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Sample records for medical ozone therapy

  1. Ozone Therapy in Dentistry

    PubMed Central

    Domb, William C

    2014-01-01

    Summary The 21st century dental practice is quite dynamic. New treatment protocols and new materials are being developed at a rapid pace. Ozone dental therapy falls into the category of new treatment protocols in dentistry, yet ozone is not new at all. Ozone therapy is already a major treatment modality in Europe, South America and a number of other countries. What is provided here will not be an exhaustive scientific treatise so much as a brief general introduction into what dentists are now doing with ozone therapies and the numerous oral/systemic links that make this subject so important for physicians so that, ultimately, they may serve their patients more effectively and productively. PMID:25363268

  2. Ozone therapy: A clinical review.

    PubMed

    Elvis, A M; Ekta, J S

    2011-01-01

    Ozone (O(3)) gas discovered in the mid-nineteenth century is a molecule consisting of three atoms of oxygen in a dynamically unstable structure due to the presence of mesomeric states. Although O(3) has dangerous effects, yet researchers believe it has many therapeutic effects. Ozone therapy has been utilized and heavily studied for more than a century. Its effects are proven, consistent, safe and with minimal and preventable side effects. Medical O(3) is used to disinfect and treat disease. Mechanism of actions is by inactivation of bacteria, viruses, fungi, yeast and protozoa, stimulation of oxygen metabolism, activation of the immune system. Medication forms in a gaseous state are somewhat unusual, and it is for this reason that special application techniques have had to be developed for the safe use of O(3). In local applications as in the treatment of external wounds, its application in the form of a transcutaneous O(3) gas bath has established itself as being the most practical and useful method, for example at low (sub-atmospheric) pressure in a closed system guaranteeing no escape of O(3) into the surrounding air. Ozonized water, whose use is particularly known in dental medicine, is optimally applied as a spray or compress. Diseases treated are infected wounds, circulatory disorders, geriatric conditions, macular degeneration, viral diseases, rheumatism/arthritis, cancer, SARS and AIDS.

  3. Ozone therapy: A clinical review

    PubMed Central

    Elvis, A. M.; Ekta, J. S.

    2011-01-01

    Ozone (O3) gas discovered in the mid-nineteenth century is a molecule consisting of three atoms of oxygen in a dynamically unstable structure due to the presence of mesomeric states. Although O3 has dangerous effects, yet researchers believe it has many therapeutic effects. Ozone therapy has been utilized and heavily studied for more than a century. Its effects are proven, consistent, safe and with minimal and preventable side effects. Medical O3 is used to disinfect and treat disease. Mechanism of actions is by inactivation of bacteria, viruses, fungi, yeast and protozoa, stimulation of oxygen metabolism, activation of the immune system. Medication forms in a gaseous state are somewhat unusual, and it is for this reason that special application techniques have had to be developed for the safe use of O3. In local applications as in the treatment of external wounds, its application in the form of a transcutaneous O3 gas bath has established itself as being the most practical and useful method, for example at low (sub-atmospheric) pressure in a closed system guaranteeing no escape of O3 into the surrounding air. Ozonized water, whose use is particularly known in dental medicine, is optimally applied as a spray or compress. Diseases treated are infected wounds, circulatory disorders, geriatric conditions, macular degeneration, viral diseases, rheumatism/arthritis, cancer, SARS and AIDS. PMID:22470237

  4. Ozone therapy in periodontics

    PubMed Central

    Gupta, G; Mansi, B

    2012-01-01

    Gingival and Periodontal diseases represent a major concern both in dentistry and medicine. The majority of the contributing factors and causes in the etiology of these diseases are reduced or treated with ozone in all its application forms (gas, water, oil). The beneficial biological effects of ozone, its anti-microbial activity, oxidation of bio-molecules precursors and microbial toxins implicated in periodontal diseases and its healing and tissue regeneration properties, make the use of ozone well indicated in all stages of gingival and periodontal diseases. The primary objective of this article is to provide a general review about the clinical applications of ozone in periodontics. The secondary objective is to summarize the available in vitro and in vivo studies in Periodontics in which ozone has been used. This objective would be of importance to future researchers in terms of what has been tried and what the potentials are for the clinical application of ozone in Periodontics. PMID:22574088

  5. Medical Therapy of Acromegaly

    PubMed Central

    Plöckinger, U.

    2012-01-01

    This paper outlines the present status of medical therapy of acromegaly. Indications for permanent postoperative treatment, postirradiation treamtent to bridge the interval until remission as well as primary medical therapy are elaborated. Therapeutic efficacy of the different available drugs—somatostatin receptor ligands (SRLs), dopamine agonists, and the GH antagonist Pegvisomant—is discussed, as are the indications for and efficacy of their respective combinations. Information on their mechanism of action, and some pharmakokinetic data are included. Special emphasis is given to the difficulties to define remission criteria of acromegaly due to technical assay problems. An algorithm for medical therapy in acromegaly is provided. PMID:22550484

  6. [Studies on ozone therapy of acne vulgaris].

    PubMed

    Gloor, M; Lipphardt, B A

    1976-02-01

    Ozone therapy using the Vapozone 9, an instrument in normal commercial usage, has been carried out on the forehead of 16 male test persons on 7 consecutive days. Before the treatment began and at the end of the treatment period the skin surface lipids on the unchanged skin (casual level) and two hours after defatting the skin (replacement sum) were taken by direct extraction and analysed by means of thin layer chromatography. The results of these investigations rule out a decrease in the free fatty acids by this therapy. As a result of this finding it may assumed that no desinfecting effect on the corynebacterium acnes and other lipasereleasing microorganisms can be attributed to ozone therapy.

  7. Medical therapy of urolithiasis.

    PubMed

    Micali, S; Grande, M; Sighinolfi, M C; De Carne, C; De Stefani, S; Bianchi, G

    2006-11-01

    Nephrolithiasis treatment has become easier and less invasive with the development of extracorporeal shockwave lithotripsy (SWL) and endourologic techniques. However, medical therapy represents a well-established and complementary approach that can improve the efficacy of SWL and endourology. During recent decades, pharmacologic intervention has become more effective in stone disease: drugs can control the pain of renal colic, interfere at various levels in lithogenesis, and contribute to the expulsion of stones. It is well known that lithogenesis is a multifactorial process influenced by environmental-nutritional factors (low urinary volume, diet rich in animal protein, etc) and metabolic alterations; i.e., hypercalciuria, hyperuricosuria, and deficiency of stone-inhibiting factors (citrate, magnesium, glycosaminoglycans [GAGs]). Specific drugs such as citrate, allopurinol, and thiazide represent highly effective treatments for the promoting factors. Furthermore, recent findings suggest an interesting role for a phytotherapeutic agent, Phillantus niruri, and its inhibitory action on calcium oxalate crystallization related to the higher incorporation of GAGs into the calculi. Another step forward in medical management of stone disease is expulsive therapy. Many studies have proven the efficacy of medical expulsive therapy with nifedipine and alpha-blockers: their specific action on ureteral smooth muscle in association with anti-edema drugs accounts for their efficacy in expelling ureteral stones. In this paper, we provide an update on the medical treatment of stone disease, focusing our attention on what is known and what is new in renal colic and litholithic and expulsive medical therapy.

  8. Ozone Therapy for Tumor Oxygenation: a Pilot Study

    PubMed Central

    2004-01-01

    Tumor hypoxia is an adverse factor for chemotherapy and radiotherapy. Ozone therapy is a non-conventional form of medicine that has been used successfully in the treatment of ischemic disorders. This prospective study was designed to assess the effect of ozone therapy on tumor oxygenation. Eighteen subjects were recruited for the study. Systemic ozone therapy was administered by autohemotransfusion on three alternate days over one week. Tumor oxygenation levels were measured using polarographic needle probes before and after the first and the third ozone therapy session. Overall, no statistically significant change was observed in the tumor oxygenation in the 18 patients. However, a significant decrease was observed in hypoxic values ≤10 and ≤5 mmHg of pO2. When individually assessed, a significant and inverse non-linear correlation was observed between increase in oxygenation and the initial tumor pO2 values at each measuring time-point, thus indicating that the more poorly-oxygenated tumors benefited most (rho = −0.725; P = 0.001). Additionally, the effect of ozone therapy was found to be lower in patients with higher hemoglobin concentrations (rho = −0.531; P < 0.034). Despite being administered over a very short period, ozone therapy improved oxygenation in the most hypoxic tumors. Ozone therapy as adjuvant in chemo-radiotherapy warrants further research. PMID:15257330

  9. Ozone- A Biological Therapy in Dentistry- Reality or Myth?????

    PubMed

    Naik, Saraswathi V; K, Rajeshwari; Kohli, Shivani; Zohabhasan, Sayyad; Bhatia, Shekhar

    2016-01-01

    The usage of ozone in dentistry has been proposed because of its antimicrobial, disinfectant, biocompatibility and healing properties. In the last decade a number of therapeutic protocols with ozone have been developed to address common dental infections associated with periodontal disease, RCT and caries. Despite these advantages, therapeutic ozone's application in dentistry is limited because of its possible side effects. Hence, dental practitioners need to know the proper usage of ozone therapy that can provide better patient care and considerably cut down the time and cost of the treatment. PMID:27386005

  10. Oxygen/ozone as a medical gas mixture. A critical evaluation of the various methods clarifies positive and negative aspects

    PubMed Central

    2011-01-01

    Besides oxygen, several other gases such as NO, CO, H2, H2S, Xe and O3 have come to age over the past few years. With regards to O3, its mechanisms of action in medicine have been clarified during the last two decades so that now a comprehensive framework for understanding and recommending ozone therapy in various pathologies is available. O3 used within the determined therapeutic window is absolutely safe and more effective than golden standard medications in numerous pathologies, like vascular diseases. However, ozone therapy is mostly in practitioners' hands and some recent developments for increasing cost effectiveness and speed of treatment are neither standardized, nor evaluated toxicologically. Hence, the aim of this article is to emphasize the need to objectively assess the pros and cons of oxygen/ozone as a medical gas mixture in the hope that ozone therapy will be accepted by orthodox medicine in the near future. PMID:22146387

  11. Ozone therapy in dentistry. A brief review for physicians.

    PubMed

    Domb, William C

    2014-10-31

    The 21(st) century dental practice is quite dynamic. New treatment protocols and new materials are being developed at a rapid pace. Ozone dental therapy falls into the category of new treatment protocols in dentistry, yet ozone is not new at all. Ozone therapy is already a major treatment modality in Europe, South America and a number of other countries. What is provided here will not be an exhaustive scientific treatise so much as a brief general introduction into what dentists are now doing with ozone therapies and the numerous oral/systemic links that make this subject so important for physicians so that, ultimately, they may serve their patients more effectively and productively. PMID:25363268

  12. Ozone- A Biological Therapy in Dentistry- Reality or Myth?????

    PubMed Central

    Naik, Saraswathi V.; K, Rajeshwari; Kohli, Shivani; Zohabhasan, Sayyad; Bhatia, Shekhar

