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Sample records for japanese clinical settings

  1. Cognitive behavioral therapy for depression among adults in Japanese clinical settings: a single-group study

    PubMed Central

    2010-01-01

    Background Empirical support for cognitive behavioral therapy (CBT) for treating Japanese patients with major depression is lacking, therefore, a feasibility study of CBT for depression in Japanese clinical settings is urgently required. Findings A culturally adapted, 16-week manualized individual CBT program for Japanese patients with major depressive disorder was developed. A total of 27 patients with major depression were enrolled in a single-group study with the purpose of testing the feasibility of the program. Twenty six patients (96%) completed the study. The mean total score on the Beck Depression Inventory-II (BDI-II) for all patients (Intention-to-treat sample) improved from 32.6 to 11.7, with a mean change of 20.8 (95% confidence interval: 17.0 to 24.8). Within-group effect size at the endpoint assessment was 2.64 (Cohen's d). Twenty-one patients (77.7%) showed treatment response and 17 patients (63.0%) achieved remission at the end of the program. Significant improvement was observed in measurement of subjective and objective depression severity (assessed by BDI-II, Quick Inventory of Depressive Symptomatology-Self Rated, and Hamilton Depression Rating Scale), dysfunctional attitude (assessed by Dysfunctional Attitude Scale), global functioning (assessed by Global Assessment of Functioning of DSM-IV) and subjective well-being (assessed by WHO Subjective Well-being Inventory) (all p values < 0.001). Conclusions Our manualized treatment comprised of a 16-week individual CBT program for major depression appears feasible and may achieve favorable treatment outcomes among Japanese patients with major depression. Further research involving a larger sample in a randomized, controlled trial design is warranted. Trial registration UMIN-CTR UMIN000002542. PMID:20529252

  2. Response sets of Japanese and American students

    ERIC Educational Resources Information Center

    Gordon, Leonard V.; Kikuchi, Akio

    1970-01-01

    The School Environment Preference Schedule or SEPS measures the extent to which the student accepts those attitudes, values, and behaviors fostered in traditional school environments. Inferences regarding cultural differences must include consideration of response sets. (DB)

  3. 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

  4. Ethical Issues in Clinical Settings.

    ERIC Educational Resources Information Center

    Bain, Linda L.; And Others

    1993-01-01

    Four papers on ethical issues in physical education clinical settings are presented: (1) "Ethical Issues in Teaching" (L. Bain); (2) "Ethics in Professional Advising and Academic Counseling of Graduate Students" (G. Roberts); (3) "Ethical Issues in Clinical Services" (R. Singer); and (4) a reaction to the three previous papers by Bonnie Berger.…

  5. 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…

  6. 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…

  7. [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. PMID:15957015

  8. Cardioprotection in the clinical setting.

    PubMed

    Ivanes, Fabrice; Mewton, Nathan; Rioufol, Gilles; Piot, Christophe; Elbaz, Meyer; Revel, Didier; Croisille, Pierre; Ovize, Michel

    2010-06-01

    Reperfusion therapy is the primary treatment of acute myocardial infarction and must be applied as soon as possible to limit the ischemic insult. Unfortunately, reperfusion is responsible for additional myocardial damage likely involving opening of the mitochondrial permeability transition pore. Ischemic postconditioning is a powerful intervention that dramatically reduces lethal reperfusion injury. Several clinical studies using angioplasty postconditioning now support its protective effects in patients with an acute myocardial infarction. Alternatively, pharmacological postconditioning could afford comparable protection and be applied to a much larger number of patients. Indeed, the mitochondrial permeability transition pore inhibitor cyclosporine A has been shown to generate a similar protection in acute myocardial infarction patients. Future large-scale trials are needed to determine whether angioplasty or pharmacological postconditioning may improve clinical outcome in STEMI patients. PMID:20589423

  9. Children who survived Japanese concentration camps: clinical observations and therapy.

    PubMed

    Krell, R

    1990-03-01

    The majority of children who survived concentration camps have remained silent about their experiences. Their memories, rather than fading with time, have intensified. In the 1970s previously silent Jewish child survivors declared themselves through books and films. Child survivors of Dutch origin who were the victims of Japanese concentration camps are similarly emerging from silence. Parents and even psychiatrists do not credit child survivors with their ability to remember. As a result, child survivors have difficulty verifying their memories and have spoken very little about them. The numbers of patients with this particular childhood experience are increasing as noted in Dutch clinics devoted to the care of victims of war. This paper focuses on two such patients in order to alert North American psychiatrists to their existence and to crucial aspects of their care.

  10. Problem Based Learning in a Clinical Setting.

    ERIC Educational Resources Information Center

    Rouse, Michael W.; Borsting, Eric

    1990-01-01

    A problem-based learning approach emphasizing problem solving and self-directed learning was designed for third-year students entering vision therapy clinic rotations. The approach's use in a clinical setting, student and faculty response, and preliminary conclusions about the approach's advantages and disadvantages are discussed. (Author/MSE)

  11. 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.

  12. Goal-setting in clinical medicine.

    PubMed

    Bradley, E H; Bogardus, S T; Tinetti, M E; Inouye, S K

    1999-07-01

    The process of setting goals for medical care in the context of chronic disease has received little attention in the medical literature, despite the importance of goal-setting in the achievement of desired outcomes. Using qualitative research methods, this paper develops a theory of goal-setting in the care of patients with dementia. The theory posits several propositions. First, goals are generated from embedded values but are distinct from values. Goals vary based on specific circumstances and alternatives whereas values are person-specific and relatively stable in the face of changing circumstances. Second, goals are hierarchical in nature, with complex mappings between general and specific goals. Third, there are a number of factors that modify the goal-setting process, by affecting the generation of goals from values or the translation of general goals to specific goals. Modifying factors related to individuals include their degree of risk-taking, perceived self-efficacy, and acceptance of the disease. Disease factors that modify the goal-setting process include the urgency and irreversibility of the medical condition. Pertinent characteristics of the patient-family-clinician interaction include the level of participation, control, and trust among patients, family members, and clinicians. The research suggests that the goal-setting process in clinical medicine is complex, and the potential for disagreements regarding goals substantial. The nature of the goal-setting process suggests that explicit discussion of goals for care may be necessary to promote effective patient-family-clinician communication and adequate care planning.

  13. The N-Gram Hypothesis Applied to Matched Sets of Visualized Japanese-English Technical Documents.

    ERIC Educational Resources Information Center

    Rorvig, Mark; Smith, Michael M.; Uemura, Aya

    1999-01-01

    Shape Recovery Analysis (SHERA), a new visual analytical technique, is applied to the N-Gram hypothesis on matched Japanese-English technical documents. Results reveal compaction in the translation of Japanese subject terms to English subject terms. The biagram approach to the Japanese data yields a remarkable similarity to the matching visualized…

  14. [Causal attribution and conflict resolution in the Japanese language instruction setting].

    PubMed

    Kagami, Tomiyo; Ohbuchi, Ken-ichi

    2004-02-01

    Conflicts sometimes arise between the language teachers and foreign students in the Japanese language instruction setting. The purpose of this study was to investigate the relationship of causal attribution and selection of conflict resolution strategies in such conflicts, and to explicate the characteristics of intercultural conflicts resolution strategies, especially paying attention to the teacher expectation of student strategy to resolve a conflict. A questionnaire was administered to 84 Japanese teachers, 214 Chinese students, and 154 Korean students. Results indicated that when students attributed the conflict to the teachers, they chose assertive strategies, and that when attributed to themselves, compromising strategies were used. Moreover, while Chinese students tended to use such compromising strategies as cooperation and obedience when they attributed the conflict to cultural differences, Korean students did not tend to use non-confrontational strategies. The teachers did not expect their students to use assertive strategies, and the large gap between teacher and student perception of assertive strategies could be one of reasons for difficulties that arise in such intercultural conflict resolution.

  15. [Causal attribution and conflict resolution in the Japanese language instruction setting].

    PubMed

    Kagami, Tomiyo; Ohbuchi, Ken-ichi

    2004-02-01

    Conflicts sometimes arise between the language teachers and foreign students in the Japanese language instruction setting. The purpose of this study was to investigate the relationship of causal attribution and selection of conflict resolution strategies in such conflicts, and to explicate the characteristics of intercultural conflicts resolution strategies, especially paying attention to the teacher expectation of student strategy to resolve a conflict. A questionnaire was administered to 84 Japanese teachers, 214 Chinese students, and 154 Korean students. Results indicated that when students attributed the conflict to the teachers, they chose assertive strategies, and that when attributed to themselves, compromising strategies were used. Moreover, while Chinese students tended to use such compromising strategies as cooperation and obedience when they attributed the conflict to cultural differences, Korean students did not tend to use non-confrontational strategies. The teachers did not expect their students to use assertive strategies, and the large gap between teacher and student perception of assertive strategies could be one of reasons for difficulties that arise in such intercultural conflict resolution. PMID:15112508

  16. Nurses’ experiences of humour in clinical settings

    PubMed Central

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

    2015-01-01

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

  17. Impact of Contraceptive Counseling in Clinical Settings

    PubMed Central

    Zapata, Lauren B.; Tregear, Stephen J.; Curtis, Kathryn M.; Tiller, Marie; Pazol, Karen; Mautone-Smith, Nancy; Gavin, Loretta E.

    2015-01-01

    Context This systematic review evaluated the evidence on the impact of contraceptive counseling provided in clinical settings on reproductive health outcomes to provide information to guide national recommendations on quality family planning services. Evidence acquisition Multiple databases were searched during 2010–2011 for peer-reviewed articles published in English from January 1985 through February 2011 describing studies that evaluated contraceptive counseling interventions in clinical settings. Studies were excluded if they focused primarily on prevention of HIV or sexually transmitted infections, focused solely on men, or were conducted outside the U.S., Canada, Europe, Australia, or New Zealand. Evidence synthesis The initial search identified 12,327 articles, of which 22 studies (from 23 articles) met the inclusion criteria. Six studies examined the impact of contraceptive counseling among adolescents, with four finding a significant positive impact on at least one outcome of interest. Sixteen studies examined the impact of counseling among adults or mixed populations (adults and adolescents), with 11 finding a significant positive impact on at least one outcome of interest. Conclusions Promising components of contraceptive counseling were identified despite the diversity of interventions and inability to compare the relative effectiveness of one approach versus another. The evidence base would be strengthened by improved documentation of counseling procedures; assessment of intervention implementation and fidelity to put study findings into context; and development and inclusion of more RCTs, studies conducted among general samples of women, and studies with sample sizes sufficient to detect important behavioral outcomes at least 12 months post-intervention. PMID:26190845

  18. Feasibility and clinical utility of the Japanese version of the Abbey pain scale in Japanese aged care.

    PubMed

    Takai, Yukari; Yamamoto-Mitani, Noriko; Chiba, Yumi; Kato, Ayako

    2014-06-01

    Active usage of observational pain scales in Japanese aged-care facilities has not been previously described. Therefore, to examine the feasibility and clinical utility of the Abbey Pain Scale-Japanese version (APS-J), this study examined the interrater reliability of the APS-J among a researcher, nurses, and care workers in aged-care facilities in Japan. This study also aimed to obtain nurses' and care workers' opinions on use of the scale. The following data were collected from 88 residents of two aged-care facilities: demographics, Barthel Index, Folstein Mini-Mental Examination (MMSE), 15-item Geriatric Depression Scale (GDS-15), and APS-J for pain. The researchers, nurses, and care workers independently assessed the residents' pain by using the APS-J, and intraclass correlation coefficients (ICC) for interrater reliability and Cronbach alpha for internal consistency were examined. The ICC between researchers and nurses, researchers and care workers, and nurses and care workers were 0.68, 0.74, and 0.76, respectively. Nurses and care workers were invited for focus group interviews to obtain their opinions regarding APS-J use. During these interviews, nurses and care workers stated that the observational points of APS-J subscales were the criteria they normally used to evaluate residents' pain. Several nurses and care workers reported a gap between the estimated pain intensity and APS-J score. Unclear APS-J criteria, difficulties in observing residents, and insufficient practice guidelines were also reported. Our findings indicate that the APS-J has moderate reliability and clinically utility. To facilitate APS-J usage, education and clinical guidelines for pain management may be required for nurses and care workers.

  19. 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 style), reading…

  20. 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…

  1. A Clinical Study of Adult Japanese Encephalitis in the Chonnam District, Korea, During Summer of 1982

    PubMed Central

    Bom, Hee Seung; Kang, Hyung Koo; Joh, Nam Joong; Kim, Sei Jong; Yoon, Chong Mann; Cho, Kun Kook; Park, Hong Bae

    1986-01-01

    In the summer of 1982, we experienced a great number of patients with Japanese encephalitis compared with the previous years. We have studied 85 adult cases of Japanese encephalitis which were diagnosed clinically and/or serologically. A difference between improved and expired cases was also investigated. We found that deteriorated mental state, elevated SGOT (AST) level, lower hemagglutination-inhibition(H-I) titer, and a more acute onset of the illness were associated with higher mortality. The mortality rate in our cases was 35.3 percent. PMID:15759371

  2. Comprehensive screening for a complete set of Japanese-population-specific filaggrin gene mutations.

    PubMed

    Kono, M; Nomura, T; Ohguchi, Y; Mizuno, O; Suzuki, S; Tsujiuchi, H; Hamajima, N; McLean, W H I; Shimizu, H; Akiyama, M

    2014-04-01

    Mutations in FLG coding profilaggrin cause ichthyosis vulgaris and are an important predisposing factor for atopic dermatitis. Until now, most case-control studies and population-based screenings have been performed only for prevalent mutations. In this study, we established a high-throughput FLG mutation detection system by real-time PCR with a set of two double-dye probes and conducted comprehensive screening for almost all of the Japanese-population-specific FLG mutations (ten FLG mutations). The present comprehensive screening for all ten FLG mutations provided a more precise prevalence rate for FLG mutations (11.1%, n = 820), which seemed high compared with data of previous reports based on screening for limited numbers of FLG mutations. Our comprehensive screening suggested that population-specific FLG mutations may be a significant predisposing factor for hay fever (odds ratio = 2.01 [95% CI: 1.027-3.936, P < 0.05]), although the sample sizes of this study were too small for reliable subphenotype analysis on the association between FLG mutations and hay fever in the eczema patients and the noneczema individuals, and it is not clear whether the association between FLG mutations and hay fever is due to the close association between FLG mutations and hay fever patients with eczema.

  3. Setting up a clinical engineering department.

    PubMed

    Guignon, E

    1980-01-01

    The problems of cost, personnel qualifications, task assignment, and productivity involved in establishing a clinical engineering department are addressed in this paper. A basic department consisting of a Clinical Engineer, a Biomedical Equipment Technician, a Testing Technician and a Clerical Assistant can provide a full range of clinical engineering services to a hospital with 225 instruments. The annual cost of such a department, including materials, would be approximately $90,000. The average capital investment in a selection of 225 instruments would be on the order of $860,000. This paper discusses levels of skills within a clinical engineering department, and the services that a hospital could expect from a four-man department. PMID:10246340

  4. Clinical neuropsychology in the criminal forensic setting.

    PubMed

    Denney, R L; Wynkoop, T F

    2000-04-01

    This article reviews the application of clinical neuropsychology to criminal court proceedings, a complex, underserved, yet growing area of neuropsychological practice. The authors write from the perspective that the audience is primarily neurorehabilitation clinicians with limited experience in criminal matters. Discussions on the theoretical differences between clinical and forensic work, the forensic evaluation process with conceptual model, historical and current perspectives on criminal competencies and responsibility, prediction of dangerousness, and professional and ethical issues often encountered in criminal neuropsychology are provided.

  5. Prevalence of depressive symptoms in a Japanese occupational setting: a preliminary study.

    PubMed

    Iwata, N; Okuyama, Y; Kawakami, Y; Saito, K

    1989-11-01

    We measured the prevalence of depressive symptoms in 2,190 Japanese tax office workers using the Japanese version of the Center for Epidemiologic Studies Depression Scale (CES-D). Score distribution by sex was more symmetrical and the mean score of each sex was higher than in the United States population. A high level of depressive symptoms was found in 15.2 percent of males and 10.6 percent of females by controlling for age and marital status. Males aged 50 years and over had more depressive symptoms than other male age groups. Perceived stress, related both to family life and the workplace, was associated with a high level of depressive symptoms. "Long-distance marriage" ("business bachelorhood"), peculiar to Japanese occupations, had little influence on depressive symptomatology.

  6. 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…

  7. 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.

  8. 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.

  9. The quality of conduct in Japanese clinical trials: deficiencies found in GCP inspections.

    PubMed

    Ono, Shunsuke; Kodama, Yasuo; Nagao, Taku; Toyoshima, Satoshi

    2002-02-01

    The quality of commercially sponsored clinical studies in Japan was examined with reference to deficiencies in the audit reports issued by the Organization for Pharmaceutical Safety and Research (OPSR). The OPSR is responsible for domestic good clinical practice auditing in Japan. Routine audits from 1997 to 2000 for 331 hospitals revealed various types of deficiencies such as errors in case report form (CRF) entries, institutional review board problems, and protocol deviations. The high prevalence of CRF-related deficiencies seemed to stem from peculiarities of the Japanese study environment such as the historical lack of on-site monitoring by the sponsor and the absence of research nurses. Characteristics in usual medical practices such as multiple drug use and loose informed consent also seemed to be associated with prevalence of similar deficiencies in clinical trials.

  10. Clinical, biochemical, and genetic features of non-classical 21-hydroxylase deficiency in Japanese children.

    PubMed

    Kashimada, Kenichi; Ishii, Tomohiro; Nagasaki, Keisuke; Ono, Makoto; Tajima, Toshihiro; Yokota, Ichiro; Hasegawa, Yukihiro

    2015-01-01

    Non-classical 21-hydroxylase deficiency (NC21-OHD) is a mild form of 21-hydroxylase deficiency lacking apparent symptoms of androgen excess at birth. Most NC21-OHD cases are diagnosed after the onset of puberty, while a substantial number of patients are not diagnosed during childhood. Previous studies have reported ethnic differences in the prevalence of NC21-OHD. To date, the clinical features of NC21-OHD in Japanese children have not been systemically reported. Thus, we performed 3 independent analyses: retrospective analyses of newborn screening in 2 major Japanese cities (Sapporo and Niigata) and a national surveillance collecting clinical information from pediatric endocrinologists throughout the country. During the last 10 years, one case of NC21-OHD was diagnosed by newborn screening in each city, resulting in incidences of 2.0 (95% confidence interval = 0.0-5.9) and 2.1 (0.0-6.2) per 1,000,000 in Sapporo and Niigata, respectively. We collected information from 85% of the 135 Councilors of Japanese Society of Pediatric Endocrinology. Fifteen NC21-OHD patients were diagnosed during childhood, resulting in the estimated prevalence of 0.58 (0.28-1.1) per 1,000,000. Eleven patients were discovered by newborn screening, 7 patients developed hyperandrogenism symptoms (2-8 years of age, median 7), and 9 patients were treated with hydrocortisone at the time of the survey. Ten out of 13 patients showed compound heterozygosity for the P30L mutation of CYP21A2. Our study suggests that the prevalence/incidence of NC21-OHD is lower than that in Western countries, and that the age for initial onset of androgen excess symptoms varies during the prepubertal period.

  11. [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.

  12. 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

  13. 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

  14. 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

  15. Caregiver burden among Japanese informal caregivers of cognitively impaired elderly in community settings.

    PubMed

    Hirakawa, Yoshihisa; Kuzuya, Masafumi; Enoki, Hiromi; Hasegawa, Jun; Iguch, Akihisa

    2008-01-01

    Because dementia is a progressive disease, formal long-term care providers and care managers need information on how the severity of cognitive impairment affects caregiver burden in order to better assist family caregivers. However, research to guide care providers in behavioral symptom-management is not well developed. The purpose of this study was to examine the relationship between dementia status and burden of family caregivers. The subjects were 1875 community-dwelling elderly eligible for public long-term care insurance. The data we used in this analysis included the caregivers' and dependents' characteristics. The main outcome was subjective caregiver burden assessed by the Japanese version of the Zarit Burden Interview (J-ZBI). A total of 1559 pairs of dependents and caregivers were included in the analysis. The pairs were sorted into three mutually exclusive categories: no dementia, mild dementia, and severe dementia. Two hundred sixty-one dependents had severe dementia, and 725 had mild dementia. Although differences were found among the dementia categories in levels of caregiver burden according to the J-ZBI before and after adjusting for these baseline variables, the odds ratios equal nearly 1. The present study shows that severity of dementia is not associated with caregiver burden in Japan. PMID:17767968

  16. Clinical outcome and neurological sequelae in serologically confirmed cases of Japanese encephalitis patients in Assam, India.

    PubMed

    Baruah, H C; Biswas, D; Patgiri, D; Mahanta, J

    2002-12-01

    We report the clinical outcome and prognostic factors in 39 cases of childhood Japanese Encephalitis admitted to a tertiary hospital of Upper Assam and followed up for 421 days in the community. The mortality rate was 20.5% in our study. The mean GCS (9.97 +/- 0.91) was higher in surviving cases than the fatal cases (GCS 7.5 +/- 1.78) at admission. The fatal cases died within 4.75 +/- 3.19 days in the hospital. All the patients had low BMI (surviving cases 13.54 +/- 2.3; fatal cases 12.05 +/- 0.12) and were anemic. Cerebrospinal fluid (CSF) was clear in 91.4% cases but pressure and protein content were increased in all cases. About 10% cases had parkinsonian features at the time of discharge. Residual symptoms remained in about one third of cases even after 421 days. PMID:12522277

  17. Mild Clinical Course of Severe Fever with Thrombocytopenia Syndrome Virus Infection in an Elderly Japanese Patient

    PubMed Central

    Ohagi, Yuko; Nakamoto, Chiaki; Nakamoto, Hiromichi; Saijo, Masayuki; Shimojima, Masayuki; Nakano, Yoshio; Fujimoto, Tokuzo

    2014-01-01

    Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious and hemorrhagic disease recently described in China and western Japan. A 71-year-old healthy Japanese woman noticed a tick biting her after harvesting in an orchard and removed it herself. She developed diarrhea, anorexia, and chills eight days later. Because these symptoms continued, she visited a primary care physician 6 days after the onset. Laboratory data revealed thrombocytopenia, leukocytopenia, and elevated liver enzymes. She was then referred to our hospital. Although not completely fulfilling the diagnostic criteria used in a retrospective study in Japan, SFTS was suspected, and we detected SFTS virus in the patient's blood using RT-PCR. However, she recovered without intensive treatment and severe complications 13 days after the onset. In this report, we present a mild clinical course of SFTS virus infection in Japan in detail. PMID:25574405

  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.

  19. [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.

  20. First clinical application of the DuraHeart centrifugal ventricular assist device for a Japanese patient.

    PubMed

    Yoshitake, Isamu; El-Banayosy, Aly; Yoda, Masataka; Hata, Mitsumasa; Sezai, Akira; Niino, Tetsuya; Wakui, Shinji; Koerfer, Reiner; Minami, Kazutomo

    2009-09-01

    The DuraHeart ventricular assist device (VAD) is a third-generation implantable centrifugal pump with a magnetically levitated impeller. Since February 2007, the device has been clinically applied with excellent results as a bridge to heart transplantation in Europe. As of this writing, however, the device has yet to be approved by the Ministry of Health, Labour and Welfare for clinical use in Japan. We herein report the first clinical application of this device for a Japanese patient. A 31-year-old man with dilated cardiomyopathy was transferred to the Heart and Diabetes Center NRW (HDZ-NRW) in Bad Oeynhausen, Germany, where he was to await heart transplantation. The transfer was safely completed under management with low-dose dopamine. His condition gradually deteriorated at HDZ-NRW, and the DuraHeart left ventricular assist device was implanted for the left ventricle at 7 weeks after admission. Shortly thereafter, however, on POD 7, a Thoratec VAD had to be inserted on the right side due to refractory right heart failure. The right ventricular assist device could be explanted after a 3-month assist, and the patient is now waiting for heart transplantation at home in Germany.

  1. 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,…

  2. Baccalaureate Nursing Students' Communication Process in the Clinical Setting.

    ERIC Educational Resources Information Center

    Kotecki, Catherine Nuss

    2002-01-01

    Interviews (n=22) and observations (n=14) in clinical settings were coded and analyzed to identify student nurses' problems in communicating with patients and the process of learning solutions. The process involved affirming the self, engaging the patient, experiencing communication breakdown, and refining the repertoire of communication…

  3. 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…

  4. 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. PMID:26928824

  5. 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.

  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. 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…

  8. 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…

  9. 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.

  10. 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. PMID:25817352

  11. 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.

  12. 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. PMID:17959255

  13. 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.

  14. 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

  15. 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. PMID:26351216

  16. 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

  17. Manual Linear Movements to Assess Spasticity in a Clinical Setting

    PubMed Central

    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. PMID:23335966

  18. Clinical Traumatic Brain Injury in the Preclinical Setting.

    PubMed

    Berkner, Justin; Mannix, Rebekah; Qiu, Jianhua

    2016-01-01

    Traumatic brain injury (TBI) is the leading cause of death and disability for people under 45 years of age. Clinical TBI is often the result of disparate forces resulting in heterogeneous injuries. Preclinical modeling of TBI is a vital tool for studying the complex cascade of metabolic, cellular, and molecular post-TBI events collectively termed secondary injury. Preclinical models also provide an important platform for studying therapeutic interventions. However, modeling TBI in the preclinical setting is challenging, and most models replicate only certain aspects of clinical TBI. This chapter details the most widely used models of preclinical TBI, including the controlled cortical impact, fluid percussion, blast, and closed head models. Each of these models replicates particular critical aspects of clinical TBI. Prior to selecting a preclinical TBI model, it is important to address what aspect of human TBI is being sought to evaluate. PMID:27604710

  19. Student nurses' experiences of anxiety in the clinical setting.

    PubMed

    Melincavage, Sharon M

    2011-11-01

    It is known that some student nurses who experience anxiety during clinical experiences leave nursing education programs. If nurse educators can better understand the anxiety of student nurses during clinical experience, they will be able to develop educational interventions to minimize students' anxiety. Decreasing anxiety has a two-fold effect. First, when anxiety is decreased, learning may be increased. Second, decreasing anxiety may help alleviate the nursing shortage because more students complete their nursing education. This qualitative phenomenological study examines student nurses' perception of anxiety in the clinical setting. Situated cognition learning theory is the theoretical framework. The main method of data collection is unstructured face-to-face interviews with 7 student nurses. The data was analyzed using a thematic analysis. The themes are reported in the rich descriptive words of the subjects. Implications for practice are discussed.

  20. 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.

  1. Clinical aspects and adrenal functions in eleven Japanese children with X-linked adrenoleukodystrophy.

    PubMed

    Miyoshi, Yoko; Sakai, Norio; Hamada, Yusuke; Tachibana, Makiko; Hasegawa, Yasuhiro; Kiyohara, Yuki; Yamada, Hiroyuki; Murakami, Mari; Kondou, Hiroki; Kimura-Ohba, Shihoko; Mine, Junji; Sato, Tatsuharu; Kamio, Noriko; Ueda, Hitoshi; Suzuki, Yasuhiro; Shiomi, Masashi; Ohta, Hideaki; Shimozawa, Nobuyuki; Ozono, Keiichi

    2010-01-01

    X-linked adrenoleukodystrophy (X-ALD) is a genetic disease associated with demyelination of the central nervous system, adrenocortical insufficiency and accumulation of very long chain fatty acids. It is a clinically heterogeneous disorder ranging from a severe childhood cerebral form to an asymptomatic form. The incidence in Japan is estimated to be between 1:30,000 and 1:50,000 boys as determined by a nationwide retrospective survey between 1990 and 1999, which found no cases with Addison's form. We reviewed the medical records of eleven Japanese boys with X-ALD from 1990 to 2010 in our institute. Eight patients were detected by neuropsychological abnormalities, whereas a higher prevalence of unrecognized adrenocortical insufficiency (5/11: 45%) was observed than previously recognized. While no neurological abnormalities were demonstrated in two brothers, the elder brother had moderate Addison's disease at diagnosis and the presymptomatic younger brother progressed to Addison's disease six months after the diagnosis of X-ALD. Early detection of impaired adrenal function as well as early identification of neurologically presymptomatic patients by genetic analysis is essential for better prognosis. Addison's form might be overlooked in Japan; therefore, X-ALD should be suspected in patients with adrenocortical insufficiency.

  2. Teaching in daily clinical practice: how to teach in a clinical setting.

    PubMed

    Ruesseler, M; Obertacke, U

    2011-06-01

    Teaching in the clinical setting is challenging; however, it is the location where students apply their learned facts and learn skills and attitudes most effectively. In order to improve clinical teaching, it is important to know and implement the principles of adult learning. The clinical teacher should know or assess the learners' prior knowledge and skills, as well as their stage of learning, before starting a new teaching session. The learners should be actively involved in the clinical processes. Questions to probe students' deeper understanding and capability to analyze, synthesize, and apply medical knowledge should be an important part of clinical teaching. Regular structured feedback is an important part of any learning experience.

  3. Educational Preparation for the Clinic Job Setting: Clinical Athletic Trainers' Perspectives

    ERIC Educational Resources Information Center

    Schilling, Jim; Combs, Martha

    2011-01-01

    Context: Acquiring input from all stakeholders on the importance of existing competencies and suggestions for new ones is essential to competency-based pedagogical design quality. Objective: To survey athletic trainers (ATs) employed in clinical settings to assess their perceptions of the competencies most pertinent to their settings and whether…

  4. 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. PMID:27045304

  5. Clinical Pearls in Using Antiarrhythmic Drugs in the Outpatient Setting.

    PubMed

    Parker, Mary H; Sanoski, Cynthia A

    2016-02-01

    A role for oral antiarrhythmic drugs (AADs) remains in clinical practice for patients with atrial and ventricular arrhythmias in spite of advances in nonpharmacologic therapy. Pharmacists play a vital role in the appropriate use of AAD dosing, administration, adverse effects, interactions, and monitoring. Pharmacists who are involved in providing care to patients with cardiac arrhythmias must remain updated regarding the efficacy and safety of the most commonly used AADs. This review will address key issues for appropriate initiation and maintenance of commonly selected Vaughan-Williams Class Ic and III agents in the outpatient setting.

  6. [Screening of sexually transmitted diseases in clinical and non-clinical settings in Salvador, Bahia, Brazil].

    PubMed

    de Codes, José Santiago; Cohen, Deborah Ann; de Melo, Neli Almeida; Teixeira, Guilherme Gonzaga; Leal, Alexandre dos Santos; Silva, Tiago de Jesus; de Oliveira, Miucha Pereira Rios

    2006-02-01

    The objectives were to study: (1) acceptance of STD screening in non-clinical settings for asymptomatic individuals; (2) risk factors and STD prevalence among individuals in non-clinical and clinical settings; and (3) non-clinical screening of asymptomatic populations as a feasible method for STD control. We recruited 139 males and 486 females between 18 and 30 years of age from a family planning clinic, schools, and community centers in low-income neighborhoods. We asked about STD symptoms and STD/HIV risk behaviors and tested the individuals for gonorrhea, Chlamydia, syphilis, and HIV. Except for HIV, women recruited directly from the community had higher STD rates than those who came in for care at the clinic. Screening in non-clinical settings in Brazil is feasible and has a high yield among young adults in low-income communities. Infected participants would likely never have otherwise sought care or been tested or treated. STD control efforts could be implemented in any site that can reach populations at risk and become a routine procedure in health care settings where people report for problems unrelated to STDs.

  7. 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

  8. 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

  9. Clinical observations of odontomas in Japanese children: 39 cases including one recurrent case.

    PubMed

    Tomizawa, M; Otsuka, Y; Noda, T

    2005-01-01

    Retrospective investigations of odontomas in Japanese children and one recurrent case were carried out. Thirty-nine cases of odontoma in 38 children were treated in the Paediatric Dentistry Clinic of Niigata University Dental Hospital between September 1979 and December 2002. The patients consisted of 23 males and 15 females and their ages ranged from 1 year 2 months to 14 years old. The chief complaints were delayed tooth eruption in 19 cases (five: primary teeth, 14: permanent teeth), retention of primary teeth in 11, incidentally found on the radiographic examination in eight cases, and swelling of the jaw in one case. Thirty-four cases (87%) were associated with tooth eruption disturbances. The most frequently affected region was the maxillary anterior region. Treatment consisted of surgical removal of odontomas in all cases, after which if the impacted teeth did not erupt, exposure of the crown and/or orthodontic traction was performed. Pathological diagnoses were compound odontoma in 30 cases, complex odontoma (n = 7), and compound and complex odontoma (n = 2). A retrospective study of the radiographs revealed the developing process of odontomas in four cases and odontoma disturbed tooth eruption since the early uncalcified developing stage. A recurrent case was a boy aged 6 years 5 months in whom the first surgical removal of odontoma was performed at the age of 1 year 8 months. Recurrence of an odontoma is very rare, but in very young children odontomas are in the early developing stages, containing uncalcified portions, so it is important to perform periodical observations until the succedaneous teeth erupt.

  10. 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

  11. 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

  12. Medical research in clinical emergency settings in Europe.

    PubMed

    Lötjönen, S

    2002-06-01

    Clinical emergencies necessitate immediate action to avert the danger to the patient's life or health. Emergency patients might be in greatest need of novel therapies, and even presumed willing to assume some risk, but research into emergency conditions should be conducted under commonly accepted principles that fulfil the scientific, ethical, and legal criteria. Such criteria already exist in the US, but are still under development in Europe. This article introduces criteria upon which trials in emergency settings may be ethically and legally justified in Europe. Based on both legal texts and professional guidelines, the author has established seven conditions for emergency research, of which informed consent and its substitutes, as well as the conditions of direct benefit requirement and necessity, are considered most problematic and therefore analysed more closely. Other conditions include absence of alternative methods, scientific validity, and approval by an ethics committee.

  13. [Analysis of an intercultural clinical practice in a judicial setting].

    PubMed

    Govindama, Yolande

    2007-01-01

    This article analyses an intercultural clinical practice in a legal setting from an anthropological and psychoanalytical perspective, demonstrating necessary reorganizations inherent to the framework. The culture of the new country and its founding myth being implicit to the judicial framework, the professional intervening introduces psychoanalytical references particularly totemic principles and the symbolic father by making genealogy, a universal object of transmission as guarantee of fundamental taboos of humanity. The metacultural perspective in this approach integrates ethnopsychoanalytical principles put forth by Devereux as well as the method although this latter has been adapted to the framework. This approach allows to re-question Devereux's ethnopsychoanalytical principles by opening the debate on the perspective of a psychoanalytical as well as psychiatric.

  14. Molecular epidemiology and clinical spectrum of hereditary spastic paraplegia in the Japanese population based on comprehensive mutational analyses.

    PubMed

    Ishiura, Hiroyuki; Takahashi, Yuji; Hayashi, Toshihiro; Saito, Kayoko; Furuya, Hirokazu; Watanabe, Mitsunori; Murata, Miho; Suzuki, Mikiya; Sugiura, Akira; Sawai, Setsu; Shibuya, Kazumoto; Ueda, Naohisa; Ichikawa, Yaeko; Kanazawa, Ichiro; Goto, Jun; Tsuji, Shoji

    2014-03-01

    Hereditary spastic paraplegia (HSP) is one of the most genetically heterogeneous neurodegenerative disorders characterized by progressive spasticity and pyramidal weakness of lower limbs. Because >30 causative genes have been identified, screening of multiple genes is required for establishing molecular diagnosis of individual patients with HSP. To elucidate molecular epidemiology of HSP in the Japanese population, we have conducted mutational analyses of 16 causative genes of HSP (L1CAM, PLP1, ATL1, SPAST, CYP7B1, NIPA1, SPG7, KIAA0196, KIF5A, HSPD1, BSCL2, SPG11, SPG20, SPG21, REEP1 and ZFYVE27) using resequencing microarrays, array-based comparative genomic hybridization and Sanger sequencing. The mutational analysis of 129 Japanese patients revealed 49 mutations in 46 patients, 32 of which were novel. Molecular diagnosis was accomplished for 67.3% (33/49) of autosomal dominant HSP patients. Even among sporadic HSP patients, mutations were identified in 11.1% (7/63) of them. The present study elucidated the molecular epidemiology of HSP in the Japanese population and further broadened the mutational and clinical spectra of HSP. PMID:24451228

  15. 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

  16. Dignity in care in the clinical setting: a narrative review.

    PubMed

    Lin, Yea-Pyng; Watson, Roger; Tsai, Yun-Fang

    2013-03-01

    This review aimed to explore nursing literature and research on dignity in care of inpatients and to evaluate how the care patients received in the hospital setting was related to perceived feelings of being dignified or undignified. Studies conducted between 2000 and 2010 were considered, using Cumulative Index to Nursing and Allied Health Literature and MEDLINE, and the search terms 'patient dignity', 'dignity in care', 'human dignity and nursing' and 'dignity and nursing ethics'. Findings revealed, from the perspectives of nurses and patients, that dignity in care in the hospital setting is seen to be influenced by physical environment, staff attitude and behaviour, organisational culture and patient independence. This review can help nurses to better understand dignity in care, and for policy makers, there are implications about determining the physical environment, staff attitude and behaviour and organisational culture needed to promote patient dignity in nursing. By identifying the most important factors from patients' and nurses' perspectives that contribute to dignity in care, nursing interventions, such as campaigns and education in clinical practice, can be developed.

  17. A Clinical Librarian-Nursing Partnership to Bridge Clinical Practice and Research in an Oncology Setting.

    PubMed

    Ginex, Pamela K; Hernandez, Marisol; Vrabel, Mark

    2016-09-01

    Nurses today work in practice settings where the expectation is to "draw upon the best evidence to provide the care most appropriate to each patient" (Olsen, Goolsby, & McGinnis, 2009, p. 10) while caring for patients with high acuity in highly specialized settings. Within the nursing profession, the Magnet Recognition Program® advocates for exemplary professional practice and the generation of new knowledge through research and clinical innovation. Nurses working in a clinical setting are often the best resource to identify important clinical questions and gaps in practice, but a lack of resources presents challenges to nurses in fully developing their questions and identifying the most appropriate methods to answer them. These challenges often fall into three broad categories: individual nurse characteristics, organizational characteristics, and environmental characteristics (Dobbins, Ciliska, Cockerill, Barnsley, & DiCenso, 2002). Creating a dedicated partnership between nurses and library staff is one method that can overcome these challenges to use existing resources and support nurses who are asking and answering important clinical questions (DePalma, 2005; Vrabel, 2005). 
. PMID:27541547

  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. PMID:26166322

  19. 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

  20. Light-induced deterioration test of carboplatin under clinical settings.

    PubMed

    Okamoto, Yoshiaki; Tazumi, Keiko; Sanada, Yasuaki; Tsugane, Mamiko; Uejima, Etsuko

    2010-10-01

    Chemotherapeutic drug dosages are calculated precisely based on the patient's height, body weight, and renal function, etc. To ensure safe and favorable outcomes of treatment, dosing solutions are prepared by appropriate mixing of the drug solutions based on such calculations. The package inserts for many injectable preparations include a warning for storing the product "shielded from light." However, there are no reports of stability assessment of a mixed product against light exposure or the residual amount of active ingredient in the dosing solution during or at the end of treatment. We evaluated the stability of carboplatin from the time of mixing of the dosing solution until the end of drug infusion in a clinical-like setting. With 4-hour exposure to outdoor scattered light, the dosing solution began to show discoloration by 1 hour, becoming dark yellow by 4 hours, with reduction of the percent residual carboplatin to about 23%. To identify the optimal light-shielding shade, the dosing solution was shielded from outdoor scattered light with 1 of 3 protective covers: aluminum foil, yellow plastic shade, and brown plastic shade. The yellow plastic shade prevented any changes of the appearance of the dosing solution during the 4-hour exposure period. The percent residual carboplatin, determined by HPLC, in the dosing solution shielded with a yellow plastic shade was about 85.2% at 2 hours and 78.6% at 4 hours. Thus carboplatin dosing solution should be completely shielded from light until infusion is completed.

  1. Confocal microendoscope for use in a clinical setting

    NASA Astrophysics Data System (ADS)

    Udovich, Joshua A.; Rouse, Andrew R.; Tanbakuchi, Anthony; Brewer, Molly A.; Sampliner, Richard; Gmitro, Arthur F.

    2007-02-01

    A mobile confocal microendoscope for use in a clinical setting has been developed. This system employs an endoscope consisting of a custom designed objective lens with a fiber optic imaging bundle to collect in-vivo images of patients. Some highlights and features of this mobile system include frame rates of up to 30 frames per second, an automated focus mechanism, automated dye delivery, clinician control, and the ability to be used in an area where there is a single 110V outlet. All optics are self-contained and the entire enclosure and catheter can be moved between surgical suites, sterilized and brought online in under 15 minutes. At this time, all data have been collected with a 488 nm laser, but the system is able to have a second laser line added to provide additional imaging capability. Preliminary in vivo results of images from the ovaries using topical fluorescein as a contrast agent are shown. Future plans for the system include use of acridine orange (AO) or SYTO-16 as a nucleic acid stain.

  2. Physician judgment in clinical settings: methodological influences and cognitive performance.

    PubMed

    Dawson, N V

    1993-07-01

    Understanding the quality of physicians' intuitive judgments is essential in determining the appropriate use of their judgments in medical decision-making (vis-a-vis analytical or actuarial approaches). As part of this process, the quality of physicians' predictions must be assessed because prediction is fundamental to common clinical tasks: determining diagnosis, prognosis, and therapy; establishing monitoring intervals; performing screening and preventive maneuvers. Critical evaluation of predictive capabilities requires an assessment of the components of the prediction process: the data available for prediction, the method used for prediction, and the accuracy of prediction. Although variation in and uncertainty about the underlying data elements are often acknowledged as a source of inaccurate predictions, prediction also can be confounded by both methodological and cognitive limitations. During the past two decades, numerous factors have been recognized that may bias test characteristics (sensitivity and specificity). These same factors may also produce bias in intuitive judgments. The use of cognitive processes to simplify judgment tasks (e.g., the availability and representativeness heuristics) and the presence of certain biases in the judgment process (e.g., ego, regret) may present obstacles to accurate estimation of probabilities by physicians. Limitations on the intuitive use of information (cognitive biases) have been demonstrated in both medical and nonmedical decision-making settings. Recent studies have led to a deepening understanding of the advantages and disadvantages of intuitive and analytical approaches to decision making. Here, many aspects of the basis for this understanding are reviewed.

  3. 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.

  4. Japanese; Japanese Songs.

    ERIC Educational Resources Information Center

    Defense Language Inst., Washington, DC.

    This supplementary textbook for students of Japanese presents a collection of 43 songs--folk songs, nursery songs, lullabies, love songs, wedding songs, graduation songs, the national anthem, drinking songs, school songs, and Christmas carols. With the exception of the carols, the musical scores are presented with their Japanese lyrics. The…

  5. Acute Zonal Occult Outer Retinopathy in Japanese Patients: Clinical Features, Visual Function, and Factors Affecting Visual Function

    PubMed Central

    Saito, Saho; Saito, Wataru; Saito, Michiyuki; Hashimoto, Yuki; Mori, Shohei; Noda, Kousuke; Namba, Kenichi; Ishida, Susumu

    2015-01-01

    Purpose To evaluate the clinical features and investigate their relationship with visual function in Japanese patients with acute zonal occult outer retinopathy (AZOOR). Methods Fifty-two eyes of 38 Japanese AZOOR patients (31 female and 7 male patients; mean age at first visit, 35.0 years; median follow-up duration, 31 months) were retrospectively collected: 31 untreated eyes with good visual acuity and 21 systemic corticosteroid-treated eyes with progressive visual acuity loss. Variables affecting the logMAR values of best-corrected visual acuity (BCVA) and the mean deviation (MD) on Humphrey perimetry at initial and final visits were examined using multiple stepwise linear regression analysis. Results In untreated eyes, the mean MD at the final visit was significantly higher than that at the initial visit (P = 0.00002). In corticosteroid-treated eyes, the logMAR BCVA and MD at the final visit were significantly better than the initial values (P = 0.007 and P = 0.02, respectively). The final logMAR BCVA was 0.0 or less in 85% of patients. Variables affecting initial visual function were moderate anterior vitreous cells, myopia severity, and a-wave amplitudes on electroretinography; factors affecting final visual function were the initial MD values, female sex, moderate anterior vitreous cells, and retinal atrophy. Conclusions Our data indicated that visual functions in enrolled patients significantly improved spontaneously or after systemic corticosteroids therapy, suggesting that Japanese patients with AZOOR have good visual outcomes during the follow-up period of this study. Furthermore, initial visual field defects, gender, anterior vitreous cells, and retinal atrophy affected final visual functions in these patients. PMID:25919689

  6. Labor Resource Use for Endoscopic Gastric Cancer Screening in Japanese Primary Care Settings: A Work Sampling Study

    PubMed Central

    Goto, Rei; Arai, Kohei; Kitada, Hirotsugu; Ogoshi, Kazuei; Hamashima, Chisato

    2014-01-01

    Objective Endoscopic gastric cancer is screened in primary care settings, but how much resources are required to deliver this service remains unknown. This study determines how much time and human resources are used for endoscopic gastric cancer and for each component of the procedure. Materials and Methods Upper endoscopic procedures were prospectively observed using a work sampling technique. This study analyzed data from patients who underwent upper endoscopic gastric cancer screening at primary care clinics that provide this service. The main outcome measurements were time intervals and total time intervals that considered the numbers of simultaneously engaged workers and were calculated as the product of time intervals and the number of workers, and the labor cost of individual components of each procedure. Results We observed 44 upper endoscopic procedures at four outpatient clinics. Pre-procedure (preparation and pre-medication), procedure (from intubation to extubation) and post-procedure (recovery and cleaning) accounted for 34.1%, 10.6% and 54.4% of the total time, respectively. Of the overall total time intervals (mean: 4453 person-seconds), 29.3%, 14.4% and 55.7% of the total time was devoted to pre-procedure, procedure and post-procedure, respectively. The post-procedure was the most time- and labor-consuming component from the viewpoints of both total time and labor cost. Conclusions Most of the time taken to complete endoscopic gastric cancer screening is consumed by preparation, pre-medication and post-procedures in which nurses play key roles. PMID:24523875

  7. 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…

  8. 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…

  9. 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

  10. 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

  11. Phase II clinical study of eribulin monotherapy in Japanese patients with metastatic breast cancer who had well-defined taxane resistance.

    PubMed

    Inoue, Kenichi; Saito, Tsuyoshi; Okubo, Katsuhiko; Kimizuka, Kei; Yamada, Hirofumi; Sakurai, Takashi; Ishizuna, Kazuo; Hata, Satoshi; Kai, Toshihiro; Kurosumi, Masafumi

    2016-06-01

    No clinical evidence on the efficacy and safety of eribulin monotherapy has been obtained by a prospective clinical study in patients with metastatic breast cancer (MBC) who had well-defined taxane resistance. The present Phase II, multicenter, single-arm, open-label study aimed to obtain the evidence. Japanese female patients, aged 33-74 years who had the metastasis of taxane-resistant and histopathologically confirmed breast cancer, received eribulin mesylate 1.4 mg/m(2) (equivalent to eribulin 1.23 mg/m(2) [expressed as free base]) as a 2- to 5-min intravenous infusion on days 1 and 8 of each 21-day cycle. The primary endpoint was the clinical benefit rate (CBR) [complete response (CR), partial response (PR), and long-term stable disease (LSD) ≥24 weeks]. A total of 51 patients underwent chemotherapy cycles (median 4; range 1-42 cycles). The CBR was 39.2 % (CR 2.0 %; PR 23.5 %; and LSD 13.7 %), and the rate of progressive disease was 49.0 %. The median progression-free survival and the median overall survival were 3.6 months [95 % confidence interval (CI) 2.6-4.6 months] and 11.7 months (95 % CI 9.2-14.2 months), respectively. Grade 3 or greater adverse events were leukopenia (23.5 %), neutropenia (35.3 %), anemia (5.9 %), and febrile neutropenia (7.8 %). The incidences of grade 3 and 4 peripheral sensory neuropathy were 2.0 and 0 %, respectively. Eribulin showed a clinically manageable tolerability profile by dose adjustments or symptomatic treatment. Eribulin was effective and well tolerated in heavily pretreated patients with MBC who had well-defined taxane resistance, thus providing a potential therapeutic option in the clinical settings. PMID:27125669

  12. A Randomized Clinical Trial of Smoking Cessation Treatments Provided in HIV Clinical Care Settings

    PubMed Central

    2013-01-01

    Introduction: Identifying successful smoking treatment interventions and methods of delivery is critical given the smoking rates among HIV-positive populations and the medical implications of smoking in this population. This study compared the efficacy of 3 smoking cessation interventions provided in HIV clinical treatment settings. Methods: Following a baseline assessment, 209 HIV-positive smokers were randomly assigned to 1 of 3 conditions in a parallel group design. Treatment conditions were individual counseling plus nicotine replacement treatment (NRT), a computer-based Internet smoking treatment plus NRT, and self-help plus NRT. Smoking status was determined at follow-up assessments completed at 12, 24, 36, and 52 weeks following treatment initiation. Results: Cessation rates ranged from 15% to 29%; however, no statistically significant differences in abstinence were found among the treatment conditions over time. Those employed, those who reported a greater desire to quit, or those with lower mood disturbance scores were more likely to achieve abstinence (p < .01). The number of cigarettes participants reported smoking in the 24hr prior to each assessment significantly declined over time (p < .001). Conclusions: Although we found no differences in abstinence rates across groups, the results indicate that integration of smoking cessation interventions is feasible in HIV clinical treatment settings, and cessation results are promising. The overall abstinence rates we report are comparable to those found in similar treatment studies across multiple populations. Further research is warranted. PMID:23430708

  13. 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.

  14. Assessing digital and quantitative EEG in clinical settings.

    PubMed

    Nuwer, M R

    1998-11-01

    Assessment of clinical utility involves a series of steps based primarily on published peer-reviewed medical literature. Relevant publications usually use the scientific method, appropriate control groups, blinded reading, prospective design, and other study elements. Assessments are more credible when conducted by those who do not have a conflict of interest in the technique. A detailed assessment of digital and quantitative EEG was conducted recently by the American Academy of Neurology. The American Clinical Neurophysiology Society was a joint sponsor. This assessment concluded that digital EEG is an excellent substitute for paper EEG. It also found quantitative techniques helpful in epilepsy monitoring, seizure detections, and in operating room/intensive care unit trend monitors. Several other applications were considered promising, whereas some applications were considered not ready for clinical use. Substantial problems still plague the field, predisposing to false-positive results.

  15. A measure to evaluate deformable registration fields in clinical settings.

    PubMed

    Schreibmann, Eduard; Pantalone, Paul; Waller, Anthony; Fox, Tim

    2012-01-01

    Deformable registration has migrated from a research topic to a widely used clinical tool that can improve radiotherapeutic treatment accuracy by tracking anatomical changes. Although various mathematical formulations have been reported in the literature and implemented in commercial software, we lack a straightforward method to verify a given solution in routine clinical use. We propose a metric using concepts derived from vector analysis that complements the standard evaluation tools to identify unrealistic wrappings in a displacement field. At the heart of the proposed procedure is identification of vortexes in the displacement field that do not correspond to underlying anatomical changes. Vortexes are detected and their intensity quantified using the CURL operator and presented as a vortex map overlaid on the original anatomy for rapid identification of problematic regions. We show application of the proposed metric on clinical scenarios of adaptive radiotherapy and treatment response assessment, where the CURL operator quantitatively detected errors in the displacement field and identified problematic regions that were invisible to classical voxel-based evaluation methods. Unrealistic warping not visible to standard voxel-based solution assessment can produce erroneous results when the deformable solution is applied on a secondary dataset, such as dose matrix in adaptive therapy or PET data for treatment response assessment. The proposed metric for evaluating deformable registration provides increased usability and accuracy of detecting unrealistic deformable registration solutions when compared to standard intensity-based approaches. It is computationally efficient and provides a valuable platform for the clinical acceptance of image-guided radiotherapy. PMID:22955647

  16. [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. PMID:26790594

  17. 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…

  18. 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…

  19. Bisphosphonate-related osteonecrosis of jaw (BRONJ) in Japanese population: a case series of 13 patients at our clinic.

    PubMed

    Nomura, Takeshi; Shibahara, Takahiko; Uchiyama, Takeshi; Yamamoto, Nobuharu; Shibui, Takeo; Yakushiji, Takashi; Watanabe, Akira; Muramatsu, Kyotaro; Ogane, Satoshi; Murayama, Masato; Sekine, Riyo; Nakata, Erika; Fujimoto, Yuko

    2013-01-01

    Bisphosphonate-related osteonecrosis of the jaw (BRONJ) affects quality of life and is an important problem for dentists. A Japanese position paper on BRONJ was published in 2010. The purpose of this study was to review clinical data on the treatment of BRONJ obtained at the Clinic of Oral and Maxillofacial Surgery, Tokyo Dental College, Chiba Hospital to further our understanding of this disease. A total of 13 patients (6 men and 7 women) were included. All the patients included in this study had received Bisphosphonate (BP) therapy and had BRONJ. Five of them (38.5%) had received oral BP therapy for osteoporosis, while the remaining 8 (61.5%) had received parenteral BP therapy for bone metastases from breast or prostate cancer. Osteoporosis patients were treated with risedronate or alendronate. Breast or prostate cancer patients were treated with zoledronate. Two patients with rheumatoid arthritis were treated with corticosteroid. Three patients had diabetes mellitus. Eleven patients were treated with antibiotics, while 5 underwent surgical treatment. Discontinuation of BP was recorded in 7 patients during dental treatment. Sequestration was observed in 6 patients during an 11-month follow-up. Eventually, healing and improvement of the oral mucosa were observed in 3 patients. The current standard treatment for BRONJ does not always provide good results. It is necessary to accumulate further clinical data to establish more effective treatment strategies for BRONJ.

