunity for directly boosting the group energy and work on therapeutic alliance.

  16. Interprofessional teamwork skills as predictors of clinical outcomes in a simulated healthcare setting.

    PubMed

    Shrader, Sarah; Kern, Donna; Zoller, James; Blue, Amy

    2013-01-01

    Teaching interprofessional (IP) teamwork skills is a goal of interprofessional education. The purpose of this study was to examine the relationship between IP teamwork skills, attitudes and clinical outcomes in a simulated clinical setting. One hundred-twenty health professions students (medicine, pharmacy, physician assistant) worked in interprofessional teams to manage a "patient" in a health care simulation setting. Students completed the Interdisciplinary Education Perception Scale (IEPS) attitudinal survey instrument. Students' responses were averaged by team to create an IEPS attitudes score. Teamwork skills for each team were rated by trained observers using a checklist to calculate a teamwork score (TWS). Clinical outcome scores (COS) were determined by summation of completed clinical tasks performed by the team based on an expert developed checklist. Regression analyses were conducted to determine the relationship of IEPS and TWS with COS. IEPS score was not a significant predictor of COS (p=0.054), but TWS was a significant predictor (p<0.001) of COS. Results suggest that in a simulated clinical setting, students' interprofessional teamwork skills are significant predictors of positive clinical outcomes. Interprofessional curricular models that produce effective teamwork skills can improve student performance in clinical environments and likely improve teamwork practice to positively affect patient care outcomes.

  17. Measuring performance to drive improvement: development of a clinical indicator set for general medicine.

    PubMed

    Brand, C; Lam, S K L; Roberts, C; Gorelik, A; Amatya, B; Smallwood, D; Russell, D

    2009-06-01

    There are delays in implementing evidence about effective therapy into clinical practice. Clinical indicators may support implementation of guideline recommendations. To develop and evaluate the short-term impact of a clinical indicator set for general medicine. A set of clinical process indicators was developed using a structured process. The indicator set was implemented between January 2006 and December 2006, using strategies based on evidence about effectiveness and local contextual factors. Evaluation included a structured survey of general medical staff to assess awareness and attitudes towards the programme and qualitative assessment of barriers to implementation. Impact on documentation of adherence to clinical indicators was assessed by auditing a random sample of medical records before (2003-2005) and after (2006) implementation. Clinical indicators were developed for the following areas: venous thromboembolism, cognition, chronic heart failure, chronic obstructive pulmonary disease, diabetes, low trauma fracture, patient written care plans. The programme was well supported and incurred little burden to staff. Implementation occurred largely as planned; however, documentation of adherence to clinical indicators was variable. There was a generally positive trend over time, but for most indicators this was independent of the implementation process and may have been influenced by other system improvement activities. Failure to demonstrate a significant impact during the pilot phase is likely to have been influenced by administrative factors, especially lack of an integrative data documentation and collection process. Successful implementation in phase two is likely to depend upon an effective data collection system integrated into usual care.

  18. Knowledge discovery in clinical databases based on variable precision rough set model.

    PubMed Central

    Tsumoto, S.; Ziarko, W.; Shan, N.; Tanaka, H.

    1995-01-01

    Since a large amount of clinical data are being stored electronically, discovery of knowledge from such clinical databases is one of the important growing research area in medical informatics. For this purpose, we develop KDD-R (a system for Knowledge Discovery in Databases using Rough sets), an experimental system for knowledge discovery and machine learning research using variable precision rough sets (VPRS) model, which is an extension of original rough set model. This system works in the following steps. First, it preprocesses databases and translates continuous data into discretized ones. Second, KDD-R checks dependencies between attributes and reduces spurious data. Third, the system computes rules from reduced databases. Finally, fourth, it evaluates decision making. For evaluation, this system is applied to a clinical database of meningoencephalitis, whose computational results show that several new findings are obtained. PMID:8563283

  19. Handheld technologies in a clinical setting: state of the technology and resources.

    PubMed

    Tooey, Mary Joan; Mayo, Alexa

    2003-08-01

    Handheld or palm-based computing technology, commonly known as personal digital assistants (PDAs), are having a tremendous impact in many personal, educational, and business settings. The potential is particularly compelling for healthcare, specifically in the clinical setting. By exploring the development of the technology, applications, and products, as well as issues regarding its use, a better understanding of this technology can be gained. The rapid acceptance and ongoing swift development of handheld computing technology is leading to an evolution in the way clinical data and information move to and from the bedside and into the patient record. This article focuses on three main areas related to PDAs: the development of the palm technology, its potential in clinical settings, and available specific resources.

  20. Neuroimaging in psychiatry: an update on neuroimaging in the clinical setting.

    PubMed

    Power, Brian D; Nguyen, T; Hayhow, B; Looi, Jcl

    2016-04-01

    We offered guidance on the role of structural and functional neuroimaging modalities for the general psychiatrist and for trainees in the clinical setting. We outlined the utility of neuroimaging modalities in the clinical setting, specifically with a view to understanding the pathophysiology of manifestations of disease. Both structural and functional neuroimaging modalities have a clear role in diagnostic evaluation in the spectrum of neurodegenerative disorders. Whilst the role of neuroimaging in patients with mood, anxiety and psychotic disorders is less clear, structural and functional imaging modalities have utility in the clinical setting in the form of diagnostic refinement and in understanding the pathophysiology of disorders, towards explaining manifestations and planning treatment. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  1. Population pharmacokinetics of phenobarbital by mixed effect modelling using routine clinical pharmacokinetic data in Japanese neonates and infants: an update.

    PubMed

    Yukawa, M; Yukawa, E; Suematsu, F; Takiguchi, T; Ikeda, H; Aki, H; Mimemoto, M

    2011-12-01

    Optimal use of phenobarbital in the neonatal population requires information regarding the drug's pharmacokinetics and the influence of various factors, such as different routes of administration, on the drug's disposition. However, because of sampling restrictions, it is often difficult to perform traditional pharmacokinetic studies in neonates and infants. This study was conducted to establish the role of patient characteristics in estimating doses of phenobarbital for neonates and infants using routine therapeutic drug monitoring data. The population pharmacokinetics of phenobarbital was evaluated using 109 serum concentration measurements obtained from routine phenobarbital monitoring of 70 neonates and infants. The data were analysed using the non-linear mixed effects model. A one-compartment pharmacokinetic model with first-order elimination was used. Covariates screened were current total bodyweight (TBW), gestational age, postnatal age (PNA), post-conceptional age, gender and neonates-infants clearance factor (serum concentration of phenobarbital; Conc). The final pharmacokinetic parameters were CL/F (mL/h) = (5.95.TBW (kg) +1.41.PNA (weeks)) Conc (serum phenobarbital concentration >50 μg/mL)(-0.221),Vd/F(L) =1.01.TBW (kg), and F = 0.483 for oral administration and F = 1 was assumed for suppository. Conc(-0.221) is 1 for phenobarbital concentration <50 μg/mL. The important variables for predicting phenobarbital clearance in this study were TBW, PNA and Conc. Phenobarbital clearance increases proportionately with increasing TBW, and an older newborn was expected to have a higher rate of clearance than a younger newborn of equal bodyweight. Moreover, the clearance of phenobarbital decreased nonlinearly with increasing serum concentration of phenobarbital >50 μg/mL (Conc(-0.221) ). We developed a new model for neonate and infant dosing of phenobarbital with good predictive performance. Clinical application of our model should permit more accurate

  2. Effects of incivility in clinical practice settings on nursing student burnout.

    PubMed

    Babenko-Mould, Yolanda; Laschinger, Heather K S

    2014-10-31

    To examine the relationship between nursing students' exposure to various forms of incivility in acute care practice settings and their experience of burnout. Given that staff nurses and new nurse graduates are experiencing incivility and burnout in the workplace, it is plausible that nursing students share similar experiences in professional practice settings. A cross-sectional survey design was used to assess Year 4 nursing students' (n=126) perceptions of their experiences of incivility and burnout in the clinical learning environment. Students completed instruments to assess frequency of uncivil behaviors experienced during the past six months from nursing staff, clinical instructors, and other health professionals in the acute care practice setting and to measure student burnout. Reported incidences of incivility in the practice setting were related to burnout. Higher rates of incivility, particularly from staff nurses, were associated with higher levels of both components of burnout (emotional exhaustion and cynicism).

  3. Contextual assessment of couples therapy: the Clinical Discourse Q-Sets.

    PubMed

    Kogan, Steven M; Walters, Lynda H; Daniels, Tracey

    2002-10-01

    This article describes a method for creating highly contextual assessments of couples therapy interaction using concepts from Systemic Functional Linguistics (SFL). According to SFL, talk in interaction serves three primary functions: to mediate social relations, to negotiate representations of reality, and to organize and structure the event as coherent. These concepts are operationalized using observational q-methodology. The Clinical Discourse Q-Sets (CDQS) include three separate q-sets for use by trained observers in rating 12-min segments of couples therapy conversation. Each q-set captures one aspect of the communication process as defined by Systemic Functional theory. Good-to-high reliabilities for the q-set profiles over various (n = 16) couples therapy episodes were found. Preliminary evidence for the conceptual structure and clinical validity of the system was found.

  4. Differences in Investigator-Initiated Trials between Japan and Other Countries: Analyses of Clinical Trials Sponsored by Academia and Government in the ClinicalTrials.gov Registry and in the Three Japanese Registries.

    PubMed

    Ito, Tatsuya

    2016-01-01

    Following the amendment of the Pharmaceutical Affairs Law in Japan in 2003 researchers were permitted to begin investigator-initiated trials (IITs). In subsequent years, however, the number of IITs remained low. In other countries in Asia as well as in Europe, North America, and South Africa, the number of IITs has increased over the past decade. The differences in the characteristics of IITs between Japan and other countries are unknown. Some studies have analyzed the characteristics of all clinical trials according to registry databases, but there has been less research focusing on IITs. The purpose of this study is to analyze the characteristics of IITs in the ClinicalTrials.gov registry and in the three Japanese registries, to identify differences in IITs between Japan and other countries. Using Thomson Reuters Pharma™, trials sponsored by academia and government as IITs in 2010 and registered in ClinicalTrials.gov were identified. IITs from 2004 to 2012 in Japan were identified in the three Japanese registries: the University Hospital Medical Information Network Clinical Trials Registry, the Japan Pharmaceutical Information Center Clinical Trials Information, and the Japan Medical Association Center for Clinical Trials, Clinical Trials Registry. Characterization was made of the trial purposes, phases, participants, masking, arms, design, controls, and other data. New and revised IITs registered in ClinicalTrials.gov during 2010 averaged about 40% of all sponsor-identified trials. IITs were nearly all early-phase studies with small numbers of participants. A total of 56 Japanese IITs were found over a period of 8 years, and these were also almost nearly all early-phase studies with small numbers of participants. There appear to be no great differences between Japan and other countries in terms of characteristics of IITs. These results should prompt a new review of the IIT environment in Japan.

  5. Differences in Investigator-Initiated Trials between Japan and Other Countries: Analyses of Clinical Trials Sponsored by Academia and Government in the ClinicalTrials.gov Registry and in the Three Japanese Registries

    PubMed Central

    Ito, Tatsuya

    2016-01-01

    Background Following the amendment of the Pharmaceutical Affairs Law in Japan in 2003 researchers were permitted to begin investigator-initiated trials (IITs). In subsequent years, however, the number of IITs remained low. In other countries in Asia as well as in Europe, North America, and South Africa, the number of IITs has increased over the past decade. The differences in the characteristics of IITs between Japan and other countries are unknown. Some studies have analyzed the characteristics of all clinical trials according to registry databases, but there has been less research focusing on IITs. Aims The purpose of this study is to analyze the characteristics of IITs in the ClinicalTrials.gov registry and in the three Japanese registries, to identify differences in IITs between Japan and other countries. Methods Using Thomson Reuters Pharma™, trials sponsored by academia and government as IITs in 2010 and registered in ClinicalTrials.gov were identified. IITs from 2004 to 2012 in Japan were identified in the three Japanese registries: the University Hospital Medical Information Network Clinical Trials Registry, the Japan Pharmaceutical Information Center Clinical Trials Information, and the Japan Medical Association Center for Clinical Trials, Clinical Trials Registry. Characterization was made of the trial purposes, phases, participants, masking, arms, design, controls, and other data. Results New and revised IITs registered in ClinicalTrials.gov during 2010 averaged about 40% of all sponsor-identified trials. IITs were nearly all early-phase studies with small numbers of participants. A total of 56 Japanese IITs were found over a period of 8 years, and these were also almost nearly all early-phase studies with small numbers of participants. Conclusion There appear to be no great differences between Japan and other countries in terms of characteristics of IITs. These results should prompt a new review of the IIT environment in Japan. PMID:26848574

  6. Toward clinical scholarship: promoting evidence-based practice in the clinical setting.

    PubMed

    Mohide, E Ann; Coker, Esther

    2005-01-01

    Organizational interventions are being suggested to increase the rate of quality research dissemination and uptake. This article describes how one tertiary institution is using an evidence-based nursing (EBN) committee as an organizational strategy to shift its nursing culture toward clinical scholarship. A number of approaches and activities that have stimulated the movement toward evidence-based practice (EBP) are examined: organizational commitment to EBP, strategic positioning of the EBN committee within nursing's administrative structure, articulation of a mission, conceptualization of a model for EBN practice, learning on the job, selection and adoption of an evidence-based model for implementing change, marketing for a change in culture toward clinical scholarship, and other selected examples of projects undertaken by the committee. Action-oriented principles associated with committee experiences are related to the approaches and activities.

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

    PubMed Central

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

    2013-01-01

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

  8. Neuropsychiatric clinical trials: should they accommodate real-world practices or set standards for clinical practices?

    PubMed

    Becker, Robert E; Greig, Nigel H

    2009-02-01

    Evidence-based psychiatry seeks the best research evidence for use in patient care. Recent research suggests that problems with accuracy, precision, bias, and other sources of unreliability potentially interfere with the validity of psychiatry's evidence base. Because many negative clinical research studies go unpublished, awareness and fuller understanding of these problems are blocked by lack of access to relevant data. Based on the importance of scientific soundness of neuropsychiatric research and patient care, we argue for increased attentiveness by investigators and practitioners to how clinical trials (CTs) interdependently estimate the efficacy of treatments and the effectiveness of methods as fair tests of efficacy. Deference by CT investigators to real-world practice conditions at research sites because of the unreliability introduced into data by these practices does not ensure unbiased evaluations of treatment efficacy. We argue for more systematic attention to sources of unreliability in CT investigations and increased commitments to assure the validity of the neuropsychiatric evidence base. These recommendations aim to determine neuropsychiatric drug efficacy with greater certainty to better quantify the clinical importance of drug-associated effects and to provide CT-evidenced guidance for practitioners to most effectively use drug efficacy in patient care.

  9. Social interactions between veterinary medical students and their teachers in an ambulatory clinic setting in Finland.

    PubMed

    Koskinen, Heli I

    2010-01-01

    In this study, the social interactions between students and their teachers in an ambulatory clinic setting were investigated using Bales's interaction process analysis framework. Observational data were collected during five small-group sessions. The observations were quantified, and the behaviors of students and teachers were compared statistically. This study demonstrated that the interaction between students and their teachers was for the most part equal and could be characterized as "positively task oriented." The study has implications for veterinary educators wishing to use social psychology frameworks to assess the quality of learning in small-group clinical setting.

  10. Perceived Frequency of Peer-Assisted Learning in the Laboratory and Collegiate Clinical Settings

    PubMed Central

    Henning, Jolene M.; Weidner, Thomas G.; Snyder, Melissa; Dudley, William N.

    2012-01-01

    Context: Peer-assisted learning (PAL) has been recommended as an educational strategy to improve students' skill acquisition and supplement the role of the clinical instructor (CI). How frequently students actually engage in PAL in different settings is unknown. Objective: To determine the perceived frequency of planned and unplanned PAL (peer modeling, peer feedback and assessment, peer mentoring) in different settings. Design: Cross-sectional study. Setting: Laboratory and collegiate clinical settings. Patients or Other Participants: A total of 933 students, 84 administrators, and 208 CIs representing 52 (15%) accredited athletic training education programs. Intervention(s): Three versions (student, CI, administrator) of the Athletic Training Peer Assisted Learning Survey (AT-PALS) were administered. Cronbach α values ranged from .80 to .90. Main Outcome Measure(s): Administrators' and CIs' perceived frequency of 3 PAL categories under 2 conditions (planned, unplanned) and in 2 settings (instructional laboratory, collegiate clinical). Self-reported frequency of students' engagement in 3 categories of PAL in 2 settings. Results: Administrators and CIs perceived that unplanned PAL (0.39 ± 0.22) occurred more frequently than planned PAL (0.29 ± 0.19) regardless of category or setting (F1,282 = 83.48, P < .001). They perceived that PAL occurred more frequently in the collegiate clinical (0.46 ± 0.22) than laboratory (0.21 ± 0.24) setting regardless of condition or category (F1,282 = 217.17, P < .001). Students reported engaging in PAL more frequently in the collegiate clinical (3.31 ± 0.56) than laboratory (3.26 ± 0.62) setting regardless of category (F1,860 = 13.40, P < .001). We found a main effect for category (F2,859 = 1318.02, P < .001), with students reporting they engaged in peer modeling (4.01 ± 0.60) more frequently than peer mentoring (2.99 ± 0.88) (P < .001) and peer assessment and feedback (2.86 ± 0.64) (P < .001). Conclusions: Participants

  11. Women's Health Care Minimum Data Set: pilot test and validation for use in clinical practice.

    PubMed

    Farley, Cindy L; Tharpe, Nell; Miller, Liane; Ruxer, Debbie Jenkins

    2006-01-01

    Basic elements of the structure, process, and outcomes of midwifery practice have not been fully determined, particularly in the areas of women's gynecologic and primary health care. The American College of Nurse-Midwives (ACNM) supported the development of clinical data sets to describe structure, process, and outcomes of midwifery practice for use by clinical practitioners. The Woman's Health Care Minimum Data Set was developed using a panel of expert midwives and other women's health care professionals, as well as literature resources. Students of the Graduate Midwifery Program at Philadelphia University performed pilot testing of the Woman's Health Care Minimum Data Set as a service to the profession of midwifery while applying concepts learned in their research methods courses. Each student (n = 19) recruited a midwifery practice in which she had a clinical affiliation, and gathered data sets on the previous 30 consecutive women's health care encounters by CNMs or CMs (n = 569). Item analysis and refinement were done. Criterion-related validity and construct-related validity of the Woman's Health Care Minimum Data Set were explored through comparison with the medical record and through the testing of plausible hypotheses. The Woman's Health Care Minimum Data Set has the potential to be an important instrument in documenting and understanding the evolving nature of the practice of primary women's health care by midwives and other women's health care providers.

  12. Diagnosing migraine in research and clinical settings: the validation of the Structured Migraine Interview (SMI).

    PubMed

    Samaan, Zainab; Macgregor, E Anne; Andrew, Dowson; McGuffin, Peter; Farmer, Anne

    2010-01-14

    Migraine is a common disorder that is highly co-morbid with psychopathological conditions such as depression and anxiety. Despite the extensive research and availability of treatment, migraine remains under-recognised and undertreated. The aim of this study was to design a short and practical screening tool to identify migraine for clinical and research purposes. The structured migraine interview (SMI) based on the International Classification of Headache Disorders (ICHD) criteria was used in a clinical setting of headache sufferers and compared to clinical diagnosis by headache specialist. In addition to the validating characteristics of the interview different methods of administration were also tested. The SMI has high sensitivity (0.87) and modest specificity (0.58) when compared to headache specialist's clinical diagnosis. Our study demonstrated that a structured interview based on the ICHD criteria is a useful and valid tool to identify migraine in research settings and to a limited extent in clinical settings, and could be used in studies on large samples where clinical interviews are less practical.

  13. Support in Clinical Settings as Perceived by Nursing Students in Iran: A Qualitative Study

    PubMed Central

    Joolaee, Soodabeh; Ashghali Farahani, Mansoureh; Jafarian Amiri, Seyedeh Roghayeh; Varaei, Shokoh

    2016-01-01

    Background Although support is one of the most substantial needs of nursing students during clinical education, it is not clearly defined in the literature. Objectives The current study aimed to explore the concept of support in clinical settings as perceived by nursing students. Materials and Methods A qualitative content analysis was used to explore the meaning of student support in clinical settings. A purposive sampling with maximum variation was used to select the participants among bachelor nursing students in the nursing school of Babol University of Medical Sciences in the north of Iran. Semi-structured interviews were conducted to gather the perceptions and experiences of seventeen nursing students. Conventional content analysis was applied to analyze the data. Results In the current study, the main theme, nurturance, was emerged with seven subthemes of humanistic behavior with the student, respectful communication with students, accepting the student in the clinical setting, sustaining confidence, need based supervision, accepting the profession in the society and empowerment. Conclusions Nursing students support in the clinical education requires a nurturing care; a care that leads to the sense of worthiness and respectability in students and contributes to the improvement of their clinical abilities. PMID:27331057

  14. Diagnosing migraine in research and clinical settings: The validation of the Structured Migraine Interview (SMI)

    PubMed Central

    2010-01-01

    Background Migraine is a common disorder that is highly co-morbid with psychopathological conditions such as depression and anxiety. Despite the extensive research and availability of treatment, migraine remains under-recognised and undertreated. The aim of this study was to design a short and practical screening tool to identify migraine for clinical and research purposes. Methods The structured migraine interview (SMI) based on the International Classification of Headache Disorders (ICHD) criteria was used in a clinical setting of headache sufferers and compared to clinical diagnosis by headache specialist. In addition to the validating characteristics of the interview different methods of administration were also tested. Results The SMI has high sensitivity (0.87) and modest specificity (0.58) when compared to headache specialist's clinical diagnosis. Conclusions Our study demonstrated that a structured interview based on the ICHD criteria is a useful and valid tool to identify migraine in research settings and to a limited extent in clinical settings, and could be used in studies on large samples where clinical interviews are less practical. PMID:20074361

  15. [Education Program of Kampo-medicine for Undergraduates in Preparation for Clinical Setting].

    PubMed

    Homma, Masato

    2016-01-01

    Kampo-medicine has become popular in Japanese medical practice combined with western medicine. For example, Daikenchu-To for intestinal obstruction after surgical operation, Shakuyakukanzo-To and Goshajinki-Gan for anti-cancer agents-induced neuropathy, and Yokkan-San for behavioral psychological symptoms of dementia are alternatively used in addition to conventional treatments in Japan. However, combined use of Kampo-medicine and western medicine may cause unexpected adverse events including undesirable drug-drug interactions because Kampo-medicine was not originally developed to be used with western medicine. Although adverse effects of Kampo-medicine are rare compared with those of western medicine, severe events such as liver dysfunction and interstitial pneumonia have been reported in increasing trends. Medical staff including pharmacists, therefore, should be aware of the onset of adverse events before the patients' symptoms become severe. Several adverse effects are caused by chemical constituents such as glycyrrhizin in licorice for pseudoaldosteronism and geniposide in Gardeniae fructus for mesenteric phlebosclerosis. To understand the adverse effects of Kampo-medicine, pharmacists should learn trends in current medication as well as pharmacology and toxicology of the chemical constituents in pharmacognosy. These issues should also be addressed in educational materials for students of clinical pharmacy and pharmacy practice.

  16. Is the BMI cut-off level for Japanese females for obesity set too high? A consideration from a body composition perspective.

    PubMed

    Kagawa, Masaharu; Uenishi, Kazuhiro; Kuroiwa, Chiharu; Mori, Miki; Binns, Colin W

    2006-01-01

    The aim of the study was to determine the sensitivity and specificity of the BMI cut-off points that have been applied in the National Nutritional Survey in Japan (NNS-J) for young Japanese females. The relationship between the body mass index (BMI) and percentage body fat (%BF) of 139 young Japanese females (aged 18-27 years old) was examined using dual energy x-ray absorptiometry (DXA) and anthropometry. The sensitivity and specificity of the BMI cut-off point that has been in use in Japan was compared with the cut-off point proposed for Asia-Pacific population (the WPRO classification). The regression equation calculated for the relationship between the BMI and %BF using the DXA scan data was %BF = -15.152+2.058*BMI; R2 = 0.612, SEE = 3.66. From this equation the BMI value that corresponded with %BF of 30% was calculated to be 21.9kg/m2 (95%CI: 16.9-28.6). From the sensitivity and specificity analysis, it was found that more than 90% of Japanese females with %BF >30% were misclassified as "not obese" when the BMI value of 25kg/m2 was used to identify obese individuals. The misclassification reduced to 60% when the BMI value of 23kg/m2 was used as a cut-off point. The results indicate that the current classification used in the NNS-J may not precisely reflect the obesity status of young Japanese females and a considerable proportion of females with a large fat deposition would be misclassified as not obese. The current study shows the importance of including detailed body composition assessments to determine obesity level of individuals.