    2016-01-01

    The usage of ozone in dentistry has been proposed because of its antimicrobial, disinfectant, biocompatibility and healing properties. In the last decade a number of therapeutic protocols with ozone have been developed to address common dental infections associated with periodontal disease, RCT and caries. Despite these advantages, therapeutic ozone’s application in dentistry is limited because of its possible side effects. Hence, dental practitioners need to know the proper usage of ozone therapy that can provide better patient care and considerably cut down the time and cost of the treatment. PMID:27386005

  13. Ozone Therapy on Cerebral Blood Flow: A Preliminary Report

    PubMed Central

    2004-01-01

    Ozone therapy is currently being used in the treatment of ischemic disorders, but the underlying mechanisms that result in successful treatment are not well known. This study assesses the effect of ozone therapy on the blood flow in the middle cerebral and common carotid arteries. Seven subjects were recruited for the therapy that was performed by transfusing ozone-enriched autologous blood on 3 alternate days over 1 week. Blood flow quantification in the common carotid artery (n = 14) was performed using color Doppler. Systolic and diastolic velocities in the middle cerebral artery (n = 14) were estimated using transcranial Doppler. Ultrasound assessments were conducted at the following three time points: 1) basal (before ozone therapy), 2) after session #3 and 3) 1 week after session #3. The common carotid blood flow had increased by 75% in relation to the baseline after session #3 (P < 0.001) and by 29% 1 week later (P = 0.039). In the middle cerebral artery, the systolic velocity had increased by 22% after session #3 (P = 0.001) and by 15% 1 week later (P = 0.035), whereas the diastolic velocity had increased by 33% after session #3 (P < 0.001) and by 18% 1 week later (P = 0.023). This preliminary Doppler study supports the clinical experience of achieving improvement by using ozone therapy in peripheral ischemic syndromes. Its potential use as a complementary treatment in cerebral low perfusion syndromes merits further clinical evaluation. PMID:15841265

  14. Medical therapy, calcium oxalate urolithiasis

    NASA Technical Reports Server (NTRS)

    Ruml, L. A.; Pearle, M. S.; Pak, C. Y.

    1997-01-01

    The development of diagnostic protocols that identify specific risk factors for calcium oxalate nephrolithiasis has led to the formulation of directed medical regimens that are aimed at correcting the underlying metabolic disturbances. Initiation of these treatment programs has reduced markedly the rate of stone formation in the majority of patients who form stones. This article discusses the rationale that underlies the choice of medical therapy for the various pathophysiologic causes of calcium oxalate nephrolithiasis and the appropriate use of available medications.

  15. [Benign prostatic hyperplasia: medical therapy].

    PubMed

    Schlenker, B; Gratzke, C; Weidlich, P; Seitz, M; Reich, O; Stief, C G

    2007-08-16

    Primary aims of the medical therapy for BPH are improvement of subjective symptoms and quality of life as well as the prevention of long-term complications such as acute urinary retention and renal failure. Secondary goal is inhibition of disease progression. The medical therapy should be tailored to each patient according to the individual complaints and risk of progression. Plant extracts, alpha-blockers and 5-alpha reductase inhibitors represent the most common prescribed substances. Recent data suggest beneficial effects for the use of antimuscarinic agents and phosphodiesterase type 5 inhibitors. PMID:17912863

  16. Role of ozone therapy in minimal intervention dentistry and endodontics - a review.

    PubMed

    A, Shilpa Reddy; Reddy, Narender; Dinapadu, Sainath; Reddy, Manoranjan; Pasari, Srikanth

    2013-06-01

    Ozone has been successfully used in medical field since many years owing to its oxidizing property making it an excellent antimicrobial agent. Moreover its potent anti-inflammatory property along with favorable cellular and humoral immune response made ozone an effective therapeutic agent. Also its ability to arrest and reverse carious lesions in a predictable way opened up a new chapter in minimal intervention dentistry. Furthermore its efficacy in curbing resistant poly microbial root canal flora appears very promising. This article is based on information through valid textbooks, peer reviews, journals and medline/pubmed search. How to cite this article: Reddy S A, Reddy N, Dinapadu S, Reddy M, Pasari S. Role of Ozone Therapy in Minimal Intervention Dentistry and Endodontics - A Review. J Int Oral Health 2013; 5(3):102-108. PMID:24155611

  17. Role of Ozone Therapy in Minimal Intervention Dentistry and Endodontics - A Review

    PubMed Central

    A, Shilpa Reddy; Reddy, Narender; Dinapadu, Sainath; Reddy, Manoranjan; Pasari, Srikanth

    2013-01-01

    Ozone has been successfully used in medical field since many years owing to its oxidizing property making it an excellent antimicrobial agent. Moreover its potent anti-inflammatory property along with favorable cellular and humoral immune response made ozone an effective therapeutic agent. Also its ability to arrest and reverse carious lesions in a predictable way opened up a new chapter in minimal intervention dentistry. Furthermore its efficacy in curbing resistant poly microbial root canal flora appears very promising. This article is based on information through valid textbooks, peer reviews, journals and medline/pubmed search. How to cite this article: Reddy S A, Reddy N, Dinapadu S, Reddy M, Pasari S. Role of Ozone Therapy in Minimal Intervention Dentistry and Endodontics - A Review. J Int Oral Health 2013; 5(3):102-108. PMID:24155611

  18. Extracorporeal blood oxygenation and ozonation: clinical and biological implications of ozone therapy.

    PubMed

    Di Paolo, N; Gaggiotti, E; Galli, F

    2005-01-01

    Some lines of evidence have suggested that the challenge to antioxidants and biomolecules provoked by pro-oxidants such as ozone may be used to generate a controlled stress response of possible therapeutic relevance in some immune dysfunctions and chronic, degenerative conditions. Immune and endothelial cells have been proposed to be elective targets of the positive molecular effects of ozone and its derived species formed during blood ozonation. On the bases of these underlying principles and against often prejudicial scepticism and concerns about its toxicity, ozone has been used in autohemotherapy (AHT) for four decades with encouraging results. However, clinical application and validation of AHT have been so far largely insufficient. Latterly, a new and more effective therapeutic approach to ozone therapy has been established, namely extracorporeal blood oxygenation and ozonation (EBOO). This technique, first tested in vitro and then in vivo in sheep and humans (more than 1200 treatments performed in 82 patients), is performed with a high-efficiency apparatus that makes it possible to treat with a mixture of oxygen-ozone (0.5-1 microg/ml oxygen) in 1 h of extracorporeal circulation up to 4800 ml of heparinized blood without technical or clinical problems, whereas only 250 ml of blood can be treated with ozone by AHT. The EBOO technique can be easily adapted for use in hemodialysis also. The standard therapeutic cycle lasts for 7 weeks in which 14 treatment sessions of 1 h are performed. After a session of EBOO, the interaction of ozone with blood components results in 4-5-fold increased levels of thiobarbituric acid reactants and a proportional decrease in plasma protein thiols without any appreciable erythrocyte haemolysis. On the basis of preliminary in vitro evidence, these simple laboratory parameters may represent a useful complement in the routine monitoring of biological compliance to the treatment. The clinical experience gained so far confirms the

  19. Medication management during electroconvulsant therapy

    PubMed Central

    Zolezzi, Monica

    2016-01-01

    Electroconvulsive therapy (ECT) has demonstrated to be highly effective and safe, even life saving for many psychiatric disorders such as major depression, bipolar disorder and schizophrenia. Most patients who require ECT are also on concurrent pharmacotherapy. As such, the objective of this article is to provide a review of the most recent literature focusing on the medications used during an ECT procedure and on the effects of concurrent psychiatric and non-psychiatric medications on the effectiveness and safety of ECT. The review also attempts to summarize the recommendations derived from existing documents to guide pharmacotherapy decisions for patients undergoing ECT. For this purpose, using electronic databases, an extensive search of the current literature was made using ECT and medications or drug classes as keywords. PMID:27143894

  20. Medical therapy for calculus disease.

    PubMed

    Singh, Shrawan K; Agarwal, Mayank Mohan; Sharma, Sumit

    2011-02-01

    Urolithiasis is a common problem with a high recurrence rate. Medical therapy directed to relieve agonizing pain, expulsion of stone, dissolution of uric acid and cystine stone and prevention of recurrence. NSAIDs are superior to opioids for renoureteral colic because their use doesn't induce vomiting and there is lesser requirement of rescue analgesia. In randomized trials, anticholinergics were not found to be beneficial. Alpha blockers, particularly tamsulosin, reduce pain and facilitate expulsion of stone and fragments of stone following extracorporeal shock wave lithotripsy (SWL) and ureterorenoscopic lithotripsy. Potassium citrate helps in chemodissolution of uric acid and cystine stones and is useful in prevention of stone recurrence in general and in those who have undergone SWL or percutaneious nephrolithotomy. Other measures for prevention of stone recurrence include fluid and dietary therapy, counteracting underlying metabolic abnormalities using suitable medications, phytotheurapeutic agents and probiotics. Once the role of nanobacteria is established in genesis of urinary stones, anti-nanobacteria therapy holds the promise of opening new horizons for prevention of urinary stones. PMID:21244607

  1. Compact accelerator for medical therapy

    DOEpatents

    Caporaso, George J.; Chen, Yu-Jiuan; Hawkins, Steven A.; Sampayan, Stephen E.; Paul, Arthur C.

    2010-05-04

    A compact accelerator system having an integrated particle generator-linear accelerator with a compact, small-scale construction capable of producing an energetic (.about.70-250 MeV) proton beam or other nuclei and transporting the beam direction to a medical therapy patient without the need for bending magnets or other hardware often required for remote beam transport. The integrated particle generator-accelerator is actuable as a unitary body on a support structure to enable scanning of a particle beam by direction actuation of the particle generator-accelerator.

  2. Medical Art Therapy: Defining a Field.

    ERIC Educational Resources Information Center

    Malchiodi, Cathy A.

    Although art therapy has traditionally focused on the use of art expression in psychotherapy, the practice of medical art therapy has begun to grow rapidly. This paper provides a brief overview of the emerging specialty of medical art therapy and its importance as a counseling tool with people suffering from serious health problems. The paper…

  3. Medical therapy for premature ejaculation

    PubMed Central

    Mohee, Amar; Eardley, Ian

    2011-01-01

    Premature ejaculation (PE) is a common male sexual dysfunction. Advances in PE research have been hampered owing to a nonstandardized definition of PE, until the definition by the International Society of Sexual Medicine (ISSM) in 2009. Once the diagnosis of PE is established through a thorough history, a variety of medical therapies is available, including tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), centrally acting opiates, phosphodiesterase 5 inhibitors and topical desensitizing creams. Most of these treatments increase the intravaginal ejaculation latency time (IELT) and patient satisfaction scores, with the most convincing evidence for SSRIs and topical creams. Daily SSRIs such as paroxetine, although efficacious, do have a substantial and prolonged side effect profile. Dapoxetine, which is a on-demand SSRI, is the only licensed drug for the treatment of PE, increasing IELT by a factor of 2.5 to 3 with limited and tolerable side effects. In the near future, the topical aerosol PSD502 is due to be licensed for the treatment of PE, increasing IELT by up to a factor of 6 but having minimal local and negligible systemic side effects. PMID:22046199

  4. Does intraperitoneal medical ozone preconditioning and treatment ameliorate the methotrexate induced nephrotoxicity in rats?