  20. Clinical decision making of nurses working in hospital settings.

    PubMed

    Bjørk, Ida Torunn; Hamilton, Glenys A

    2011-01-01

    This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive frequencies, t-tests, Chi-Square test, and linear regression. Nurses' decision making was categorized into analytic-systematic, intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in predominantly surgical units.

  1. Selection and Evaluation Guidelines for Clinical Education Settings in Athletic Training.

    PubMed

    Weidner, Thomas G.; Laurent, Tim

    2001-03-01

    OBJECTIVE: To develop and test standards and associated criteria for the selection and evaluation of a clinical education setting in athletic training. DESIGN AND SETTING: A previously validated set of 20 standards for physical therapy clinical education settings, the associated criteria, and 2 related evaluation forms were systematically judged, revised, and adapted through a survey process. SUBJECTS: Program directors, clinical instructors, and students involved with athletic training clinical education from 28 athletic training education programs approved by the National Athletic Trainers' Association or accredited by the Commission on Accreditation of Allied Health Education Programs. MEASUREMENTS: We tabulated respondents' critiques and ratings by type of respondent. Items were judged as to whether they were relevant, practical, and suggestive of high-quality clinical education settings. RESULTS: We accepted a final set of 12 standards and 31 associated criteria to measure these standards. The student form lists 23 criteria relevant to these accepted standards. The accepted standards include the following: learning environment, program planning, ethical standards, administrative support, and Setting Coordinator of Clinical Education. CONCLUSIONS: The 12 standards, criteria, and related forms developed in this research project should be used as guidelines rather than as minimal requirements. They could be helpful in forming an impression not only about a particular clinical setting but also about the requirements of clinical education in general. Further research should include evaluating and comparing perceptions between sexes and among ethnic groups concerning their clinical education experiences. Also, standards and criteria for clinical instruction in athletic training should be systematically developed. PMID:12937517

  2. Selection and Evaluation Guidelines for Clinical Education Settings in Athletic Training.

    PubMed

    Weidner, Thomas G.; Laurent, Tim

    2001-03-01

    OBJECTIVE: To develop and test standards and associated criteria for the selection and evaluation of a clinical education setting in athletic training. DESIGN AND SETTING: A previously validated set of 20 standards for physical therapy clinical education settings, the associated criteria, and 2 related evaluation forms were systematically judged, revised, and adapted through a survey process. SUBJECTS: Program directors, clinical instructors, and students involved with athletic training clinical education from 28 athletic training education programs approved by the National Athletic Trainers' Association or accredited by the Commission on Accreditation of Allied Health Education Programs. MEASUREMENTS: We tabulated respondents' critiques and ratings by type of respondent. Items were judged as to whether they were relevant, practical, and suggestive of high-quality clinical education settings. RESULTS: We accepted a final set of 12 standards and 31 associated criteria to measure these standards. The student form lists 23 criteria relevant to these accepted standards. The accepted standards include the following: learning environment, program planning, ethical standards, administrative support, and Setting Coordinator of Clinical Education. CONCLUSIONS: The 12 standards, criteria, and related forms developed in this research project should be used as guidelines rather than as minimal requirements. They could be helpful in forming an impression not only about a particular clinical setting but also about the requirements of clinical education in general. Further research should include evaluating and comparing perceptions between sexes and among ethnic groups concerning their clinical education experiences. Also, standards and criteria for clinical instruction in athletic training should be systematically developed.

  3. Imagery in the clinical setting: a tool for healing.

    PubMed

    Reed, Terry

    2007-06-01

    This article addresses the why and how of imagery and its relation with holistic theories. The description of clinical applications, program development, and research demonstrates successful interventions in virtually every area of nursing. Case examples show the profound healing that is experienced by the patient and the nurse simultaneously through this work. Imagery is harmless, is time- and cost-effective, and creates a healing partnership between the nurse and patient. PMID:17544682

  4. Efficacy and Clinical Characteristics of Liraglutide in Japanese Patients With Type 2 Diabetes

    PubMed Central

    Ito, Daisuke; Iuchi, Takujiro; Kurihara, Susumu; Inoue, Ikuo; Katayama, Shigehiro; Inukai, Kouichi

    2015-01-01

    Background Liraglutide was first released in Japan as a long-acting once-daily glucagon-like peptide-1 receptor agonist. The maximum dose in Japan is 0.9 mg/day, which is half of that used in the United States and the European Union (1.8 mg/day). The efficacy of this maximum allowable dose of liraglutide for Japanese patients and the profiles of those patients for whom this agent should be recommended remain unclear. Methods This study aimed to examine the effective use of liraglutide in Japanese type 2 diabetic patients. We administered liraglutide to 60 patients, who had been managed with oral hypoglycemic agents or diet and exercise therapy only, during a period of 6 months. Results Though HbA1c levels significantly decreased, by approximately 1.5%, after 6 months of liraglutide administration, no significant changes in body weights were observed. The 0.6 mg dose was effective in approximately 40% of patients. In contrast, the effects of a dose increase from 0.6 mg to 0.9 mg were small. The greatest efficacy, as shown by a 2.5% HbA1c decrease, was achieved in non-obese patients. Thus, efficacy decreased as the degree of obesity increased. In addition, efficacy was higher in patients who had a diabetes duration of less than 10 years and was also higher in the group that had a low sulfonylurea (SU) index, when we define the SU index as mg/glimepiride × years of treatment. Conclusions As appetite suppressions and associated decreases in body weights were not observed in obese patients, the efficacy of liraglutide at 0.9 mg did not appear to be high. Rather, it appeared to be highly effective for patients who were non-obese and for whom amelioration of blood glucose elevations could be anticipated via the stimulation of insulin secretion. Therefore, we found that liraglutide at doses of 0.9 mg was highly effective in non-obese patients who were in the early stages of diabetes and was particularly effective in patients who had not yet been administered SU agents

  5. [Training program for clinical psychologists in general hospital settings].

    PubMed

    Nakashima, Yoshifumi

    2011-01-01

    Physicians in hospitals are so exhausted that mental healthcare providers other than physicians, such as psychologists, might be necessary. A clinical education program for psychologists in general hospitals has been developed. Applicants should be at Level 2 of Stoltenberg & McNeil's IDM (Integrated Development Model) model. Seven domains of objectives are introduced. Core competencies are multi-dimensional knowledge, understanding dynamics and collaborating, and communication skills with challenging patients. Sustainable education strategies and evaluation methods are discussed. A TV-based education program is useful for the purpose of acquiring general medical knowledge.

  6. [Recognition of tissue oxygen debt in clinical settings].

    PubMed

    Kopić, J; Jelić, J

    1998-01-01

    Despite intensive treatment, a great proportion of ICU patients is resuscitated incompletely. Presence of tissue oxygen debt is the crucial pathophysiologic element of multiple organ failure development and death in these patients. Parameters of oxygen metabolism, monitored in time, except prognostic value give us the possibility of therapeutic intervention, oriented to the prevention of multiple organ failure. In addition to parameters of global oxygen transport and utilization, gastric tonometry has been used in recent years, as a method for organ specific identification of tissue oxygen debt. In the article are considered acceptable and available options of solving this problem in everyday clinical work. PMID:9769634

  7. 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.

  8. 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.

  9. A spectrum of clinical presentations in seven Japanese patients with vitamin d deficiency.

    PubMed

    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

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

    PubMed

    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

  11. 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

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

    PubMed

    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

  13. Damages at Japanese assisted reproductive technology clinics by the Great Eastern Japan Earthquake of 2011.

    PubMed

    Ishihara, Osamu; Yoshimura, Yasunori

    2011-06-30

    The Great Eastern Japan Earthquake of 2011 and consequent tsunami affected many IVF clinics in northeastern Japan. Twelve clinics lost at least one embryo, but all the frozen embryos stored in liquid nitrogen tanks were safe. Emergency power supply is the first priority issue in an unpredictable natural disaster.

  14. 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

  15. 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

  16. 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…

  17. The support that mentors receive in the clinical setting.

    PubMed

    Watson, S

    2000-10-01

    This paper looks at the support systems that mentors in a trust both need and have. It was a study to examine the causes of stress within mentoring with a view to exploring this aspect of the role and to examine the clinical learning environment. The English National Board (ENB) has stated that mentoring is a requirement for all nurse training. The literature speaks of the importance of the role of the mentor to the student. There has also been research showing that this role is stressful and needs support if it is to be fully effective. However, there is little research into the nature and quality of the support received or required by mentors. This study addresses issues that had not been previously addressed in that it looks at the nature of the support required by the mentors to enable them to perform their duties both to the student and to the patients in their care. The study is largely ethnographic in nature. It consists of a short series of unstructured interviews of selected experienced mentors as a means of collecting data to enable the construction of a questionnaire that was submitted to all mentors within the trust. This is to allow the trust and educational institution to work on developing newer and better support systems both for the present placement and also for future placements. PMID:12173263

  18. Development of clinical policies and guidelines in acute settings.

    PubMed

    Collins, Sean; Patel, Seraphim

    This article outlines a model for developing policies and discusses some of the issues involved in the process of writing, approving and disseminating clinical policies and guidelines. It does not seek to dwell on policy drafting per se because guidance is readily available that can help authors to write and implement policies using evidence-based practice, research, implementation and audit skills. Any individual policy, however, does not exist in a vacuum, but in a network of related policies. There is relatively little practical guidance, literature or debate about the methodology that can be applied to developing an organisational policy framework, or how an understanding of this context can help those planning to develop a policy for their organisation. The article draws on the authors' experiences of policy development from the perspective of an acute NHS trust and discusses the challenges of developing a proactive and co-ordinated approach to policy work. It concludes with a recognition of some useful internal and external checks that can help policy authors to identify the extent to which policy is translated into practice.

  19. 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…

  20. "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…

  1. Using GENOVA and FACETS to Set Multiple Standards on Performance Assessment for Certification in Medical Translation from Japanese into English

    ERIC Educational Resources Information Center

    Kozaki ,Y.

    2004-01-01

    This article presents a standard-setting procedure for performance assessment in a foreign language, through which some of the major problems facing performance assessment in criterion-referenced testing can be addressed. The procedure, which was geared to revealing and accommodating inter-judge variability, employed the synergy of multiple…

  2. 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. PMID:26601447

  3. 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

  4. 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

  5. Turning Japanese?

    ERIC Educational Resources Information Center

    Huwitz, Nina

    1990-01-01

    Relates observations of the Japanese educational system by a U.S. high school history teacher. Finds the Japanese system impressive but argues that such a centralized and authoritarian system would not work in the United States. Educators should learn from Japanese schools, not copy them. Recommends U.S. educators seek agreement on educational…

  6. 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…

  7. 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.

  8. [Clinical usefulness of the new Japanese glomerular filtration rate equation for initial and individualized dosage adjustment concentrations of vancomycin].

    PubMed

    Kuroda, Naoki; Ueshima, Satoshi; Sato, Tomoaki; Kobiki, Eriko; Kawasaki, Yoichi; Matsunaga, Hisashi; Nakura, Hironori; Sendo, Toshiaki

    2012-01-01

    To clarify whether the new Japanese glomerular filtration rate (eGFR) equation was able to accurately determine the initial and individualized dosage adjustment concentrations of vancomycin (VCM), the predictive performance for VCM concentrations using the eGFR and Cockcroft-Gault (CG) equations was compared. Data were retrospectively collected from clinical records of 90 patients with MRSA infection whose trough and peak VCM concentrations had been determined. The predicted VCM initial and individualized dosage adjustment concentrations were performed with the 2-compartment linear model using pharmacokinetic parameter means and their individual values via Bayesian estimation, respectively. The prediction error (PE) and its absolute value (APE) between the observed and predicted VCM concentrations were calculated as indices of bias and accuracy in predictive performance, respectively. In the initial dosage adjustment of VCM, the PE value, calculated with the eGFR equation in trough and peak VCM concentrations of patients whose BMI were 18.5 kg/m(2) and higher, was significantly smaller than that calculated with the CG equation. In particular, both PE and APE values obtained from the eGFR calculated concentrations from nonelderly patients (younger than 65 years old) were significantly improved compared with those from the CG equation. In the individualized dosage adjustment of VCM, the eGFR equation gave a significantly smaller PE value in nonelderly patients' trough concentrations than the CG equation. These findings provide useful information for adjusting the VCM dosage to achieve optimal therapeutic efficacy in patients with MRSA infection.

  9. 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. PMID:24478188

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

    PubMed Central

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

    2016-01-01

    BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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

  11. 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. PMID:27653863

  12. 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.

  13. Prevalence of abdominal migraine and recurrent abdominal pain in a Japanese clinic.

    PubMed

    Hikita, Toshiyuki

    2016-07-01

    Prevalence of abdominal migraine (AM) and recurrent abdominal pain (RAP) was evaluated in patients who visited Hikita Pediatric Clinic between May 2010 and April 2015. Patient data were collected prospectively using a questionnaire. Out of a total of 3611 cases, observed prevalence was 2.44% for repeated abdominal pain over a period of ≥3 months, 1.47% for RAP, and 0.19% for AM. Duration of abdominal pain was longer for AM than for non-AM RAP. Certain clinical features were significantly different between AM and non-AM RAP. No correlations were found among age at onset, frequency of attack, and duration of attack for various types of RAP. It was difficult to determine useful diagnostic criteria for distinguishing between AM and non-AM RAP. They did not appear to be separate disease entities but, instead, lie on a disease spectrum. The present prevalence of AM (0.19%) was lower than that in many previous studies from countries other than Japan. PMID:27460403

  14. Nurse-led clinics: 10 essential steps to setting up a service.

    PubMed

    Hatchett, Richard

    This article outlines 10 key steps for practitioners to consider when setting up and running a nurse-led clinic. It lays emphasis on careful planning, professional development and the need to audit and evaluate the service to ensure the clinic is measurably effective. PMID:19068891

  15. 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.

  16. Comparison of Clinical Teaching by Residents and Attending Physicians in Inpatient and Lecture Settings.

    ERIC Educational Resources Information Center

    Bergen, Merlynn R.; And Others

    1993-01-01

    A study examined differences in the clinical teaching of 21 medical residents and 19 attending physicians in 2 settings: inpatient care and lectures. Results indicated that ratings were generally similar for the two groups, but setting was a significant source of variance. Self-assessments were similar. Implications for instruction are discussed.…

  17. 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

  18. 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. PMID:23806363

  19. 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.

  20. 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.

  1. 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…

  2. 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.

  3. 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

  4. 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

  5. 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

  6. Establishing research in a palliative care clinical setting: perceived barriers and implemented strategies.

    PubMed

    Bullen, Tracey; Maher, Kate; Rosenberg, John P; Smith, Bradley

    2014-02-01

    There are many challenges in developing research projects in research-naïve clinical settings, especially palliative care where resistance to participate in research has been identified. These challenges to the implementation of research are common in nursing practice and are associated with attitudes towards research participation, and some lack of understanding of research as a process to improve clinical practice. This is despite the professional nursing requirement to conduct research into issues that influence palliative care practice. The purpose of this paper is to describe the process of implementing a clinical research project in collaboration with the clinicians of a palliative care community team and to reflect on the strategies implemented to overcome the challenges involved. The challenges presented here demonstrate the importance of proactively implementing engagement strategies from the inception of a research project in a clinical setting.

  7. Operationalizing NIMH Research Domain Criteria (RDoC) in naturalistic clinical settings.

    PubMed

    Sharp, Carla; Fowler, J Christopher; Salas, Ramiro; Nielsen, David; Allen, Jon; Oldham, John; Kosten, Thomas; Mathew, Sanjay; Madan, Alok; Frueh, B Christopher; Fonagy, Peter

    2016-01-01

    Recently, the National Institute of Mental Health (NIMH) introduced the Research Domain Criteria (RDoC) initiative to address two major challenges facing the field of psychiatry: (1) the lack of new effective personalized treatments for psychiatric disorders, and (2) the limitations associated with categorically defined psychiatric disorders. Although the potential of RDoC to revolutionize personalized psychiatric medicine and psychiatric nosology has been acknowledged, it is unclear how to implement RDoC in naturalistic clinical settings as part of routine outcomes research. In this article, the authors present the major RDoC principles and then show how these principles are operationalized in The Menninger Clinic's McNair Initiative for Neuroscience Discovery-Menninger & Baylor College of Medicine (MIND-MB) study. The authors discuss how RDoC-informed outcomes-based assessment in clinical settings can transform personalized clinical care through multimodal treatments. PMID:27583809

  8. 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

  9. Genetic acquisition of NDM gene offers sustainability among clinical isolates of Pseudomonas aeruginosa in clinical settings.

    PubMed

    Mishra, Shweta; Upadhyay, Supriya; Sen, Malay Ranjan; Maurya, Anand Prakash; Choudhury, Debarati; Bhattacharjee, Amitabha

    2015-01-01

    New Delhi metallo β-lactamases are one of the most significant emerging resistance determinants towards carbapenem drugs. Their persistence and adaptability often depends on their genetic environment and linkage. This study reports a unique and novel arrangement of blaNDM-1 gene within clinical isolates of Pseudomonas aeruginosa from a tertiary referral hospital in north India. Three NDM positive clonally unrelated clinical isolates of P. aeruginosa were recovered from hospital patients. Association of integron with blaNDM-1 and presence of gene cassettes were assessed by PCR. Genetic linkage of NDM gene with ISAba125 was determined and in negative cases linkage in upstream region was mapped by inverse PCR. In which only one isolate's NDM gene was linked with ISAba125 for mobility, while other two reveals new genetic arrangement and found to be inserted within DNA directed RNA polymerase gene of the host genome detected by inverse PCR followed by sequencing analysis. In continuation significance of this novel linkage was further analyzed wherein promoter site detected by Softberry BPROM software and activity were assessed by cloning succeeding semi-quantitative RT-PCR indicating the higher expression level of NDM gene. This study concluded out that the unique genetic makeup of NDM gene with DNA-dependent-RNA-polymerase favours adaptability to the host in hospital environment against huge antibiotic pressure. PMID:25635921

  10. Genetic acquisition of NDM gene offers sustainability among clinical isolates of Pseudomonas aeruginosa in clinical settings.

    PubMed

    Mishra, Shweta; Upadhyay, Supriya; Sen, Malay Ranjan; Maurya, Anand Prakash; Choudhury, Debarati; Bhattacharjee, Amitabha

    2015-01-01

    New Delhi metallo β-lactamases are one of the most significant emerging resistance determinants towards carbapenem drugs. Their persistence and adaptability often depends on their genetic environment and linkage. This study reports a unique and novel arrangement of blaNDM-1 gene within clinical isolates of Pseudomonas aeruginosa from a tertiary referral hospital in north India. Three NDM positive clonally unrelated clinical isolates of P. aeruginosa were recovered from hospital patients. Association of integron with blaNDM-1 and presence of gene cassettes were assessed by PCR. Genetic linkage of NDM gene with ISAba125 was determined and in negative cases linkage in upstream region was mapped by inverse PCR. In which only one isolate's NDM gene was linked with ISAba125 for mobility, while other two reveals new genetic arrangement and found to be inserted within DNA directed RNA polymerase gene of the host genome detected by inverse PCR followed by sequencing analysis. In continuation significance of this novel linkage was further analyzed wherein promoter site detected by Softberry BPROM software and activity were assessed by cloning succeeding semi-quantitative RT-PCR indicating the higher expression level of NDM gene. This study concluded out that the unique genetic makeup of NDM gene with DNA-dependent-RNA-polymerase favours adaptability to the host in hospital environment against huge antibiotic pressure.

  11. 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…

  12. 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.

  13. Conducting clinical research in community mental health settings: Opportunities and challenges

    PubMed Central

    Tcheremissine, Oleg V; Rossman, Whitney E; Castro, Manuel A; Gardner, Dineen R

    2014-01-01

    Tremendous progress has been made in the past decade surrounding the underlying mechanisms and treatment of neuropsychiatric disease. Technological advancements and a broadened research paradigm have contributed to the understanding of the neurochemistry, brain function and brain circuitry involved in neuropsychiatric disorders. The predominant area of unmet medical need in the United States is major psychiatric disorders, and major depressive disorder is the leading cause of disability for ages 15-44. Total spending on research and development by the pharmaceutical industry has grown exponentially during the past decade, but fewer new molecular entities (NME) for the treatment of major psychiatric disorders have received regulatory approvals compared to other therapeutic areas. Though significant expansion has occurred during the “decade of the brain”, the translation of clinical trials outcomes into the community mental health setting is deficient. Randomized controlled trials (RCTs) have been the standard approach to clinical evaluation of the safety and efficacy of NMEs for the past 60 years; however, there are significant barriers and skepticism in the implementation of evidence-based outcomes into clinical practice. Recruitment of patients, shortages of experienced clinical researchers, regulatory requirements and later translation of outcomes into clinical practice are ever growing problems faced by investigators. The community mental health setting presents particular barriers in the replication of therapeutic outcomes from RCTs. The diagnostic complexity of major psychiatric diseases and the highly selective patient populations involved in clinical trials lend to the gap in translation from the “bench to the bedside”. The community mental health setting lends to a diverse patient population with numerous co-morbidities and environmental factors that are unaccounted in the average RCT. While we acknowledge the enormous complexity in developing novel

  14. Centers Speak Up: The Clinical Context for Health Information Technology in the Ambulatory Care Setting

    PubMed Central

    Cheung, Ming; Webster, Tashonna R.; Curry, Leslie; Bradley, Elizabeth H.; Fifield, Judith; Burstin, Helen

    2008-01-01

    Background Clinicians in ambulatory care settings are increasingly called upon to use health information technology (health IT) to improve practice efficiency and performance. Successful adoption of health IT requires an understanding of how clinical tasks and workflows will be affected; yet this has not been well described. Objective To describe how health IT functions within a clinical context. Design Qualitative study, using in-depth, semi-structured interviews. Participants Executives and staff at 4 community health centers, 3 health center networks, and 1 large primary care organization. Approach Transcribed audio-recorded interviews, analyzed using the constant comparative method. Results Systematic characterization of clinical context identified 6 primary clinical domains. These included results management, intra-clinic communication, patient education and outreach, inter-clinic coordination, medication management, and provider education and feedback. We generated clinical process diagrams to characterize these domains. Participants suggested that underlying workflows for these domains must be fully operational to ensure successful deployment of health IT. Conclusions Understanding the clinical context is a necessary precursor to successful deployment of health IT. Process diagrams can serve as the basis for EHR certification, to identify challenges, to measure health IT adoption, or to develop curricular content regarding the role of health IT in clinical practice. PMID:18373132

  15. Linking Postdoctoral General Dentistry Programs with Community-Based Clinical Care Settings.

    ERIC Educational Resources Information Center

    Weaver, Richard G.; Gray, Carolyn F.; Demby, Neal A.; Cinotti, William R.; Clark, Nereyda P.; Hicks, Jeffrey L.

    1997-01-01

    Reports results of a working group convened by the American Association of Dental Schools to examine establishment of dental education programs with significant affiliations with community-based clinical care settings. Identifies factors and conditions believed to be critical to successful program linkages, including goals and objectives, support…

  16. Adventure Counseling as an Adjunct to Group Counseling in Hospital and Clinical Settings

    ERIC Educational Resources Information Center

    Gillen, Mark C.; Balkin, Richard S.

    2006-01-01

    Adventure counseling has been thought of as a highly specialized application of group counseling skills in a wilderness environment. In fact, adventure counseling is based on a developmental theory of group, can be useful for a variety of clients, and can be thoughtfully integrated into clinical and hospital settings. This article describes the…

  17. The use of standardized clients in research in the veterinary clinical setting.

    PubMed

    Nogueira Borden, Leandra J; Adams, Cindy L; Ladner, Lynda D

    2008-01-01

    This article describes the first use of undisclosed standardized clients (SCs) for research in the veterinary clinical setting. The study described here used SCs to investigate veterinarian-client communication during euthanasia discussions. Use of this methodology allowed us to avoid several ethical and logistical challenges associated with gathering observational data on sensitive subject matter. In medicine, standardized patients (SPs) are used extensively in teaching, medical school examinations, and licensing examinations. Increasingly, SPs are being used in research to evaluate physicians' performance in the clinical setting, including assessment of physician-patient communication. Several veterinary schools have recently introduced SCs for teaching and evaluation of student veterinarians. Until now, however, SCs have not been used for research in the veterinary clinical setting. Two cases were designed to reflect common reasons for discussion of euthanasia in private practice. A random sample of 32 consenting veterinarians in southern Ontario saw each case. Appointments were audio-recorded and analyzed using a communication assessment tool adapted from human medicine. At the end of each appointment, the SC disclosed his or her identity and both veterinarian and SC completed questionnaires to describe their perceptions of the communication that took place. This article describes in detail the use of SCs in this study, including case design, training, preparation for visits, use of animal patients, and challenges faced. The use of SCs was shown to be a feasible method of assessing veterinarian-client communication in the clinical setting. PMID:19066360

  18. 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…

  19. 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…

  20. 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…

  1. Use of Brief Experimental Analyses in Outpatient Clinic and Home Settings

    ERIC Educational Resources Information Center

    Wacker, David; Berg, Wendy; Harding, Jay; Cooper-Brown, Linda

    2004-01-01

    We describe the historic and current use of brief experimental analysis procedures in outpatient clinic and home settings. We discuss some applications of the designs and suggest design modifications for improving internal validity. We describe our application of the designs to longitudinal, in-home programs for children with severe behavior…

  2. Opening Options: Making Field Education Work in a Private Practice Clinic Setting

    ERIC Educational Resources Information Center

    Mooradian, John K.; Knaggs, Constance; Hock, Robert; LaCharite, David

    2011-01-01

    This article describes the use of social work field placements in a private practice setting to prepare MSW students for clinical work. The authors used "autoethnography", which is personal narrative that explores the writer's experience of life, to describe interpersonal and contextual characteristics, as well as procedures implemented to conduct…

  3. 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

  4. The clinical features and prognosis of rhabdomyosarcoma: follow-up studies on pediatric tumors from the Japanese Pediatric Tumor Registry 1971-1980. Part II. Committee of Malignant Tumors, Japanese Society of Pediatric Surgeons.

    PubMed

    Nakada, K

    1990-09-01

    A retrospective study was conducted on 126 patients with rhabdomyosarcoma enrolled in the Japanese Pediatric Tumor Registry between 1971 and 1980. The age of the patients ranged from less than 1 year to 15 years, and the male to female ratio was 1.3:1.0. Primary sites included the pelvis (37.3 per cent), abdomen (23.8 per cent), head and neck (21.4 per cent), thorax (9.5 per cent), extremities (6.4 per cent) and unknown (1.6 per cent). According to the staging system of the Japanese Society of Pediatric Surgeons, the extent of disease was classified into stages Ia (26.2 per cent of the total); Ib (14.6 per cent); II (12.6 per cent), III (29.1 per cent) and IV (17.5 per cent). The clinical stage was significantly correlated with survival outcome in this series (p less than 0.05). Age, sex, histology and primary site per se had no independent prognostic influence on tumor-free survival. With regard to treatment modalities, surgery was performed in 94.0 per cent of the patients, and radiotherapy at a mean dose of 37 Gy, and/or multi-agent chemotherapy in 41.7 per cent and 80.0 per cent, respectively. The patients who underwent total excision had a better survival outcome than those who did not (p less than 0.05). Combination chemotherapy such as VAC was more commonly administered in the latter study period. The overall 2-year tumor-free survival rate (2YTFSR) significantly improved from 24.0 per cent in the former period between 1971 and 1975 to 48.7 per cent in the latter period between 1976 and 1980 (p less than 0.05). PMID:2243442

  5. 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

  6. 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. PMID:26891679

  7. 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.

  8. 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.

  9. Best practices sharing: Setting up a professional clinical research unit in India

    PubMed Central

    Divate, Uma; Das, Soma; Bhosale, Neelambari; Divate, Pathik

    2014-01-01

    The Drug Controller General of India has recently come up with very stringent laws to tighten the regulatory framework around clinical trials. One-way of improving the credibility of India and its researchers in the eyes of the regulators, sponsors and the general public is through professional site management team or setting up clinical research unit (CRU). The CRU acts as a bridge between the sponsor and the investigator. The CRU model has been better explained with the help of a good example of a clinical research institute. Since, a successful clinical trial needs high quality data, timeliness and clear communication between all parties, a professional CRU with a team of dedicated and trained professionals and infrastructure with written procedures and policies may be a solution to the pain and agony of poor site performance and investigator insufficiency and pressure. PMID:24551586

  10. 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.

  11. 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

  12. 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

  13. Providing pastoral care services in a clinical setting to veterans at-risk of suicide.

    PubMed

    Kopacz, Marek S

    2013-09-01

    The value of enhanced spiritual wellbeing has largely been overlooked as part of suicide prevention efforts in Veterans. The aim of this qualitative study is to examine the clinical pastoral care services provided by VA Chaplains to Veterans at-risk of suicide. This study was conducted using in-depth interviews with five Chaplains affiliated with a medical center located in upstate New York. This study was able to show that some at-risk individuals do actively seek out pastoral care, demonstrating a demand for such services. In conclusion, a pastoral care framework may already exist in some clinical settings, giving at-risk Veterans the opportunity to access spiritual care.

  14. Priority setting in family change and clinical practice: the Family FIRO Model.

    PubMed

    Doherty, W J; Colangelo, N; Hovander, D

    1991-06-01

    We update a theoretical framework for understanding priority setting for the management of family change, with special emphasis on developmental change. We propose that three core dimensions of family interaction--inclusion, control, and intimacy--constitute an optimal priority sequence for managing major family change stemming from life-cycle transitions and other stressful experiences. In the next section of the article, we compare the Family FIRO Model and other models of family change. Finally, we suggest that therapists can benefit from an explicit, clinical decision-making model for setting priorities in treatment: issues of inclusion take precedence over issues of control, which in turn take precedence over issues of intimacy.

  15. The influence of training on the rating of physical therapist student performance in the clinical setting.

    PubMed

    Vendrely, Ann; Carter, Russell

    2004-01-01

    and the CPI only group. This study indicated that completion of CIECP and CPI training affected rating of the first criterion of the CPI compared with clinical instructors who completed the CPI only. Completion of the CIECP only affected the rating of the second CPI criterion compared with CPI-only training. Previous use of the instrument was not significant in this study. Assessment of student performance in the clinical setting is a complex task and further analysis of the training and use of the CPI is needed.

  16. Creation of an interprofessional clinical experience for healthcare professions trainees in a nursing home setting.

    PubMed

    Ford, Channing R; Foley, Kathleen T; Ritchie, Christine S; Sheppard, Kendra; Sawyer, Patricia; Swanson, Mark; Harada, Caroline N; Brown, Cynthia J

    2013-07-01

    Successful interprofessional teams are essential when caring for older adults with multiple complex medical conditions that require ongoing management from a variety of disciplines across healthcare settings. To successfully integrate interprofessional education into the healthcare professions curriculum, the most effective learning experiences should utilize adult learning principles, reflect real-life practice, and allow for interaction among trainees representing a variety of health professions. Interprofessional clinical experiences are essential to prepare future healthcare professionals to provide quality patient care and understand the best methods for utilizing members of the healthcare team to provide that care. To meet this need, the University of Alabama at Birmingham Geriatric Education Center has developed an Interprofessional Clinical Experience (ICE) to expose future healthcare providers to an applied training experience with older adults in the nursing home setting. This paper outlines how this program was developed, methods used for program evaluation, and how the outcome data influenced program revisions. PMID:23631410

  17. Genetic counsellors in Sweden: their role and added value in the clinical setting.

    PubMed

    Pestoff, Rebecka; Ingvoldstad, Charlotta; Skirton, Heather

    2016-03-01

    Genetic testing is becoming more commonplace in general and specialist health care and should always be accompanied by genetic counselling, according to Swedish law. Genetic counsellors are members of the multi-disciplinary team providing genetic counselling. This study examined the role and added value of genetic counsellors in Sweden, using a cross-sectional on-line survey. The findings showed that the genetic counsellors added value in the clinical setting by acting as the 'spider-in-the-web' regarding case management, having a more holistic, ethical and psychological perspective, being able to offer continuous support and build a relationship with the patient, and being more accessible than medical geneticists. The main difference between a genetic counsellor and medical geneticist was that the doctor had the main medical responsibility. Thus genetic counsellors in Sweden contribute substantially to the care of patients in the clinical genetic setting. PMID:26014428

  18. Facilitating the nurse practitioner's research role: using a microcomputer for data entry in clinical settings.

    PubMed

    Matteson, P S; Hawkins, J W

    1993-01-01

    Data coding and entry can be a tedious and error-prone component of research. Statistical packages for a microcomputer are now available that enable the researcher to create data entry forms in a spread sheet format. In this article the use of software that can be used for data entry, manipulation, and analysis is discussed. In a practice setting these features are particularly useful, because the nurse practitioner can take the microcomputer to the clinical facility and enter data directly from client-provider interactions or from records. In clinical settings where client data are entered directly into a computer database as part of assessment and care giving, data can be downloaded onto this or similar programs for manipulation and analysis.

  19. 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.

  20. "A golden opportunity": Exploring interprofessional learning and practice in rural clinical settings.

    PubMed

    Spencer, Judy; Woodroffe, Jessica; Cross, Merylin; Allen, Penny

    2015-01-01

    Little is known about interprofessional practice (IPP) and interprofessional learning (IPL) in rural health services, despite national funding and continuing emphasis on increasing students' clinical placements in rural areas. This short paper outlines a study in Tasmania, Australia, which investigated how and under what contexts and conditions IPP and IPL occur in rural clinical settings, and the enabling factors and strategies that promote this learning and practice. This study employed a mixed method design comprising focus group discussions and a survey involving health professionals from two rural health services. The findings demonstrate that formal and informal arrangements, the collaborative nature of small, close-knit healthcare teams and patient-centred models of care employed in rural practice settings, provide ideal contexts for IPP and IPL. The study has implications for promoting organisational readiness for IPP and IPL and harnessing the potential of rural services to promote and develop students' interprofessional capability.

  1. 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. PMID:27185282

  2. 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

  3. 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.

  4. 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.

  5. Wound staging: can nurses apply classroom education to the clinical setting?

    PubMed

    Arnold, N; Watterworth, B

    1995-06-01

    Traditionally, education on wound staging has been conducted in the classroom using drawings, photographs or slides to illustrate examples of wound stages. These methods portray wounds two-dimensionally, but clinically, wounds are three-dimensional. Seven home care nurses in central Florida were given a pre-test and post-test of 16 slides, four of each stage. Field visits with three of these nurses were then conducted by an ET nurse to evaluate the application of this education into clinical practice in the home setting. The questions studied were: Do nurses learn to accurately assess stages of wounds from classroom education? Does classroom ability to stage wounds equate to ability to stage correctly in the clinical setting? Test results showed Stage II and Stage III wounds to be most problematic in the classroom. The most improvement was seen in the staging of Stage II and Stage IV wounds two-dimensionally. In the field, one nurse consistently staged wounds correctly while two had problems with correct staging. Additional investigation is required to determine if these results can be generalized to other home health nurses and if changes in clinical ability will occur over time. PMID:7612139

  6. Mining for clinical expertise in (undocumented) order sets to power an order suggestion system.

    PubMed

    Chen, Jonathan H; Altman, Russ B

    2013-01-01

    Physician orders, the concrete manifestation of clinical decision making, are enhanced by the distribution of clinical expertise in the form of order sets and corollary orders. Conventional order sets are top-down distributed by committees of experts, limited by the cost of manual development, maintenance, and limited end-user awareness. An alternative explored here applies statistical data-mining to physician order data (>330K order instances from >1.4K inpatient encounters) to extract clinical expertise from the bottom-up. This powers a corollary order suggestion engine using techniques analogous to commercial product recommendation systems (e.g., Amazon.com's "Customers who bought this…" feature). Compared to a simple benchmark, the item-based association method illustrated here improves order prediction precision from 13% to 18% and further to 28% by incorporating information on the temporal relationship between orders. Incorporating statistics on conditional order frequency ratios further refines recommendations beyond just "common" orders to those relevant to a specific clinical context.

  7. 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.

  8. Safety of telemental healthcare delivered to clinically unsupervised settings: a systematic review.

    PubMed

    Luxton, David D; Sirotin, Anton P; Mishkind, Matthew C

    2010-01-01

    The safety of telemental healthcare delivered to clinically unsupervised settings, such as a personal residence, must be established to inform policy and further the dissemination of telemental health programs. The aim of this article is to provide an overview of safety issues associated with telemental healthcare and, through a systematic literature review, evaluate the safety of telemental healthcare delivered to unsupervised settings. The review resulted in a total of nine studies that specifically evaluated the delivery of telemental healthcare to unsupervised settings. Six of the nine studies reviewed explicitly described safety plans or specific precautions that could be used if necessary. Two of the nine studies reported events that required the researchers to use safety procedures to effectively respond to concerns they had regarding participant safety. In both of these studies, the issues were resolved with prescribed safety procedures. Recommendations and future directions for the development and evaluation of safety protocols are discussed.

  9. Plaster and synthetic cast temperatures in a clinical setting: an in vivo study.

    PubMed

    Ahmed, Sonya S; Carmichael, Kelly D

    2011-02-01

    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.

  10. A handbook for student nurses to guide clinical experiences in the school setting.

    PubMed

    English, D; Marcontel, M

    2001-08-01

    For more than 30 years, nursing students have had the opportunity to have clinical experiences related to their course requirements in the Dallas Public Schools. The Dallas Independent School District School Health Services Department staff provide an orientation to student nurses before their first day in the school clinic. To enhance their learning experience and clarify the regulations and expectations for student nurses, a handbook was prepared for the use of school nurses and the students. The Basic Health Care for the School-age Child: A Handbook for Student Nurses outlines the use of the school as a clinical experience setting. Another purpose for the handbook is to reduce the stress of this clinical rotation for the student nurse and for the staff nurse who serves as the student nurse's preceptor. This article describes the development of the expectations for the clinical experience and the information included in the handbook. An outline of the material included in each section is presented to provide ideas for school nurses who provide or are considering providing a rotation for student nurses in their schools.

  11. [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.

  12. 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

  13. 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.

  14. Evaluating cognitive impairment in the clinical setting: practical screening and assessment tools.

    PubMed

    Valcour, Victor G

    2011-12-01

    HIV-associated neurocognitive disorders (HAND) remain a substantial problem in the era of combination antiretroviral therapy. Neither the Mini Mental State Exam nor the HIV Dementia Scale is sufficiently sensitive for HAND. The Montreal Cognitive Assessment shows promise, but current data suggest that adding an additional test will be needed to improve sensitivity for the clinical setting. Patient reporting of symptoms is insensitive as most cases of HAND are asymptomatic. Examination of cerebrospinal fluid (CSF) is sometimes warranted in select patients to evaluate for CSF HIV RNA detectability. CSF escape of virus, when CSF HIV RNA is detectable but plasma HIV RNA is not, appears to be a relatively uncommon event in the clinical setting where the level of detectability for typical clinical assays is around 50 copies/mL. In cases of CSF escape, cognitive improvement has been linked to changes in antiretroviral regimens that are aimed at either overcoming antiretroviral resistance or improving central nervous system (CNS) penetration-effectiveness. Currently, for most patients with HAND in the absence of unusual features, there are insufficient data for a recommendation to routinely intensify therapy with a neurointensive antiretroviral regimen; however, there is considerable uncertainty given emerging data and variability in approach among experts in the field. This article summarizes a case-based presentation by Victor G. Valcour, MD, at the 14th Annual Clinical Conference for the Ryan White HIV/AIDS Program held in Tampa, Florida, in June 2011. The Clinical Conference is sponsored by the IAS-USA under the Health Resources and Services Administration (HRSA) contract number HHSH250200900010C.

  15. 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.

  16. A Phase II Clinical Study of mFOLFOX6 Plus Bevacizumab as First-line Therapy for Japanese Advanced/Recurrent Colorectal Cancer Patients

    PubMed Central

    Nishina, Tomohiro; Takano, Yoshinao; Denda, Tadamichi; Yasui, Hisateru; Takeda, Koji; Ura, Takashi; Esaki, Taito; Okuyama, Yusuke; Kondo, Ken; Takahashi, Yasuo; Sugiyama, Yasuyuki; Muro, Kei

    2013-01-01

    Objective In Japan, there had been no prospective clinical studies conducted in terms of modified FOLFOX6 + bevacizumab therapy. We performed a post-marketing Phase II multicenter clinical study to examine the efficacy and safety of this regimen as first-line therapy for Japanese patients with advanced/recurrent colorectal cancer. Methods Bevacizumab (5 mg/kg) was administered intravenously, and then oxaliplatin (85 mg/m2) and levofolinate calcium (200 mg/m2) were infused intravenously over 2 h. Subsequently, a bolus dose of 5-fluorouracil (400 mg/m2) was injected, followed by infusion of 5-fluorouracil (2400 mg/m2) for 46 h. This regimen was repeated every 2 weeks until 24 cycles unless there was disease progression, unacceptable toxicity or patient refusal. The primary end point was the response rate. Results Among the 70 patients enrolled, two patients withdrew the study before treatment, and 68 patients were eligible for analysis of efficacy and safety. The response rate was 51.5% (95% confidence interval: 39.0–63.8%). The median progression-free survival and median overall survival time were 12.6 months (95% confidence interval: 10.4–14.5 months) and 28.5 months [95% confidence interval: 23.1 months–(not applicable)], respectively. There were no treatment-related deaths observed. The most common Grade 3 and 4 adverse events included neutropenia in 35.3% of the patients, peripheral neuropathy in 16.2% and hypertension in 16.2%. All adverse events were manageable and tolerable. The exploratory analysis of polymorphisms of three genes, ERCC1, XPD and GSTP1, did not show any trends in terms of correlation with the efficacy or safety of modified FOLFOX6 + bevacizumab therapy. Conclusions Modified FOLFOX6 + bevacizumab therapy was manageable and tolerable in Japanese patients, achieving a high response rate. PMID:23999770

  17. SubmiRine: assessing variants in microRNA targets using clinical genomic data sets

    PubMed Central

    Maxwell, Evan K.; Campbell, Joshua D.; Spira, Avrum; Baxevanis, Andreas D.

    2015-01-01

    MicroRNAs (miRNAs) regulate gene expression by binding to partially complementary sequences on target mRNA transcripts, thereby causing their degradation, deadenylation, or inhibiting their translation. Genomic variants can alter miRNA regulation by modifying miRNA target sites, and multiple human disease phenotypes have been linked to such miRNA target site variants (miR-TSVs). However, systematic genome-wide identification of functional miR-TSVs is difficult due to high false positive rates; functional miRNA recognition sequences can be as short as six nucleotides, with the human genome encoding thousands of miRNAs. Furthermore, while large-scale clinical genomic data sets are becoming increasingly commonplace, existing miR-TSV prediction methods are not designed to analyze these data. Here, we present an open-source tool called SubmiRine that is designed to perform efficient miR-TSV prediction systematically on variants identified in novel clinical genomic data sets. Most importantly, SubmiRine allows for the prioritization of predicted miR-TSVs according to their relative probability of being functional. We present the results of SubmiRine using integrated clinical genomic data from a large-scale cohort study on chronic obstructive pulmonary disease (COPD), making a number of high-scoring, novel miR-TSV predictions. We also demonstrate SubmiRine's ability to predict and prioritize known miR-TSVs that have undergone experimental validation in previous studies. PMID:25813044

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. A Japanese family with adrenoleukodystrophy with a codon 291 deletion: a clinical, biochemical, pathological, and genetic report.

    PubMed

    Kano, S; Watanabe, M; Kanai, M; Koike, R; Onodera, O; Tsuji, S; Okamoto, K; Shoji, M

    1998-06-30

    We report a Japanese family with adrenoleukodystrophy (ALD) with a three base pair deletion (delGAG 291) in the ALD gene. A variety of phenotypes were observed within this family. While the proband (patient 1) was classified as having a rare intermediate type of adult cerebral and cerebello-brain stem forms, his younger brother (patient 2) and nephew (patient 3) had a childhood ALD type. Another nephew (patient 4) of patient 1 was classified as having an adolescent form. The tau level in the cerebrospinal fluid (CSF) in patient 1 was as high as that of patients with Alzheimer's disease (AD). His brain magnetic resonance image (MRI) showed abnormalities in the bilateral cerebellar hemispheres and brain stem, but not in the cerebral white matter, where marked reductions of the cerebral blood flow and oxygen metabolism were clearly demonstrated by positron emission tomography (PET). In patients 2 and 3, the autopsy findings showed massive demyelination of the cerebral white matter with sparing of the U-fibers, compatible with the findings of childhood ALD. Oleic and erucic acids (Lorenzo's Oil) were administered to patients 1 and 4, but sufficient effectiveness was not obtained. The findings in this family suggest that delGAG291 is part of the cause of Japanese ALD with phenotypic variations. Moreover, although the scale of the study is limited, there is a possibility that PET can detect an insidious lesion which is undetectable by computed tomogram (CT) or MRI analysis, and that the higher level of tau reflects the process of neuronal degeneration in ALD. Lorenzo's Oil should be given in the early stage.

  5. Are Patients Receiving Health Promotion Advice in the Chiropractic Teaching Clinic Setting?

    PubMed Central

    Evans, Marion Willard; Page, Gregory; Ndetan, Harrison; Martinez, Daniel; Brandon, Patricia; Daniel, Dwain; Walker, Clark

    2011-01-01

    Purpose: The aim of this study was to analyze patient-reported health issues and levels of engagement, discussion of needed lifestyle changes, and goal setting with the patient’s intern or staff doctor before and after a brief intervention to increase health-promoting activities in the clinic. Methods: Patient surveys were developed and administered to outpatients before and after a brief intervention aimed at increasing staff and intern engagement with patients on health promotion measures. Patients self-reported areas of need and levels of engagement by their doctor or intern. Data were analyzed as pre- and postintervention independent, cross-sectional samples. Frequencies and chi-square assessments were performed. Results: One hundred twenty-eight preintervention surveys and 162 postintervention surveys were collected. Back pain was the most common reason for being seen in the clinic (60% of patients) and most patients were white. More than 10% were smokers in both samples. Many patients reported poor diet, unhealthy weight, sleep issues, stress, or lack of regular physical activity, but 65% of the preintervention group and 72% of the postintervention group said a needed lifestyle change was discussed. Goals were set for 74% of the preintervention group and 84% of the postintervention group (p = .04). Information on lifestyle change was received by 52% of preintervention patients and 62% of postintervention patients and most were satisfied with this information. Goal setting was more common when a lifestyle change was discussed. Written information that was related to physical activity, for example, increased 350% (p < .0001). Conclusion: There are many opportunities for discussing needed lifestyle changes with patients. Patients self-report health behavioral issues related to physical activity, unhealthy weight, diet, stress, and sleep. More can be done in this area by this clinic, but initial assessments of impact from a brief intervention seem to have

  6. 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

  7. 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.

  8. Can We Quantify Functional Improvement Following Total Knee Arthroplasty in the Clinical Setting?

    PubMed

    Parks, Nancy L; Whitney, Catherine E; Engh, Gerard A

    2015-12-01

    The purpose of this study was to determine if improvements in knee function after arthroplasty could be practicably measured in the clinical setting using available, validated technology. The tools we assessed included a timed test of common activities, a platform posturography analysis, and a portable gait laboratory device to quantify body segment motion. We measured the function of 25 total knee arthroplasty patients before surgery and at 1, 4, 12, and 24 months after surgery. Assessment of sit-to-stand, walking, stair climbing, lunging, Knee Society Scores, and Oxford Survey Scores were collected at each interval. Patients showed significant improvement in step length, gait speed, symmetry of weight distribution, symmetry of lunging, and speed of stair climbing. Changes in function with long-term follow-up can be precisely measured, making this technology promising for clinical or research applications.

  9. 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. PMID:27275914

  10. 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.

  11. Healthy relationships: the adoption, adaptation, and implementation of a DEBI within two clinical settings.

    PubMed

    Precht, Allison M; Ryerson Espino, Susan; Villela Perez, Veronica; Ingram, Mercedes Vaughn; Amodei, Nancy; Miller, Amanda; Gonzalez, Marisol

    2015-05-01

    The use of evidence-based interventions is increasingly expected within public health settings. However, there continues to be an evidence gap between what works in the literature and in practice. The current multiple case study focused on the adoption, adaptation, capacity building, implementation, and evaluation of healthy relationships (HR) in two demonstration project sites. Our lens for reflection and writing has been highly practical, with an aim of sharing experiences with others interested in adopting HR or another Diffusion of Effective Behavioral Interventions in clinical settings with resource challenges. Although both sites recognized the powerful influence HR had on participants and staff, they reported that HR is resource-intensive regarding training, implementation, and evaluation, limiting the possibility of sustaining the intervention.

  12. 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. PMID:23159868

  13. 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.

  14. Supporting generalist nurses in the rural setting with the introduction of a clinical assessment process.

    PubMed

    Rabbetts, Lyn

    2016-03-01

    The aim of this research was to evaluate the implementation of an assessment process for general nurses involved in providing end-of-life care. A mixed-method, three-phased study was conducted on a medical ward at a regional hospital in a rural setting. Participating nurses completed a questionnaire about their awareness levels of the five validated scales included in the assessment of patients receiving palliative care. Auditing of the completed assessment forms was conducted at the interim and post data collection points and focus groups were conducted in the final phase. Analysis of the data revealed that nurses were able to integrate the use of this assessment process into the care of this group of patients. The author concludes, while nurses working in rural settings require general clinical knowledge of a wide range of patient groups, validated assessment scales can assist them in the provision of evidence-based palliative care. PMID:27018738

  15. Experiences of and perspectives on genetic testing for breast/ovarian cancer in and outside of the customary clinical setting.

    PubMed

    Buckmaster, A M; Gallagher, P

    2010-11-01

    Recently, genetic testing has begun to move from the customary clinical setting (with restrictive entry criteria) into the offices of GPs and the homes of consumers (Williams-Jones, 2003). This research aimed to look at participants' experiences of genetic testing for hereditary breast and ovarian cancer in a clinical environment, and subsequently ascertain potential psychosocial issues associated with genetic testing outside the customary clinical setting. Semi-structured interviews were conducted with eight female participants who had undergone genetic testing within a clinical setting. Transcripts were analysed using Interpretative Phenomenological Analysis. Three super-ordinate themes emerged. Participants' 'battle for control' reflected a perceived loss of control due to their cancer experiences. The 'psychological impact of having experienced/witnessed cancer' highlighted the psychological burden that many participants and their family members lived with. Finally, 'scepticism towards testing outside the clinical setting' was expressed by all participants; they were suspicious of this method of testing. These themes highlighted the potential psychological strain of undergoing genetic testing outside the clinical setting. They also highlighted the wariness with which participants approached the possible introduction of testing outside the customary clinical setting. Psychosocial implications of genetic testing outside the clinical setting were discussed in light of these findings.

  16. 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…

  17. Tocilizumab in systemic juvenile idiopathic arthritis in a real-world clinical setting: results from 1 year of postmarketing surveillance follow-up of 417 patients in Japan

    PubMed Central

    Yokota, Shumpei; Itoh, Yasuhiko; Morio, Tomohiro; Origasa, Hideki; Sumitomo, Naokata; Tomobe, Minako; Tanaka, Kunihiko; Minota, Seiji

    2016-01-01

    Objectives To evaluate the safety and effectiveness of tocilizumab (TCZ) in patients with systemic juvenile idiopathic arthritis (sJIA) in real-world clinical settings in Japan. Methods Paediatric patients with sJIA initiating TCZ between April 2008 and February 2012 and those previously enrolled in clinical trials who initiated TCZ before April 2008 were enrolled in a Japanese registry surveillance programme. Safety and effectiveness parameters were collected for 52 weeks. Results Of 417 patients enrolled, mean age was 11.2 years and 48.0% were female. TCZ exposure was 407.0 patient-years (PYs). Baseline corticosteroid use was higher than in clinical trials. Rates of total adverse events (AEs) and serious AEs (SAEs) were 224.3/100 PYs and 54.5/100 PYs, respectively, with SAEs higher than previously reported. The most frequent AEs and SAEs were infections and infestations (69.8/100 PYs and 18.2/100 PYs, respectively). 74 serious infections occurred in 55 patients (18.2/100 PYs); higher than previously reported. 26 macrophage activation syndrome events were reported in 24 patients (6.4/100 PYs). Fever and rash symptoms improved from baseline to week 52 (54.6% to 5.6% and 43.0% to 5.6%, respectively). At 4 weeks, 8 weeks and 52 weeks, 90.5%, 96.2% and 99.0% of patients achieved normal C reactive protein levels (<0.3 mg/dL), respectively. Conclusions These first real-world data demonstrated that TCZ was well tolerated, with acceptable safety and effectiveness in patients with sJIA. Higher incidences of SAEs and serious infections may be due to differences, such as corticosteroid use and concomitant diseases, between patient populations enrolled in previously reported clinical trials and this study. PMID:26644233

  18. Is DSM widely accepted by Japanese clinicians?

    PubMed

    Someya, T; Takahashi, M; Takahashi, M

    2001-10-01

    The Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III), a new standardized diagnostic system with multiaxial diagnosis, operational criteria and renewed definitions of mental disorders, was introduced in 1980 and prompted movements to reform conventions in Japanese psychiatry. This review overviews the initial response of Japanese clinicians to accept DSM-III, and its effects on the development of systematic research of psychiatric diagnosis. These new research activities include those on reliability of psychiatric diagnosis, application of various evaluation tools, discussion on the concept of mental disorders, relation of personality disorders with depressive disorders, and Taijin-kyofusho, or culturally distinctive phobia in Japan. A reference database search to survey the latest trend on psychiatric research indicated that the number of papers published by Japanese workers increased sharply after 1987, and DSM apparently greatly influenced their internationalization. Twenty years after the publication of DSM-III, a questionnaire on the use of DSM-IV was set out in 2000 to survey how widely DSM is utilized in clinical practice in Japan. Two hundred and twelve psychiatrists answered the questionnaire, and the results show that DSM has been accepted positively by the younger generation, while the older generation (over 40s) has still less interest in DSM, and DSM is used mainly for research purposes rather than in daily practice.