  17. Care coordination in the spina bifida clinic setting: current practice and future directions.

    PubMed

    Brustrom, Jennifer; Thibadeau, Judy; John, Lisa; Liesmann, Jaime; Rose, Shyanika

    2012-01-01

    Although the potential benefits of care coordination are widely recognized, little is known about care coordination in the multidisciplinary spina bifida clinic setting. This study examined several aspects of care coordination in this environment. We conducted semi-structured interviews with clinic staff (N = 43) and focus groups with caregivers (N = 38) at seven spina bifida clinics in the United States. Clinic staff described several primary goals of care coordination, including coordinating multiple services during one visit to ease the burden on families. Although the structure of care coordination varied across the clinics, several clinics had a dedicated care coordinator. Barriers and facilitators to care coordination included staffing issues, clinic day logistics, community resources, and family-related concerns. Despite challenges associated with care coordination processes, clinic staff and caregivers alike believed that care coordination is beneficial. Study findings suggest ways that care might be coordinated optimally in spina bifida clinics. A synthesis of these findings for clinics interested in implementing care coordination or improving the care coordination services they currently offer is provided. Copyright © 2012 National Association of Pediatric Nurse Practitioners. All rights reserved.

  18. HIV/AIDS Clinical Manifestations and their Implication for Patient Clinical Staging in Resource Limited Settings in Tanzania.

    PubMed

    Boniphace, Idindili; Omari, Minzi; Susan Fred, Rumisha; Ferdinand, Mugusi; Marcel, Tanner

    2011-01-01

    Tanzania HIV/AIDS management follows WHO clinical staging which requires CD4 counts as complement. Lacking CD4 counts facilities in rural health facilities remains a challenge. Simplified and sensitive clinical staging based on local clinical patterns is useful to ensure effective care without CD4 counts. To assess whether local HIV clinical manifestations can be used to guide HIV management in settings with limited access to CD4 counts in Tanzania. A Cross-sectional study conducted at Tumbi and Chalinze health facilities documented clinical manifestations and CD4 counts in 360 HIV/AIDS patients. Simplified management groups comprised of severe and moderate disease were formed based on clinical manifestations and CD4 counts results. Symptoms with high frequency were used to predict severe disease. A Weight loss (48.3%) and chronic cough (40.8 %) were the most reported manifestations in the study population. More than 50% of patients presented with CD4≤200. Most symptoms were found to be highly sensitive (71% to 93%) in predicting severe immunosuppression using CD4<200 cut-off point as a 'Gold standard'. Chronic diarrhoea presented in 10.6%, and predicted well severe immunosuppression either alone (OR 1.95, 95%CI, 0.95-4.22) or in combination (OR 4.21, 95%CI 0.92-19.33) with other symptoms. Basing strictly on WHO clinical staging 30.8% of patients were detected to be severely immunosuppressed (Stage 4). While using our proposed management categories of severe and moderate immunosuppression 70% of patients were put into the severe immunosuppression group, consistent with CD4 cut-off count of≤350. HIV/AIDS clinics managing large cohorts should develop validated site specific guidelines based on local experiences. Simplified guidelines are useful for resource constrained settings without CD4 counting facilities.

  19. An interdisciplinary memory clinic: a novel practice setting for pharmacists in primary care.

    PubMed

    Rojas-Fernandez, Carlos H; Patel, Tejal; Lee, Linda

    2014-06-01

    Pharmacists have developed innovative practices in various settings as singular providers or as members of multidisciplinary or interdisciplinary teams. Examples include pharmacists practicing in heart failure, hypertension, or hyperlipidemia clinics. There is a paucity of literature describing pharmacists in interdisciplinary memory clinics and specifically pharmacists practicing in interdisciplinary, primary care-based memory clinics. New practice models should be disseminated to guide others in the development of similar models given the complexity of this population. Patients with dementia are more difficult to manage because of cognitive impairment, behavioral and psychological symptoms, the common presence of multiple comorbidities, and related polypharmacy and caregiver issues. These challenges require expertise in neurodegenerative disorders and geriatrics. The purpose of this article is to describe the role of clinical pharmacists providing care to patients with cognitive complaints in a primary care-based, interdisciplinary memory clinic, with a focus on how the pharmacist practices and is integrated in this collaborative care setting. Patients are assessed using an interdisciplinary approach, with team consensus for assessment and planning of care. Pharmacists' activities include assessment of (1) appropriateness of medications based on frailty, (2) medications that can impair cognition and/or function, (3) medication adherence and management skills, and (4) vascular risk factor control. Pharmacists provide education regarding medications and diseases, ensure appropriate transitions in care, and conduct home visits. Pharmacist participation in this clinic represents a novel opportunity to advance pharmacy practice in primary care, interdisciplinary models. Work is ongoing to describe outcomes attributable to pharmacist participation in this clinic.

  20. The epidemiology, clinical features, and long-term prognosis of Japanese encephalitis in central sarawak, malaysia, 1997-2005.

    PubMed

    Ooi, Mong How; Lewthwaite, Penny; Lai, Boon Foo; Mohan, Anand; Clear, Daniela; Lim, Lina; Krishnan, Shekhar; Preston, Teresa; Chieng, Chae Hee; Tio, Phaik Hooi; Wong, See Chang; Cardosa, Jane; Solomon, Tom

    2008-08-15

    Japanese encephalitis is a major public health problem in Asia. However, there is little data on the long-term outcome of Japanese encephalitis survivors. We prospectively evaluated children with serologically confirmed Japanese encephalitis over an 8.3-year period. The patients were assessed and their outcomes were graded with a functional outcome score at hospital discharge and at follow-up appointments. We examined how patient outcome at hospital discharge compared with that at long-term follow-up visits, when changes in outcome occurred, and the prognostic indicators of the eventual outcome. One hundred and eighteen patients were recruited into the study, and 10 (8%) died during the acute phase of illness. At hospital discharge, 44 (41%) of the 108 patients who survived had apparent full recovery; 3 (3%) had mild, 28 (26%) had moderate, and 33 (31%) had severe neurological sequelae. Eighty six of the 108 patients were followed up for a median duration of 52.9 months (range, 0.9-114.9 months). During follow-up, 31 patients experienced improvement, but 15 patients experienced deterioration in their outcome grade. In most cases, assessment during the first 3-6 months after hospital discharge was predictive of the long-term outcome. More than one-half of the patients continued to experience neuropsychological sequelae and behavioral disorders. A combination of poor perfusion, Glasgow coma score < or =8, and > or =2 witnessed seizures predicted a poor long-term outcome with 65% sensitivity and 92% specificity. Neurological assessment of Japanese encephalitis survivors at hospital discharge does not predict long-term outcome. Seizures and shock are treatable risk factors for a poor outcome at hospital discharge and at long-term follow-up visits.

  1. Refining Video Game Use Questionnaires for Research and Clinical Application: Detection of Problematic Response Sets

    ERIC Educational Resources Information Center

    Faust, Kyle A.; Faust, David; Baker, Aaron M.; Meyer, Joseph F.

    2012-01-01

    Even when relatively infrequent, deviant response sets, such as defensive and careless responding, can have remarkably robust effects on individual and group data and thereby distort clinical evaluations and research outcomes. Given such potential adverse impacts and the widespread use of self-report measures when appraising addictions and…

  2. Bullying Behaviors and Self Efficacy among Nursing Students at Clinical Settings: Comparative Study

    ERIC Educational Resources Information Center

    Kassem, Awatef Hassan

    2015-01-01

    Background: Nursing students who experienced bullying behaviors feel anger and missing their concentration, their capability to achieve a desired outcome. Also self-efficacy, often referred to as self-confidence, is essential to nursing students' ability and performance in the clinical setting. Aim: Study aimed to examine relation between bullying…

  3. The Clinical Nurse Specialist in the School Setting: Case Management of Migrant Children with Dental Disease.

    ERIC Educational Resources Information Center

    Good, Mary Ellen

    This paper presents strategies for the clinical nurse specialist (CNS) in the school setting to use in case management of migrant children with dental disease. Although dental disease is the major health problem of all school-age children in the nation, the problem is even more severe for children of migrant farmworkers. Leininger's transcultural…

  4. No New HIV Infections With Increasing Use of HIV Preexposure Prophylaxis in a Clinical Practice Setting

    PubMed Central

    Volk, Jonathan E.; Marcus, Julia L.; Phengrasamy, Tony; Blechinger, Derek; Nguyen, Dong Phuong; Follansbee, Stephen; Hare, C. Bradley

    2015-01-01

    Referrals for and initiation of preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection increased dramatically in a large clinical practice setting since 2012. Despite high rates of sexually transmitted infections among PrEP users and reported decreases in condom use in a subset, there were no new HIV infections in this population. PMID:26334052

  5. Perspectives of Educators Across Clinical and Scholarly/Scientific Work Settings.

    ERIC Educational Resources Information Center

    Pickle, Judy

    1983-01-01

    Tested 40 teachers and teacher educators to determine whether educators associated with clinical vs. scholarly/scientific work settings would view classroom events using different perspectives. These educators responded to three videotaped and six written scenarios of classroom events. Significant differences were found between work-setting…

  6. Refining Video Game Use Questionnaires for Research and Clinical Application: Detection of Problematic Response Sets

    ERIC Educational Resources Information Center

    Faust, Kyle A.; Faust, David; Baker, Aaron M.; Meyer, Joseph F.

    2012-01-01

    Even when relatively infrequent, deviant response sets, such as defensive and careless responding, can have remarkably robust effects on individual and group data and thereby distort clinical evaluations and research outcomes. Given such potential adverse impacts and the widespread use of self-report measures when appraising addictions and…

  7. The Clinical Nurse Specialist in the School Setting: Case Management of Migrant Children with Dental Disease.

    ERIC Educational Resources Information Center

    Good, Mary Ellen

    This paper presents strategies for the clinical nurse specialist (CNS) in the school setting to use in case management of migrant children with dental disease. Although dental disease is the major health problem of all school-age children in the nation, the problem is even more severe for children of migrant farmworkers. Leininger's transcultural…

  8. Help-Seeking Behaviors among Athletic Training Students in the Clinical Education Setting: A Pilot Study

    ERIC Educational Resources Information Center

    Nakajima, Mikiko Aoyagi; Freesemann, Keith W.

    2013-01-01

    Context: Help-seeking is an important self-regulating and proactive strategy that prepares students to be successful learners. It is particularly important in the clinical education setting, in which students must actively engage in learning. Objective: To determine both the type of help-seeking behaviors used by athletic training students in the…

  9. Medical students developing confidence and patient centredness in diverse clinical settings: a longitudinal survey study.

    PubMed

    McNair, Ruth; Griffiths, Leonie; Reid, Katharine; Sloan, Hannah

    2016-07-15

    Medical student clinical confidence and positive attitudes to patient centredness are important outcomes of medical education. The clinical placement setting is regarded as a critical support to these outcomes, so understanding how the setting is influential is important. The aim of this study was to compare students' attitudes towards patient-centredness and clinical confidence as they progressed through their medical course, and understand the influence of diverse clinical placement zones. Students at one Australian medical school completed a questionnaire at the beginning of second year and at the end of their third year of medical training. The questionnaire measured attitudes to patient centred care, clinical confidence, role modelling experiences and clinical learning experiences. Descriptive analyses investigated change in these attitudes over time. Repeated measures analysis of variance was used to assess the influence of placement location on each variable of interest. Responses to two open-ended questions were also coded by two researchers and themes were identified. Student confidence increased over the course of two years of clinical training (p < 0.001), but attitudes to patient centredness (p = 0.933) did not change. The location of clinical placements (urban, outer urban and rural) was unrelated to levels of confidence or patient centredness. Students had positive attitudes towards patient-centredness throughout, and noted its importance in contributing to quality care. Patient-centred care was encouraged within the clinical placements, and was influenced by positive and negative role modelling, direct teaching, and opportunities to practise patient-centred care. A new generation of doctors with a strong patient-centred focus is emerging. Medical schools have a responsibility to facilitate clinical placements that will support the acquisition and maintenance of skills in patient centred care through positive role modelling.

  10. Knowledge mining from clinical datasets using rough sets and backpropagation neural network.

    PubMed

    Nahato, Kindie Biredagn; Harichandran, Khanna Nehemiah; Arputharaj, Kannan

    2015-01-01

    The availability of clinical datasets and knowledge mining methodologies encourages the researchers to pursue research in extracting knowledge from clinical datasets. Different data mining techniques have been used for mining rules, and mathematical models have been developed to assist the clinician in decision making. The objective of this research is to build a classifier that will predict the presence or absence of a disease by learning from the minimal set of attributes that has been extracted from the clinical dataset. In this work rough set indiscernibility relation method with backpropagation neural network (RS-BPNN) is used. This work has two stages. The first stage is handling of missing values to obtain a smooth data set and selection of appropriate attributes from the clinical dataset by indiscernibility relation method. The second stage is classification using backpropagation neural network on the selected reducts of the dataset. The classifier has been tested with hepatitis, Wisconsin breast cancer, and Statlog heart disease datasets obtained from the University of California at Irvine (UCI) machine learning repository. The accuracy obtained from the proposed method is 97.3%, 98.6%, and 90.4% for hepatitis, breast cancer, and heart disease, respectively. The proposed system provides an effective classification model for clinical datasets.

  11. Knowledge Mining from Clinical Datasets Using Rough Sets and Backpropagation Neural Network

    PubMed Central

    Nahato, Kindie Biredagn; Harichandran, Khanna Nehemiah; Arputharaj, Kannan

    2015-01-01

    The availability of clinical datasets and knowledge mining methodologies encourages the researchers to pursue research in extracting knowledge from clinical datasets. Different data mining techniques have been used for mining rules, and mathematical models have been developed to assist the clinician in decision making. The objective of this research is to build a classifier that will predict the presence or absence of a disease by learning from the minimal set of attributes that has been extracted from the clinical dataset. In this work rough set indiscernibility relation method with backpropagation neural network (RS-BPNN) is used. This work has two stages. The first stage is handling of missing values to obtain a smooth data set and selection of appropriate attributes from the clinical dataset by indiscernibility relation method. The second stage is classification using backpropagation neural network on the selected reducts of the dataset. The classifier has been tested with hepatitis, Wisconsin breast cancer, and Statlog heart disease datasets obtained from the University of California at Irvine (UCI) machine learning repository. The accuracy obtained from the proposed method is 97.3%, 98.6%, and 90.4% for hepatitis, breast cancer, and heart disease, respectively. The proposed system provides an effective classification model for clinical datasets. PMID:25821508

  12. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review.

    PubMed

    Agerwala, Suneel M; McCance-Katz, Elinore F

    2012-01-01

    Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs. Screening large numbers of individuals presents an opportunity to engage those who are in need of treatment. However, additional research is needed to determine how best to implement SBIRT.

  13. Integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into Clinical Practice Settings: A Brief Review

    PubMed Central

    Agerwala, Suneel M.; McCance-Katz, Elinore F.

    2013-01-01

    Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs. Screening large numbers of individuals presents an opportunity to engage those who are in need of treatment. However, additional research is needed to determine how best to implement SBIRT. PMID:23210379

  14. Relationships between self-rated oral health, subjective symptoms, oral health behavior and clinical conditions in Japanese university students: a cross-sectional survey at Okayama University

    PubMed Central

    2013-01-01

    Background Self-rated oral health is a valid and useful summary indicator of overall oral health status and quality of life. However, few studies on perception of oral health have been conducted among Japanese young adults. This study investigated whether oral health behavior, subjective oral symptoms, or clinical oral status were associated with self-rated oral health in Japanese young adults. Methods This cross-sectional survey included 2,087 students (1,183 males, 904 females), aged 18 and 19 years, at Okayama University, Japan. A self-administered questionnaire was distributed and an oral examination was performed. Results In a structural equation modeling analysis, the score of decayed, missing and filled teeth (DMFT) significantly affected self-rated oral health (p <0.05) and the effect size was highest. Malocclusion, subjective symptoms of temporomandibular disorders (TMD) and stomatitis, and poor oral health behavior significantly induced self-rated poor oral health with small effect sizes (p <0.05). Clinical periodontal conditions and Oral Hygiene Index-simplified were not related to self-rated oral health. Conclusion Self-rated oral health was influenced by subjective symptoms of TMD and stomatitis, oral health behavior, the score of DMFT, and malocclusion. The evaluation of these parameters may be a useful approach in routine dental examination to improve self-rated oral health in university students. PMID:24195632

  15. Multiplex PCR for the Detection of 10 Viruses Causing Encephalitis/Encephalopathy and its Application to Clinical Samples Collected from Japanese Children with Suspected Viral.

    PubMed

    Pham, Ngan T K; Ushijima, Hiroshi; Thongprachum, Aksara; Trinh, Quang D; Khamrin, Pattara; Arakawa, Chikako; Ishii, Wakako; Okitsu, Shoko; Komine-Aizawa, Shihoko; Hayakawa, Satoshi

    2017-01-01

    Acute encephalitis is a serious neurological condition having a high mortality rate and affecting both children and adults. This study aimed to develop a multiplex PCR method for the simultaneous screening of clinical samples for the presence of the 10 viruses presently considered as the major viral causes of acute encephalitis/ encephalopathy in Asia. Using previously published primers that have been widely used to screen for herpes virus-6, influenza A virus, human parechovirus, herpes simplex viruses 1 and 2, Japanese encephalitis virus, group A rotavirus, enterovirus, adenovirus, and dengue virus in clinical samples, a single-tube multiplex PCR assay was developed and was tested for its sensitivity and specificity. The method was then applied to screen 57 clinical samples, consisting of 13 fecal samples, 5 throat swabs, 3 post-nasal swabs, 18 serum samples, and 18 cerebrospinal fluid (CSF) samples, collected from 18 hospitalized Japanese children with suspected viral encephalitis/encephalopathy for the target viruses, and the results were compared with those of a monoplex PCR method. Positive viral controls of the 10 viruses were correctly typed using this multiplex PCR method. The multiplex PCR method showed high specificity with no unspecific amplification to non-target viruses. The results of applying this PCR method for screening clinical samples showed that 6 fecal samples, 2 serum samples, and 1 CSF sample collected from 7 patients were positive for a virus, specifically group A rotavirus (4 patients, 22.2%), enterovirus (2 patients, 11.1%), or adenovirus (1 patient, 5.6%). In comparison with monoplex PCR, for group A rotavirus, enterovirus, and adenovirus, the sensitivity of this multiplex PCR method decreased for serum, cerebrospinal fluid, and throat swab samples. This newly developed multiplex PCR method is a simple, rapid diagnostic tool and can be used to screen clinical samples for viruses causing acute encephalitis/encephalopathy in children in

  16. Clinical utility of the prostate cancer gene 3 (PCA3) urine assay in Japanese men undergoing prostate biopsy.

    PubMed

    Ochiai, Atsushi; Okihara, Koji; Kamoi, Kazumi; Oikawa, Takehiro; Shimazui, Toru; Murayama, Shin-Ichiro; Tomita, Kyoichi; Umekawa, Tohru; Uemura, Hirotsugu; Miki, Tsuneharu

    2013-05-01

    WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: It is known that a prostate cancer gene 3 (PCA3) urine assay is superior to serum PSA level or PSA-related indices for predicting a positive biopsy result in European and US men. This is the first report on PCA3 in a large cohort of Japanese men. The diagnostic value of the PCA3 score in Japanese men was similar to those reported in European and US men. The study concludes that a combination of PSA density and PCA3 score may be useful for selecting patients who could avoid an unnecessary biopsy. To examine the diagnostic performance of the prostate cancer gene 3 (PCA3) score for prostate cancer in Japanese men undergoing prostate biopsy. This Japanese, multicentre study included 647 Asian men who underwent extended prostate biopsy with elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE). Urine samples were collected after DRE. The PCA3 score was determined using a PROGENSA PCA3 assay and correlated with biopsy outcome. Its diagnostic accuracy was compared with that of serum PSA level, prostate volume (PV), PSA density (PSAD), and free/total PSA ratio (f/t PSA). A total of 633 urine samples were successfully analysed (the informative rate was 98%). Median PSA was 7.6 ng/mL. Biopsy revealed cancer in 264 men (41.7%). The PCA3 score for men with prostate cancer was significantly higher than that for men with negative biopsies (median PCA3 score: 49 vs. 18; P < 0.001). The rate of positive biopsy was 16.0% in men with a PCA3 score of <20 and 60.6% in those with a PCA3 score of ≥50. Using a PCA3 score threshold of 35, sensitivity and specificity were 66.5 and 71.6%, respectively. The area under the curve of the PCA3 score was significantly higher than that of the f/t PSA in men with PSA 4-10 ng/mL (0.742 vs 0.647; P < 0.05). In men with PSAD < 0.15 and PCA3 < 20, only three (4.2%) out of 72 men had prostate cancer. The PCA3 score was significantly superior to f/t PSA in

  17. Complementary and alternative medicine use by visitors to rural Japanese family medicine clinics: results from the international complementary and alternative medicine survey.

    PubMed

    Shumer, Gregory; Warber, Sara; Motohara, Satoko; Yajima, Ayaka; Plegue, Melissa; Bialko, Matthew; Iida, Tomoko; Sano, Kiyoshi; Amenomori, Masaki; Tsuda, Tsukasa; Fetters, Michael D

    2014-09-25

    There is growing interest in the use of complementary and alternative medicine (CAM) throughout the world, however previous research done in Japan has focused primarily on CAM use in major cities. The purpose of this study was to develop and distribute a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) to assess the use of CAM among people who visit rural Japanese family medicine clinics. Using a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q), a cross-sectional survey was conducted in three rural family medicine clinics. All patients and those accompanying patients who met inclusion criteria were eligible to participate. Data were entered into SPSS Statistics and analyzed for use by age, gender, and location. Of the 519 respondents who participated in the project, 415 participants reported CAM use in the past 12 months (80.0%). When prayer is excluded, the prevalence of CAM use drops to 77.3% in the past year, or 403 respondents. The most common forms of CAM used by respondents were pain relief pads (n = 170, 32.8%), herbal medicines/supplements (n = 167, 32.2%), and massage by self or family (n = 166, 32.0%). Female respondents, individuals with higher levels of education, and those with poorer overall health status were more likely to use CAM than respondents without these characteristics. Only 22.8% of CAM therapies used were reported to physicians by survey participants. These data indicate that CAM use in rural Japan is common. The results are consistent with previous studies that show that Japanese individuals are more interested in forms of CAM such as pain relief pads and massage, than in mind-body forms of CAM like relaxation and meditation. Due to the high utilization of certain CAM practices, and given that most CAM users do not disclose their CAM use to their doctors, we conclude that physicians in rural Japan would benefit by asking about CAM use

  18. Strategic planning in medical education: enhancing the learning environment for students in clinical settings.

    PubMed

    Gordon, J; Hazlett, C; Ten Cate, O; Mann, K; Kilminster, S; Prince, K; O'Driscoll, E; Snell, L; Newble, D

    2000-10-01

    The 1999 Cambridge Conference was held in Northern Queensland, Australia, on the theme of clinical teaching and learning. It provided an opportunity for groups of academic medical educators to consider some of the challenges posed by recent changes to health care delivery and medical education across a number of countries. This paper describes the issues raised by the practical challenges posed by the current environment and how they might be addressed in ways that could promote more effective learning in clinical settings. A SWOT analysis is a tool that can help in forward planning by identifying the strengths, weaknesses, opportunities and threats presented by any situation. Our SWOT analysis was used to generate a list of items, from which we chose those most feasible and most likely to promote positive change. Twenty different issues were identified, with four of them chosen by consensus for further elaboration. The discussion gave rise to four main recommended strategies: ensuring that clinical teachers thoroughly understand the purpose and process of learning in clinical settings; equipping learners with 'survival skills'; making the best use of learning resources within different clinical environments and making judicious use of information technology to enhance learning efficiency. The four strategies were selected not only because of their inherent importance, but also because of their feasibility. Modest changes can motivate students to feel part of a clinical team and a 'community of practice' and enhance their capacity for self-regulated practice.