    PubMed Central

    Aslaner, Arif; Çakır, Tuğrul; Çelik, Betül; Doğan, Uğur; Mayir, Burhan; Akyüz, Cebrail; Polat, Cemal; Baştürk, Ahmet; Soyer, Vural; Koç, Süleyman; Şehirli, Ahmet Özer

    2015-01-01

    Methotrexate is a chemotherapeutic agent used for many cancer treatments. It leads to toxicity with its oxidative injury. The purpose of our study is investigating the medical ozone preconditioning and treatment has any effect on the methotrexate-induced kidneys by activating antioxidant enzymes in rats. Eighteen rats were divided into three equal groups; control, Mtx without and with medical ozone. Nephrotoxicity was performed with a single dose of 20 mg/kg Mtx intraperitoneally at the fifteenth day of experiment on groups 2 and 3. Medical ozone preconditioning was performed at a dose of 25 mcg/ml (5 ml) intraperitoneally everyday in the group 3 and treated with medical ozone for five more days while group 2 was received only 5 ml of saline everyday for twenty days. All rats were sacrificed at the end of third week and the blood and kidney tissue samples were obtained to measure the levels of TNF-α, IL-1β, malondialdehyde, glutathione and myeloperoxidase. Kidney injury score was evaluated histolopatologically. Medical ozone preconditioning and treatment ameliorated the biochemical parameters and kidney injury induced by Mtx. There was significant increase in tissue MDA, MPO activity, TNF-α and IL-1β (P<0.05) and significant decrease in tissue GSH and histopathology (P<0.05) after Mtx administration. The preconditioning and treatment with medical ozone ameliorated the nephrotoxicity induced by Mtx in rats by activating antioxidant enzymes and prevented renal tissue. PMID:26550330

  5. Ozone

    MedlinePlus

    ... reactive form of oxygen. In the upper atmosphere, ozone forms a protective layer that shields us from the sun’s ultraviolet rays. At ground level, ozone is a harmful air pollutant and a primary ...

  6. Comparison of the Effects of Low-Level Laser Therapy and Ozone Therapy on Bone Healing.

    PubMed

    Alan, Hilal; Vardi, Nigar; Özgür, Cem; Acar, Ahmet Hüseyin; Hüseyin, Ahmet; Yolcu, Ümit; Doğan, Derya Ozdemir

    2015-07-01

    This study aims to compare the effect of low-level laser therapy (LLLT) and ozone therapy on the bone healing. Thirty-six adult male Wistar albino rats were used for this study. Monocortical defects were shaped in right femur of all rats. Defects were filled with nano-hydroxyapatite graft. The animals were divided into 3 groups and each group was than divided into 2 subgroups. Then, LLLT with a diode laser was applied to the first group (G1), ozone therapy was applied to the second group (G2), and no treatment was applied to the third group as a control group (G3). Animals were sacrificed after 4th and 8th weeks and the sections were examined to evaluate the density of the inflammation, the formation of connective tissue, the osteogenic potential, and osteocalcin activity. As a result, there were no significant differences among the groups of 4 weeks in terms of new bone formation. In the immunohistochemical assessment, the number of osteocalcin-positive cells was higher in the laser group compared to the other group of 4 weeks; this difference was statistically significant in the LLLT and ozone groups (P < 0.05). Histomorphometric assessment showed that the new bone areas were higher in the LLLT and ozone groups; furthermore, there was a statistically significant difference in the LLLT in comparison with the control group at 8th week (P < 0.05). At the same time immunohistochemical assessment showed that osteocalcin-positive cells were considerably higher in G2 than G1 at 8th week (P < 0.05). The findings of this study may be the result of differences in the number of treatment sessions. Further studies are therefore needed to determine the optimal treatment modality.

  7. [Laser radiations in medical therapy].

    PubMed

    Richand, P; Boulnois, J L

    1983-06-30

    The therapeutic effects of various types of laser beams and the various techniques employed are studied. Clinical and experimental research has shown that Helio-Neon laser beams are most effective as biological stimulants and in reducing inflammation. For this reasons they are best used in dermatological surgery cases (varicose ulcers, decubital and surgical wounds, keloid scars, etc.). Infrared diode laser beams have been shown to be highly effective painkillers especially in painful pathologies like postherpetic neuritis. The various applications of laser therapy in acupuncture, the treatment of reflex dermatologia and optic fibre endocavital therapy are presented. The neurophysiological bases of this therapy are also briefly described.

  8. Ozone

    MedlinePlus

    Ozone is a gas. It can be good or bad, depending on where it is. "Good" ozone occurs naturally about 10 to 30 miles above ... the sun's ultraviolet rays. Part of the good ozone layer is gone. Man-made chemicals have destroyed ...

  9. Non-thermal atmospheric pressure HF plasma source: generation of nitric oxide and ozone for bio-medical applications

    NASA Astrophysics Data System (ADS)

    Kühn, S.; Bibinov, N.; Gesche, R.; Awakowicz, P.

    2010-01-01

    A new miniature high-frequency (HF) plasma source intended for bio-medical applications is studied using nitrogen/oxygen mixture at atmospheric pressure. This plasma source can be used as an element of a plasma source array for applications in dermatology and surgery. Nitric oxide and ozone which are produced in this plasma source are well-known agents for proliferation of the cells, inhalation therapy for newborn infants, disinfection of wounds and blood ozonation. Using optical emission spectroscopy, microphotography and numerical simulation, the gas temperature in the active plasma region and plasma parameters (electron density and electron distribution function) are determined for varied nitrogen/oxygen flows. The influence of the gas flows on the plasma conditions is studied. Ozone and nitric oxide concentrations in the effluent of the plasma source are measured using absorption spectroscopy and electro-chemical NO-detector at variable gas flows. Correlations between plasma parameters and concentrations of the particles in the effluent of the plasma source are discussed. By varying the gas flows, the HF plasma source can be optimized for nitric oxide or ozone production. Maximum concentrations of 2750 ppm and 400 ppm of NO and O3, correspondingly, are generated.

  10. Medical Therapy for Pediatric Vascular Anomalies

    PubMed Central

    Margolin, Judith F.; Soni, Heather Mills; Pimpalwar, Sheena

    2014-01-01

    Vascular anomalies (VAs) comprise a large variety of individual diagnoses that in different phases of treatment require a diverse number of medical specialists to provide optimal care. Medical therapies include agents usually associated with cancer chemotherapy, such as vincristine, as well more immunomodulatory types of drugs, such as glucocorticoids and sirolimus. These immunomodulating drugs are being successfully applied in cases that are typically categorized as vascular tumors, including kaposiform hemangioendothelioma (KHE) and tufted angioma (TA), as well as some of the more invasive types of vascular malformations (i.e., microcystic lymphatic malformations and blue rubber bleb nevus syndrome (BRBNS). These therapies need to be combined with good supportive care, which often involves anticoagulation, antimicrobial prophylaxis, and comprehensive pain and symptom-relief strategies, as well as appropriate drug monitoring and management of side effects of medical treatment. The optimal care of these patients frequently involves close collaboration between surgeons, interventional and conventional radiologists, medical subspecialists, and nurses. PMID:25045333

  11. The protective effect of intraperitoneal medical ozone preconditioning and treatment on hepatotoxicity induced by methotrexate

    PubMed Central

    Aslaner, Arif; Çakır, Tuğrul; Çelik, Betül; Doğan, Uğur; Akyüz, Cebrail; Baştürk, Ahmet; Polat, Cemal; Gündüz, Umut; Mayir, Burhan; Şehirli, Ahmet Özer

    2015-01-01

    The aim of this study is to determine the effects of medical ozone preconditioning and treatment on the methotrexate acute induced hepatotoxicity in rats that has not reports elsewhere. Eighteen rats were randomly assigned into three equal groups; control, Mtx and Mtx with ozone. Hepatotoxicity was performed with a single dose of 20 mg/kg Mtx to group 2 and group 3 at the fifteenth day. The medical ozone preconditioning was administered intraperitonealy in group 3 for fifteen days and more five days after inducing Mtx. The other rats of the group 1 and 2 received saline injection. At the twentyfirst day the blood and the liver tissue samples were obtained to measure the levels of liver enzymes ALT and AST, proinflamatory cytokines TNF-α, IL-1β, malondialdehyde, glutathione and myeloperoxidase. And the histolopatological examination was evaluated for injury score. In our study Mtx administration caused a significant increase on the liver enzymes ALT and AST, the tissue MDA and MPO activity and significant decrease in the tissue GSH. Moreover the both pro-inflammatory cytokines were significantly increased in the Mtx group. Medical ozone preconditioning and treatment reversed all these biochemical parameters and histopathological changes of the hepatotoxicity induced by Mtx. We conclude that medical ozone ameliorates Mtx induced hepatotoxicity in rats. PMID:26550257

  12. 42 CFR 410.132 - Medical nutrition therapy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Medical nutrition therapy. 410.132 Section 410.132... PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical Nutrition Therapy § 410.132 Medical nutrition therapy. (a) Conditions for coverage of MNT services. Medicare Part B pays for MNT...

  13. 21 CFR 892.5300 - Medical neutron radiation therapy system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Medical neutron radiation therapy system. 892.5300... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5300 Medical neutron radiation therapy system. (a) Identification. A medical neutron radiation therapy system is a device intended...

  14. 21 CFR 892.5300 - Medical neutron radiation therapy system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Medical neutron radiation therapy system. 892.5300... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5300 Medical neutron radiation therapy system. (a) Identification. A medical neutron radiation therapy system is a device intended...

  15. 21 CFR 892.5300 - Medical neutron radiation therapy system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Medical neutron radiation therapy system. 892.5300... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5300 Medical neutron radiation therapy system. (a) Identification. A medical neutron radiation therapy system is a device intended...

  16. 21 CFR 892.5300 - Medical neutron radiation therapy system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Medical neutron radiation therapy system. 892.5300... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5300 Medical neutron radiation therapy system. (a) Identification. A medical neutron radiation therapy system is a device intended...

  17. 21 CFR 892.5300 - Medical neutron radiation therapy system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical neutron radiation therapy system. 892.5300... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5300 Medical neutron radiation therapy system. (a) Identification. A medical neutron radiation therapy system is a device intended...