  19. Nomenclature and basic concepts in automation in the clinical laboratory setting: a practical glossary.

    PubMed

    Evangelopoulos, Angelos A; Dalamaga, Maria; Panoutsopoulos, Konstantinos; Dima, Kleanthi

    2013-01-01

    In the early 80s, the word automation was used in the clinical laboratory setting referring only to analyzers. But in late 80s and afterwards, automation found its way into all aspects of the diagnostic process, embracing not only the analytical but also the pre- and post-analytical phase. While laboratories in the eastern world, mainly Japan, paved the way for laboratory automation, US and European laboratories soon realized the benefits and were quick to follow. Clearly, automation and robotics will be a key survival tool in a very competitive and cost-concious healthcare market. What sets automation technology apart from so many other efficiency solutions are the dramatic savings that it brings to the clinical laboratory. Further standardization will assure the success of this revolutionary new technology. One of the main difficulties laboratory managers and personnel must deal with when studying solutions to reengineer a laboratory is familiarizing themselves with the multidisciplinary and technical terminology of this new and exciting field. The present review/glossary aims at giving an overview of the most frequently used terms within the scope of laboratory automation and to put laboratory automation on a sounder linguistic basis.

  20. Conflict Resolution in the Clinical Setting: A Story Beyond Bioethics Mediation.

    PubMed

    Morreim, Haavi

    2015-01-01

    Because ethics consults are often more about conflict than moral puzzlement, the skills of conflict resolution and communication facilitation are now deemed a core competency for ethics consultants. Those skills range beyond the traditional ambit of "bioethics mediation," as illustrated here by a recent mediation regarding a difficult discharge. As conflict permeates healthcare, often spawning downstream ethical issues, conflict resolution services might be deemed a genre of preventive ethics suitably offered by ethics committees. If so, a strong distinction must be made. "Bioethics mediation" as historically defined is a curious amalgam between a consultant who recommends, and a mediator who facilitates consensus among the parties at the table. On closer examination this approach is problematic, particularly in the clinical setting. A mediator who acts as consultant, telling parties what they should do or directly circumscribing the limits of an "acceptable" decision, quickly becomes just another pair of fists in the fight. At that point the odds for reaching genuine agreement, as opposed to a transient acquiescence, diminish markedly. Accordingly, those who undertake conflict resolution in the clinical setting need to distinguish quite sharply between facilitative mediation, versus a consultant's role. PMID:26711422

  1. Measuring Data Quality Through a Source Data Verification Audit in a Clinical Research Setting.

    PubMed

    Houston, Lauren; Probst, Yasmine; Humphries, Allison

    2015-01-01

    Health data has long been scrutinised in relation to data quality and integrity problems. Currently, no internationally accepted or "gold standard" method exists measuring data quality and error rates within datasets. We conducted a source data verification (SDV) audit on a prospective clinical trial dataset. An audit plan was applied to conduct 100% manual verification checks on a 10% random sample of participant files. A quality assurance rule was developed, whereby if >5% of data variables were incorrect a second 10% random sample would be extracted from the trial data set. Error was coded: correct, incorrect (valid or invalid), not recorded or not entered. Audit-1 had a total error of 33% and audit-2 36%. The physiological section was the only audit section to have <5% error. Data not recorded to case report forms had the greatest impact on error calculations. A significant association (p=0.00) was found between audit-1 and audit-2 and whether or not data was deemed correct or incorrect. Our study developed a straightforward method to perform a SDV audit. An audit rule was identified and error coding was implemented. Findings demonstrate that monitoring data quality by a SDV audit can identify data quality and integrity issues within clinical research settings allowing quality improvement to be made. The authors suggest this approach be implemented for future research.

  2. The results of a survey of physicians about the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2014 and its clinical use.

    PubMed

    Mogi, Masaki; Hasebe, Naoyuki; Horiuchi, Masatsugu; Shimamoto, Kazuaki; Umemura, Satoshi

    2016-09-01

    The current study investigated physicians' awareness and use of the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2014 (JSH2014) and is based on the results of a survey performed by the Publicity and Advertisement Committee of JSH. A questionnaire was used to survey physicians' awareness of the JSH2014, their recommended target blood pressure for hypertensive patients with complications and their use of antihypertensive drugs. Physicians who downloaded a PDF version of JSH2014 during the 6 months after its publication (April-September 2014) were asked to complete an online questionnaire. Of the 7872 respondents, 91% were aware of the JSH and complied partially, mostly or completely with it in their practice. With reference to hypertensive patients, ∼70% of physicians who completed the questionnaire recommended a target blood pressure (BP) of 140/90 mm Hg for an office BP value, and 40% recommended 135/85 mm Hg for a home BP value. Physicians recommended target BP levels of 130/80 mm Hg for patients with diabetes or chronic kidney disease (50-63% of physician surveyed) and for elderly patients with diabetes or kidney disease (45-55% of respondents), whereas they recommended 140/90 mm Hg for elderly patients with low cardiovascular disease risk (56-60% of physician surveyed) and for patients with chronic-phase stroke (40-47% of respondents). The most commonly prescribed combination of antihypertensive drugs was angiotensin receptor blocker (ARB) with calcium channel blocker. In addition, physicians' first choice of drug for patients with diabetes or chronic kidney disease was most often ARB. Overall, the survey results showed that the new recommendations from the JSH2014 accurately reflect daily clinical practices for hypertension management used by Japanese physicians. PMID:27169398

  3. Compliance of clinical trial registries with the World Health Organization minimum data set: a survey

    PubMed Central

    Moja, Lorenzo P; Moschetti, Ivan; Nurbhai, Munira; Compagnoni, Anna; Liberati, Alessandro; Grimshaw, Jeremy M; Chan, An-Wen; Dickersin, Kay; Krleza-Jeric, Karmela; Moher, David; Sim, Ida; Volmink, Jimmy

    2009-01-01

    Background Since September 2005 the International Committee of Medical Journal Editors has required that trials be registered in accordance with the World Health Organization (WHO) minimum dataset, in order to be considered for publication. The objective is to evaluate registries' and individual trial records' compliance with the 2006 version of the WHO minimum data set. Methods A retrospective evaluation of 21 online clinical trial registries (international, national, specialty, pharmaceutical industry and local) from April 2005 to February 2007 and a cross-sectional evaluation of a stratified random sample of 610 trial records from the 21 registries. Results Among 11 registries that provided guidelines for registration, the median compliance with the WHO criteria were 14 out of 20 items (range 6 to 20). In the period April 2005–February 2007, six registries increased their compliance by six data items, on average. None of the local registry websites published guidelines on the trial data items required for registration. Slightly more than half (330/610; 54.1%, 95% CI 50.1% – 58.1%) of trial records completed the contact details criteria while 29.7% (181/610, 95% CI 26.1% – 33.5%) completed the key clinical and methodological data fields. Conclusion While the launch of the WHO minimum data set seemed to positively influence registries with better standardisation of approaches, individual registry entries are largely incomplete. Initiatives to ensure quality assurance of registries and trial data should be encouraged. Peer reviewers and editors should scrutinise clinical trial registration records to ensure consistency with WHO's core content requirements when considering trial-related publications. PMID:19624821

  4. Do Subjective Measures Improve the Ability to Identify Limited Health Literacy in a Clinical Setting?

    PubMed Central

    Goodman, Melody S.; Griffey, Richard T.; Carpenter, Christopher R.; Blanchard, Melvin; Kaphingst, Kimberly A.

    2016-01-01

    Background Existing health literacy assessments developed for research purposes have constraints that limit their utility for clinical practice, including time requirements and administration protocols. The Brief Health Literacy Screen (BHLS) consists of 3 self-administered Single-Item Literacy Screener (SILS) questions and obviates these clinical barriers. We assessed whether the addition of SILS items or the BHLS to patient demographics readily available in ambulatory clinical settings reaching underserved patients improves the ability to identify limited health literacy. Methods We analyzed data from 2 cross-sectional convenience samples of patients from an urban academic emergency department (n = 425) and a primary care clinic (n = 486) in St. Louis, Missouri. Across samples, health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), Newest Vital Sign (NVS), and the BHLS. Our analytic sample consisted of 911 adult patients, who were primarily female (62%), black (66%), and had at least a high school education (82%); 456 were randomly assigned to the estimation sample and 455 to the validation sample. Results The analysis showed that the best REALM-R estimation model contained age, sex, education, race, and 1 SILS item (difficulty understanding written information). In validation analysis this model had a sensitivity of 62%, specificity of 81%, a positive likelihood ratio (LR+) of 3.26, and a negative likelihood ratio (LR−) of 0.47; there was a 28% misclassification rate. The best NVS estimation model contained the BHLS, age, sex, education and race; this model had a sensitivity of 77%, specificity of 72%, LR+ of 2.75, LR− of 0.32, and a misclassification rate of 25%. Conclusions Findings suggest that the BHLS and SILS items improve the ability to identify patients with limited health literacy compared with demographic predictors alone. However, despite being easier to administer in clinical settings, subjective

  5. Informed consent procedure for clinical trials in emergency settings: the Polish perspective.

    PubMed

    Iwanowski, Piotr S

    2007-09-01

    Setting reasonable and fair limits of emergency research acceptability in ethical norms and legal regulations must still adhere to the premise of well-being of the research subject over the interests of science and society. Informed consent of emergency patients to be enrolled in clinical trials is a particularly difficult issue due to impaired competencies of patients' to give consent, short diagnostic and therapeutic windows, as well as the requirement to provide detailed information to participants. Whereas the Declaration of Helsinki, Good Clinical Practice guideline, Additional Protocol to the European Bioethical Convention concerning Biomedical Research, as well as appropriate regulations adopted by the Food and Drugs Administration (USA) allow waivers from participants' consent or deferred consent for emergency research, the regulations of most European Community countries following the Clinical Trial Directive (2001/20/EC) do not give space for a deferred consent or a waiver from consent for adult patients (unless surrogate consent is made use of). This is even more confusing in case of Poland, where conflicting regulations on a waiver from a participant's consent in emergency research exist and the regulations on surrogate consent of temporarily incompetent adults are too restrictive and authorise only the guardianship courts to consent, which is not or hardly feasible in practice. European Community regulations need to be amended to allow for implementation of the deferred consent or waivers from consent for emergency research in order to enable ethical research of emergency conditions that should become a large part of important public health priorities. PMID:18210227

  6. [Analysis of nursing skills in the clinical diagnosis and evaluation setting].

    PubMed

    Pedarribes, Georges; Lefeuvre, Gwenaël

    2014-01-01

    The research work presented in this article concerns reengineering of the registered nurse diploma, particularly definition of Skills group No. 1: evaluate a clinical situation and establish a nursing diagnosis. It was designed to analyse real nursing practices in a typical clinical evaluation and diagnosis setting on admission of a patient to hospital. This analysis essentially focused on the cognitive processes used to organise nursing practices. The theoretical framework of professional training allowed this analysis to be performed on the basis of concepts of skills, schema and operative model. The research protocol focused on self-assessment interviews allowing explanation of the schemas used by a skilled nurse and a trainee nurse on admission of a patient in the day hospital for colonoscopy. An analysis of these schemas and especially the operative model of the skilled nurse demonstrated the organising concepts of effective nursing practice. The results, apart from their heuristic value to provide a better understanding of nursing professional practices, also provide resources to design training in nursing clinical evaluation. PMID:25490222

  7. Assessing diabetes practices in clinical settings: precursor to building community partnerships around disease management.

    PubMed

    Prochaska, John D; Mier, Nelda; Bolin, Jane N; Hora, Kerrie L; Clark, Heather R; Ory, Marcia G

    2009-12-01

    Many recommended best practices exist for clinical and community diabetes management and prevention. However, in many cases, these recommendations are not being fully utilized. It is useful to gain a sense of currently utilized and needed practices when beginning a partnership building effort to ameliorate such practice problems. The purpose of this study was to assess current practices in clinical settings within the Brazos Valley in preparation for beginning a community-based participatory research project on improving diabetes prevention and management in this region. Fifty-seven physicians with admission privileges to a regional health system were faxed a survey related to current diabetes patient loads, knowledge and implementation of diabetes-related best practices, and related topics. Both qualitative and quantitative examination of the data was conducted. Fifteen percent of responding providers indicated they implemented diabetes prevention best practices, with significant differences between primary-care physicians and specialists. Respondents indicated a need for educational and counseling resources, as well as an increased health-care workforce in the region. The utilization of a faxed-based survey proved an effective means for assessing baseline data as well as serving as a catalyst for further discussion around coalition development. Results indicated a strong need for both clinical and community-based services regarding diabetes prevention and management, and provided information and insight to begin focused community dialogue around diabetes prevention and management needs across the region. Other sites seeking to begin similar projects may benefit from a similar process.

  8. HIV/AIDS and lipodystrophy: Implications for clinical management in resource-limited settings

    PubMed Central

    Finkelstein, Julia L; Gala, Pooja; Rochford, Rosemary; Glesby, Marshall J; Mehta, Saurabh

    2015-01-01

    Introduction Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings. Methods We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n=799), 90 studies were included in this review. Results and Discussion Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden. Conclusions Lipodystrophy is common in resource

  9. Two Japanese siblings affected with Chikungunya fever with different clinical courses: Imported infections from the Cook Islands.

    PubMed

    Kondo, Makoto; Akachi, Shigehiro; Ando, Katsuhiko; Nomura, Tatsuma; Yamanaka, Keiichi; Mizutani, Hitoshi

    2016-06-01

    Two Japanese siblings visited the Cook Islands on business and stayed for 2 months. The sister developed a high fever, arthralgia, erythema and leg edema on the day after returning to Japan. The brother also developed neck and joint pain on the day following the sister's onset. Subsequently, his erythematous lesions spread over his whole body. Chikungunya virus was detected from the sister's blood and urine by specific reverse transcription polymerase chain reaction, but not in the brother's samples. Retrospectively, his history of Chikungunya fever was confirmed by the presence of the anti-Chikungunya virus immunoglobulin (Ig)M and IgG antibodies using the specific enzyme-linked immunoassay. In Japan, no autochthonous case of Chikungunya fever was reported previously. We should give attention to the imported infectious diseases for epidemic prevention. This report warns about the danger of the imported infectious diseases, and also suggests that covering the topic of infectious disease in the world is critical to doctors as well as travelers.

  10. An experience in Japanese academic medicine.

    PubMed Central

    Tierney, L M

    1994-01-01

    The Japanese health care system has been highly praised for its universal access, freedom of patient choice, maintenance of a private system, and creative funding. Japanese citizens enjoy general good health, low infant mortality, and long life expectancy. Nevertheless, aspects of Japanese medical education, both graduate and undergraduate, and the structure of academic departments differ from those seen in the United States. A sabbatical spent teaching general internal medicine in Japan provided the experience for this review of the Japanese system. I describe the structure and function of departments of medicine and observations made at daily clinical teaching exercises in hospitals throughout the country. PMID:8160464

  11. 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)

  12. Prevalence and clinical characterization of Japanese diabetes mellitus with an A-to-G mutation at nucleotide 3243 of the mitochondrial tRNA{sup Leu (UUR)} gene

    SciTech Connect

    Odawara, Masato; Sasaki, Kayoko; Yamashita, Kamejiro

    1995-04-01

    An A-to-G mutation at nucleotide position 3243 of the mitochondrial genome has been associated with insulin-dependent diabetes mellitus (IDDM) and with noninsulin-dependent diabetes mellitus (NIDDM) with deafness. We investigated the prevalence of this mutation in Japanese patients with IDDM, NIDDM, and impaired glucose tolerance (IGT) and in nondiabetic control individuals, and we identified it in 3 of 300 patients with NIDDM or IGT (1.0%). None of these individuals had significant sensorineural hearing loss. None of the 94 IDDM or the 115 nondiabetic control subjects was positive for this mutation. Oral glucose tolerance test revealed that a 57-yr-old male with this mutation was rather hyperinsulinemic in the fasting state. The insulin secretion in this patient decreased with age; he did not complain of any hearing disorder, although audiometry revealed a slight elevation of hearing threshold at high frequencies. In conclusion, we found that a mitochondrial gene mutation at nucleotide position 3243 was present in about 1% of NIDDM patients including those patients with IGT. The subtype of diabetes mellitus with this mutation may have a clinical profile similar to that found in patients with NIDDM commonly seen in outpatient clinics. 25 refs., 2 figs., 1 tab.

  13. The Quality of Care Provided to Women with Urinary Incontinence in Two Clinical Settings

    PubMed Central

    Anger, Jennifer T.; Alas, Alexandriah; Litwin, Mark S.; Chu, Stephanie D.; Bresee, Catherine; Roth, Carol P.; Rashid, Rezoana; Shekelle, Paul; Wenger, Neil S.

    2016-01-01

    Purpose Our aim was to test the feasibility of a set of quality-of-care indicators for urinary incontinence (UI) and, at the same time, measure the care provided to women with UI in two different clinical settings. Materials and Methods This was a pilot test of a set of quality-of-care indicators (QIs). This was a pilot test of a set of quality-of-care indicators (QIs). Twenty QIs were previously developed using the RAND Appropriateness method. These QIs were used to measure care received for 137 women with a urinary incontinence (UI) diagnosis in a 120-physician hospital-based multi-specialty medical group (MSG). We also performed an abstraction of 146 patient records from primary care offices in Southern California. These charts were previously used as part of the Assessing Care of Vulnerable Elders Project (ACOVE). As a post-hoc secondary analysis, the two populations were compared with respect to quality, as measured by compliance with the QIs. Results In the ACOVE population, 37.7% of patients with UI underwent a pelvic examination, versus 97.8% in the MSG. Only 15.6% of cases in the MSG and 14.2% in ACOVE (p=0.86) had documentation that pelvic floor exercises were offered. Relatively few women with a body mass index (BMI) of >25 were counseled about weight loss in either population (20.9% MSG vs. 26.1% ACOVE, p=0.76). For women undergoing sling surgery, documentation of counseling about risks was lacking, and only 9.3% of eligible cases (MSG only) had documentation of the risks of mesh. Conclusions QIs are a feasible means to measure the care provided to women with UI. Care varied by population studied, yet deficiencies in care were prevalent in both patient populations studied. PMID:27164512

  14. A feasible high spatiotemporal resolution breast DCE-MRI protocol for clinical settings.

    PubMed

    Tudorica, Luminita A; Oh, Karen Y; Roy, Nicole; Kettler, Mark D; Chen, Yiyi; Hemmingson, Stephanie L; Afzal, Aneela; Grinstead, John W; Laub, Gerhard; Li, Xin; Huang, Wei

    2012-11-01

    Three dimensional bilateral imaging is the standard for most clinical breast dynamic contrast-enhanced (DCE) MRI protocols. Because of high spatial resolution (sRes) requirement, the typical 1-2 min temporal resolution (tRes) afforded by a conventional full-k-space-sampling gradient echo (GRE) sequence precludes meaningful and accurate pharmacokinetic analysis of DCE time-course data. The commercially available, GRE-based, k-space undersampling and data sharing TWIST (time-resolved angiography with stochastic trajectories) sequence was used in this study to perform DCE-MRI exams on thirty one patients (with 36 suspicious breast lesions) before their biopsies. The TWIST DCE-MRI was immediately followed by a single-frame conventional GRE acquisition. Blinded from each other, three radiologist readers assessed agreements in multiple lesion morphology categories between the last set of TWIST DCE images and the conventional GRE images. Fleiss' κ test was used to evaluate inter-reader agreement. The TWIST DCE time-course data were subjected to quantitative pharmacokinetic analyses. With a four-channel phased-array breast coil, the TWIST sequence produced DCE images with 20 s or less tRes and ~ 1.0×1.0×1.4 mm(3) sRes. There were no significant differences in signal-to-noise (P=.45) and contrast-to-noise (P=.51) ratios between the TWIST and conventional GRE images. The agreements in morphology evaluations between the two image sets were excellent with the intra-reader agreement ranging from 79% for mass margin to 100% for mammographic density and the inter-reader κ value ranging from 0.54 (P<.0001) for lesion size to 1.00 (P<.0001) for background parenchymal enhancement. Quantitative analyses of the DCE time-course data provided higher breast cancer diagnostic accuracy (91% specificity at 100% sensitivity) than the current clinical practice of morphology and qualitative kinetics assessments. The TWIST sequence may be used in clinical settings to acquire high

  15. Profiles of Risk Among HIV-infected Youth in Clinic Settings

    PubMed Central

    Huszti, Heather C.; Wilson, Patrick A.; Kahana, Shoshana; Nichols, Sharon; Gonin, René; Xu, Jiahong; Kapogiannis, Bill G.

    2014-01-01

    Despite the rising number of new HIV infections among youth, few tailored interventions for youth living with HIV (YLH) have been developed and rigorously tested. Developing tailored interventions necessitates identifying different profiles of YLH and understanding how risk and protective factors cluster together. Obtaining this critical information requires accessing a sufficiently large sample of YLH from diverse geographic settings such as those available through the Adolescent Trials Network for HIV Interventions (ATN). We recruited a cross-sectional sample of 1,712 YLH from ATN clinics; participants completed a survey on psychosocial and health factors. Using latent class analysis on nine composite variables representing risk factors, we identified five classes distinguished by substance use, sexual behavior, and pregnancy history and differing on health outcomes. Findings suggest a need for tailored interventions addressing multiple risky behaviors of HIV-infected youth and research to clarify how intervention effectiveness may differ by risk profile. PMID:25117556

  16. Long-term efficacy and safety of a generic atorvastatin in usual clinical care setting.

    PubMed

    Ong, L M; Punithavathi, N; Lena, Y L L; Mahanim, O; Leekha, S

    2011-08-01

    A multicentre study was conducted to assess the long term efficacy and safety of a generic atorvastatin in the treatment of primary hypercholesterolaemia. Eighty five patients who received 10mg or 20 mg of atorvastatin for 8 weeks depending on target cholesterol goal were followed up by their own physicians and had final evaluation at 52 weeks. Reduction in mean low density Lipoprotein (LDL-C) was 36.5%, 37.9% and 32.2% at weeks 4, 8 and 52 respectively. LDL-C target was maintained in 81% and 69% of patients at week 8 and 52 respectively without drug related serious adverse events. Generic atorvastatin is safe and effective in usual clinical care setting. PMID:22111443

  17. Qualitative observation in a clinical setting: challenges at end of life.

    PubMed

    Bloomer, Melissa J; Cross, Wendy; Endacott, Ruth; O'Connor, Margaret; Moss, Cheryle

    2012-03-01

    This paper explores the methodological challenges associated with undertaking qualitative observation in the clinical setting at end of life. The authors reflect on their experiences of using non-participant observation to explore the nursing care delivered to dying patients in acute hospital wards. The challenges of observation as a method, clearly defining the participant group and involving vulnerable populations, such as the dying patients and their families, will be discussed. Consideration is also given to defining and working within the observational field, the researchers' dual roles, cost versus benefit, impact of culture, religion and ethnicity, and the determination of research limits/boundaries, with reflections from the authors' own experiences used to exemplify the issues.

  18. Automated knowledge acquisition from clinical databases based on rough sets and attribute-oriented generalization.

    PubMed Central

    Tsumoto, S.

    1998-01-01

    Rule induction methods have been proposed in order to acquire knowledge automatically from databases. However, conventional approaches do not focus on the implementation of induced results into an expert system. In this paper, the author focuses not only on rule induction but also on its evaluation and presents a systematic approach from the former to the latter as follows. First, a rule induction system based on rough sets and attribute-oriented generalization is introduced and was applied to a database of congenital malformation to extract diagnostic rules. Then, by the use of the induced knowledge, an expert system which makes a differential diagnosis on congenital disorders is developed. Finally, this expert system was evaluated in an outpatient clinic, the results of which show that the system performs as well as a medical expert. PMID:9929279

  19. Technical solutions for mitigating security threats caused by health professionals in clinical settings.

    PubMed

    Fernandez-Aleman, Jose Luis; Belen Sanchez Garcia, Ana; Garcia-Mateos, Gines; Toval, Ambrosio

    2015-08-01

    The objective of this paper is to present a brief description of technical solutions for health information system security threats caused by inadequate security and privacy practices in healthcare professionals. A literature search was carried out in ScienceDirect, ACM Digital Library and IEEE Digital Library to find papers reporting technical solutions for certain security problems in information systems used in clinical settings. A total of 17 technical solutions were identified: measures for password security, the secure use of e-mail, the Internet, portable storage devices, printers and screens. Although technical safeguards are essential to the security of healthcare organization's information systems, good training, awareness programs and adopting a proper information security policy are particularly important to prevent insiders from causing security incidents. PMID:26736528

  20. Technical solutions for mitigating security threats caused by health professionals in clinical settings.

    PubMed

    Fernandez-Aleman, Jose Luis; Belen Sanchez Garcia, Ana; Garcia-Mateos, Gines; Toval, Ambrosio

    2015-08-01

    The objective of this paper is to present a brief description of technical solutions for health information system security threats caused by inadequate security and privacy practices in healthcare professionals. A literature search was carried out in ScienceDirect, ACM Digital Library and IEEE Digital Library to find papers reporting technical solutions for certain security problems in information systems used in clinical settings. A total of 17 technical solutions were identified: measures for password security, the secure use of e-mail, the Internet, portable storage devices, printers and screens. Although technical safeguards are essential to the security of healthcare organization's information systems, good training, awareness programs and adopting a proper information security policy are particularly important to prevent insiders from causing security incidents.

  1. Clinical decision support and acute low back pain: evidence-based order sets.

    PubMed

    Forseen, Scott E; Corey, Amanda S

    2012-10-01

    Low back pain is one of the most common reasons for visits to physicians in the ambulatory care setting. Estimated medical expenditures related to low back pain have increased disproportionately relative to the more modest increase in the prevalence of self-reported low back pain in the past decade. The increase in spine care expenditures has not been associated with improved patient outcomes. Evidence-based order templates presented in this article are designed to assist practitioners through the process of managing patients with acute low back pain. A logical method of choosing, developing, and implementing clinical decision support interventions is presented that is based on the best available scientific evidence. These templates may be reasonably expected to improve patient care, decrease inappropriate imaging utilization, reduce the inappropriate use of steroids and narcotics, and potentially decrease the number of inappropriate invasive procedures. PMID:23025864

  2. Initiating the mollusk genomics annotation community: toward creating the complete curated gene-set of the Japanese Pearl Oyster, Pinctada fucata.

    PubMed

    Kawashima, Takeshi; Takeuchi, Takeshi; Koyanagi, Ryo; Kinoshita, Shigeharu; Endo, Hirotoshi; Endo, Kazuyoshi

    2013-10-01

    The genome sequence of the Japanese pearl oyster, the first draft genome from a mollusk, was published in February 2012. In order to curate the draft genome assemblies and annotate the predicted gene models, two annotation Jamborees were held in Okinawa and Tokyo. To date, 761 genes have been surveyed and curated. A preparatory meeting and a debriefing were held at the Misaki Marine Biological Station before and after the Jamborees. These four events, in conjunction with the sequence-decoding project, have facilitated the first series of gene annotations. Genome annotators among the Jamboree participants added 22 functional categories to the annotation system to date. Of these, 17 are included in Generic Gene Ontology. The other five categories are specific to molluskan biology, such as "Byssus Formation" and "Shell Formation", including Biomineralization and Acidic Proteins. A total of 731 genes from our latest version of gene models are annotated and classified into these 22 categories. The resulting data will serve as a useful reference for future genomic analyses of this species as well as comparative analyses among mollusks.

  3. Clinical Setting Influences Off-Label and Unlicensed Prescribing in a Paediatric Teaching Hospital

    PubMed Central

    Czarniak, Petra; Bint, Lewis; Favié, Laurent; Parsons, Richard; Hughes, Jeff; Sunderland, Bruce

    2015-01-01

    Purpose To estimate the prevalence of off-label and unlicensed prescribing during 2008 at a major paediatric teaching hospital in Western Australia. Methods A 12-month retrospective study was conducted at Princess Margaret Hospital using medication chart records randomly selected from 145,550 patient encounters from the Emergency Department, Inpatient Wards and Outpatient Clinics. Patient and prescribing data were collected. Drugs were classified as off-label or unlicensed based on Australian registration data. A hierarchical system of age, indication, route of administration and dosage was used. Drugs were classified according to the Anatomical Therapeutic Chemical Code. Results A total of 1,037 paediatric patients were selected where 2,654 prescriptions for 330 different drugs were prescribed to 699 patients (67.4%). Most off-label drugs (n = 295; 43.3%) were from the nervous system; a majority of unlicensed drugs were systemic hormonal preparations excluding sex hormones (n = 22, 32.4%). Inpatients were prescribed more off-label drugs than outpatients or Emergency Department patients (p < 0.0001). Most off-label prescribing occurred in infants and children (31.7% and 35.9% respectively) and the highest percentage of unlicensed prescribing (7.2%) occurred in infants (p < 0.0001). There were 25.7% of off-label and 2.6% of unlicensed medications prescribed across all three settings. Common reasons for off-label prescribing were dosage (47.4%) and age (43.2%). Conclusion This study confirmed off-label and unlicensed use of drugs remains common. Further, that prevalence of both is influenced by the clinical setting, which has implications in regards to medication misadventure, and the need to have systems in place to minimise medication errors. Further, there remains a need for changes in the regulatory system in Australia to ensure that manufacturers incorporate, as it becomes available, evidence regarding efficacy and safety of their drugs in children in the

  4. Human thermoregulation and measurement of body temperature in exercise and clinical settings.

    PubMed

    Lim, Chin Leong; Byrne, Chris; Lee, Jason Kw

    2008-04-01

    This review discusses human thermoregulation during exercise and the measurement of body temperature in clinical and exercise settings. The thermoregulatory mechanisms play important roles in maintaining physiological homeostasis during rest and physical exercise. Physical exertion poses a challenge to thermoregulation by causing a substantial increase in metabolic heat production. However, within a non-thermolytic range, the thermoregulatory mechanisms are capable of adapting to sustain physiological functions under these conditions. The central nervous system may also rely on hyperthermia to protect the body from "overheating." Hyperthermia may serve as a self-limiting signal that triggers central inhibition of exercise performance when a temperature threshold is achieved. Exposure to sub-lethal heat stress may also confer tolerance against higher doses of heat stress by inducing the production of heat shock proteins, which protect cells against the thermolytic effects of heat. Advances in body temperature measurement also contribute to research in thermoregulation. Current evidence supports the use of oral temperature measurement in the clinical setting, although it may not be as convenient as tympanic temperature measurement using the infrared temperature scanner. Rectal and oesophagus temperatures are widely accepted surrogate measurements of core temperature (Tc), but they cause discomfort and are less likely to be accepted by users. Gastrointestinal temperature measurement using the ingestible temperature sensor provides an acceptable level of accuracy as a surrogate measure of Tc without causing discomfort to the user. This form of Tc measurement also allows Tc to be measured continuously in the field and has gained wider acceptance in the last decade.

  5. Recognizing Binge-Eating Disorder in the Clinical Setting: A Review of the Literature

    PubMed Central

    Kornstein, Susan G.; Kunovac, Jelena L.; Herman, Barry K.; Culpepper, Larry

    2016-01-01

    Objective: Review the clinical skills needed to recognize, diagnose, and manage binge-eating disorder (BED) in a primary care setting. Data Sources: A PubMed search of English-language publications (January 1, 2008–December 11, 2014) was conducted using the term binge-eating disorder. Relevant articles known to the authors were also included. Study Selection/Data Extraction: Publications focusing on preclinical topics (eg, characterization of receptors and neurotransmitter systems) without discussing clinical relevance were excluded. A total of 101 publications were included in this review. Results: Although BED is the most prevalent eating disorder, it is underdiagnosed and undertreated. BED can be associated with medical (eg, type 2 diabetes and metabolic syndrome) and psychiatric (eg, depression and anxiety) comorbidities that, if left untreated, can impair quality of life and functionality. Primary care physicians may find diagnosing and treating BED challenging because of insufficient knowledge of its new diagnostic criteria and available treatment options. Furthermore, individuals with BED may be reluctant to seek treatment because of shame, embarrassment, and a lack of awareness of the disorder. Several short assessment tools are available to screen for BED in primary care settings. Pharmacotherapy and psychotherapy should focus on reducing binge-eating behavior, thereby reducing medical and psychiatric complications. Conclusions: Overcoming primary care physician– and patient-related barriers is critical to accurately diagnose and appropriately treat BED. Primary care physicians should take an active role in the initial recognition and assessment of suspected BED based on case-finding indicators (eg, eating habits and being overweight), the initial treatment selection, and the long-term follow-up of patients who meet DSM-5 BED diagnostic criteria. PMID:27733955

  6. National Priority Setting of Clinical Practice Guidelines Development for Chronic Disease Management.

    PubMed

    Jo, Heui-Sug; Kim, Dong Ik; Oh, Moo-Kyung

    2015-12-01

    By November 2013, a total of 125 clinical practice guidelines (CPGs) have been developed in Korea. However, despite the high burden of diseases and the clinical importance of CPGs, most chronic diseases do not have available CPGs. Merely 83 CPGs are related to chronic diseases, and only 40 guidelines had been developed in the last 5 yr. Considering the rate of the production of new evidence in medicine and the worsening burden from chronic diseases, the need for developing CPGs for more chronic diseases is becoming increasingly pressing. Since 2011, the Korean Academy of Medical Sciences and the Korea Centers for Disease Control and Prevention have been jointly developing CPGs for chronic diseases. However, priorities have to be set and resources need to be allocated within the constraint of a limited funding. This study identifies the chronic diseases that should be prioritized for the development of CPGs in Korea. Through an objective assessment by using the analytic hierarchy process and a subjective assessment with a survey of expert opinion, high priorities were placed on ischemic heart disease, cerebrovascular diseases, Alzheimer's disease and other dementias, osteoarthritis, neck pain, chronic kidney disease, and cirrhosis of the liver.

  7. G6PD Deficiency in an HIV Clinic Setting in the Dominican Republic.

    PubMed

    Xu, Julia Z; Francis, Richard O; Lerebours Nadal, Leonel E; Shirazi, Maryam; Jobanputra, Vaidehi; Hod, Eldad A; Jhang, Jeffrey S; Stotler, Brie A; Spitalnik, Steven L; Nicholas, Stephen W

    2015-10-01

    Because human immunodeficiency virus (HIV)-infected patients receive prophylaxis with oxidative drugs, those with glucose-6-phosphate dehydrogenase (G6PD) deficiency may experience hemolysis. However, G6PD deficiency has not been studied in the Dominican Republic, where many individuals have African ancestry. Our objective was to determine the prevalence of G6PD deficiency in Dominican HIV-infected patients and to attempt to develop a cost-effective algorithm for identifying such individuals. To this end, histories, chart reviews, and G6PD testing were performed for 238 consecutive HIV-infected adult clinic patients. The overall prevalence of G6PD deficiency (8.8%) was similar in males (9.3%) and females (8.5%), and higher in Haitians (18%) than Dominicans (6.4%; P = 0.01). By logistic regression, three clinical variables predicted G6PD status: maternal country of birth (P = 0.01) and a history of hemolysis (P = 0.01) or severe anemia (P = 0.03). Using these criteria, an algorithm was developed, in which a patient subset was identified that would benefit most from G6PD screening, yielding a sensitivity of 94.7% and a specificity of 97.2%, increasing the pretest probability (8.8-15.1%), and halving the number of patients needing testing. This algorithm may provide a cost-effective strategy for improving care in resource-limited settings.

  8. G6PD Deficiency in an HIV Clinic Setting in the Dominican Republic

    PubMed Central

    Xu, Julia Z.; Francis, Richard O.; Lerebours Nadal, Leonel E.; Shirazi, Maryam; Jobanputra, Vaidehi; Hod, Eldad A.; Jhang, Jeffrey S.; Stotler, Brie A.; Spitalnik, Steven L.; Nicholas, Stephen W.

    2015-01-01

    Because human immunodeficiency virus (HIV)-infected patients receive prophylaxis with oxidative drugs, those with glucose-6-phosphate dehydrogenase (G6PD) deficiency may experience hemolysis. However, G6PD deficiency has not been studied in the Dominican Republic, where many individuals have African ancestry. Our objective was to determine the prevalence of G6PD deficiency in Dominican HIV-infected patients and to attempt to develop a cost-effective algorithm for identifying such individuals. To this end, histories, chart reviews, and G6PD testing were performed for 238 consecutive HIV-infected adult clinic patients. The overall prevalence of G6PD deficiency (8.8%) was similar in males (9.3%) and females (8.5%), and higher in Haitians (18%) than Dominicans (6.4%; P = 0.01). By logistic regression, three clinical variables predicted G6PD status: maternal country of birth (P = 0.01) and a history of hemolysis (P = 0.01) or severe anemia (P = 0.03). Using these criteria, an algorithm was developed, in which a patient subset was identified that would benefit most from G6PD screening, yielding a sensitivity of 94.7% and a specificity of 97.2%, increasing the pretest probability (8.8–15.1%), and halving the number of patients needing testing. This algorithm may provide a cost-effective strategy for improving care in resource-limited settings. PMID:26240158

  9. Prevalence of Acanthamoeba and superbugs in a clinical setting: coincidence or hyperparasitism?

    PubMed

    Siddiqui, Ruqaiyyah; Sagheer, Mehwish; Khan, Naveed Ahmed

    2013-03-01

    Antibacterial strategies to eradicate superbugs from hospitals/nursing homes have had limited success, suggesting the need for employing innovative preventative measures and better understanding of the prevalence of microbial pathogens in close proximity of susceptible populations. A total of 120 environmental samples were collected from the Aga Khan University hospital. Amoebae were identified using morphological characteristics as well as PCR using genus-specific primers, while bacteria were identified using standard biochemical testing. Out of 120 samples tested, 52 (43.3 %) samples were positive for Acanthamoeba, while all 120 (100 %) samples were positive for bacteria. Following bacterial identification, samples showed mixed bacterial populations. Out of 120 samples, 76 (63.3 %) samples were positive for Bacillus spp., 64 (53.3 %) samples were positive for Corynebacterium spp., 32 (26.6 %) samples were positive for Staphylococcus spp., and 9 (7.5 %) samples were positive for Micrococcus spp. The antibiotic susceptibility showed that all bacterial isolates recovered were multiple drug-resistant. The current findings suggest that Acanthamoeba and bacteria coexist in a clinical environment. Given that Acanthamoeba can harbor bacteria, anti-amoebic approaches may represent a strategy in eradicating "superbugs" from the clinical setting in addition to the current measures.

  10. Rapid diagnostic tests versus clinical diagnosis for managing people with fever in malaria endemic settings

    PubMed Central

    Odaga, John; Sinclair, David; Lokong, Joseph A; Donegan, Sarah; Hopkins, Heidi; Garner, Paul

    2014-01-01

    Background In 2010, the World Health Organization recommended that all patients with suspected malaria are tested for malaria before treatment. In rural African settings light microscopy is often unavailable. Diagnosis has relied on detecting fever, and most people were given antimalarial drugs presumptively. Rapid diagnostic tests (RDTs) provide a point-of-care test that may improve management, particularly of people for whom the RDT excludes the diagnosis of malaria. Objectives To evaluate whether introducing RDTs into algorithms for diagnosing and treating people with fever improves health outcomes, reduces antimalarial prescribing, and is safe, compared to algorithms using clinical diagnosis. Search methods We searched the Cochrane Infectious Disease Group Specialized Register; CENTRAL (The Cochrane Library); MEDLINE; EMBASE; CINAHL; LILACS; and the metaRegister of Controlled Trials for eligible trials up to 10 January 2014. We contacted researchers in the field and reviewed the reference lists of all included trials to identify any additional trials. Selection criteria Individual or cluster randomized trials (RCTs) comparing RDT-supported algorithms and algorithms using clinical diagnosis alone for diagnosing and treating people with fever living in malaria-endemic settings. Data collection and analysis Two authors independently applied the inclusion criteria and extracted data. We combined data from individually and cluster RCTs using the generic inverse variance method. We presented all outcomes as risk ratios (RR) with 95% confidence intervals (CIs), and assessed the quality of evidence using the GRADE approach. Main results We included seven trials, enrolling 17,505 people with fever or reported history of fever in this review; two individually randomized trials and five cluster randomized trials. All trials were conducted in rural African settings. In most trials the health workers diagnosing and treating malaria were nurses or clinical officers with less

  11. Microbial Contamination of the White Coats of Dental Staff in the Clinical Setting

    PubMed Central

    Priya, Harsh; Acharya, Shashidhar; Bhat, Meghashyam; Ballal, Mamtha

    2009-01-01

    Background and aims Although wearing a white coat is an accepted part of medical and dental practice, it is a potential source of cross-infection. The objective of this study was to determine the level and type of microbial contamination present on the white coats of dental interns, graduate students and faculty in a dental clinic. Materials and methods Questionnaire and cross-sectional survey of the bacterial contamination of white coats in two predetermined areas (chest and pocket) on the white coats were done in a rural dental care center. Paired sample t-test and chi-square test were used for Statistical analysis. Results 60.8% of the participants reported washing their white coats once a week. Grading by the examiner revealed 15.7% dirty white coats. Also, 82.5% of the interns showed bacterial contamination of their white coats compared to 74.7% graduate students and 75% faculty members irrespective of the area examined. However, chest area was consistently a more bacterio-logically contaminated site as compared to the pocket area. Antibiotic sensitivity testing revealed resistant varieties of micro-organisms against Amoxicillin (60%), Erythromycin (42.5%) and Cotrimoxazole (35.2%). Conclusion The white coats seem to be a potential source of cross-infection in the dental setting. The bacterial contamina-tion carried by white coats, as demonstrated in this study, supports the ban on white coats from non-clinical areas. PMID:23230502

  12. Using the Promise of Sonodynamic Therapy in the Clinical Setting against Disseminated Cancers

    PubMed Central

    Trendowski, Matthew

    2015-01-01

    Sonodynamic therapy (SDT) is a form of ultrasound therapy in which specialized chemotherapeutic agents known as sonosensitizers are administered to increase the efficacy of ultrasound-mediated preferential damage of neoplastic cells. Multiple in vitro and in vivo studies have indicated that SDT has the ability to exhibit profound physical and chemical changes on cellular structure. As supportive as the data have been, assessment of this method at the clinical level has been limited to only solid tumors. Although SDT has shown efficacy against multiple adherent neoplastic cell lines, it has also shown particular promise with leukemia-derived cell lines. Potential procedures to administer SDT to leukemia patients are heating the appendages as ultrasound is applied to these areas (Heat and Treat), using an ultrasound probe to scan the body for malignant growths (Target and Destroy), and extracorporeal blood sonication (EBS) through dialysis. Each method offers a unique set of benefits and concerns that will need to be evaluated in preclinical mammalian models of malignancy before clinical examination can be considered. PMID:26380110

  13. Diagnostic tests for influenza and other respiratory viruses: determining performance specifications based on clinical setting.

    PubMed

    Takahashi, Hiroshi; Otsuka, Yoshihito; Patterson, Bruce K

    2010-06-01

    The lack of sensitivity of rapid immunoassays in detecting the novel 2009 H1N1 influenza virus infection has led to recommendations on influenza diagnostic testing for clinicians treating patients as well as advising clinicians on testing decisions. Studies have also shown that rapid immunoassays for seasonal influenza virus show considerable variability in performance characteristics, based on age of patient, prevalence of disease, course of infection, and the quality of the kit used. While public health authorities are currently focused on influenza virus diagnostics, a lack of sensitivity of rapid immunoassays for other viral respiratory pathogens has been widely reported, such as the very limited value of rapid immunoassays for the detection of respiratory syncytial virus in adults. In light of the lack of sensitivity of diagnostic tests for suspected 2009 H1N1 influenza virus infection, as well as their variable performance characteristics for seasonal influenza virus, a number of recommendations have been made by public health authorities advising clinicians on the need for clinical judgment as an important part of testing and treatment decisions as well as reliance on local epidemiologic and surveillance data. With the availability of new molecular methodologies that are user-friendly and allow the front-line physician as well as hospital infection control programs to significantly improve respiratory viral diagnostics, there is a need to carefully determine the most optimal diagnostic testing methodology based on the clinical setting. This review will describe the historical, current, and changing dynamics of respiratory virus infection diagnostics.

  14. Placebo mechanisms across different conditions: from the clinical setting to physical performance

    PubMed Central

    Pollo, Antonella; Carlino, Elisa; Benedetti, Fabrizio

    2011-01-01

    Although the great increase in interest in the placebo phenomenon was spurred by the clinical implications of its use, the progressive elucidation of the neurobiological and pharmacological mechanisms underlying the placebo effect also helps cast new light on the relationship between mind (and brain) and body, a topic of foremost philosophical importance but also a major medical issue in light of the complex interactions between the brain on the one hand and body functions on the other. While the concept of placebo can be a general one, with a broad definition generally applicable to many different contexts, the description of the cerebral processes called into action in specific situations can vary widely. In this paper, examples will be given where physiological or pathological conditions are altered following the administration of an inert substance or verbal instructions tailored to induce expectation of a change, and explanations will be offered with details on neurotransmitter changes and neural pathways activated. As an instance of how placebo effects can extend beyond the clinical setting, data in the physical performance domain and implications for sport competitions will also be presented and discussed. PMID:21576136

  15. Comparing fibromyalgia patients from primary care and rheumatology settings: clinical and psychosocial features.

    PubMed

    Boyer, Ana Lledó; Mira Pastor, Maria Angeles; Calatayud, Nieves Pons; Lopez-Roig, Sofía; Cantero Terol, Maria Carmen

    2009-08-01

    The aim of this study was to compare clinical symptoms, perceived health status, health resource use and psychosocial features in fibromyalgia (FM) patients at different health care levels. A total of 315 participants were recruited from primary care (PC) (n=101) and rheumatology settings (RS) (n=214). Subjects completed a protocol of clinical features and health resource use, hospital anxiety and depression scale, sickness impact profile, chronic pain self-efficacy scale, multidimensional pain locus of control scale, perceived health competence scale and chronic pain coping inventory. Student's t test, effect size, and contrast and power test were performed to examine differences between samples. FM patients treated in PC and RS were similar in most variables assessed and only differed significantly in tender points, sleep disturbance, wellness-focused coping strategies and in self-efficacy beliefs. The similarities do not support patient selection through care levels and thus, in the Spanish health care system at least, endorse PC as a reference unit for treatment and questioning the benefits of referring patients to RS.

  16. [Reflections on the clinical reports «minimum data set»].

    PubMed

    Prieto de Paula, J M; Franco Hidalgo, S

    2012-02-01

    Royal Decree 1093/2010 (3 September 2010) establishes the minimum data set that the clinical reports of discharges and outpatient visits elaborated in the facilities of the National Health System should contain, among others. Until then, the Ministerial Order 221/1984, that only required the drawing up of a discharge report for patients seen in a hospital-regime health care establishment, was in force. In spite of the importance of these documents, their quality is far from that desired, especially that of the reports on visits, which, among other things, are not performed in a high percentage of the cases. Recently the Sociedad Española de Medicina Interna (SEMI) (Spanish Society of Internal Medicine), in collaboration with other scientific societies, issued some recommendations for the drawing up of the discharge reports. In this present work, a series of thoughts are made on the implications of the new decree, especially in the case of the reports of the outpatient clinics.

  17. Interprofessional education through shadowing experiences in multi-disciplinary clinical settings

    PubMed Central

    2010-01-01

    The World Health Organization has recently added Interprofessional Education (IPE) to its global health agenda recognizing it as a necessary component of all health professionals' education. We suggest mandatory interprofessional shadowing experiences as a mechanism to be used by chiropractic institutions to address this agenda. IPE initiatives of other professions (pharmacy and medicine) are described along with chiropractic. This relative comparison of professions local to our jurisdiction in Ontario, Canada is made so that the chiropractic profession may take note that they are behind other health care providers in implementing IPE. Interprofessional shadowing experiences would likely take place in a multi-disciplinary clinical setting. We offer an example of how two separate professions within a Family Health Team (FHT) can work together in such a setting to enhance both student learning and patient care. For adult learners, using interprofessional shadowing experiences with learner-derived and active objectives across diverse health professional groups may help to improve the educational experience. Mandatory interprofessional shadowing experiences for chiropractors during their training can enhance future collaborative practice and provide success in reaching a goal common to each profession - improved patient care. PMID:21126343

  18. ART Adherence Measurement in Non-Clinical Settings in South India

    PubMed Central

    Kleinman, Nora J.; Manhart, Lisa E.; Mohanraj, Rani; Kumar, Shuba; Jeyaseelan, L.; Rao, Deepa; Simoni, Jane M.

    2016-01-01

    Optimal adherence to antiretroviral therapy (ART) is key to viral suppression, but may be impeded by psychosocial consequences of HIV-infection such as stigma and depression. Measures of adherence in India have been examined in clinic populations, but little is known about the performance of these measures outside clinical settings. We conducted a cross-sectional study of 151 Tamil-speaking people living with HIV/AIDS (PLHA) in India recruited through HIV support networks and compared single item measures from the Adult AIDS Clinical Trial Group (AACTG) scale, a visual analog scale (VAS), and a question on timing of last missed dose. Depression was measured using the Major Depression Inventory (MDI) and HIV-related stigma was measured using an adaptation of the Berger Stigma Scale. Mean age was 35.6 years (SD±5.9); 55.6% were male; mean MDI score was 11.9 (SD±9.1); and mean stigma score was 67.3 (SD±12.0). Self-reported perfect adherence (no missed doses) was 93.3% using the AACTG item, 87.1% using last missed dose, and 83.8% using the VAS. The measures had moderate agreement with each other (kappa 0.45 - 0.57). Depression was associated with lower adherence irrespective of adherence measure used, and remained significantly associated in multivariable analyses adjusting for age and marital status. Stigma was not associated with adherence irrespective of the measure used. The VAS captured the greatest number of potentially non-adherent individuals and may be useful for identifying PLHA in need of adherence support. Given the consistent and strong association between poorer adherence and depression, programs that jointly address adherence and mental health for PLHA in India may be more effective than programs targeting only one. PMID:25119585

  19. Teaching the psychosocial aspects of care in the clinical setting: practical recommendations.

    PubMed

    Kern, David E; Branch, William T; Jackson, Jeffrey L; Brady, Donald W; Feldman, Mitchell D; Levinson, Wendy; Lipkin, Mack

    2005-01-01

    Communication skills and the psychosocial dimensions of patient care are increasingly taught in medical schools and generalist residency programs. Evidence suggests they are not reinforced or optimally implemented in clinical training. The authors present the product of an iterative process that was part of a national faculty development program and involved both experts and generalist teachers concerning teaching psychosocial medicine while precepting medical students and residents in clinical settings. Using scientific evidence, educational theory, and experience, the authors developed recommendations, presented them in workshops, and revised them based on input from other experts and teachers, who gave feedback and added suggestions. The results are practical, expert consensus recommendations for clinical preceptors on how to teach and reinforce learning in this area. General skills to use in preparing the trainee for improved psychosocial care are organized into the mnemonic "CAARE MORE": Connect personally with the trainee; Ask psychosocial questions and Assess the trainee's knowledge/attitudes/skills/behaviors; Role model desired attitudes/skills/behaviors; create a safe, supportive, enjoyable learning Environment; formulate specific Management strategies regarding psychosocial issues; Observe the trainee's affect and behavior; Reflect and provide feedback on doctor-patient and preceptor-trainee interactions; and provide Educational resources and best Evidence. The preceptor-trainee teaching skills that are recommended parallel good doctor-patient interaction skills. They can be used during both preceptor-trainee and preceptor-trainee-patient encounters. Important common psychosocial situations that need to be managed in patients include substance abuse, depression, anxiety, somatoform disorder, physical and sexual abuse, and posttraumatic stress disorder. For these problems, where high-level evidence exists, specific psychosocial questions for screening and

  20. Bioethics of life programs: Taking seriously moral pluralism in clinical settings

    PubMed Central

    2010-01-01

    Background In the more and more globalized world, the experience of moral pluralism (often related to, or based upon, religious pluralism) has become a common issue which ethical importance is undeniable. Potential conflicts between patients' and therapeutic teams' moral views and between moral beliefs of the particular member of this team are being resolved in the light of bioethical theories, among which principlism remains the mainstream approach to biomedical ethics. The question arises, however, whether this approach, in itself, as being strictly bound to the specific and distinct American philosophical tradition, is to be considered the tool for so called 'moral imperialism'. Also architectures of principlism, in particular by elaborating the concept of common morality, defend the applicability of their theory to the pluralistic settings, it should be emphasized that the idea that some norms and standards of moral character are shared by all morally serious people in every culture has attracted criticism both from empirical as well as theoretical backgrounds. Objective This paper aims at reconsidering principlism so that it would be more suitable for resolving moral dilemma in ethically pluralistic clinical settings. Methods Lakatos' sophisticated methodological falsification is used into two different ways: (1) to construct a concept of 'life programs' and (2) to confront a newly elaborated ethical theory with principlism. The reflection is limited to the norms related to the key issue in clinical ethics, i.e., respecting the patient's autonomy. Results The concepts of common morality and particular moralities are interpreted (in the light of Lakatos' philosophy of sciences) as 'hard core' and 'protective belt' of life programs, respectively. Accepting diversity of research programs, Lakatos maintains the idea of the objectivity of truth. Analogously, the plurality of life programs does not put into question the objectivity of moral values. The plurality of

  1. Adherence to Pre-Exposure Prophylaxis for HIV Prevention in a Clinical Setting

    PubMed Central

    Montgomery, Madeline C.; Oldenburg, Catherine E.; Nunn, Amy S.; Mena, Leandro; Anderson, Peter; Liegler, Teri; Mayer, Kenneth H.; Patel, Rupa; Almonte, Alexi; Chan, Philip A.