  19. Inter-professional Education in the Acute-Care Setting: The Clinical Instructor's Point of View

    PubMed Central

    Chau, Jennifer; Denomme, Jocelyn; Cott, Cheryl A.

    2011-01-01

    ABSTRACT Purpose: The purpose of this study was to gain an understanding of the opportunities and challenges involved in providing clinical inter-professional education (IPE) to physical therapy (PT) students in the acute-care setting from the perspective of PT clinical instructors (CIs). Methods: Focus groups were conducted in four acute-care hospitals in Toronto. Participants were recruited using a purposive and convenience sampling approach in order to enhance our understanding of the perceptions of acute-care PT CIs. Eighteen full-time PT CIs with an average of 11 years in practice participated. A constant comparative process was employed to identify recurrent issues and themes within and between groups. Results: Three main themes emerged from the focus groups: (1) Clinical IPE happens when inter-professional collaboration (IPC) occurs; however, IPC differs according to setting, access to other professions, time, support, and structure. (2) IPE is a lifelong learning process that applies to both CIs and students. (3) Student preparedness is a prerequisite for clinical IPE. Conclusions: IPC is an integral part of clinical IPE that requires ongoing commitment and reflection by CIs to ensure that they are ready to instruct students who have some preparation in formal IPE. More knowledge about providing clinical IPE in a structured manner, through academic and health institutions, will allow CIs to become role models for future generations of PT students. PMID:22210981

  20. Suitability of the PROMIS Alcohol Use Short Form for Screening in a HIV Clinical Care Setting*

    PubMed Central

    Gibbons, Laura E.; Fredericksen, Rob; Merrill, Joseph O.; McCaul, Mary E.; Chander, Geetanjali; Hutton, Heidi; Lober, William B.; Mathews, W. Chris; Mayer, Kenneth; Burkholder, Greer; Willig, James H.; Mugavero, Michael J.; Saag, Michael S.; Kitahata, Mari M.; Edwards, Todd C.; Patrick, Donald L; Crane, Heidi M.; Crane, Paul K.

    2016-01-01

    Background At-risk alcohol use is important to identify in clinical settings to facilitate interventions. The Patient-Reported Outcomes Measurement Information System (PROMIS) Alcohol Use Short Form was developed through an item response theory process, but its utility as a screening instrument in clinical care has not been reported. Objective To determine the ability of the PROMIS Alcohol Use Short Form to identify people with current or future at-risk alcohol use defined by the Alcohol Use Disorders Identification Test consumption (AUDIT-C) instrument. Methods Observational study of people living with HIV (PLWH) in clinical care at four sites across the US. Patients completed a tablet-based clinical assessment prior to seeing their providers at clinic appointments. We used 3 definitions of clinically-relevant at-risk alcohol use and determined the proportion of PLWH with current or future at-risk drinking identified by the PROMIS instrument. Results Of 2,497 PLWH who endorsed ≥1 drink in the prior 12 months, 1,500 PLWH (60%) endorsed “never” for all PROMIS items. In that group, 26% had clinically-relevant at-risk alcohol use defined by one or more AUDIT-C definitions. At follow-up (N=1,608), high baseline PROMIS scores had 55% sensitivity for at-risk drinking among those with at-risk drinking at baseline, and 22% sensitivity among those without baseline risk. Conclusions The PROMIS Alcohol Use Short Form cannot be used alone to identify PLWH with clinically-relevant at-risk alcohol use. Optimal assessment of problem drinking behavior is not clear, but there does not seem to be an important role for the PROMIS instrument in this clinical setting. PMID:27209223

  1. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey

    PubMed Central

    Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo

    2017-01-01

    [Purpose] This study aimed to investigate Japanese physical therapists’ attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions. PMID:28265139

  2. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey.

    PubMed

    Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo

    2017-02-01

    [Purpose] This study aimed to investigate Japanese physical therapists' attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions.

  3. The attributes of an effective teacher differ between the classroom and the clinical setting.

    PubMed

    Haws, Jolene; Rannelli, Luke; Schaefer, Jeffrey P; Zarnke, Kelly; Coderre, Sylvain; Ravani, Pietro; McLaughlin, Kevin

    2016-10-01

    Most training programs use learners' subjective ratings of their teachers as the primary measure of teaching effectiveness. In a recent study we found that preclinical medical students' ratings of classroom teachers were associated with perceived charisma and physical attractiveness of the teacher, but not intellect. Here we explored whether the relationship between these variables and teaching effectiveness ratings holds in the clinical setting. We asked 27 Internal Medicine residents to rate teaching effectiveness of ten teachers with whom they had worked on a clinical rotation, in addition to rating each teacher's clinical skills, physical attractiveness, and charisma. We used linear regression to study the association between these explanatory variables and teaching effectiveness ratings. We found no association between rating of physical attractiveness and teaching effectiveness. Clinical skill and charisma were independently associated with rating of teaching effectiveness (regression coefficients [95 % confidence interval] 0.73 [0.60, 0.85], p < 0.001 and 0.12 [0.01, 0.23], p = 0.03, respectively). The variables associated with effectiveness of classroom and clinical teachers differ, suggesting context specificity in teaching effectiveness ratings. Context specificity may be explained by differences in the exposure that learners have to teachers in the classroom versus clinical setting-so that raters in the clinical setting may base ratings upon observed behaviours rather than stereotype data. Alternatively, since subjective ratings of teaching effectiveness inevitably incorporate learners' context-specific needs, the attributes that make a teacher effective in one context may not meet the needs of learners in a different context.

  4. Validation of antibiotic susceptibility testing guidelines in a routine clinical microbiology laboratory exemplifies general key challenges in setting clinical breakpoints.

    PubMed

    Hombach, Michael; Courvalin, Patrice; Böttger, Erik C

    2014-07-01

    This study critically evaluated the new European Committee for Antimicrobial Susceptibility Testing (EUCAST) antibiotic susceptibility testing guidelines on the basis of a large set of disk diffusion diameters determined for clinical isolates. We report several paradigmatic problems that illustrate key issues in the selection of clinical susceptibility breakpoints, which are of general importance not only for EUCAST but for all guidelines systems, i.e., (i) the need for species-specific determinations of clinical breakpoints/epidemiological cutoffs (ECOFFs), (ii) problems arising from pooling data from various sources, and (iii) the importance of the antibiotic disk content for separating non-wild-type and wild-type populations. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  5. Uptake of clinical trials in a palliative care setting: a retrospective cohort study.

    PubMed

    Eastman, Peter; Le, Brian; McCarthy, Gillian; Watt, James; Rosenthal, Mark

    2015-03-01

    There has been growth in the number of clinical trials conducted in the palliative care setting. However, issues exist regarding patient acceptance and vulnerability as well as the appropriateness of conducting trials in the dying patient. This study aimed to investigate the uptake of palliative care clinical trials at the Royal Melbourne Hospital, evaluate patient demographics for those enrolled onto study and assess the proportion of patients who died within 28 days of enrolling on a palliative care clinical trial. A retrospective cohort study of all patients prescreened and enrolled onto palliative care clinical trials by the Palliative Care Clinical Trials Team (PCCTT) at the Royal Melbourne Hospital over a 27-month period was undertaken. Of 515 patients referred to the PCCTT for consideration of trial enrollment, 64 (12.4%) were subsequently enrolled onto one of six clinical trials open during the study period. About 62.5% were non-cancer patients; 81.3% of all patients completed the trial intervention and 65.6% completed trial follow-up; 28.1% of patients enrolled died within 28 days of trial commencement. More than 500 patients were referred for assessment of clinical trial participation perhaps reflecting clinician acceptance of palliative care clinical trials. A number of enrolled patients were involved in trials during their terminal phase, indicating a willingness of participants to be involved, despite poor prognosis. © 2014 Wiley Publishing Asia Pty Ltd.

  6. Fifty-two-week long-term clinical study of luseogliflozin as monotherapy in Japanese patients with type 2 diabetes mellitus inadequately controlled with diet and exercise.

    PubMed

    Seino, Yutaka; Kaku, Kohei; Inagaki, Nobuya; Haneda, Masakazu; Sasaki, Takashi; Fukatsu, Atsushi; Ubukata, Michito; Sakai, Soichi; Samukawa, Yoshishige

    2015-01-01

    Luseogliflozin, a selective sodium glucose cotransporter 2 inhibitor, was demonstrated in a previous 24-week study of type 2 diabetic patients to be efficacious and well tolerated. This study mainly aimed to evaluate the long-term safety of luseogliflozin monotherapy in Japanese type 2 diabetic patients based on the Japanese guidelines. Additionally, long-term efficacy was also evaluated. Patients on diet and exercise therapy alone with an HbA1c of 6.9-10.5% received luseogliflozin 2.5 mg once daily for 52 weeks. For patients with insufficient glycemic control, this dose was able to be increased to 5 mg at Week 24. Adverse events (AEs), clinical laboratory tests, vital signs and 12-lead electrocardiograms were used to assess safety. Efficacy endpoints consisted of changes in HbA1c, fasting plasma glucose (FPG), and body weight from baseline. Of 299 patients who received luseogliflozin, 279 completed the study. Most AEs were mild in severity with incidences of AEs and adverse drug reactions at 75.3% and 16.7%, respectively. Although hypoglycemia was observed in 7 patients (2.3%), no major hypoglycemic episodes occurred. The incidences of AEs of special interest, including pollakiuria, volume depletion and urinary tract/genital infections, were at acceptable levels. Luseogliflozin significantly lowered HbA1c (-0.50%, P< 0.001), FPG (-16.3 mg/dL, P< 0.001) and body weight (-2.68 kg, P< 0.001) at Week 52 compared to baseline. Up-titration to 5 mg further improved glycemic control. In this long-term study of Japanese type 2 diabetic patients, luseogliflozin monotherapy was well tolerated for 52 weeks and provided a sustained glycemic lowering effect and reduced body weight.

  7. Lung cancer staging: the value of PET depends on the clinical setting

    PubMed Central

    2014-01-01

    Background Although positron emission tomography (PET) imaging is widely recommended in the evaluation of patients with lung cancer, randomized controlled trials (RCTs) assessing this have demonstrated inconsistent results. We asked whether differences in the clinical context and endpoints could explain these discrepancies. Methods We used realist synthesis methods to analyze how contextual differences among RCTs affected the results. We focused on RCTs to minimize confounding yet permit evaluation of differences by comparing across studies. Results This analysis suggests that the impact of PET depends on the clinical setting. PET is of greatest benefit in identifying M1 disease in patients with a high chance of such involvement and when little traditional imaging [e.g., abdominal/pelvis computed tomography (CT) and bone scan] is used. Identification of N2,3 involvement by PET prior to resection is seen primarily when there is at least a moderate probability of such and the rate of invasive staging is high. The rate of N2 disease not identified preoperatively appears to increase if PET is used to avoid invasive mediastinal staging in clinical settings in which the risk of N2,3 involvement is moderately high. There is both a potential benefit in avoiding stage-inappropriate resection as well as a risk of missed (stage-appropriate) resection if PET findings are not evaluated carefully. Conclusions A blanket recommendation for PET may be too simplistic without considering nuances of the clinical setting. PMID:25589964

  8. Advances In Infection Surveillance and Clinical Decision Support With Fuzzy Sets and Fuzzy Logic.

    PubMed

    Koller, Walter; de Bruin, Jeroen S; Rappelsberger, Andrea; Adlassnig, Klaus-Peter

    2015-01-01

    By the use of extended intelligent information technology tools for fully automated healthcare-associated infection (HAI) surveillance, clinicians can be informed and alerted about the emergence of infection-related conditions in their patients. Moni--a system for monitoring nosocomial infections in intensive care units for adult and neonatal patients--employs knowledge bases that were written with extensive use of fuzzy sets and fuzzy logic, allowing the inherent un-sharpness of clinical terms and the inherent uncertainty of clinical conclusions to be a part of Moni's output. Thus, linguistic as well as propositional uncertainty became a part of Moni, which can now report retrospectively on HAIs according to traditional crisp HAI surveillance definitions, as well as support clinical bedside work by more complex crisp and fuzzy alerts and reminders. This improved approach can bridge the gap between classical retrospective surveillance of HAIs and ongoing prospective clinical-decision-oriented HAI support.

  9. An Automated Medical Information Management System (OpScan-MIMS) in a Clinical Setting

    PubMed Central

    Margolis, S.; Baker, T.G.; Ritchey, M.G.; Alterescu, S.; Friedman, C.

    1981-01-01

    This paper describes an automated medical information management system within a clinic setting. The system includes an optically scanned data entry system (OpScan), a generalized, interactive retrieval and storage software system(Medical Information Management System, MIMS) and the use of time-sharing. The system has the advantages of minimal hardware purchase and maintenance, rapid data entry and retrieval, user-created programs, no need for user knowledge of computer language or technology and is cost effective. The OpScan-MIMS system has been operational for approximately 16 months in a sexually transmitted disease clinic. The system's application to medical audit, quality assurance, clinic management and clinical training are demonstrated.

  10. Medication therapy management clinic: perception of healthcare professionals in a University medical center setting.

    PubMed

    Shah, Mansi; Markel Vaysman, Anna; Wilken, Lori

    2013-07-01

    To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM) clinic services, by healthcare professionals in a large, urban, university medical care setting. This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. Sixty-two healthcare professionals (32%) completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as 'excellent', 44% as 'good', 5% as 'fair', and 0% stated 'poor'. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise. In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

  11. The process of transitioning to digital operations in a clinic setting.

    PubMed

    Freeh, M; McFall, J; Nieves, A

    2001-06-01

    Transitioning to digital imaging operations in a department of radiology is often difficult for many radiologists, but it is a change that many have made effectively. Transitioning to digital operations in a clinic setting is even more difficult for the referring physician operating a business in the clinic. This paper will discuss our experience with transitioning several off site clinics to digital imaging operations. We will discuss the process followed to identify the physical equipment required to support clinic operations in a digital imaging environment, the process followed to help the physicians adjust their work patterns to allow them to practice in a digital imaging environment, and the benefits and pitfalls of implementing digital imaging in an off site clinic. Four off site clinic locations will be evaluated: 1. cancer clinic located immediately adjacent to the main hospital that relies heavily on CT and MRI images in their practice, 2. small clinic located about 60 miles from the main hospital that acquires xray images on site, 3. larger clinic located about 20 miles from the main hospital that acquires xray, MRI and CT images on site, 4. sports medicine clinic located about 2 miles from the main hospital that acquires xray images on site. Each of these clinics has a very different patient clientele and therefore operates differently in nearly all aspects of their daily operations. The physician's need for and use of film and digital images varies significantly between the sites and therefore each site has presented different challenges to our implementation process. As we explain the decisions that were made for each of these sites and reveal the methods that were used to help the physicians make the transition, the readers should be able to draw information that will be helpful to them as they make their own transition to a digital operation.

  12. Estimation of maximal oxygen uptake via submaximal exercise testing in sports, clinical, and home settings.

    PubMed

    Sartor, Francesco; Vernillo, Gianluca; de Morree, Helma M; Bonomi, Alberto G; La Torre, Antonio; Kubis, Hans-Peter; Veicsteinas, Arsenio

    2013-09-01

    Assessment of the functional capacity of the cardiovascular system is essential in sports medicine. For athletes, the maximal oxygen uptake [Formula: see text] provides valuable information about their aerobic power. In the clinical setting, the (VO(2max)) provides important diagnostic and prognostic information in several clinical populations, such as patients with coronary artery disease or heart failure. Likewise, VO(2max) assessment can be very important to evaluate fitness in asymptomatic adults. Although direct determination of [VO(2max) is the most accurate method, it requires a maximal level of exertion, which brings a higher risk of adverse events in individuals with an intermediate to high risk of cardiovascular problems. Estimation of VO(2max) during submaximal exercise testing can offer a precious alternative. Over the past decades, many protocols have been developed for this purpose. The present review gives an overview of these submaximal protocols and aims to facilitate appropriate test selection in sports, clinical, and home settings. Several factors must be considered when selecting a protocol: (i) The population being tested and its specific needs in terms of safety, supervision, and accuracy and repeatability of the VO(2max) estimation. (ii) The parameters upon which the prediction is based (e.g. heart rate, power output, rating of perceived exertion [RPE]), as well as the need for additional clinically relevant parameters (e.g. blood pressure, ECG). (iii) The appropriate test modality that should meet the above-mentioned requirements should also be in line with the functional mobility of the target population, and depends on the available equipment. In the sports setting, high repeatability is crucial to track training-induced seasonal changes. In the clinical setting, special attention must be paid to the test modality, because multiple physiological parameters often need to be measured during test execution. When estimating VO(2max), one has

  13. Characteristics and management of arachnoid cyst in the pediatric headache clinic setting.

    PubMed

    Eidlitz-Markus, Tal; Zeharia, Avi; Cohen, Yishai Haimi; Konen, Osnat

    2014-01-01

    Arachnoid cysts are generally identified incidentally on brain imaging, although they occasionally cause symptoms because of expansion or bleeding. This study aims to describe patients in whom an arachnoid cyst was identified on magnetic resonance imaging (MRI) study performed for the evaluation of headache in a pediatric headache clinic and to highlight the clinical dilemma posed by this finding. A retrospective descriptive study design was used. The electronic database of a tertiary pediatric headache clinic was searched for all newly admitted patients with headache who underwent MRI evaluation in 2008-2013. The indications for imaging were based on clinical practice parameters recommended by the Subcommittee of the American Academy of Neurology. Clinical and imaging parameters were collected from the files. Findings were compared between patients with and without an arachnoid cyst. Of the 250 (31%) of 800 patients who met the inclusion criteria, 11 (4.4%) had an arachnoid cyst. Two patients had a ruptured cyst with midline shifting and a large subdural collection. Both presented with headache, vomiting, phonophobia, and photophobia. In the other 9 asymptomtic patients with an arachnoid cyst, imaging showed only a mild mass effect without midline shifting; their symptoms were considered unrelated to the cyst. The patients with a symptomatic arachnoid cyst were referred for surgery, with good outcome. Arachnoid cysts are found in a small percentage of brain scans performed for evaluation of headache in the setting of a hospital-based pediatric headache clinic. For the long run in these clinical settings, most of the cysts are asymptomatic. Precise anamnesis, neurologic examination, and imaging performed according to accepted practice guidelines may help clinicians determine if the headache and symptoms are caused by the cyst or if they should seek primary headache diagnosis with overlapping symptoms. The clinical distinction between symptomatic and asymptomatic

  14. Operational and Clinical Strategies to Address Drug Cost Containment in the Acute Care Setting.

    PubMed

    McConnell, Karen J; Guzman, Oscar E; Pherwani, Nisha; Spencer, Dustin D; Van Cura, Jennifer D; Shea, Katherine M

    2017-01-01

    To provide clinical and operational strategies to generate drug cost savings in the hospital setting. A search of the PubMed database was performed with no time limit through July 2016. All original prospective and retrospective studies, peer-reviewed guidelines, consensus statements, review articles, and accompanying references were evaluated for inclusion. Only articles published in the English language were included. Investigators reviewed 937 abstracts. The review of the literature showed that acute care hospitals are under increasing financial pressures, and the pharmacy is often responsible for opportunities to manage drug costs. The literature also indicated that cost-containment strategies in the acute care setting range from pharmacy-directed activities to initiatives requiring interdisciplinary collaboration and strategic planning. Hospital pharmacies should consider establishing an interdisciplinary team that is responsible for systematically reviewing drug cost implications and leading any initiatives that are deemed necessary. Acute care settings can use various operational and clinical strategies to lower their expenditures on high-cost drugs. Operational strategies include various activities that pharmacy staff implement related to contracting, purchasing, and inventory management. Clinical strategies utilize clinical pharmacists working with interdisciplinary teams to develop and maintain a formulary, implement established-use criteria for select drugs, use dose optimization, and implement other clinical tactics aimed at cost containment. After initiatives are implemented, assessing the outcomes of the initiatives is important to determine how successful they were at lowering costs safely and effectively. Acute care hospitals can use various operational and clinical strategies to lower overall drug costs. A systematic stepwise approach is recommended to ensure relevant drugs are regularly reviewed and addressed as needed. © 2016 Pharmacotherapy

  15. How Stable are Temperaments in the Clinical Setting: A Pilot Study

    PubMed Central

    Karam, Elie G.; El Khoury, Elaine; Itani, Lynn

    2016-01-01

    Background An essential point in evaluating the utility of measuring temperaments is the stability of the instrument used especially in the presence of mental disorders. One of the most commonly used instruments in the clinical setting is the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS-A). To our knowledge, the TEMPS-A’s stability in an outpatient adult clinical setting has not been evaluated. Objective: To assess the stability of the effect of temperament, time and clinical intervention. Methods: A sample of 89 adult outpatients was assessed at baseline and follow-up on their TEMPS-A scores. Diagnoses of mental disorders were reached through clinical interviews, and the severity of the conditions was clinically assessed at baseline and follow-up on a Likert scale. Changes in scores were examined in terms of z-scores, and possible predictors of the change in scores were assessed. Results: Eighty-nine percent of all subjects’ temperaments scores did not change or changed less than one z-score, and specifically: 84.2% in the case of depressive, 89.9% for cyclothymic, 92.1% for hyperthymic, 92.2% for irritable, and 86.5% for anxious temperaments. For all of the five temperaments, age, gender, time difference between baseline and follow up, number of diagnoses, and percent improvement were not significantly associated with the change in temperament scores. Limitations: Well-established severity measures would add to the validity of any future findings. Conclusion: Shifts in temperament scores between baseline and follow-up were minor, thus proving the stability of temperaments and the TEMPS-A scale in a clinical setting. PMID:27733865

  16. How Stable are Temperaments in the Clinical Setting: A Pilot Study.

    PubMed

    Karam, Elie G; El Khoury, Elaine; Itani, Lynn

    2016-01-01

    An essential point in evaluating the utility of measuring temperaments is the stability of the instrument used especially in the presence of mental disorders. One of the most commonly used instruments in the clinical setting is the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS-A). To our knowledge, the TEMPS-A's stability in an outpatient adult clinical setting has not been evaluated. To assess the stability of the effect of temperament, time and clinical intervention. A sample of 89 adult outpatients was assessed at baseline and follow-up on their TEMPS-A scores. Diagnoses of mental disorders were reached through clinical interviews, and the severity of the conditions was clinically assessed at baseline and follow-up on a Likert scale. Changes in scores were examined in terms of z-scores, and possible predictors of the change in scores were assessed. Eighty-nine percent of all subjects' temperaments scores did not change or changed less than one z-score, and specifically: 84.2% in the case of depressive, 89.9% for cyclothymic, 92.1% for hyperthymic, 92.2% for irritable, and 86.5% for anxious temperaments. For all of the five temperaments, age, gender, time difference between baseline and follow up, number of diagnoses, and percent improvement were not significantly associated with the change in temperament scores. Well-established severity measures would add to the validity of any future findings. Shifts in temperament scores between baseline and follow-up were minor, thus proving the stability of temperaments and the TEMPS-A scale in a clinical setting.

  17. TNF-α promoter polymorphism: a factor contributing to the different immunological and clinical phenotypes in Japanese encephalitis

    PubMed Central

    2012-01-01

    Background More than three billion populations are living under the threat of Japanese encephalitis in South East Asian (SEA) countries including India. The pathogenesis of this disease is not clearly understood and is probably attributed to genomic variations in viral strains as well as the host genetic makeup. The present study is to determine the role of polymorphism of TNF-alpha promoter regions at positions -238G/A, -308G/A, -857C/T and -863C/A in the severity of Japanese encephalitis patients. Methods Total of 142 patients including 66 encephalitis case (IgM/RT-PCR positive), 16 fever cases (IgM positive) without encephalitis and 60 apparently healthy individuals (IgG positive) were included in the study. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) using site specific restriction enzymes were implemented for polymorphism study of TNF alpha promoter. Results Following the analysis of the digestion patterns of four polymorphic sites of the TNF- alpha promoter region, a significant association was observed between the allele -308A and -863C with the patients of Japanese encephalitis. Conclusions TNF- alpha 308 G/A has been shown to be associated with elevated TNF- alpha transcriptional activity. On the other hand, polymorphism at position -863C/A in the promoter region has been reported to be associated with reduced TNF- alpha promoter activity and lower plasma TNF levels. As per the literature search, this is the first study to identify the role of TNF- alpha promoter in JE infection. Our results show that subjects with - 308A and -863C alleles are more vulnerable to the severe form of JE infection. PMID:22276993

  18. Identifying an Efficient Set of Items Sensitive to Clinical-Range Externalizing Problems in Children

    PubMed Central

    Petersen, Isaac T.; Bates, John E.; Dodge, Kenneth A.; Lansford, Jennifer E.; Pettit, Gregory S.