  18. Group 2 PH: Medical Therapy.

    PubMed

    Guazzi, Marco; Labate, Valentina

    2016-01-01

    Pulmonary hypertension (PH) secondary to left heart disease, classified as Group 2, is a widely underestimated target of therapy. Prevention and treatment of initial subclinical stages are not valued as a priority in the management of this chronic disease population, whereas attention is high for PH consequences in patients with advanced heart failure (HF) requiring a left ventricular mechanical assist device or heart transplant candidates. Even so, there is a growing interest toward the evidence of a clinical and prognostic role of PH in the elderly populations and in HF with preserved ejection fraction (HFpEF). Certainly, along with a prevalence definition not yet defined, the search for effective pharmacological approaches that might favorably affect the aging process and the natural history of HFpEF from earlier stages is not an easy task. Pharmacological studies that have tested some traditional pulmonary arterial hypertension approved drugs (i.e., prostanoids and endothelin-1 receptor blockers) primarily in PH and HF with reduced ejection fraction have not been positive, especially because of concomitant side effects, i.e., systemic hypotension, fluid retention and hepatic toxicity. In recent years, interest has moved toward drugs overexpressing the nitric oxide (NO)-cyclic guanosine monophosphate pathway with recent availability of well-tolerated selective pulmonary vasodilators, such as phosphodiesterase type 5 inhibitors and guanylate cyclase stimulators. Single center studies performed with these drugs have shown good tolerability and safety profile providing alternating hemodynamic results mainly because of recruitment of patients at different stages of the pulmonary vascular disease. Nonetheless, the overexpression of NO pathway appears to remain the most solid background for targeting lung microvessel dysfunction and treating RV dysfunction since the earliest stages of the disease. PMID:27389809

  19. Microcirculation and structural reorganization of the bladder mucosa in chronic cystitis under conditions of ozone therapy.

    PubMed

    Neimark, A I; Nepomnyashchikh, L M; Lushnikova, E L; Bakarev, M A; Abdullaev, N A; Sizov, K A

    2014-01-01

    Structural reorganization of the bladder mucosa in chronic cystitis and its correction by ozone therapy were studied. A relationship between the epithelial layer restructuring of different kinds (dystrophy, metaplasia, and degeneration), level of cell proliferation, and ultrastructural organization of urotheliocytes was detected. This complex of structural reactions was combined with dysregulation of tissue bloodflow in the bladder mucosa, shown by laser Doppler flowmetry. Positive structural changes were most marked in intravesical and less so in parenteral ozone therapy added to the therapeutic complex and manifested in reduction of inflammation and alteration in parallel with more intense reparative reactions. A special feature of parenteral ozone therapy was a significant improvement of microcirculation in the bladder mucosa.

  20. Alpha-emitters for medical therapy workshop

    SciTech Connect

    Feinendegen, L.E.; McClure, J.J.

    1996-12-31

    A workshop on ``Alpha-Emitters for Medical Therapy`` was held May 30-31, 1996 in Denver Colorado to identify research goals and potential clinical needs for applying alpha-particle emitters and to provide DOE with sufficient information for future planning. The workshop was attended by 36 participants representing radiooncology, nuclear medicine, immunotherapy, radiobiology, molecular biology, biochemistry, radiopharmaceutical chemistry, dosimetry, and physics. This report provides a summary of the key points and recommendations arrived at during the conference.

  1. 42 CFR 414.64 - Payment for medical nutrition therapy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for medical nutrition therapy. 414.64... Other Practitioners § 414.64 Payment for medical nutrition therapy. (a) Payment under the physician fee schedule. Medicare payment for medical nutrition therapy is made under the physician fee schedule...

  2. 42 CFR 414.64 - Payment for medical nutrition therapy.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for medical nutrition therapy. 414.64... Other Practitioners § 414.64 Payment for medical nutrition therapy. (a) Payment under the physician fee schedule. Medicare payment for medical nutrition therapy is made under the physician fee schedule...

  3. Angina Treatment -- Medical Versus Interventional Therapy (Beyond the Basics)

    MedlinePlus

    ... stop the progression of the disease and thereby prolong life. MEDICAL ANGINA TREATMENT — Medical treatment for coronary ... be recommended. Stenting has not been shown to prolong life compared with medical therapy. It is used ...

  4. Mechanisms of Action Involved in Ozone Therapy: Is healing induced via a mild oxidative stress?

    PubMed Central

    2011-01-01

    The potential mechanisms of action of ozone therapy are reviewed in this paper. The therapeutic efficacy of ozone therapy may be partly due the controlled and moderate oxidative stress produced by the reactions of ozone with several biological components. The line between effectiveness and toxicity of ozone may be dependent on the strength of the oxidative stress. As with exercise, it is well known that moderate exercise is good for health, whereas excessive exercise is not. Severe oxidative stress activates nuclear transcriptional factor kappa B (NFκB), resulting in an inflammatory response and tissue injury via the production of COX2, PGE2, and cytokines. However, moderate oxidative stress activates another nuclear transcriptional factor, nuclear factor-erythroid 2-related factor 2 (Nrf2). Nrf2 then induces the transcription of antioxidant response elements (ARE). Transcription of ARE results in the production of numerous antioxidant enzymes, such as SOD, GPx, glutathione-s-transferase(GSTr), catalase (CAT), heme-oxygenase-1 (HO-1), NADPH-quinone-oxidoreductase (NQO-1), phase II enzymes of drug metabolism and heat shock proteins (HSP). Both free antioxidants and anti-oxidative enzymes not only protect cells from oxidation and inflammation but they may be able to reverse the chronic oxidative stress. Based on these observations, ozone therapy may also activate Nrf2 via moderate oxidative stress, and suppress NFκB and inflammatory responses. Furthermore, activation of Nrf2 results in protection against neurodegenerative diseases, such as Alzheimer's and Parkinson's diseases. Mild immune responses are induced via other nuclear transcriptional factors, such as nuclear factor of activated T-cells (NFAT) and activated protein-1 (AP-1). Additionally, the effectiveness of ozone therapy in vascular diseases may also be explained by the activation of another nuclear transcriptional factor, hypoxia inducible factor-1α (HIF-1a), which is also induced via moderate

  5. Pharmacogenetics in electroconvulsive therapy and adjunctive medications.

    PubMed

    Mirzakhani, Hooman; van Noorden, Martijn S; Swen, Jesse; Nozari, Ala; Guchelaar, Henk-Jan

    2015-01-01

    Electroconvulsive therapy (ECT) has shown apparent efficacy in treatment of patients with depression and other mental illnesses who do not respond to psychotropic medications or need urgent control of their symptoms. Pharmacogenetics contributes to an individual's sensitivity and response to a variety of drugs. Clinical insights into pharmacogenetics of ECT and adjunctive medications not only improves its safety and efficacy in the indicated patients, but can also lead to the identification of novel treatments in psychiatric disorders through understanding of potential molecular and biological mechanisms involved. In this review, we explore the indications of pharmacogenetics role in safety and efficacy of ECT and present the evidence for its role in patients with psychiatric disorders undergoing ECT.

  6. Gene therapy and medical genetics on Internet.

    PubMed

    Seemann, O; Seemann, M D; Preuss, U; Kuss, J P; Soyka, M

    1998-09-17

    In this report we consider the development of the Internet, from its origins as a military invention in the times of the cold war to its present day role, together with the World Wide Web, as a means of global communication which plays a key role in medical research and particularly in medical genetics. A few of the major genetics related research projects and gene research centers are introduced and their aims are briefly discussed. Detailed information about chromosome and gene mapping, together with sequence and structure databases, can be easily and rapidly accessed through the Internet. A variety of web-sites are briefly described and then listed at the end of the report, which will serve as a useful starting point from which the interested reader can access an almost endless source of genetics related information on the Internet. Finally, some of the ethical, legal and social implications of the links between gene therapy and the Intemet are considered.

  7. Ozone

    SciTech Connect

    Not Available

    1988-06-01

    The author discusses the debate over whether concern about a hole in the ozone layer in Antarctic is real or science fiction. There is a growing consensus that efforts must be taken to protect the ozone layer. The issue now is not whether chlorofluorocarbons (CFCs) should be controlled and regulated but how much and how soon. The United States has urged that the production of dangerous CFCs, and any other chemicals that affect the ozone layer, be restricted immediately to current levels and that their use be reduced 95 percent over the next decade. The American position was too strong for many European nations and the Japanese. Negotiations at an international conference on the matter broke down. The breakdown is due in part to a more acute concern for environmental matters in the United States than exists in many countries. Meanwhile CFCs are linked to another environmental problem that equally threatens the world - the Greenhouse Effect. The earth is in a natural warming period, but man could be causing it to become even warmer. The Greenhouse Effect could have a catastrophic impact on mankind, although nothing has been proven yet.

  8. Effect of Ozone Therapy (OT) on Healing of Colonic Anastomosis in a Rat Model of Peritonitis

    PubMed Central

    Erginel, Başak; Erginel, Turgay; Aksoy, Bilgin; Dokucu, Ali İhsan

    2014-01-01

    Background: Ozone is a three-oxygen molecule (O3). Ozone therapy (OT) is systematically effective when pathological inflammatory and immunologic processes are activated. Among of these conditions are wound healing, macular degeneration related to aging, and conditions that are ischemic or infectious. Aims: The aim of this study was to determine the effects of OT on wound healing of intestinal anastomosis in the presence of peritonitis in a rat model. Study Design: Animal experimentation. Methods: A total of 40 Wistar albino rats were randomized into four groups (n=10) including: sham (S), peritonitis (P), ozone 0 (O0), and ozone 24 (O24). In group S, only cecal dissection was carried out. The S group had only a cecal dissection and intestinal anastomosis performed, but no peritonitis. In all other groups, cecal ligation and puncture (CLP) followed the cecal dissection to induce bacterial peritonitis. 24 h after puncture, a cecal resection and ileocolic anastomosis were performed. In group P, 24 h after CLP, a cecal resection and ileocolic anastomosis were performed and no ozone was administered. In group O0, immediately after the anastomosis, and in group O24, starting 24 hours after the anastomosis, an intraperitoneal 1 mg/kg/day ozone administration was applied for seven days. On the seventh day the animals were sacrificed, the anastomotic bursting pressures (BP) and the hydroxyproline values of the anastomotic tissues were measured, and histopathologic examination of the anastomotic segment was carried out. Results: The highest BP was in group S, with 211±23.13 mmHg. The mean BP of group P was 141±56.25 mmHg, which was significantly lower than in the other two peritonitis groups that received ozone therapy, group O0 and O24, where it was 192±22 and 166±45 mmHg, respectively (p<0.05). The difference in the BP between groups O0 and O24 was not statistically significant (p>0.05). Histopathologic analyses of the anastomotic segments determined there was

  9. Medication therapy management services: definitions and outcomes.

    PubMed

    Pellegrino, Annette N; Martin, Michelle T; Tilton, Jessica J; Touchette, Daniel R