    2016-01-01

    Background The HIV epidemic in the United States (US) disproportionately affects gay, bisexual, and other men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) using co-formulated tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) has demonstrated high efficacy in reducing HIV incidence among MSM. However, low adherence was reported in major efficacy trials and may present a substantial barrier to successful PrEP implementation. Rates of adherence to PrEP in “real-world” clinical settings in the US remain largely unknown. Methods We reviewed demographic and clinical data for the first 50 patients to enroll in a clinical PrEP program in Providence, Rhode Island. We analyzed self-reported drug adherence as well as drug concentrations in dried blood spots (DBS) from patients who attended either a three- or six-month follow-up appointment. We further assessed drug concentrations and the resistance profile of a single patient who seroconverted while taking PrEP. Results Of the first 50 patients to be prescribed PrEP, 62% attended a follow-up appointment at three months and 38% at six months. Of those who attended an appointment at either time point (70%, n = 35), 92% and 95% reported taking ±4 doses/week at three and six months, respectively. Drug concentrations were performed on a random sample of 20 of the 35 patients who attended a follow-up appointment. TDF levels consistent with ±4 doses/week were found in 90% of these patients. There was a significant correlation between self-reported adherence and drug concentrations (r = 0.49, p = 0.02). One patient who had been prescribed PrEP seroconverted at his three-month follow-up visit. The patient’s drug concentrations were consistent with daily dosing. Population sequencing and ultrasensitive allele-specific PCR detected the M184V mutation, but no other TDF- or FTC-associated mutations, including those present as minor variants. Conclusion In this clinical PrEP program, adherence was high

  2. Clinical Features of Autoimmune Autonomic Ganglionopathy and the Detection of Subunit-Specific Autoantibodies to the Ganglionic Acetylcholine Receptor in Japanese Patients

    PubMed Central

    Koga, Michiaki; Kanda, Takashi; Murata, Kenya; Suzuki, Takashi; Kurono, Hiroko; Kunimoto, Masanari; Kaida, Ken-ichi; Mukaino, Akihiro; Sakai, Waka; Maeda, Yasuhiro; Matsuo, Hidenori

    2015-01-01

    Autoimmune autonomic ganglionopathy (AAG) is a rare acquired channelopathy that is characterized by pandysautonomia, in which autoantibodies to ganglionic nicotinic acetylcholine receptors (gAChR) may play a central role. Radioimmunoprecipitation (RIP) assays have been used for the sensitive detection of autoantibodies to gAChR in the serum of patients with AAG. Here, we developed luciferase immunoprecipitation systems (LIPS) to diagnose AAG based on IgGs to both the α3 and β4 gAChR subunits in patient serum. We reviewed the serological and clinical data of 50 Japanese patients who were diagnosed with AAG. With the LIPS testing, we detected anti-α3 and -β4 gAChR antibodies in 48% (24/50) of the patients. A gradual mode of onset was more common in the seropositive group than in the seronegative group. Patients with AAG frequently have orthostatic hypotension and upper and lower gastrointestinal tract symptoms, with or without anti-gAChR. The occurrence of autonomic symptoms was not significantly different between the seropositive and seronegative group, with the exception of achalasia in three patients from the seropositive group. In addition, we found a significant overrepresentation of autoimmune diseases in the seropositive group and endocrinological abnormalities as an occasional complication of AAG. Our results demonstrated that the LIPS assay was a useful novel tool for detecting autoantibodies against gAChR in patients with AAG. PMID:25790156

  3. Clinical efficacy and tolerability of two Japanese traditional herbal medicines, Hachimi-jio-gan and Gosha-jinki-gan, for lower urinary tract symptoms with cold sensitivity.

    PubMed

    Yagi, Hiroshi; Sato, Ryo; Nishio, Kojiro; Arai, Gaku; Soh, Shigehiro; Okada, Hiroshi

    2015-10-01

    We evaluated the efficacy and tolerability of Hachimi-jio-gan (HJG; bā wèi dì huáng wán) and Gosha-jinki-gan (GJG; jì shēng shèn qì wán), two traditional Japanese medicines, in 60 patients with lower urinary tract symptoms (LUTS) having cold sensitivity unresponsive to α1-blockers or antimuscarinic drugs. All patients received a mixture of HJG or GJG for 12 weeks in addition to α1-blockers or antimuscarinic drugs as add-on therapy. International Prostate Symptom Score, International Prostate Symptom Score-Quality of Life, Benign Prostatic Hyperplasia Impact Index, and the number of nocturnal voids were statistically much improved. However, there was no change in maximal urinary flow rate and post-void residual urine. Urinary 8-hydroxy-2-deoxyguanosine was statistically greatly improved from baseline after treatment in the HJG group compared to the GJG group. Adverse reactions were observed in 8.3% of patients, but all reactions were mild. Both HJG and GJG mixtures can serve as safe and effective potential therapeutic alternatives in patients with LUTS and cold sensitivity unresponsive to α1-blockers or antimuscarinic drugs. Additionally, HJG mixture was found to have anti-oxidative activity, and therefore further long-term clinical investigations are needed to examine its anti-aging effects in addition to its effect on urinary symptoms.

  4. Ethical Issues for Clinical Studies That use Human Embryonic Stem Cells: The 2014 Revisions to the Japanese Guidelines.

    PubMed

    Mizuno, Hiroshi

    2015-10-01

    The use of human embryonic stem cells (hESCs) in clinical studies has been expanding in recent years. The application of hESCs in clinical studies raises ethical issues from a different standpoint compared with the use of other types of stem cells. In Japan, the Guidelines on the Derivation of Human Embryonic Stem Cells, and Guidelines on the Distribution and Utilization of Human Embryonic Stem Cells had been revised for clinical studies in 2014. In the revised guidelines, the method for protection of personal information was changed to offer the choice between unlinkable anonymization and linkable anonymization, to enable the use of information on diseases suffered by donors and the assurance of traceability for safety. Procedures for re-consent are generally prohibited out of consideration for donors' feelings. However, obtaining re-consent is permitted when consent for re-consent has been received in advance and approval has been given by an ethical review board, in which case the donors may be contacted. Incidental findings obtained from hESCs are not disclosed individually to donors, while the research results should be actively published for the common good. These guidelines have enabled the derivation, distribution, and use of hESCs for clinical studies.

  5. Virologic response and haematologic toxicity of boceprevir- and telaprevir-containing regimens in actual clinical settings

    PubMed Central

    Butt, A. A.; Yan, P.; Shaikh, O. S.; Freiberg, M. S.; Re, V. Lo; Justice, A. C.; Sherman, K. E.

    2016-01-01

    SUMMARY Effectiveness, safety and tolerability of boceprevir (BOC) and telaprevir (TPV) in actual clinical settings remain unknown. We determined rates of sustained virologic response (SVR) and haematologic adverse effects among persons treated with BOC- or TPV-containing regimens, compared with pegylated interferon/ribavirin (PEG/RBV). Using an established cohort of hepatitis C virus (HCV)-infected persons, Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), we identified those treated with a BOC- or TPV-containing regimen and HCV genotype 1-infected controls treated with PEG/RBV. We excluded those with HIV co-infection and missing HCV RNA values to determine SVR. Primary endpoints were SVR (undetectable HCV RNA ≥12 weeks after treatment completion) and haematologic toxicity (grade 3/4 anaemia, neutropenia and thrombocytopenia). We evaluated 2288 persons on BOC-, 409 on TPV-containing regimen and 6308 on PEG/RBV. Among these groups, respectively, 31%, 43% and 9% were treatment-experienced; 17%, 37% and 14% had baseline cirrhosis; 63%, 54% and 48% were genotype 1a. SVR rates among noncirrhotics were as follows: treatment naïve: 65% (BOC), 67% (TPV) and 31% (PEG/RBV); treatment experienced: 57% (BOC), 54% (TPV) and 13% (PEG/RBV); (P-value not significant for BOC vs TPV; P < 0.0001 for BOC or TPV vs PEG/RBV). Haematologic toxicities among BOC-, TPV- and PEG/RBV-treated groups were as follows: grade 3/4 anaemia 7%, 11% and 3%; grade 4 thrombocytopenia 2.2%, 5.4% and 1.7%; grade 4 neutropenia 8.2%, 5.6% and 3.4%. SVR rates are higher and closer to those reported in pivotal clinical trials among BOC- and TPV-treated persons compared with PEG/RBV-treated persons. Haematologic adverse events are frequent, but severe toxicity is uncommon. PMID:25524834

  6. A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting

    PubMed Central

    Rashid-Doubell, F; Mohamed, S; Elmusharaf, K; O'Neill, C S

    2016-01-01

    Objective The aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital. Design Interpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting. Setting and participants Senior medical students at an international medical school in the Middle East. Results Three main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside. Conclusions Mobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner. PMID:27142860

  7. Cultural brokerage: Creating linkages between voices of lifeworld and medicine in cross-cultural clinical settings.

    PubMed

    Lo, Ming-Cheng Miriam

    2010-09-01

    Culturally competent healthcare has emerged as a policy solution to racial and ethnic health disparities in the United States. Current research indicates that patient-centered care is a central component of culturally competent healthcare, and a rich literature exists on how to elicit patients' lifeworld voices through open-ended questions, sensitive communication skills, and power-sharing interaction styles. But it remains largely unclear how doctors create linkages between cultures of medicine and lifeworld as two sets of incongruent meaning systems. Without such linkages, a doctor lacks the cultural tool to incorporate her patient's assumptions or frameworks into the voice of medicine, rendering it difficult to (at least partially) expand and transform the latter from within. This study explores how doctors perform this bridging work, conceptualized as cultural brokerage, on the job. Cultural brokerage entails mutual inclusion of different sets of schemas or frameworks with which people organize their meanings and information. Based on 24 in-depth interviews with primary care physicians in Northern California, this study inductively documents four empirical mechanisms of cultural brokerage: 'translating between health systems', 'bridging divergent images of medicine', 'establishing long-term relationships', and 'working with patients' relational networks'. Furthermore, the study argues that cultural brokerage must be understood as concrete 'cultural labor', which involves specific tasks and requires time and resources. I argue that the performance of cultural brokerage work is embedded in the institutional contexts of the clinic and therefore faces two macro-level constraints: the cultural ideology and the political economy of the American healthcare system. PMID:20801996

  8. Experience in Strategic Networking to Promote Palliative Care in a Clinical Academic Setting in India

    PubMed Central

    Nair, Shoba; Tarey, SD; Barathi, B; Mary, Thiophin Regina; Mathew, Lovely; Daniel, Sudha Pauline

    2016-01-01

    Background: Palliative care in low and middle-income countries is a new discipline, responding to a greater patient need, than in high-income countries. By its very nature, palliative as a specialty has to network with other specialties to provide quality care to patients. For any medical discipline to grow as a specialty, it should be well established in the teaching medical institutions of that country. Data show that palliative care is more likely to establish and grow in an academic health care institution. It is a necessity that multiple networking strategies are adopted to reach this goal. Objectives: (1) To describe a strategic approach to palliative care service development and integration into clinical academic setting. (2) To present the change in metrics to evaluate progress. Design and Setting: This is a descriptive study wherein, the different strategies that are adopted by the Department of Palliative Medicine for networking in an academic health care institution and outside the institution are scrutinized. Measurement: The impact of this networking was assessed, one, at the level of academics and the other, at the level of service. The number of people who attended various training programs conducted by the department and the number of patients who availed palliative care service over the years were assessed. Results: Ten different strategies were identified that helped with networking of palliative care in the institution. During this time, the referrals to the department increased both for malignant diseases (52–395) and nonmalignant diseases (5–353) from 2000 to 2013. The academic sessions conducted by the department for undergraduates also saw an increase in the number of hours from 6 to 12, apart from the increase in a number of courses conducted by the department for doctors and nurses. Conclusion: Networking is an essential strategy for the establishment of a relatively new medical discipline like palliative care in a developing and

  9. Mentoring in the Clinical Setting to Improve Student Decision-Making Competence

    ERIC Educational Resources Information Center

    Stick-Mueller, Misty; Boesch, Ron; Silverman, Steven; Carpenter, Scott; Illingworth, Robert; Countryman, James

    2010-01-01

    Introduction: The physician-intern relationship can be difficult to develop. A new chiropractic intern in a teaching clinic undergoes a major transition from classroom to clinical practice and must learn to turn classroom knowledge into clinical application. The ability to start formulating clinical techniques and apply them on a patient is…

  10. Antecedents of ethical decision-making: intercollegiate sporting environments as clinical education and practice settings.

    PubMed

    Caswell, Shane V; Ambegaonkar, Jatin P; Caswell, Amanda M; Gould, Trenton E

    2009-01-01

    Unique among allied health care professions, athletic training is predominately practiced amid competitive intercollegiate sports. Competitive sporting environments have been suggested to adversely impact morality, ethical decision-making (EDM), and behavior. The purposes of this study were to (1) investigate the effect of institutional National Collegiate Athletic Association (NCAA) participation level on preferred ethical ideologies and EDM, (2) determine the relationship between professional status (athletic training student [ATS] or certified athletic trainer [ATC]) and ethical ideology preferences and EDM, and (3) examine whether preferred ethical ideology is related to differences in EDM. A nationally representative sample of 610 ATSs and ATCs from 30 athletic training education programs, stratified by NCAA division level, participated in the study. All participants completed a demographic survey, the Ethics Position Questionnaire, and the Dilemmas in Athletic Training Questionnaire. No significant relationships were noted between NCAA participation level and respondents' ethical ideology preferences. However, ATSs and ATCs demonstrated significant preferences for specific ethical ideologies, with students adopting the subjectivist ideology more than expected and the exceptionist ideology less than expected and ATCs adopting the exceptionist ideology more than expected and the situationist ideology less than expected. In contrast to some previous research, our results suggest that competitive sporting environments do not affect ATSs' and ATCs' ethical ideology and EDM abilities at the collegiate level. These findings serve as a baseline for future research examining the ethical ideologies and ethical decision-making levels of athletic training practitioners and other allied health professionals across clinical settings.

  11. Blood transcriptomic markers for major depression: from animal models to clinical settings.

    PubMed

    Redei, Eva E; Mehta, Neha S

    2015-05-01

    Depression is a heterogeneous disorder and, similar to other spectrum disorders, its manifestation varies by age of onset, severity, comorbidity, treatment responsiveness, and other factors. A laboratory blood test based on specific biomarkers for major depressive disorder (MDD) and its subgroups could increase diagnostic accuracy and expedite the initiation of treatment. We identified candidate blood biomarkers by examining genome-wide expression differences in the blood of animal models representing both the genetic and environmental/stress etiologies of depression. Human orthologs of the resulting transcript panel were tested in pilot studies. Transcript abundance of 11 blood markers differentiated adolescent subjects with early-onset MDD from adolescents with no disorder (ND). A set of partly overlapping transcripts distinguished adolescent patients who had comorbid anxiety disorders from those with only MDD. In adults, blood levels of nine transcripts discerned subjects with MDD from ND controls. Even though cognitive behavioral therapy (CBT) resulted in remission of some patients, the levels of three transcripts consistently signaled prior MDD status. A coexpression network of transcripts seems to predict responsiveness to CBT. Thus, our approach can be developed into clinically valid diagnostic panels of blood transcripts for different manifestations of MDD, potentially reducing diagnostic heterogeneity and advancing individualized treatment strategies.

  12. Locating assistive technology research in a clinical setting: an occupational perspective.

    PubMed

    Fowler-Davis, Sally; Evans, Laura; Cudd, Peter

    2015-01-01

    Peer research was used to identify the experience and perceptions of assistive technology and telecare adoption in a UK healthcare context. A narrative account of participation and learning is intended to provoke further dialogue. There have been a range of policy and implementation initiatives that are within the direct experience of organisational actors over the last 15 years and this engagement allows for specific reflection on the service achievements and some of the barriers to implementation of technology changes in rehabilitation practice and service design. Insights are presented that suggest a reification of research priorities and a need to align technology, through patient and public engagement, to provider priorities. In addition, an improvement in adoption would be based on sustained capacity building within the Occupational Therapy workforce and a re-focus on specific knowledge sharing and learning about technology. Given the shared desire to promote the sustained adoption of appropriate technology for assistance and rehabilitation it is suggested the voice of practitioners is strengthened through research and knowledge exchange in the clinical setting.

  13. Feasibility of Screening for Type 1 Diabetes and Celiac Disease in a Pediatric Clinic Setting

    PubMed Central

    Gesualdo, Patricia D.; Bautista, Kimberly A.; Waugh, Kathleen C.; Yu, Liping; Norris, Jill M.; Rewers, Marian J.; Baxter, Judith

    2016-01-01

    Objective Type 1 diabetes (T1D) or celiac disease (CD) develops in at least 2% of the general population. Early detection of disease-specific autoimmunity and subsequent monitoring would be possible if screening tests were more widely available. Currently screening for islet autoimmunity is available only in a research setting and CD-specific autoimmunity screening is limited to those in high risk groups. This study assessed the feasibility of incorporating T1D and CD autoantibody screening into a pediatric practice. Methods Patient engagement strategies, blood collection preference, blood sample volume, rate of autoantibody detection in the general population, and parental satisfaction were assessed. Over 5 weeks, research staff recruited 200 patients aged 2–6 yr from two pediatric practices in the Denver area to be screened for six islet autoantibodies (IAs) and the transglutaminase antibody. Results Of the 765 parents approached, 200 (26%) completed the same day screening. Of the 565 subjects who did not complete the screening, 345 expressed interest, but were unable to make a participation decision. A finger stick, compared to a venous draw, was the preferred method of sample collection. Both methods yielded sufficient volume for autoantibody determination. IAs or the transglutaminase antibody were detected in 11 subjects. Parents expressed satisfaction with all aspects of participation. Conclusion The results of this study suggest that it is feasible to conduct this type of screening in a pediatric clinic. Such screening could lead to increased disease awareness and the possible benefits that can result from early detection. PMID:26251221

  14. Twelve tips on how to set up postgraduate training via remote clinical supervision.

    PubMed

    Wearne, Susan; Dornan, Tim; Teunissen, Pim W; Skinner, Timothy

    2013-11-01

    Doctors-in-training can now be supervised remotely by specialist clinicians using information and communication technology. This provides an intermediate stage of professional development between on-site supervision and independent medical practice. Remote supervision could increase training capacity, particularly in underserved areas and ensure doctors are willing and able to practice where they are needed once qualified. Remotely supervised doctors learn via virtual autonomy in clinical decision making and working at the limits of their abilities. It suits experienced registrars with resilience, insight into their strengths and weaknesses, capacity to self-monitor and correct, and willingness to seek help. These doctors benefit from remote supervisors who facilitate their learning, monitor their well-being, and support them holistically. Educational organisations need to oversee remote placements and match the right registrar, to the right placement with the right supervisor. We outline in our twelve tips how to set up remote supervision in order to maximise the educational benefits and minimise the risks.

  15. Performance of four carbon dioxide absorbents in experimental and clinical settings.

    PubMed

    Yamakage, M; Takahashi, K; Takahashi, M; Satoh, J-I; Namiki, A

    2009-03-01

    To evaluate the performance of four kinds of carbon dioxide (CO(2)) absorbents (Medisorb GE Healthcare, Amsorb Plus Armstrong Medical, YabashiLime Yabashi Industries, and Sodasorb LF Grace Performance Chemicals), we measured their dust production, acceptability of colour indicator, and CO(2) absorption capacity in in vitro experimental settings and the concentration of compound A in an inspired anaesthetic circuit during in vivo clinical practice. In vitro, the order of the dust amount was Sodasorb LF > Medisorb > Amsorb Plus = YabashiLime both before and after shaking. The order of the color acceptability was similar: Sodasorb LF > Amsorb Plus = Medisorb > YabashiLime both initially and 16 h after CO(2) exhaustion. During exposure to 200 ml.min(-1) CO(2) in vitro, the period until 1 kg of fresh soda lime allowed inspired CO(2) to increase to 0.7 kPa (as a mark of utilisation of the absorbent) was longer with Medisorb (1978 min) than with the other absorbents (1270-1375 min). In vivo, compound A (1.0% inspired sevoflurane) was detected only when using Medisorb. While Medisorb has the best ability to absorb CO(2), it alone produces compound A.

  16. Fad diets and obesity--Part I: Measuring weight in a clinical setting.

    PubMed

    Moyad, Mark A

    2004-04-01

    Obesity is a recognized epidemic in many regions around the world and billions of dollars are spent each year in attempting to combat this problem. However, before a discussion of the different conventional and alternative treatments for obesity can be initiated, it is first critical to determine whether or not a certain individual is actually overweight, obese, or has an excess of adipose tissue. Therefore, a review of the various popular and unpopular measurements of obesity is needed. A variety of measurements exist such as bioelectrical impedance, body mass index (BMI), crude weight, densitometry, dual energy x-ray absorptiometry (DEXA), lean body mass (LBM), skinfold thickness, and waist-to-hip ratio (WHR). All of these measurements contain inherent advantages and disadvantages, but many of these can still be used in a clinical setting. Health professionals should acquaint themselves with these different measurements in order to take the first step in bringing attention to and potentially treating a condition that affects virtually every medical discipline.

  17. Practicability of Hygienic Wrapping of Touchscreen Operated Mobile Devices in a Clinical Setting

    PubMed Central

    Hammon, Matthias; Kunz, Bernd; Dinzl, Veronika; Kammerer, Ferdinand J.; Schwab, Siegfried A.; Bogdan, Christian; Uder, Michael; Schlechtweg, Philipp M.

    2014-01-01

    Background To prove effectiveness of wrapping tablet computers in order to reduce microbiological contamination and to evaluate whether a plastic bag-covered tablet leads to impaired user satisfaction or touchscreen functionality. Materials and Methods Within a period of 11 days 115 patients were provided with a tablet computer while waiting for their magnetic resonance imaging examination. Every day the contamination of the surface of the tablet was determined before the first and after the final use. Before the device was handed over to a patient, it was enclosed in a customized single-use plastic bag, which was analyzed for bacterial contamination after each use. A questionnaire was applied to determine whether the plastic bag impairs the user satisfaction and the functionality of the touchscreen. Results Following the use by patients the outside of the plastic bags was found to be contaminated with various bacteria (657.5 ± 368.5 colony forming units/day); some of them were potentially pathogenic. In contrast, the plastic bag covered surface of the tablet was significantly less contaminated (1.7 ± 1.9 colony forming units/day). Likewise, unused plastic bags did not show any contamination. 11% of the patients reported problems with the functionality of the touchscreen. These patients admitted that they had never used a tablet or a smartphone before. Conclusions Tablets get severely contaminated during usage in a clinical setting. Wrapping with a customized single-use plastic bag significantly reduces microbiological contamination of the device, protects patients from the acquisition of potentially pathogenic bacteria and hardly impairs the user satisfaction and the functionality of the touchscreen. PMID:25180580

  18. Expansive learning in the university setting: the case for simulated clinical experience.

    PubMed

    Haigh, Jacquelyn

    2007-03-01

    This paper argues that simulated practice in the university setting is not just a second best to learning in the clinical area but one which offers the potential for deliberation and deep learning [Eraut, M., 2000. Non-formal learning, implicit learning and tacit knowledge in professional work. Journal of Educational Psychology, 70, 113-136]. The context of student learning in an undergraduate midwifery programme is analysed using human activity theory [Engeström, Y., 2001. Expansive learning at work: toward an activity theoretical reconceptualization. Journal of Education and Work, 14, 133-156]. The advantages of this approach to student learning as opposed to situated learning theory and the concept of legitimate peripheral participation [Lave, J., Wenger, E., 1991. Situated Learning: Legitimate Peripheral Participation. Cambridge University Press, New York] are discussed. An activity system changes as a result of contradictions and tensions between what it purports to produce and the views of stakeholders (multi-voicedness) as well as its historical context (Historicity of activity). A focus group with students highlights their expressed need for more simulated practice experience. The views of midwifery lecturers are sought as an alternative voice on this tension in the current programme. Qualitative differences in types of simulated experience are explored and concerns about resources are raised in the analysis. Discussion considers the value of well planned simulations in encouraging the expression of tacit understanding through a group deliberative learning process [Eraut, M., 2000. Non-formal learning, implicit learning and tacit knowledge in professional work. Journal of Educational Psychology, 70, 113-136].

  19. Therapeutic drug monitoring of racemic venlafaxine and its main metabolites in an everyday clinical setting.

    PubMed

    Reis, Margareta; Lundmark, Jöns; Björk, Henrik; Bengtsson, Finn

    2002-08-01

    When Efexor (venlafaxine) became available in Sweden, a therapeutic drug monitoring (TDM) service was developed in the authors' laboratory. This analytical service was available to all physicians in the country. From March 1996, to November 1997, 797 serum concentration analyses of venlafaxine (VEN) and its main metabolites, O-desmethylvenlafaxine (ODV), N-desmethylvenlafaxine (NDV), and N,O-didesmethylvenlafaxine (DDV) were requested. These samples, each of which was accompanied by clinical information on a specially designed request form, represented 635 inpatients or outpatients, comprising all ages, treated in a naturalistic setting. The first sample per patient, drawn as a trough value in steady state and with documented concomitant medication, was further evaluated pharmacokinetically (n = 187). The doses prescribed were from 37.5 mg/d to 412.5 mg/d. There was a wide interindividual variability of serum concentrations on each dose level, and the mean coefficient of variation of the dose-corrected concentrations (C/D) was 166% for C/D VEN, 60% for C/D ODV, 151% for C/D NDV, and 59% for C/D DDV. The corresponding CV for the ratio ODV/VEN was 110%. However, within patients over time, the C/D VEN and ODV/VEN variation was low, indicating stability in individual metabolizing capacity. Patients over 65 years of age had significantly higher concentrations of C/D VEN and C/D ODV than the younger patients. Women had higher C/D NDV and C/D DDV, and a higher NDV/VEN ratio than men, and smokers showed lower C/D ODV and C/D DDV than nonsmokers. A number of polycombinations of drugs were assessed for interaction screening, and a trend for lowered ODV/VEN ratio was found, predominantly with concomitant medication with CNS-active drug(s) known to inhibit CYP2D6.

  20. How Iranian Medical Trainees Approach their Responsibilities in Clinical Settings; A Grounded Theory Research

    PubMed Central

    Asemani, Omid; Iman, Mohammad Taghi; Moattari, Marzieh; Khayyer, Mohammad; Sharif, Farkhondeh; Tabei, Seyed Ziaaddin

    2015-01-01

    Background: It seems we are now experiencing “responsibility problems” among medical trainees (MTs) and some of those recently graduated from medical schools in Iran. Training responsible professionals have always been one of the main concerns of medical educators. Nevertheless, there is a dearth of research in the literature on “responsibility” especially from the medical education point of view. Therefore, the present study was carried out with the aim of presenting a theoretical based framework for understanding how MTs approach their responsibilities in educational settings. Method: This qualitative study was conducted at Shiraz University of Medical Sciences (SUMS) using the grounded theory methodology. 15 MTs and 10 clinical experts and professional nurses were purposefully chosen as participants. Data was analyzed using the methodology suggested by Corbin and Strauss, 1998. Results: “Try to find acceptance toward expectations”, “try to be committed to meet the expectations” and “try to cope with unacceptable expectations” were three main categories extracted based on the research data. Abstractly, the main objective for using these processes was “to preserve the integrity of student identity” which was the core category of this research too. Moreover, it was also found that practically, “responsibility” is considerably influenced by lots of positive and negative contextual and intervening conditions. Conclusion: “Acceptance” was the most decisive variable highly effective in MTs’ responsibility. Therefore, investigating the “process of acceptance” regarding the involved contextual and intervening conditions might help medical educators correctly identify and effectively control negative factors and reinforce the constructive ones that affect the concept of responsibility in MTs. PMID:26379351

  1. Preliminary Validation of Angle-Independent Myocardial Elastography Using MR Tagging in a Clinical Setting

    PubMed Central

    Lee, Wei-Ning; Qian, Zhen; Tosti, Christina L.; Brown, Truman R.; Metaxas, Dimitris N.; Konofagou, Elisa E.

    2014-01-01

    Myocardial Elastography (ME), a radio-frequency (RF) based speckle tracking technique, was employed in order to image the entire two-dimensional (2D) transmural deformation field in full view, and validated against tagged Magnetic Resonance Imaging (tMRI) in normal as well as reperfused (i.e., treated myocardial infarction (MI)) human left ventricles. RF ultrasound and tMRI frames were acquired at the papillary muscle level in 2D short-axis (SA) views at nominal frame rates of 136 (fps; real time) and 33 fps (electrocardiogram (ECG)-gated), respectively. In ultrasound, in-plane, 2D (lateral and axial) incremental displacements were iteratively estimated using one-dimensional (1D) cross-correlation and recorrelation techniques in a 2D search with a 1D matching kernel. In tMRI, cardiac motion was estimated by a template-matching algorithm on a 2D grid-shaped mesh. In both ME and tMRI, cumulative 2D displacements were estimated and then used to estimate 2D Lagrangian finite systolic strains, from which polar (i.e., radial and circumferential) strains, namely angle-independent measures, were further obtained through coordinate transformation. Principal strains, which are angle-independent and less centroid-dependent than polar strains, were also computed and imaged based on the 2D finite strains with a previously established strategy. Both qualitatively and quantitatively, angle-independent ME is shown to be capable of 1) estimating myocardial deformation in good agreement with tMRI estimates in a clinical setting and of 2) differentiating abnormal from normal myocardium in a full left-ventricular view. Finally, the principal strains are suggested to be an alternative diagnostic tool of detecting cardiac disease with the characteristics of their reduced centroid dependence. PMID:18952364

  2. Effects of ostracism and sex on alcohol consumption in a clinical laboratory setting.

    PubMed

    Bacon, Amy K; Cranford, Alexi N; Blumenthal, Heidemarie

    2015-09-01

    Drinking to cope with negative affect is a drinking pattern that leads to problematic alcohol use both in college and after graduation. Despite theory and correlational evidence to this effect, establishing a link between stress and alcohol consumption among college students in the laboratory has yielded both a limited number of studies and, at times, inconsistent results. The present study attempts to resolve these issues through investigating the effects of an ecologically relevant stressor-ostracism-on alcohol consumption in a clinical laboratory setting. Social drinking college students (N = 40; 55% female) completed a 5-min game of Cyberball and were randomly assigned either to be included or excluded in the virtual ball-toss game. The amount (in ml) of beer consumed in a subsequent mock taste test served as our primary dependent variable, with breath alcohol concentration (BrAC) as a secondary dependent variable. Results indicated that excluded participants reported a trend toward an increase in negative affect from pre- to post-Cyberball, and endorsed significantly lower self-esteem, belonging, control, and belief in a meaningful existence compared to included participants. A significant Sex × Condition effect indicated that excluded women consumed less beer than both included women and excluded men, supported by a nonsignificant trend in BrAC. Men did not differ in their consumption of beer as a result of Cyberball condition. Implications of sex and social context on alcohol use are discussed, as well as ostracism as a method for investigating relationships between social stress and alcohol use.

  3. Effects of ostracism and sex on alcohol consumption in a clinical laboratory setting.

    PubMed

    Bacon, Amy K; Cranford, Alexi N; Blumenthal, Heidemarie

    2015-09-01

    Drinking to cope with negative affect is a drinking pattern that leads to problematic alcohol use both in college and after graduation. Despite theory and correlational evidence to this effect, establishing a link between stress and alcohol consumption among college students in the laboratory has yielded both a limited number of studies and, at times, inconsistent results. The present study attempts to resolve these issues through investigating the effects of an ecologically relevant stressor-ostracism-on alcohol consumption in a clinical laboratory setting. Social drinking college students (N = 40; 55% female) completed a 5-min game of Cyberball and were randomly assigned either to be included or excluded in the virtual ball-toss game. The amount (in ml) of beer consumed in a subsequent mock taste test served as our primary dependent variable, with breath alcohol concentration (BrAC) as a secondary dependent variable. Results indicated that excluded participants reported a trend toward an increase in negative affect from pre- to post-Cyberball, and endorsed significantly lower self-esteem, belonging, control, and belief in a meaningful existence compared to included participants. A significant Sex × Condition effect indicated that excluded women consumed less beer than both included women and excluded men, supported by a nonsignificant trend in BrAC. Men did not differ in their consumption of beer as a result of Cyberball condition. Implications of sex and social context on alcohol use are discussed, as well as ostracism as a method for investigating relationships between social stress and alcohol use. PMID:25642585

  4. Screening for syphilis among men who have sex with men in various clinical settings

    PubMed Central

    Debattista, J; Dwyer, J; Anderson, R; Rowling, D; Patten, J; Mortlock, M

    2004-01-01

    Objectives: To assess the prevalence of syphilis infections among men who have sex with men (MSM) accessing the Brisbane Sexual Health Clinic during the period 1997 up to May 2003, data were collated through three clinical programmes conducted by the service—a large inner city mainstream sexual health clinic and two small outreach sessional clinics conducted on the site of male sex on premises venues (SOPV). Data analysis also provided the opportunity to evaluate the effectiveness of the smaller outreach clinics to access populations of MSM less likely to attend or identify at the larger mainstream clinic, and therefore enhance the detection of previously undiagnosed sexually transmissible infections. Methods: Computerised records from 1997–2003 were collated for a statistical analysis of syphilis and other STI pathology results for all MSM accessing the mainstream clinic, and two outreach clinics. Results: A review of client charts showed that 16 new syphilis diagnoses were made over the previous 5 years, but only two of these infections (both through the mainstream clinic) were early syphilis and therefore transmissible. All other cases were latent infections. A higher proportion of bisexual men was identified with positive syphilis serology but this was just below significance (p = 0.06). Significantly, almost a third of syphilis diagnoses (all latent) were made at SOPV outreach clinics, despite the much lower proportion of clients seen overall through the SOPV clinics. For other sexually transmissible infections, the mainstream clinic demonstrated greater efficiency at case detection. Conclusion: Outreach clinics located in male saunas may serve an effective function in syphilis screening by facilitating access for a particular subpopulation of MSM (bisexual, married men). These outreach clinics may provide important outlets for education and opportunistic screening of asymptomatic MSM and foster a greater willingness for men to honestly self identify

  5. Developing a technology for the use of operant extinction in clinical settings: an examination of basic and applied research.

    PubMed Central

    Lerman, D C; Iwata, B A

    1996-01-01

    Extinction of operant behavior, which involves terminating the reinforcement contingency that maintains a response, is important to the development, generalization, and reduction of behavior in clinical settings. We review basic and applied research findings on variables that influence the direct and indirect effects of extinction and discuss the potential value of a general technology for the use of extinction. We suggest that current research findings are not sufficient for the development of a comprehensive, applied technology of extinction and provide extensive guidelines for further studies on factors that may affect the course of extinction in clinical settings. PMID:8926226

  6. Clinical efficacy and tolerability of Gosha-jinki-gan, a Japanese traditional herbal medicine, for nocturia

    PubMed Central

    Yagi, Hiroshi; Nishio, Kojiro; Sato, Ryo; Arai, Gaku; Soh, Shigehiro; Okada, Hiroshi

    2015-01-01

    We evaluated the efficacy and tolerability of Gosha-jinki-gan (GJG; 濟生腎氣丸 jì shēng shèn qì wán) in 30 cases of nocturia (夜尿 yè niào) unresponsive to α1-blockers or antimuscarinic drugs. All patients received GJG extract powder (2.5 g) three times a day for 12 weeks as an add-on therapy to α1-blockers or antimuscarinic drugs. Subjective outcomes assessed by the International Prostate Symptom Score—quality of life, and the benign prostatic hyperplasia impact index and objective outcomes assessed by urinary frequency and the urine production rate at night showed significant improvement after treatment. Moreover, other objective outcomes assessed by maximum flow rates, postvoid residual, serum human atrial natriuretic peptide levels, and urinary 8-hydroxy-2′-deoxyguanosine levels did not change. Adverse events were observed in 10% of cases; however, these events were mild. GJG appears to be a safe and effective potential therapeutic alternative for patients with nocturia unresponsive to α1-blockers or antimuscarinic drugs. Further clinical investigations are required to elucidate the precise pathophysiologic mechanisms of GJG in nocturia. PMID:26870690

  7. Clinical efficacy and tolerability of two Japanese traditional herbal medicines, Hachimi-jio-gan and Gosha-jinki-gan, for lower urinary tract symptoms with cold sensitivity

    PubMed Central

    Yagi, Hiroshi; Sato, Ryo; Nishio, Kojiro; Arai, Gaku; Soh, Shigehiro; Okada, Hiroshi

    2015-01-01

    We evaluated the efficacy and tolerability of Hachimi-jio-gan (HJG; 八味地黃丸 bā wèi dì huáng wán) and Gosha-jinki-gan (GJG; 濟生腎氣丸 jì shēng shèn qì wán), two traditional Japanese medicines, in 60 patients with lower urinary tract symptoms (LUTS) having cold sensitivity unresponsive to α1-blockers or antimuscarinic drugs. All patients received a mixture of HJG or GJG for 12 weeks in addition to α1-blockers or antimuscarinic drugs as add-on therapy. International Prostate Symptom Score, International Prostate Symptom Score–Quality of Life, Benign Prostatic Hyperplasia Impact Index, and the number of nocturnal voids were statistically much improved. However, there was no change in maximal urinary flow rate and post-void residual urine. Urinary 8-hydroxy-2-deoxyguanosine was statistically greatly improved from baseline after treatment in the HJG group compared to the GJG group. Adverse reactions were observed in 8.3% of patients, but all reactions were mild. Both HJG and GJG mixtures can serve as safe and effective potential therapeutic alternatives in patients with LUTS and cold sensitivity unresponsive to α1-blockers or antimuscarinic drugs. Additionally, HJG mixture was found to have anti-oxidative activity, and therefore further long-term clinical investigations are needed to examine its anti-aging effects in addition to its effect on urinary symptoms. PMID:26587398

  8. Phase III Clinical Trials Comparing the Immunogenicity and Safety of the Vero Cell-Derived Japanese Encephalitis Vaccine Encevac with Those of Mouse Brain-Derived Vaccine by Using the Beijing-1 Strain

    PubMed Central

    Miyazaki, Chiaki; Okada, Kenji; Ozaki, Takao; Hirose, Mizuo; Iribe, Kaneshige; Ishikawa, Yuji; Togashi, Takehiro; Ueda, Kohji

    2014-01-01

    The immunogenicity and safety of an inactivated cell culture Japanese encephalitis vaccine (CC-JEV) were compared with those of an inactivated mouse brain-derived Japanese encephalitis vaccine (MB-JEV) in phase III clinical multicenter trials conducted in children. The vaccines contain the same Japanese encephalitis virus strain, the Beijing-1 strain. Two independent clinical trials (trials 1 and 2) were conducted. Trial 1 was conducted in 468 healthy children. Each subject was injected with 17 μg per dose of either CC-JEV or MB-JEV, and the immunogenicity and safety of the vaccines were investigated. Trial 1 showed that CC-JEV was more immunogenic and reactive than MB-JEV at the same dose. Therefore, to adjust the immunogenicity of CC-JEV to that of MB-JEV, a vaccine that has had a good track record regarding its efficacy for a long time, trial 2 was conducted in 484 healthy children. To improve the stability, CC-JEV was converted from a liquid type to a freeze-dried type of vaccine. Each subject was injected subcutaneously with either 4 μg per dose of CC-JEV, 8 μg per dose of CC-JEV, or 17 μg per dose of MB-JEV twice, at an interval of 2 to 4 weeks, followed by an additional booster immunization 1 to 15 months after the primary immunization. Based on the results of trial 2, 4 μg per dose of the freeze-dried CC-JEV (under the label Encevac) was selected as a substitute for the MB-JEV. Encevac was approved and launched in 2011 and has since been in use as a 2nd-generation Japanese encephalitis vaccine in Japan. (These studies have been registered at the JapicCTI under registration no. JapicCTI-132063 and JapicCTI-080586 for trials 1 and 2, respectively.) PMID:24334689

  9. The perceived need for Japanese nursing faculty members to learn English: issues related to career development.

    PubMed

    Anazawa, Ryoko; Ishikawa, Hirono; Kiuchi, Takahiro

    2012-04-01

    In Japan, nurses are increasingly expected to use English in various settings. English language proficiency is indispensable in almost all aspects of the clinical experience and for career development of Japanese nurses. This article introduces the idea of Japanese nurses learning the English language to enhance their career development and provides succinct survey results about the perceived need for learning English, based on responses from 145 nursing faculty members across Japan. Analyses showed that most faculty members considered English language proficiency important for nursing expertise and career development. Overall, the results indicated that Japanese nurses require continuing English language education. Further study of their need to learn English and ways to implement English education programs is required.

  10. The usefulness of holotranscobalamin in predicting vitamin B12 status in different clinical settings.

    PubMed

    Herrmann, Wolfgang; Obeid, Rima; Schorr, Heike; Geisel, Jürgen

    2005-02-01

    Serum concentrations of homocysteine (Hcy) and methylmalonic acid (MMA) become increased in B12-deficient subjects and are therefore, considered specific markers of B12 deficiency. Serum level of holotranscobalamin (holoTC) becomes decreased before the development of the metabolic dysfunction. We investigated the usefulness of holoTC in diagnosing B12 deficiency in some clinical settings. We measured serum concentrations of holoTC, MMA, Hcy and total B12 in omnivores, vegetarians, elderly people and haemodialysis patients. Our results indicated that the incidence of holoTC <35 pmol/L was highest in the vegans (76%). Low holoTC and elevated MMA were detected in 64% of the vegans and 43% of the lacto- and lacto-ovovegetarians. An elevated MMA and a low holoTC were found in subjects with total serum B12 as high as 300 pmol/L. The distribution of holoTC in elderly people was similar to that in younger adults (median holoTC 55 pmol/L in both groups). A low holoTC and an elevated MMA were found in 16% of the elderly group. An elevated MMA and a normal holoTC were found in 20% of the elderly group who had a relatively high median serum concentration of creatinine (106.1 micromol/L). Serum concentrations of holoTC in dialysis patients were considerably higher than all other groups (median 100 pmol/L). This was also associated with severely increased serum levels of MMA (median 987 nmol/L). From these results it can be concluded that serum concentration of holoTC is a much better predictor of B12 status than total B12. This was particularly evident in case of dietary B12 deficiency. Serum concentrations of holoTC as well as MMA can be affected by renal dysfunction. Elevated MMA and normal holoTC in patients with renal insufficiency may not exclude vitamin B12 deficiency. HoloTC seems not to be a promising marker in predicting B12 status in renal patients.

  11. Diagnosing Borderline Personality Disorder: Examination of How Clinical Indicators Are Used by Professionals in the Health Setting

    ERIC Educational Resources Information Center

    Treloar, Amanda Jane Commons; Lewis, Andrew J.

    2009-01-01

    This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline…

  12. The Nonprofit Clinic at the University of Pittsburgh: Preparing Students for Transition to Professional Settings

    ERIC Educational Resources Information Center

    Kearns, Kevin P.

    2014-01-01

    The Nonprofit Clinic at the University of Pittsburgh gives graduate students the opportunity to serve as management consultants to nonprofit organizations. This article describes the learning objectives, logistics, and outcomes of the Nonprofit Clinic. Bloom's 1956 taxonomy of learning objectives is employed to assess learning outcomes.

  13. How can student experience enhance the development of a model of interprofessional clinical skills education in the practice placement setting?

    PubMed

    O'Carroll, Veronica; Braid, Margaret; Ker, Jean; Jackson, Cathy

    2012-11-01

    The practice placement setting offers opportunities and challenges for engaging students in high-quality interprofessional learning. The Fife Interprofessional Clinical Skills Model for Education was established to develop structured interprofessional learning opportunities for students during their clinical attachments in NHS Fife. This short report describes the delivery and evaluation of the model, which was piloted with students from the nursing, medicine and allied health professions. Scheduled workshops were delivered within primary and secondary care locations. The learning activities involved exploring and comparing their professional identities, discussing roles and responsibilities within the healthcare team and practicing nontechnical clinical skills. Students who participated in the workshops reported that they developed a better understanding of each other's roles and responsibilities and also identified that this would be transferable knowledge to their future practice. Exploring the student experience has assisted in developing relevant and accessible interprofessional learning opportunities within the practice placement setting. PMID:22866817

  14. Marine Biodiversity in Japanese Waters

    PubMed Central

    Fujikura, Katsunori; Lindsay, Dhugal; Kitazato, Hiroshi; Nishida, Shuhei; Shirayama, Yoshihisa

    2010-01-01

    To understand marine biodiversity in Japanese waters, we have compiled information on the marine biota in Japanese waters, including the number of described species (species richness), the history of marine biology research in Japan, the state of knowledge, the number of endemic species, the number of identified but undescribed species, the number of known introduced species, and the number of taxonomic experts and identification guides, with consideration of the general ocean environmental background, such as the physical and geological settings. A total of 33,629 species have been reported to occur in Japanese waters. The state of knowledge was extremely variable, with taxa containing many inconspicuous, smaller species tending to be less well known. The total number of identified but undescribed species was at least 121,913. The total number of described species combined with the number of identified but undescribed species reached 155,542. This is the best estimate of the total number of species in Japanese waters and indicates that more than 70% of Japan's marine biodiversity remains un-described. The number of species reported as introduced into Japanese waters was 39. This is the first attempt to estimate species richness for all marine species in Japanese waters. Although its marine biota can be considered relatively well known, at least within the Asian-Pacific region, considering the vast number of different marine environments such as coral reefs, ocean trenches, ice-bound waters, methane seeps, and hydrothermal vents, much work remains to be done. We expect global change to have a tremendous impact on marine biodiversity and ecosystems. Japan is in a particularly suitable geographic situation and has a lot of facilities for conducting marine science research. Japan has an important responsibility to contribute to our understanding of life in the oceans. PMID:20689840

  15. Development of proteomic signatures of platelet activation using surface-enhanced laser desorption/ionization technology in a clinical setting.

    PubMed

    Yin, Wei; Czuchlewski, David; Peerschke, Ellinor I

    2008-06-01

    The objective of this study was to develop proteomic profiles that would distinguish between resting and activated platelets in a clinical setting using surface-enhanced laser desorption/ionization (SELDI) time of flight (TOF) technology. A data set of 50 donors was analyzed. Distinct spectral patterns emerged in the low-molecular-weight range (2-10 kDa) for resting platelets and platelets aggregated with adenosine diphosphate (ADP) or thrombin receptor activation peptide SFLLRN (TRAP) and in platelets exposed to shear stress. Platelets from patients treated with ADP receptor antagonists did not show the expected change in proteomic profile following aggregation with ADP. These data provide the first demonstration that proteomic signatures of platelets can be developed using SELDI-TOF in a clinical laboratory setting. PMID:18480001

  16. Pediatric Dental Clinic Location and Utilization in a High Resource Setting

    PubMed Central

    Dumas, S. Amanda; Polk, Deborah

    2016-01-01

    OBJECTIVES Examine dental utilization by Medicaid-insured children living in a high resource area. Characterize distance and travel-related variables to accessing care. METHODS Cross-sectional data was collected on dental clinics in Pittsburgh, Pennsylvania, caring for Medicaid-insured children ≥1 year. Shortest distances, drive times, and bus travel between dental clinics and high-poverty census tracts was determined through geographical information systems analysis. Primary care clinic (PCC) survey data was analyzed for children’s dental use. Demographic characteristics and travel-related variables were compared between children who had and had not been to a dentist. RESULTS Ten dental clinics accepted Medicaid-insured children ≥1 year. Mean distance between high-poverty census tracts and their nearest clinic was 1.2 miles (±0.2 miles), with mean bus travel time 15.6 minutes (±12.3 minutes). Overall, 46% of PCC children reported a dental visit, and this was not significantly different between those who lived in a high poverty census tract versus those who did not (41% and 35%, respectively, P=.58). Children traveled a mean distance of 4.75 miles (SD 2.37 miles) to their dental clinic. Mean distance to their nearest dental clinic was 2.81 miles (SD 2.12 miles). CONCLUSION Dental clinics in a high resource area are in close proximity to where young Medicaid-insured children live; and distances between children’s homes and dental clinics are not significantly different between children who had and had not reported a dental visit, suggesting that barriers persist despite close proximity. Regardless, closer proximity may contribute to the higher utilization of services observed compared with national rates. PMID:25664477

  17. The primary care clinic as a setting for continuing medical education: program description.

    PubMed

    Pérez-Cuevas, R; Reyes, H; Guiscafré, H; Juárez-Díaz, N; Oviedo, M; Flores, S; Muñoz, O

    2000-11-14

    The Mexican Institute of Social Security (IMSS) is Mexico's Largest state-financed health care system, providing care to 50 million people. This system comprises 1450 family medicine clinics staffed by 14,000 family physicians, as well as 240 secondary care hospitals and 10 tertiary care medical centres. We developed a program of continuing medical education (CME) for IMSS family physicians. The program had 4 stages, which were completed over a 7-month period: development of clinical guidelines, training of clinical instructors, an educational intervention (consisting of interactive workshops, individual tutorials and peer group sessions), and evaluation of both physicians' performance and patients' health status. The pilot study was conducted in an IMSS family medicine clinic providing care to 45,000 people; 20 family physicians and 4 clinical instructors participated. The 2 main reasons for visits to IMSS family medicine clinics are acute respiratory infections and type 2 diabetes mellitus. Therefore, patients being treated at the clinic for either of these illnesses were included in the study. The sources of data were interviews with physicians and patients, clinical records and written prescriptions. A 1-group pretest-posttest design was used to compare physicians' performance in treating the 2 illnesses of interest. We found that the daily activities of the clinic could be reorganized to accommodate the CME program and that usual provision of health care services was maintained. Physicians accepted and participated actively in the program, and their performance improved over the course of the study. We conclude that this CME strategy is feasible, is acceptable to family physicians and may improve the quality of health care provided at IMSS primary care facilities. The effectiveness and sustainability of the strategy should be measured through an evaluative study.

  18. High Diagnostic Yield of Whole Exome Sequencing in Participants with Retinal Dystrophies in a Clinical Ophthalmology Setting

    PubMed Central

    Lee, Kristy; Berg, Jonathan S.; Milko, Laura; Crooks, Kristy; Lu, Mei; Bizon, Chris; Owen, Phillips; Wilhelmsen, Kirk C.; Weck, Karen E.; Evans, James P.; Garg, Seema

    2015-01-01

    Purpose To assess the diagnostic yield and the practicality of implementing whole exome sequencing within a clinical ophthalmology setting. Design Evaluation of a diagnostic protocol. Methods Setting Patient participants were enrolled during clinical appointments in a university based Ophthalmic Genetics clinic. Patient Population Twenty-six patients with a variety of presumed hereditary retinal dystrophies. Intervention: Participants were offered whole exome sequencing in addition to clinically available sequencing gene panels between July 2012 and January 2013 to determine the molecular etiology of their retinal dystrophy. Main Outcome Measures Diagnostic yield and acceptability of whole exome sequencing in patients with retinal disorders. Results Twenty-six of 29 (~90%) eligible patients who were approached opted to undergo molecular testing. Each participant chose whole exome sequencing in addition to, or in lieu of, clinically available sequencing gene panels. Time to obtain informed consent was manageable in the clinical context. Whole exome sequencing successfully identified known pathogenic mutations or suspected deleterious variants in 57.7% of participants. Additionally, one participant had 2 autosomal dominant medically actionable incidental findings (unrelated to retinopathy) that were reported to enable the participant to take preventive action and reduce risk for future disease. Conclusions In this study, we identified the molecular etiology for more than half of all participants. Additionally, we found that participants were widely accepting of whole exome sequencing and the possibility of being informed about medically actionable incidental findings. PMID:25910913

  19. Building youths' resilience within a psychiatric outpatient setting: results from a pilot clinical intervention project.

    PubMed

    Waaktaar, Trine; Christie, Helen J; Borge, Anne Inger Helmen; Torgersen, Svenn

    2004-02-01

    The relevance of resilience research for clinical practice has not yet been established. In this intervention pilot study, the aim was to explore how group work based on enhancing the participants' creativity, self-efficacy, active coping, and sense of continuity could be utilized within a clinical context for adolescents with stressful background experiences. 31 participants and 24 parents completed pre-, post-, and 1-yr. follow-up assessments of the youths' behavior difficulties, as well as depression, positive life attitude, coping, and prosocial behavior. Apart from a drop in self-rated prosocial behavior, no significant treatment effects were found. Implications for clinical practice and research are indicated.

  20. Japanese and Japanese American Youth in Literature.

    ERIC Educational Resources Information Center

    Zitlow, Connie S.; Stover, Lois

    1998-01-01

    Explores the wealth of literature by and about Japan and Japanese Americans. Presents a structure for a history unit focusing on Japanese Americans. Summarizes curricular and literary issues to consider. Presents annotations of 69 works of literature and reference and teaching materials. (RS)

  1. The Japanese Mind: Understanding Contemporary Japanese Culture.

    ERIC Educational Resources Information Center

    Davies, Roger J., Ed.; Ikeno, Osamu, Ed.