    2015-01-01

    The present study applied item response theory to identify an efficient set of items of the Achenbach Externalizing scale from the Child Behavior Checklist (CBCL; 33 items) and Teacher's Report Form (TRF; 35 items) that were sensitive to clinical-range scores. Mothers and teachers rated children's externalizing problems annually from ages 5 to 13 years in two independent samples (Ns = 585 and 1,199). Item properties for each rater across ages 5–8 and 9–13 were examined with item response theory. We identified 10 mother- and teacher-reported items from both samples based on the items' measurement precision for sub-clinical and clinical levels of externalizing problems: externalizing problems that involve meanness to others, destroying others' things, fighting, lying and cheating, attacking people, screaming, swearing/obscene language, temper tantrums, threatening people, and being loud. Scores on the scales using these items had strong reliability and psychometric properties, capturing nearly as much information as the full Externalizing scale for classifying clinical levels of externalizing problems. Scores on the scale with the 10 CBCL items had moderate accuracy, equivalent to the full Externalizing scale, in classifying diagnoses of conduct disorder based on a research diagnostic interview. Of course, comprehensive clinical assessment would consider additional items, dimensions of behavior, and sources of information, too, but it appears that the behaviors tapped by this select set of items may be core to externalizing psychopathology in children. PMID:26322800

  19. Setting up a Nuchal Translucency Clinic: What Radiologists Need to Know.

    PubMed

    Onyeacholem, Ifeanyi; Kleiner, Beth; Hull, Andrew D; Chibuk, Jason; Romine, Lorene; Anton, Tracy; Pretorius, Dolores H

    2016-03-01

    The purpose of this article was to discuss the process of setting up a nuchal translucency (NT) screening clinic in clinical practice, how to interpret the information in combination with other clinical tests, what to do if abnormal results are obtained, and to illustrate some of the fetal anomalies that are associated with an increased NT. The NT was initially implemented to predict the likelihood of a fetus with Down syndrome. Maternal age can be combined with fetal NT and maternal serum biochemistry (free β-hCG and PAPP-A) at 11 to 14 weeks to identify about 90% of affected fetuses. Setting up a clinic to perform the NT screening requires certified physicians and certified sonographers. Certification can be obtained for both physicians and sonographers through Nuchal Translucency Quality Review and Fetal Medicine Foundation. Cell-free DNA testing is now altering what our patients are choosing to evaluate fetuses at risk for chromosomal anomalies and congenital anomalies. Common pitfalls to performing, interpreting, and conveying results of the NT are illustrated in this article. Nasal bone measurement, fetal anatomy examination and fetal echocardiography are tools that add sensitivity to the detection of chromosomal abnormalities. Examples of fetal anomalies discovered during the NT screening are also illustrated. Screening for obstetric complications is an additional benefit to the NT clinic.

  20. Developing students' time management skills in clinical settings: practical considerations for busy nursing staff.

    PubMed

    Cleary, Michelle; Horsfall, Jan

    2011-06-01

    In clinical settings, nursing staff often find themselves responsible for students who have varying time management skills. Nurses need to respond sensitively and appropriately, and to teach nursing students how to prioritize and better allocate time. This is important not only for developing students' clinical skills but also for shaping their perceptions about the quality of the placement and their willingness to consider it as a potential work specialty. In this column, some simple, practical strategies that nurses can use to assist students with improving their time management skills are identified. Copyright 2011, SLACK Incorporated.

  1. [Effective communication strategies to frame the trainer-trainee dialogue in the clinical setting].

    PubMed

    Gachoud, D; Félix, S; Monti, M

    2015-11-04

    Communication between trainer and trainee plays a central role in teaching and learning in the clinical environment. There are various strategies to frame the dialogue between trainee and trainer. These strategies allow trainers to be more effective in their supervision, which is important in our busy clinical environment. Communication strategies are well adapted to both in- and out-patient settings, to both under- and postgraduate contexts. This article presents three strategies that we think are particularly useful. They are meant to give feedback, to ask questions and to present a case.

  2. Walking Adaptability after a Stroke and Its Assessment in Clinical Settings

    PubMed Central

    Balasubramanian, Chitralakshmi K.; Clark, David J.; Fox, Emily J.

    2014-01-01

    Control of walking has been described by a tripartite model consisting of stepping, equilibrium, and adaptability. This review focuses on walking adaptability, which is defined as the ability to modify walking to meet task goals and environmental demands. Walking adaptability is crucial to safe ambulation in the home and community environments and is often severely compromised after a stroke. Yet quantification of walking adaptability after stroke has received relatively little attention in the clinical setting. The objectives of this review were to examine the conceptual challenges for clinical measurement of walking adaptability and summarize the current state of clinical assessment for walking adaptability. We created nine domains of walking adaptability from dimensions of community mobility to address the conceptual challenges in measurement and reviewed performance-based clinical assessments of walking to determine if the assessments measure walking adaptability in these domains. Our literature review suggests the lack of a comprehensive well-tested clinical assessment tool for measuring walking adaptability. Accordingly, recommendations for the development of a comprehensive clinical assessment of walking adaptability after stroke have been presented. Such a clinical assessment will be essential for gauging recovery of walking adaptability with rehabilitation and for motivating novel strategies to enhance recovery of walking adaptability after stroke. PMID:25254140

  3. Walking adaptability after a stroke and its assessment in clinical settings.

    PubMed

    Balasubramanian, Chitralakshmi K; Clark, David J; Fox, Emily J

    2014-01-01

    Control of walking has been described by a tripartite model consisting of stepping, equilibrium, and adaptability. This review focuses on walking adaptability, which is defined as the ability to modify walking to meet task goals and environmental demands. Walking adaptability is crucial to safe ambulation in the home and community environments and is often severely compromised after a stroke. Yet quantification of walking adaptability after stroke has received relatively little attention in the clinical setting. The objectives of this review were to examine the conceptual challenges for clinical measurement of walking adaptability and summarize the current state of clinical assessment for walking adaptability. We created nine domains of walking adaptability from dimensions of community mobility to address the conceptual challenges in measurement and reviewed performance-based clinical assessments of walking to determine if the assessments measure walking adaptability in these domains. Our literature review suggests the lack of a comprehensive well-tested clinical assessment tool for measuring walking adaptability. Accordingly, recommendations for the development of a comprehensive clinical assessment of walking adaptability after stroke have been presented. Such a clinical assessment will be essential for gauging recovery of walking adaptability with rehabilitation and for motivating novel strategies to enhance recovery of walking adaptability after stroke.

  4. Clinical assessment of a supplement of Pycnogenol® and L-arginine in Japanese patients with mild to moderate erectile dysfunction.

    PubMed

    Aoki, Hiromitsu; Nagao, Junji; Ueda, Taro; Strong, Jeffry M; Schonlau, Frank; Yu-Jing, Song; Lu, Yan; Horie, Shigeo

    2012-02-01

    A double-blind parallel group comparison design clinical study was conducted in Japanese patients with mild to moderate erectile dysfunction to investigate the efficacy of a supplement containing Pycnogenol® and L-arginine. Subjects were instructed to take a supplement (Pycnogenol® 60 mg/day, L-arginine 690 mg/day and aspartic acid 552 mg/day) or an identical placebo for 8 weeks, and the results were assessed using the five-item erectile domain (IIEF-5) of the International Index of Erectile Function. Additionally, blood biochemistry, urinalysis and salivary testosterone were measured. Eight weeks of supplement intake improved the total score of the IIEF-5. In particular, a marked improvement was observed in 'hardness of erection' and 'satisfaction with sexual intercourse'. A decrease in blood pressure, aspartate transaminase and γ-glutamyl transpeptidase (γ-GTP), and a slight increase in salivary testosterone were observed in the supplement group. No adverse reactions were observed during the study period. In conclusion, Pycnogenol® in combination with L-arginine as a dietary supplement is effective and safe in Japanese patients with mild to moderate erectile dysfunction.

  5. [Ethical dilemma for nurses who manage marital violence in clinical setting].

    PubMed

    Hou, Wen-Li; Kuo, Ya-Wen; Huang, Mei-Chih

    2008-06-01

    Marital violence or intimate partner violence is a serious and recurring public health issue. In the clinical setting, battered women often seek medical advice, because of the health problems that result from marital violence. Thus, nursing staff are the first persons to come into contact with the battered women. Can nurses execute their notify responsibility to prevent continued injury before obtained the woman's agreement? Will this action violate the principle of autonomy or not? Nurses would face an ethical dilemma when they care for battered women. The purpose of this article is to use Aroskar's ethical decision making model to analyze and clarify the ethical dilemmas involved in managing marital violence, including: under the value systems of the person, the profession, and time to illustrate the basic information, decision theory dimensions, and ethical theories or positions. It is hoped that this article provides an ethical decision making model for the ethical dilemmas facing nurses who manage marital violence in the clinical setting.

  6. Setting Global Standards for Stem Cell Research and Clinical Translation: The 2016 ISSCR Guidelines.

    PubMed

    Daley, George Q; Hyun, Insoo; Apperley, Jane F; Barker, Roger A; Benvenisty, Nissim; Bredenoord, Annelien L; Breuer, Christopher K; Caulfield, Timothy; Cedars, Marcelle I; Frey-Vasconcells, Joyce; Heslop, Helen E; Jin, Ying; Lee, Richard T; McCabe, Christopher; Munsie, Megan; Murry, Charles E; Piantadosi, Steven; Rao, Mahendra; Rooke, Heather M; Sipp, Douglas; Studer, Lorenz; Sugarman, Jeremy; Takahashi, Masayo; Zimmerman, Mark; Kimmelman, Jonathan

    2016-06-14

    The International Society for Stem Cell Research (ISSCR) presents its 2016 Guidelines for Stem Cell Research and Clinical Translation (ISSCR, 2016). The 2016 guidelines reflect the revision and extension of two past sets of guidelines (ISSCR, 2006; ISSCR, 2008) to address new and emerging areas of stem cell discovery and application and evolving ethical, social, and policy challenges. These guidelines provide an integrated set of principles and best practices to drive progress in basic, translational, and clinical research. The guidelines demand rigor, oversight, and transparency in all aspects of practice, providing confidence to practitioners and public alike that stem cell science can proceed efficiently and remain responsive to public and patient interests. Here, we highlight key elements and recommendations in the guidelines and summarize the recommendations and deliberations behind them.

  7. Operationalizing the concept of the optimal healing environment in clinical settings: the importance of "readiness".

    PubMed

    Findlay, Barbara; Verhoef, Marja

    2004-01-01

    Creation of an optimal healing environment (OHE) in a clinical setting is a multifaceted undertaking and subject to a wide variety of developmental influences. While comprehensive definitions for OHE might provide sufficient guidance for communicating philosophy and values and developing patient-practitioner processes, direction for creating a supportive administrative structure or establishing an evaluation/research strategy is less defined. Operationalizing the concept of OHE by breaking it down into components such as values, structure, process, and measurement of outcomes, proved to be a useful framework for analyzing the evolution of our integrated care program. Future OHE initiatives may benefit from using this type of framework to assess readiness among cocreators prior to development and implementation, as a guide for ongoing evaluation of an OHE postimplementation and as a basis for comparing OHEs across a variety of clinical settings.

  8. A new standardized set of ecological pictures for experimental and clinical research on visual object processing.

    PubMed

    Viggiano, Maria Pia; Vannucci, Manila; Righi, Stefania

    2004-06-01

    A new set of 174 pictures in black-and-white, coloured and spatially filtered versions, taken from photographs of real objects belonging to different semantic categories, was realised for experimental and clinical research on visual object processing. Two samples, one of English speakers and one of Italian speakers, were tested in order to provide the normative data for each picture, in both black-and-white and coloured versions, in relation to familiarity, visual complexity and name agreement.

  9. The Utility of Three Screening Questionnaires for Obstructive Sleep Apnea in a Sleep Clinic Setting

    PubMed Central

    Kim, Bomi; Lee, Eun Mi; Chung, Yoo-Sam; Kim, Woo-Sung

    2015-01-01

    Purpose The aim of this study was to determine the diagnostic value of three screening questionnaires in identifying Korean patients at high risk for obstructive sleep apnea (OSA) in a sleep clinic setting in Korea. Materials and Methods Data were collected from 592 adult patients with suspected OSA who visited a sleep center. All patients completed the Sleep Apnea of Sleep Disorder Questionnaire (SA-SDQ), the Berlin questionnaire, and the STOP-Bang questionnaire. Estimated OSA risk was compared to a diagnosis of OSA. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each questionnaire. Results The prevalence of OSA was 83.6% using an apnea-hypopnea index (AHI) ≥5/h and 58.4% for an AHI ≥15/h. The STOP-Bang questionnaire had a high sensitivity (97% for AHI ≥5/h, 98% for AHI ≥15/h), but the specificity was low (19% and 11%, respectively). In contrast, the sensitivity of the SA-SDQ was not high enough (68% for AHI ≥5/h, 74% for AHI ≥15/h) to be useful in a clinical setting, whereas the specificity was relatively good (66% and 61%, respectively). The sensitivity and specificity values of the Berlin questionnaire fell between those of the STOP-Bang questionnaire and the SA-SDQ. Conclusion The STOP-Bang questionnaire may be useful for screening OSA in a sleep clinic setting, but its specificity is lower than the acceptable level for this purpose. A new screening questionnaire with a high sensitivity and acceptable specificity is therefore needed in a sleep clinic setting. PMID:25837173

  10. The Predictive Value of Ultrasound Learning Curves Across Simulated and Clinical Settings.

    PubMed

    Madsen, Mette E; Nørgaard, Lone N; Tabor, Ann; Konge, Lars; Ringsted, Charlotte; Tolsgaard, Martin G

    2017-01-01

    The aim of the study was to explore whether learning curves on a virtual-reality (VR) sonographic simulator can be used to predict subsequent learning curves on a physical mannequin and learning curves during clinical training. Twenty midwives completed a simulation-based training program in transvaginal sonography. The training was conducted on a VR simulator as well as on a physical mannequin. A subgroup of 6 participants underwent subsequent clinical training. During each of the 3 steps, the participants' performance was assessed using instruments with established validity evidence, and they advanced to the next level only after attaining predefined levels of performance. The number of repetitions and time needed to achieve predefined performance levels were recorded along with the performance scores in each setting. Finally, the outcomes were correlated across settings. A good correlation was found between time needed to achieve predefined performance levels on the VR simulator and the physical mannequin (Pearson correlation coefficient .78; P < .001). Performance scores on the VR simulator correlated well to the clinical performance scores (Pearson correlation coefficient .81; P = .049). No significant correlations were found between numbers of attempts needed to reach proficiency across the 3 different settings. A post hoc analysis found that the 50% fastest trainees at reaching proficiency during simulation-based training received higher clinical performance scores compared to trainees with scores placing them among the 50% slowest (P = .025). Performances during simulation-based sonography training may predict performance in related tasks and subsequent clinical learning curves. © 2016 by the American Institute of Ultrasound in Medicine.

  11. Interventions to Improve Sexually Transmitted Disease Screening in Clinic-Based Settings.

    PubMed

    Taylor, Melanie M; Frasure-Williams, Jessica; Burnett, Phyllis; Park, Ina U

    2016-02-01

    The asymptomatic nature and suboptimal screening rates of sexually transmitted diseases (STD) call for implementation of successful interventions to improve screening in community-based clinic settings with attention to cost and resources. We used MEDLINE to systematically review comparative analyses of interventions to improve STD (chlamydia, gonorrhea, or syphilis) screening or rescreening in clinic-based settings that were published between January 2000 and January 2014. Absolute differences in the percent of the target population screened between comparison groups or relative percent increase in the number of tests or patients tested were used to score the interventions as highly effective (>20% increase) or moderately effective (5%-19% increase) in improving screening. Published cost of the interventions was described where available and, when not available, was estimated. Of the 4566 citations reviewed, 38 articles describing 42 interventions met the inclusion criteria. Of the 42 interventions, 16 (38.1%) were categorized as highly effective and 14 (33.3%) as moderately effective. Effective low-cost interventions (<$1000) included the strategic placement of specimen collection materials or automatic collection of STD specimens as part of a routine visit (7 highly effective and 1 moderately effective) and the use of electronic health records (EHRs; 3 highly effective and 4 moderately effective). Patient reminders for screening or rescreening (via text, telephone, and postcards) were highly effective (3) or moderately effective (2) and low or moderate cost (<$1001-10,000). Interventions with dedicated clinic staff to improve STD screening were highly effective (2) or moderately effective in improving STD screening (1) but high-cost ($10,001-$100,000). Successful interventions include changing clinic flow to routinely collect specimens for testing, using EHR screening reminders, and reminding patients to get screened or rescreened. These strategies can be

  12. Recommendations for blood pressure measuring devices for office/clinic use in low resource settings.

    PubMed

    Parati, Gianfranco; Mendis, Shanthi; Abegunde, Dele; Asmar, Ronald; Mieke, Stephan; Murray, Alan; Shengelia, Bakuti; Steenvoorden, Gijs; Van Montfrans, Gert; O'Brien, Eoin

    2005-02-01

    This paper, which summarizes the conclusions of a WHO Expert meeting, is aimed at proposing indications to develop technical specifications for an accurate and affordable blood pressure measuring device for office/clinic use in low resource settings. Blood pressure measuring devices to be used in low resource settings should be accurate, affordable, and easily available worldwide. Given the serious inherent inaccuracy of the auscultatory technique, validated and affordable electronic devices, that have the option to select manual readings, seem to be a suitable solution for low resource settings. The agreement on the technical specifications for automated blood pressure measuring devices for office/clinic use in low resource settings included the following features: high accuracy, adoption of electronic transducers and solar batteries for power supply, standard rates of cuff inflation and deflation, adequate cuff size, digital display powered by solar batteries, facilities for adequate calibration, environmental requirements, no need of memory function, resistance to shock and temperature changes, and low cost. Availability of a device with these features should be accompanied by adequate training of health care personnel, who should guarantee implementation of the procedures recommended in recent European and American Guidelines for accurate blood pressure measurement.

  13. The OMERACT Core Domain Set for Outcome Measures for Clinical Trials in Polymyalgia Rheumatica.

    PubMed

    Mackie, Sarah L; Twohig, Helen; Neill, Lorna M; Harrison, Eileen; Shea, Beverley; Black, Rachel J; Kermani, Tanaz A; Merkel, Peter A; Mallen, Christian D; Buttgereit, Frank; Mukhtyar, Chetan; Simon, Lee S; Hill, Catherine L

    2017-10-01

    To inform development of a core domain set for outcome measures for clinical trials in polymyalgia rheumatica (PMR), we conducted patient consultations, a systematic review, a Delphi study, and 2 qualitative studies. Domains identified by 70% or more of physicians and/or patients in the Delphi study were selected. The conceptual framework derived from the 2 qualitative research studies helped inform the meaning of each domain and its relationship to the others. The draft core domain set was refined by further discussion with patients and physicians who had participated in the Delphi study. At the Outcome Measures in Rheumatology (OMERACT) 2016, the domains were discussed and prioritized by 8 breakout groups. Formal voting took place at the end of the workshop and in the final plenary. Ninety-three percent of voters in the final plenary agreed that the inner core of domains considered mandatory for clinical trials of PMR should consist the following: laboratory markers of systemic inflammation, pain, stiffness, and physical function. Patient's global and fatigue were considered important but not mandatory (outer core). The research agenda included psychological impact, weakness, physical activity, participation, sleep, imaging, and health-related quality of life. This core domain set was considered sufficiently well-defined that the next step will be to apply the OMERACT Filter 2.0 Instrument Selection Algorithm to select candidate instruments for a subsequent "deeper dive" into the data. This will allow instruments to be mapped onto each of our core domains to derive a core outcome set for PMR.

  14. Clinical Manifestations, Epidemiology, and Laboratory Diagnosis of Human Monocytotropic Ehrlichiosis in a Commercial Laboratory Setting

    PubMed Central

    Olano, Juan P.; Hogrefe, Wayne; Seaton, Brent; Walker, David H.

    2003-01-01

    Clinical, epidemiological, and laboratory diagnostic issues of human monocytotropic ehrlichiosis (HME) were investigated in a retrospective case study conducted at a national reference laboratory (Focus Technologies, formerly MRL Reference Laboratory), and at the University of Texas Medical Branch at Galveston, Texas, during 1997 and 1998. Standard questionnaires were sent to physicians for each laboratory-diagnosed patient 2 days to 2 weeks after immunofluorescent antibody assay results were available. Among the 41 cases for which data were obtained, 32 (78%) were definite cases of HME, and 9 (22%) were probable cases of HME. Tick bite or exposure to ticks was recorded in more than 97% of cases. The most prominent clinical findings were fever, abdominal tenderness, and regional lymphadenopathy. There was an association between age and severity of illness. The main laboratory findings included leukopenia, thrombocytopenia, and elevated aspartate aminotransferase and alanine aminotransferase. Clinical and laboratory findings were nonspecific and were not good predictors of the severity of illness. The 90% of patients who received doxycycline treatment underwent rapid clinical improvement with a favorable outcome. The usual duration of effective treatment with doxycycline was 7 to 10 days. This retrospective study is unique because it was based in a commercial reference laboratory setting that receives specimens from different geographic locations. The clinical and laboratory information from 41 patients provides insight into the epidemiological, clinical, and laboratory characteristics of HME. PMID:12965923

  15. [International Nursing Minimum Data Set: a comparative study with tools of a pediatric clinic].

    PubMed

    Marques, Daniela Karina Antão; de Souza, Gabriela Lisieux Lima; da Silva, Amanda Benício; da Silva, Aline Franco; da Nóbrega, Maria Miriam Lima

    2014-01-01

    Descriptive and comparative study, developed from two historical used to implement the Systematization of Nursing Care in a Pediatric clinic of a teaching hospital. It aimed to compare the International Nursing Minimum Data Set (i-NMDS) with the data contained in nursing clinical assessment tools that are used in the application of the Nursing Process in the area of Children and Teenagers Health in a Pediatric Clinic. From the sixteen items evaluated that belong to the proposal of the i-NMDS, the nursing clinical assessment tool for hospitalized teenagers included 12 (75%), while the instrument for children from 0 to 5 years old presented 7 (43.75%). It was concluded that the nursing clinical assessment tools analyzed did not include the i-NMDS data in its entirety. It is suggested that there should be an improvement on the development of the nursing clinical assessment tools, using standardized nursing language for planning assistance, documenting activities, identify and measure the results of practice.

  16. Use and development of clinical pathways by registered nurses in an acute paediatric setting.

    PubMed

    Roberts, Pamela; Boldy, Duncan; Robertson, Jeanette

    2005-10-01

    Clinical pathways are widely regarded as providing valuable knowledge about specific types of patients and their care, as well as providing direct guidance in clinical practice. In Australia, the use of care pathways has occurred with seemingly minimal professional nursing debate as to their benefits in practice. Comments supporting the introduction of pathways into clinical practice have focused on assistance to decision making, facilitation of clinical judgements about care, assistance in improving practice and utility as educational tools, particularly for new staff, new graduates and casual employees. A survey of 259 nurses working in an acute paediatric setting sought to gain their views about pathways of care with regard to satisfaction with use, content of pathway, ability to use in practice, effect on practice and commitment to use. While the most positive findings to emerge from the research indicated that nurses liked clinical pathways because they saved time and reduced documentation requirements, issues were also raised about the need for a broader, more inclusive development process for pathways, and an improved education program for staff use. The implications to arise from these findings are important for senior staff and educators who are responsible for staff orientation programs and ongoing staff development as well as for those responsible for the development and implementation of clinical pathways into practice.