    2009-01-01

    In the US, the Medicare Modernization Act of 2003 required that Medicare Part D insurers provide medication therapy management (MTM) services (MTMS) to selected beneficiaries, with the goals of providing education, improving adherence, or detecting adverse drug events and medication misuse. These broad goals and variety in MTM programmes available make assessment of these programmes difficult. The objectives of this article are to review the definitions of MTMS proposed by various stakeholders, and to summarize and evaluate the outcomes of MTMS consistent with those that may be offered in Medicare Part D or reimbursed by State Medicaid programmes. MTM programmes are approved by the Centers for Medicare and Medicaid Services (CMS). Pharmacy, medical and insurance organizations have provided guidelines and definitions for MTM programmes, distinguishing them from other types of community pharmacy activities. MTM has been distinguished from disease state management because of the focus on medications and multiple conditions. It differs from patient counselling because it is delivered independent of dispensing and involves collaboration with patients and providers. There is no consensus on the recommended mode of delivery (i.e. face-to-face or by telephone) for MTM. A MEDLINE search was conducted to identify articles published after 2000 using the search terms 'medication therapy management' and 'medication management'. Studies with outcomes evaluating community-based programmes consistent with MTMS, regardless of MTMS reimbursement source, were included in the review. Seven publications describing four MTMS were identified. For each of the identified articles, we describe the study design, service setting, inclusion criteria and outcomes. An additional three surveys describing multiple MTMS were identified and are summarized. Finally, ongoing efforts by CMS to evaluate the success of MTMS in the US are described. To date, there are limited outcomes available for MTMS

  10. Medical Therapy in Chronic Thromboembolic Pulmonary Hypertension.

    PubMed

    Pepke-Zaba, Joanna; Jais, Xavier; Channick, Richard

    2016-07-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but life-threatening condition resulting from unresolved thromboembolic obstructions. Pulmonary endarterectomy surgery is currently the standard of treatment, as it is potentially curative; however, not all cases are amenable to surgical intervention due to distal distribution of the organized thromboembolic material or the presence of comorbidities. Up to one-third of patients have persistent or recurrent pulmonary hypertension after pulmonary endarterectomy. In addition to the occlusive organized thromboembolic material, there is a small-vessel vasculopathy in nonoccluded parts of the pulmonary circulation that is histologically similar to that described in pulmonary arterial hypertension. This observation has led to frequent off-license use of approved pulmonary arterial hypertension therapies in CTEPH. Small uncontrolled trials have investigated prostacyclin analogs, endothelin receptor antagonists, and phosphodiesterase type 5 inhibitors in CTEPH with mixed results. A phase III study of the endothelin receptor antagonist bosentan met only one of its two coprimary end points. The first large randomized controlled trial showing a positive treatment effect was the Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase Stimulator Trial (CHEST). This study led to the licensing of riociguat for use in inoperable or persistent recurrent CTEPH. Rigorous randomized controlled trials of medical therapy for CTEPH are needed, and several are underway or planned. In the future, outcomes research may be facilitated by identification of novel end points specific to CTEPH. PMID:27571006

  11. Medical therapy for polycystic liver disease.

    PubMed

    Khan, S; Dennison, A; Garcea, G

    2016-01-01

    Introduction Somatostatin analogues and rapamycin inhibitors are two classes of drugs available for the management of polycystic liver disease but their overall impact is not clearly established. This article systematically reviews the literature on the medical management of polycystic liver disease. The outcomes assessed include reduction in liver volume and the impact on quality of life. Methods The English language literature published between 1966 and August 2014 was reviewed from a MEDLINE(®), PubMed, Embase™ and Cochrane Library search. Search terms included 'polycystic', 'liver', 'sirolimus', 'everolimus', 'PCLD', 'somatostatin', 'octreotide', 'lanreotide' and 'rapamycin'. Both randomised trials and controlled studies were included. References of the articles retrieved were also searched to identify any further eligible publications. The studies included were appraised using the Jadad score. Results Seven studies were included in the final review. Five studies, of which three were randomised trials, investigated the role of somatostatin analogues and the results showed a mean reduction in liver volume ranging from 2.9% at six months to 4.95 ±6.77% at one year. Only one randomised study examined the influence of rapamycin inhibitors. This trial compared dual therapy with everolimus and octreotide versus octreotide monotherapy. Liver volume reduced by 3.5% and 3.8% in the control and intervention groups respectively but no statistical difference was found between the two groups (p=0.73). Two randomised trials investigating somatostatin analogues assessed quality of life using SF-36(®). Only one subdomain score improved in one of the trials while two subdomain scores improved in the other with somatostatin analogue therapy. Conclusions Somatostatin analogues significantly reduce liver volumes after six months of therapy but have only a modest improvement on quality of life. Rapamycin inhibitors do not confer any additional advantage.

  12. 42 CFR 414.64 - Payment for medical nutrition therapy.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Payment for medical nutrition therapy. 414.64 Section 414.64 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Physicians and Other Practitioners § 414.64 Payment for medical nutrition therapy. (a) Payment under...

  13. 42 CFR 414.64 - Payment for medical nutrition therapy.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Payment for medical nutrition therapy. 414.64 Section 414.64 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Physicians and Other Practitioners § 414.64 Payment for medical nutrition therapy. (a) Payment under...

  14. 42 CFR 414.64 - Payment for medical nutrition therapy.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Payment for medical nutrition therapy. 414.64 Section 414.64 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Physicians and Other Practitioners § 414.64 Payment for medical nutrition therapy. (a) Payment under...

  15. Efficacy of medical therapy in treatment of chronic rhinosinusitis.

    PubMed

    Young, Lee C; Stow, Nicholas W; Zhou, Lifeng; Douglas, Richard G

    2012-01-01

    Uncomplicated chronic rhinosinusitis (CRS) is generally treated with medical therapy initially and surgery is contemplated only after medical therapy has failed. However, there is considerable variation in the medical treatment regimens used and studies defining their efficacy are few. The aim of this study was to determine the proportion of patients treated medically who responded sufficiently well so that surgery was not required. Subgroup analysis to identify clinical features that predicted a favorable response to medical therapy was also performed. Eighty patients referred to the Otorhinolaryngology Clinic at North Shore Hospital were treated with a standardized medical therapy protocol (oral prednisone for 3 weeks, oral antibiotics and ongoing saline lavage and intranasal budesonide spray). Symptom scores were collected before and after medical therapy. Clinical features such as presence of polyps, asthma, and aspirin hypersensitivity were recorded. Failure of medical therapy was defined as the persistence of significant CRS symptoms, and those patients who failed medical therapy were offered surgery. Follow-up data were available for 72 (90%) patients. Of this group, 52.5%, (95% CI, 42.7%, 62.2%) failed to respond adequately to medical therapy and were offered surgery. The remaining patients (37.5%) were successfully treated with medical therapy and did not require surgery at the time of follow-up. The premedical therapy symptom scores were significantly higher than the postmedical therapy symptom scores (p < 0.01). The symptom scores of those patients postmedical therapy who proceeded to have surgery were significantly higher than the group who responded well to maximum medical therapy (MMT) and did not require surgery (p < 0.0001). There were no significant differences in the proportion of patients with asthma, aspirin sensitivity, or polyps between the groups failing or not failing MMT. In approximately one-third of patients with CRS, medical therapy

  16. Medical management of neurogenic bladder with oral therapy

    PubMed Central

    2016-01-01

    This is a review of the most current literature on medical management of the neurogenic bladder (NGB) to treat detrusor overactivity (DO), improve bladder compliance and treat urinary incontinence. The use of antimuscarinics, alpha blockers, tricyclic antidepressants, desmopressin and mirabegron will be discussed along with combination therapy to improve efficacy. These medical therapies will be the focus of this review with surgical therapy and botulinum toxin injections being the subject of other articles in this series. PMID:26904412

  17. Medical management of neurogenic bladder with oral therapy.

    PubMed

    Cameron, Anne P

    2016-02-01

    This is a review of the most current literature on medical management of the neurogenic bladder (NGB) to treat detrusor overactivity (DO), improve bladder compliance and treat urinary incontinence. The use of antimuscarinics, alpha blockers, tricyclic antidepressants, desmopressin and mirabegron will be discussed along with combination therapy to improve efficacy. These medical therapies will be the focus of this review with surgical therapy and botulinum toxin injections being the subject of other articles in this series.

  18. Targets for medical therapy in obesity.

    PubMed

    Baretić, Maja

    2012-01-01

    Obesity has more than doubled since 1980 all over the world, and in the European perspective it does not seem to be better. Obesity-related diseases like diabetes, hypertension, coronary heart disease, stroke and hyperlipidemia are the main cause of mortality and morbidity in developed countries. These are the reasons for continuous search for efficient treatment of obesity. One of the options is medical therapy. Over history, many anti-obesity drugs were introduced and subsequently removed from the market due to various side effects. Unfortunately, there is still no ideal drug for the treatment of obesity, and the current ones are very strictly evaluated. The anti-obesity drug should target patients that have previously failed to lose weight with lifestyle interventions, with body mass index (BMI) ≥30, or those with BMI ≥27 plus concomitant obesity-related risk factors or diseases. The only drug currently approved in Europe is orlistat, a pancreatic lipase inhibitor. Sibutramine, an appetite suppressant (serotonin-norepinephrine reuptake inhibitor), has been off the market since 2010 due to cardiovascular side effects. There is a large group of drugs used for other indications with weight loss effects, e.g. incretin mimetics or analogues used in the treatment of diabetes type 2, topiramate used as an anticonvulsant, and fluoxetine and sertraline used in the treatment of depression. PMID:22722433

  19. Resource Letter MPRT-1: Medical Physics in Radiation Therapy

    NASA Astrophysics Data System (ADS)

    Ratliff, Steven T.

    2009-09-01

    This resource letter provides a guide to the literature on medical physics in the field of radiation therapy. Journal articles, books, and websites are cited for the following topics: radiological physics, particle accelerators, radiation dose measurements, protocols for radiation dose measurements, radiation shielding and radiation protection, neutron, proton, and heavy-ion therapies, imaging for radiation therapy, brachytherapy, quality assurance, treatment planning, dose calculations, and intensity-modulated and image-guided therapy.

  20. The perfect marriage: solution-focused therapy and motivational interviewing in medical family therapy.

    PubMed

    Stermensky, Gage; Brown, Kristina S

    2014-01-01

    Medical family therapy has many potential uses in behavioral medicine and primary care. Current research was reviewed to determine the most advantageous way to apply solution-focused therapy and motivational interviewing as a perfect marriage in medical family therapy. An extensive literature review was done in the following databases for medical family therapy: Proquest, EBSCO, Medline, and PsychInfo. The search resulted in 86 relevant articles, of which 46 of the most recent were selected for review. Medical family therapy lacks current research that supports solution-focused therapy or motivational interviewing. However, evidence supports the use of solution-focused therapy as a brief format, as well as the closely related intervention, motivational interviewing. While medical family therapy presents many hopeful possibilities in the fields of behavioral medicine, psychology, and marriage and family therapy, little evidence currently exists for the most effective implementation. This review found evidence supporting solution-focused therapy and motivational interviewing as the perfect marriage of the collaborative team approaches for the future implementation and use of specific interventions in medical family therapy. PMID:25657948

  1. Endovascular Versus Medical Therapy for Atherosclerotic Renovascular Disease

    PubMed Central

    Yu, Mark Shipeng; Folt, David A.; Drummond, Christopher A.; Haller, Steven T.; Cooper, Emily L.; Brewster, Pamela; Evans, Kaleigh L.