    This collection of essays offers an overview of contemporary Japanese culture, and can serve as a resource for classes studying Japan. The 28 essays offer an informative, accessible look at the values, attitudes, behavior patterns, and communication styles of modern Japan from the unique perspective of the Japanese people. Filled with examples…

  2. English Loanwords in Japanese.

    ERIC Educational Resources Information Center

    Kay, Gillian

    1995-01-01

    Examines the historical and cultural contexts of word borrowing from English into Japanese, processes of nativization, and functions served by English loanwords. Notes that linguistic and cultural borrowing is to some extent kept separate from native language and culture, resulting in a Japanese/Western dichotomy in Japanese life and language. (20…

  3. Japanese Radio Exercises. Revised.

    ERIC Educational Resources Information Center

    Young, Jocelyn

    This unit focuses on Japanese radio exercises which became popular in Japan just after World War II and are still used among students and workers in companies to help raise morale and form group unity. The exercises reflect the general role of exercise in Japanese culture--to serve as a symbol of unity and cooperation among the Japanese, as well…

  4. Laboratory approach for diagnosis of toluene-based inhalant abuse in a clinical setting

    PubMed Central

    Jain, Raka; Verma, Arpita

    2016-01-01

    The steady increase of inhalant abuse is a great challenge for analytical toxicologists. This review describes an overview of inhalant abuse including the extent of the problem, types of products abused, modes of administration, pharmacology and effects of inhalants, the role of laboratory, interpretation of laboratory results and clinical considerations. Regular laboratory screening for inhalant abuse as well as other substance abuse and health risk behaviors must be a part of standard clinical care. PMID:26957863

  5. Considerations in Applying the Results of Randomized Controlled Clinical Trials to the Care of Older Adults With Kidney Disease in the Clinical Setting: The SHARP Trial.

    PubMed

    Butler, Catherine R; O'Hare, Ann M

    2016-01-01

    The Study of Heart and Renal Protection (SHARP) found that treatment with ezetemibe and low-dose simvastatin reduced the incidence of major atherosclerotic events in patients with kidney disease. Due to the paucity of evidence-based interventions that lower cardiovascular morbidity in this high-risk population, the SHARP trial will likely have a large impact on clinical practice. However, applying the results of clinical trials conducted in select populations to the care of individual patients in real-world settings can be fraught with difficulty. This is especially true when caring for older adults with complex comorbidity and limited life expectancy. These patients are often excluded from clinical trials, frequently have competing health priorities, and may be less likely to benefit and more likely to be harmed by medications. We discuss key considerations in applying the results of the SHARP trial to the care of older adults with CKD in real-world clinical settings using guiding principles set forth by the American Geriatrics Society's Expert Panel on the Care of Older Adults with Multimorbidity. Using this schema, we emphasize the importance of evaluating trial results in the unique context of each patient's goals, values, priorities, and circumstances.

  6. Pharmacy Students’ Preference for Using Mobile Devices in a Clinical Setting for Practice-Related Tasks

    PubMed Central

    Hastings, Justine F.; Bryant, Jennifer E.

    2015-01-01

    Objective. To examine pharmacy students’ ownership of, use of, and preference for using a mobile device in a practice setting. Methods. Eighty-one pharmacy students were recruited and completed a pretest that collected information about their demographics and mobile devices and also had them rank the iPhone, iPad mini, and iPad for preferred use in a pharmacy practice setting. Students used the 3 devices to perform pharmacy practice-related tasks and then completed a posttest to again rank the devices for preferred use in a pharmacy practice setting. Results. The iPhone was the most commonly owned mobile device (59.3% of students), and the iPad mini was the least commonly owned (18.5%). About 70% of the students used their mobile devices at least once a week in a pharmacy practice setting. The iPhone was the most commonly used device in a practice setting (46.9% of students), and the iPod Touch was the least commonly used device (1.2%). The iPad mini was the most preferred device for use in a pharmacy practice setting prior to performing pharmacy practice-related tasks (49.4% of students), and was preferred by significantly more students after performing the tasks (70.4%). Conclusion. Pharmacy students commonly use their mobile devices in pharmacy practice settings and most selected the iPad mini as the preferred device for use in a practice setting even though it was the device owned by the fewest students. PMID:25861103

  7. Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting

    PubMed Central

    Yang, Heechul; Lee, Chun Kyon; Kim, Gun Bea

    2016-01-01

    Purpose To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results. Materials and Methods From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix. Results All technical and clinical success–i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control–was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12–32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change. Conclusion Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding. PMID:27189294

  8. Evaluation of RSA set-up from a clinical biplane fluoroscopy system for 3D joint kinematic analysis

    PubMed Central

    BONANZINGA, TOMMASO; SIGNORELLI, CECILIA; BONTEMPI, MARCO; RUSSO, ALESSANDRO; ZAFFAGNINI, STEFANO; MARCACCI, MAURILIO; BRAGONZONI, LAURA

    2016-01-01

    Purpose dinamic roentgen stereophotogrammetric analysis (RSA), a technique currently based only on customized radiographic equipment, has been shown to be a very accurate method for detecting three-dimensional (3D) joint motion. The aim of the present work was to evaluate the applicability of an innovative RSA set-up for in vivo knee kinematic analysis, using a biplane fluoroscopic image system. To this end, the Authors describe the set-up as well as a possible protocol for clinical knee joint evaluation. The accuracy of the kinematic measurements is assessed. Methods the Authors evaluated the accuracy of 3D kinematic analysis of the knee in a new RSA set-up, based on a commercial biplane fluoroscopy system integrated into the clinical environment. The study was organized in three main phases: an in vitro test under static conditions, an in vitro test under dynamic conditions reproducing a flexion-extension range of motion (ROM), and an in vivo analysis of the flexion-extension ROM. For each test, the following were calculated, as an indication of the tracking accuracy: mean, minimum, maximum values and standard deviation of the error of rigid body fitting. Results in terms of rigid body fitting, in vivo test errors were found to be 0.10±0.05 mm. Phantom tests in static and kinematic conditions showed precision levels, for translations and rotations, of below 0.1 mm/0.2° and below 0.5 mm/0.3° respectively for all directions. Conclusions the results of this study suggest that kinematic RSA can be successfully performed using a standard clinical biplane fluoroscopy system for the acquisition of slow movements of the lower limb. Clinical relevance a kinematic RSA set-up using a clinical biplane fluoroscopy system is potentially applicable and provides a useful method for obtaining better characterization of joint biomechanics. PMID:27602352

  9. Sluggish Cognitive Tempo in a Child and Adolescent Clinical Outpatient Setting.

    PubMed

    Camprodon-Rosanas, Ester; Batlle, Santiago; Estrada-Prat, Xavier; Aceña-Díaz, Marta; Petrizan-Aleman, Araitz; Pujals, Elena; Martin-López, Luis M; Pérez-Solá, Víctor; Ribas-Fitó, Núria

    2016-09-01

    Sluggish cognitive tempo (SCT) symptoms have largely emerged from investigations of attention-deficit/hyperactivity disorder (ADHD). Recent research has demonstrated the relevance of SCT symptoms in the field of clinical child and adolescent psychiatry. The goal of this research was to study the symptoms of SCT in a clinical child and adolescent sample and to define its features and comorbid conditions. We reviewed 834 clinical records of patients referred to Child and Adolescent Mental Health Services and examined SCT symptoms and their relation with sociodemographic data, clinical diagnosis, comorbid conditions, Child Behavior Checklist dimensions, and intelligence quotient. Of the 515 patients (age range, 4 to 17 y, 62.5% male) for whom a fully completed Child Behavior Checklist for Children and Adolescents was available, 20.8% showed high levels of SCT symptoms. SCT symptoms were strongly associated with age, internalizing symptoms, learning disabilities, and ADHD inattentive subtype (ADHD-I). No significant correlations with intelligence quotient were found. We concluded that SCT symptoms are highly prevalent in a clinical sample, and that these symptoms might be related to the difficulties that some individuals have in responding to demands in their environments, such as academic or social demands, as they increase over time. PMID:27648500

  10. Biomarkers in Type 1 diabetes: Application to the clinical trial setting

    PubMed Central

    Tooley, James E.; Herold, Kevan C.

    2014-01-01

    Purpose of Review Biomarkers of type 1 diabetes are important for assessing risk of developing disease, monitoring disease progression, and determining responses to clinical treatments. Here we review recent advances in the development of biomarkers of type 1 diabetes with a focus on their utility in clinical trials. Recent Findings Measurements of auto antibodies and metabolic outcomes have been the foundation of monitoring type 1 diabetes for the past 20 years. Recent advancements have lead to improvements in T cell specific assays that have been used in large-scale clinical trials to measure antigen specific T cell responses. Additionally, new tools are being developed for the measurement of β cell mass and death that will allow for more direct measurement of disease activity. Lastly, recent studies have used both immunologic and non-immunologic biomarkers to identify responders to treatments in clinical trials. Summary Use of biomarkers in the study of type 1 diabetes have largely not changed over the past 20 years, however recent advancements in the field are establishing new techniques that allow for more precise monitoring of disease progression. These new tools will ultimately lead to an improvement in understanding of disease and will be utilized in clinical trials. PMID:24937037

  11. Definition of a core set of quality indicators for the assessment of HIV/AIDS clinical care: a systematic review

    PubMed Central

    2013-01-01

    Background Several organizations and individual authors have been proposing quality indicators for the assessment of clinical care in HIV/AIDS patients. Nevertheless, the definition of a consensual core set of indicators remains controversial and its practical use is largely limited. This study aims not only to identify and characterize these indicators through a systematic literature review but also to propose a parsimonious model based on those most used. Methods MEDLINE, SCOPUS, Cochrane databases and ISI Web of Knowledge, as well as official websites of organizations dealing with HIV/AIDS care, were searched for articles and information proposing HIV/AIDS clinical care quality indicators. The ones that are on patient’s perspective and based on services set were excluded. Data extraction, using a predefined data sheet based on Cochrane recommendations, was done by one of the authors while a second author rechecked the extracted data for any inconsistency. Results A total of 360 articles were identified in our search query but only 12 of them met the inclusion criteria. We also identified one relevant site. Overall, we identified 65 quality indicators for HIV/AIDS clinical care distributed as following: outcome (n=15) and process-related (n=50) indicators; generic (n=36) and HIV/AIDS disease-specific (n=29) indicators; baseline examinations (n=19), screening (n=9), immunization (n=4), prophylaxis (n=5), HIV monitoring (n=16), and therapy (=12) indicators. Conclusions There are several studies that set up HIV clinical care indicators, with only a part of them useful to assess the HIV clinical care. More importantly, HIV/AIDS clinical care indicators need to be valid, reliable and most of all feasible. PMID:23809537

  12. Re-engineering opportunities in clinical research using workflow analysis in community practice settings.

    PubMed

    Khan, Sharib A; Kukafka, Rita; Bigger, J Thomas; Johnson, Stephen B

    2008-11-06

    In this paper we examine frequently performed clinical research activities with the objective of identifying aspects of workflow that could be amenable to informatics-based re-engineering. This paper is part of a series of studies under the NIH Roadmap initiative, which examines workflow of clinical research in community practices. We describe three common work activities, detailing the main actors involved, the tools used and the challenges faced. These activities illustrate inefficiencies in the clinical research workflow which include: a) lack of supporting tools to perform routine work activities, b) redundancy, low reuse of data and poor interoperability between systems and c) the fragmented and distributed nature of the workflow. We identify opportunities for re-engineering at both a micro (activity) and macro level (organization).

  13. Point substitutions in Japanese alloalbumins.

    PubMed

    Arai, K; Madison, J; Huss, K; Ishioka, N; Satoh, C; Fujita, M; Neel, J V; Sakurabayashi, I; Putnam, F W

    1989-08-01

    We have completed the structural study of five rare types of inherited albumin variants (alloalbumins) discovered in the Biochemical Genetics Study of 15,581 unrelated children in Hiroshima and Nagasaki. We have also identified the structural change in five other alloalbumin specimens detected during clinical electrophoresis of sera from Japanese living near Tokyo. Each of the five albumin variants from Nagasaki and Hiroshima has a single amino acid substitution. All of these substitutions differ, and none has been reported in non-Japanese populations. No instances of proalbumin variants or of albumin B (the most frequent alloalbumins in Caucasians) were detected in the children in Hiroshima and Nagasaki. However, one instance of a variant proalbumin and two examples of albumin B occurred in Japanese from the vicinity of Tokyo. In addition a previously unreported point substitution was found in albumin Tochigi, which is present in two unrelated persons from Tochigi prefecture. Four of the point mutations in the Japanese alloalbumins are in close proximity in a short segment of the polypeptide chain (residues 354-382) in which three additional point substitutions have been reported in diverse populations. These results, combined with earlier data, suggest that point substitutions are grouped in certain segments of the albumin molecule.

  14. Priority-setting in healthcare: a framework for reasonable clinical judgements.

    PubMed

    Baerøe, K

    2009-08-01

    What are the criteria for reasonable clinical judgements? The reasonableness of macro-level decision-making has been much discussed, but little attention has been paid to the reasonableness of applying guidelines generated at a macro-level to individual cases. This paper considers a framework for reasonable clinical decision-making that will capture cases where relevant guidelines cannot reasonably be followed. There are three main sections. (1) Individual claims on healthcare from the point of view of concerns about equity are analysed. (2) The demands of responsibility and equity on professional clinical performance are discussed, and how the combination of these demands emerges into seven requirements that constitute the framework is explored. Since this framework is developed to assist in reasonable clinical decision-making, practical implications of all these requirements are also suggested. (3) Challenges concerning the framework are discussed. First, a crucial presumption that the framework relies upon is considered-namely, clinicians' willingness to justify their decisions as requested. Then how public deliberation may influence clinical decision-making is discussed. Next is a consideration of how clinicians' need to have confidence in their own judgements in order to perform in a manner worthy of trust would be compatible with adherence to the framework supported by public deliberation. It is concluded that fair distribution in the interplay between macro- and micro-level considerations can be secured by legitimising procedures on each level, by ensuring well-organised and continuing public debate and by basing individual clinical judgements upon well-justified and principled normative bases. PMID:19644007

  15. Evaluating the Accuracy of an Aneroid Sphygmomanometer in a Clinical Trial Setting

    PubMed Central

    Ma, Yong; Temprosa, Marinella; Fowler, Sarah; Prineas, Ronald J.; Montez, Maria G.; Brown-Friday, Janet; Carrion-Petersen, Mary L.; Whittington, Tracy

    2009-01-01

    BACKGROUND The mercury sphygmomanometer, the “gold” standard for blood pressure measurements, has been gradually phased out in many institutions because of environmental concerns. Our on-going clinical trial compared the use of mercury vs. aneroid sphygmomanometers, before implementing a study-wide transition to the aneroid sphygmomanometer. METHODS The Diabetes Prevention Program Outcomes Study (DPPOS) studied the accuracy of the Welch allyn Tycos 767-Series Mobile aneroid sphygmomanometer from 20 March 2006 to 21 June 2006 at multiple clinic centers. We compared readings from 997 participants in 24 clinic centers using both mercury and aneroid sphygmomanometers. RESULTS The study found no statistically significant difference for systolic blood pressure (SBP) (P > 0.05) and a small but significantly (P < 0.0001) lower (0.8 mm hg) reading for diastolic blood pressure (DBP) using the aneroid sphygmomanometer. Regression analysis of aneroid vs. mercury showed regression lines (Y = 4.8 + 0.96X for SBP, Y = 3.1 + 0.95X for DBP) slightly but statistically significantly different from the line of equality (P < 0.001). Participants’ age, sex, race/ethnicity, body mass index, blood pressure, and clinical center together explain about 8−10% of the variation of the difference between readings from the two sphygmomanometers. Based on the above result, on 1 august 2006, DPPOS clinics began the conversion from mercury to aneroid sphygmomanometers. CONCLUSIONS The Welch allyn Tycos 767-Series Mobile aneroid model 7670−04 tested in this validation study can be used to replace mercury model in clinical trials. PMID:19057514

  16. Space, structure and social dynamics within the clinical setting: two case studies of assisted reproduction in Mexico City.

    PubMed

    González-Santos, Sandra P

    2011-01-01

    Drawing on the concept of therapeutic environments and comparing two case studies, this paper explores the interaction between the spatial factors of the clinical setting, the structural elements of the health system, and the specific treatment requirements of assisted reproduction in order to see the type and degree of privacy and accessibility, as well as the particular social dynamics (i.e. patient-physician and among patients) fostered in two Mexico City fertility clinics. Both cases suggest that certain types of therapeutic environments encourage the formation of spontaneous support groups while others favour the patient-physician relationship. PMID:20961798

  17. Female genital mutilation management in the ambulatory clinic setting: a case study and review of the literature.

    PubMed

    Craven, Spencer; Kavanagh, Alex; Khavari, Rose

    2016-01-01

    A 31-year-old patient with obstructive voiding symptoms and apareunia in the setting of Type III female genital mutilation/cutting (FGM/C) is presented. The patient underwent ambulatory clinic defibulation to relieve her symptoms. FGM has been shown to have serious immediate complications and many chronic complications that greatly impact patients' lives. Several case series have been published describing center-specific experience with defibulation procedures for Type III FGM/C. Here, we present the treatment of a patient with Type III FGM/C in an ambulatory urology clinic in the United States.

  18. Female genital mutilation management in the ambulatory clinic setting: a case study and review of the literature

    PubMed Central

    Craven, Spencer; Kavanagh, Alex; Khavari, Rose

    2016-01-01

    A 31-year-old patient with obstructive voiding symptoms and apareunia in the setting of Type III female genital mutilation/cutting (FGM/C) is presented. The patient underwent ambulatory clinic defibulation to relieve her symptoms. FGM has been shown to have serious immediate complications and many chronic complications that greatly impact patients’ lives. Several case series have been published describing center-specific experience with defibulation procedures for Type III FGM/C. Here, we present the treatment of a patient with Type III FGM/C in an ambulatory urology clinic in the United States. PMID:27333917

  19. Automated discovery of medical expert system rules from clinical databases based on rought sets

    SciTech Connect

    Tsumoto, Shusaku; Tanaka, Hiroshi

    1996-12-31

    Automated knowledge acquisition is an important research issue to solve the bottleneck problem in developing expert systems. Although many inductive learning methods have been proposed for this purpose, most of the approaches focus only on inducing classification rules. However, medical experts also learn other information important for diagnosis from clinical cases. In this paper, a rule induction method is introduced, which extracts not only classification rules but also other medical knowledge needed for diagnosis. This system is evaluated on a clinical database of headache, whose experimental results show that our proposed method correctly induces diagnostic rules and estimates the statistical measures of rules.

  20. Developing an outpatient wound care clinic in an acute rehabilitation setting.

    PubMed

    Sheehan, Diane Dudas; Zeigler, Mary H

    2010-01-01

    People with disability are at high risk for skin breakdown,which requires ongoing prevention and management. An outpatient rehabilitation wound clinic was developed to handle a variety of acute and chronic wounds for this unique population. This article describes how two advanced practice nurses proposed the idea for the wound care clinic and formulated a business plan, which was critical to successfully administering an outpatient wound care service. Essential components of the business plan included the goals, scope of service, professional practice model, benefits, rationale, marketing analysis, predicted volumes, regulatory imperatives, and financial needs.

  1. Can a patient smart card improve decision making in a clinical setting?.

    PubMed

    Bérubé, J; Papillon, M J; Lavoie, G; Durant, P; Fortin, J P

    1995-01-01

    In the health field, clinical information is the raw material for the clinician delivering health services. Therefore, the clinical information available to the physician is often incomplete or even non¿existent upon consultation. Furthermore, the reconstruction of the medical history, which is the most important source of data for the clinician to establish a diagnosis and initiate a treatment, suffers from many constraints. The smart card, like the one used in Quebec's project, could ease the physician's decision-making by allowing fast access to accurate and pertinent data. The smart card is a major asset in the present health system.

  2. Identifying the barriers to conducting outcomes research in integrative health care clinic settings - a qualitative study

    PubMed Central

    2010-01-01

    Background Integrative health care (IHC) is an interdisciplinary blending of conventional medicine and complementary and alternative medicine (CAM) with the purpose of enhancing patients' health. In 2006, we designed a study to assess outcomes that are relevant to people using such care. However, we faced major challenges in conducting this study and hypothesized that this might be due to the lack of a research climate in these clinics. To investigate these challenges, we initiated a further study in 2008, to explore the reasons why IHC clinics are not conducting outcomes research and to identify strategies for conducting successful in-house outcomes research programs. The results of the latter study are reported here. Methods A total of 25 qualitative interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews. Results Barriers identified by participants fell into four categories: organizational culture, organizational resources, organizational environment and logistical challenges. Cultural challenges relate to the philosophy of IHC, organizational leadership and practitioner attitudes and beliefs. Participants also identified significant issues relating to their organization's lack of resources such as funding, compensation, infrastructure and partnerships/linkages. Environmental challenges such as the nature of a clinic's patient population and logistical issues such as the actual implementation of a research program and the applicability of research data also posed challenges to the conduct of research. Embedded research leadership, integration of personal and professional values about research, alignment of research activities and clinical workflow processes are some of the factors identified by participants that support IHC clinics' ability to conduct outcomes research. Conclusions Assessing and enhancing the broader evaluation culture of IHC clinics

  3. Vaginal Birth After Caesarean Section in Low Resource Settings: The Clinical and Ethical Dilemma.

    PubMed

    Wanyonyi, Sikolia; Muriithi, Francis G

    2015-10-01

    Vaginal birth after Caesarean section (VBAC) has long been practised in low resource settings using unconventional methods. This not only poses danger to the woman and her baby, but could also have serious legal and ethical implications. The adoption of this practice has been informed by observational studies with many deficiencies; this is so despite other studies from settings in which the standard of care is much better that show that elective repeat Caesarean section (ERCS) may actually be safer than VBAC. This raises questions about whether we should insist on a dangerous practice when there are safer alternatives. We highlight some of the challenges faced in making this decision, and discuss why the fear of ERCS may not be justified after all in low resource settings. Since a reduction in rates of Caesarean section may not be applicable in these regions, because their rates are already low, the emphasis should instead be on adequate birth spacing and safer primary operative delivery.

  4. Setting up the On-Site Marriage and Family Therapy Clinical Training Course

    ERIC Educational Resources Information Center

    Ratanasiripong, Paul; Ghafoori, Bita

    2009-01-01

    The first clinical training experience or practicum for graduate students in a Marriage and Family Therapy (MFT) program is one of the most important aspects of the entire training program. After a year-long journey through textbook and classroom knowledge, students have the opportunity to finally apply their skills to real life environments with…

  5. Integrated genomic DNA/RNA profiling of hematologic malignancies in the clinical setting.

    PubMed

    He, Jie; Abdel-Wahab, Omar; Nahas, Michelle K; Wang, Kai; Rampal, Raajit K; Intlekofer, Andrew M; Patel, Jay; Krivstov, Andrei; Frampton, Garrett M; Young, Lauren E; Zhong, Shan; Bailey, Mark; White, Jared R; Roels, Steven; Deffenbaugh, Jason; Fichtenholtz, Alex; Brennan, Timothy; Rosenzweig, Mark; Pelak, Kimberly; Knapp, Kristina M; Brennan, Kristina W; Donahue, Amy L; Young, Geneva; Garcia, Lazaro; Beckstrom, Selmira T; Zhao, Mandy; White, Emily; Banning, Vera; Buell, Jamie; Iwanik, Kiel; Ross, Jeffrey S; Morosini, Deborah; Younes, Anas; Hanash, Alan M; Paietta, Elisabeth; Roberts, Kathryn; Mullighan, Charles; Dogan, Ahmet; Armstrong, Scott A; Mughal, Tariq; Vergilio, Jo-Anne; Labrecque, Elaine; Erlich, Rachel; Vietz, Christine; Yelensky, Roman; Stephens, Philip J; Miller, Vincent A; van den Brink, Marcel R M; Otto, Geoff A; Lipson, Doron; Levine, Ross L

    2016-06-16

    The spectrum of somatic alterations in hematologic malignancies includes substitutions, insertions/deletions (indels), copy number alterations (CNAs), and a wide range of gene fusions; no current clinically available single assay captures the different types of alterations. We developed a novel next-generation sequencing-based assay to identify all classes of genomic alterations using archived formalin-fixed paraffin-embedded blood and bone marrow samples with high accuracy in a clinically relevant time frame, which is performed in our Clinical Laboratory Improvement Amendments-certified College of American Pathologists-accredited laboratory. Targeted capture of DNA/RNA and next-generation sequencing reliably identifies substitutions, indels, CNAs, and gene fusions, with similar accuracy to lower-throughput assays that focus on specific genes and types of genomic alterations. Profiling of 3696 samples identified recurrent somatic alterations that impact diagnosis, prognosis, and therapy selection. This comprehensive genomic profiling approach has proved effective in detecting all types of genomic alterations, including fusion transcripts, which increases the ability to identify clinically relevant genomic alterations with therapeutic relevance. PMID:26966091

  6. Assessing Language Competence: Guidelines for Assisting Persons with Limited English Proficiency in Research and Clinical Settings.

    ERIC Educational Resources Information Center

    Acevedo, Marcela C.; Reyes, Carla J.; Annett, Robert D.; Lopez, Edith M.

    2003-01-01

    Current guidelines indicate that therapeutic interactions must be in the client's primary language. This article addresses the ethical dilemmas faced by monolingual clinicians and researchers who must assess the foreign language competence of an interpreter. Guidelines are proposed for assessing language competence of staff in clinical and…

  7. Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

    PubMed Central

    2012-01-01

    Background The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. Methods Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. Results The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. Conclusions These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors. PMID:22333210

  8. Occupational Settings Facilitating Wisdom-Related Knowledge: The Sample Case of Clinical Psychologists.

    ERIC Educational Resources Information Center

    Smith, Jacqui; And Others

    1994-01-01

    Examined whether clinical psychology practice facilitated access to and acquisition of wisdom, defined as expert knowledge in fundamental pragmatics of life. Compared responses to wisdom-related dilemmas from young and older clinicians with responses from other professionals. Young and older adults did not differ on factual knowledge, procedural…

  9. Integrated genomic DNA/RNA profiling of hematologic malignancies in the clinical setting

    PubMed Central

    He, Jie; Abdel-Wahab, Omar; Nahas, Michelle K.; Wang, Kai; Rampal, Raajit K.; Intlekofer, Andrew M.; Patel, Jay; Krivstov, Andrei; Frampton, Garrett M.; Young, Lauren E.; Zhong, Shan; Bailey, Mark; White, Jared R.; Roels, Steven; Deffenbaugh, Jason; Fichtenholtz, Alex; Brennan, Timothy; Rosenzweig, Mark; Pelak, Kimberly; Knapp, Kristina M.; Brennan, Kristina W.; Donahue, Amy L.; Young, Geneva; Garcia, Lazaro; Beckstrom, Selmira T.; Zhao, Mandy; White, Emily; Banning, Vera; Buell, Jamie; Iwanik, Kiel; Ross, Jeffrey S.; Morosini, Deborah; Younes, Anas; Hanash, Alan M.; Paietta, Elisabeth; Roberts, Kathryn; Mullighan, Charles; Dogan, Ahmet; Armstrong, Scott A.; Mughal, Tariq; Vergilio, Jo-Anne; Labrecque, Elaine; Erlich, Rachel; Vietz, Christine; Yelensky, Roman; Stephens, Philip J.; Miller, Vincent A.; van den Brink, Marcel R. M.; Otto, Geoff A.; Lipson, Doron

    2016-01-01

    The spectrum of somatic alterations in hematologic malignancies includes substitutions, insertions/deletions (indels), copy number alterations (CNAs), and a wide range of gene fusions; no current clinically available single assay captures the different types of alterations. We developed a novel next-generation sequencing-based assay to identify all classes of genomic alterations using archived formalin-fixed paraffin-embedded blood and bone marrow samples with high accuracy in a clinically relevant time frame, which is performed in our Clinical Laboratory Improvement Amendments–certified College of American Pathologists–accredited laboratory. Targeted capture of DNA/RNA and next-generation sequencing reliably identifies substitutions, indels, CNAs, and gene fusions, with similar accuracy to lower-throughput assays that focus on specific genes and types of genomic alterations. Profiling of 3696 samples identified recurrent somatic alterations that impact diagnosis, prognosis, and therapy selection. This comprehensive genomic profiling approach has proved effective in detecting all types of genomic alterations, including fusion transcripts, which increases the ability to identify clinically relevant genomic alterations with therapeutic relevance. PMID:26966091

  10. The Affective Reactivity Index: A Concise Irritability Scale for Clinical and Research Settings

    ERIC Educational Resources Information Center

    Stringaris, Argyris; Goodman, Robert; Ferdinando, Sumudu; Razdan, Varun; Muhrer, Eli; Leibenluft, Ellen; Brotman, Melissa A.

    2012-01-01

    Background: Irritable mood has recently become a matter of intense scientific interest. Here, we present data from two samples, one from the United States and the other from the United Kingdom, demonstrating the clinical and research utility of the parent- and self-report forms of the Affective Reactivity Index (ARI), a concise dimensional measure…

  11. Use of the Autism Diagnostic Observation Schedule (ADOS) in a Clinical Setting

    ERIC Educational Resources Information Center

    Molloy, Cynthia A.; Murray, Donna S.; Akers, Rachel; Mitchell, Terry; Manning-Courtney, Patricia

    2011-01-01

    The aim of this study was to examine the Autism Diagnostic Observation Schedule (ADOS) as it is commonly used in clinical practice. ADOS classifications were compared to final diagnoses given by a multidisciplinary team to 584 children referred for evaluation for possible autism spectrum disorder (ASD) at the Cincinnati Children's Hospital Medical…

  12. Effectiveness of Computer-Based Treatment for Dyslexia in a Clinical Care Setting: Outcomes and Moderators

    ERIC Educational Resources Information Center

    Tijms, Jurgen

    2011-01-01

    The clinical effectiveness of a treatment for children with dyslexia was examined, as well as the moderating impact of plausible cognitive and socio-economic factors on treatment success. Results revealed that the treatment group accrued significant greater gains than the control group in reading and spelling skills. The treatment group obtained a…

  13. An Evidence-Based Practice Model across the Academic and Clinical Settings

    ERIC Educational Resources Information Center

    Wolter, Julie A.; Corbin-Lewis, Kim; Self, Trisha; Elsweiler, Anne

    2011-01-01

    This tutorial is designed to provide academic communication sciences and disorders (CSD) programs, at both the undergraduate and graduate levels, with a comprehensive instructional model on evidence-based practice (EBP). The model was designed to help students view EBP as an ongoing process needed in all clinical decision making. The three facets…

  14. A Tool To Evaluate How to Learn from Experience in Clinical Settings.

    ERIC Educational Resources Information Center

    Dumas, Louise; Villeneuve, Jean; Chevrier, Jacques

    2000-01-01

    An evaluation tool for the process of learning from experience in a clinical practicum at baccalaureate nursing level was developed and validated. This reflective type of process evaluation helps students link theory to practice and think critically. (Contains 50 references.) (JOW)

  15. Intentions in critical clinical settings: a study of medical students' perceptions.

    PubMed

    Juth, Niklas; Tillberg, Therése; Lynöe, Niels

    2011-08-01

    The aim of this pilot study was to develop a realistic clinical case for identifying Knobe's asymmetric effect, ie, the tendency to ascribe intentions to a larger extent when an act is considered wrong, as well as to compare medical students at the beginning and end of their curriculum. A vignette about a critically ill 72-year-old patient in need of an operation was used, with two different outcomes: the patient dies or the patient recovers. Approximately half of the students received the 'recovery case' and half the 'death case'. The questions asked were whether it was right to perform the risky operation and whether the head of the clinic brought about the patient's death/recovery intentionally. Among students in their first term an asymmetry in response pattern was identified. This asymmetry was not found among students in their final term. The difference between term 1 and term 11 students is believed to be due to the socialisation of medical students towards clinical reasoning regarding the moral role of intentions. Although no Knobe effect could be detected among term 11 students, a related adaptation effect was detected, indicating that students at the end of their medical school also tend to adapt their ascription of intentions to their moral evaluation of the act. By using clinically relevant cases a new effect has thus been identified that might be useful when investigating experienced clinicians and their views on intentions. The cases and effect merit further investigation.

  16. Reflective Observation in the Clinical Education Setting: A Way to Promote Learning

    ERIC Educational Resources Information Center

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

    2015-01-01

    Context: Clinical experiences help athletic training students gain real-time learning experiences by engaging in patient care. Observational learning has been identified as important to athletic training student development, yet little is known about its effectiveness. Objective: To explore the athletic training students' perspectives on their…

  17. Teaching Reflective Practice in Practice Settings: Students' Perceptions of Their Clinical Educators

    ERIC Educational Resources Information Center

    Trede, Franziska; Smith, Megan

    2012-01-01

    Reflective practice in practice settings can enhance practice knowledge, self-assessment and lifelong learning, develop future practice capability and professional identity, and critically appraise practice traditions rather than reproduce them. The inherent power imbalance between student and educator runs the risk for the reflective practice…

  18. Language Interaction in Clinical and Educational Settings. ASHA Monographs No. 30.

    ERIC Educational Resources Information Center

    Kovarsky, Dana, Ed.; And Others

    This collection of papers focuses on how adults communicate with children in institutional settings such as public schools and day care centers, and how professionals in the field of communication disorders communicate among themselves. Papers include: "Introduction: Linguistic Theories and Language Interaction" (Madeline M. Maxwell); "Inuit…

  19. Treating Children and Adolescents in Residential and Inpatient Settings. Developmental Clinical Psychology and Psychiatry. Volume 36.

    ERIC Educational Resources Information Center

    Lyman, Robert D.; Campbell, Nancy R.

    This book examines the various components of hospital, residential, and outpatient treatments for children and adolescents with mental disorders. Options and settings for residential care are presented, including the principles and practical issues, such as providing continuing education, that underlie the decision making for placement of youth in…

  20. Giving feedback to learners in clinical and academic settings: practical considerations.

    PubMed

    Cleary, Michelle L; Walter, Garry

    2010-04-01

    In this column, we outline key points about feedback for staff to consider in everyday practice, with a view to making the task less daunting. In turn, we address the meaning of feedback, elements of good feedback, placement objectives, setting, frequency, identifying areas of weakness, recognition and praise, dealing with unfavorable reactions, and dissatisfaction with the feedback process. PMID:20411885

  1. Low levels of HIV test coverage in clinical settings in the UK: a systematic review of adherence to 2008 guidelines

    PubMed Central

    Elmahdi, Rahma; Gerver, Sarah M; Gomez Guillen, Gabriela; Fidler, Sarah; Cooke, Graham; Ward, Helen

    2014-01-01

    Objectives To quantify the extent to which guideline recommendations for routine testing for HIV are adhered to outside of genitourinary medicine (GUM), sexual health (SH) and antenatal clinics. Methods A systematic review of published data on testing levels following publication of 2008 guidelines was undertaken. Medline, Embase and conference abstracts were searched according to a predefined protocol. We included studies reporting the number of HIV tests administered in those eligible for guideline recommended testing. We excluded reports of testing in settings with established testing surveillance (GUM/SH and antenatal clinics). A random effects meta-analysis was carried out to summarise level of HIV testing across the studies identified. Results Thirty studies were identified, most of which were retrospective studies or audits of testing practice. Results were heterogeneous. The overall pooled estimate of HIV test coverage was 27.2% (95% CI 22.4% to 32%). Test coverage was marginally higher in patients tested in settings where routine testing is recommended (29.5%) than in those with clinical indicator diseases (22.4%). Provider test offer was found to be lower (40.4%) than patient acceptance of testing (71.5%). Conclusions Adherence to 2008 national guidelines for HIV testing in the UK is poor outside of GUM/SH and antenatal clinics. Low levels of provider test offer appear to be a major contributor to this. Failure to adhere to testing guidelines is likely to be contributing to late diagnosis with implications for poorer clinical outcomes and continued onwards transmission of HIV. Improved surveillance of HIV testing outside of specialist settings may be useful in increasing adherence testing guidelines. PMID:24412996

  2. Informed consent for whole-genome sequencing studies in the clinical setting. Proposed recommendations on essential content and process

    PubMed Central

    Ayuso, Carmen; Millán, José M; Mancheño, Marta; Dal-Ré, Rafael

    2013-01-01

    The development of new massive sequencing techniques has now made it possible to significantly reduce the time and costs of whole-genome sequencing (WGS). Although WGS will soon become a routine testing tool, new ethical issues have surfaced. In light of these concerns, a systematic review of papers published by expert authors on IC or specific ethical issues related to IC for WGS analysis in the clinical setting has been conducted using the Pubmed, Embase and Cochrane Library databases. Additionally, a search was conducted for international ethical guidelines for genetic studies published by scientific societies and ethical boards. Based on these documents, a minimum set of information to be provided to patients in the IC form was determined. Fourteen and seven documents from the database search and from scientific societies, respectively, were selected. A very high level of consistency between them was found regarding the recommended IC form content. Pre-test counselling and general information common to all genetic tests should be included in the IC form for WGS for diagnostic purposes, but additional information addressing specific issues on WGS are proposed, such as a plan for the ethical, clinically oriented return of incidental findings. Moreover, storage of additional information for future use should also be agreed upon with the patient in advance. Recommendations for WGS studies in the clinical setting concerning both the elements of information and the process of obtaining the IC as well as how to handle the results obtained are proposed. PMID:23321621

  3. Sharing raw data from clinical trials: what progress since we first asked "Whose data set is it anyway?".

    PubMed

    Vickers, Andrew J

    2016-05-04

    Ten years ago, one of the first papers published in Trials was a commentary entitled "Whose data set is it anyway?" The commentary pointed out that trialists routinely refused requests for data sharing and argued that this attitude was a community standard that had no rational basis. At the time, there had been few calls for clinical trial data sharing and certainly no institutional support. Today the situation could not be more different. Numerous organizations now recommend or require raw data to be made available, including the International Committee of Medical Journal Editors, which recently proposed that clinical trial data sharing be a "condition of … publication." Furthermore, the literature is replete with papers covering an enormously wide variety of topics on data sharing. But despite a tectonic shift in attitudes, we are yet to see clinical trial data sharing become an unquestioned norm, where a researcher can readily download a data set from a trial almost as easily as they can now download a copy of the published paper. The battle over the next few years is to go beyond changing minds to ensuring that real data sets are routinely made available.

  4. Clinical problem solving ability of BSc and diploma nursing students in Indian setting--a comparison.

    PubMed

    Ezhilarasu, Punitha

    2012-01-01

    Clinical Problem Solving Ability (CPSA) is an important skill essential for nurses to achieve professional excellence which is developed during the educational process. A sample of 215 students from BSc and Diploma nursing educational programmes were studied to determine their CPSA and the differences were compared. A written simulation instrument (Ezhilarasu, 2000) with a Cronbach's alpha of 0.81 was used to measure the CPSA. BSc students scored significantly higher than Diploma students (p = 0). Final year students from both the programmes scored higher than the first year students (p = 0.01). The least commonly used step in clinical problem solving is evaluation. Along with other studies, this study also supports the influence of the educational process in the development of CPSA. Appropriate teaching strategies and role modelling by faculty should become an essential part in all nursing educational institutions.

  5. Preparing culturally and linguistically diverse nursing students for clinical practice in the health care setting.

    PubMed

    Harvey, Theresa; Robinson, Carolyn; Frohman, Rena

    2013-07-01

    The number of culturally and linguistically diverse (CALD) students seeking enrollment in higher education courses in Western countries where English is the predominant language has grown considerably in the past decade, especially in undergraduate health care courses. When enrolled in nursing courses, students are required to complete clinical placements. Such experiences can create significant challenges for CALD students where language, cultural differences, and interpretation of cultural norms complicate the learning process. To assist CALD nursing students to transition successfully, an extracurricular integrated curriculum program was developed and implemented at a university in Queensland, Australia. The program is a series of interactive workshops based on the principles of caring pedagogy and student-centered learning. The program applies strategies that combine small-group discussions with peers, role-plays, and interactions with final-year nursing student volunteers. Evaluation of the program suggests it has assisted most of the students surveyed to be successful in their clinical studies. PMID:23721071

  6. Return of individual research results and incidental findings in the clinical trials cooperative group setting.

    PubMed

    Ferriere, Michael; Van Ness, Brian

    2012-04-01

    The National Cancer Institute (NCI)-funded cooperative group cancer clinical trial system develops experimental therapies and often collects samples from patients for correlative research. The cooperative group bank (CGB) system maintains biobanks with a current policy not to return research results to individuals. An online survey was created, and 10 directors of CGBs completed the surveys asking about understanding and attitudes in changing policies to consider return of incidental findings (IFs) and individual research results (IRRs) of health significance. The potential impact of the 10 consensus recommendations of Wolf et al. presented in this issue are examined. Reidentification of samples is often not problematic; however, changes to the current banking and clinical trial systems would require significant effort to fulfill an obligation of recontact of subjects. Additional resources, as well as a national advisory board would be required to standardize implementation.

  7. Preparing culturally and linguistically diverse nursing students for clinical practice in the health care setting.

    PubMed

    Harvey, Theresa; Robinson, Carolyn; Frohman, Rena

    2013-07-01

    The number of culturally and linguistically diverse (CALD) students seeking enrollment in higher education courses in Western countries where English is the predominant language has grown considerably in the past decade, especially in undergraduate health care courses. When enrolled in nursing courses, students are required to complete clinical placements. Such experiences can create significant challenges for CALD students where language, cultural differences, and interpretation of cultural norms complicate the learning process. To assist CALD nursing students to transition successfully, an extracurricular integrated curriculum program was developed and implemented at a university in Queensland, Australia. The program is a series of interactive workshops based on the principles of caring pedagogy and student-centered learning. The program applies strategies that combine small-group discussions with peers, role-plays, and interactions with final-year nursing student volunteers. Evaluation of the program suggests it has assisted most of the students surveyed to be successful in their clinical studies.

  8. Effect of Transmission Setting and Mixed Species Infections on Clinical Measures of Malaria in Malawi

    PubMed Central

    Bruce, Marian C.; Macheso, Allan; Kelly-Hope, Louise A.; Nkhoma, Standwell; McConnachie, Alex; Molyneux, Malcolm E.

    2008-01-01

    Background In malaria endemic regions people are commonly infected with multiple species of malaria parasites but the clinical impact of these Plasmodium co-infections is unclear. Differences in transmission seasonality and transmission intensity between endemic regions have been suggested as important factors in determining the effect of multiple species co-infections. Principal Findings In order to investigate the impact of multiple-species infections on clinical measures of malaria we carried out a cross-sectional community survey in Malawi, in 2002. We collected clinical and parasitological data from 2918 participants aged >6 months, and applied a questionnaire to measure malaria morbidity. We examined the effect of transmission seasonality and intensity on fever, history of fever, haemoglobin concentration ([Hb]) and parasite density, by comparing three regions: perennial transmission (PT), high intensity seasonal transmission (HIST) and low intensity seasonal transmission (LIST). These regions were defined using multi-level modelling of PCR prevalence data and spatial and geo-climatic measures. The three Plasmodium species (P. falciparum, P. malariae and P. ovale) were randomly distributed amongst all children but not adults in the LIST and PT regions. Mean parasite density in children was lower in the HIST compared with the other two regions. Mixed species infections had lower mean parasite density compared with single species infections in the PT region. Fever rates were similar between transmission regions and were unaffected by mixed species infections. A history of fever was associated with single species infections but only in the HIST region. Reduced mean [Hb] and increased anaemia was associated with perennial transmission compared to seasonal transmission. Children with mixed species infections had higher [Hb] in the HIST region. Conclusions Our study suggests that the interaction of Plasmodium co-infecting species can have protective effects against

  9. Task–Technology Fit of Video Telehealth for Nurses in an Outpatient Clinic Setting

    PubMed Central

    Finkelstein, Stanley M.

    2014-01-01

    Abstract Background: Incorporating telehealth into outpatient care delivery supports management of consumer health between clinic visits. Task–technology fit is a framework for understanding how technology helps and/or hinders a person during work processes. Evaluating the task–technology fit of video telehealth for personnel working in a pediatric outpatient clinic and providing care between clinic visits ensures the information provided matches the information needed to support work processes. Materials and Methods: The workflow of advanced practice registered nurse (APRN) care coordination provided via telephone and video telehealth was described and measured using a mixed-methods workflow analysis protocol that incorporated cognitive ethnography and time–motion study. Qualitative and quantitative results were merged and analyzed within the task–technology fit framework to determine the workflow fit of video telehealth for APRN care coordination. Results: Incorporating video telehealth into APRN care coordination workflow provided visual information unavailable during telephone interactions. Despite additional tasks and interactions needed to obtain the visual information, APRN workflow efficiency, as measured by time, was not significantly changed. Analyzed within the task–technology fit framework, the increased visual information afforded by video telehealth supported the assessment and diagnostic information needs of the APRN. Conclusions: Telehealth must provide the right information to the right clinician at the right time. Evaluating task–technology fit using a mixed-methods protocol ensured rigorous analysis of fit within work processes and identified workflows that benefit most from the technology. PMID:24841219

  10. Clinical Setting and Management Approach Matters: Metabolic Testing Rates in Antipsychotic-Treated Youth and Adults

    PubMed Central

    Nicol, Ginger; Campagna, Elizabeth J; Garfield, Lauren D; Newcomer, John W; Parks, Joe; Morrato, Elaine

    2015-01-01

    Background Guidelines recommend increased metabolic monitoring in antipsychotic-treated patients. State and federal agencies are striving to address under-screening. Methods Rates of glucose and lipid testing among antipsychotic-treated youth and adults in Missouri Medicaid (N=9,473) in Community Mental Health Centers (CMHCs), with and without case management, versus other care settings were evaluated. Multivariable logistic regressions determined which characteristics were independently associated with metabolic testing. Results Rates of glucose and lipid testing were 37.0% and 17.3% in youth and 68.7% and 34.9% in adults, respectively. Adjusted odds of glucose and lipid testing were higher in patients receiving care in a CMHC with case management [youth: AOR=1.68 (95% CI=1.37-2.04), 2.40(1.91-3.02); adults: 1.43(1.18-1.74), 1.97(1.64-2.36)], or without [youth: 1.89(1.61-2.22), 2.35(1.94-2.85); adults: 1.44(1.22-1.70), 1.48(1.27-1.74)] versus other settings. Conclusions Within Missouri Medicaid, receiving care at a CMHC was associated with higher rates of metabolic testing, possibly reflecting state efforts to promote health homes in these settings. PMID:26325456

  11. RIPC for multiorgan salvage in clinical settings: evolution of concept, evidences and mechanisms.

    PubMed

    Randhawa, Puneet Kaur; Bali, Anjana; Jaggi, Amteshwar Singh

    2015-01-01

    Ischemic preconditioning is an intrinsic process in which preconditioning ischemia (ischemia of shorter duration) protects the organs against the subsequent index ischemia (sustained ischemia). Remote ischemic preconditioning (RIPC) is an innovative treatment approach in which interspersed cycles of preconditioning ischemia followed by reperfusion to a remote organ (other than target organ) protect the target organ against index ischemia and reperfusion-induced injury. RIPC of various organs to provide multi-organ salvage became a successful approach in numerous species of animals. Consequently, the concept of RIPC evolved in clinical setups, and provided beneficial effects in alleviating ischemia-reperfusion-induced injury in various remote organs, including myocardium. Clinically, RIPC stimulus is generally delivered by inflating the blood pressure cuff tied on the upper arm 20 mm greater than the systolic blood pressure, rendering the forearm ischemic for 5 min, followed 5 min reperfusion by deflating the cuff. This cycle is repeated for 3-4 consecutive periods to precondition the tissue and improve the survival. The institution of RIPC is beneficial in mitigating myocardial injury in patients undergoing various surgical interventions including coronary artery bypass graft surgery, abdominal aortic aneurysm repair, percutaneous coronary intervention, heart valve surgery, drug-eluting stent implantation, kidney transplantation, elective decompression surgery. The involvement of hypoxia inducible factor-1α (HIF-1α), ATP-sensitive potassium channels, signal transducer and activator of transcription (STAT), matrix metalloproteinases, O-linked β-N-acetylglucosamine (O-GlcNAc) levels, autonomous nervous system in mediating RIPC-induced cardioprotective effects has been explored clinically. However, comprehensive studies are required to elucidate the other possible mechanisms responsible for producing multi-organ protection during RIPC.

  12. Diagnosis of paediatric HIV infection in a primary health care setting with a clinical algorithm.

    PubMed Central

    Horwood, C.; Liebeschuetz, S.; Blaauw, D.; Cassol, S.; Qazi, S.

    2003-01-01

    OBJECTIVE: To determine the validity of an algorithm used by primary care health workers to identify children with symptomatic human immunodeficiency virus (HIV) infection. This HIV algorithm is being implemented in South Africa as part of the Integrated Management of Childhood Illness (IMCI), a strategy that aims to improve childhood morbidity and mortality by improving care at the primary care level. As AIDS is a leading cause of death in children in southern Africa, diagnosis and management of symptomatic HIV infection was added to the existing IMCI algorithm. METHODS: In total, 690 children who attended the outpatients department in a district hospital in South Africa were assessed with the HIV algorithm and by a paediatrician. All children were then tested for HIV viral load. The validity of the algorithm in detecting symptomatic HIV was compared with clinical diagnosis by a paediatrician and the result of an HIV test. Detailed clinical data were used to improve the algorithm. FINDINGS: Overall, 198 (28.7%) enrolled children were infected with HIV. The paediatrician correctly identified 142 (71.7%) children infected with HIV, whereas the IMCI/HIV algorithm identified 111 (56.1%). Odds ratios were calculated to identify predictors of HIV infection and used to develop an improved HIV algorithm that is 67.2% sensitive and 81.5% specific in clinically detecting HIV infection. CONCLUSIONS: Children with symptomatic HIV infection can be identified effectively by primary level health workers through the use of an algorithm. The improved HIV algorithm developed in this study could be used by countries with high prevalences of HIV to enable IMCI practitioners to identify and care for HIV-infected children. PMID:14997238

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

    PubMed Central

    2015-01-01

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

  14. Evaluation of Clinical Diagnosis of Fetal Distress and Perinatal Outcome in a Low Resource Nigerian Setting

    PubMed Central

    Ibekwe, Perpetus Chudi; Onu, Fidelis Agwu; Onwe, Ogah Emeka; Ezeonu, Thecla Chinonyelum; Omeje, Innocent

    2016-01-01

    Introduction Fetal distress has been shown to contribute to the increasing caesarean section rate. There has been controversy on the usefulness of clinical diagnosis of fetal distress using only the intermittent counting of the fetal heart rate and/or passage of meconium-stained liquor. Aim To evaluate the clinical diagnosis of fetal distress and the perinatal outcome. Materials and Methods This was a retrospective study in which the case records of the patients, who were diagnosed of fetal distress at Federal Teaching Hospital, Abakaliki, Nigeria, from January 1, 2008 to December 31, 2014, were collated. The statistical analysis was done using the Statistical Package for Social Sciences version 17 software (SPSS Inc., Chicago IL, USA). Results Out of the 15,640 deliveries carried out within the study period, 3,761 (24.05%) deliveries were through caesarean section. A total of 326 (8.9%) of the 3,761 caesarean sections were due to fetal distress within the study period. More so, a total of 227 (70.9%) babies were born with ≥ 7 Apgar score at the 1st minute of delivery. The perinatal mortality rate was 31.25 per 1000 deliveries. Though birth asphyxia was recorded more on babies of mothers that had fresh meconium-stained liquor and whose decision-intervention interval was more than 30 minutes when compared with those without any of the two conditions, there was no statistical significant difference between them. Conclusion The clinical diagnosis of fetal distress is accurate in 29.1% of the cases. However, it has led to an unnecessary caesarean section in the remaining 70.9% of the parturients. In order to reduce this high trend of unnecessary caesarean sections due to clinical diagnosis of fetal distress in this environment, antepartum fetal assessment with non-stress test or biophysical profile and intrapartum use of continuous electronic fetal monitoring should be used to confirm or refute the fetal distress before any surgical intervention. Fetal blood sampling

  15. Telehealth nurse practitioner student clinical experiences: an essential educational component for today's health care setting.

    PubMed

    Hawkins, Shelley Yerger

    2012-11-01

    In order to meet the continuous changes and innovations within the health care system, nurse practitioner faculty must look to the future and prepare nurse practitioner graduates who deliver safe, quality patient care addressing the realities of a global society with a fast-paced expansion of technologies. Preparing nurse practitioner students for practice must include more than information technology knowledge in graduate nursing programs. Formal clinical experiences using various telehealth applications must be integrated into nurse practitioner training. Innovative strategies must be explored by nurse practitioner faculty to assure that graduates can meet the demanding technological demands of our current health care society.

  16. [How to Understand "Clinical Ethics" and "Research Ethics" in Clinical Settings--Incorporation of IRB, REC, and CEC in Hospital Organizations].

    PubMed

    Ita, Koichiro

    2016-02-01

    As the traditional definition of "medical ethics" has recently changed markedly with advances in medical knowledge and technology, medical doctors and researchers in Japan are required to understand and apply both research and clinical ethics. Quite frequently, ethical problems in clinical settings cannot be addressed by the simple application of good will, hard work, and perseverance by medical personnel. The Ministry of Health, Labour and Welfare (MHLW) and the Ministry of Education, Culture, Sports, Science and Technology (MEXT) have jointly published "Ethical Guidelines for Clinical Studies;" however, clear guidelines (legal, ministerial, or governmental) outlining the expectations regarding clinical ethics do not exist. All medical personnel face deep ethical dilemmas. In these instances, if the fulfillment of 'ethics' relies solely on the capacity of personnel to apply their own individual moral efforts, the result will be burn-out among these workers who have a strong sense of responsibility. In order to avoid this, a system which comprises multiple physicians, nurses, and other personnel must be established, allowing collaboration when an appropriate response is required. A major factor supporting this approach is the offering of Clinical Ethics Consultations.

  17. [How to Understand "Clinical Ethics" and "Research Ethics" in Clinical Settings--Incorporation of IRB, REC, and CEC in Hospital Organizations].