  17. The challenge of integrating self-management support into clinical settings.

    PubMed

    McGowan, Patrick

    2013-02-01

    Best practice diabetes mellitus clinical treatment and education takes place in the medical clinic, however, patient outcomes are largely mediated through their own behaviour and lifestyle that occurs after they leave the clinical setting. Once they return home, people usually continue to engage in the social, cultural and lifestyle behaviours that had contributed to having diabetes in the first place. Although a host of factors (e.g. economic, health care team and system, condition and client-related) can impact a client's capacity to self-manage, there are client, organizational and community level strategies that may partially mitigate these difficulties. To address client behaviour, clinicians are increasingly becoming skilled to incorporate self-management support including behavioural counselling interventions into routine practice. At the organizational level, the operation and structure of the clinical setting may create difficulty for staff to provide self-management support. Sustaining benefits on a day-to-day basis presents an additional challenge. This article will review several common implementation barriers to self-management support and describe strategies and techniques used elsewhere to successfully integrate self-management support as a core care component for persons with diabetes.

  18. A Qualitative Inquiry into Nursing Students' Experience of Facilitating Reflection in Clinical Setting

    PubMed Central

    Yamani, Nikoo

    2017-01-01

    Background and Aim. Reflection is known as a skill that is central to nursing students' professional development. Due to the importance and the role of reflection in clinical areas of nursing, it is important to know how to achieve it. However, nursing trainers face the challenge of how to help their students to improve reflection in clinical settings. The aim of this study was to investigate the nursing students' experiences of facilitating reflection during clinical practice. This qualitative study was conducted by qualitative content analysis approach. Twenty nursing students during the second to eighth semester of their educational program were selected for participation using purposive sampling. Data were collected through in-depth semistructured interviews. The interview was transcribed verbatim, and qualitative content analysis was used to analyze the data. From the data analysis, four main themes were extracted. Motivation to reflect, complex experiences, efficient trainer, and effective relations were four main themes obtained from study that, in interaction with each other, had facilitating roles in students' reflective process on experiences. The findings revealed that the nursing students' reflection in clinical settings is effective in personal and professional level. Reflection of nursing students depends on motivational and educational factors and these factors increase the quality of care in patients. Furthermore, nursing educators need to create nurturing climate as well as supporting reflective behaviors of nursing students. PMID:28474003

  19. Identifying an efficient set of items sensitive to clinical-range externalizing problems in children.

    PubMed

    Petersen, Isaac T; Bates, John E; Dodge, Kenneth A; Lansford, Jennifer E; Pettit, Gregory S

    2016-05-01

    The present study applied item response theory to identify an efficient set of items of the Achenbach Externalizing scale from the Child Behavior Checklist (CBCL; 33 items) and Teacher's Report Form (TRF; 35 items) that were sensitive to clinical-range scores. Mothers and teachers rated children's externalizing problems annually from ages 5 to 13 years in 2 independent samples (Ns = 585 and 1,199). Item properties for each rater across ages 5-8 and 9-13 were examined with item response theory. We identified 10 mother- and teacher-reported items from both samples based on the items' measurement precision for subclinical and clinical levels of externalizing problems: externalizing problems that involve meanness to others, destroying others' things, fighting, lying and cheating, attacking people, screaming, swearing/obscene language, temper tantrums, threatening people, and being loud. Scores on the scales using these items had strong reliability and psychometric properties, capturing nearly as much information as the full Externalizing scale for classifying clinical levels of externalizing problems. Scores on the scale with the 10 CBCL items had moderate accuracy, equivalent to the full Externalizing scale, in classifying diagnoses of conduct disorder based on a research diagnostic interview. Of course, comprehensive clinical assessment would consider additional items, dimensions of behavior, and sources of information, too, but it appears that the behaviors tapped by this select set of items may be core to externalizing psychopathology in children. (PsycINFO Database Record

  20. A Qualitative Inquiry into Nursing Students' Experience of Facilitating Reflection in Clinical Setting.

    PubMed

    Karimi, Shahnaz; Haghani, Fariba; Yamani, Nikoo; Najafi Kalyani, Majid

    2017-01-01

    Background and Aim. Reflection is known as a skill that is central to nursing students' professional development. Due to the importance and the role of reflection in clinical areas of nursing, it is important to know how to achieve it. However, nursing trainers face the challenge of how to help their students to improve reflection in clinical settings. The aim of this study was to investigate the nursing students' experiences of facilitating reflection during clinical practice. This qualitative study was conducted by qualitative content analysis approach. Twenty nursing students during the second to eighth semester of their educational program were selected for participation using purposive sampling. Data were collected through in-depth semistructured interviews. The interview was transcribed verbatim, and qualitative content analysis was used to analyze the data. From the data analysis, four main themes were extracted. Motivation to reflect, complex experiences, efficient trainer, and effective relations were four main themes obtained from study that, in interaction with each other, had facilitating roles in students' reflective process on experiences. The findings revealed that the nursing students' reflection in clinical settings is effective in personal and professional level. Reflection of nursing students depends on motivational and educational factors and these factors increase the quality of care in patients. Furthermore, nursing educators need to create nurturing climate as well as supporting reflective behaviors of nursing students.

  1. How medical residents perceive the quality of supervision provided by attending doctors in the clinical setting.

    PubMed

    Busari, Jamiu O; Weggelaar, Nielske M; Knottnerus, Andrieke C; Greidanus, Petra-Marie; Scherpbier, Albert J J A

    2005-07-01

    The supervision of medical residents is a key responsibility of attending doctors in the clinical setting. Most attending doctors, however, are unfamiliar with the principles of effective supervision. Although inconsistent, supervision has been shown to be both important and effective for the professional development of medical residents. To examine how medical residents perceive the supervisory roles of attending doctors, in terms of what they perceive as poor supervision and what they characterise as good supervisory practice. We carried out a questionnaire survey of 38 medical residents at the Department of Paediatrics at the teaching hospital of the University of Amsterdam, the Netherlands. Attending doctors directly involved with the supervision of medical residents participated in the study. The clinical settings where supervision occurred included the neonatal and paediatric intensive care units and the general paediatric wards. Medical residents rated the quality of supervision they received in all departments positively. A majority of the attending doctors were rated highly in 'overall supervision'. Creating pleasant learning environments and being stimulated to learn and function independently were aspects of supervision characterised positively. Coaching in clinical skills and procedures, effective communication skills and clinical decision making using principles of cost-appropriate care were aspects of supervision found to be deficient. This study shows that medical residents enjoy supervision from collaborative, understanding and patient attending doctors. Medical residents prefer to be treated as adult learners and enjoy feedback that is constructive, measured and adapted to their professional needs.

  2. 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.

  3. [Conscientious objection in the clinical setting. A proposal for its appropriate use].

    PubMed

    Couceiro, A; Seoane, J A; Hernando, P

    2011-01-01

    Social changes and new technologies have brought new problems in doctor-patient relationships. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. The paper aims to clarify what conscientious objection means in a plural society based on a deliberative democracy and to show the different ways of understanding this society in order to respect both the ethical reasons of individuals and the compulsory normative framework of the Rule of Law. Furthermore, the paper identifies some clinical settings where conscientious objection is often invoked by healthcare professionals, and points out and analyses the arguments that explain why this appeal for conscientious objection is neither legitimate nor correct. Finally, it provides examples of the legal basis and Spanish jurisprudence, as well as the relevant clinical and ethical literature on this topic.

  4. Cutaneous HIV-associated Kaposi sarcoma: a potential setting for management by clinical observation.

    PubMed

    Beatrous, Surget V; Grisoli, Stratton B; Riahi, Ryan R; Cohen, Philip R

    2017-06-15

    Kaposi sarcoma (KS) is a malignancy of viral etiology whose course ranges from cutaneous limited lesions to fulminant disease with multi-organ involvement. Four clinical variants of the disease exist: classic, endemic, iatrogenic, and epidemic. Iatrogenic and epidemic variants of Kaposi sarcoma develop in the setting of immune suppression. Transplant recipients who develop iatrogenic KS typically demonstrate improvement of lesions following de-escalation of immunosuppressive therapy. Similarly, HIV-infected patients who begin highly active antiretroviral therapy (HAART) experience immune reconstitution, which can induce KS regression. We describe two patients with varying clinical outcomes of cutaneous-limited HIV-associated KS after immune reconstitution with HAART. We propose that immune reconstitution with HAART, followed by clinical and radiographic surveillance for disease progression, may be an appropriate initial management strategy for limited cutaneous HIV-associated KS. In patients with more extensive disease at presentation or failure of HAART alone, antineoplastic therapy should be instituted.

  5. The prescribing clinical health psychologist: a hybrid skill set in the new era of integrated healthcare.

    PubMed

    McGuinness, Kevin M

    2012-12-01

    The prescribing clinical health psychologist brings together in one individual a combination of skills to create a hybrid profession that can add value to any healthcare organization. This article addresses the high demand for mental health services and the inequitable distribution of mental health practitioners across the nation. The close link between physical and mental health and evidence that individuals in psychological distress often enter the mental health system via primary care medical clinics is offered as background to a discussion of the author's work as a commissioned officer of the U.S. Public Health Service assigned to the Chaparral Medical Center of La Clinica de Familia, Inc. near the U.S.-Mexico border. The prescribing clinical health psychologist in primary care medical settings is described as a valuable asset to the future of professional psychology.

  6. Clinical instructors' and athletic training students' perceptions of teachable moments in an athletic training clinical education setting.

    PubMed

    Rich, Valerie J

    2009-01-01

    For some time, educators have advised clinical instructors (CIs) to capture the elusive teachable moment in clinical education. However, a universal definition of a teachable moment does not exist. Without a clear understanding of this concept, CIs and athletic training students (ATSs) may have difficulty facilitating the teachable moment. To recognize and define a teachable moment as it relates to the athletic training clinical education setting and to identify potential barriers to creating the teachable moment. Mixed-methods design employing grounded theory and quantitative analysis. Collegiate sports medicine clinic affiliated with a Commission on Accreditation of Allied Health Education Programs-accredited athletic training education program. 11 CIs (6 men, 5 women) and 11 ATSs (3 men, 8 women). Participants completed a teachable moment questionnaire to define and identify teachable moments. Follow-up semistructured interviews were conducted after data collection. A qualitative analysis was conducted on responses using open, axial, and selective coding. Member checking was conducted to establish trustworthiness. Qualitative data were quantified to descriptively report the findings. Engaged clinical experiences were the overarching theme. Three major themes that defined a teachable moment emerged: (1) professional discourse about skills, techniques, research, and special cases; (2) authentic experience or actual hands-on experience; and (3) skill development or time for skill instruction, practice, role playing, and simulations. Participants reported 158 teachable moments (CIs = 75, ATSs = 83). Lack of time and other duties were examples of barriers hindering the teachable moment. The teachable moment occurs when a CI and an ATS actively participate and interact with each other to enhance learning and foster intellectual curiosity in the clinical education environment. An underlying barrier to the teachable moment is perceived to be the CI's day

  7. Open-source mobile digital platform for clinical trial data collection in low-resource settings

    PubMed Central

    van Dam, Joris; Omondi Onyango, Kevin; Midamba, Brian; Groosman, Nele; Hooper, Norman; Spector, Jonathan; Pillai, Goonaseelan (Colin); Ogutu, Bernhards

    2017-01-01

    Background Governments, universities and pan-African research networks are building durable infrastructure and capabilities for biomedical research in Africa. This offers the opportunity to adopt from the outset innovative approaches and technologies that would be challenging to retrofit into fully established research infrastructures such as those regularly found in high-income countries. In this context we piloted the use of a novel mobile digital health platform, designed specifically for low-resource environments, to support high-quality data collection in a clinical research study. Objective Our primary aim was to assess the feasibility of a using a mobile digital platform for clinical trial data collection in a low-resource setting. Secondarily, we sought to explore the potential benefits of such an approach. Methods The investigative site was a research institute in Nairobi, Kenya. We integrated an open-source platform for mobile data collection commonly used in the developing world with an open-source, standard platform for electronic data capture in clinical trials. The integration was developed using common data standards (Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model), maximising the potential to extend the approach to other platforms. The system was deployed in a pharmacokinetic study involving healthy human volunteers. Results The electronic data collection platform successfully supported conduct of the study. Multidisciplinary users reported high levels of satisfaction with the mobile application and highlighted substantial advantages when compared with traditional paper record systems. The new system also demonstrated a potential for expediting data quality review. Discussion and Conclusions This pilot study demonstrated the feasibility of using a mobile digital platform for clinical research data collection in low-resource settings. Sustainable scientific capabilities and infrastructure are essential to attract and

  8. Setting up of a cerebral visual impairment clinic for children: Challenges and future developments.

    PubMed

    Philip, Swetha Sara

    2017-01-01

    The aim of this study is to describe the setting up of a cerebral visual impairment (CVI) clinic in a tertiary care hospital in South India and to describe the spectrum of cases seen. The CVI clinic, set up in February 2011, receives interdisciplinary input from a core team involving a pediatrician, neurologist, psychiatrist, occupational therapist, pediatric ophthalmologist, and an optometrist. All children, <18 years of age, with cerebral palsy (CP), learning disability, autism, neurodegenerative diseases, and brain trauma are referred to the clinic for functional vision assessment and opinion for further management. One thousand four hundred and seventy-eight patients were seen in the CVI clinic from February 2011 to September 2015. Eighty-five percent of the patients were from different parts of India. In the clinic, 61% had CP, 28% had seizure disorders, autism was seen in 9.5%, and learning disability, neurodegenerative conditions, and brain injury together constituted 1.5%. Most of the children (45%) had moderate CP. Forty percent of CVI was due to birth asphyxia, but about 20% did not have any known cause for CVI. Seventy percent of patients, who came back for follow-up, were carrying out the habilitation strategies suggested. Average attendance of over 300 new patients a year suggests a definite need for CVI clinics in the country. These children need specialized care to handle their complex needs. Although difficult to coordinate, an interdisciplinary team including the support groups and voluntary organizations is needed to facilitate the successful implementation of such specialized service.

  9. Open-source mobile digital platform for clinical trial data collection in low-resource settings.

    PubMed

    van Dam, Joris; Omondi Onyango, Kevin; Midamba, Brian; Groosman, Nele; Hooper, Norman; Spector, Jonathan; Pillai, Goonaseelan Colin; Ogutu, Bernhards

    2017-02-01

    Governments, universities and pan-African research networks are building durable infrastructure and capabilities for biomedical research in Africa. This offers the opportunity to adopt from the outset innovative approaches and technologies that would be challenging to retrofit into fully established research infrastructures such as those regularly found in high-income countries. In this context we piloted the use of a novel mobile digital health platform, designed specifically for low-resource environments, to support high-quality data collection in a clinical research study. Our primary aim was to assess the feasibility of a using a mobile digital platform for clinical trial data collection in a low-resource setting. Secondarily, we sought to explore the potential benefits of such an approach. The investigative site was a research institute in Nairobi, Kenya. We integrated an open-source platform for mobile data collection commonly used in the developing world with an open-source, standard platform for electronic data capture in clinical trials. The integration was developed using common data standards (Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model), maximising the potential to extend the approach to other platforms. The system was deployed in a pharmacokinetic study involving healthy human volunteers. The electronic data collection platform successfully supported conduct of the study. Multidisciplinary users reported high levels of satisfaction with the mobile application and highlighted substantial advantages when compared with traditional paper record systems. The new system also demonstrated a potential for expediting data quality review. This pilot study demonstrated the feasibility of using a mobile digital platform for clinical research data collection in low-resource settings. Sustainable scientific capabilities and infrastructure are essential to attract and support clinical research studies. Since many research structures

  10. Setting up of a cerebral visual impairment clinic for children: Challenges and future developments

    PubMed Central

    Philip, Swetha Sara

    2017-01-01

    Aim: The aim of this study is to describe the setting up of a cerebral visual impairment (CVI) clinic in a tertiary care hospital in South India and to describe the spectrum of cases seen. Materials and Methods: The CVI clinic, set up in February 2011, receives interdisciplinary input from a core team involving a pediatrician, neurologist, psychiatrist, occupational therapist, pediatric ophthalmologist, and an optometrist. All children, <18 years of age, with cerebral palsy (CP), learning disability, autism, neurodegenerative diseases, and brain trauma are referred to the clinic for functional vision assessment and opinion for further management. Results: One thousand four hundred and seventy-eight patients were seen in the CVI clinic from February 2011 to September 2015. Eighty-five percent of the patients were from different parts of India. In the clinic, 61% had CP, 28% had seizure disorders, autism was seen in 9.5%, and learning disability, neurodegenerative conditions, and brain injury together constituted 1.5%. Most of the children (45%) had moderate CP. Forty percent of CVI was due to birth asphyxia, but about 20% did not have any known cause for CVI. Seventy percent of patients, who came back for follow-up, were carrying out the habilitation strategies suggested. Conclusions: Average attendance of over 300 new patients a year suggests a definite need for CVI clinics in the country. These children need specialized care to handle their complex needs. Although difficult to coordinate, an interdisciplinary team including the support groups and voluntary organizations is needed to facilitate the successful implementation of such specialized service. PMID:28300737

  11. Japanese Characters in Written Japanese.

    ERIC Educational Resources Information Center

    Buck, James H.

    From the sixth to the eighth century A.D., Japan was the recipient of massive cultural infusions from China. This acceptance of the Chinese pattern included, and to a great extent was based on, the acceptance of the Chinese language. The Chinese writing system was applied to Japanese because there was no other model to follow and in spite of the…

  12. A managed clinical network for cardiac services: set-up, operation and impact on patient care

    PubMed Central

    E StC Hamilton, Karen; M Sullivan, Frank; T Donnan, Peter; Taylor, Rex; Ikenwilo, Divine; Scott, Anthony; Baker, Chris; Wyke, Sally

    2005-01-01

    Abstract Purpose To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. Methods This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Results Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and ‘bed down’. Its primary “modus operand” was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not

  13. Athletic Training Students in the College/ University Setting and the Scope of Clinical Education

    PubMed Central

    Weidner, Thomas G; Noble, Gary L; Pipkin, Jennifer B

    2006-01-01

    Context: Athletic training education programs must provide the proper type and amount of clinical supervision in order for athletic training students to obtain appropriate clinical education and to meet Board of Certification examination requirements. Objective: To assess athletic training students' perceptions of the type and amount of clinical supervision received during clinical education. Design: Cross-sectional design. Setting: 124 CAAHEP-accredited NCAA institutions. Patients or Other Participants: We obtained a national stratified random sample (by National Athletic Trainers' Association district) of undergraduate athletic training students from 61 Commission on Accreditation of Allied Health Education Programs–accredited athletic training education programs. A total of 851 athletic training students participated in the study. Main Outcome Measure(s): Differences among athletic training students with first-aider/provider qualifications, student supervision during moderate-risk and increased-risk sports, program/institutional characteristics, type and amount of clinical supervision, and students' academic level and mean percentage of time spent in different types of clinical supervision. Results: A total of 276 (32.4%) of the students reported that they supplied medical care and athletic training–related coverage beyond that of a first aider/provider. Athletic training students stating that they traveled with teams without supervision numbered 342 (40.2%). A significant difference was noted between the amount of supervision reported by sophomore and senior students ( P < .01). Conclusions: Athletic training students do not seem to be receiving appropriate clinical supervision and are often acting outside the scope of clinical education. PMID:17273468

  14. Emergence of Rare Species of Nontuberculous Mycobacteria as Potential Pathogens in Saudi Arabian Clinical Setting

    PubMed Central

    Varghese, Bright; Enani, Mushira; Shoukri, Mohammed; AlThawadi, Sahar; AlJohani, Sameera; Al- Hajoj, Sahal

    2017-01-01

    Background Clinical relevance of nontuberculous mycobacteria (NTM) is increasing worldwide including in Saudi Arabia. A high species diversity of NTM’s has been noticed in a recent study. However, the identification in diagnostic laboratories is mostly limited to common species. The impact of NTM species diversity on clinical outcome is so far neglected in most of the clinical settings. Methodology/Principal Findings During April 2014 to September 2015, a nationwide collection of suspected NTM clinical isolates with clinical and demographical data were carried out. Primary identification was performed by commercial line probe assays. Isolates identified up to Mycobacterium species level by line probe assays only were included and subjected to sequencing of 16S rRNA, rpoB, hsp65 and 16S-23S ITS region genes. The sequence data were subjected to BLAST analysis in GenBank and Ez-Taxon databases. Male Saudi nationals were dominated in the study population and falling majorly into the 46–59 years age group. Pulmonary cases were 59.3% with a surprising clinical relevance of 75% based on American Thoracic Society guidelines. Among the 40.7% extra-pulmonary cases, 50% of them were skin infections. The identification revealed 16 species and all of them are reporting for the first time in Saudi Arabia. The major species obtained were Mycobacterium monascence (18.5%), M. cosmeticum (11.1%), M. kubicae (11.1%), M. duvalli (7.4%), M.terrae (7.4%) and M. triplex (7.4%). This is the first report on clinical relevance of M. kubicae, M. tusciae, M.yongonense, M. arupense and M.iranicum causing pulmonary disease and M. monascence, M. duvalli, M. perigrinum, M. insubricum, M. holsaticum and M. kyorinense causing various extra-pulmonary diseases in Saudi Arabia. Ascites caused by M. monascence and cecum infection by M. holsaticum were the rarest incidents. Conclusions/Significance To the first time in the country, clinical significance of various rare NTM’s are well explored and

  15. Hidden outpatient oncology clinical nursing minimum data set: findings from an Italian multi-method study.

    PubMed

    Palese, Alvisa; Zanini, Antonietta; Carlevaris, Erika; Morandin, Annalisa; Carpanelli, Ivana; Dante, Angelo

    2013-08-01

    The main aim of this study was to present the hidden Clinical Nursing Minimum Data Set adopted by Italian nurses in outpatient oncology settings. A multi-method study design articulated in three phases was conducted from November 2009 to December 2010. A cross-sectional study design involving outpatient oncology centres located in the 20 Italian regions was undertaken in order to collect structured nursing records used by nurses in the documentation of daily nursing care. An evaluation of the items contained in each nursing record was performed in order to individuate homogeneities. A content analysis of the items was therefore undertaken in order to categorise them in assessment, problems, intervention, and outcomes. A total of 1080 different items from the structured nursing records were counted, comprising on average 29 items (range 8-175; ±40.4) for each record. A total of 330 (30.6%) out of 1080 were categorised as assessment items, 146 (13.5%) as problems, 583 (54.0%) as interventions and 21 (1.9%) as outcomes items. Italian nurses have developed a micro-system Clinical Nursing Minimum Data Set capturing and documenting several types of clinical data, following their implicit representation of what it is important to document: much consideration is given to nursing surveillance/monitoring and to at-risk problems, indicating the importance of the nursing role in the prevention and early recognition of a patient's clinical deterioration. However, there is a need to develop a macro-system national NMDS which will be useful for evaluating nursing outcomes and making decisions on workforce resources. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Plaster and synthetic cast temperatures in a clinical setting: an in vivo study.

    PubMed

    Ahmed, Sonya S; Carmichael, Kelly D

    2011-01-01

    Previous studies have reported thermal injuries with thick cast materials and warm dip water temperatures, often much higher than is clinically applicable. The goal of this study was to assess the temperature produced in vivo by current casting techniques and materials. The study was done using clinically applicable materials and water temperatures. A single volunteer was used to test skin temperatures produced with various casting techniques. We tested several types of fiberglass and plaster of 5 or 10 layers, used soft roll of 1 or 3 layers, and used dip water temperatures of 30 °C and 40 °C. We tested 2 plaster types: Johnson & Johnson Specialist Fast Set and Specialist Extra Fast Set (New Brunswick, New Jersey). Fiberglass tested included 3M Scotchcast Poly Casting Tape and Scotchcast Plus (St Paul, Minnesota), Royce Medical Techform (Camarrillo, California), and DeBusk Classic Synthetic Tape (Powell, Tennessee). The highest temperature reached using 30 °C water temperature was 39 °C with 10 layers of 3M Scotchcast fiberglass and 1 layer of soft roll. The highest temperature reached with 40 °C water was 39.5 °C, which was reached twice: once with Johnson & Johnson Fast Set Plaster with 5 layers of plaster and 3 layers of soft roll, and once with DeBusk Classic Synthetic Casting Tape of 10 layers with 1 layer of soft roll. Under the clinically applicable conditions described in this study, using the materials we tested and with a normal vascular supply, it is unlikely that temperatures high enough to cause a burn will be produced. We caution that good clinical judgment is advised if a patient reports a cast is too hot.