    2016-01-01

    The diagnosis of renal artery stenosis (RAS) has become increasingly common in part due to greater awareness of ischemic renal disease and increased use of diagnostic techniques. Over 90 % of RAS cases are caused by atherosclerotic renovascular disease (ARVD). Patients with ARVD are at high risk for fatal and nonfatal cardiovascular and renal events. The mortality rate in patients with ARVD is high, especially with other cardiovascular or renal comorbidities. Recent clinical studies have provided substantial evidence concerning medical therapy and endovascular interventional therapeutic approaches for ARVD. Despite previous randomized clinical trials, the optimal therapy for ARVD remained uncertain until the results of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial were released recently. CORAL demonstrated that optimal medical therapy was equally effective to endovascular therapy in the treatment of ARVD. Clinicians can now practice with more evidence-based medicine to treat ARVD and potentially decrease mortality in patients with ARVD using optimal medical therapy. PMID:25301353

  2. An Art Therapy Protocol for the Medical Trauma Setting.

    ERIC Educational Resources Information Center

    Appleton, Valerie E.

    1993-01-01

    Presents art therapy intervention protocol developed for burn trauma unit over 10-year period. Considers research model for assessing artwork and psychosocial transition from trauma, rationales for art therapy in medical settings, and documentation. Case study illustrates ways that art media were used to review, integrate, and express personal…

  3. The Importance of Teacher Involvement in Medication Therapy

    ERIC Educational Resources Information Center

    Ryan, Joseph B.; Katsiyannis, Antonis

    2009-01-01

    Over the past several decades, there has been a steady increase in the use of medication therapy to help control student behavior within schools. While psychotropic medications do not "cure" mental illnesses, they have demonstrated efficacy in helping children function better at school and within their home environment. However, it is important…

  4. Medical physics aspects of particle therapy.

    PubMed

    Jäkel, Oliver

    2009-11-01

    Charged particle beams offer an improved dose conformation to the target volume when compared with photon radiotherapy, with better sparing of normal tissue structures close to the target. In addition, beams of heavier ions exhibit a strong increase of the linear energy transfer in the Bragg peak when compared with the entrance region. These physical and biological properties make ion beams more favourable for radiation therapy of cancer than photon beams. As a consequence, particle therapy with protons and heavy ions has gained increasing interest worldwide. This contribution summarises the physical and biological principles of charged particle therapy with ion beams and highlights some of the developments in the field of beam delivery, the principles of treatment planning and the determination of absorbed dose in ion beams. The clinical experience gathered so far with carbon ion therapy is briefly reviewed.

  5. Ozone Therapy in Ethidium Bromide-Induced Demyelination in Rats: Possible Protective Effect.

    PubMed

    Salem, Neveen A; Assaf, Naglaa; Ismail, Manal F; Khadrawy, Yasser A; Samy, Mohga

    2016-08-01

    Multiple sclerosis, an autoimmune inflammatory disease of the central nervous system, is characterized by excessive demyelination. The study aimed to investigate the possible protective effect of ozone (O3) therapy in ethidium bromide (EB)-induced demyelination in rats either alone or in combination with corticosteroids in order to decrease the dose of steroid therapy. Rats were divided into Group (1) normal control rats received saline, Group (2) Sham-operated rats received saline, Group (3) Sham-operated rats received vehicle (oxygen), Group (4) EB-treated rats received EB, Group (5) EB-treated rats received O3, Group (6) EB-treated rats received methylprednisolone (MP), and Group (7) EB-treated rats received half the dose of MP concomitant with O3. EB-treated rats showed a significant increase in the number of footfalls in the grid walk test, decreased brain GSH, and paraoxonase-1 enzyme activity, whereas brain MDA, TNF-α, IL-1β, INF-γ, Cox-2 immunoreactivity, and p53 protein levels were increased. A significant decline in brain serotonin, dopamine, norepinephrine, and MBP immunoreactivity was also reported. Significant improvement of the above-mentioned parameters was demonstrated with the administration of either MP or O3, whereas best amelioration was achieved by combining half the dose of MP with ozone. PMID:26467344

  6. Applications of medical informatics in antibiotic therapy.

    PubMed

    Evans, R S; Pestotnik, S L

    1994-01-01

    The Infectious Disease Society of America is concerned about the excessive and inappropriate use of antibiotics in U.S. hospitals. Applications of Medical Informatics can help improve the use of antibiotics and help improve patient care by monitoring and managing enormous amounts of patient information. Monitoring the duration of every antibiotic ordered in the hospital or keeping tract of the antibiotic susceptibilities for five years are examples of tasks better performed by computers. The impact of computers in medicine is seen by some as disappointing. The computer revolution has not had the impact in medicine experienced by other areas. The acceptance and use of computers by medicine will be evolutionary rather than revolutionary. In 1979, the MYCIN project demonstrated that the computer could aid physicians in the selection of antibiotics. However, MYCIN was never clinically used because physicians were require to enter all patient information into the computer. The development of computerized medical records is an essential step to further the development and implementation of computer-aided decision support. The science of Medical Informatics is still relatively new but is emerging as a distinct academic field. A few hospitals are now installing information systems and have determined that these systems will play an essential role in their ability to survive into the next century. The telephone and the automobile have been recognized as two of the most important tools for improving medical care during the past 100 years. People could more readily get medical care and the time to transmit medical information was greatly reduced through physician use of the telephone and automobile. The computer is a tool that can be used to help physicians manage the great amount of medical information being generated every day. The computer can also alert the physician of patient conditions that need attention. However, it is the physician who must use and apply the

  7. Irritable bowel syndrome treatment: cognitive behavioral therapy versus medical treatment

    PubMed Central

    Mahvi-Shirazi, Majid; Rasoolzade-Tabatabaei, Sayed-Kazem; Amini, Mohsen

    2012-01-01

    Introduction The study aims to investigate two kinds of treatment in patients suffering from irritable bowel syndrome (IBS) and consequently compares its efficacy on improving the symptoms and mental health of patients; one with just medical treatment and another through a combination of psychotherapy and medical treatment. Material and methods Applying general sampling, 50 IBS patients were selected from among those who used to refer to a Gastroenterology Clinic. After physical and mental evaluations based on ROME-II scale and SCL-90-R questionnaires, the subjects were randomly superseded into: the control group with medical treatment and, the case group with a combination of medical and psychological treatments. The acquired data were then analyzed through t-test and Mann-Whitney U-test. Results The findings show that the mental health of patients receiving cognitive behavioral therapy along with the medical treatment was higher than those of the control group at post-test level. It was observed that the therapy reduces the disability caused by IBS. Comparatively, while the cognitive therapy and medical treatments cured 80% of the patients, those receiving cognitive therapy alone showed an extensive reduction of symptoms. Conclusions Considering the role of cognitive behavioral therapy, it is therefore recommend that such patients be managed by a combined team of gastroenterologists and psychologists. PMID:22457686

  8. Interest in medical therapy for celiac disease

    PubMed Central

    Tennyson, Christina A.; Simpson, Suzanne; Lebwohl, Benjamin; Lewis, Suzanne

    2013-01-01

    Objectives: A gluten-free diet is the treatment for celiac disease, but pharmaceutical agents are being developed. The level of interest amongst patients in using a medication to treat celiac disease is unknown. This study examined the level of interest amongst patients in medication to treat celiac disease. Methods: A questionnaire was distributed to celiac disease patients and data were collected on demographics, presentation, and interest in medication. Three validated celiac disease-specific instruments were incorporated: Celiac Disease Associated Quality of Life, the Celiac Symptom Index, and the Celiac Dietary Adherence Test. Results: Responses were received from 365 individuals with biopsy-proven celiac disease. Respondents were 78% (n = 276) female, 48% (n = 170) over 50 years of age, and experienced a classical (diarrhea predominant) presentation in 44% (n = 154). Of the 339 individuals answering the question regarding use of a medication to treat celiac disease, 66% were interested. Interest was greatest in older individuals (71% >50 years of age versus 60% <50 years of age, p = 0.0415), men (78% men versus 62% women, p = 0.0083), frequent restaurant customers (76% versus 58%, p = 0.0006), those dissatisfied with their weight (73% versus 51%, p = 0.0003) and those concerned with the cost of a gluten-free diet (77% versus 64%, p = 0.0176). Length of time since diagnosis, education, presentation, and symptoms with gluten exposure did not demonstrate any effect. Interest in medication was associated with a worse quality of life (CD-QOL 69.4 versus 80.1, p < 0.0001). Conclusions: Most individuals with celiac disease are interested in using a medication. Interest was highest among men, older individuals, frequent restaurant customers, individuals dissatisfied with their weight or concerned with the cost of a gluten-free diet, and those with a worse quality of life. PMID:24003336

  9. Prayer and meditation as medical therapies.

    PubMed

    Harmon, R L; Myers, M A

    1999-08-01

    Prayer and meditation have been used as health-enhancing techniques for centuries. Their use has been investigated more recently in the context of more conventional, allopathic medical approaches. These studies, despite methodological limitations, show some promise for the formal application and integration of these techniques into western medical practice. Some potential benefits from meditation include reduced perceived stress and improvement in mild hypertension. Prayer appears to offer subjective benefit to those who pray; the effects of intercessory prayer on the health status of unknowing individuals requires more investigation.

  10. Medical cannabis and chronic opioid therapy.

    PubMed

    Reisfield, Gary M

    2010-12-01

    Fourteen states and the District of Columbia have legalized the use of cannabis for medical purposes. A small, high-quality literature supports the efficacy of medical cannabis for the treatment of neuropathic pain. The smoked botanical product, however, is associated with a number of adverse medical and psychiatric consequences. Furthermore, experimental data indicate that acute use of cannabis results in impairment of every important metric related to the safe operation of a motor vehicle. Epidemiological data show associations between recent cannabis use and both psychomotor impairment and motor vehicle crashes, associations that are strengthened by the concomitant use of alcohol and other central nervous system depressants. Finally, data from pain clinics reveals an unusually high prevalence of cannabis use in nearly all age groups and an association between cannabis use and opioid and other substance misuse. Based on available data and expert opinion, concomitant use of cannabis and opioids is an absolute contraindication to the operation of a motor vehicle. In patients who use cannabis and are prescribed opioids, heightened vigilance for opioid- and other substance-related problems is warranted. It is appropriate to refrain from prescribing opioids to individuals using medical cannabis if there is reasonable suspicion that the combination will pose a risk to the patient or others.

  11. Medical therapy for pediatric inflammatory bowel disease.

    PubMed

    Sherlock, Mary E; Griffiths, Anne M

    2012-04-01

    Pediatric inflammatory bowel disease encompasses a spectrum of disease phenotype, severity, and responsiveness to treatment. Intestinal healing rather than merely symptom control is an especially important therapeutic goal in young patients, given the potential for growth impairment as a direct effect of persistent chronic inflammation and the long life ahead, during which other disease complications may occur. Corticosteroids achieve rapid symptom control, but alternate steroid-sparing strategies with greater potential to heal the intestine must be rapidly adopted. Exclusive enteral nutrition is an alternate short-term treatment in pediatric Crohn's disease. The results of multi-center pediatric clinical trials of both infliximab and adalimumab in Crohn's disease and of infliximab in ulcerative colitis (all in children with unsatisfactory responses to other therapies) have now been reported and guide treatment regimens in clinical practice. Optimal patient selection and timing of anti-TNF therapy requires clinical judgment. Attention must be paid to sustaining responsiveness safely.