    PubMed

    Ita, Koichiro

    2016-02-01

    As the traditional definition of "medical ethics" has recently changed markedly with advances in medical knowledge and technology, medical doctors and researchers in Japan are required to understand and apply both research and clinical ethics. Quite frequently, ethical problems in clinical settings cannot be addressed by the simple application of good will, hard work, and perseverance by medical personnel. The Ministry of Health, Labour and Welfare (MHLW) and the Ministry of Education, Culture, Sports, Science and Technology (MEXT) have jointly published "Ethical Guidelines for Clinical Studies;" however, clear guidelines (legal, ministerial, or governmental) outlining the expectations regarding clinical ethics do not exist. All medical personnel face deep ethical dilemmas. In these instances, if the fulfillment of 'ethics' relies solely on the capacity of personnel to apply their own individual moral efforts, the result will be burn-out among these workers who have a strong sense of responsibility. In order to avoid this, a system which comprises multiple physicians, nurses, and other personnel must be established, allowing collaboration when an appropriate response is required. A major factor supporting this approach is the offering of Clinical Ethics Consultations. PMID:27311285

  18. Preconception Counseling and Care in the Setting of HIV: Clinical Characteristics and Comorbidities

    PubMed Central

    Boelig, Rupsa C.; Coleman, Jenell S.; Keller, Jean; Sewell, Catherine; Anderson, Jean

    2015-01-01

    Objective. To describe the demographic and clinical characteristics of HIV-infected individuals and HIV-affected couples who were referred for preconception counseling (PCC) at a large urban US-based HIV clinic. Methods. Electronic medical records were reviewed for HIV-infected individuals and HIV-affected couples. Medical, reproductive, surgical, psychosocial, and family history data were abstracted. Univariate analyses were done. Results. There were 8 single HIV-infected women and 100 HIV-affected couples who underwent PCC. HIV-infected women were older (mean age 35 years versus 32 years, P = 0.06), were more likely to smoke (23% versus 0%, P < 0.01), and had more medical comorbidities (57% versus 33%, P = 0.04) than HIV-uninfected women. The majority of couples were serodiscordant (77%), and of these couples, 32% had a detectable plasma viral load and 33% report inconsistent condom use. Conclusions. HIV-infected women have a number of medical and psychosocial issues, including those related to HIV that may increase the risk of adverse pregnancy outcomes and HIV perinatal and sexual transmission. PCC is an important intervention to optimize maternal management to improve perinatal outcomes and minimize transmission risks. PMID:25838753

  19. Midwifery student exposure to workplace violence in clinical settings: An exploratory study.

    PubMed

    McKenna, Lisa; Boyle, Malcolm

    2016-03-01

    Evidence indicates that nurses regularly experience bullying within the workplace which has the potential for health and social effects, as well as worker attrition. Literature suggests that nursing students are exposed to workplace violence during clinical placements including from health professionals and mentors, however little is known about midwifery students. This study sought to examine undergraduate midwifery students' experiences of workplace violence during clinical placements. A cross-sectional approach using a paper-based survey, the Paramedic Workplace Questionnaire, was used to solicit the information. Students were exposed to workplace violence with the main act being intimidation (30%), verbal abuse (17%), physical abuse (3%), and sexual harassment (3%). In more than three-quarters of the incidents the students had some level of apprehension or were frightened as a result of the violence. Students responded to the acts of violence with changes to emotions, self-confidence, and a desire to "give up". This paper demonstrates ways in which midwifery students are vulnerable to potential workplace violence from various sources. Support mechanisms need to be developed to ensure this can be minimised. PMID:26672901

  20. An in vivo transcriptome data set of natural antisense transcripts from Plasmodium falciparum clinical isolates

    PubMed Central

    Subudhi, Amit Kumar; Boopathi, P.A.; Garg, Shilpi; Middha, Sheetal; Acharya, Jyoti; Pakalapati, Deepak; Saxena, Vishal; Aiyaz, Mohammed; Orekondy, Harsha B.; Mugasimangalam, Raja C.; Sirohi, Paramendra; Kochar, Sanjay K.; Kochar, Dhanpat K.; Das, Ashis

    2014-01-01

    Antisense transcription is pervasive among biological systems and one of the products of antisense transcription is natural antisense transcripts (NATs). Emerging evidences suggest that they are key regulators of gene expression. With the discovery of NATs in Plasmodium falciparum, it has been suggested that these might also be playing regulatory roles in this parasite. However, all the reports describing the diversity of NATs have come from parasites in culture condition except for a recent study published by us. In order to explore the in vivo diversity of NATs in P. falciparum clinical isolates, we performed a whole genome expression profiling using a strand-specific 244 K microarray that contains probes for both sense and antisense transcripts. In this report, we describe the experimental procedure and analysis thereof of the microarray data published recently in Gene Expression Omnibus (GEO) under accession number GSE44921. This published data provide a wealth of information about the prevalence of NATs in P. falciparum clinical isolates from patients with diverse malaria related disease conditions. Supplementary information about the description and interpretation of the data can be found in a recent publication by Subudhi et al. in Experimental Parasitology (2014). PMID:26484136

  1. Do organizational and clinical ethics in a hospital setting need different venues?

    PubMed

    Førde, Reidun; Hansen, Thor Willy Ruud

    2014-06-01

    The structure of ethics work in a hospital is complex. Professional ethics, research ethics and clinical ethics committees (CECs) are important parts of this structure, in addition to laws and national and institutional codes of ethics. In Norway all hospital trusts have a CEC, most of these discuss cases by means of a method which seeks to include relevant guidelines and laws into the discussion. In recent years many committees have received more cases which have concerned questions of principle. According to Ellen Fox and co-authors the traditional CEC model suffers from a number of weaknesses. Therefore, in their organization a separate body deals with organizational matters. In this paper, we discuss what is gained and what is lost by creating two separate bodies doing ethics consultation. We do this through an analysis of detailed minutes of CEC discussions in one CEC during a 6-year period. 30 % of all referrals concerned matters of principle. Some of these discussions originated in a dilemma related to a particular patient. Most of the discussions had some consequences within the hospital organization, for clinical practice, for adjustment of guidelines, or may have influenced national policy. We conclude that a multiprofessional CEC with law and ethics competency and patient representation may be well suited also for discussion of general ethical principles. A CEC is a forum which can help bridge the gap between clinicians and management by increasing understanding for each others' perspectives.

  2. Variance of Standardized Uptake Values for FDG-PET/CT Greater in Clinical Practice than Under Ideal Study Settings

    PubMed Central

    Kumar, Virendra; Nath, Kavindra; Berman, Claudia G.; Kim, Jongphil; Tanvetyanon, Tawee; Chiappori, Alberto A; Gatenby, Robert A.; Gillies, Robert J.; Eikman, Edward A.

    2012-01-01

    Purpose Measurement variance affects the clinical effectiveness of PET-based measurement as a semi-quantitative imaging biomarker for cancer response in individual patients and for planning clinical trials. In this study, we measured test-retest reproducibility of SUV measurements under clinical practice conditions, and recorded recognized deviations from protocol compliance. Methods Instrument performance calibration, display and analyses conformed to manufacture recommendations. Baseline clinical 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-PET/CT examinations were performed and then repeated at 1 – 7 days. Intended scan initiation uptake period was to repeat the examinations at the same time for each study after injection of 12 mCi FDG tracer. Avidity of uptake was measured in 62 tumors in 21 patients as standardized uptake value for maximum voxel (SUVmax) and for a mean of sampled tumor voxels (SUVmean). Results The range of SUVmax and SUVmean was 1.07–21.47 and 0.91–14.69, respectively. Intraclass correlation coefficient (ICC) between log of SUVmax and log of SUVmean was 0.93 (95% CI: 0.88–0.95) and 0.92 (95% CI: 0.87–0.95), respectively. Correlation analysis failed to show an effect on uptake period variation on SUV measurements between the two examinations, suggesting additional sources of noise. The threshold criteria for relative difference from baseline for the 95% confidence interval were ±49% or ±44% for SUVmax or SUVmean, respectively. Conclusion Variance of SUV for FDG-PET/CT in current clinical practice in a single institution was greater than expected when compared to benchmarks reported under stringent efficacy study settings. Under comparable clinical practice conditions, interpretation of changes in tumor avidity in individuals, and assumptions in planning clinical trials may be affected. PMID:23354032

  3. Selecting an optimal abbreviated ICF set for clinical practice among rehabilitants with subacute stroke: retrospective analysis of patient records.

    PubMed

    Saltychev, Mikhail; Tarvonen-Schröder, Sinikka; Eskola, Merja; Laimi, Katri

    2013-06-01

    To evaluate the adequacy of abbreviated versions of International Classification of Functioning, Disability and Health (ICF) (the WHO ICF Checklist and the ICF Comprehensive Core Set for Stroke) with respect to the specific clinical needs of a stroke rehabilitation unit before their implementation at a practical level. Common descriptions of functional limitations were identified from patient records of 10 subsequent subacute stroke patients referred to an inpatient multiprofessional rehabilitation unit of a university hospital. These descriptions were then converted into ICF categories, and the list was compared with the ICF Checklist of the WHO and the ICF Comprehensive and Brief Core Sets for Stroke developed by the ICF Research Branch. From the study population (50% women), 71 different, second-level ICF categories were identified, averaging 36.4 categories/patient (SD 5.8, range 28-46). Except for one category, all of the categories identified were also found in the ICF Comprehensive Core Set for Stroke. Of the categories identified, 49 (69%) were found in the WHO ICF Checklist. All except one category included in the ICF Brief Core Set for Stroke were also in our list. The Comprehensive Core Set for Stroke was found to be a good potential starting point for the practical implementation of the ICF in a stroke rehabilitation unit.

  4. Occupational settings facilitating wisdom-related knowledge: the sample case of clinical psychologists.

    PubMed

    Smith, J; Staudinger, U M; Baltes, P B

    1994-10-01

    Wisdom can be defined as expert knowledge in the fundamental pragmatics of life. Examined here is whether clinical practice may facilitate access to and acquisition of such knowledge. Spontaneous think-aloud responses to 2 wisdom-related dilemmas from young (M = 32 years) and older (M = 70 years) clinicians were compared with responses obtained from other professionals. Raters judged clinicians' responses as higher on 5 criteria of wisdom: factual knowledge, procedural knowledge, life-span contextualism, value relativism, and management of uncertainty. Contrary to most studies of cognitive aging, young and older adults did not differ. Rather, each age-cohort group received highest ratings when responding to a life dilemma matched to their own life phase. Discussed is the application of a wisdom framework to assessing therapeutic treatment goals and therapist interventions as well as global changes in client's beliefs during therapy. PMID:7806731

  5. Clinical considerations for the diagnosis and treatment of ADHD in the managed care setting.

    PubMed

    Jensen, Peter S

    2009-05-01

    Although symptoms of attention-deficit/ hyperactivity disorder (ADHD) are certainly most visible in children, the syndrome persists into adolescence in 40% to 70% of cases and into adulthood in 50% or more of cases. Accurate recognition of the disorder is clouded by the frequent presence of psychiatric comorbidities. Contributing to these challenges, managed care providers in primary care are often inexperienced in identifying and treating ADHD in adults because of a lack of formalized training. As such, special consideration must be given to each individual age group and includes identifying common clinical presentations, characterizing the disorder and its comorbidities, applying validated rating scales as screening and treatment outcome measures, and individually assessing patients' optimal response to determine the best course of therapy. Pharmacotherapy is often initiated to target ADHD symptoms with either a stimulant medication or nonstimulants. In addition, behavioral interventions are often applied to treat comorbidities and associated impairments of ADHD. PMID:19601688

  6. The Practical Uses of Ultrasound in a Clinical Setting to Diagnose Thrombosis of the Ulnar Artery

    PubMed Central

    Serafine, Matthew S.; Peterson, Charles S.

    2013-01-01

    A 43-year-old professional skateboarder presented to the sports medicine clinic with complaints of left wrist pain to the ulnar aspect. Two weeks prior to presentation, his wrist became suddenly painful with no specific trauma. He reported a history of falls over the years while skateboarding but none directly correlated to his onset of wrist pain. Radiographic results were negative for wrist or hand fracture. Physical examination yielded tenderness and mild swelling to the ulnar aspect of the wrist. Musculoskeletal ultrasound was used to assess tendon and ligament integrity, all of which was intact. Both radial and ulnar arteries were visualized, and ulnar artery thrombosis was incidentally diagnosed. He was advised to immediately proceed to the hospital, where an open arthrectomy was performed to the ulnar artery the following day. The patient was released from the hospital 2 days later and subsequently made a full recovery. PMID:24459558

  7. Degradation of the endothelial glycocalyx in clinical settings: searching for the sheddases

    PubMed Central

    Becker, Bernhard F; Jacob, Matthias; Leipert, Stephanie; Salmon, Andrew H J; Chappell, Daniel

    2015-01-01

    The endothelial glycocalyx has a profound influence at the vascular wall on the transmission of shear stress, on the maintenance of a selective permeability barrier and a low hydraulic conductivity, and on attenuating firm adhesion of blood leukocytes and platelets. Major constituents of the glycocalyx, including syndecans, heparan sulphates and hyaluronan, are shed from the endothelial surface under various acute and chronic clinical conditions, the best characterized being ischaemia and hypoxia, sepsis and inflammation, atherosclerosis, diabetes, renal disease and haemorrhagic viral infections. Damage has also been detected by in vivo microscopic techniques. Matrix metalloproteases may shed syndecans and heparanase, released from activated mast cells, cleaves heparan sulphates from core proteins. According to new data, not only hyaluronidase but also the serine proteases thrombin, elastase, proteinase 3 and plasminogen, as well as cathepsin B lead to loss of hyaluronan from the endothelial surface layer, suggesting a wide array of potentially destructive conditions. Appropriately, pharmacological agents such as inhibitors of inflammation, antithrombin and inhibitors of metalloproteases display potential to attenuate shedding of the glycocalyx in various experimental models. Also, plasma components, especially albumin, stabilize the glycocalyx and contribute to the endothelial surface layer. Though symptoms of the above listed diseases and conditions correlate with sequelae expected from disturbance of the endothelial glycocalyx (oedema, inflammation, leukocyte and platelet adhesion, low reflow), therapeutic studies to prove a causal connection have yet to be designed. With respect to studies on humans, some clinical evidence exists for benefits from application of sulodexide, a preparation delivering precursors of the glycocalyx constituent heparan sulphate. At present, the simplest option for protecting the glycocalyx seems to be to ensure an adequate level of

  8. Degradation of the endothelial glycocalyx in clinical settings: searching for the sheddases.

    PubMed

    Becker, Bernhard F; Jacob, Matthias; Leipert, Stephanie; Salmon, Andrew H J; Chappell, Daniel

    2015-09-01

    The endothelial glycocalyx has a profound influence at the vascular wall on the transmission of shear stress, on the maintenance of a selective permeability barrier and a low hydraulic conductivity, and on attenuating firm adhesion of blood leukocytes and platelets. Major constituents of the glycocalyx, including syndecans, heparan sulphates and hyaluronan, are shed from the endothelial surface under various acute and chronic clinical conditions, the best characterized being ischaemia and hypoxia, sepsis and inflammation, atherosclerosis, diabetes, renal disease and haemorrhagic viral infections. Damage has also been detected by in vivo microscopic techniques. Matrix metalloproteases may shed syndecans and heparanase, released from activated mast cells, cleaves heparan sulphates from core proteins. According to new data, not only hyaluronidase but also the serine proteases thrombin, elastase, proteinase 3 and plasminogen, as well as cathepsin B lead to loss of hyaluronan from the endothelial surface layer, suggesting a wide array of potentially destructive conditions. Appropriately, pharmacological agents such as inhibitors of inflammation, antithrombin and inhibitors of metalloproteases display potential to attenuate shedding of the glycocalyx in various experimental models. Also, plasma components, especially albumin, stabilize the glycocalyx and contribute to the endothelial surface layer. Though symptoms of the above listed diseases and conditions correlate with sequelae expected from disturbance of the endothelial glycocalyx (oedema, inflammation, leukocyte and platelet adhesion, low reflow), therapeutic studies to prove a causal connection have yet to be designed. With respect to studies on humans, some clinical evidence exists for benefits from application of sulodexide, a preparation delivering precursors of the glycocalyx constituent heparan sulphate. At present, the simplest option for protecting the glycocalyx seems to be to ensure an adequate level of

  9. Bevacizumab for neovascular age-related macular degeneration in Chinese patients in a clinical setting

    PubMed Central

    Ng, Danny Siu-Chun; Kwok, Alvin Kwan-Ho; Tong, Justin Man-Kit; Chan, Clement Wai-Nang; Li, Walton Wai-Tat

    2016-01-01

    AIM To determine the outcome of non-investigational treatment with intravitreal bevacizumab (IVB) in neovascular age-related macular degeneration (AMD) patients. METHODS Retrospective chart review of 81 eyes with neovascular AMD followed-up for at least 12mo and received 3-monthly loading IVB injections. Re-treat was based upon the individual clinician's judgment. Best-corrected visual acuity (BCVA) and optical coherence tomography measurements of central foveal thickness outcomes were evaluated at 12, 24mo. RESULTS Eighty-one eyes (of 75 patients) completed 12mo of follow-up and 44 eyes (of 41 patients) completed 24mo of follow-up. The mean baseline logMAR BCVA significantly improved from 0.94±0.69 to 0.85±0.68 at 12mo (P<0.001) and from 0.91±0.65 to 0.85±0.60 (P=0.004) at 24mo. The proportion of eyes that lost <15 logMAR letters at 12mo was 90.1% and at 24mo was 81.8%. IVB was effective in improving visual acuity in both treatment naïve and previous photodynamic therapy (PDT)-treated subgroups. Treatment naive patients required significantly fewer injections than patients with prior PDT. Multiple regression analysis identified that poorer baseline visual acuity was associated with greater improvement in visual acuity (P=0.015). CONCLUSION Fewer injections in clinical practice may result in suboptimal visual outcomes compared with clinical trials of IVB in neovascular AMD patients. Poor baseline visual acuity and prior PDT treatment may also improve vision after IVB. The safety and durability of effect was maintained at 24mo. PMID:27158614

  10. The Impact of Iterative Reconstruction on Computed Tomography Radiation Dosimetry: Evaluation in a Routine Clinical Setting

    PubMed Central

    Moorin, Rachael E.; Gibson, David A. J.; Forsyth, Rene K.; Fox, Richard

    2015-01-01

    Purpose To evaluate the effect of introduction of iterative reconstruction as a mandated software upgrade on radiation dosimetry in routine clinical practice over a range of computed tomography examinations. Methods Random samples of scanning data were extracted from a centralised Picture Archiving Communication System pertaining to 10 commonly performed computed tomography examination types undertaken at two hospitals in Western Australia, before and after the introduction of iterative reconstruction. Changes in the mean dose length product and effective dose were evaluated along with estimations of associated changes to annual cancer incidence. Results We observed statistically significant reductions in the effective radiation dose for head computed tomography (22–27%) consistent with those reported in the literature. In contrast the reductions observed for non-contrast chest (37–47%); chest pulmonary embolism study (28%), chest/abdominal/pelvic study (16%) and thoracic spine (39%) computed tomography. Statistically significant reductions in radiation dose were not identified in angiographic computed tomography. Dose reductions translated to substantial lowering of the lifetime attributable risk, especially for younger females, and estimated numbers of incident cancers. Conclusion Reduction of CT dose is a priority Iterative reconstruction algorithms have the potential to significantly assist with dose reduction across a range of protocols. However, this reduction in dose is achieved via reductions in image noise. Fully realising the potential dose reduction of iterative reconstruction requires the adjustment of image factors and forgoing the noise reduction potential of the iterative algorithm. Our study has demonstrated a reduction in radiation dose for some scanning protocols, but not to the extent experimental studies had previously shown or in all protocols expected, raising questions about the extent to which iterative reconstruction achieves dose

  11. Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting

    PubMed Central

    Szarewski, Anne; Cadman, Louise; Mallett, Susan; Austin, Janet; Londesborough, Philip; Waller, Jo; Wardle, Jane; Altman, Douglas G; Cuzick, Jack

    2007-01-01

    Objectives: To compare the performance and acceptability of unsupervised self-sampling with clinician sampling for high-risk human papillomavirus (HPV) types for the first time in a UK screening setting. Setting: Nine hundred and twenty women, from two demographically different centres, attending for routine cervical smear testing Methods: Women performed an unsupervised HPV self-test. Immediately afterwards, a doctor or nurse took an HPV test and cervical smear. Women with an abnormality on any test were offered colposcopy. Results: Twenty-one high-grade and 39 low-grade cervical intraepithelial neoplasias (CINs) were detected. The sensitivity for high-grade disease (CIN2+) for the self HPV test was 81% (95% confidence interval [CI] 60–92), clinician HPV test 100% (95% CI 85–100), cytology 81% (95% CI 60–92). The sensitivity of both HPV tests to detect high- and low-grade cervical neoplasia was much higher than that of cytology (self-test 77% [95%CI 65–86], clinician test 80% [95% CI 68–88], cytology 48% [95% CI 36–61]). For both high-grade alone, and high and low grades together, the specificity was significantly higher for cytology (greater than 95%) than either HPV test (between 82% and 87%). The self-test proved highly acceptable to women and they reported that the instructions were easy to understand irrespective of educational level. Conclusions: Our results suggest that it would be reasonable to offer HPV self-testing to women who are reluctant to attend for cervical smears. This approach should now be directly evaluated among women who have been non-attenders in a cervical screening programme. PMID:17362570

  12. A novel approach to fit testing the N95 respirator in real time in a clinical setting.

    PubMed

    Or, Peggy; Chung, Joanne; Wong, Thomas

    2016-02-01

    The instant measurements provided by the Portacount fit-test instrument have been used as the gold standard in predicting the protection of an N95 respirator in a laboratory environment. The conventional Portacount fit-test method, however, cannot deliver real-time measurements of face-seal leakage when the N95 respirator is in use in clinical settings. This research was divided into two stages. Stage 1 involved developing and validating a new quantitative fit-test method called the Personal Respiratory Sampling Test (PRST). In Stage 2, PRST was evaluated in use during nursing activities in clinical settings. Eighty-four participants were divided randomly into four groups and were tested while performing bedside nursing procedures. In Stage 1, a new PRST method was successfully devised and validated. Results of Stage 2 showed that the new PRST method could detect different concentrations and different particle sizes inside the respirator while the wearer performed different nursing activities. This new fit-test method, PRST, can detect face seal leakage of an N95 respirator being worn while the wearer performs clinical activities. Thus, PRST can help ensure that the N95 respirator actually fulfils its function of protecting health-care workers from airborne pathogens. PMID:24828795

  13. Teachers' Perceptions of Their Mentoring Role in Three Different Clinical Settings: Student Teaching, Early Field Experiences, and Entry Year Teaching

    ERIC Educational Resources Information Center

    Gut, Dianne M.; Beam, Pamela C.; Henning, John E.; Cochran, Deborah C.; Knight, Rhonda Talford

    2014-01-01

    The purpose of this study was to determine the differences in mentoring across three different clinical settings: student teaching, early field experiences, and entry year teachers. Eighteen teachers with mentoring experience in all three clinical settings were selected and interviewed. The teachers' expectations for teacher development,…

  14. Exploring the dimensions of doctor-patient relationship in clinical practice in hospital settings.

    PubMed

    Shrivastava, Saurabh RamBiharilal; Shrivastava, Prateek Saurabh; Ramasamy, Jegadeesh

    2014-05-01

    The Doctor-Patient Relationship (DPR) is a complex concept in the medical sociology in which patients voluntarily approach a doctor and thus become a part of a contract in which they tends to abide with the doctor's guidance. Globally, the DPR has changed drastically over the years owing to the commercialization and privatization of the health sector. Furthermore, the dynamics of the DPR has shown a significant change because of the formulation of consumer protection acts; clauses for professional misconduct and criminal negligence; establishment of patient forums and organizations; massive expansion of the mass media sector leading to increase in health awareness among people; and changes in the status of the doctors. Realizing the importance of DPR in the final outcome and quality of life of the patient, multiple measures have been suggested to make a correct diagnosis and enhance healing. To conclude, good DPR is the crucial determinant for a better clinical outcome and satisfaction with the patients, irrespective of the socio-cultural determinants. PMID:24847480

  15. Cardiovascular risk and combined oral contraceptives: clinical decisions in settings of uncertainty.

    PubMed

    Beller, Jennifer P; McCartney, Christopher R

    2013-01-01

    Although generally safe, combined oral contraceptives (COCs) are associated with risks, including an estimated 2-fold increased relative risk of cardiovascular events. For most women taking COCs for contraception, absolute cardiovascular risks are very low, and the overall risks of COCs are outweighed by the risks of unwanted pregnancy. Nonetheless, risks of COCs may be excessive in some women, and both the American College of Obstetricians (ACOG) and the World Health Organization (WHO) have offered contraindications for COC use. Complicating this issue, COCs are commonly used for reasons other than contraception (eg, polycystic ovary syndrome, which is associated with subfertility and cardiovascular risk factors). Thus, in some clinical scenarios, ACOG and WHO guidelines may offer incomplete guidance regarding whether COC use would be associated with an unacceptable risk-benefit ratio. We propose that cardiovascular risk calculators may be helpful in some patients, as an adjunct to ACOG and WHO guidelines, by allowing physicians to estimate the attributable risk of COC-related cardiovascular events.

  16. Evaluation of Team-Based Care in an Urban Free Clinic Setting.

    PubMed

    Iddins, Brenda W; Frank, Jennifer Sandson; Kannar, Pegah; Curry, William A; Mullins, Melissa; Hites, Lisle; Selleck, Cynthia

    2015-01-01

    This article reports the experiences of a school of nursing, academic health center, and community-based organization working via an interprofessional collaborative practice model to meet the mutual goal of serving the health care needs of an indigent, largely minority population in Birmingham, Alabama. The population suffers disproportionately from chronic health problems including diabetes, obesity, cardiovascular disease, asthma, and mental health disorders. The program emphasizes diabetes management because the academic health center recognized the need for transitional and primary care, including mental health services, for the increasing numbers of uninsured patients with diabetes and its comorbidities. Half of the clinicians involved in this project had no prior experience with interprofessional collaborative practice, and there was confusion regarding the roles of team members from the partnering institutions. Activities involving care coordination consistently received low scores on weekly rating scales leading to the creation of positions for a nurse care manager and pharmaceutical patient assistance program coordinator. Conversely, shared decision making and cooperation ratings were consistently high. Evaluation identified the need for reliable, accessible data and data analysis to target clinically effective interventions and care coordination and to assess cost effectiveness. The strengths, challenges, lessons learned, and next steps required for sustainability of this alignment are discussed. PMID:26049603

  17. Exploring the dimensions of doctor-patient relationship in clinical practice in hospital settings.

    PubMed

    Shrivastava, Saurabh RamBiharilal; Shrivastava, Prateek Saurabh; Ramasamy, Jegadeesh

    2014-05-01

    The Doctor-Patient Relationship (DPR) is a complex concept in the medical sociology in which patients voluntarily approach a doctor and thus become a part of a contract in which they tends to abide with the doctor's guidance. Globally, the DPR has changed drastically over the years owing to the commercialization and privatization of the health sector. Furthermore, the dynamics of the DPR has shown a significant change because of the formulation of consumer protection acts; clauses for professional misconduct and criminal negligence; establishment of patient forums and organizations; massive expansion of the mass media sector leading to increase in health awareness among people; and changes in the status of the doctors. Realizing the importance of DPR in the final outcome and quality of life of the patient, multiple measures have been suggested to make a correct diagnosis and enhance healing. To conclude, good DPR is the crucial determinant for a better clinical outcome and satisfaction with the patients, irrespective of the socio-cultural determinants.

  18. Education leadership in the clinical health care setting: a framework for nursing education development.

    PubMed

    Mockett, Lynda; Horsfall, Janine; O'Callaghan, Wendy

    2006-12-01

    This paper describes how a new framework for clinical nursing education was introduced at Counties Manukau District Health Board (CMDHB), New Zealand. The project was initiated in response to the significant legislative and post registration nursing education changes within New Zealand. The journey of change has been a significant undertaking, and has required clear management, strong leadership, perseverance and understanding of the organisation's culture. The approach taken to managing the change had four stages, and reflects various change management models. The first stage, the identification process, identified the impetus for change. Creating the vision is the second stage and identified what the change would look like within the organisation. To ensure success and to guide the process of change a realistic and sustainable vision was developed. Implementing the vision was the third stage, and discusses the communication and pilot phase of implementing the nursing education framework. Stage four, embedding the vision, explores the process and experiences of changing an education culture and embedding the vision into an organisation. The paper concludes by discussing the importance of implementing robust, consistent, strategic and collaborative processes--that reflect and evaluate best educational nursing practice.

  19. Documentation of prescriptions and clinical outcomes in a homeopathic hospital setting in West Bengal, India.

    PubMed

    Saha, Subhranil; Koley, Munmun; Ghosh, Shubhamoy; Giri, Mohan; Das, Asim; Goenka, Rachna

    2015-07-01

    Documentation of prescriptions and clinical outcomes in routine homeopathic practice is a prerequisite for conducting targeted research in homeopathy. Six homeopathic physicians participated in methodical data collection over a 3-month period in 6 outpatient departments of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, West Bengal, India. A specifically designed Microsoft Excel spreadsheet enabled recording of consecutive appointments-date, patient identity, medical condition/complaint, whether chronic/acute, new/follow-up case, patient-assessed outcome (7-point Likert-type scale: -3 to +3), prescribed homeopathic medication, and whether other medication/s being taken for the condition. Spreadsheets were submitted monthly for data synthesis and analysis. A total of 1972 patients' follow-up generated data of 2905 appointments, of which 2272 (78.2%) were positive, 183 (6.3%) negative, and 450 (15.5%) showed no change. Strongly positive outcomes (scores of +2/+3) were recorded in osteoarthritis, piles, cough, dysfunctional uterine bleeding, chronic suppurative otitis media, and conjunctivitis. This systematic recording short-listed promising areas of future homeopathic research.

  20. College as Moratorium: The Hidden Functions of Japanese College Education.

    ERIC Educational Resources Information Center

    Cordilia, Ann

    Japanese universities have been characterized by critics as "leisurelands" where students concentrate too much on amusements and too little on learning. While university experience for Japanese students does not always result in acquiring testable academic knowledge as efficiently as in high school, the university does provide a setting for a…

  1. Implications of cultured periodontal ligament cells for the clinical and experimental setting: a review

    PubMed Central

    Marchesan, Julie Teresa; Scanlon, Christina Springstead; Soehren, Stephen; Matsuo, Masato; Kapila, Yvonne L.

    2011-01-01

    The periodontal ligament (PDL) is a key contributor to the process of regeneration of the periodontium. The heterogeneous nature of the PDL tissue, its development during early adulthood, and the different conditions to which the PDL tissue is exposed to in vivo impart on the PDL unique characteristics that may be of consequence during its cultivation in vitro. Several factors affecting the in vivo setting influence the behavior of PDL fibroblasts in culture. The purpose of this review is to address distinct factors that influence the behavior of PDL fibroblasts in culture — in vivo-in vitro transitions, cell identification/isolation markers, primary PDL cultures and cell lines, tooth-specific factors, and donor-specific factors. Based on the reviewed studies, the authors recommendations include the use of several identification markers to confirm cell identity, use of primary cultures at early passage to maintain unique PDL heterogeneic characteristics, and noting donor conditions such as age, systemic health status, and tooth health status. Continued efforts will expand our understanding of the in vitro and in vivo behavior of cells, with the goal of orchestrating optimal periodontal regeneration. This understanding will lead to improved evidence-based rationales for more individualized and predictable periodontal regenerative therapies. PMID:21470594

  2. Interprofessional clinical training for undergraduate students in an emergency department setting.

    PubMed

    Ericson, Anne; Masiello, Italo; Bolinder, Gunilla

    2012-07-01

    Interprofessional education (IPE) for teams of undergraduate students has since 1999 been carried out at the orthopedic emergency department at the Karolinska University Hospital. During a 2-week period, teams of medical, nursing and physiotherapy students practice together. With the aim of training professional and collaboration skills, the teams take care of patients with varying acute complaints, under the guidance of supervisors from each profession. This study describes the educational model and compares the attitudes of the different student categories participating in this unique IPE model. All students who participated in this experience during the period 2008-2010 were asked to fill in a questionnaire on completion of their training period. Results showed that all three categories, with no significant difference, highly appreciated the setting and the team training. Results also showed that the training significantly increased the students' knowledge of their own professional role as well as their knowledge of the other professions. We conclude that training at an emergency department can provide excellent opportunities for interprofessional team training for undergraduate students. The teamwork enhances the students' understanding of the professional roles and can contribute to a more holistic approach to patient care. PMID:22506846

  3. Clinical trials with a programmable hearing aid set for various listening environments.

    PubMed

    Ringdahl, A; Eriksson-Mangold, M; Israelsson, B; Lindkvist, A; Mangold, S

    1990-08-01

    A conventional hearing aid has a frequency response that does not change much at normal listening levels. It is therefore unlikely that optimal speech intelligibility and optimal listening comfort can be obtained simultaneously, or in different listening environments. With a programmable hearing aid with multiple memories the listener can choose between a range of sound pictures, which increases the chance of finding a suitable frequency curve for each listening situation. The programmable hearing aid with eight separate settings stored in eight memories, was compared with personal hearing aids fitted according to the recommendations of the National Acoustic Laboratories (NAL) by 22 experienced hearing aid users. One memory of the programmable hearing aid was initially fitted according to the NAL recommendation. The other memories were programmed to give variations around that recommendation. One aim was to investigate whether the hearing-impaired user took advantage of different frequency responses to achieve listening improvements in acoustically different environments. Another aim was to evaluate the ergonomic and acoustical features of the programmable hearing aid, compared with other well fitted hearing aids. The evaluations were based on comparisons of the test hearing aid to the personal aid for each subject, looking at speech tests, direct paired comparison judgements, sound quality judgements and interviews. A majority of the subjects experienced substantial benefit from being able to use different frequency response curves in different environments. With the test hearing aid the subjects performed better in speech discrimination tests in noise.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Clinical setting influences patterns of interaction between osteoporosis patient and physician.

    PubMed

    Gasparik, Andrea Ildiko

    2014-08-01

    The importance of healthy behavior for bone health, as well as low adherence to anti-osteoporosis medication are well-described problems. Both, lifestyle habits and compliance with drug-therapy are influenced by the relationship between patients and physicians. We analyzed 152 consecutive doctor-patient interactions conducted in public and private practices specialized in the management of osteoporosis. We recorded the duration of the consultation and the relative length of: (a) Personal and medical history collection, (b) Physical examination, (c) Explanation of the diagnosis and treatment modalities, and (d) Administrative tasks. The overall length and the respective duration of the four phases of the consultation significantly differ in private versus public practices. In the private practice, doctors spend more time with the patient and dedicate a higher proportion of their time to history collection and explanation of diagnosis/treatment for osteoporosis. While we do not integrate data on medication adherence, we believe that since more time is dedicated to health education, patients consulting in the private sector have a greater probability to adopt a healthy lifestyle and better/ longer take anti-osteoporosis medications. Further investigations are needed to assess if the differences in patient and doctor behaviors in the public-private settings have a significant impact on therapeutic adherence and subsequently fracture reduction in patients receiving anti-osteoporosis treatment.

  5. Tracking dental patient tobacco use and intervention in the academic clinical setting.

    PubMed

    Morgan, Susan K; Dumire, William; Caudill, Carol; Lewis, Amy

    2012-11-01

    The purpose of this study was to illustrate one method of tracking patients' tobacco use and monitoring cessation interventions with electronic dental records in an academic dental setting. Records from 465 tobacco users were analyzed to assess patients' tobacco use and providers' intervention techniques. The results indicate that 75 percent of the patients whose records were analyzed had used tobacco for more than ten years and the cold turkey approach was the most common cessation method. Ninety-seven percent of the patients whose records were analyzed used cigarettes. The most common pharmacotherapy recommended in combination with counseling for smoking cessation was the nicotine patch, followed by nicotine gum, varenicline (Chantix), the nicotine lozenge, bupropion SR (Zyban), and the nicotine oral inhaler. Incorporating tobacco use questions into the electronic dental record can ensure that tobacco use and intervention techniques are addressed and documented in dental records. Electronic dental records provide an opportunity to collect data related to tobacco use and intervention techniques for purposes of further evaluation and research. PMID:23144480

  6. Can we teach core clinical obstetrics and gynaecology skills using low fidelity simulation in an interprofessional setting?

    PubMed

    Kumar, Arunaz; Gilmour, Carole; Nestel, Debra; Aldridge, Robyn; McLelland, Gayle; Wallace, Euan

    2014-12-01

    Core clinical skills acquisition is an essential component of undergraduate medical and midwifery education. Although interprofessional education is an increasingly common format for learning efficient teamwork in clinical medicine, its value in undergraduate education is less clear. We present a collaborative effort from the medical and midwifery schools of Monash University, Melbourne, towards the development of an educational package centred around a core skills-based workshop using low fidelity simulation models in an interprofessional setting. Detailed feedback on the package was positive with respect to the relevance of the teaching content, whether the topic was well taught by task trainers and simulation models used, pitch of level of teaching and perception of confidence gained in performing the skill on a real patient after attending the workshop. Overall, interprofessional core skills training using low fidelity simulation models introduced at an undergraduate level in medicine and midwifery had a good acceptance.

  7. An integrated clinical pharmacology approach for deriving dosing recommendations in a regulatory setting: review of recent cases in psychiatry drugs.

    PubMed

    Younis, Islam R; Rogers, Hobart; Zhang, Huixia; Zhu, Hao; Uppoor, Ramana S; Mehta, Mehul U

    2013-10-01

    Clinical pharmacology as an interdisciplinary science is unique in its capacity and the diversity of the methods and approaches it can provide to derive dosing recommendations in various subpopulations. This article illustrates cases where an integrated clinical pharmacology approach was used to derive dosing recommendations for psychiatry drugs within regulatory settings. The integrated approach is based on the view that once a drug is shown to be effective in the general population, it is reasonable to take into consideration other relevant findings and the use of alternative scientific tools and analysis to derive dosing recommendations in specific populations. The method provides useful means to solve the challenges of the paucity of available data and lead to clear dosing instructions. This in turn expands the benefits of any given drug to all individuals in which the drug is likely to be effective. PMID:23842865

  8. The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings.

    PubMed

    Stoicea, Nicoleta; Baddigam, Ramya; Wajahn, Jennifer; Sipes, Angela C; Arias-Morales, Carlos E; Gastaldo, Nicholas; Bergese, Sergio D

    2016-01-01

    The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and, therefore, the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care. PMID:27493935

  9. The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings

    PubMed Central

    Stoicea, Nicoleta; Baddigam, Ramya; Wajahn, Jennifer; Sipes, Angela C.; Arias-Morales, Carlos E.; Gastaldo, Nicholas; Bergese, Sergio D.

    2016-01-01

    The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and, therefore, the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care. PMID:27493935

  10. A rigorous approach for selection of optimal variant sets for carrier screening with demonstration of clinical utility

    PubMed Central

    Perreault-Micale, Cynthia; Davie, Jocelyn; Breton, Benjamin; Hallam, Stephanie; Greger, Valerie

    2015-01-01

    Carrier screening for certain diseases is recommended by major medical and Ashkenazi Jewish (AJ) societies. Most carrier screening panels test only for common, ethnic-specific variants. However, with formerly isolated ethnic groups becoming increasingly intermixed, this approach is becoming inadequate. Our objective was to develop a rigorous process to curate all variants, for relevant genes, into a database and then apply stringent clinical validity classification criteria to each in order to retain only those with clear evidence for pathogenicity. The resulting variant set, in conjunction with next-generation DNA sequencing (NGS), then affords the capability for an ethnically diverse, comprehensive, highly specific carrier-screening assay. The clinical utility of our approach was demonstrated by screening a pan-ethnic population of 22,864 individuals for Bloom syndrome carrier status using a BLM variant panel comprised of 50 pathogenic variants. In addition to carriers of the common AJ founder variant, we identified 57 carriers of other pathogenic BLM variants. All variants reported had previously been curated and their clinical validity documented, or were of a type that met our stringent, preassigned validity criteria. Thus, it was possible to confidently report an increased number of Bloom’s syndrome carriers compared to traditional, ethnicity-based screening, while not reducing the specificity of the screening due to reporting variants of unknown clinical significance. PMID:26247052

  11. A new approach to training back-propagation artificial neural networks: empirical evaluation on ten data sets from clinical studies.

    PubMed

    Ciampi, Antonio; Zhang, Fulin

    2002-05-15

    We present a new approach to training back-propagation artificial neural nets (BP-ANN) based on regularization and cross-validation and on initialization by a logistic regression (LR) model. The new approach is expected to produce a BP-ANN predictor at least as good as the LR-based one. We have applied the approach to ten data sets of biomedical interest and systematically compared BP-ANN and LR. In all data sets, taking deviance as criterion, the BP-ANN predictor outperforms the LR predictor used in the initialization, and in six cases the improvement is statistically significant. The other evaluation criteria used (C-index, MSE and error rate) yield variable results, but, on the whole, confirm that, in practical situations of clinical interest, proper training may significantly improve the predictive performance of a BP-ANN.

  12. A degenerate primer MOB typing (DPMT) method to classify gamma-proteobacterial plasmids in clinical and environmental settings.

    PubMed

    Alvarado, Andrés; Garcillán-Barcia, M Pilar; de la Cruz, Fernando

    2012-01-01

    Transmissible plasmids are responsible for the spread of genetic determinants, such as antibiotic resistance or virulence traits, causing a large ecological and epidemiological impact. Transmissible plasmids, either conjugative or mobilizable, have in common the presence of a relaxase gene. Relaxases were previously classified in six protein families according to their phylogeny. Degenerate primers hybridizing to coding sequences of conserved amino acid motifs were designed to amplify related relaxase genes from γ-Proteobacterial plasmids. Specificity and sensitivity of a selected set of 19 primer pairs were first tested using a collection of 33 reference relaxases, representing the diversity of γ-Proteobacterial plasmids. The validated set was then applied to the analysis of two plasmid collections obtained from clinical isolates. The relaxase screening method, which we call "Degenerate Primer MOB Typing" or DPMT, detected not only most known Inc/Rep groups, but also a plethora of plasmids not previously assigned to any Inc group or Rep-type.

  13. Melatonin-dopamine interactions: from basic neurochemistry to a clinical setting.

    PubMed

    Zisapel, N

    2001-12-01

    To review the interaction between melatonin and the dopaminergic system in the hypothalamus and striatum and its potential clinical use in dopamine-related disorders in the central nervous system. Medline-based search on melatonin-dopamine interactions in mammals. Melatonin. the hormone produced by the pineal gland at night. influences circadian and seasonal rhythms, most notably the sleep-wake cycle and seasonal reproduction. The neurochemical basis of these activities is not understood yet. Inhibition of dopamine release by melatonin has been demonstrated in specific areas of the mammalian central nervous system (hypothalamus, hippocampus, medulla-pons, and retina). Antidopaminergic activities of melatonin have been demonstrated in the striatum. Dopaminergic transmission has a pivotal role in circadian entrainment of the fetus, in coordination of body movement and reproduction. Recent findings indicate that melatonin may modulate dopaminergic pathways involved in movement disorders in humans. In Parkinson patients melatonin may, on the one hand, exacerbate symptoms (because of its putative interference with dopamine release) and, on the other, protect against neurodegeneration (by virtue of its antioxidant properties and its effects on mitochondrial activity). Melatonin appears to be effective in the treatment of tardive dyskinesia. a severe movement disorder associated with long-term blockade of the postsynaptic dopamine D2 receptor by antipsychotic drugs in schizophrenic patients. The interaction of melatonin with the dopaminergic system may play a significant role in the nonphotic and photic entrainment of the biological clock as well as in the fine-tuning of motor coordination in the striatum. These interactions and the antioxidant nature of melatonin may be beneficial in the treatment of dopamine-related disorders. PMID:12043836

  14. A recently developed MRI scoring system for hand osteoarthritis: its application in a clinical setting.

    PubMed

    Ramonda, Roberta; Favero, Marta; Vio, Stefania; Lacognata, Carmelo; Frallonardo, Paola; Belluzzi, Elisa; Campana, Carla; Lorenzin, Mariagrazia; Ortolan, Augusta; Angelini, Federico; Piccoli, Antonio; Oliviero, Francesca; Punzi, Leonardo

    2016-08-01

    This study aimed to apply the recently proposed Oslo hand osteoarthritis magnetic resonance imaging (MRI) scoring system to evaluate MRI findings in a cohort of patients affected by long-standing erosive hand osteoarthritis (EHOA). Eleven female EHOA patients (median 59 [interquartile range 62-52] years, disease duration 9.5 [interquartile range 13-3.75] years) underwent MRI (1.5 T) of the dominant hand, and synovitis, bone marrow lesions (BMLs), joint space narrowing, osteophytes, cysts, malalignment, and erosions were scored using the Oslo scoring system. Intra- and inter-reader reliability were assessed. The patients also underwent X-ray examination, and bone features were evaluated using the same scoring system. Pain and tenderness were assessed during a physical examination. Spearman's non-parametric test was used to analyze the correlations between variables. MRI intra- and inter-reader reliability were found between good and moderate for many features. No statistical differences were found between the radiographs and MRI with regard to detection of JSN, malalignment, and bone erosions. Synovitis was detected in 39.8 % of the 80 joints examined (in a mild form in 80 %), erosions were found in 51.1 %, and BMLs were identified in 20.5 and 23.9 % at the distal and the proximal side, respectively. BMLs at both the proximal and distal ends were correlated with tender joints (BML distal p = 0.0013, BML proximal p = 0.012). The presence of synovitis was correlated with tenderness (p = 0.004) and erosions at both the distal and proximal joints (p = 0.004). The presence of erosions correlated with tender joints (p < 0.01) and the mean visual analog scale (VAS) score (distal p = 0.03, proximal p = 0.01). Synovitis and BMLs were correlated with clinical symptoms in our patients affected with long-standing EHOA. PMID:27236512

  15. The Japanese American Story.

    ERIC Educational Resources Information Center

    Fukei, Budd

    This book presents a view of the Japanese American experience from the time of their immigration to this country in the 1800s to their acculturation into American society in the 1970s. Topics dealt with include the prejudice and mistrust experienced by the Japanese immigrants in this country, particularly their evacuation and internment in…

  16. Japanese Quality Control Circles.

    ERIC Educational Resources Information Center

    Nishiyama, Kazuo

    In recent years, United States scholars with an interest in international business and organizational communication have begun to notice the success of Japanese "quality control circles." These are small groups, usually composed of seven to ten workers, who are organized at the production levels within most large Japanese factories. A typical…

  17. Japanese Media in English.

    ERIC Educational Resources Information Center

    Tanaka, Sachiko Oda

    1995-01-01

    Describes the use of English in the media in Japan, focusing on the role and history of English-language newspapers, radio, and television programs, as well as the proliferation of English-language films shown in Japanese cinemas. Discusses the implications of English in the Japanese media. (20 references) (MDM)

  18. Japanese Elementary School Education.

    ERIC Educational Resources Information Center

    Stevenson, Harold W.

    1991-01-01

    Discusses the development of Japanese elementary education in the context of three periods of its history. Considers salient characteristics of Japanese elementary schools and teaching procedures; these include curriculum; social and moral education; classroom environment; teachers; afterschool classes; college entrance examinations; the kyoiku…

  19. Organizational development trajectory of a large academic radiotherapy department set up similarly to a prospective clinical trial: the MAASTRO experience

    PubMed Central

    Boersma, L; Dekker, A; Hermanns, E; Houben, R; Govers, M; van Merode, F; Lambin, P

    2015-01-01

    Objective: To simultaneously improve patient care processes and clinical research activities by starting a hypothesis-driven reorganization trajectory mimicking the rigorous methodology of a prospective clinical trial. Methods: The design of this reorganization trajectory was based on the model of a prospective trial. It consisted of (1) listing problems and analysing their potential causes, (2) defining interventions, (3) defining end points and (4) measuring the effect of the interventions (i.e. at baseline and after 1 and 2 years). The primary end point for patient care was the number of organizational root causes of incidents/near incidents; for clinical research, it was the number of patients in trials. There were several secondary end points. We analysed the data using two sample z-tests, χ2 test, a Mann–Whitney U test and the one-way analysis of variance with Bonferroni correction. Results: The number of organizational root causes was reduced by 27% (p < 0.001). There was no effect on the percentage of patients included in trials. Conclusion: The reorganizational trajectory was successful for the primary end point of patient care and had no effect on clinical research. Some confounding events hampered our ability to draw strong conclusions. Nevertheless, the transparency of this approach can give medical professionals more confidence in moving forward with other organizational changes in the same way. Advances in knowledge: This article is novel because managerial interventions were set up similarly to a prospective clinical trial. This study is the first of its kind in radiotherapy, and this approach can contribute to discussions about the effectiveness of managerial interventions. PMID:25679320

  20. Twenty years of the Journal of Clinical Psychology in Medical Settings: we hope you will enjoy the show.

    PubMed

    Rozensky, Ronald H; Tovian, Steven M; Sweet, Jerry J

    2014-03-01

    The 20th anniversary of the Journal of Clinical Psychology in Medical Settings is celebrated by highlighting the scientist-practitioner philosophy on which it was founded. The goal of the Journal-to provide an outlet for evidence-based approaches to healthcare that underscore the important scientific and clinical contributions of psychology in medical settings-is discussed. The contemporary relevance of this approach is related to the current implementation of the Patient Protection and Affordable Care and its focus on accountability and the development of an interprofessional healthcare workforce; both of which have been foci of the Journal throughout its history and will continue to be so into the future. Several recommendations of future topic areas for the Journal to highlight regarding scientific, practice, policy, and education and training in professional health service psychology are offered. Successfully addressing these topics will support the growth of the field of psychology in the ever evolving healthcare system of the future and continue ensure that the Journal is a key source of professional information in health service psychology.

  1. Antibiotic use and clinical outcomes in the acute setting under management by an infectious diseases acute physician versus other clinical teams: a cohort study

    PubMed Central

    Jones, Nicola; Mistry, Vikash; Crook, Derrick; Peto, Tim; Walker, A Sarah

    2016-01-01

    Objectives To assess the magnitude of difference in antibiotic use between clinical teams in the acute setting and assess evidence for any adverse consequences to patient safety or healthcare delivery. Design Prospective cohort study (1 week) and analysis of linked electronic health records (3 years). Setting UK tertiary care centre. Participants All patients admitted sequentially to the acute medical service under an infectious diseases acute physician (IDP) and other medical teams during 1 week in 2013 (n=297), and 3 years 2012–2014 (n=47 585). Primary outcome measure Antibiotic use in days of therapy (DOT): raw group metrics and regression analysis adjusted for case mix. Secondary outcome measures 30-day all-cause mortality, treatment failure and length of stay. Results Antibiotic use was 173 vs 282 DOT/100 admissions in the IDP versus non-IDP group. Using case mix-adjusted zero-inflated Poisson regression, IDP patients were significantly less likely to receive an antibiotic (adjusted OR=0.25 (95% CI 0.07 to 0.84), p=0.03) and received shorter courses (adjusted rate ratio (RR)=0.71 (95% CI 0.54 to 0.93), p=0.01). Clinically stable IDP patients of uncertain diagnosis were more likely to have antibiotics held (87% vs 55%; p=0.02). There was no significant difference in treatment failure or mortality (adjusted p>0.5; also in the 3-year data set), but IDP patients were more likely to be admitted overnight (adjusted OR=3.53 (95% CI 1.24 to 10.03), p=0.03) and have longer length of stay (adjusted RR=1.19 (95% CI 1.05 to 1.36), p=0.007). Conclusions The IDP-led group used 30% less antibiotic therapy with no adverse clinical outcome, suggesting antibiotic use can be reduced safely in the acute setting. This may be achieved in part by holding antibiotics and admitting the patient for observation rather than prescribing, which has implications for costs and hospital occupancy. More information is needed to indicate whether any such longer admission will

  2. Effects of polysaccharide derived from black currant on relieving clinical symptoms of Japanese cedar pollinosis: a randomized double-blind, placebo-controlled trial.

    PubMed

    Dejima, Kenji; Ohshima, Akihiro; Yanai, Takaaki; Yamamoto, Reiko; Takata, Ryoji; Yoshikawa, Toshikazu

    2007-12-01

    We investigated the efficacy of the polysaccharide derived from black currant, named cassis polysaccharide (CAPS), for inhibiting Japanese cedar pollinosis symptoms and improving quality of life by a randomized double-blind, placebo-controlled trial in 2006. A total of 28 subjects were enrolled in the study, and 10 subjects in each group completed the trial. Although there was no significant difference between the CAPS and placebo group in the weekly mean value of any symptom in the daily symptom diary at any time, a smaller degree of final symptom aggravation was found in the CAPS group. Significant aggravation of the score was finally observed in the placebo group with inferior conch swelling and with sneezing, itchy nose, itchy eye and watery eye in the Japan rhino-conjunctivitis quality of life questionnaire assessment, while the changes observed in the CAPS group were not significant. In conclusion, our findings clearly indicate that CAPS would be useful as a food supplement in assisting the treatment of Japanese cedar pollinosis.

  3. Effects of polysaccharide derived from black currant on relieving clinical symptoms of Japanese cedar pollinosis: a randomized double-blind, placebo-controlled trial.