  17. [Present situation and future prospects of the certification system for medical technologists--from the viewpoint of the Japanese Society of Clinical Cytology].

    PubMed

    Hatakeyama, Shigeharu; Hirooka, Yasuaki

    2012-06-01

    The circumstances surrounding the certification examination for cytotechnologists in Japan are closely related with the history of the Japanese Society of Clinical Cytology. The examination for cytotechnologists is open only to medical technologists. The examination has two parts: primary and secondary. Qualification for candidacy for the secondary examination requires candidates to have passed the primary examination. The rate of successful applicants in the past 10 years was approximately 25-40%. Certified cytotechnologists are required to renew their qualifications every 4 years for their study and job history. I will present the purpose of the qualification update system, future themes, the reporting system for cytodiagnosis, and the possibility that the certification examination for cytotechnologists will become a national examination.

  18. Clinical, pathological, and genetic features of limb-girdle muscular dystrophy type 2A with new calpain 3 gene mutations in seven patients from three Japanese families.

    PubMed

    Kawai, H; Akaike, M; Kunishige, M; Inui, T; Adachi, K; Kimura, C; Kawajiri, M; Nishida, Y; Endo, I; Kashiwagi, S; Nishino, H; Fujiwara, T; Okuno, S; Roudaut, C; Richard, I; Beckmann, J S; Miyoshi, K; Matsumoto, T

    1998-11-01

    We report on the clinical, pathological, and genetic features of 7 patients with limb-girdle muscular dystrophy type 2A (LGMD2A) from three Japanese families. The mean age of onset was 9.7+/-3.1 years (mean+/-SD), and loss of ambulance occurred at 38.5+/-2.1 years. Muscle atrophy was predominant in the pelvic and shoulder girdles, and proximal limb muscles. Muscle pathology revealed dystrophic changes. In two families, an identical G to C mutation at position 1080 the in calpain 3 gene was identified, and a frameshift mutation (1796insA) was found in the third family. The former mutation results in a W360R substitution in the proteolytic site of calpain 3, and the latter in a deletion of the Ca2+-binding domain.

  19. CORRIGENDUM: Clinical Presentation, Management and Outcome of Japanese Patients With Acute Myocardial Infarction in the Troponin Era--Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET).

    PubMed

    Ishihara, Masaharu; Fujino, Masashi; Ogawa, Hisao; Yasuda, Satoshi; Noguchi, Teruo; Nakao, Koichi; Ozaki, Yukio; Kimura, Kazuo; Suwa, Satoru; Fujimoto, Kazuteru; Nakama, Yasuharu; Morita, Takashi; Shimizu, Wataru; Saito, Yoshihiko; Tsujita, Kennichi; Nishimura, Kunihiko; Miyamoto, Yoshihiro

    2015-01-01

    The authors apologize for the incorrect statement in the Methods section. The correct statement is shown below. Page 1256, right column, lines 10–12: Incorrect: Consecutive patients hospitalized within 48 h of onset of AMI at 28 Japanese medical institutions were enrolled between July 2013 and May 2014. Correct: Consecutive patients hospitalized within 48 h of onset of AMI at 28 Japanese medical institutions were enrolled between July 2012 and March 2014.

  20. The Prevalence of Internet Addiction among a Japanese Adolescent Psychiatric Clinic Sample with Autism Spectrum Disorder And/or Attention-Deficit Hyperactivity Disorder: A Cross-Sectional Study

    ERIC Educational Resources Information Center

    So, Ryuhei; Makino, Kazunori; Fujiwara, Masaki; Hirota, Tomoya; Ohcho, Kozo; Ikeda, Shin; Tsubouchi, Shouko; Inagaki, Masatoshi

    2017-01-01

    Extant literature suggests that autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are risk factors for internet addiction (IA). The present cross-sectional study explored the prevalence of IA among 132 adolescents with ASD and/or ADHD in a Japanese psychiatric clinic using Young's Internet Addiction Test. The…

  1. A case of Barber-Say syndrome in a male Japanese newborn

    PubMed Central

    Suga, Kenichi; Shono, Miki; Goji, Aya; Matsuura, Sato; Inoue, Miki; Kawahito, Masami; Kinoshita, Michiyo; Takeda, Misa; Mori, Kazuhiro

    2014-01-01

    Key Clinical Message We reported a case of Barber-Say syndrome (BSS) in a Japanese newborn. Distinctive features of BSS were found; macrostomia, gingival dysplasia, cup-shaped low-set ears, wrinkling redundant skin, and hypertrichosis. Fundus showed subretinal drusenoid deposits, a novel finding of BSS. Genetic analysis is underway using next-generation genome sequencing and microarray analysis. PMID:25614816

  2. Net clinical benefit of rivaroxaban versus warfarin in Japanese patients with nonvalvular atrial fibrillation: a subgroup analysis of J-ROCKET AF.

    PubMed

    Uchiyama, Shinichiro; Hori, Masatsugu; Matsumoto, Masayasu; Tanahashi, Norio; Momomura, Shin-Ichi; Goto, Shinya; Izumi, Tohru; Koretsune, Yukihiro; Kajikawa, Mariko; Kato, Masaharu; Ueda, Hitoshi; Iekushi, Kazuma; Yamanaka, Satoshi; Tajiri, Masahiro

    2014-01-01

    The risk factors that have been identified for bleeding events with rivaroxaban are predominantly the same as those predicting thromboembolic ones in patients with atrial fibrillation (AF). Our aim was to determine the net clinical benefit (NCB) from the results of the J-ROCKET AF trial, in which rivaroxaban was compared with warfarin in Japanese patients with AF. Two strategies were adopted to quantify the NCB. First, the NCB was calculated as the number of ischemic strokes avoided with anticoagulation minus the number of excess intracranial hemorrhage (ICH) with a weight of 1.5. Second, the composite end point of major bleeding events and secondary efficacy end points (stroke, noncentral nervous system systemic embolism, myocardial infarction and death) to ascertain the NCB were established. Subgroup analysis by CHADS2 score or creatinine clearance was also performed. The adjusted NCB, which was given a weight of 1.5 for ICH, was nominally significant in favor of rivaroxaban therapy (difference in incidence rate -2.13; 95% confidence interval [CI]: -.26 to -3.99). Furthermore, the event rate of the composite end point tended to be lower in patients treated with rivaroxaban than in those treated with warfarin (rivaroxaban: 4.97% per year, warfarin: 6.11% per year; difference in incidence rate: -1.14; 95% CI: -3.40 to 1.12). The event rate of the composite end point tended to be consistently low in patients treated with rivaroxaban in the subanalysis by CHADS2 score and renal function. Analysis of the NCB supports that rivaroxaban therapy provides clinical benefit for Japanese patients with AF. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Comparison of drug sensitivity and genotypes of clinically isolated strains of levofloxacin-resistant Streptococcus pneumoniae obtained from Okinawa Island, the Japanese main island and Hong Kong.

    PubMed

    Sunagawa, Satoko; Fujita, Jiro; Higa, Futoshi; Tateyama, Masao; Haranaga, Shusaku; Nakasone, Isamu; Yamane, Nobuhisa; Uno, Tsukasa

    2011-08-01

    The prevalence of fluoroquinolone-resistant Streptococcus pneumoniae is increasing worldwide. In the present study, a comparison of drug sensitivity and genotypes of clinically isolated strains of levofloxacin (LVFX)-resistant S. pneumoniae obtained from Hong Kong, Okinawa Island and the Japanese main island (Honshu) was performed. MICs of quinolones (LVFX, tosufloxacin, ciprofloxacin, gatifloxacin and sitafloxacin (STFX)) and other antibiotics (penicillin G, cefcapene, cefditoren, clarithromycin and azithromycin) were determined by a microdilution broth method according to the Clinical and Laboratory Standards Institute Standards. The quinolone-resistance determining regions (QRDRs) of gyrA, gyrB, parC and parE of these strains were analyzed by PCR-based sequencing. All 40 strains tested had more than one amino-acid substitution in the QRDRs of gyrA, gyrB, parC or parE. Although there seemed to be some clonality in strains obtained from Hong Kong, there was no clonality in strains obtained from Okinawa and Japan. Strains obtained from Hong Kong, Okinawa Island and the Japanese main island were genetically different by pulsed-field gel electrophoresis analysis. The range of MIC values of STFX against isolates resistant to LVFX (MIC 4-32 mg l(-1)) was 0.12-0.5 mg l(-1), and MIC(80) values of STFX against LVFX-resistant isolates were 0.25 mg l(-1). This study suggests that LVFX-resistant S. pneumoniae is similar in all three locations and STFX is potent against LVFX-resistant S. pneumoniae with multiple mutations in QRDRs of gyrase A and topoisomerase IV.

  4. Pancreatic safety in Japanese patients with type 2 diabetes treated with once weekly dulaglutide 0.75 mg up to 52 weeks in phase 3 clinical trials.

    PubMed

    Emoto, Masanori; Oura, Tomonori; Matsui, Akiko; Kazama, Hirotaka; Iwamoto, Noriyuki

    2017-02-27

    The effects of incretin therapies on pancreatic safety are currently being evaluated. In 3 phase 3 clinical studies of once weekly dulaglutide 0.75 mg (dulaglutide) in Japanese patients with type 2 diabetes (T2D), symptoms suggestive of acute pancreatitis as well as pancreatic enzymes were assessed and the risk of acute pancreatitis was evaluated. Patients who met any of the predefined criteria (clinical signs/symptoms of acute pancreatitis, confirmed amylase or lipase level ≥3 times the upper limit of normal [ULN], abdominal imaging of the pancreas) were adjudicated for acute pancreatitis by a blinded external committee. A total of 43 events in 40 patients (dulaglutide, 35/917 patients; liraglutide, 2/137 patients; insulin glargine, 2/180 patients; and placebo, 2/70 patients) were adjudicated (1 patient had events adjudicated during both placebo and dulaglutide treatment); 2 patients treated with dulaglutide had acute pancreatitis confirmed (2/917 [0.2%]; 2.651 patients/1,000 patient-years). One of these patients was diagnosed by the investigator with acute pancreatitis related to dulaglutide, but there was no typical abdominal pain. The event in the other patient occurred following an endoscopic ultrasound-guided fine needle aspiration. Transient increases in lipase ≥3×ULN were observed in 2% of patients in both the dulaglutide and liraglutide groups; the incidence in dulaglutide-treated patients was not significantly different from the incidences in liraglutide, placebo-, or insulin glargine-treated patients. Results of systematic assessments of pancreatic safety in 3 phase 3 studies for up to 52 weeks do not suggest an increased risk of acute pancreatitis in Japanese patients treated with dulaglutide.

  5. Bayesian approaches in medical device clinical trials: a discussion with examples in the regulatory setting.

    PubMed

    Bonangelino, Pablo; Irony, Telba; Liang, Shengde; Li, Xuefeng; Mukhi, Vandana; Ruan, Shiling; Xu, Yunling; Yang, Xiting; Wang, Chenguang

    2011-09-01

    Challenging statistical issues often arise in the design and analysis of clinical trials to assess safety and effectiveness of medical devices in the regulatory setting. The use of Bayesian methods in the design and analysis of medical device clinical trials has been increasing significantly in the past decade, not only due to the availability of prior information, but mainly due to the appealing nature of Bayesian clinical trial designs. The Center for Devices and Radiological Health at the Food and Drug Administration (FDA) has gained extensive experience with the use of Bayesian statistical methods and has identified some important issues that need further exploration. In this article, we discuss several topics relating to the use of Bayesian statistical methods in medical device trials, based on our experience and real applications. We illustrate the benefits and challenges of Bayesian approaches when incorporating prior information to evaluate the effectiveness and safety of a medical device. We further present an example of a Bayesian adaptive clinical trial and compare it to a traditional frequentist design. Finally, we discuss the use of Bayesian hierarchical models for multiregional trials and highlight the advantages of the Bayesian approach when specifying clinically relevant study hypotheses.

  6. The clinical use of Kampo medicines (traditional Japanese herbal treatments) for controlling cancer patients’ symptoms in Japan: a national cross-sectional survey

    PubMed Central

    2012-01-01

    Background Kampo medicines are traditional Japanese medicines produced from medicinal plants and herbs. Even though the efficacy of Kampo medicines for controlling cancer-related symptoms is being reported, their actual nationwide clinical use has not been comprehensively investigated. We aimed to investigate physicians’ recognition of Kampo medicines and their clinical use for cancer patients in the field of palliative care. Methods A cross-sectional self-administered anonymous questionnaire was distributed to 549 physicians working in palliative care teams at 388 core cancer treatment hospitals and 161 certified medical institutions that have palliative care units (PCUs). Results Valid responses were obtained from 311 physicians (response rate, 56.7%) who were evenly distributed throughout the country without significant geographical biases. Kampo medicines were prescribed for controlling cancer-related symptoms by 64.3% of the physicians. The symptoms treated with Kampo medicines were numbness/hypoesthesia (n = 99, 49.5%), constipation (n = 76, 38.0%), anorexia/weight loss (n = 72, 36%), muscle cramps (n = 71, 35.5%) and languor/fatigue (n = 64, 32.0%). Regarding open issues about prescription, 60.7% (n = 173) of the physicians raised the issue that the dosage forms need to be better devised. Conclusions To increase the clinical use of Kampo medicines, more evidence from clinical studies is necessary. In addition, their mechanisms of action should be clarified through laboratory studies. PMID:23167528

  7. Creating an optical spectroscopy system for use in a primary care clinical setting (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Eshein, Adam; Nguyen, The-Quyen; Radosevich, Andrew J.; Gould, Bradley; Wu, Wenli; Konda, Vani; Yang, Leslie W.; Koons, Ann; Feder, Seth; Valuckaite, Vesta; Roy, Hemant K.; Backman, Vadim

    2016-03-01

    While there are a plethora of in-vivo spectroscopic techniques that have demonstrated the ability to detect a number of diseases in research trials, very few techniques have successfully become a fully realized clinical technology. This is primarily due to the stringent demands on a clinical device for widespread implementation. Some of these demands include: simple operation requiring minimal or no training, safe for in-vivo patient use, no disruption to normal clinic workflow, tracking of system performance, warning for measurement abnormality, and meeting all FDA guidelines for medical use. Previously, our group developed a fiber optic probe-based optical sensing technique known as low-coherence enhanced backscattering spectroscopy (LEBS) to quantify tissue ultrastructure in-vivo. Now we have developed this technique for the application of prescreening patients for colonoscopy in a primary care (PC) clinical setting. To meet the stringent requirements for a viable medical device used in a PC clinical setting, we developed several novel components including an automated calibration tool, optical contact sensor for signal acquisition, and a contamination sensor to identify measurements which have been affected by debris. The end result is a state-of-the-art medical device that can be realistically used by a PC physician to assess a person's risk for harboring colorectal precancerous lesions. The pilot study of this system shows great promise with excellent stability and accuracy in identifying high-risk patients. While this system has been designed and optimized for our specific application, the system and design concepts are universal to most in-vivo fiber optic based spectroscopic techniques.

  8. A comparison of work-exacerbated asthma cases from clinical and epidemiological settings

    PubMed Central

    Henneberger, Paul K; Liang, Xiaoming; Lemière, Catherine

    2013-01-01

    BACKGROUND: Clinical and epidemiological studies commonly use different case definitions in different settings when investigating work-exacerbated asthma (WEA). These differences are likely to impact characteristics of the resulting WEA cases. OBJECTIVES: To investigate this issue by comparing two groups of WEA cases, one identified using an intensive clinical evaluation and another that fulfilled epidemiological criteria. METHODS: A total of 53 clinical WEA cases had been referred for suspected work-related asthma to two tertiary clinics in Canada, where patients completed tests that confirmed asthma and ruled out asthma caused by work. Forty-seven epidemiological WEA cases were employed asthma patients treated at a health maintenance organization in the United States who completed a questionnaire and spirometry, and fulfilled criteria for WEA based on self-reported, work-related worsening of asthma and relevant workplace exposures as judged by an expert panel. RESULTS: Using different case criteria in different settings resulted in case groups that had a mix of similarities and differences. The clinical WEA cases were more likely to have visited a doctor’s office ≥3 times for asthma in the past year (75% versus 11%; P<0.0001), but did not seek more asthma-related emergency or in-patient care, or have lower spirometry values. The two groups differed substantially according to the industries and occupations where the cases worked. CONCLUSIONS: Findings from both types of studies should be considered when measuring the contribution of work to asthma exacerbations, identifying putative agents, and selecting industries and occupations in which to implement screening and surveillance programs. PMID:23762884

  9. Interprofessional education and practice guide No. 5: Interprofessional teaching for prequalification students in clinical settings.

    PubMed

    Lie, Désirée A; Forest, Christopher P; Kysh, Lynn; Sinclair, Lynne

    2016-05-01

    The importance of interprofessional education in health professions training is increasingly recognised through new accreditation guidelines. Clinician teachers from different professions may find themselves being asked to teach or supervise learners from multiple health professions, focusing on interprofessional dynamics, interprofessional communication, role understanding, and the values and ethics of collaboration. Clinician teachers often feel prepared to teach learners from their own profession but may feel ill prepared to teach learners from other professions. In this guide, we draw upon the collective experience from two countries: an institution from the United States with experience in guiding faculty to teach in a student-run interprofessional clinic and an institution from Canada that offers interprofessional experiences to students in community and hospital settings. This guide offers teaching advice to clinician educators in all health professions who plan to or already teach in an interprofessional clinical setting. We anticipate that clinician teachers can learn to fully engage learners from different professions, precept effectively, recognise common pitfalls, increase their confidence, reflect, and become role models to deliver effective teaching in interprofessional settings.

  10. Documentation of functional and clinical effects of infant nutrition: setting the scene for COMMENT.

    PubMed

    Koletzko, Berthold; Szajewska, Hania; Ashwell, Margaret; Shamir, Raanan; Aggett, Peter; Baerlocher, Kurt; Noakes, Paul; Braegger, Christian; Calder, Philip; Campoy Folgoso, Cristina; Colomb, Virginie; Decsi, Tamás; Domellöf, Magnus; Dupont, Christophe; Fewtrell, Mary; van Goudoever, Johannes B; Michaelsen, Kim F; Mihatsch, Walter; Guarino, Alfredo; Koletzko, Sibylle; Rigo, Jacques; Turck, Dominique; Taminiau, Jan

    2012-01-01

    The Early Nutrition Academy and the Child Health Foundation, in collaboration with the Committee on Nutrition, European Society for Paediatric Gastroenterology, Hepatology and Nutrition, held a workshop in March 2011 to explore guidance on acquiring evidence on the effects of nutritional interventions in infants and young children. The four objectives were to (1) provide guidance on the quality and quantity of evidence needed to justify conclusions on functional and clinical effects of nutrition in infants and young children aged <3 years; (2) agree on a range of outcome measures relevant to nutrition trials in this age group for which agreed criteria are needed; (3) agree on an updated 'core data set' that should generally be recorded in nutrition trials in infants and young children, and (4) provide guidance on the use of surrogate markers in paediatric nutrition research. The participants discussed these objectives and agreed to set up six first working groups under the auspices of the Consensus Group on Outcome Measures Made in Paediatric Enteral Nutrition Clinical Trials (COMMENT). Five groups will aim to identify and define criteria for assessing key outcomes, i.e. growth, acute diarrhoea, atopic dermatitis and cows' milk protein allergy, infections and 'gut comfort'. The sixth group will review and update the 'core data set'. The COMMENT Steering Committee will discuss and decide upon a method for reaching consensus which will be used by all working groups and plan to meet again within 2 years and to report and publish their conclusions. Copyright © 2012 S. Karger AG, Basel.

  11. Antibiotic Resistant Superbugs: Assessment of the Interrelationship of Occurrence in Clinical Settings and Environmental Niches.

    PubMed

    Adegoke, Anthony Ayodeji; Faleye, Adekunle Christopher; Singh, Gulshan; Stenström, Thor Axel

    2016-12-27

    The increasing threat to global health posed by antibiotic resistance remains of serious concern. Human health remains at higher risk due to several reported therapeutic failures to many life threatening drug resistant microbial infections. The resultant effects have been prolonged hospital stay, higher cost of alternative therapy, increased mortality, etc. This opinionated review considers the two main concerns in integrated human health risk assessment (i.e., residual antibiotics and antibiotic resistant genes) in various compartments of human environment, as well as clinical dynamics associated with the development and transfer of antibiotic resistance (AR). Contributions of quorum sensing, biofilms, enzyme production, and small colony variants in bacteria, among other factors in soil, water, animal farm and clinical settings were also considered. Every potential factor in environmental and clinical settings that brings about AR needs to be identified for the summative effects in overall resistance. There is a need to embrace coordinated multi-locational approaches and interrelationships to track the emergence of resistance in different niches in soil and water versus the hospital environment. The further integration with advocacy, legislation, enforcement, technological innovations and further research input and recourse to WHO guidelines on antibiotic policy would be advantageous towards addressing the emergence of antibiotic resistant superbugs.

  12. What Really Motivates Iranian Nurses to Be Creative in Clinical Settings?: A Qualitative Study

    PubMed Central

    Isfahani, Sara Shahsavari; Hosseini, Mohammad Ali; Khoshknab, Masoud Fallahi; Peyrovi, Hamid; Khanke, Hamid Reza

    2015-01-01

    Background: Creativity and innovation are key elements for organization improvement, particularly in nursing, and for finding alternatives for solving nurses’ occupational problems. Nurses’ creativity is affected by motivation. Although, there are many possible sources of motivation, the Iranian nurses’ creativity is seldom clarified, and the most important factors motivating nurses to be creative in clinical settings has rarely been addressed. Objectives: The aim of this study was to explore Iranian nurses’ experiences regarding the most important factors that motivate their creativity in clinical settings. Methods: This qualitative study was conducted using conventional content analysis approach. A purposive sample of sixteen nurses was recruited from two educational hospitals affiliated to Tehran and Jahrom Universities of Medical Sciences in Iran. Data were gathered through conducting face-to-face semi-structured interviews and were analyzed by qualitative content analysis approach. Findings: Five main themes emerged from the data analysis, including: (a) Intrinsic motivators, (b) Extrinsic motivators, (c) Achievement motivators, (d) Relational or altruistic motivators, and (e) Spiritual motivators. Conclusions: Study findings indicated that nurses are creative and innovative individuals. So nurse managers and health policy makers should consider creativity as an integral part of all health and clinical strategies and policies. They should support creative and innovative efforts of nurses and provide a climate in which nurses engage in more creative and productive behaviors. PMID:26156918

  13. 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. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Role of TWEAK/Fn14 signalling pathway in lupus nephritis and other clinical settings.

    PubMed

    González-Sánchez, Diego A; Álvarez, Cristian M; Vásquez, Gloria; Gómez-Puerta, José A

    2016-08-29

    Knowledge of the signalling pathways involved in various diseases has enabled advances in the understanding of pathophysiological, diagnostic and therapeutic models of several inflammatory and autoimmune diseases. Systemic lupus erythematosus is a widely studied autoimmune disease that can affect multiple organs, with a major impact on morbidity and mortality when it involves the kidneys. Over the past 10 years, interest in the role of the TWEAK/Fn14 signalling pathway in lupus nephritis, as well as other clinical settings, has increased. By reviewing the literature, this article assesses the role of this pathway in lupus nephritis, underlines the importance of TWEAK in urine (uTWEAK) as a biomarker of the disease and stresses the favourable results published in the literature from the inhibition of the TWEAK/Fn14 pathway as a therapeutic target in experimental animal models, demonstrating its potential application in other settings. Results of ongoing clinical trials and future research will give us a better understanding of the real benefit of blocking this pathway in the clinical course of several conditions.