  12. Effectiveness of a Short-Term Treatment of Oxygen-Ozone Therapy into Healing in a Posttraumatic Wound

    PubMed Central

    Degli Agosti, Irene; Mazzacane, Bruno; Peroni, Gabriella; Bianco, Sandra; Guerriero, Fabio; Ricevuti, Giovanni

    2016-01-01

    Introduction. A number of studies suggest that oxygen-ozone therapy may have a role in the treatment of chronic, nonhealing, or ischemic wounds for its disinfectant and antibacterial properties. Nonhealing wounds are a significant cause of morbidity. Here we present a case of subcutaneous oxygen-ozone therapy used to treat a nonhealing postoperative wound in a young man during a period of 5 weeks. Case Presentation. A 46-year-old man had a motorcycle accident and underwent amputation of the right tibia and fibula. At the discharge he came to our attention to start rehabilitation treatment. At that time the wound was ulcerated but it was afebrile with no signs of inflammation and negativity to blood tests. At 2 months from the trauma despite appropriate treatment and dressing, the wound was slowly improving and the patient complained of pain. For this reason in addition to standard dressing he underwent oxygen-ozone therapy. After 5 weeks of treatment the wound had healed. Conclusion. In patients with nonhealing wounds, oxygen-ozone therapy could be helpful in speeding the healing and reducing the pain thanks to its disinfectant property and by the increase of endogenous oxygen free radicals' scavenging properties. Compared to standard dressing and other treatments reported in the literature it showed a shorter time of action. PMID:27738434

  13. Best evidence for medical therapy for carotid artery stenosis.

    PubMed

    Constantinou, Jason; Jayia, Parveen; Hamilton, George

    2013-10-01

    Carotid atheromatous disease is an important cause of stroke and represents a key target in stroke prevention. Randomized trials have shown the efficacy of carotid endarterectomy in secondary stroke prevention. Carotid stenting presents a less invasive alternative to surgical intervention. Advances in medical management, if compliance can be ensured, are leading to improvement in outcomes when implemented as sole therapy in the treatment of atherosclerotic carotid stenosis. This includes lifestyle modification, blood pressure control, and antiplatelet and statin therapy. Over the last 20 years, the annual rate of ipsilateral stroke associated with asymptomatic carotid stenosis has decreased from 2% to 4% to less than 1%. This is largely due to improvements in medical therapy. However, despite numerous trials and years of clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial. This article presents and summarizes the evidence supporting best medical treatment for carotid artery stenosis.

  14. Contemporary medical therapy for polycystic ovary syndrome.

    PubMed

    Lanham, M S M; Lebovic, D I; Domino, S E

    2006-12-01

    Polycystic ovary syndrome is a multi-system endocrinopathy with long-term metabolic and cardiovascular health consequences. Patients typically present due to symptoms of irregular menstruation, hair growth, or infertility; however, recent management options are aimed at further treating underlying glucose-insulin abnormalities as well as androgen excess for proactive control of symptoms. By a 2003 international consensus conference, diagnosis is made by two out of three criteria: chronic oligoovulation or anovulation after excluding secondary causes, clinical or biochemical evidence of hyperandrogenism (but not necessarily hirsutism due to inter-patient variability in hair follicle sensitivity), and radiological evidence of polycystic ovaries. Traditional medical treatment options include oral contraceptive pills, cyclic progestins, ovulation induction, and anti-androgenic medications (aldosterone antagonist, 5alpha-reductase antagonist, and follicle ornithine decarboxylase inhibitor). Recent pharmacotherapies include insulin-sensitizing medications metformin and two thiazolidinediones (rosiglitazone/Avandia and pioglitazone/Actos), a CYP19 aromatase inhibitor (letrozole/Femara), and statins to potentially lower testosterone levels.

  15. Gantry for medical particle therapy facility

    DOEpatents

    Trbojevic, Dejan

    2012-05-08

    A particle therapy gantry for delivering a particle beam to a patient includes a beam tube having a curvature defining a particle beam path and a plurality of fixed field magnets sequentially arranged along the beam tube for guiding the particle beam along the particle path. In a method for delivering a particle beam to a patient through a gantry, a particle beam is guided by a plurality of fixed field magnets sequentially arranged along a beam tube of the gantry and the beam is alternately focused and defocused with alternately arranged focusing and defocusing fixed field magnets.

  16. Gantry for medical particle therapy facility

    DOEpatents

    Trbojevic, Dejan

    2013-04-23

    A particle therapy gantry for delivering a particle beam to a patient includes a beam tube having a curvature defining a particle beam path and a plurality of superconducting, variable field magnets sequentially arranged along the beam tube for guiding the particle beam along the particle path. In a method for delivering a particle beam to a patient through a gantry, a particle beam is guided by a plurality of variable field magnets sequentially arranged along a beam tube of the gantry and the beam is alternately focused and defocused with alternately arranged focusing and defocusing variable field magnets.

  17. Medical association supports studies on marijuana therapy.

    PubMed

    1995-06-16

    The Gay and Lesbian Medical Association (GLMA) issued a statement on May 19, 1995, announcing its support of clinical trials of the therapeutic uses of marijuana. The U.S. Department of Health and Human Services has continued to resist permitting clinical trials of marijuana despite evidence that it can relieve symptoms of cancer, multiple sclerosis, and glaucoma. According to Dr. Alvin Novick, head of GLMA's AIDS Task Force, the Clinton Administration is being asked to not let its political fears blind it to the positive and legitimate scientific research designed to alleviate the suffering of thousands of AIDS patients.

  18. Medical and alternative therapies in urinary tract stone disease

    PubMed Central

    Yuvanc, Ercan; Yilmaz, Erdal; Tuglu, Devrim; Batislam, Ertan

    2015-01-01

    Nephrolithiasis is a serious problem for both patients and the health system. Recurrence stands out as a significant problem in urinary system stone disease, the prevalence of which is increasing gradually. If recurrence is not prevented, patients may go through recurrent operations due to nephrolithiasis. While classical therapeutic options are available for all stone types, the number of randomized controlled studies and extensive meta-analyses focusing on their efficiency are inadequate. Various alternative therapeutic options to these medical therapies also stand out in recent years. The etiology of urolithiasis is multifactorial and not always related to nutritional factors. Nutrition therapy seems to be useful, either along with pharmacological therapy or as a monotherapy. General nutrition guidelines are useful in promoting public health and developing nutrition plans that reduce the risk or attenuate the effects of diseases affected by nutrition. Nutrition therapy involves the evaluation of a patient’s nutritional state and intake, the diagnosis of nutrition risk factors, and the organization and application of a nutrition program. The main target is the reduction or prevention of calculus formation and growth via decreasing lithogenic risk factors and increasing lithogenic inhibitors in urine. This review focuses briefly on classical medical therapy, along with alternative options, related diets, and medical expulsive therapy. PMID:26558186

  19. [Impact of ozone therapy on the electrophysiological parameters of the retina in patients operated on for its rhegmatogenous detachment].

    PubMed

    Neroev, V V; Sarygina, O I; Zueva, M V; Tsapenko, I V; Egorova, E N

    2007-01-01

    The impact of ozone therapy on changes in the data of maximum combined electroretinography (ERG), macular ERG (MERG), and rhythmic ERG (RERG) at 12, 32, and 40 Hz was studied in the rehabilitative period in patients operated on for rhegmatogenous retinal detachment. The integral and local glial indices K(g) and K(c) were calculated. Studies were conducted before, within 1 week and 1 and 2 months after a course of therapy. With ozone therapy, ERG and RERG depended on the specific features of changes available in the fundus of the eye before surgery. In the early rehabilitative period after surgery (circlage with subretinal fluid removal), ozone therapy normalized the glial indices, by decreasing the supernormal activity of Muller's glial cells and drastically increasing their reduced activity. The maximum effect was revealed for the function of phororeceptors (except for the eyes showing pronounced myopic dystrophic changes in the fundus). There were increases in MERG, ERG b-wave, and low-frequency RERG by 12 Hz, i.e. improved functions of the macular region and distal neurons of the retinal rod cell system. A latent period was established for the manifestation of a positive effect of ozonwe therapy on the functional of neurons of the internal retinal nuclear layer, as evidenced by RERG changes. Ozone therapy positively affect retinal electrogenesis in cases of total retinal detachment accompanied by a pronounced reduction in the glial index Kg before surgery. The therapy was found to have a positive impact on the functional activity of the retina of pair eyes, by developing within a one-moth latent period.

  20. Nurses' perceptions of complementary and alternative medical therapies.

    PubMed

    Brolinson, P G; Price, J H; Ditmyer, M; Reis, D

    2001-06-01

    The purpose of this study was to identify the perceptions of nurses toward the effectiveness and safety, as well as their recommendations for and personal use of complementary and alternative medical therapies. A, random sample of 1000 nurses throughout the United States were surveyed using a three-wave mailing. About half of the respondents perceived there was conclusive evidence or preponderance of evidence that five therapies were effective: biofeedback, chiropractic, meditation/relaxation, multi-vitamins, and massage therapy. The same amount of nurses also perceived five therapies as definitely safe: hypnotherapy, chiropractic, acupressure, acupuncture, and healing touch. However, the nurses were most likely to recommend (regularly or periodically) four therapies: multivitamins, massage, meditation/relaxation, and pastoral/spiritual counseling. The vast majority (79%) of nurses perceived their professional preparation in this area to be fair or poor.