    PubMed

    Dejima, Kenji; Ohshima, Akihiro; Yanai, Takaaki; Yamamoto, Reiko; Takata, Ryoji; Yoshikawa, Toshikazu

    2007-12-01

    We investigated the efficacy of the polysaccharide derived from black currant, named cassis polysaccharide (CAPS), for inhibiting Japanese cedar pollinosis symptoms and improving quality of life by a randomized double-blind, placebo-controlled trial in 2006. A total of 28 subjects were enrolled in the study, and 10 subjects in each group completed the trial. Although there was no significant difference between the CAPS and placebo group in the weekly mean value of any symptom in the daily symptom diary at any time, a smaller degree of final symptom aggravation was found in the CAPS group. Significant aggravation of the score was finally observed in the placebo group with inferior conch swelling and with sneezing, itchy nose, itchy eye and watery eye in the Japan rhino-conjunctivitis quality of life questionnaire assessment, while the changes observed in the CAPS group were not significant. In conclusion, our findings clearly indicate that CAPS would be useful as a food supplement in assisting the treatment of Japanese cedar pollinosis. PMID:18071252

  4. The Role of the Occupational Therapist in the Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings

    PubMed Central

    Fraker, Joyce; Kales, Helen C.; Blazek, Mary; Kavanagh, Janet; Gitlin, Laura N.

    2014-01-01

    Neuropsychiatric symptoms (NPS) of dementia include aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, and disinhibition. NPS affect dementia patients nearly universally across dementia stages and etiologies. They are associated with poor patient and caregiver outcomes including increased health care utilization, excess morbidity and mortality, and earlier nursing home placement, as well as caregiver stress, depression and reduced employment. There are no FDA-approved medications for NPS, but it is common clinical practice to use psychotropic medications such as antipsychotics to control symptoms; however, antipsychotics show only modest efficacy in improving NPS and have significant risks for patients, including side effects and mortality. Non-pharmacologic treatments are considered first-line by multiple medical bodies and expert consensus, show evidence for efficacy and have limited potential for adverse effects. Ideally, non-pharmacological management of NPS in clinical settings occurs in multidisciplinary teams where occupational therapists (OTs) play an important collaborative role in the care of the person with dementia. Our group has articulated an evidence-informed structured approach to the management of NPS that can be integrated into diverse practice settings and used by providers of various disciplines. The “DICE” (Describe, Investigate, Create, and Evaluate) approach is inherently patient- and caregiver- centered as patient and caregiver concerns are integral to each step of the process. DICE offers a clinical reasoning approach through which providers can more efficiently and effectively choose optimal treatment plans. The purpose of this paper is to describe the role of the OT in using the DICE approach for NPS management. PMID:24354328

  5. International neurocognitive normative study: neurocognitive comparison data in diverse resource-limited settings: AIDS Clinical Trials Group A5271.

    PubMed

    Robertson, K; Jiang, H; Evans, S R; Marra, C M; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, T B; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S; Kumarasamy, N; la Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L; Amod, F; Walawander, A

    2016-08-01

    Infrastructure for conducting neurological research in resource-limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment and normative data needed for clinical interpretation impedes research and clinical care. Here, we report on ACTG 5271, which provided neurological training of clinical site personnel and collected neurocognitive normative comparison data in diverse settings. At ten sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n = 240), India (n = 480), Malawi (n = 481), Peru (n = 239), South Africa (480), Thailand (n = 240), and Zimbabwe (n = 240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline and 770 at 6 months. Participants were enrolled in eight strata, gender (female and male), education (<10 and ≥10 years), and age (<35 and ≥35 years). Of 2400 enrolled, 770 completed the 6-month follow-up. As expected, significant between-country differences were evident in all the neurocognitive test scores (p < 0.0001). There was variation between the age, gender, and education strata on the neurocognitive tests. Age and education were important variables for all tests; older participants had poorer performance, and those with higher education had better performance. Women had better performance on verbal learning/memory and speed of processing tests, while men performed better on motor tests. This study provides the necessary neurocognitive normative data needed to build infrastructure for future neurological and neurocognitive studies in diverse RLS. These normative data are a much-needed resource for both clinicians and researchers. PMID:26733457

  6. International neurocognitive normative study: neurocognitive comparison data in diverse resource-limited settings: AIDS Clinical Trials Group A5271.

    PubMed

    Robertson, K; Jiang, H; Evans, S R; Marra, C M; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, T B; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S; Kumarasamy, N; la Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L; Amod, F; Walawander, A

    2016-08-01

    Infrastructure for conducting neurological research in resource-limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment and normative data needed for clinical interpretation impedes research and clinical care. Here, we report on ACTG 5271, which provided neurological training of clinical site personnel and collected neurocognitive normative comparison data in diverse settings. At ten sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n = 240), India (n = 480), Malawi (n = 481), Peru (n = 239), South Africa (480), Thailand (n = 240), and Zimbabwe (n = 240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline and 770 at 6 months. Participants were enrolled in eight strata, gender (female and male), education (<10 and ≥10 years), and age (<35 and ≥35 years). Of 2400 enrolled, 770 completed the 6-month follow-up. As expected, significant between-country differences were evident in all the neurocognitive test scores (p < 0.0001). There was variation between the age, gender, and education strata on the neurocognitive tests. Age and education were important variables for all tests; older participants had poorer performance, and those with higher education had better performance. Women had better performance on verbal learning/memory and speed of processing tests, while men performed better on motor tests. This study provides the necessary neurocognitive normative data needed to build infrastructure for future neurological and neurocognitive studies in diverse RLS. These normative data are a much-needed resource for both clinicians and researchers.

  7. Invasive candidiasis in critical care setting, updated recommendations from “Invasive Fungal Infections-Clinical Forum”, Iran

    PubMed Central

    Elhoufi, Ashraf; Ahmadi, Arezoo; Asnaashari, Amir Mohammad Hashem; Davarpanah, Mohammad Ali; Bidgoli, Behrooz Farzanegan; Moghaddam, Omid Moradi; Torabi-Nami, Mohammad; Abbasi, Saeed; El-Sobky, Malak; Ghaziani, Ali; Jarrahzadeh, Mohammad Hossein; Shahrami, Reza; Shirazian, Farzad; Soltani, Farhad; Yazdinejad, Homeira; Zand, Farid

    2014-01-01

    Invasive candidiasis (IC) bears a high risk of morbidity and mortality in the intensive care units (ICU). With the current advances in critical care and the use of wide-spectrum antibiotics, invasive fungal infections (IFIs) and IC in particular, have turned into a growing concern in the ICU. Further to blood cultures, some auxiliary laboratory tests and biomarkers are developed to enable an earlier detection of infection, however these test are neither consistently available nor validated in our setting. On the other hand, patients’ clinical status and local epidemiology data may justify the empiric antifungal approach using the proper antifungal option. The clinical approach to the management of IC in febrile, non-neutropenic critically ill patients has been defined in available international guidelines; nevertheless such recommendations need to be customized when applied to our local practice. Over the past three years, Iranian experts from intensive care and infectious diseases disciplines have tried to draw a consensus on the management of IFI with a particular focus on IC in the ICU. The established IFI-clinical forum (IFI-CF), comprising the scientific leaders in the field, has recently come up with and updated recommendation on the same (June 2014). The purpose of this review is to put together literature insights and Iranian experts’ opinion at the IFI-CF, to propose an updated practical overview on recommended approaches for the management of IC in the ICU. PMID:25374806

  8. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings

    PubMed Central

    Nadeem, Sayyada Ghufrana; Hakim, Shazia Tabassum; Kazmi, Shahana Urooj

    2010-01-01

    Introduction Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. Material and methods A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal–tween 80 agar and biochemical methods by using API 20 C AUX. Results The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. Conclusion The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients. PMID:21483597

  9. Addressing Social Determinants of Health in a Clinic Setting: The WellRx Pilot in Albuquerque, New Mexico.

    PubMed

    Page-Reeves, Janet; Kaufman, Will; Bleecker, Molly; Norris, Jeffrey; McCalmont, Kate; Ianakieva, Veneta; Ianakieva, Dessislava; Kaufman, Arthur

    2016-01-01

    Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients. PMID:27170801

  10. Efficient and scalable expansion of human pluripotent stem cells under clinically compliant settings: a view in 2013

    PubMed Central

    Wang, Ying; Cheng, Linzhao; Gerecht, Sharon

    2015-01-01

    Human pluripotent stem cells (hPSCs) hold great promise for revolutionizing regenerative medicine for their potential applications in disease modeling, drug discovery, and cellular therapy. Many their applications require robust and scalable expansion of hPSCs, even under settings compliant to good clinical practices. Rapid evolution of media and substrates provided safer and more defined culture conditions for long-term expansion of undifferentiated hPSCs in either adhesion or suspension. With well-designed automatic systems or fully controlled bioreactors, production of a clinically relevant quantity of hPSCs could be achieved in the near future. The goal is to find a scalable, xeno-free, chemically defined, and economic culture system for clinical-grade expansion of hPSCs that complies the requirements of current Good Manufacturing Practices (cGMP). This review provides an updated overview of the current development and challenges on the way to accomplish this goal, including discussions on basic principles for bioprocess design, serum-free media, extracellular matric or synthesized substrate, microcarrier- or cell aggregate-based suspension culture, and scalability and practicality of equipment. PMID:24132657

  11. Efficient and scalable expansion of human pluripotent stem cells under clinically compliant settings: a view in 2013.

    PubMed

    Wang, Ying; Cheng, Linzhao; Gerecht, Sharon

    2014-07-01

    Human pluripotent stem cells (hPSCs) hold great promise for revolutionizing regenerative medicine for their potential applications in disease modeling, drug discovery, and cellular therapy. Many their applications require robust and scalable expansion of hPSCs, even under settings compliant to good clinical practices. Rapid evolution of media and substrates provided safer and more defined culture conditions for long-term expansion of undifferentiated hPSCs in either adhesion or suspension. With well-designed automatic systems or fully controlled bioreactors, production of a clinically relevant quantity of hPSCs could be achieved in the near future. The goal is to find a scalable, xeno-free, chemically defined, and economic culture system for clinical-grade expansion of hPSCs that complies the requirements of current good manufacturing practices. This review provides an updated overview of the current development and challenges on the way to accomplish this goal, including discussions on basic principles for bioprocess design, serum-free media, extracellular matric or synthesized substrate, microcarrier- or cell aggregate-based suspension culture, and scalability and practicality of equipment. PMID:24132657

  12. Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence.

    PubMed

    Bray, Lucy; Snodin, Jill; Carter, Bernie

    2015-06-01

    This critical reflection on the ethical concerns of current practice is underpinned by a systematic synthesis of current evidence focusing on why and how children are held or restrained for clinical procedures within acute care and the experiences of those present when a child is held against their wishes. Empirical evidence from a range of clinical settings internationally demonstrates that frequently children are held for procedures to be completed; younger children and those requiring procedures perceived as urgent are more likely to be held. Parents and health professionals express how holding children for procedures can cause feelings of moral distress expressed as uncertainty, guilt and upset and that this act breaches the trusting and protective relationship established with children. Despite this, children's rights and alternatives to holding are not always respected or explored. Children's experiences and perceptions are absent from current literature. Children and young people have a moral right to have their voice and protests heard and respected and for these to inform judgements of their best interests and the actions of health professionals. Without robust evidence, debate and recognition that children are frequently held against their wishes in clinical practice for procedures which may not be urgent, children's rights will continue to be compromised. PMID:25053126

  13. Addressing Social Determinants of Health in a Clinic Setting: The WellRx Pilot in Albuquerque, New Mexico.

    PubMed

    Page-Reeves, Janet; Kaufman, Will; Bleecker, Molly; Norris, Jeffrey; McCalmont, Kate; Ianakieva, Veneta; Ianakieva, Dessislava; Kaufman, Arthur

    2016-01-01

    Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients.

  14. Development and validation of an app-based cell counter for use in the clinical laboratory setting

    PubMed Central

    Thurman, Alexander C.; Davis, Jessica L.; Jan, Max; McCulloch, Charles E.; Buelow, Benjamin D.

    2015-01-01

    Introduction: For decades cellular differentials have been generated exclusively on analog tabletop cell counters. With the advent of tablet computers, digital cell counters – in the form of mobile applications (“apps”) – now represent an alternative to analog devices. However, app-based counters have not been widely adopted by clinical laboratories, perhaps owing to a presumed decrease in count accuracy related to the lack of tactile feedback inherent in a touchscreen interface. We herein provide the first systematic evidence that digital cell counters function similarly to standard tabletop units. Methods: We developed an app-based cell counter optimized for use in the clinical laboratory setting. Paired counts of 188 peripheral blood smears and 62 bone marrow aspirate smears were performed using our app-based counter and a standard analog device. Differences between paired data sets were analyzed using the correlation coefficient, Student's t-test for paired samples and Bland–Altman plots. Results: All counts showed excellent agreement across all users and touch screen devices. With the exception of peripheral blood basophils (r = 0.684), differentials generated for the measured cell categories within the paired data sets were highly correlated (all r ≥ 0.899). Results of paired t-tests did not reach statistical significance for any cell type (all P > 0.05), and Bland–Altman plots showed a narrow spread of the difference about the mean without evidence of significant outliers. Conclusions: Our analysis suggests that no systematic differences exist between cellular differentials obtained via app-based or tabletop counters and that agreement between these two methods is excellent. PMID:25722942

  15. Clients becoming teachers: Speech-language pathology students' understanding of rehabilitation following clinical practicum in a rehabilitation setting.

    PubMed

    Attrill, Stacie; Gunn, Simon

    2010-04-01

    There has been limited research investigating the conceptual development of rehabilitation in speech-language pathology (SLP) students. The aim of this study was to describe SLP students' understanding of rehabilitation following completion of a clinical practicum in a rehabilitation setting. This study was conducted using a qualitative approach according to grounded theory methodology. Semi-structured interviews were conducted with 10 SLP students who had completed a practicum in a rehabilitation setting. Interview data analysis revealed the emergence of five axial categories. Clients becoming teachers was identified as the core category, as the notion that clients were fundamental to students' understanding of rehabilitation occurred reliably throughout the data and related to all other categories. A theoretical model was proposed that demonstrated successive levels of support to students in the acquisition of their understanding of rehabilitation on practicum. Students' understanding of rehabilitation was derived from client-related interactions and factors experienced on practicum in rehabilitation settings. Rehabilitation practicum provided students with a rich and complex learning environment that may facilitate the development of the "core skills" identified for rehabilitation practice.

  16. Modalities of Infant-Mother Interaction in Japanese, Japanese American Immigrant, and European American Dyads

    PubMed Central

    Bornstein, Marc H.; Cote, Linda R.; Haynes, O. Maurice; Suwalsky, Joan T. D.; Bakeman, Roger

    2011-01-01

    Cultural variation in relations and moment-to-moment contingencies of infant-mother person-oriented and object-oriented interactions were examined and compared in 118 Japanese, Japanese American immigrant, and European American dyads with 5.5-month-olds. Infant and mother person-oriented behaviors were positively related in all cultural groups, but infant and mother object-oriented behaviors were positively related only among European Americans. In all groups, infant and mother behaviors within each modality were mutually contingent. Culture moderated lead-lag relations: Japanese infants were more likely than their mothers to respond in object-oriented interactions, European American mothers were more likely than their infants to respond in person-oriented interactions. Japanese American dyads behaved more like European American dyads. Interaction, infant effects, and parent socialization findings are set in cultural and accultural models of transactions between young infants and their mothers. PMID:22860874

  17. Modalities of infant-mother interaction in Japanese, Japanese American immigrant, and European American dyads.

    PubMed

    Bornstein, Marc H; Cote, Linda R; Haynes, O Maurice; Suwalsky, Joan T D; Bakeman, Roger

    2012-11-01

    Cultural variation in relations and moment-to-moment contingencies of infant-mother person-oriented and object-oriented interactions were compared in 118 Japanese, Japanese American immigrant, and European American dyads with 5.5-month-olds. Infant and mother person-oriented behaviors were related in all cultural groups, but infant and mother object-oriented behaviors were related only among European Americans. Infant and mother behaviors within each modality were mutually contingent in all groups. Culture moderated lead-lag relations: Japanese infants were more likely than their mothers to respond in object-oriented interactions; European American mothers were more likely than their infants to respond in person-oriented interactions. Japanese American dyads behaved like European American dyads. Interactions, infant effects, and parent socialization findings are set in cultural and accultural models of infant-mother transactions. PMID:22860874

  18. Awareness of the Japanese Society of Hypertension Guidelines for the Management of Hypertension and their use in clinical practices: 2009 survey results.

    PubMed

    Obara, Taku; Ubeda, Sergio Ramón Gutiérrez; Ohkubo, Takayoshi; Matsuura, Hideo; Ishimitsu, Toshihiko; Takata, Masanobu; Rakugi, Hiromi; Imai, Yutaka

    2015-06-01

    The objective of this study was to investigate physicians' awareness and use of the Japanese Society of Hypertension (JSH) Guidelines for the Management of Hypertension (JSH2004 and JSH2009), and determine what changes need to be implemented in the future. A questionnaire was used to survey physicians' awareness and their use of JSH2004 and JSH2009. Physicians attending educational seminars on hypertension that were held during the months after the publication of JSH2009 (January-April 2009) were asked to participate in the survey. Of the 5795 respondents, 88% were aware of the JSH2009 publication. Furthermore, physicians were also aware of JSH2004, with about 90% using JSH2004 in their practice. A hypertension blood pressure (BP) reference value of 140/90 mm Hg was used by 55% in office BP, whereas 31% used 135/85 mm Hg for home BP. Target BP levels used by physicians were 130/80 mm Hg for patients with diabetes or kidney disease (52%) and for elderly patients with diabetes or kidney disease (45%), whereas 140/90 mm Hg was used for elderly patients with low cardiovascular disease risk (44%) and for patients with chronic-phase stroke (27%). Answers to the questionnaire varied among physicians according to sex, age, workplace and specialty. The majority of the participating Japanese physicians were familiar with both JSH2004 and JSH2009, with many following the guidelines in their practice. However, some physicians use different reference values for hypertension and target BP levels. Physicians' adherence to and use of the guidelines should be regularly examined and promoted.

  19. Learning from Analysis of Japanese EFL Texts

    ERIC Educational Resources Information Center

    Weir, George R. S.; Ozasa, Toshiaki

    2010-01-01

    Japan has a long tradition of teaching English as a foreign language (EFL). A common feature of EFL courses is reliance on specific textbooks as a basis for graded teaching, and periods in Japanese EFL history are marked by the introduction of different textbook series. These sets of textbooks share the common goal of taking students from…

  20. The So-Called Japanese Passive.

    ERIC Educational Resources Information Center

    Howard, Irwin

    The principal claim of this paper is that the Japanese passive consists of two different constructions, each derived from a distinct deep structure and each having associated with it a distinct set of syntactic and semantic properties. One of these constructions, the "adversative passive," implies that the grammatical subject of the sentence is…

  1. Clinical excellence: evidence on the assessment of senior doctors' applications to the UK Advisory Committee on Clinical Excellence Awards. Analysis of complete national data set

    PubMed Central

    Campbell, John L; Abel, Gary

    2016-01-01

    Objectives To inform the rational deployment of assessor resource in the evaluation of applications to the UK Advisory Committee on Clinical Excellence Awards (ACCEA). Setting ACCEA are responsible for a scheme to financially reward senior doctors in England and Wales who are assessed to be working over and above the standard expected of their role. Participants Anonymised applications of consultants and senior academic GPs for awards were considered by members of 14 regional subcommittees and 2 national assessing committees during the 2014–2015 round of applications. Design It involved secondary analysis of complete anonymised national data set. Primary and secondary outcome measures We analysed scores for each of 1916 applications for a clinical excellence award across 4 levels of award. Scores were provided by members of 16 subcommittees. We assessed the reliability of assessments and described the variance in the assessment of scores. Results Members of regional subcommittees assessed 1529 new applications and 387 renewal applications. Average scores increased with the level of application being made. On average, applications were assessed by 9.5 assessors. The highest contributions to the variance in individual assessors' assessments of applications were attributable to assessors or to residual variance. The applicant accounted for around a quarter of the variance in scores for new bronze applications, with this proportion decreasing for higher award levels. Reliability in excess of 0.7 can be attained where 4 assessors score bronze applications, with twice as many assessors being required for higher levels of application. Conclusions Assessment processes pertaining in the competitive allocation of public funds need to be credible and efficient. The present arrangements for assessing and scoring applications are defensible, depending on the level of reliability judged to be required in the assessment process. Some relatively minor reconfiguration in

  2. Integration of heterogeneous clinical decision support systems and their knowledge sets: feasibility study with Drug-Drug Interaction alerts.

    PubMed

    Kam, Hye Jin; Kim, Jeong Ah; Cho, InSook; Kim, Yoon; Park, Rae Woong

    2011-01-01

    There exist limitations in both commercial and in-house clinical decision support systems (CDSSs) and issues related to the integration of different knowledge sources and CDSSs. We chose Standard-based Shareable Active Guideline Environment (SAGE) as a new architecture with knowledge integration and a centralized knowledge base which includes authoring/management functions and independent CDSS, and applied it to Drug-Drug Interaction (DDI) CDSS. The aim of this study was to evaluate the feasibility of the newly integrated DDI alerting CDSS into a real world hospital information system involving construction of an integrated CDSS derived from two heterogeneous systems and their knowledge sets. The proposed CDSS was successfully implemented and compensated for the weaknesses of the old CDSS from knowledge integration and management, and its applicability in actual situations was verified. Although the DDI CDSS was constructed as an example case, the new CDS architecture might prove applicable to areas of CDSSs.

  3. Cost-effective organization of an institutional human cancer biobank in a clinical setting: CRO-Biobank experience toward harmonization.

    PubMed

    Cervo, Silvia; De Paoli, Paolo; Perin, Tiziana; Canzonieri, Vincenzo; Steffan, Agostino

    2015-01-01

    This report describes the organization of the Biobank of the CRO Aviano National Cancer Institute, Aviano (CRO- Biobank), Italy, implemented as a structured facility dedicated to collecting human biological samples. It describes a particular disease-specific biobank and the integration of a research biobank in a clinical setting. The CRO-Biobank's mission is rooted in supporting and implementing cancer research, with its main focus on optimizing technical and quality processes, while also investigating ethical, legal and IT topics.The CRO-Biobank has implemented processes aimed at guaranteeing the safety of the providers, protecting patient privacy and ensuring both the traceability and quality of its samples. Our 8 years of experience allow us to offer insights and useful suggestions that may solve theoretical and practical issues that can arise when starting up new biobanks or developing existing biobanks further.

  4. Danish clinical guidelines for examination and treatment of overweight and obese children and adolescents in a pediatric setting.

    PubMed

    Johansen, Anders; Holm, Jens-Christian; Pearson, Seija; Kjærsgaard, Mimi; Larsen, Lone Marie; Højgaard, Birgitte; Cortes, Dina

    2015-05-01

    Overweight children are at an increased risk of becoming obese adults, which may lead to shorter life expectancies in the current generation of children as compared to their parents. Furthermore, being an overweight child has a negative psycho-social impact. We consider obesity in children and adolescents a chronic illness, which is in line with the American Medical Society. We summarize the evidence for the efficacy of a combination of diet, physical activity and behavior-focused interventions in a family-based setting. The present guidelines propose a multidisciplinary service implemented as a "chronic care model" based on "best clinical practice" inspired by an American expert committee and the daily practice of The Children's Obesity Clinic at Copenhagen University Hospital Holbaek. Children and adolescents should be referred for examination and treatment in a pediatric setting when BMI corresponds to an isoBMI of minimum 30 or BMI corresponds to an isoBMI of 25 and complex obesity is suspected. Obtaining a thorough medical history is pivotal. We propose a structured interview to ensure collection of all relevant information. We recommend physical examination focused on BMI, waist circumference, growth, pubertal stage, blood pressure, neurology and skin and provide comprehensive paraclinical investigations for obesity and obesity related conditions. Treatment of obesity in children and adolescents is fully dependent on the combined effort of the entire family. This cannot be overemphasized! The main principle of the treatment is developing an individual detailed plan for every patient to reduce caloric intake whilst increasing physical activity, leaving no ambiguity with the recommendations.

  5. Clinical experience with fortnightly buprenorphine/naloxone versus buprenorphine in Italy: preliminary observational data in an office-based setting.

    PubMed

    Amato, Patrizia

    2010-01-01

    Buprenorphine/naloxone is a new option for the management of opioid dependence. It has a reduced potential for abuse or misuse compared with methadone and buprenorphine alone, and has a long half-life allowing less frequent dosing. Buprenorphine/naloxone appears to be well suited for the management of opioid dependence in an office-based setting. The aim of this study was to evaluate the efficacy and safety of a buprenorphine/naloxone combination treatment in an office-based setting. Therefore, we evaluated the effect on misuse/diversion, quality of care, quality of life and service delivery. Seventy-eight patients were switched to buprenorphine/naloxone from either methadone or buprenorphine alone; the median duration of previous buprenorphine or methadone treatment was 10 years. Patients received buprenorphine/naloxone and were evaluated throughout a 1-year follow-up period. Treatment was self-administered by the patients every 2 weeks and the mean buprenorphine dosage at 1 year was 8 mg/day. Comparisons were made before and after the switch for patients who switched from buprenorphine alone to buprenorphine/naloxone. Switching to buprenorphine/naloxone was not associated with clinically relevant problems in 50% of patients studied. Buprenorphine/naloxone provided satisfactory coverage of withdrawal symptoms in 78.1% of patients, and 50% of patients were satisfied with buprenorphine/naloxone therapy. Seventy-eight per cent of patients reported improved psychosocial functioning. The majority of patients (approximately 85%) were negative for opioids during toxicological testing. A significantly higher proportion of treatment recipients were highly satisfied during buprenorphine/naloxone administration (p < 0.001 compared with buprenorphine given before the switch). Other outcomes were similar during buprenorphine and buprenorphine/naloxone administration. Fortnightly self-administration of buprenorphine/naloxone appeared to be cost saving for the clinic

  6. Disrupting P-glycoprotein function in clinical settings: what can we learn from the fundamental aspects of this transporter?

    PubMed Central

    Chung, Francisco S; Santiago, Jayson S; Jesus, Miguel Francisco M De; Trinidad, Camille V; See, Melvin Floyd E

    2016-01-01

    P-glycoprotein is one of the most well-studied drug transporters, significant for its role in cancer multiple drug resistance. However, using P-gp inhibitors with the aim of enhancing the therapeutic efficacy of anti-cancer drugs has led to disappointing outcomes. Furthermore, several lead compounds suggested by in vitro and pre-clinical studies have shown variable pharmacokinetics and therapeutic efficacies when applied in the clinical setting. This review will highlight the need to revisit a sound approach to better design and apply P-gp inhibitors in light of safety and efficacy. Challenges confronting the issue hinge upon myriad studies that do not necessarily represent the heterogeneous target population of this therapeutic approach. The application of P-gp modulators has also been complicated by the promiscuous substrate-binding behaviour of P-gp, as well as toxicities related to its intrinsic presence in healthy tissue. This review capitalizes on information spanning genetics, energetics, and pharmacology, bringing to light some fundamental aspects that ought to be reconsidered in order to improve upon and design the next generation of P-gp inhibitors. PMID:27648351

  7. Use of formalin-fixed and paraffin-embedded tissues for diagnosis and therapy in routine clinical settings.

    PubMed

    Berg, Daniela; Malinowsky, Katharina; Reischauer, Bilge; Wolff, Claudia; Becker, Karl-Friedrich

    2011-01-01

    Formalin-fixed and paraffin-embedded (FFPE) tissues are used routinely everyday in hospitals world-wide for histopathological diagnosis of diseases like cancer. Due to formalin-induced cross-linking of proteins, FFPE tissues present a particular challenge for proteomic analysis. Nevertheless, there has been recent progress for extraction-based protein analysis in these tissues. Novel tools developed in the last few years are urgently needed because precise protein biomarker quantification in clinical FFPE tissues will be crucial for treatment decisions and to assess success or failure of current and future personalized molecular therapies. Furthermore, they will help to conceive why only a subset of patients responds to individualized treatments. Reverse phase protein array (RPPA) is a very promising new technology for quick and simultaneous analysis of many patient samples allowing relative and absolute protein quantifications. In this chapter, we show how protein extraction from FFPE tissues might facilitate the implementation of RPPA for therapy decisions and discuss challenges for application of RPPA in clinical trials and routine settings.

  8. Disrupting P-glycoprotein function in clinical settings: what can we learn from the fundamental aspects of this transporter?

    PubMed Central

    Chung, Francisco S; Santiago, Jayson S; Jesus, Miguel Francisco M De; Trinidad, Camille V; See, Melvin Floyd E

    2016-01-01

    P-glycoprotein is one of the most well-studied drug transporters, significant for its role in cancer multiple drug resistance. However, using P-gp inhibitors with the aim of enhancing the therapeutic efficacy of anti-cancer drugs has led to disappointing outcomes. Furthermore, several lead compounds suggested by in vitro and pre-clinical studies have shown variable pharmacokinetics and therapeutic efficacies when applied in the clinical setting. This review will highlight the need to revisit a sound approach to better design and apply P-gp inhibitors in light of safety and efficacy. Challenges confronting the issue hinge upon myriad studies that do not necessarily represent the heterogeneous target population of this therapeutic approach. The application of P-gp modulators has also been complicated by the promiscuous substrate-binding behaviour of P-gp, as well as toxicities related to its intrinsic presence in healthy tissue. This review capitalizes on information spanning genetics, energetics, and pharmacology, bringing to light some fundamental aspects that ought to be reconsidered in order to improve upon and design the next generation of P-gp inhibitors.

  9. Real-Time Continuous Glucose Monitoring in the Clinical Setting: The Good, the Bad, and the Practical

    PubMed Central

    Mamkin, Irene; Ten, Svetlana; Bhandari, Sonal; Ramchandani, Neesha

    2008-01-01

    Real-time continuous glucose monitoring (RT-CGM) is the latest technological breakthrough in diabetes care. Despite its limitations of lag time between sensor and blood glucose, the need for calibration, false detection of and failure to detect hypoglycemia, and mild discomfort or skin irritation reported in some users, RT-CGM is a highly beneficial tool that can be used to detect nocturnal or unrecognized hypoglycemia and glycemic variability. This, in turn, can lead to better treatment decisions, which may improve metabolic control and decrease the incidence and progression of diabetes complications. The RT-CGM devices are fairly accurate and easy to use. It is not difficult to establish a clinical RT-CGM program in the office. However, it requires persistence and an understanding of the patient's perspective of using RT-CGM so it can be presented and taught appropriately. This article discusses the benefits and limitations of RT-CGM and establishment of a RT-CGM program in the clinical setting. PMID:19885273

  10. Nursing students' experiences with screening, brief intervention, and referral to treatment for substance use in the clinical/hospital setting.

    PubMed

    Braxter, Betty J; Puskar, Kathy; Mitchell, Ann M; Hagle, Holly; Gotham, Heather; Terry, Martha Ann

    2014-01-01

    Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective early intervention when used across healthcare settings, its implementation has been difficult, in part because of lack of training, healthcare providers' feelings of low self-efficacy in performing SBIRT, and negative attitudes about people who use alcohol and drugs. This study used qualitative descriptive methods to examine baccalaureate nursing students' experiences with practicing SBIRT in clinical rotations following in-depth classroom work and skill-based training. Fifty-five junior level nursing students participated in four focus groups. Three overarching themes describe students' experiences with SBIRT. Students expressed a positive impact of the training on their attitudes and feelings of self-efficacy regarding the use of SBIRT, differences in opinions about whether SBIRT should be used universally with all patients or as a targeted intervention with only some patients, and that SBIRT is a nursing responsibility. These results suggest that education and training can affect attitudes and efficacy, but that attention needs to be paid to how SBIRT is implemented within different healthcare settings.

  11. Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa.

    PubMed

    Schaftenaar, E; Peters, R P H; Baarsma, G S; Meenken, C; Khosa, N S; Getu, S; McIntyre, J A; Osterhaus, A D M E; Verjans, G M G M

    2016-09-01

    The purpose of this investigation was to determine the clinical and corneal microbial profile of infectious keratitis in a high human immunodeficiency virus (HIV) prevalence setting in rural South Africa. Data in this cross-sectional study were collected from patients presenting with symptoms of infectious keratitis (n = 46) at the ophthalmology outpatient department of three hospitals in rural South Africa. Corneal swabs were tested for herpes simplex virus type 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV) and adenovirus DNA by real-time polymerase chain reaction (PCR) and for bacteria and fungi by culture. Based on clinical history, disease characteristics and laboratory results, 29 (63 %) patients were diagnosed as viral keratitis, including 14 (48 %) viral keratitis cases complicated by bacterial superinfection, and 17 (37 %) as bacterial keratitis. VZV and HSV-1 DNA was detected in 11 (24 %) and 5 (11 %) corneal swabs, respectively. Among clinically defined viral keratitis cases, a negative viral swab was predominantly (93 %) observed in cases with subepithelial inflammation and was significantly associated with an increased duration of symptoms (p = 0.003). The majority of bacteria cultured were Gram-positive (24/35), including Staphylococcus epidermidis and S. aureus. Viral aetiology was significantly associated with a history of herpes zoster ophthalmicus (p < 0.001) and a trend was observed between viral aetiology and HIV infection (p = 0.06). Twenty-one (47 %) keratitis cases were complicated by anterior uveitis, of which 18 (86 %) were HIV-infected cases with viral keratitis. The data implicate a high prevalence of herpetic keratitis, in part complicated by bacterial superinfection and/or uveitis, in HIV-infected individuals presenting with infectious keratitis in rural South Africa. PMID:27236644

  12. Exemplary Care and Learning Sites: A Model for Achieving Continual Improvement in Care and Learning in the Clinical Setting

    PubMed Central

    Ogrinc, Greg; Hoffman, Kimberly G.; Stevenson, Katherine M.; Shalaby, Marc; Beard, Albertine S.; Thörne, Karin E.; Coleman, Mary T.; Baum, Karyn D.

    2016-01-01

    Problem Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. Approach From 2008–2012, an iterative, interactive process was used to develop the ECLS model and its core elements—patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012–2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site’s ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Outcomes Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. Next Steps The next test of the model should be prospective, linked to clinical and educa tional outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development. PMID:26760058

  13. How the Japanese work.

    PubMed

    Chambers, D W

    1998-01-01

    The Japanese do not work harder or even use different approaches so much as they aim for a different result--one that balances process and results and extends the definition of quality beyond the product itself to include cost and convenience to the customer as well. Ten methods of the Japanese kaizen culture of work are presented with applications and contrasts to American dentistry.

  14. Entry-Level Athletic Trainers' Self-Confidence in Clinical Skill Preparedness for Treating Athletic and Emergent Settings Populations

    ERIC Educational Resources Information Center

    Morin, Gary E.; Misasi, Sharon; Davis, Charles; Hannah, Corey; Rothbard, Matthew

    2014-01-01

    Context: Clinical education is an important component of athletic training education. Concern exists regarding whether clinical experience adequately prepares students to perform professional skills after graduation, particularly with patients in emerging settings. Objective: To determine the confidence levels of athletic training graduates in…

  15. Application of empirically supported treatments to clinical settings. In: Jelalian, E., Steele, R.G., editors. Handbook of Childhood and Adolescent Obesity

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This book chapter identifies treatments for pediatric obesity that have been shown to be effective in research settings and discusses how these treatments can be implemented in an applied clinical setting. Behavior-based treatments have demonstrated the best outcomes. Commonly used behavioral strate...

  16. Comparative clinical profile of mirtazapine and duloxetine in practical clinical settings in Japan: a 4-week open-label, parallel-group study of major depressive disorder

    PubMed Central

    Nagao, Kei; Kishi, Taro; Moriwaki, Masatsugu; Fujita, Kiyoshi; Hirano, Shigeki; Yamanouchi, Yoshio; Funahashi, Toshihiko; Iwata, Nakao

    2013-01-01

    No studies have compared mirtazapine with duloxetine in patients with major depressive disorder (MDD). Fifty-six patients were nonrandomly assigned to a 4-week treatment with either 15 to 45 mg/day of mirtazapine (n = 22) or 20 to 60 mg/day of duloxetine (n = 34). The primary efficacy measurements were the Hamilton Rating Scale for Depression (HRSD) and the Montgomery–Åsberg Depression 6-point Rating Scale (MADRS) scores. The second efficacy measurements were the response and remission rates of treatment. Tolerability assessments were also performed. Fifty-six patients (43 male; age, 43.6 years) were recruited. There was no significant difference in the discontinuation rate between the mirtazapine and duloxetine treatment groups (P = 0.867). Both mirtazapine and duloxetine significantly improved the HRSD and MADRS scores from baseline (P < 0.0001–0.0004). While mirtazapine was superior to duloxetine in the reduction of HRSD scores (P = 0.0421), there was no significant change in MADRS scores in terms of between-group differences (P = 0.171). While more somnolence was observed with mirtazapine (P = 0.0399), more nausea was associated with duloxetine (P = 0.0089). No serious adverse events were observed for either antidepressant. Mirtazapine and duloxetine were safe and well-tolerated treatments for Japanese patients with MDD. Double-blind controlled studies are needed to further explore the efficacy and safety of mirtazapine and duloxetine in Japanese patients with MDD. PMID:23766648

  17. Installation of a Neuromate Robot for Stereotactic Surgery: Efforts to Conform to Japanese Specifications and an Approach for Clinical Use—Technical Notes

    PubMed Central

    KAJITA, Yasukazu; NAKATSUBO, Daisuke; KATAOKA, Hirotada; NAGAI, Toshiya; NAKURA, Takahiro; WAKABAYASHI, Toshihiko

    2015-01-01

    The neuromate is a commercially available, image-guided robotic system for use in stereotactic surgery and is employed in Europe and North America. In June 2015, this device was approved in accordance with the Pharmaceutical Affairs Law in Japan. The neuromate can be specified to a wide range of stereotactic procedures in Japan. The stereotactic X-ray system, developed by a Japanese manufacturer, is normally attached to the operating table that provides lateral and anteroposterior images to verify the positions of the recording electrodes. The neuromate is designed to be used with the patient in the supine position on a flat operating table. In Japan, deep brain stimulation surgery is widely performed with the patient's head positioned upward so as to minimize cerebrospinal fluid leakage. The robot base where the patient's head is fixed has an adaptation for a tilted head position (by 25 degrees) to accommodate the operating table at proper angle to hold the patient's upper body. After these modifications, the accuracy of neuromate localization was examined on a computed tomography phantom preparation, showing that the root mean square error was 0.12 ± 0.10 mm. In our hospital, robotic surgeries, such as those using the Da Vinci system or neuromate, require operative guidelines directed by the Medical Risk Management Office and Biomedical Research and Innovation Office. These guidelines include directions for use, procedural manuals, and training courses. PMID:26511113

  18. Clinical features of diabetes mellitus with the mitochondrial DNA 3243 (A-G) mutation in Japanese: maternal inheritance and mitochondria-related complications.

    PubMed

    Suzuki, Susumu; Oka, Yoshitomo; Kadowaki, Takashi; Kanatsuka, Azuma; Kuzuya, Takeshi; Kobayashi, Masashi; Sanke, Tokio; Seino, Yutaka; Nanjo, Kishio

    2003-03-01

    Diabetes mellitus with the mitochondrial DNA 3243(A-G) mutation is reported to represent 0.5-2.8% of the general diabetic population. Since the characterization of diabetes with the mutation is still incomplete, we undertook a nation-wide case-finding study of genetically defined patients using questionnaires in Japan. One hundred and thirteen Japanese diabetic patients with the mutation were registered and analyzed. The patients had a high prevalence of maternal inheritance of diabetes and deafness, short and thin stature, and showed an early middle-aged onset of diabetes and deafness. Eighty-six percent of the patients required insulin therapy due to the progressive insulin secretory defect. Glucose intolerance of the mothers was associated with an early middle-aged onset of diabetes, reduction in the insulin secretory capacity, early requirement of insulin therapy, and increases in the daily insulin dose. The heteroplasmic concentrations of the 3243 mutation in leukocytes were low and declined with aging. The patients had advanced microvascular complications, and mitochondria-related complications such as cardiomyopathy, cardiac conductance disorders, neuromuscular symptoms, neuropsychiatric disturbance, and macular pattern dystrophy. Thus, this study has revealed that: (1) diabetes mellitus with the 3243 mutation is a subtype of diabetes mellitus with mitochondria-related complications; and (2) insulin secretory ability is more severely impaired in the patients whose mothers were glucose intolerance.

  19. A model for managing and monitoring the quality of glucometers used in a high-volume clinical setting

    PubMed Central

    Aykal, Güzin; Yegin, Ayşenur; Tekeli, Özgür; Yilmaz, Necat

    2016-01-01

    Introduction The aim of this study is to present a model for assuring the quality of a large number of glucometers being used in a high-volume hospital clinical setting. Materials and methods Internal quality-control samples and blood samples from two patients were used to determine the accuracy of 83 glucometers used at our hospital. On each glucometer three levels of control were used for glucose concentrations determination. In addition, the difference between the results from patient samples obtained with the glucometers and the hexokinase reference method were compared. The differences were assessed based on the International Organization for Standardization (ISO 15197) standards. Results The glucose concentrations were as follows: 2.51 ± 0.34 mmol/L for the hypo-control samples; 5.12 ± 0.32 mmol/L for the low-control samples; and 16.11 ± 1.03 mmol/L for high-control samples. All results were within the expected ranges. For Patient I, the result with the first group of 52 glucometers was 11.56 ± 0.5 mmol/L, while the result for Patient II with the second group of 31 glucometers was 10.52 ± 0.62 mmol/L. All data points of the study complied with the requirements of the Clarke error grid. Conclusion All quality-control and comparison assay results were appropriate for evaluating glucometers used in a high-volume hospital setting. The method used in this study can be suggested as a model for laboratory managers, especially in similar high-volume hospitals. PMID:27346965

  20. Community-acquired diarrhea among children and adults in urban settings in Senegal: clinical, epidemiological and microbiological aspects

    PubMed Central

    2013-01-01

    Background Only limited data are available relating to the etiology of diarrhea in children and adults in Senegal. The aim of this prospective study was to describe the epidemiology and etiology of community-acquired diarrheal infections in children and adults living in urban settings. Methods A prospective study was carried out from March 2009 to December 2010, in the urban region of Dakar, Senegal. Patients with acute diarrhea were enrolled, interviewed to collect their clinical history, and their stools were tested for bacteria, virus and parasites. Results A total of 223 patients (including 112 children younger than five years old) with diarrhea were included. At least one enteropathogen was detected in 81% (180/223) of the patients: 29% (64/223) had bacterial infections (mainly diarrheagenic E. coli and Shigella spp), 21% (39/185) viral infections (mainly rotavirus) and 14% (31/223) parasitic infections. Co-infection was identified in 17.8% (32/180) of the patients. Viral infection was significantly more frequent in children under five years old during the dry season. Bacteria and parasites were equally frequent in all age groups. There was a seasonal variation of bacterial infections during the study period, with a higher proportion of infections being bacterial, and due to Salmonella spp. in particular, during the rainy season. Conclusion Our study suggests that in urban settings in Senegal, rotavirus is the principal cause of pediatric diarrhea during the dry season and that the proportion of bacterial infections seems to be higher during the rainy season. Further work is needed to document the burden of diarrheal diseases in sub-Saharan urban communities and to identify risk factors, including those linked to the rapid and unplanned urbanization in Africa. PMID:24321175

  1. [Japanese Association of Clinical Laborato Physicians--What We Are Doing Now and How We Should Develop in the Future as Competent Members of Team Medicine].

    PubMed

    Murakami, Junko

    2014-11-01

    No clinical laboratory would admit they do not practice team medicine, at least conceptually. However, true team medicine is more than an aspiration--it is an intentional care structure built, led, and delivered by a diverse, multidisciplinary team of physicians, medical technologists, nurses, pharmacists, and dozens of other professionals. We clinical laboratory physicians are able to fulfill an important role as competent members of the team medicine. Because we can look at the results of clinical examinations of patients earlier than anyone else, we can interpret the patient's condition by analyzing that results, and provide useful information to facilitate team medicine. I have conducted a questionnaire survey on team medicine targeting clinical laboratory physicians to clarify the tasks we are performing. In this paper, I describe what clinical laboratory physicians are currently doing, and how should we develop in the future.

  2. The effect of mass screening by physical examination combined with regular breast self-examination on clinical stage and course of Japanese women with breast cancer.

    PubMed

    Koibuchi, Y; Iino, Y; Takei, H; Maemura, M; Horiguchi, J; Yokoe, T; Morishita, Y

    1998-01-01

    A mass screening program for breast cancer in Japan consists of physical examination (PE) and education on regular breast self-examination (BSE). The effect of PE with BSE on clinical stages and courses of breast cancer patients were retrospectively analyzed. Clinical stages and courses were compared between; i) patients who were examined in outpatient clinics (OPC, n=587), ii) patients who were detected by mass screening with regular BSE [BSE(+), n=68], and iii) without BSE [BSE(-), n=178]. Clinical stage in BSE(+) was significantly earlier than that in BSE(-) or OPC. As early stage cancer was most common in BSE(+), conservative surgery was mostly selected. Survival curve in BSE(+) was significantly better than those in BSE(-) or OPC. BSE complements the role of mass screening by PE for early detection and a more favorable clinical course.

  3. A Japanese approach for CKD-MBD.

    PubMed

    Yokoyama, Keitaro; Taniguchi, Masatomo; Fukagawa, Masafumi

    2013-12-01

    Disturbances in mineral and bone metabolism have a critical role in the pathogenesis of cardiovascular complications in patients with chronic kidney disease (CKD). The term 'renal osteodystrophy' has recently been replaced by 'CKD-mineral and bone disorder (CKD-MBD)', which includes abnormalities in bone and mineral metabolism and vascular calcification. The Japanese Society for Dialysis Therapy clinical practice guideline for the management of secondary hyperparathyroidism in chronic dialysis patients was originally published in Japanese in 2006, then in English in 2008. During the past 5 years, this first guideline has contributed to a considerably better understanding and control of secondary hyperparathyroidism in CKD patients by physicians, other medical professionals, and the patients themselves. However, since its publication several new therapeutic modalities have become available for Japanese dialysis patients, which added more evidence to this area. Thus, we revised the guideline to include several new policies, and the new guideline was published in Japanese in 2012. This article contains the new guideline text, and clinical significance of CKD-MBD in Japan. PMID:25019029

  4. The GOCCLES® medical device is effective in detecting oral cancer and dysplasia in dental clinical setting. Results from a multicentre clinical trial.

    PubMed

    Moro, A; De Waure, C; Di Nardo, F; Spadari, F; Mignogna, M D; Giuliani, M; Califano, L; Giannì, A B; Cardarelli, L; Celentano, A; Bombeccari, G; Pelo, S

    2015-12-01

    The purpose of this study is to demonstrate that the GOCCLES® medical device allows proper autofluorescence examination of the oral mucosa in a dental care setting. This is a non-randomised multicentre clinical trial on consecutive patients at risk for oral cancer. Patients underwent a classical naked eye inspection of the oral cavity followed by autofluorescence examination wearing the GOCCLES® spectacles while the light from a dental curing light irradiated the oral mucosa. Lesions were defined as visible potentially malignant lesions and/or fluorescence loss areas. All persisting lesions underwent excisional or incisional biopsy. Sixty-one patients were enrolled. Data from 64 biopsies were analysed. Of the 62 lesions identified by the device, 31 were true positives. The device identified 31 of 32 true positive lesions. One lesion (an invasive carcinoma) was not visible to the naked eye. The device identified all lesions classified as moderate dysplasia to invasive cancer. In 56.7% of cases, true positive lesions showed greater extension when observed through the device. The GOCCLES® medical device allowed the direct visualisation of fluorescence loss in patients suffering from mild to severe dysplasia and in situ to invasive oral cancer. It allowed autofluorescence examination with each source of light used during the study. These results suggest that the role of the autofluorescence visualisation is that of a complementary inspection following naked eye examination when dealing with patients at risk for oral cancer. The device allows detection of otherwise invisible lesions and otherwise impossible complete resections. PMID:26900252

  5. Ontology-based modeling of clinical practice guidelines: a clinical decision support system for breast cancer follow-up interventions at primary care settings.

    PubMed

    Abidi, Samina R; Abidi, Syed S R; Hussain, Sajjad; Shepherd, Mike

    2007-01-01

    Breast cancer follow-up care can be provided by family physicians after specialists complete the primary treatment. Cancer Care Nova Scotia has developed a breast cancer follow-up Clinical Practice Guideline (CPG) targeting family physicians. In this paper we present a project to computerize and deploy the said CPG in a Breast Cancer Follow-up Decision Support System (BCF-DSS) for use by family physicians in a primary care setting. We present a semantic web approach to model the CPG knowledge and employ a logic-based proof engine to execute the CPG in order to infer patient-specific recommendations. We present the three stages of the development of BCF-DSS--i.e., (a) Computerization of the paper-based CPG for Breast Cancer follow-up; (b) Development of three ontologies--i.e., the Breast Cancer Ontology, the CPG ontology based on the Guideline Element Model (GEM) and a Patient Ontology; and (c) Execution of the Breast Cancer follow-up CPG through a logic-based CPG execution engine.

  6. Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome

    PubMed Central

    Marra, Alexandre R; Edmond, Michael B; Wenzel, Richard P; Bearman, Gonzalo ML

    2007-01-01

    Background Clostridium difficile-associated disease (CDAD) is a serious nosocomial infection, however few studies have assessed CDAD outcome in the intensive care unit (ICU). We evaluated the epidemiology, clinical course and outcome of hospital-acquired CDAD in the critical care setting. Methods We performed a historical cohort study on 58 adults with a positive C. difficile cytotoxin assay result occurring in intensive care units. Results Sixty-two percent of patients had concurrent infections, 50% of which were bloodstream infections. The most frequently prescribed antimicrobials prior to CDAD were anti-anaerobic agents (60.3%). Septic shock occurred in 32.8% of CDAD patients. The in-hospital mortality was 27.6%. Univariate analysis revealed that SOFA score, at least one organ failure and age were predictors of mortality. Charlson score ≥3, gender, concurrent infection, and number of days with diarrhea before a positive C. difficile toxin assay were not significant predictors of mortality on univariate analysis. Independent predictors for death were SOFA score at infection onset (per 1-point increment, OR 1.40; CI95 1.13–1.75) and age (per 1-year increment, OR 1.10; CI95 1.02–1.19). Conclusion In ICU patients with CDAD, advanced age and increased severity of illness at the onset of infection, as measured by the SOFA score, are independent predictors of death. PMID:17517130

  7. A simplified edge illumination set-up for quantitative phase contrast mammography with synchrotron radiation at clinical doses

    NASA Astrophysics Data System (ADS)

    Longo, Mariaconcetta; Rigon, Luigi; Lopez, Frances C. M.; Chen, Rongchang; Dreossi, Diego; Zanconati, Fabrizio; Longo, Renata

    2015-02-01

    This work presents the first study of x-ray phase contrast imaging based on a simple implementation of the edge illumination method (EIXPCi) in the field of mammography with synchrotron radiation. A simplified EIXPCi set-up was utilized to study a possible application in mammography at clinical doses. Moreover, through a novel algorithm capable of separating and quantifying absorption and phase perturbations of images acquired in EIXPCi modality, it is possible to extract quantitative information on breast images, allowing an accurate tissue identification. The study was carried out at the SYRMEP beamline of Elettra synchrotron radiation facility (Trieste, Italy), where a mastectomy specimen was investigated with the EIXPCi technique. The sample was exposed at three different energies suitable for mammography with synchrotron radiation in order to test the validity of the novel algorithm in extracting values of linear attenuation coefficients integrated over the sample thickness. It is demonstrated that the quantitative data are in good agreement with the theoretical values of linear attenuation coefficients calculated on the hypothesis of the breast with a given composition. The results are promising and encourage the current efforts to apply the method in mammography with synchrotron radiation.

  8. Detection and Management of Diabetes during Pregnancy in Low Resource Settings: Insights into Past and Present Clinical Practices

    PubMed Central

    Delamou, Alexandre; Belaid, Loubna; De Brouwere, Vincent

    2016-01-01

    Background. Timely and adequate treatment is important to limit complications of diabetes affecting pregnancy, but there is a lack of knowledge on how these women are managed in low resource settings. Objective. To identify modalities of gestational diabetes detection and management in low and lower middle income countries. Methods. We conducted a scoping review of published literature and searched the databases PubMed, Web of Science, Embase, and African Index Medicus. We included all articles published until April 24, 2016, containing information on clinical practices of detection and management of gestational diabetes irrespective of publication date or language. Results. We identified 23 articles mainly from Asia and sub-Saharan Africa. The majority of studies were conducted in large tertiary care centers and hospital admission was reported in a third of publications. Ambulatory follow-up was generally done by weekly to fortnightly visits, whereas self-monitoring of blood glucose was not the norm. The cesarean section rate for pregnancies affected by diabetes ranged between 20% and 89%. Referral of newborns to special care units was common. Conclusion. The variety of reported provider practices underlines the importance of promoting latest consensus guidelines on GDM screening and management and the dissemination of information regarding their implementation. PMID:27803934

  9. Effects of Physical Exercise on Neuroinflammation, Neuroplasticity, Neurodegeneration, and Behavior: What We Can Learn From Animal Models in Clinical Settings.

    PubMed

    Svensson, Martina; Lexell, Jan; Deierborg, Tomas

    2015-07-01

    Physical exercise is a cornerstone in the management of many neurodegenerative disorders, such as Parkinson's disease, dementia, and stroke. However, much of its beneficial effects on improving motor functions and cognition as well as decreasing neurodegeneration and neuroinflammation are not yet well understood. The obvious limitations of studying the protective mechanisms behind exercise, for example, brain plasticity and neurodegeneration, could be overcome by generating novel animal models of neurodegenerative disorders. In this narrative review, we discuss the beneficial effects of exercise performed in animal models of neurodegenerative disorders and how the results from animal studies can be used in clinical settings. From preclinical studies, the positive effects of exercise have been related to increased levels of neurotrophic factors, elevated expression of anti-inflammatory cytokines, and reduced levels of pro-inflammatory cytokines and activated microglia. It is clear that parameters influencing the effect of exercise, such as intensity, still remain to be investigated in animal studies in order to find the optimal program that can be translated into exercise interventions for patients with neurodegenerative diseases.