  15. An innovative system for 3D clinical photography in the resource-limited settings

    PubMed Central

    2014-01-01

    Background Kaposi’s sarcoma (KS) is the most frequently occurring cancer in Mozambique among men and the second most frequently occurring cancer among women. Effective therapeutic treatments for KS are poorly understood in this area. There is an unmet need to develop a simple but accurate tool for improved monitoring and diagnosis in a resource-limited setting. Standardized clinical photographs have been considered to be an essential part of the evaluation. Methods When a therapeutic response is achieved, nodular KS often exhibits a reduction of the thickness without a change in the base area of the lesion. To evaluate the vertical space along with other characters of a KS lesion, we have created an innovative imaging system with a consumer light-field camera attached to a miniature “photography studio” adaptor. The image file can be further processed by computational methods for quantification. Results With this novel imaging system, each high-quality 3D image was consistently obtained with a single camera shot at bedside by minimally trained personnel. After computational processing, all-focused photos and measurable 3D parameters were obtained. More than 80 KS image sets were processed in a semi-automated fashion. Conclusions In this proof-of-concept study, the feasibility to use a simple, low-cost and user-friendly system has been established for future clinical study to monitor KS therapeutic response. This 3D imaging system can be also applied to obtain standardized clinical photographs for other diseases. PMID:24929434

  16. Stem cells: progress in research and edging towards the clinical setting.

    PubMed

    Stanworth, S J; Newland, A C

    2001-01-01

    Mouse embryonic stem cells have been shown to differentiate into a variety of tissues in vitro and in transplantation experiments can produce many different cell types. Multipotent stem cells in adult humans have also shown a high degree of plasticity: haemopoietic stem cells, for example, have been shown to contribute to several other tissues, such as liver. From these simple observations there has been considerable extrapolation into the use of such putative totipotent stem cells in the clinical setting, with the development of 'designer' tissue engineering, whose aim is to create large tissues or even whole organs for clinical use. In practical terms, however, there are many limitations and difficulties and clinical use has been restricted to a very few settings, eg the use of fetal cells in Parkinson's disease. Nonetheless, there is enormous potential in this area, and also in the application of embryonic or adult stem cells as carriers for gene therapy; but the limitations of such treatment, in particular the stability of manipulated cells, and the problems of ageing and Ooncogenicity, not to mention a host of ethical and regulatory issues, all need to be considered.

  17. 3D OCT imaging in clinical settings: toward quantitative measurements of retinal structures

    NASA Astrophysics Data System (ADS)

    Zawadzki, Robert J.; Fuller, Alfred R.; Zhao, Mingtao; Wiley, David F.; Choi, Stacey S.; Bower, Bradley A.; Hamann, Bernd; Izatt, Joseph A.; Werner, John S.

    2006-02-01

    The acquisition speed of current FD-OCT (Fourier Domain - Optical Coherence Tomography) instruments allows rapid screening of three-dimensional (3D) volumes of human retinas in clinical settings. To take advantage of this ability requires software used by physicians to be capable of displaying and accessing volumetric data as well as supporting post processing in order to access important quantitative information such as thickness maps and segmented volumes. We describe our clinical FD-OCT system used to acquire 3D data from the human retina over the macula and optic nerve head. B-scans are registered to remove motion artifacts and post-processed with customized 3D visualization and analysis software. Our analysis software includes standard 3D visualization techniques along with a machine learning support vector machine (SVM) algorithm that allows a user to semi-automatically segment different retinal structures and layers. Our program makes possible measurements of the retinal layer thickness as well as volumes of structures of interest, despite the presence of noise and structural deformations associated with retinal pathology. Our software has been tested successfully in clinical settings for its efficacy in assessing 3D retinal structures in healthy as well as diseased cases. Our tool facilitates diagnosis and treatment monitoring of retinal diseases.

  18. What Really Motivates Iranian Nurses to Be Creative in Clinical Settings?: A Qualitative Study.

    PubMed

    Shahsavari Isfahani, Sara; Hosseini, Mohammad Ali; Fallahi Khoshknab, Masoud; Peyrovi, Hamid; Khanke, Hamid Reza

    2015-02-24

    Creativity and innovation are key elements for organization improvement, particularly in nursing, and for finding alternatives for solving nurses' occupational problems. Nurses' creativity is affected by motivation. Although, there are many possible sources of motivation, the Iranian nurses' creativity is seldom clarified, and the most important factors motivating nurses to be creative in clinical settings has rarely been addressed. The aim of this study was to explore Iranian nurses' experiences regarding the most important factors that motivate their creativity in clinical settings. This qualitative study was conducted using conventional content analysis approach. A purposive sample of sixteen nurses was recruited from two educational hospitals affiliated to Tehran and Jahrom Universities of Medical Sciences in Iran. Data were gathered through conducting face-to-face semi-structured interviews and were analyzed by qualitative content analysis approach. Five main themes emerged from the data analysis, including: (a) Intrinsic motivators, (b) Extrinsic motivators, (c) Achievement motivators, (d) Relational or altruistic motivators, and (e) Spiritual motivators. Study findings indicated that nurses are creative and innovative individuals. So nurse managers and health policy makers should consider creativity as an integral part of all health and clinical strategies and policies. They should support creative and innovative efforts of nurses and provide a climate in which nurses engage in more creative and productive behaviors.

  19. Online access to MEDLINE in clinical settings: impact of user fees.

    PubMed Central

    Haynes, R B; Ramsden, M F; McKibbon, K A; Walker, C J

    1991-01-01

    The effect of introducing user fees on the frequency and quality of MEDLINE searching with GRATEFUL MED by physicians in clinical settings was tested. After training and free use (prior study), consenting participants were randomly allocated to pay searching costs (pay group) or continue without fees (no pay group). Fifty-nine physicians participated. Among the prior study's frequent searchers, the pay group searched at less than one third of the rate of those assigned to no pay. For less frequent searchers in the prior study, only 48% of those assigned to pay did any searches, compared with 85% for the no pay group (P = 0.006), and for those who did search, their frequency was almost half. However, there was no significant difference in the quality of searches; both groups demonstrated about equivalent recall (P = 0.77), but significantly lower precision (P = 0.03) than for the librarian's independent searches. Similarly, there was no difference in the proportion of searches affecting clinical decisions for the two groups. Thus, imposing user charges for online searching in clinical settings after a period of free use adversely affects searching quantity, but not quality. MEDLINE providers should consider whether user fees will undermine its benefits. PMID:1958910

  20. Three Decades of Comprehensive Geriatric Assessment: Evidence Coming From Different Healthcare Settings and Specific Clinical Conditions.

    PubMed

    Pilotto, Alberto; Cella, Alberto; Pilotto, Andrea; Daragjati, Julia; Veronese, Nicola; Musacchio, Clarissa; Mello, Anna Maria; Logroscino, Giancarlo; Padovani, Alessandro; Prete, Camilla; Panza, Francesco

    2017-02-01

    Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional capabilities of older adults to develop a coordinated plan to maximize overall health with aging. Specific criteria used by CGA programs to evaluate patients include age, medical comorbidities, psychosocial problems, previous or predicted high healthcare utilization, change in living situation, and specific geriatric conditions. However, no universal criteria have been agreed upon to readily identify patients who are likely to benefit from CGA. Evidence from randomized controlled trials and large systematic reviews and meta-analyses suggested that the healthcare setting may modify the effectiveness of CGA programs. Home CGA programs and CGA performed in the hospital were shown to be consistently beneficial for several health outcomes. In contrast, the data are conflicting for posthospital discharge CGA programs, outpatient CGA consultation, and CGA-based inpatient geriatric consultation services. The effectiveness of CGA programs may be modified also by particular settings or specific clinical conditions, with tailored CGA programs in older frail patients evaluated for preoperative assessment, admitted or discharged from emergency departments and orthogeriatric units or with cancer and cognitive impairment. CGA is capable of effectively exploring multiple domains in older age, being the multidimensional and multidisciplinary tool of choice to determine the clinical profile, the pathologic risk and the residual skills as well as the short- and long-term prognosis to facilitate the clinical decision making on the personalized care plan of older persons.

  1. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel.

    PubMed

    Kales, Helen C; Gitlin, Laura N; Lyketsos, Constantine G

    2014-04-01

    Noncognitive neuropsychiatric symptoms (NPS) of dementia (aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition) affect individuals with dementia nearly universally across dementia stages and etiologies. NPS are associated with poor outcomes for individuals with dementia and caregivers, including excess morbidity and mortality, greater healthcare use, and earlier nursing home placement, as well as caregiver stress, depression, and difficulty with employment. Although the Food and Drug Administration has not approved pharmacotherapy for NPS, psychotropic medications are frequently used to manage these symptoms, but in the few cases of proven pharmacological efficacy, significant risk of adverse effects may offset benefits. There is evidence of efficacy and limited potential for adverse effects of nonpharmacological treatments, typically considered first line, but their uptake as preferred treatments remains inadequate in real-world clinical settings. Thus, the field currently finds itself in a predicament in terms of management of these difficult symptoms. It was in this context that the University of Michigan Program for Positive Aging, working in collaboration with the Johns Hopkins Alzheimer's Disease Research Center and Center for Innovative Care in Aging sponsored and convened a multidisciplinary expert panel in Detroit, Michigan, in fall 2011 with three objectives: to define critical elements of care for NPS in dementia; to construct an approach describing the sequential and iterative steps of managing NPS in real-world clinical settings that can be used as a basis for integrating nonpharmacological and pharmacological approaches; and to discuss how the approach generated could be implemented in research and clinical care.

  2. Diagnostic accuracy of the Self-administered, Self-reported History Questionnaire for lumbar spinal stenosis patients in Japanese primary care settings: a multicenter cross-sectional study (DISTO-project).

    PubMed

    Kato, Kinshi; Sekiguchi, Miho; Yonemoto, Koji; Kakuma, Tatsuyuki; Nikaido, Takuya; Watanabe, Kazuyuki; Otani, Koji; Yabuki, Shoji; Kikuchi, Shin-ichi; Konno, Shin-ichi

    2015-09-01

    Diagnostic support tools for lumbar spinal stenosis such as the Self-administered, Self-reported History Questionnaire have been developed in Japan, but no report has demonstrated the diagnostic accuracy of this questionnaire in Japanese primary care settings. This multicenter, cross-sectional survey was performed to evaluate and improve the diagnostic accuracy of this questionnaire for lumbar spinal stenosis patients in Japanese primary care settings. The lumbar spinal stenosis diagnosis support tool project was conducted in 1657 hospitals to evaluate the diagnostic accuracy of the Self-administered, Self-reported History Questionnaire in Japan from 2011 to 2012. Consecutive adults (≥50 years old) from physicians, including non-orthopedic general practitioners and orthopedic general practitioners, were considered for enrollment. Consecutive adults (≥50 years old) with low back pain from hospital-based orthopedic surgeons were also considered for enrollment. The diagnostic accuracy of the Self-administered, Self-reported History Questionnaire with initial and several new cutoff points in classifying patients according to the presence of lumbar spinal stenosis was assessed in terms of sensitivity, specificity and negative predictive values. Among the 33,545 patients, 10,199 (30.4 %) were diagnosed with lumbar spinal stenosis by the physicians. The Self-administered, Self-reported History Questionnaire version 1.1 with a new cutoff point was more sensitive than the Self-administered, Self-reported History Questionnaire version 1.0 with the initial cutoff point (79.8 vs. 68.3 %) and less specific (68.8 vs. 75.1 %) for lumbar spinal stenosis diagnosis. The respective negative predictive values were 88.5 and 84.3 %. The Self-administered, Self-reported History Questionnaire version 1.1 with the new cutoff was more sensitive and had higher negative predictive value than version 1.0 with the initial cutoff. Therefore, the improved Self-administered, Self

  3. Developing core outcome measurement sets for clinical trials: OMERACT filter 2.0.

    PubMed

    Boers, Maarten; Kirwan, John R; Wells, George; Beaton, Dorcas; Gossec, Laure; d'Agostino, Maria-Antonietta; Conaghan, Philip G; Bingham, Clifton O; Brooks, Peter; Landewé, Robert; March, Lyn; Simon, Lee S; Singh, Jasvinder A; Strand, Vibeke; Tugwell, Peter

    2014-07-01

    Lack of standardization of outcome measures limits the usefulness of clinical trial evidence to inform health care decisions. This can be addressed by agreeing on a minimum core set of outcome measures per health condition, containing measures relevant to patients and decision makers. Since 1992, the Outcome Measures in Rheumatology (OMERACT) consensus initiative has successfully developed core sets for many rheumatologic conditions, actively involving patients since 2002. Its expanding scope required an explicit formulation of its underlying conceptual framework and process. Literature searches and iterative consensus process (surveys and group meetings) of stakeholders including patients, health professionals, and methodologists within and outside rheumatology. To comprehensively sample patient-centered and intervention-specific outcomes, a framework emerged that comprises three core "Areas," namely Death, Life Impact, and Pathophysiological Manifestations; and one strongly recommended Resource Use. Through literature review and consensus process, core set development for any specific health condition starts by identifying at least one core "Domain" within each of the Areas to formulate the "Core Domain Set." Next, at least one applicable measurement instrument for each core Domain is identified to formulate a "Core Outcome Measurement Set." Each instrument must prove to be truthful (valid), discriminative, and feasible. In 2012, 96% of the voting participants (n=125) at the OMERACT 11 consensus conference endorsed this model and process. The OMERACT Filter 2.0 explicitly describes a comprehensive conceptual framework and a recommended process to develop core outcome measurement sets for rheumatology likely to be useful as a template in other areas of health care. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Attitudes of Staff Nurse Preceptors Related to the Education of Nurses with Learning Disabilities in Clinical Settings

    ERIC Educational Resources Information Center

    L'Ecuyer, Kristine Marie

    2014-01-01

    This dissertation presents a quantitative study of the attitudes of staff nurse preceptors toward nursing students with learning disabilities. There are an increased number of nursing students with learning disabilities. These students may have additional challenges in clinical settings, particularly if clinical settings do not understand or…

  5. Language interpreter utilization in the emergency department setting: a clinical review.

    PubMed

    Ramirez, Dorian; Engel, Kirsten G; Tang, Tricia S

    2008-05-01

    The emergency department (ED) serves as the entry point into the U.S. health care system for many patients with limited English proficiency (LEP). This paper reviews the literature on language interpreter utilization in the ED setting. We focused on three clinical issues related to professional language interpretation: (1) patient satisfaction, (2) health care delivery, and (3) current interpreter utilization practices. Compared with-English speaking patients, LEP patients report less satisfaction with medical encounters, have different rates of diagnostic testing, and receive less explanation and follow-up. Although professional interpretation has been associated with improvements in patient satisfaction, communication, and health care access, these services are largely under-utilized in ED settings. Reliance on untrained ad hoc interpreters, perceived time and labor associated with obtaining and working with an interpreter, and costs of implementing professional interpreter services serve as barriers to implementation and utilization.

  6. The role of setting for ketamine abuse: clinical and preclinical evidence.

    PubMed

    De Luca, Maria Teresa; Meringolo, Maria; Spagnolo, Primavera Alessandra; Badiani, Aldo

    2012-01-01

    Drug abuse is often seen as a unitary phenomenon, partly as a result of the discovery over the past three decades of shared mechanisms of action for addictive substances. Yet the pattern of drug taking is often very different from drug to drug. This is particularly evident in the case of 'club drugs', such as ketamine. Although the number of ketamine abusers is relatively small in the general population, it is quite substantial in some settings. In particular, ketamine abuse is almost exclusively limited to clubs and large music parties, which suggests a major role of context in modulating the reward effects of this drug. This review focuses on recent preclinical and clinical findings, including previously unpublished data, that provide evidence that, even under controlled conditions, ketamine reward is a function of the setting of drug taking.

  7. Chromosomal Microarray Analysis (CMA) a Clinical Diagnostic Tool in the Prenatal and Postnatal Settings.

    PubMed

    Batzir, Nurit Assia; Shohat, Mordechai; Maya, Idit

    2015-09-01

    Chromosomal microarray analysis (CMA) is a technology used for the detection of clinically-significant microdeietions or duplications, with a high sensitivity for submicroscopic aberrations. It is able to detect changes as small as 5-10Kb in size - a resolution up to 1000 times higher than that of conventional karyotyping. CMA is used for uncovering copy number variants (CNVs) thought to play an important role in the pathogenesis of a variety of disorders, primarily neurodevelopmental disorders and congenital anomalies. CMA may be applied in the prenatal or postnatal setting, with unique benefits and limitations in each setting. The growing use of CMA makes it essential for practicing physicians to understand the principles of this technology and be aware of its powers and limitations.

  8. Outcome of tobacco cessation in workplace and clinic settings: A comparative study.

    PubMed

    Ransing, Ramdas S; Patil, Dipak B; Desai, Maruti B; Modak, Asawari

    2016-01-01

    Several biological, social, and cultural factors contribute to the poor outcome of tobacco cessation interventions. Inability to engage large number of participants is one of the major identifiable factors. The objective of this study was to compare the outcome of tobacco cessation interventions in the clinical and workplace settings. In the present study, we recruited 100 participants in tobacco cessation clinic (TCC) group and workplace group (50 participants in each). Both the groups were regularly intervened and were followed up regularly at 2 weeks, 4 weeks, 3 months, and 6 months. Active interventions in the form of awareness lectures, focused group discussions, and if needed, pharmacotherapy (nicotine/non-nicotine replacement therapy) was carried out for all participants. The outcome was assessed as no change, harm reduction (>50% reduction), complete cessation, and drop out. Statistical analysis of the data was done using the Statistical Package for the Social Sciences version 21.0. At the end of 1 month, there was higher tobacco cessation rate in the workplace group versus TCC group (n = 22, 44% vs n = 9, 18%; P < 0.0001). The tobacco cessation rate was maintained even after 6 months of intervention (n = 30, 60% vs n = 12, 24%; P = 0.002) and dropout rate was also lower among the workplace group than the TCC group (n = 14, 28% vs n = 27, 54%; P < 0.0001). Our study findings suggest that the workplace setting has superior outcome in tobacco cessation and harm reduction than clinical setting. In addition, it is associated with low dropout rate and the cessation effect is maintained over a period of 6 months.

  9. Light Therapy for Seasonal Affective Disorder In a Clinical Office Setting

    PubMed Central

    Privitera, Michael R; Moynihan, Jan; Tang, Wan; Khan, Ayesha

    2011-01-01

    Objective To determine predictors of response to light therapy (LT) for seasonal affective disorder, winter version, in a clinical office setting for patients with a spectrum of seasonality, defined by the Seasonal Pattern Assessment Questionnaire (SPAQ). Method A retrospective review was done of charts of 51 patients who had been treated with a 1-week light therapy intervention. Patient self-rated scales applied in a standard manner were used to measure clinical progress. The Beck Depression Inventory (BDI) with added atypical features was used as the primary outcome variable. Sleep patterns were analyzed and the effect of psychotropic, medications on outcome was determined. Seven point scales were used to assess expected response and global response. The importance of having LT set up and available in an office setting was evaluated. Retrospective degree of disability was measured based on the SPAQ degree of problem. The severity of the depressive episode was determined based on BDI score at entry. Results Seasonality (how a patient’s symptoms vary as a function of the season of the year), degree of disability based on the SPAQ, and severity of depressive episode at entry based on the BDI predicted response to LT. Greater severity at baseline based on BDI score predicted less chance of attaining full remission within 7 days of treatment compared with patients with lower severity scores at entry on the BDI. Sleep patterns relative to a fixed treatment time of 7 AM did not predict LT response. Light therapy was effective on its own, and the results were mixed as to whether adding LT to an existing antidepressant medication produced superior results. Conclusion Degree of seasonality can be used as a predictor of response to LT and may be clinically useful when suggesting that patients consider a trial of LT. PMID:21107143

  10. Light therapy for seasonal affective disorder in a clinical office setting.

    PubMed

    Privitera, Michael R; Moynihan, Jan; Tang, Wan; Khan, Ayesha

    2010-11-01

    To determine predictors of response to light therapy (LT) for seasonal affective disorder, winter version, in a clinical office setting for patients with a spectrum of seasonality defined by the Seasonal Pattern Assessment Questionnaire (SPAQ). A retrospective review was done of charts of 51 patients who had been treated with a 1-week light therapy intervention. Patient self-rated scales applied in a standard manner were used to measure clinical progress. The Beck Depression Inventory (BDI) with added atypical features was used as the primary outcome variable. Sleep patterns were analyzed and the effect of psychotropic medications on outcome was determined. Seven point scales were used to assess expected response and global response. The importance of having LT set up and available in an office setting was evaluated. Retrospective degree of disability was measured based on the SPAQ degree of problem. The severity of the depressive episode was determined based on BDI score at entry. Seasonality (how a patient's symptoms vary as a function of the season of the year), degree of disability based on the SPAQ, and severity of depressive episode at entry based on the BDI predicted response to LT. Greater severity at baseline based on BDI score predicted less chance of attaining full remission within 7 days of treatment compared with patients with lower severity scores at entry on the BDI. Sleep patterns relative to a fixed treatment time of 7 AM did not predict LT response. Light therapy was effective on its own, and the results were mixed as to whether adding LT to an existing antidepressant medication produced superior results. Degree of seasonality can be used as a predictor of response to LT and may be clinically useful when suggesting that patients consider a trial of LT.

  11. Implementing an Evidence-Based Fall Prevention Program in an Outpatient Clinical Setting

    PubMed Central

    Li, Fuzhong; Harmer, Peter; Stock, Ronald; Fitzgerald, Kathleen; Stevens, Judy; Gladieux, Michele; Chou, Li-Shan; Carp, Kenji; Voit, Jan

    2015-01-01

    Objectives Few evidence-based fall prevention programs have been evaluated for adoption in clinical settings. This study investigated the dissemination potential of a Tai Ji Quan-based program, previously shown efficacious for reducing risk of falls in older adults, through outpatient clinical settings. Design A single-group pre-post design in which participants attended a twice weekly Tai Ji Quan training program for 24 weeks. Setting Communities in Lane County, Oregon. Participants Referral patients (N = 379) aged 65 and older living independently. Measurements Using the RE-AIM framework, the primary outcome was the proportion of participating healthcare providers who made referrals. Secondary outcomes were the proportion of referred patients agreeing to participate and enrolling in the program, and measures of program implementation, maintenance, and effectiveness (on measures of falls, balance, gait, physical performance, and balance efficacy). Results Of the 252 providers invited to participate, 157 made referrals (62% adoption rate). Of 564 patients referred, 379 (67% reach) enrolled in the program, which was successfully implemented in senior/community centers with good fidelity. Of the total number of participants, 283 completed the program (75% retention) and 212 of these attended ≥75% of the total (48) sessions. Participants reported a reduction in falls with an incidence rate of 0.13 falls per person-month and showed significant improvement from baseline in all outcome measures. A 3-month post-intervention follow-up indicated encouraging levels of program maintenance among providers, patients, and community centers. Conclusion A protocol to refer patients at increased risk of falling to a Tai Ji Quan-based program was successfully implemented among healthcare providers. The evidence-based program appears readily scalable and exportable with potential for substantial clinical and public health impact. PMID:24164465

  12. Rethinking Japanese Language Pedagogy.

    ERIC Educational Resources Information Center

    Larson, Phyllis

    2003-01-01

    Discusses the work of Seiichi Makino, a scholar of Japanese, noting that his work in establishing the Japanese proficiency guidelines helped make it appear that Japanese language teaching was part of mainstream American language teaching. (Author/VWL)

  13. Incremental learning of probabilistic rules from clinical databases based on rough set theory.

    PubMed Central

    Tsumoto, S.; Tanaka, H.

    1997-01-01

    Several rule induction methods have been introduced in order to discover meaningful knowledge from databases, including medical domain. However, most of the approaches induce rules from all the data in databases and cannot induce incrementally when new samples are derived. In this paper, a new approach to knowledge acquisition, which induce probabilistic rules incrementally by using rough set technique, is introduced and was evaluated on two clinical databases. The results show that this method induces the same rules as those induced by ordinary non-incremental learning methods, which extract rules from all the datasets, but that the former method requires more computational resources than the latter approach. PMID:9357616

  14. Monitoring antiretroviral therapy in resource-limited settings: balancing clinical care, technology, and human resources.