  10. Clinical course and outcome of disseminated intravascular coagulation diagnosed by Japanese Association for Acute Medicine criteria. Comparison between sepsis and trauma.

    PubMed

    Kushimoto, Shigeki; Gando, Satoshi; Saitoh, Daizoh; Ogura, Hiroshi; Mayumi, Toshihiko; Koseki, Kazuhide; Ikeda, Toshiaki; Ishikura, Hiroyasu; Iba, Toshiaki; Ueyama, Masashi; Eguchi, Yutaka; Otomo, Yasuhiro; Okamoto, Kohji; Endo, Shigeatsu; Shimazaki, Shuji

    2008-12-01

    The Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) study group recently announced new diagnostic criteria for DIC. These criteria have been prospectively validated and demonstrated to progress to overt DIC as defined by the International Society on Thrombosis and Haemostasis (ISTH). Although an underlying condition is essential for the development of DIC, it has never been clarified if patients with different underlying disorders have a similar course. Among 329 patients with DIC diagnosed by the JAAM criteria, those with underlying sepsis (n = 98) or trauma (n = 95) were compared. The 28-day mortality rate was significantly higher in sepsis patients than trauma patients (34.7% vs. 10.5%, p < 0.0001). Within three days of fulfilling the JAAM criteria, sepsis patients had a lower platelet count, higher prothrombin time ratio, higher systemic inflammatory response syndrome score, and higher Sequential Organ Failure Assessment score compared with trauma patients. On day 3, a significantly higher percentage of trauma patients than sepsis patients showed improvement of DIC (64.2% vs. 30.6%, p < 0.001). These differences were mainly due to patients with lower JAAM DIC scores. More than 50% of the JAAM DIC patients with sepsis who died within 28 days could not be detected by ISTH DIC criteria during the initial three days. In contrast, most trauma patients who died within 28 days had DIC simultaneously diagnosed by JAAM and ISTH criteria, except for those with brain death. These findings suggest that coagulation abnormalities, organ dysfunction, and the outcome of JAAM DIC differ between patients with sepsis and trauma.

  11. [Japanese encephalitis: a fast-changing viral disease].

    PubMed

    Rodhain, F

    2010-08-01

    The following aspects are dealt with in this article: 1) current geographical distribution of Japanese encephalitis; 2) clinical patterns of Japanese encephalitis; 3) vertebrate hosts of Japanese encephalitis virus; 4) vectors of JE virus; 5) epidemiological locations (endemic area, endemoepidemic area, epidemic area); 6) unknown epidemiological aspects; 7) JE virus serotypes; 8) evolution of the disease and recent epidemiological changes; 9) phylogenetic origin of the JE virus; 10) ecological changes in the past, factors in the emergence of the disease; and 11) the future: Can we predict how the situation will evolve?

  12. Japanese Encephalitis: Frequently Asked Questions

    MedlinePlus

    ... of Page How long does the Japanese encephalitis vaccination last? The duration of protection is unknown. For ... What are the side effects of Japanese encephalitis vaccination? Pain and tenderness are the most commonly reported ...

  13. Characteristics and outcome of patients with primary CNS lymphoma in a "real-life" setting compared to a clinical trial.

    PubMed

    Zeremski, Vanja; Koehler, Michael; Fischer, Thomas; Schalk, Enrico

    2016-04-01

    We aimed to compare the characteristics and outcome of patients treated within the multi-centre German Primary CNS Lymphoma Study Group 1 trial (G-PCNSL-SG-1; TRIAL group) and patients treated outside this clinical trial ("real-life" setting, R-LIFE group). Therefore, we conducted a retrospective single-centre study in order to analyse all patients with newly diagnosed primary CNS lymphoma (PCNSL) treated consecutively in our institution between November 2000 and June 2015. Altogether, 86 patients were analysed (median 68 years). Twenty patients were treated within (TRIAL) and 66 patients outside the clinical trial (R-LIFE), respectively. The majority (n = 75; 87 %) received high-dose methotrexate as the first-line treatment. Thirty-eight of 66 patients (57.6 %) responded to the first-line therapy. The R-LIFE patients were older (median age 70 vs. 62 years; p = 0.005) and had more frequently a worse performance status (ECOG score 2-4: 59.1 vs. 20.0 %; p = 0.004; median Karnofsky index 70 vs. 80 %; p = 0.003) and less frequently a low prognostic score (IELSG score 0-1: 19.7 vs. 45.0 %; p = 0.038), than the TRIAL patients. Median overall survial (OS) was shorter for the R-LIFE patients (9.3 months [95 % CI 1.9-16.7] vs. 33.4 months [95 % CI 17.6-49.2]; p = 0.065). Median progression-free survival (PFS) was significantly inferior for the R-LIFE patients (3.4 months [95 % CI 2.4-4.4] vs. 24.8 months [95 % CI 4.6-45.0]; p = 0.037). Our data indicate that the outcome of PCNSL patients treated outside, but about analogous to the G-PCNSL-SG-1 trial, was poor. This is likely explained by more unfavourable prognostic factors in patients being treated off trial.

  14. An investigation of general predictors for cognitive–behavioural therapy outcome for anxiety disorders in a routine clinical setting

    PubMed Central

    Nielsen, Sara Kerstine Kaya; Vangkilde, Signe; Wolitzky-Taylor, Kate B; Daniel, Sarah Ingrid Franksdatter; Hageman, Ida

    2016-01-01

    Introduction Cognitive–behavioural therapy (CBT) is effective for treating anxiety disorders and is offered in most mental health services around the world. However, a relatively large number of patients with anxiety disorders do not benefit from CBT, experience relapses or drop out. Reliable predictors of treatment effects are lacking. The aim of this study is to investigate the predictive value of emotion regulation and attentional control for CBT outcome in a routine setting. Methods and analysis In this prospective and practice-based study, 112 patients with anxiety disorders referred for manual-based group CBT at two psychiatric outpatient clinics will be recruited. Emotion regulation, severity of anxiety and attentional control will be assessed with self-report measures and with an experimental computer-based attentional control task at baseline, post-treatment and at a 6-month follow-up. Emotion regulation will be measured with Difficulties in Emotion Regulation Questionnaire, severity of anxiety will be assessed with Beck Anxiety Inventory and attentional control will be measured with the self-report questionnaire, Attention Control Scale, and with an experimental computer-based attentional control task based on theory of visual attention. Data will be analysed using multilevel mixed-effects modelling. Ethics and dissemination The study is approved by the Danish National Ethical Board, the Department of Psychology Ethical Board, University of Copenhagen and by the Danish Data Protection Agency. Study findings will be disseminated through peer-reviewed journal publications and conference presentations. The Danish Committee System on Health Research Ethics has been notified about the project. Trial registration number NCT02638363. PMID:27016248

  15. Feasibility of activity-promoting video games among obese adolescents and young adults in a clinical setting.

    PubMed

    Radon, Katja; Fürbeck, Barbara; Thomas, Silke; Siegfried, Wolfgang; Nowak, Dennis; von Kries, Rüdiger

    2011-01-01

    One component of the recent obesity epidemic is the sedentary behaviour of children and adolescents e.g., use of video games consoles. The new generation of video games requires body movements and might thus increase activity. The aim of this study was to evaluate whether such games could have an effect on physical activity in obese adolescents in a clinical setting. Between March and May 2007 activity-promoting video games ("apvg") were offered to all 84 inpatients (aged 13-28 years) registered in a long-term rehabilitation programme on a voluntary base. Reasons for (non-)attendance were assessed. Frequency and duration of use of the activity-promoting video game sessions were documented. Furthermore, heart rate and activity counts during use of "apvg", endurance training, and strength training were measured. Of 84 inpatients, 51 used the "apvg" at least once (69%) over the study period. The median weekly use of the intervention was 27 min during the first week (range 0-182 min), declining to zero (range 0-74 min) in week four. Mean heart rate during the sessions (mean 115 bpm; 95% confidence interval 108-122 bpm) was similar to the heart rate during strength training (106 bpm; 101-112 bpm). The results indicate that the video games could have an impact on the activity of obese adolescents and young adults. However, as the interest in the devices seems to be too low the suitability of them for weight reduction programmes in young people cannot be ensured. PMID:20837400

  16. Feasibility of activity-promoting video games among obese adolescents and young adults in a clinical setting.

    PubMed

    Radon, Katja; Fürbeck, Barbara; Thomas, Silke; Siegfried, Wolfgang; Nowak, Dennis; von Kries, Rüdiger

    2011-01-01

    One component of the recent obesity epidemic is the sedentary behaviour of children and adolescents e.g., use of video games consoles. The new generation of video games requires body movements and might thus increase activity. The aim of this study was to evaluate whether such games could have an effect on physical activity in obese adolescents in a clinical setting. Between March and May 2007 activity-promoting video games ("apvg") were offered to all 84 inpatients (aged 13-28 years) registered in a long-term rehabilitation programme on a voluntary base. Reasons for (non-)attendance were assessed. Frequency and duration of use of the activity-promoting video game sessions were documented. Furthermore, heart rate and activity counts during use of "apvg", endurance training, and strength training were measured. Of 84 inpatients, 51 used the "apvg" at least once (69%) over the study period. The median weekly use of the intervention was 27 min during the first week (range 0-182 min), declining to zero (range 0-74 min) in week four. Mean heart rate during the sessions (mean 115 bpm; 95% confidence interval 108-122 bpm) was similar to the heart rate during strength training (106 bpm; 101-112 bpm). The results indicate that the video games could have an impact on the activity of obese adolescents and young adults. However, as the interest in the devices seems to be too low the suitability of them for weight reduction programmes in young people cannot be ensured.

  17. Contemporary issues concerning informed consent in Japan based on a review of court decisions and characteristics of Japanese culture

    PubMed Central

    2014-01-01

    Background Since Japan adopted the concept of informed consent from the West, its inappropriate acquisition from patients in the Japanese clinical setting has continued, due in part to cultural aspects. Here, we discuss the current status of and contemporary issues surrounding informed consent in Japan, and how these are influenced by Japanese culture. Discussion Current legal norms towards informed consent and information disclosure are obscure in Japan. For instance, physicians in Japan do not have a legal duty to inform patients of a cancer diagnosis. To gain a better understanding of these issues, we present five court decisions related to informed consent and information disclosure. We then discuss Japanese culture through reviews of published opinions and commentaries regarding how culture affects decision making and obtaining informed consent. We focus on two contemporary problems involving informed consent and relevant issues in clinical settings: the misuse of informed consent and persistence in obtaining consent. For the former issue, the phrase "informed consent" is often used to express an opportunity to disclose medical conditions and recommended treatment choices. The casual use of the expression "informed consent" likely reflects deep-rooted cultural influences. For the latter issue, physicians may try to obtain a signature by doing whatever it takes, lacking a deep understanding of important ethical principles, such as protecting human dignity, serving the patient’s best interest, and doing no harm in decision-making for patients. There is clearly a misunderstanding of the concept of informed consent and a lack of complete understanding of ethical principles among Japanese healthcare professionals. Although similar in some respects to informed consent as it originated in the United States, our review makes it clear that informed consent in Japan has clear distinguishing features. Summary Japanese healthcare professionals should aim to understand

  18. Japanese Experiences: "Hentai" Narratives

    ERIC Educational Resources Information Center

    Kama, Amit

    2011-01-01

    For those acquainted with Japanese lesbian, gay, bisexual, and transgender (LGBT) issues, "Queer Voices from Japan" can be good reading. But with only 1 of its 22 chapters informative for researchers, those interested in LGBT youth studies will only indirectly gain insight into a non-Western perspective on youth and sexuality.

  19. Japanese American Intermarriage.

    ERIC Educational Resources Information Center

    Endo, Russell; Hirokawa, Dale

    Data for this study of Japanese American intermarriage in Denver (Colorado) from 1910-11 to 1980-81 were collected from marriage records in the Office of the Clerk and Recorder for the City and County of Denver. In order to compare intermarriage trends with available census figures (mostly on population size and sex composition), records were…

  20. Reflections on Japanese Education.

    ERIC Educational Resources Information Center

    Pegels, Joyce

    1979-01-01

    Describes the educational system in Japan and outlines a secondary level social studies unit. Topics include the agricultural, industrial, artistic, and religious aspects of Japan. The author observed a genuine "term spirit" among Japanese students, greater respect for school property, and a heightened awareness for the value of education. (KC)

  1. Japanese Temple Geometry

    ERIC Educational Resources Information Center

    Vincent, Jill; Vincent, Claire

    2004-01-01

    Between the 17th and 19th centuries, the Japanese government closed its borders to the outside world in an attempt to become more powerful. Foreign books were banned, people could not travel, and foreigners were not allowed to enter the country. One result of this isolation was the flourishing of sangaku--wooden tablets inscribed with intricately…

  2. Reciprocal Predicates in Japanese.

    ERIC Educational Resources Information Center

    Ishii, Yasuo

    A study of reciprocals in Japanese compares two kinds: (1) a verbal suffix "aw"; and (2) an NP argument "otagai." Although "otagai" appears to be taken care of by syntactic binding theory, it is proposed that there is no evidence for the existence of a syntactic position of the object NP in the case of "aw." The suffix can be characterized as…

  3. Implementation of a PACS for radiography training and clinical service in a university setting through a multinational effort

    NASA Astrophysics Data System (ADS)

    Tang, Fuk-hay; Law, Yuen Y.; Zhang, Jianguo; Liu, Hai L.; Chang, Tony; Matsuda, Koyo; Cao, Fei

    2001-08-01

    The Hong Kong Polytechnic University has a Radiography Division under the Development of Optometry and Radiography. The Division trains both diagnostic and therapeutic radiographers with 60 students/year and offers a B.Sc. degree. In addition the Division together with the University Health Service operates a radiography clinic with radiology consultation from radiologists from other hospitals and clinics. This paper describers the implementation of a PACS in the Division for radiography training, and for clinical service.

  4. Lipoprotein cholesterol and triglyceride concentrations associated with dog body condition score; effect of recommended fasting duration on sample concentrations in Japanese private clinics

    PubMed Central

    USUI, Shiho; YASUDA, Hidemi; KOKETSU, Yuzo

    2015-01-01

    The objectives of this study were to survey clinics’ guidance about recommended fasting duration (FD) prior to lipoprotein analysis, and to characterize lipoprotein cholesterol and triglyceride concentrations in obese and overweight dogs categorized on the basis of the 5-point body condition score (BCS) scale. A dataset was created from lipoprotein analysis medical records of 1,538 dogs from 75 breeds in 354 clinics from 2012 to 2013. A phone survey was conducted to obtain the clinics’ FD. Two-level linear mixed-effects models were applied to the data. Over 50% of the clinics said they recommended fasting for 12 hr or more. Dogs in clinics with FD 12 hr or more had lower chylomicron triglyceride concentrations than those in clinics with FD less than 8 hr (P=0.05). Mean (± SEM) BCS at sampling was 3.7 ± 0.02. Obese and overweight dogs had higher very low density lipoprotein (VLDL) and high density lipoprotein (HDL) cholesterol and triglyceride concentrations than ideal dogs (P<0.05), but no such difference was found for low density lipoprotein cholesterol and triglyceride concentrations (P≥0.07). Across all BCS, as dog age rose from 0 to 8 years old, HDL cholesterol concentrations decreased by 13.5 mg/dl, whereas VLDL triglyceride concentrations increased by 81.7 mg/dl (P<0.05). In conclusion, FD of 8 hr or less may affect lipoprotein lipid concentrations. Obese and overweight dogs were characterized as having high VLDL and HDL cholesterol and triglyceride concentrations. PMID:25866404

  5. A comparison of effectiveness of hepatitis B screening and linkage to care among foreign-born populations in clinical and nonclinical settings.

    PubMed

    Chandrasekar, Edwin; Kaur, Ravneet; Song, Sharon; Kim, Karen E

    2015-01-01

    Hepatitis B (HBV) is an urgent, unmet public health issue that affects Asian Americans disproportionately. Of the estimated 1.2 million living with chronic hepatitis B in USA, more than 50% are of Asian ethnicity, despite the fact that Asian Americans constitute less than 6% of the total US population. The Centers for Disease Control and Prevention recommends HBV screening of persons who are at high risk for the disease. Yet, large numbers of Asian Americans have not been diagnosed or tested, in large part because of perceived cultural and linguistic barriers. Primary care physicians are at the front line of the US health care system, and are in a position to identify individuals and families at risk. Clinical settings integrated into Asian American communities, where physicians are on staff and wellness care is emphasized, can provide testing for HBV. In this study, the Asian Health Coalition and its community partners conducted HBV screenings and follow-up linkage to care in both clinical and nonclinical settings. The nonclinic settings included health fair events organized by churches and social services agencies, and were able to reach large numbers of individuals. Twice as many Asian Americans were screened in nonclinical settings than in health clinics. Chi-square and independent samples t-test showed that participants from the two settings did not differ in test positivity, sex, insurance status, years of residence in USA, or education. Additionally, the same proportion of individuals found to be infected in the two groups underwent successful linkage to care. Nonclinical settings were as effective as clinical settings in screening for HBV, as well as in making treatment options available to those who tested positive; demographic factors did not confound the similarities. Further research is needed to evaluate if linkage to care can be accomplished equally efficiently on a larger scale. PMID:25609976

  6. [Expression of SET-NUP214 fusion gene in patients with T-cell acute lymphoblastic leukemia and its clinical significance].

    PubMed

    Dai, Hai-Ping; Wang, Qian; Wu, Li-Li; Ping, Na-Na; Wu, Chun-Xiao; Xie, Jun-Dan; Pan, Jin-Lan; Xue, Yong-Quan; Wu, De-Pei; Chen, Su-Ning

    2012-10-01

    This study was aimed to investigate the occurrence and clinical significance of the SET-NUP214 fusion gene in patients with T-cell acute lymphoblastic leukemia (T-ALL), analyse clinical and biological characteristics in this disease. RT-PCR was used to detect the expression of SET-NUP214 fusion gene in 58 T-ALL cases. Interphase FISH and Array-CGH were used to detect the deletion of 9q34. Direct sequencing was applied to detect mutations of PHF6 and NOTCH1. The results showed that 6 out of 58 T-ALL cases (10.3%) were detected to have the SET-NUP214 fusion gene by RT-PCR. Besides T-lineage antigens, expression of CD13 and(or) CD33 were detected in all the 6 cases. Deletions of 9q34 were detected in 4 out of the 6 patients by FISH. Array-CGH results of 3 SET-NUP214 positive T-ALL patients confirmed that this fusion gene was resulted from a cryptic deletion of 9q34.11q34.13. PHF6 and NOTCH1 gene mutations were found in 4 and 5 out of 6 SET-NUP214 positive T-ALL patients, respectively. It is concluded that SET-NUP214 fusion gene is often resulted from del(9)(q34). PHF6 and NOTCH1 mutations may be potential leukemogenic event in SET-NUP214 fusion gene.

  7. What's Stopping Them? A Study of Teachers' Use of Formative Feedback with Students Learning in the Clinical Setting

    ERIC Educational Resources Information Center

    Campos, Susan

    2013-01-01

    Acknowledging the powerful that role formative feedback plays in learning, students who are training for professions in the clinical setting and learn while working alongside professionals in their field report that they receive limited feedback. Formative feedback helps students gauge progress, identify weaknesses, and improve performance as well…

  8. The Effectiveness of Peer Taught Group Sessions of Physiotherapy Students within the Clinical Setting: A Quasi-Experimental Study

    ERIC Educational Resources Information Center

    Scott, Dee; Jelsma, Jennifer

    2014-01-01

    The study aimed to investigate whether learning from peers, learning from a clinical educator, or being the peer teacher during clinical group sessions was more effective at enhancing student learning outcomes for different health conditions. A secondary aim was to determine which method students found more satisfactory. Physiotherapy students at…

  9. Patterns of Return to Oral Intake and Decannulation Post-tracheostomy across Clinical Populations in an Acute Inpatient Setting

    ERIC Educational Resources Information Center

    Pryor, Lee; Ward, Elizabeth; Cornwell, Petrea; O'Connor, Stephanie; Chapman, Marianne

    2016-01-01

    Background: Dysphagia is often a comorbidity in patients who require a tracheostomy, yet little is known about patterns of oral intake commencement in tracheostomized patients, or how patterns may vary depending on the clinical population and/or reason for tracheostomy insertion. Aims: To document patterns of clinical management around the…

  10. The Impact of Structured Inter-professional Education on Health Care Professional Students' Perceptions of Collaboration in a Clinical Setting

    PubMed Central

    Lee, Sam; Lombardo, Samantha; Salama, Mariam; Ellis, Sandi; Kay, Theresa; Davies, Robyn; Landry, Michel D.

    2012-01-01

    ABSTRACT Purpose: To examine how a structured inter-professional education (IPE) clinical placement influences health care professional (HCP) students' perceptions of inter-professional collaboration (IPC) relative to that of students in a traditional clinical placement. Methods: This study used a mixed-methods design. The Interdisciplinary Education Perception Scale (IEPS) was administered to HCP students (n=36) in two Toronto hospitals before and after a structured 5-week IPE clinical placement to examine changes in their perceptions of IPC. Students in a traditional clinical placement (n=28) were used as a control group. Focus groups were then conducted with seven students who took part in the structured IPE clinical placement. A coding framework was devised a priori, and the qualitative results were used to explain the quantitative findings. Results: There were no statistically significant differences between groups after the structured IPE clinical placement, but the intervention group showed a greater positive trend in total IEPS scores from baseline to follow-up. Qualitative data suggest that students valued the knowledge and skills gained through the structured IPE clinical placement. Conclusions: Findings suggest that structured IPE clinical placements may provide students with valuable collaborative learning opportunities, enhanced respect for other professionals, and insight into the value of IPC in healthcare delivery. More research is needed to explore other factors that influence specific perceptions among physical therapy students. PMID:23450044

  11. Chemomechanical caries removal method versus mechanical caries removal methods in clinical and community-based setting: A comparative in vivo study

    PubMed Central

    Kumar, K. V. K. Santosh; Prasad, M. Ghanashyam; Sandeep, R. Venkata; Reddy, S. Pavani; Divya, D.; Pratyusha, K.

    2016-01-01

    Objective: To compare the effectiveness of various caries removal techniques in mandibular primary molars using Smart Burs, atraumatic restorative technique (ART) (mechanical caries removal) and Carie-care (chemomechanical caries removal [CMCR]) among primary school children in clinical and community-based settings. Materials and Methods: A total of 80 carious primary mandibular molars were selected for the study from the dental clinic and community. They were equally assigned to four groups according to caries removal technique and also by the operating site. In Group 1, caries was removed using Carie-care in the dental clinic and in Group 2, with Smart Burs in the dental clinic. In Group 3, caries was removed using Carie-care in the field and in Group 4, with the ART in the field. The time taken for caries removal, the efficacy of caries removal and patient acceptance were evaluated with different caries removal techniques. Statistical Analysis: The obtained data were subjected to statistical analysis by ANOVA test. Results: In clinical settings, Carie-care was time-consuming but was more efficient with increased acceptance than Smart Burs and the result was found to be significant statistically (P < 0.05). In community-based settings, Carie-care was more efficient, less time consuming, and showed an increased acceptance when compared to atraumatic restorative treatment and the result was found to be significant statistically (P < 0.05). Conclusions: The CMCR technique was superior to the mechanical caries removal technique in primary teeth among school children in terms of time, efficacy, and acceptance in both clinical- and community-based settings. PMID:27403059

  12. How Can We Improve Outcomes for Patients and Families Under Palliative Care? Implementing Clinical Audit for Quality Improvement in Resource Limited Settings

    PubMed Central

    Selman, Lucy; Harding, Richard

    2010-01-01

    Palliative care in India has made enormous advances in providing better care for patients and families living with progressive disease, and many clinical services are well placed to begin quality improvement initiatives, including clinical audit. Clinical audit is recognized globally to be essential in all healthcare, as a way of monitoring and improving quality of care. However, it is not common in developing country settings, including India. Clinical audit is a cyclical activity involving: identification of areas of care in need of improvement, through data collection and analysis utilizing an appropriate questionnaire; setting measurable quality of care targets in specific areas; designing and implementing service improvement strategies; and then re-evaluating quality of care to assess progress towards meeting the targets. Outcome measurement is an important component of clinical audit that has additional advantages; for example, establishing an evidence base for the effectiveness of services. In resource limited contexts, outcome measurement in clinical audit is particularly important as it enables service development to be evidence-based and ensures resources are allocated effectively. Key success factors in conducting clinical audit are identified (shared ownership, training, managerial support, inclusion of all members of staff and a positive approach). The choice of outcome measurement tool is discussed, including the need for a culturally appropriate and validated measure which is brief and simple enough to incorporate into clinical practice and reflects the holistic nature of palliative care. Support for clinical audit is needed at a national level, and development and validation of an outcome measurement tool in the Indian context is a crucial next step. PMID:20859465

  13. Westernization of lifestyle markedly increases carotid intima-media wall thickness (IMT) in Japanese people.

    PubMed

    Watanabe, Hiroshi; Yamane, Kiminori; Fujikawa, Rumi; Okubo, Masamichi; Egusa, Genshi; Kohno, Nobuoki

    2003-01-01

    To illustrate the impact of westernization of lifestyle on the development of pre-clinical atherosclerosis in Japanese people, we compared risk factors for atherosclerosis such as serum lipids, blood pressure, BMI, insulin resistance, and smoking habits between non-diabetic native Japanese and non-diabetic Japanese Americans. Two hundred and twenty two non-diabetic Japanese Americans living in Hawaii and 271 non-diabetic Japanese living in Hiroshima, Japan were studied. Carotid intima-media wall thickness (IMT) was measured in all subjects by one physician. For all measurements the same ultrasound instrumentation was used. Although no significant differences were seen in serum total cholesterol (TC), triglycerides, or LDL-cholesterol (LDL-C) levels between the two groups in the 1998 study, previous to 1998 these three parameters were significantly higher in Japanese Americans than native Japanese in our study which has spanned the past 20 years. IMT was significantly greater in Japanese Americans than native Japanese (1.20+/-0.03 mm vs. 0.98+/-0.03 mm, (mean+/-S.E.) respectively; P<0.0001). Moreover Japanese Americans reach an IMT of 1.1 mm at age 50, whereas the native Japanese reach this value at age 70. These observations indicate more rapid atherosclerosis progression in Japanese Americans. Based on our IMT measurements, the status and the estimated progression of atherosclerosis in Japanese Americans is increased. Since IMT is a validated endpoint for assessment of atherosclerotic disease risk, it can be concluded that Japanese Americans are at increased risk for cardiovascular disease.

  14. 06. Facilitating Collection of Research and Quality Data in Integrative Medicine Clinical Settings: Views From Academic, Health System and Private Clinics

    PubMed Central

    Dolor, Rowena; Victorson, David; Amoils, Steve

    2013-01-01

    Focus Areas: Integrative Approaches to Care The purpose of this panel discussion is to share successful efforts from a practice-based research network (PBRN) including ten integrative medicine clinics. The BraveNet PBRN includes integrative medicine clinics with academic health centers, large health systems, and a stand-alone private practice clinic. While clinical care is prioritized across all of these centers, introducing research into clinical sites oriented to providing care poses challenges that vary by clinic environment. We will highlight some of the unique issues encountered when trying to standardize data collection in sites practicing a patient-centered, whole-systems approach to healing as well as the solutions used to overcome these issues. We will present some operational solutions and data collected from the PBRN's ongoing data registry, entitled PRIMIER. The panel will engage attendees in a dialogue centering on potential for future analyses of existing results, ideas for possible upcoming studies, and creative ways to expand the PBRN data registry to include additional sites that may have expertise and interest in participating.

  15. Flowering of Japanese astronomy

    SciTech Connect

    Kozai, Y.

    1988-06-01

    A development history is presented for Japanese astronomy from the 6th century to the present day, together with a status report and account of future plans. About 500 professionals currently belong to the Astronomical Society of Japan. Tokyo's Mitaka Observatory employs a staff of about 70 astronomers; most modern astronomical instruments, however, have been installed at sites outside the Tokyo area. The limitations of present instruments are notably severe for astronomers working in the visible and IR wavelengths.

  16. Japanese technology assessment

    SciTech Connect

    Albus, J.

    1986-01-01

    This series of studies assesses Japanese technology in four of today's most visible high-technology areas. Selected part and chapter titles: COMPUTER SCIENCE - Artificial Intelligence and Man-Machine Interface, Processor Architecture and Computer Organization; OPTO- and MICROELECTRONICS - Metal Contacts to III-V Semi-conductors, Josephson Devices and Technology; MECHATRONICS - Flexible Manufacturing Systems Development, Manipulators/Actuators; BIOTECHNOLOGY - Genetic Information Transfer Biosensors.

  17. Suicide of Japanese Youth.

    PubMed

    Iga, M

    1981-01-01

    The uniquely intense stress due to the Examination Hell (shiken jigoku) not only generates a basic drive for Japan's economic success but also contributes to a high rate of young people's suicide. This paper discusses the major factors in the intensity of Japanese stress on both institutional and psychological levels. The social structural factors which convert stress to suicide are analyzed in terms of weak ego; restraint on aggression; a lack of social resources; and views of life, death and suicide. Japanese views of life, death and suicide are treated in terms of Absolute phenomenalism, the original form of Shintoism, to which Buddhism and Confucianism have been adjusted in Japan. Japanese phenomenalism affects suicide through its three aspects: animism, present-time oriented small groupism, and the absolute acceptance of the established social order. Confusion and conflict since World War II have increased anomic suicides; however, elements of fatalistic suicide (due to excessive formal or informal social regulations) and altruistic suicide (due to excessive formal or informal social regulations) and altruistic suicide (due to strong social integration) are evident. Suicide is still a highly institutionalized adjustment mechanism in Japan.

  18. Consensus evidence-based guidelines for in-patient management of hyperglycaemia in non-critical care setting as per Indian clinical practice.

    PubMed

    Gangopadhyay, Kalyan Kumar; Bantwal, Ganapathi; Talwalkar, Pradeep G; Muruganathan, A; Das, Ashok Kumar

    2014-07-01

    Hyperglycaemia is an indicator of poor clinical outcome and mortality in patients with or without a history of diabetes in hospitalised patients in non-critical care condition. A consensus guideline has been developed by a panel of experts based on existing guidelines with specific attention to Indian clinical practice on the management of hyperglycaemia in patients admitted to non-critical care settings. Diagnosis for hyperglycaemia at the time of hospital admission is essential for appropriate treatment during the hospital stay and at the time of discharge. Following a consistent blood glucose target from admission to discharge is recommended for optimal glycaemic management in these settings. Intervention with scheduled subcutaneous insulin therapy using basal, bolus and correctional insulin, and avoiding sliding scale insulin therapy is the key to effective management of inpatient hyperglycaemia. A safe and effective transition of therapy between home and hospital setting based on hyperglycaemic status is essential to avoid large variations in glycaemic status. The consensus guidelines will provide a basis for better clinical practice in the Indian scenario for the management of hyperglycaemia in non-critical care settings.

  19. Efficacy of keishibukuryogan, a traditional Japanese herbal medicine, in treating cold sensation and numbness after stroke: clinical improvement and skin temperature normalization in 22 stroke patients.

    PubMed

    Fujita, Keishi; Yamamoto, Tetsuya; Kamezaki, Takao; Matsumura, Akira

    2010-01-01

    Cold sensation and numbness have been reported as post-stroke sensory sequelae attributable to distal axonopathy, which is caused by chronic ischemia of diseased limbs resulting from dysfunction of vasomotor regulatory systems. Keishibukuryogan is a traditional herbal medicine used to treat symptoms of peripheral ischemia such as cold extremities. This study investigated clinical improvement and skin temperature in peripheral ischemia patients to determine the efficacy of keishibukuryogan in alleviating post-stroke cold sensation and numbness. Twenty-two stroke patients with cold sensation and/or numbness were enrolled in this study. Subjective cold sensation and numbness, evaluated using the visual analogue scale, were found in 21 and 31 limbs, respectively. The skin temperature of diseased and healthy limbs was recorded. We observed all patients for 4 weeks and 17 patients for 8 weeks after administration of keishibukuryogan. The skin temperature of diseased limbs was significantly higher than baseline at 4 weeks and 8 weeks, whereas that of healthy limbs did not change significantly. Cold sensation and numbness were significantly improved at 4 weeks and 8 weeks compared to baseline. Keishibukuryogan administration resulted in warming of diseased limbs and improved cold sensation and numbness, probably by increasing peripheral blood flow.

  20. Effect of probiotic Bifidobacterium longum BB536 [corrected] in relieving clinical symptoms and modulating plasma cytokine levels of Japanese cedar pollinosis during the pollen season. A randomized double-blind, placebo-controlled trial.

    PubMed

    Xiao, J Z; Kondo, S; Yanagisawa, N; Takahashi, N; Odamaki, T; Iwabuchi, N; Iwatsuki, K; Kokubo, S; Togashi, H; Enomoto, K; Enomoto, T

    2006-01-01

    Probiotic microorganisms have been shown to be effective in the treatment of allergic inflammation and food allergy, but their efficacy remains controversial. This study tested the effect of a yogurt supplemented with a probiotic strain Bifidobacterium longum BB536 in the treatment of Japanese cedar pollinosis (JCPsis). Forty subjects with a clinical history of JCPsis were given yoghurt either containing BB536 (BB536 yoghurt) or without BB536 (placebo yoghurt) at 2 X 100 g per day for 14 weeks, in a randomized, double-blind, placebo-controlled trial. Subjective symptoms and self-care measures were recorded daily and blood samples were taken before and during the intervention (at weeks 4, 9, and 14) to measure the blood parameter levels related to JCPsis. Yoghurt supplemented with BB536 significantly alleviated eye symptoms compared with placebo yoghurt (odds ratio 0.31; 95% confidence interval 0.10-0.97; p = 0.044). Although no statistically significant differences were detected, nasal symptoms such as itching, rhinorrhea, and blockage, as well as throat symptoms tended to be relieved with the BB536 yoghurt. BB536 tended to suppress the decreasing blood levels of interferon-gamma (IFN-y) and the increasing blood eosinophil rates; a significantly higher IFN-gamma level was observed for the difference from baseline at week 4. A decreased trend in the difference from baseline levels of JCP-specific IgE levels was also observed at week 4 in the BB536 group compared with the placebo group. In conclusion, these results suggest that intake of BB536-supplemented yoghurt may relieve JCPsis symptoms, probably through a modulating effect on Th balance.

  1. Design of clinical trials in AKI: a report from an NIDDK workshop. Trials of patients with sepsis and in selected hospital settings.

    PubMed

    Molitoris, Bruce A; Okusa, Mark D; Palevsky, Paul M; Chawla, Lakhmir S; Kaufman, James S; Devarajan, Prasad; Toto, Robert M; Hsu, Chi-yuan; Greene, Tom H; Faubel, Sarah G; Kellum, John A; Wald, Ron; Chertow, Glenn M; Levin, Adeera; Waikar, Sushrut S; Murray, Patrick T; Parikh, Chirag R; Shaw, Andrew D; Go, Alan S; Chinchilli, Vernon M; Liu, Kathleen D; Cheung, Alfred K; Weisbord, Steven D; Mehta, Ravindra L; Stokes, John B; Thompson, Aliza M; Thompson, B Taylor; Westenfelder, Christof S; Tumlin, James A; Warnock, David G; Shah, Sudhir V; Xie, Yining; Duggan, Emily G; Kimmel, Paul L; Star, Robert A

    2012-05-01

    AKI remains an important clinical problem, with a high mortality rate, increasing incidence, and no Food and Drug Administration-approved therapeutics. Advances in addressing this clinical need require approaches for rapid diagnosis and stratification of injury, development of therapeutic agents based on precise understanding of key pathophysiological events, and implementation of well designed clinical trials. In the near future, AKI biomarkers may facilitate trial design. To address these issues, the National Institute of Diabetes and Digestive and Kidney Diseases sponsored a meeting, "Clinical Trials in Acute Kidney Injury: Current Opportunities and Barriers," in December of 2010 that brought together academic investigators, industry partners, and representatives from the National Institutes of Health and the Food and Drug Administration. Important issues in the design of clinical trials for interventions in AKI in patients with sepsis or AKI in the setting of critical illness after surgery or trauma were discussed. The sepsis working group discussed use of severity of illness scores and focus on patients with specific etiologies to enhance homogeneity of trial participants. The group also discussed endpoints congruent with those endpoints used in critical care studies. The second workgroup emphasized difficulties in obtaining consent before admission and collaboration among interdisciplinary healthcare groups. Despite the difficult trial design issues, these clinical situations represent a clinical opportunity because of the high event rates, severity of AKI, and poor outcomes. The groups considered trial design issues and discussed advantages and disadvantages of several short- and long-term primary endpoints in these patients.

  2. Clinical Documentation and Data Transfer from Ebola and Marburg Virus Disease Wards in Outbreak Settings: Health Care Workers’ Experiences and Preferences

    PubMed Central

    Bühler, Silja; Roddy, Paul; Nolte, Ellen; Borchert, Matthias

    2014-01-01

    Understanding human filovirus hemorrhagic fever (FHF) clinical manifestations and evaluating treatment strategies require the collection of clinical data in outbreak settings, where clinical documentation has been limited. Currently, no consensus among filovirus outbreak-response organisations guides best practice for clinical documentation and data transfer. Semi-structured interviews were conducted with health care workers (HCWs) involved in FHF outbreaks in sub-Saharan Africa, and with HCWs experienced in documenting and transferring data from high-risk areas (isolation wards or biosafety level 4 laboratories). Methods for data documentation and transfer were identified, described in detail and categorised by requirement for electricity and ranked by interviewee preference. Some methods involve removing paperwork and other objects from the filovirus disease ward without disinfection. We believe that if done properly, these methods are reasonably safe for certain settings. However, alternative methods avoiding the removal of objects, or involving the removal of paperwork or objects after non-damaging disinfection, are available. These methods are not only safer, they are also perceived as safer and likely more acceptable to health workers and members of the community. The use of standardised clinical forms is overdue. Experiments with by sunlight disinfection should continue, and non-damaging disinfection of impregnated paper, suitable tablet computers and underwater cameras should be evaluated under field conditions. PMID:24556792

  3. [Management of Ethical Problems in the Japanese Society of Laboratory Medicine].

    PubMed

    Murakami, Masami

    2015-02-01

    The Ethics Committee of the Japanese Society of Laboratory Medicine published "Opinions of Japanese Society of Laboratory Medicine about utilization of specimens after laboratory examinations for laboratory work, education and clinical studies" in 2002, and amended it in 2008. The Ethics Committee, Committee for Conflict of Interest, Compliance Committee, and Editorial Committee for Rinsho Byori, the official journal of the Japanese Society of Laboratory Medicine, cooperate to solve ethical problems in laboratory medicine. The management of ethical problems in the Japanese Society of Laboratory Medicine is discussed.

  4. The role of psychology in a pediatric outpatient cardiology setting: preliminary results from a new clinical program.

    PubMed

    Brosig, Cheryl; Yang, Kai; Hoffmann, Raymond G; Dasgupta, Mahua; Mussatto, Kathleen

    2014-12-01

    The aim of this study was to provide a descriptive analysis of a new clinical program integrating psychology services within a pediatric outpatient cardiology clinic. Patients with congenital heart disease (CHD) (n = 79) were referred for psychological services by their pediatric cardiologist. Parents completed the child behavior checklist, and the pediatric quality of life inventory generic core scales (PedsQL parent report). Teachers completed the teacher report form. Reasons for referral included: emotional problems (29%); attention problems (25%); learning problems (22%); behavior problems (16%); and developmental delay (8%). Parents and teachers reported higher rates of behavior problems and lower quality of life scores than the general population. Psychological evaluation suggested that incorporating a psychologist within a pediatric cardiology clinic may be beneficial for children with CHD in order to optimize their psychosocial functioning. Practice implications for implementing psychology services within a pediatric outpatient cardiology program are discussed.

  5. Teaching Skills in the Clinical Setting: Planning Teaching Methods. Health Occupations Clinical Teacher Education Series for Secondary and Post-Secondary Educators.

    ERIC Educational Resources Information Center

    Shea, Mary Lou; And Others

    This learning module, which is part of a staff development program for health occupations clinical instructors, discusses selecting appropriate and effective teaching methods and identifying ways of involving students in the learning process. It includes learning activities dealing with using the teacher exposition, demonstration-performance, and…

  6. Survival of Patients with Chronic Myelocytic Leukemia: Comparisons of Estimates from Clinical Trial Settings and Population-Based Cancer Registries

    PubMed Central

    Gondos, Adam; Redaniel, Maria Theresa; Brenner, Hermann

    2011-01-01

    Introduction. The survival of patients with chronic myelocytic leukemia (CML) has improved during the past decades. However, there have been discrepancies between results reported from clinical trials and population-based studies. We aimed to elucidate the extent of these discrepancies. Methods. We examined the 5-year survival rate of patients in clinical trials of CML treatment and compared these results with the survival of patients in the general population using the Surveillance, Epidemiology, and End Results (SEER) database, correcting for differences in the age structure of the patient populations. Results. Twenty-nine trials were identified for data extraction. The survival rate calculated from SEER data was lower than the survival rate in clinical trials in the corresponding period, with differences of 2.1%–50.7%. Age-adapted survival was similar for four trials, but differences up to 35.8% were seen in most. Limitations of the study include the lack of information on chemotherapy in the SEER database and possible heterogeneity of cases. Discussion. The survival rate in clinical trials of CML treatment is higher than the survival rate of all patients with CML. We speculate that the difference may be a result of access to better medications, selection of healthier patients for trials, and the time necessary for adoption of new treatments. This finding underscores the need for population-based studies to give a more realistic idea of survival for patients with a given malignancy in the general population. PMID:21471276

  7. Patients' Perceptions of Dehumanization of Patients in Dental School Settings: Implications for Clinic Management and Curriculum Planning.

    PubMed

    Raja, Sheela; Shah, Raveena; Hamad, Judy; Van Kanegan, Mona; Kupershmidt, Alexandra; Kruthoff, Mariela

    2015-10-01

    Although the importance of empathy, rapport, and anxiety/pain awareness in dentist-patient relations has been well documented, these factors continue to be an issue with patients in many dental school clinics. The aim of this study was to develop an in-depth understanding of how patients at an urban, university-affiliated medical center and its dental school's clinic experienced oral health care and to generate ideas for improving the dental school's clinical curriculum and management of the clinic. Although patient satisfaction surveys are common, in-depth patient narratives are an underutilized resource for improving dental education. In-depth qualitative interviews were conducted with 20 uninsured or underinsured dental patients at these sites, and the results were analyzed using content analysis. Major phenomena that participants discussed were the importance of empathy and good rapport with their oral health providers and provider awareness of dental pain and anxiety. Many patients also discussed feeling dehumanized during dental visits. Based on their positive and negative experiences, the participants made suggestions for how oral health professionals can successfully engage patients in treatment. PMID:26427779

  8. Patients' Perceptions of Dehumanization of Patients in Dental School Settings: Implications for Clinic Management and Curriculum Planning.

    PubMed

    Raja, Sheela; Shah, Raveena; Hamad, Judy; Van Kanegan, Mona; Kupershmidt, Alexandra; Kruthoff, Mariela

    2015-10-01

    Although the importance of empathy, rapport, and anxiety/pain awareness in dentist-patient relations has been well documented, these factors continue to be an issue with patients in many dental school clinics. The aim of this study was to develop an in-depth understanding of how patients at an urban, university-affiliated medical center and its dental school's clinic experienced oral health care and to generate ideas for improving the dental school's clinical curriculum and management of the clinic. Although patient satisfaction surveys are common, in-depth patient narratives are an underutilized resource for improving dental education. In-depth qualitative interviews were conducted with 20 uninsured or underinsured dental patients at these sites, and the results were analyzed using content analysis. Major phenomena that participants discussed were the importance of empathy and good rapport with their oral health providers and provider awareness of dental pain and anxiety. Many patients also discussed feeling dehumanized during dental visits. Based on their positive and negative experiences, the participants made suggestions for how oral health professionals can successfully engage patients in treatment.

  9. Costing nursing care: using the clinical care classification system to value nursing intervention in an acute-care setting.

    PubMed

    Moss, Jacqueline; Saba, Virginia

    2011-08-01

    The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer ($2.43), nursing status report/assess-monitor ($4.22), medication treatment/perform-direct ($6.33), physical examination/assess-monitor ($3.20), and universal precautions/perform-direct ($1.96). Future studies across a variety of nursing specialties and units are needed to validate the relative value unit for Clinical Care Classification System action types developed for use with the Clinical Care Classification System nursing interventions as a method to cost nursing care.

  10. Group-Based Preference Assessment for Children and Adolescents in a Residential Setting: Examining Developmental, Clinical, Gender, and Ethnic Differences

    ERIC Educational Resources Information Center

    Volz, Jennifer L. Resetar; Cook, Clayton R.

    2009-01-01

    This study examines developmental, clinical, gender, and ethnic group differences in preference in residentially placed children and adolescents. In addition, this study considers whether residentially placed youth prefer stimuli currently being used as rewards as part of a campuswide token economy system and whether youth would identify preferred…

  11. Subgroup analysis of Japanese patients in a phase 3 study of lenvatinib in radioiodine-refractory differentiated thyroid cancer.

    PubMed

    Kiyota, Naomi; Schlumberger, Martin; Muro, Kei; Ando, Yuichi; Takahashi, Shunji; Kawai, Yasukazu; Wirth, Lori; Robinson, Bruce; Sherman, Steven; Suzuki, Takuya; Fujino, Katsuki; Gupta, Anubha; Hayato, Seiichi; Tahara, Makoto

    2015-12-01

    Lenvatinib significantly prolonged progression-free survival (PFS) versus placebo in patients with radioiodine-refractory differentiated thyroid cancer (RR-DTC) in the phase 3 Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (SELECT) trial. This subanalysis evaluated the efficacy and safety of lenvatinib in Japanese patients who participated in SELECT. Outcomes for Japanese patients (lenvatinib, n = 30; placebo, n = 10) were assessed in relationship to the SELECT population (lenvatinib, n = 261; placebo, n = 131). The primary endpoint was PFS; secondary endpoints included overall survival, overall response rate, and safety. Lenvatinib PFS benefit was shown in Japanese patients (median PFS: lenvatinib, 16.5 months; placebo, 3.7 months), although significance was not reached, presumably due to sample size (hazard ratio, 0.39; 95% confidence interval, 0.10-1.57; P = 0.067). Overall response rates were 63.3% and 0% for lenvatinib and placebo, respectively. No significant difference was found in overall survival. The lenvatinib safety profile was similar between the Japanese and overall SELECT population, except for higher incidences of hypertension (any grade: Japanese, 87%; overall, 68%; grade ≥3: Japanese, 80%; overall, 42%), palmar-plantar erythrodysesthesia syndrome (any grade: Japanese, 70%; overall, 32%; grade ≥3: Japanese, 3%; overall, 3%), and proteinuria (any grade: Japanese, 63%; overall, 31%; grade ≥3: Japanese, 20%; overall, 10%). Japanese patients had more dose reductions (Japanese, 90%; overall, 67.8%), but fewer discontinuations due to adverse events (Japanese, 3.3%; overall, 14.2%). There was no difference in lenvatinib exposure between the Japanese and overall SELECT populations after adjusting for body weight. In Japanese patients with radioiodine-refractory differentiated thyroid cancer, lenvatinib showed similar clinical outcomes to the overall SELECT population. Some differences in adverse event frequencies and dose

  12. Chunk Learning and the Development of Spoken Discourse in a Japanese as a Foreign Language Classroom

    ERIC Educational Resources Information Center

    Taguchi, Naoko

    2007-01-01

    This study examined the development of spoken discourse among L2 learners of Japanese who received extensive practice on grammatical chunks. Participants in this study were 22 college students enrolled in an elementary Japanese course. They received instruction on a set of grammatical chunks in class through communicative drills and the…

  13. The Perceptions of Japanese Students toward Academic English Reading: Implications for Effective ESL Reading Strategies

    ERIC Educational Resources Information Center

    Iwai, Yuko

    2008-01-01

    The population of English as a Second Language (ESL) learners has increased significantly in higher education settings in the United States today. It has been reported that Japanese ESL students are generally unsuccessful when studying in English speaking countries. The typical way of reading in English for Japanese students is the…

  14. Japanese Language Students' Attitudes toward "Kanji" and Their Perceptions on "Kanji" Learning Strategies

    ERIC Educational Resources Information Center

    Mori, Yoshiko; Shimizu, Hideko

    2007-01-01

    This study aims at identifying interpretable factors underlying Japanese language learners' attitudes toward "kanji" and their self-reported "kanji" learning strategies. It also examines the relationship between the two sets of belief factors. A questionnaire survey was conducted among Japanese language students at nine universities in the United…

  15. Immigrant Children from Latin America at Japanese Schools: Homogeneity, Ethnicity, Gender and Language in Education

    ERIC Educational Resources Information Center

    Castro-Vazquez, Genaro

    2009-01-01

    An ethnographic study conducted between 2003 and 2006 followed three children from Latin America attending three different public Japanese primary schools. The investigation concerned a Japanese-language tutoring programme for foreign children, which was evaluated by participant observation and a set of in-depth interviews with officials, school…

  16. Implementation of a Contingency Management-Based Intervention in a Community Supervision Setting: Clinical Issues and Recommendations

    ERIC Educational Resources Information Center

    Trotman, Adria J.; Taxman, Faye S.

    2011-01-01

    A cognitive-behaviorally based substance abuse treatment program was implemented within a community supervision setting. This program included a goals group that used a contingency management component and included the probation agent as a part of the treatment. In this article, the authors describe the contingency management component of the…

  17. ICF Core Set for Head and Neck Cancer: Do the Categories Discriminate Among Clinically Relevant Subgroups of Patients?

    ERIC Educational Resources Information Center

    Tschiesner, Uta; Oberhauser, Cornelia; Cieza, Alarcos

    2011-01-01

    The multidisciplinary assessment of functioning in patients with head and neck cancer (HNC) according to the "ICF Core Set for Head and Neck Cancer" (ICF-HNC) was developed in an international and multi-disciplinary approach. The ICF-HNC is an application of the ICF that was adopted by the World Health Organization. The objective of this study was…

  18. Suicide Risk Protocols: Addressing the Needs of High Risk Youths Identified through Suicide Prevention Efforts and in Clinical Settings

    ERIC Educational Resources Information Center

    Heilbron, Nicole; Goldston, David; Walrath, Christine; Rodi, Michael; McKeon, Richard

    2013-01-01

    Several agencies have emphasized the importance of establishing clear protocols or procedures to address the needs of youths who are identified as suicidal through suicide prevention programs or in emergency department settings. What constitutes optimal guidelines for developing and implementing such protocols, however, is unclear. At the request…

  19. Civil commitment for substance use disorder patients under the Florida Marchman Act: demographics and outcomes in the private clinical setting.

    PubMed

    Sweeney, Timothy J; Strolla, Michael P; Myers, David P

    2013-01-01

    The Florida Marchman Act, a statutory process for civil commitment of persons with substance use disorders. The paper describes the various methods by which the Act may be employed, and examines the demographics and outcomes of 100 patients admitted to a private treatment setting pursuant to Marchman Act authority.

  20. Molecular epidemiology of clinical and carrier strains of methicillin resistant Staphylococcus aureus (MRSA) in the hospital settings of north India

    PubMed Central

    Dar, Javid A; Thoker, Manzoor A; Khan, Jamal A; Ali, Asif; Khan, Mohammed A; Rizwan, Mohammed; Bhat, Khalid H; Dar, Mohammad J; Ahmed, Niyaz; Ahmad, Shamim

    2006-01-01

    Background The study was conducted between 2000 and 2003 on 750 human subjects, yielding 850 strains of staphylococci from clinical specimens (575), nasal cultures of hospitalized patients (100) and eye & nasal sources of hospital workers (50 & 125 respectively) in order to determine their epidemiology, acquisition and dissemination of resistance genes. Methods Organisms from clinical samples were isolated, cultured and identified as per the standard routine procedures. Susceptibility was measured by the agar diffusion method, as recommended by the Nat ional Committee for Clinical Laboratory Standards (NCCLS). The modified method of Birnboin and Takahashi was used for isolation of plasmids from staphylococci. Pulsed-field gel electrophoresis (PFGE) typing of clinical and carrier Methicillin resistant Staphylococcus aureus (MRSA) strains isolated during our study was performed as described previously. Results It was shown that 35.1% of Staphylococcus aureus and 22.5% of coagulase-negative staphylococcal isolates were resistant to methicillin. Highest percentage of MRSA (35.5%) was found in pus specimens (n = 151). The multiple drug resistance of all MRSA (n = 180) and Methicillin resistant Coagulase-negative Staphylococcus aureus (MRCNS) (n = 76) isolates was detected. In case of both methicillin-resistant as well as methicillin-sensitive Saphylococcal isolates zero resistance was found to vancomycin where as highest resistance was found to penicillin G followed by ampicillin. It was shown that the major reservoir of methicillin resistant staphylococci in hospitals are colonized/infected inpatients and colonized hospital workers, with carriers at risk for developing endogenous infection or transmitting infection to health care workers and patients. The results were confirmed by molecular typing using PFGE by SmaI-digestion. It was shown that the resistant markers G and T got transferred from clinical S. aureus (JS-105) to carrier S. aureus (JN-49) and the