    PubMed

    Hosseinipour, Mina C; Schechter, Mauro

    2010-08-01

    Due to the rapid expansion of first-line antiretroviral therapy in resource-limited settings (RLS), increasing numbers of people are living with HIV for prolonged periods of time. Treatment programs must now decide how to balance monitoring costs necessary to maximize health benefits for those already on treatment with the continued demand to initiate more patients on first-line treatment. We review currently available evidence related to monitoring strategies in RLS and discuss their implications on timing of switching to second-line treatment, development of HIV resistance, and clinical outcome.

  15. Computed tomography angiography of coronary artery bypass grafts: robustness in emergency and clinical routine settings.

    PubMed

    Heye, Tobias; Kauczor, Hans-Ulrich; Szabo, Gabor; Hosch, Waldemar

    2014-03-01

    There is a high probability for presence of irregular heart rates and artifacts in patients with previous coronary artery bypass graft (CABG) surgery. Previously reported diagnostic performance of ECG-gated 64-slice dual-source computer tomography angiography (CTA) in this patient group is based on pre-selection for normal heart rate and routine clinical setting. To investigate image quality and diagnostic performance of CTA in patients with previous CABG surgery in various clinical settings. Fifty-six non-selected, consecutive patients (110 grafts, 44 arterial, 66 venous) with previous CABG surgery were prospectively examined using a dual-source 64-slice CT (Siemens Definition, Forchheim, Germany) without utilization of CT-related pharmaceutical heart rate control. Patients were stratified according to the clinical setting: planned redo-cardiac surgery; emergency CTA within 30 days after CABG surgery; routine follow-up after CABG surgery. A reference standard was available for 30 patients (53.6%; 67/110 grafts). Image quality, artifacts, and graft patency were independently assessed by two observers. All CTAs were diagnostic despite the presence of irregular heart rhythm (25% of cases) and artifacts (72.7% of grafts). CTA was accurate in all patient groups in assessing graft patency (97.9% sensitivity; 100% specificity; 98.5% accuracy) but artifacts decreased diagnostic performance for stenosis detection (60% sensitivity; 88.6% specificity; 84.1% accuracy). Arterial grafts exhibited more surgical clip artifacts compared to venous grafts, which predominantly showed motion artifacts. Overall diagnostic quality was rated excellent in 70.9%/56.4%, good in 23.4%/39.1%, and sufficient in 5.5%/4.5% by each observer, respectively. CTA detected acute findings in 10 cases (graft bleeding, graft occlusion, pericardial hematoma, sternal instability with retrosternal abscess formation, pericardial effusion, left ventricle thrombus) in the emergency group; seven cases required

  16. Awake surgery between art and science. Part I: clinical and operative settings

    PubMed Central

    Talacchi, Andrea; Santini, Barbara; Casagrande, Francesca; Alessandrini, Franco; Zoccatelli, Giada; Squintani, Giovanna M.

    Summary Awake surgery requires coordinated teamwork and communication between the surgeon and the anesthesiologist, as he monitors the patient, the neuroradiologist as he interprets the images for intraoperative confirmation, and the neuropsychologist and neurophysiologist as they evaluate in real-time the patient’s responses to commands and questions. To improve comparison across published studies on clinical assessment and operative settings in awake surgery, we reviewed the literature, focusing on methodological differences and aims. In complex, interdisciplinary medical care, such differences can affect the outcome and the cost-benefit ratio of the treatment. Standardization of intraoperative mapping and related controversies will be discussed in Part II. PMID:24139657

  17. Awake surgery between art and science. Part I: clinical and operative settings.

    PubMed

    Talacchi, Andrea; Santini, Barbara; Casagrande, Francesca; Alessandrini, Franco; Zoccatelli, Giada; Squintani, Giovanna M

    2013-01-01

    Awake surgery requires coordinated teamwork and communication between the surgeon and the anesthesiologist, as he monitors the patient, the neuroradiologist as he interprets the images for intraoperative confirmation, and the neuropsychologist and neurophysiologist as they evaluate in real-time the patient's responses to commands and questions. To improve comparison across published studies on clinical assessment and operative settings in awake surgery, we reviewed the literature, focusing on methodological differences and aims. In complex, interdisciplinary medical care, such differences can affect the outcome and the cost-benefit ratio of the treatment. Standardization of intraoperative mapping and related controversies will be discussed in Part II.

  18. From data to the decision: A software architecture to integrate predictive modelling in clinical settings.

    PubMed

    Martinez-Millana, A; Fernandez-Llatas, C; Sacchi, L; Segagni, D; Guillen, S; Bellazzi, R; Traver, V

    2015-08-01

    The application of statistics and mathematics over large amounts of data is providing healthcare systems with new tools for screening and managing multiple diseases. Nonetheless, these tools have many technical and clinical limitations as they are based on datasets with concrete characteristics. This proposition paper describes a novel architecture focused on providing a validation framework for discrimination and prediction models in the screening of Type 2 diabetes. For that, the architecture has been designed to gather different data sources under a common data structure and, furthermore, to be controlled by a centralized component (Orchestrator) in charge of directing the interaction flows among data sources, models and graphical user interfaces. This innovative approach aims to overcome the data-dependency of the models by providing a validation framework for the models as they are used within clinical settings.

  19. Facing requests for physician-assisted suicide: toward a practical and principled clinical skill set.

    PubMed

    Emanuel, L L

    1998-08-19

    Requests for physician-assisted suicide are not a new phenomenon, and many physicians are likely to face this challenging situation. This article proposes for professionals an 8-step approach to respond to requests for physician-assisted suicide. The approach seeks to identify and treat the root causes of the request and aims to present a plan for consistent application of a set of clinical skills. Justification for the steps requires only 2 noncontentious principles: the patient should be free of unwanted intervention, and the physician is obligated to provide suffering patients with comfort care. Care based on these 2 principles alone does not include physician-assisted suicide. The approach does, however, justify patient refusal of oral intake in specific circumstances. The approach could resolve a majority of requests for physician-assisted suicide and should be tested further for clinical efficacy.

  20. The effect of nursing staff on student learning in the clinical setting.

    PubMed

    Webster, Alanna; Bowron, Caitlin; Matthew-Maich, Nancy; Patterson, Priscilla

    2016-06-01

    Aim To explore baccalaureate nursing students' perspectives of the influence of nursing staff on their learning and experience in the clinical setting. Method A qualitative description approach was used. Thirty nursing students were interviewed individually or in focus groups. Data were analysed using content analysis. Four researchers analysed the data separately and agreed on the themes. Findings Nursing staff had positive (enabling) and negative (hindering) effects on students' clinical learning and socialisation to nursing. Nursing staff may encourage and excite students when they behave as positive mentors, facilitators and motivators. However, their actions may also have a negative effect on students, decreasing their confidence, learning and desire to continue in the profession. Conclusion Nursing staff influence student learning. Their actions, attitude and willingness to teach are influential factors. The findings have implications for patient safety, nurse retention and recruitment, and preparing students for professional practice.

  1. Electronic Transfer of Clinical Nursing Minimum Data Set Facilitates Nursing Diagnoses Validation

    PubMed Central

    Delaney, Connie W.; Mehmert, Peg

    1990-01-01

    Computerized information systems may offer the most efficient, cost effective approach for maximizing the use of the Nursing Minimum Data Set to meet the data access and comparability demands for validation of nursing diagnoses. This report addressed Phases I and II of a larger study testing the research utility of the NMDS. The utility of the NMDS for retrospective validation of four nursing diagnoses as well as electronic retrieval and transfer of the NMDS from a computerized clinical information system for retrospective validation were tested? Results demonstrated that the NMDS elements as modified, as well as electronic transfer of these elements, were sufficient for retrospective validation studies. Moreover, it was possible to compare diagnoses in relationship to sex, age, race, length of stay, DRG category, and place of discharge. Methodological issues related to NMDS data retrieval, storage, and processing are identified. Implications for design of clinical nursing information systems are discussed.

  2. OPCRIT+: an electronic system for psychiatric diagnosis and data collection in clinical and research settings.

    PubMed

    Rucker, James; Newman, Stuart; Gray, Joanna; Gunasinghe, Cerisse; Broadbent, Matthew; Brittain, Philip; Baggaley, Martin; Denis, Mike; Turp, John; Stewart, Robert; Lovestone, Simon; Schumann, Gunter; Farmer, Anne; McGuffin, Peter

    2011-08-01

    The increasingly large sample size requirements of modern adult mental health research suggests the need for a data collection and diagnostic application that can be used across a broad range of clinical and research populations. Aims To develop a data collection and diagnostic application that can be used across a broad range of clinical and research settings. We expanded and redeveloped the OPCRIT system into a broadly applicable diagnostic and data-collection package and carried out an interrater reliability study of this new tool. OPCRIT+ performed well in an interrater reliability study with relatively inexperienced clinicians, giving a combined, weighted kappa of 0.70 for diagnostic reliability. OPCRIT+ showed good overall interrater reliability scores for diagnoses. It is now incorporated in the electronic patient record of the Maudsley and associated hospitals. OPCRIT+ can be downloaded free of charge at http://sgdp.iop.kcl.ac.uk/opcritplus.

  3. An easy and reliable automated method to estimate oxidative stress in the clinical setting.

    PubMed

    Vassalle, Cristina

    2008-01-01

    During the last few years, reliable and simple tests have been proposed to estimate oxidative stress in vivo. Many of them can be easily adapted to automated analyzers, permitting the simultaneous processing of a large number of samples in a greatly reduced time, avoiding manual sample and reagent handling, and reducing variability sources. In this chapter, description of protocols for the estimation of reactive oxygen metabolites and the antioxidant capacity (respectively the d-ROMs and OXY Adsorbent Test, Diacron, Grosseto, Italy) by using the clinical chemistry analyzer SYNCHRON, CX 9 PRO (Beckman Coulter, Brea, CA, USA) is reported as an example of such an automated procedure that can be applied in the clinical setting. Furthermore, a calculation to compute a global oxidative stress index (Oxidative-INDEX), reflecting both oxidative and antioxidant counterparts, and, therefore, a potentially more powerful parameter, is also described.

  4. Overcoming Practical Challenges to Conducting Clinical Research in the Inpatient Stroke Rehabilitation Setting

    PubMed Central

    Campbell, Grace B.; Skidmore, Elizabeth R.; Whyte, Ellen M.; Matthews, Judith T.

    2015-01-01

    There is a shortage of published empirical studies conducted in acute inpatient stroke rehabilitation, though such studies are greatly needed in order to shed light on the most efficacious inpatient stroke rehabilitation interventions. The inherent challenges of inpatient research may dissuade researchers from undertaking this important work. This paper describes our institution’s experience devising practical solutions to research barriers in this setting. Our efforts facilitated five simultaneous inpatient stroke rehabilitation studies, and led to several benefits, including increased effectiveness of research participant identification and enrollment, novel collaborative projects, innovative clinical care initiatives, and enhanced emotional and practical support for patients and their families. We provide recommendations based on lessons learned during our experience, and discuss benefits of this collaboration for our research participants, clinical staff, and the research team. PMID:25775955

  5. Overcoming practical challenges to conducting clinical research in the inpatient stroke rehabilitation setting.

    PubMed

    Campbell, Grace B; Skidmore, Elizabeth R; Whyte, Ellen M; Matthews, Judith T

    2015-10-01

    There is a shortage of published empirical studies conducted in acute inpatient stroke rehabilitation, though such studies are greatly needed in order to shed light on the most efficacious inpatient stroke rehabilitation interventions. The inherent challenges of inpatient research may dissuade researchers from undertaking this important work. This paper describes our institution's experience devising practical solutions to research barriers in this setting. Through concentrated efforts to overcome research barriers, such as by cultivating collaborative relationships and capitalizing on unanticipated benefits, we successfully facilitated conduct of five simultaneous inpatient stroke studies. Tangible benefits realized include increased effectiveness of research participant identification and enrollment, novel collaborative projects, innovative clinical care initiatives, and enhanced emotional and practical support for patients and their families. We provide recommendations based on lessons learned during our experience, and discuss benefits of this collaboration for our research participants, clinical staff, and the research team.

  6. Essential processes for cognitive behavioral clinical supervision: Agenda setting, problem-solving, and formative feedback.

    PubMed

    Cummings, Jorden A; Ballantyne, Elena C; Scallion, Laura M

    2015-06-01

    Clinical supervision should be a proactive and considered endeavor, not a reactive one. To that end, supervisors should choose supervision processes that are driven by theory, best available research, and clinical experience. These processes should be aimed at helping trainees develop as clinicians. We highlight 3 supervision processes we believe should be used at each supervision meeting: agenda setting, encouraging trainee problem-solving, and formative feedback. Although these are primarily cognitive-behavioral skills, they can be helpful in combination with other supervision models. We provide example dialogue from supervision exchanges, and discuss theoretical and research support for these processes. Using these processes not only encourages trainee development but also models for them how to use the same processes and approaches with clients.

  7. Utilization of Portable Radios to Improve Ophthalmology Clinic Efficiency in an Academic Setting.

    PubMed

    Davis, Alexander S; Elkeeb, Ahmed M; Vizzeri, Gianmarco; Godley, Bernard F

    2016-03-01

    Improvement in clinic efficiency in the ambulatory setting is often looked at as an area for development of lean management strategies to deliver a higher quality of healthcare while reducing errors, costs, and delays. To examine the benefits of improving team communication and its impact on clinic flow and efficiency, we describe a time-motion study performed in an academic outpatient Ophthalmology clinic and its objective and subjective results. Compared to clinic encounters without the use of the portable radios, objective data demonstrated an overall significant decreases in mean workup time (15.18 vs. 13.10), room wait (13.10 vs. 10.47), and decreased the total time needed with an MD per encounter (9.45 vs. 6.63). Subjectively, significant improvements were seen in careprovider scores for patient flow (60.78 vs. 84.29), getting assistance (61.89 vs. 88.57), moving patient charts (54.44 vs. 85.71), teamwork (69.56 vs. 91.0), communications (62.33 vs. 90.43), providing quality patient care (76.22 vs. 89.57), and receiving input on the ability to see walk-in patients (80.11 vs. 90.43). For academic purposes, an improvement in engagement in patient care and learning opportunities was noted by the clinic resident-in-training during the pilot study. Portable radios in our pilot study were preferred over the previous method of communication and demonstrates significant improvements in certain areas of clinical efficiency, subjective perception of teamwork and communications, and academic learning.

  8. Shared care requires a shared vision: communities of clinical practice in a primary care setting.

    PubMed

    Young, Jessica; Egan, Tony; Jaye, Chrystal; Williamson, Martyn; Askerud, Anna; Radue, Peter; Penese, Maree

    2017-09-01

    To understand how a vision of care is formed and shared by patients and the primary care professionals involved in their care. To achieve the best health outcomes, it is important for patients and those who care for them to have a mutual understanding about what is important to the patient in their everyday life and why, and what care is necessary to realise this vision. Shared or team care does not necessarily translate to a consistent and integrated approach to a patient's care. An individual patient's care network of clinical and lay participants can be conceptualised as the patient's own 'Community of Clinical Practice' of which they are the central member. Working alongside a long-term conditions nursing team, we conducted a focused ethnography of nine 'Communities of Clinical Practice' in one general practice setting. Participant observation, in-depth qualitative interviews with 24 participants including nine patients, and the patients' medical records. Data were analysed using a template organising style. Primary care professionals' insight into a patient's vision of care evolves through a deep knowing of the patient over time; this is shared between 'Community of Clinical Practice' members, frequently through informal communication and realised through respectful dialogue. These common values - respect, authenticity, autonomy, compassion, trust, care ethics, holism - underpin the development of a shared vision of care. A patient's vision of care, if shared, provides a focus around which 'Community of Clinical Practice' members cohere. Nurses play an important role in sharing the patient's vision of care with other participants. A shared vision of care is an aspirational concept which is difficult to articulate but with attentiveness, sustained authentic engagement and being driven by values, it should evolve amongst the core participants of a 'Community of Clinical Practice'. © 2017 John Wiley & Sons Ltd.

  9. Ethical violations in the clinical setting: the hidden curriculum learning experience of Pakistani nurses.

    PubMed

    Jafree, Sara Rizvi; Zakar, Rubeena; Fischer, Florian; Zakar, Muhammad Zakria

    2015-03-19

    The importance of the hidden curriculum is recognised as a practical training ground for the absorption of medical ethics by healthcare professionals. Pakistan's healthcare sector is hampered by the exclusion of ethics from medical and nursing education curricula and the absence of monitoring of ethical violations in the clinical setting. Nurses have significant knowledge of the hidden curriculum taught during clinical practice, due to long working hours in the clinic and front-line interaction with patients and other practitioners. The means of inquiry for this study was qualitative, with 20 interviews and four focus group discussions used to identify nurses' clinical experiences of ethical violations. Content analysis was used to discover sub-categories of ethical violations, as perceived by nurses, within four pre-defined categories of nursing codes of ethics: 1) professional guidelines and integrity, 2) patient informed consent, 3) patient rights, and 4) co-worker coordination for competency, learning and patient safety. Ten sub-categories of ethical violations were found: nursing students being used as adjunct staff, nurses having to face frequent violence in the hospital setting, patient reluctance to receive treatment from nurses, the near-absence of consent taken from patients for most non-surgical medical procedures, the absence of patient consent taking for receiving treatment from student nurses, the practice of patient discrimination on the basis of a patient's socio-demographic status, nurses withdrawing treatment out of fear for their safety, a non-learning culture and, finally, blame-shifting and non-reportage of errors. Immediate and urgent attention is required to reduce ethical violations in the healthcare sector in Pakistan through collaborative efforts by the government, the healthcare sector, and ethics regulatory bodies. Also, changes in socio-cultural values in hospital organisation, public awareness of how to conveniently report ethical

  10. Good clinical practice in resource-limited settings: translating theory into practice.

    PubMed

    Tinto, Halidou; Noor, Ramadhani A; Wanga, Charles L; Valea, Innocent; Mbaye, Maimouna Ndour; D'Alessandro, Umberto; Ravinetto, Raffaella M

    2013-04-01

    A Good Clinical Practices (GCPs) course, based on the combination of theoretical modules with a practical training in real-life conditions, was held in 2010 in Burkina Faso. It was attended by 15 trainees from nine African, Asian, and Latin American countries. There were some discrepancies between the average good results at the end of the theoretical phase and the GCP application during the first days of the practical phase, underlying the difficulties of translating theoretical knowledge into good practices. Most of the findings were not unexpected and reflected the challenges commonly faced by clinical investigators in resource-poor contexts (i.e., the high workload at peripheral health facilities, the need to conciliate routine clinical activities with clinical research, and the risk of creating a double standard among patients attending the same health facility [free care for recruited patients versus user fees for non-recruited patients with the same medical condition]). Even if limited in number and time, these observations suggest that a theoretical training alone may not be sufficient to prepare trainees for the challenges of medical research in real-life settings. Conversely, when a practical phase immediately follows a theoretical one, trainees can immediately experience what the research methodology implicates in terms of work organization and relationship with recruited and non-recruited patients. This initial experience shows the complexity of translating GCP into practice and suggests the need to rethink the current conception of GCP training.

  11. Evidence-based treatment of stuttering: III. Evidence-based practice in a clinical setting.

    PubMed

    Langevin, Marilyn; Kully, Deborah

    2003-01-01

    At the heart of evidence-based practice in stuttering treatment are four issues: (1) the collection of data to inform treatment; (2) the long standing concern with maintenance of treatment gains; (3) the need to demonstrate accountability to clients, payers and our profession as service providers; and (4) the desire to advance theoretical knowledge. This article addresses the first three of these issues from a practical point of view, illustrating how data collection for stuttering treatment outcome research in a clinical setting is intimately blended with that required for clinical purposes and providing an example of a process of evaluating data for clinical and research purposes. The reader will learn about and be able to (1) differentiate between treatment outcome and treatment efficacy research, (2) describe models for integrating data collection for treatment outcome and clinical purposes, and (3) utilize guidelines for treatment efficacy that are applicable to outcome research to evaluate data for use in treatment outcome studies and to design outcome studies.

  12. Using staff input to set priorities in an Indian Health Service clinic.

    PubMed

    Morrow, R C

    1987-01-01

    The McLaughlin Public Health Service clinic serves several thousand Lakota people (Sioux) on Standing Rock Indian Reservation, SD. In 1981, a priority-setting exercise established for the first time a grassroots expression of the concerns of the clinic's staff. A three-step process was used in which each staff member first compiled an open-ended list of health needs, then ranked the relative contribution of five factors to making these problems important, and assessed each problem listed by those factors. The factors used were mortality, morbidity, vulnerability to intervention, facilities on hand, and social implications. The resulting priority table represented each person's assessment of the health needs of the community. A composite table was created to represent the group's assessment. The staff concluded that among the many problems listed, alcoholism and diabetes were the most compelling health problems. The priority score was almost identical for each, but the reasons were different. Alcoholism was rated highly because it was felt to be widespread and had serious social implications. Diabetes was ranked highly because it was felt to be lethal and vulnerable to intervention. A significant long-term benefit to the clinic of the 3-month process was to stimulate consultation within the local clinic and to unify the health team, endowing the members with a common sense of purpose.

  13. 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

  14. [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.

  15. Clinical features and long-term outcome of a group of Japanese children with inflammatory central nervous system disorders and seropositivity to myelin-oligodendrocyte glycoprotein antibodies.

    PubMed

    Hino-Fukuyo, Naomi; Haginoya, Kazuhiro; Nakashima, Ichiro; Sato, Douglas Kazutoshi; Takahashi, Toshiyuki; Misu, Tatsuro; Fujihara, Kazuo; Hirose, Mieko; Kakisaka, Yosuke; Uematsu, Mitsugu; Kobayashi, Tomoko; Kure, Shigeo

    2015-10-01

    Myelin-oligodendrocyte glycoprotein and aquaporin-4 have been extensively analyzed as targets for humoral immune reactions in central nervous system (CNS) demyelinating diseases, and the results indicated a possible role of these antibodies in the pathogenesis of various demyelinating diseases. To investigate the antibody titer levels against myelin-oligodendrocyte glycoprotein and aquaporin-4 in pediatric patients with inflammatory CNS disorders, and to evaluate clinical significance to study anti-myelin-oligodendrocyte glycoprotein antibodies. Sera at onset from patients with acute disseminated encephalomyelitis (ADEM) in 7, optic neuritis (ON) in 5, pediatric MS in 4 and neuromyelitis optica in one were tested for myelin-oligodendrocyte glycoprotein and aquaporin-4 antibodies using cell-based assays with live transfected cells. The duration of the observation periods ranged from 1 to 21 years (median, 10 years). We also described clinical course of patients with positive anti-myelin-oligodendrocyte glycoprotein antibodies. Among 17 patients diagnosed with inflammatory CNS demyelinating diseases nine (52%) were positive to anti-myelin-oligodendrocyte glycoprotein antibodies. Of note, all cases with positive anti-myelin-oligodendrocyte glycoprotein antibodies showed seronegativity against anti-aquaporin-4 antibodies and had a favorable prognosis. This preliminary report showed that anti-myelin-oligodendrocyte glycoprotein antibodies testing at onset could be a useful tool predicting clinical outcome of children with ADEM, ON, and MS. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  16. Interobserver reliability of store-and-forward teledermatology in a clinical practice setting.

    PubMed

    Romero Aguilera, G; Cortina de la Calle, P; Vera Iglesias, E; Sánchez Caminero, P; García Arpa, M; Garrido Martín, J A

    2014-01-01

    Although many studies have evaluated the diagnostic reliability of store-and-forward (SF) teledermatology, the reliability of the technique for the diagnosis of general skin conditions in a clinical practice setting has never been demonstrated. We evaluated the reliability of SF teledermatology in clinical practice by analyzing the diagnostic agreement achieved in a subgroup of patients from the DERMATEL-2 study. Patients referred from primary care settings were randomized to 3 groups: SF, a combination of videoconferencing and SF technology (VC-SF), and a control group. This article focuses on the SF group. Clinical data were recorded and photographs taken by primary care physicians, who forwarded the data electronically. Each SF consultation package was assessed by 3 dermatologists (D1,D2,D3). Subsequently all the patients were assessed by a single dermatologist (D1) in a face-to-face consultation. Finally, 2 other dermatologists (D4,D5) assessed the agreement between the diagnoses obtained by SF and FF. In total, 457 patients (200 males and 257 females) aged between 2 months and 86 years were randomized (192 to SF, 176 to VC-SF, and 89 to the control group). The diagnostic