  1. Dyslexia and Learning Disabilities: Medical Diagnosis with Educational Therapy.

    ERIC Educational Resources Information Center

    Westerman, S. Thomas; And Others

    1982-01-01

    Ways of diagnosing dyslexia are discussed along with the developmental symptoms, which include balancing and hearing deficiencies, reversal of letters or words and unusual posture. Medical treatment with antihistamines and other drugs is described. Approximately 75 percent of individuals are shown to respond favorably to therapy. (CM)

  2. Laser therapy and photosensitive medication: a review of the evidence.

    PubMed

    Kerstein, Ryan L; Lister, Tom; Cole, Richard

    2014-07-01

    In the 2009 guidelines from the BMLA, the use of non-essential aesthetic lasers was contraindicated in patients receiving medication that causes whole-body photosensitisation as well as those causing local light sensitisation. Following this and anecdotal advice, many laser centres refuse to treat patients who are on known photosensitive medication. Therefore, specific patient cohorts that would benefit from laser therapy are being denied because of medications, such as long-term antibiotics for chronic facial acne. This article reviews the published literature on lasers and photosensitive medications, the mechanisms of photosensitivity and the role of laser in its production. The aim is to analyse the available evidence regarding adverse reactions to laser treatment related to photosensitive medication. A PubMed review of published article titles and abstracts was performed using the search term Laser with each of the following terms individually: photosensitive, photosensitiser, photosensitizer, phototoxicity, photoallergy, complications, case-report, tetracycline, minocycline, amiodarone, nitrofurantoin and medication. Four publications were identified, none of which reported any complication in the use of laser in patients taking photosensitising medication. As there are no published accounts of adverse effects of laser in patients with photosensitive medication, we performed a review of the mechanism of photosensitivity by compiling a list of photosensitive medication and the peak wavelength of radiation required to activate the drug. We recommend a national database of drugs and the wavelengths causing photosensitive reactions of each which a laser department can access prior to treatment. PMID:24590242

  3. Nanoscience and Nanotechnology: From Energy Applications to Advanced Medical Therapies

    ScienceCinema

    Tijana Rajh

    2016-07-12

    Dr. Rajh will present a general talk on nanotechnology – an overview of why nanotechnology is important and how it is useful in various fields. The specific focus will be on Solar energy conversion, environmental applications and advanced medical therapies. She has broad expertise in synthesis and characterization of nanomaterials that are used in nanotechnology including novel hybrid systems connecting semiconductors to biological molecules like DNA and antibodies. This technology could lead to new gene therapy procedures, cancer treatments and other medical applications. She will also discuss technologies made possible by organizing small semiconductor particles called quantum dots, materials that exhibit a rich variety of phenomena that are size and shape dependent. Development of these new materials that harnesses the unique properties of materials at the 1-100 nanometer scale resulted in the new field of nanotechnology that currently affects many applications in technological and medical fields.

  4. ED 02-4 MEDICAL THERAPY OF ABDOMINAL AORTIC ANEURYSMS.

    PubMed

    Jiang, Xiongjing

    2016-09-01

    Abdominal aortic aneurysm (AAA) is an important cause of mortality in older adults. Most AAAs are asymptomatic and screening programs have been introduced to identify AAAs. There is currently some recommendations for medical optimisation of patients with AAA, such as anti-hypertension, statin, Anti-platelet therapy, B-blockade, et al. Some medical treatments to limit progression of small AAAs, which have examined the potential of targeting inflammation, proteolysis, the renin-angiotensin system, the coagulation system and sex hormones as approaches to limiting AAA pathogenesis are investigated as well as. However, there is not generally accepted medical therapy for AAAs yet, Few of the treatment targets have translated into an agent, which can effectively reduce AAA progression in clinical practice. PMID:27643007

  5. Role of medication therapy management in preexposure prophylaxis therapy for HIV prevention.

    PubMed

    Ferrell, Kelli W; Woodard, Laresa M; Woodard, Todd J

    2015-02-01

    Patient medication adherence is a long-standing problem and is one that raises serious issues for patient health, public health, and health care quality. Medication nonadherence costs the US economy an estimated US$290 billion in avoidable medical spending every year. One of the most costly health conditions is HIV disease, which continues to be a serious health issue for parts of the world. About 34 million people are living with HIV around the world. With the emerging preventative treatment against HIV, known as preexposure prophylaxis (PrEP), come concerns surrounding the potential impact of nonadherence to this newly approved medication therapy. Nonadherence to antiretroviral treatments are commonly the root cause for patients not reaching their treatment goals, putting them at risk of progression and worsening of their disease and complications, such as increased risk of opportunistic infections. Therefore, it is essential to improve antiretroviral medication adherence. By identifying members who are nonadherent to their prescribed antiretroviral medications and working collaboratively with patients, physicians, and pharmacists, Medication Therapy Management (MTM) can potentially increase medication adherence by helping patients identify, resolve, and prevent issues that may affect their decision not to take a medication as intended.

  6. Role of Medical Therapy for Nonvariceal Upper Gastrointestinal Bleeding.

    PubMed

    Fortinsky, Kyle J; Bardou, Marc; Barkun, Alan N

    2015-07-01

    Nonvariceal upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality worldwide. Mortality from UGIB has remained 5-10% over the past decade. This article presents current evidence-based recommendations for the medical management of UGIB. Preendoscopic management includes initial resuscitation, risk stratification, appropriate use of blood products, and consideration of nasogastric tube insertion, erythromycin, and proton pump inhibitor therapy. The use of postendoscopic intravenous proton pump inhibitors is strongly recommended for certain patient populations. Postendoscopic management also includes the diagnosis and treatment of Helicobacter pylori, appropriate use of proton pump inhibitors and iron replacement therapy. PMID:26142032

  7. Monitoring of girls undergoing medical therapy for isosexual precocious puberty.

    PubMed

    Ambrosino, M M; Hernanz-Schulman, M; Genieser, N B; Sklar, C A; Fefferman, N R; David, R

    1994-07-01

    We evaluated the use of sonography in monitoring the efficacy of suppressive therapy with a gonadotropin releasing hormone analogue in girls being treated for isosexual precocious puberty. Ten girls 5 to 9 years of age underwent serial sonography and hormonal stimulation tests on the same day. Sonographic trends of decreasing ovarian volume and uterine length indicated early suppression even when absolute values were above threshold. Changes in ovarian volume were the most sensitive predictor of pituitary-gonadal suppression. Sonography is a sensitive and accurate method of monitoring medical therapy; ovarian volume and analysis of interval change are the most sensitive barometers of change.

  8. Monitoring of girls undergoing medical therapy for isosexual precocious puberty.

    PubMed

    Ambrosino, M M; Hernanz-Schulman, M; Genieser, N B; Sklar, C A; Fefferman, N R; David, R

    1994-07-01

    We evaluated the use of sonography in monitoring the efficacy of suppressive therapy with a gonadotropin releasing hormone analogue in girls being treated for isosexual precocious puberty. Ten girls 5 to 9 years of age underwent serial sonography and hormonal stimulation tests on the same day. Sonographic trends of decreasing ovarian volume and uterine length indicated early suppression even when absolute values were above threshold. Changes in ovarian volume were the most sensitive predictor of pituitary-gonadal suppression. Sonography is a sensitive and accurate method of monitoring medical therapy; ovarian volume and analysis of interval change are the most sensitive barometers of change. PMID:7933011

  9. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review

    PubMed Central

    Ghimire, Saurav; Castelino, Ronald L.; Lioufas, Nicole M.; Peterson, Gregory M.; Zaidi, Syed Tabish R.

    2015-01-01

    Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that

  10. Capacitive micromachined ultrasonic transducers for medical imaging and therapy

    PubMed Central

    Khuri-Yakub, Butrus T.; Oralkan, Ömer

    2011-01-01

    Capacitive micromachined ultrasonic transducers (CMUTs) have been subject to extensive research for the last two decades. Although they were initially developed for air-coupled applications, today their main application space is medical imaging and therapy. This paper first presents a brief description of CMUTs, their basic structure, and operating principles. Our progression of developing several generations of fabrication processes is discussed with an emphasis on the advantages and disadvantages of each process. Monolithic and hybrid approaches for integrating CMUTs with supporting integrated circuits are surveyed. Several prototype transducer arrays with integrated frontend electronic circuits we developed and their use for 2-D and 3-D, anatomical and functional imaging, and ablative therapies are described. The presented results prove the CMUT as a MEMS technology for many medical diagnostic and therapeutic applications. PMID:21860542

  11. Stenting and Medical Therapy for Atherosclerotic Renal-Artery Stenosis

    PubMed Central

    Cooper, Christopher J.; Murphy, Timothy P.; Cutlip, Donald E.; Jamerson, Kenneth; Henrich, William; Reid, Diane M.; Cohen, David J.; Matsumoto, Alan H.; Steffes, Michael; Jaff, Michael R.; Prince, Martin R.; Lewis, Eldrin F.; Tuttle, Katherine R.; Shapiro, Joseph I.; Rundback, John H.; Massaro, Joseph M.; D'Agostino, Ralph B.; Dworkin, Lance D.

    2016-01-01

    BACKGROUND Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain. METHODS We randomly assigned 947 participants who had atherosclerotic renal-artery stenosis and either systolic hypertension while taking two or more antihypertensive drugs or chronic kidney disease to medical therapy plus renal-artery stenting or medical therapy alone. Participants were followed for the occurrence of adverse cardiovascular and renal events (a composite end point of death from cardiovascular or renal causes, myocar-dial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for renal-replacement therapy). RESULTS Over a median follow-up period of 43 months (interquartile range, 31 to 55), the rate of the primary composite end point did not differ significantly between participants who underwent stenting in addition to receiving medical therapy and those who received medical therapy alone (35.1% and 35.8%, respectively; hazard ratio with stenting, 0.94; 95% confidence interval [CI], 0.76 to 1.17; P = 0.58). There were also no significant differences between the treatment groups in the rates of the individual components of the primary end point or in all-cause mortality. During follow-up, there was a consistent modest difference in systolic blood pressure favoring the stent group (−2.3 mm Hg; 95% CI, −4.4 to −0.2; P = 0.03). CONCLUSIONS Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease. (Funded by the National Heart, Lung and Blood Institute and others; Clinical

  12. Bacteriophages and medical oncology: targeted gene therapy of cancer.

    PubMed

    Bakhshinejad, Babak; Karimi, Marzieh; Sadeghizadeh, Majid

    2014-08-01

    Targeted gene therapy of cancer is of paramount importance in medical oncology. Bacteriophages, viruses that specifically infect bacterial cells, offer a variety of potential applications in biomedicine. Their genetic flexibility to go under a variety of surface modifications serves as a basis for phage display methodology. These surface manipulations allow bacteriophages to be exploited for targeted delivery of therapeutic genes. Moreover, the excellent safety profile of these viruses paves the way for their potential use as cancer gene therapy platforms. The merge of phage display and combinatorial technology has led to the emergence of phage libraries turning phage display into a high throughput technology. Random peptide libraries, as one of the most frequently used phage libraries, provide a rich source of clinically useful peptide ligands. Peptides are known as a promising category of pharmaceutical agents in medical oncology that present advantages such as inexpensive synthesis, efficient tissue penetration and the lack of immunogenicity. Phage peptide libraries can be screened, through biopanning, against various targets including cancer cells and tissues that results in obtaining cancer-homing ligands. Cancer-specific peptides isolated from phage libraries show huge promise to be utilized for targeting of various gene therapy vectors towards malignant cells. Beyond doubt, bacteriophages will play a more impressive role in the future of medical oncology.

  13. Medical and endoscopic therapy of primary sclerosing cholangitis.

    PubMed

    Weismüller, Tobias J; Lankisch, Tim O

    2011-12-01

    Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease mainly affecting young male patients. PSC is characterised by chronic inflammation and fibrotic strictures of the intra- and extrahepatic biliary system, which eventually lead to cholestasis and biliary cirrhosis. However, the clinical course remains very variable. As the aetiology remains unknown, the development of a causative treatment is challenging and today no specific medical therapy is available. Ursodeoxycholic acid has been widely used for the treatment of PSC, but improved only biochemistry and/or symptoms in low- or medium dosages and is probably harmful in higher dosages. Other drugs such as immunosuppressive, antifibrotic or antibiotic agents have not been proven to be effective in large clinical trials. The endoscopic therapy encompasses balloon-dilatation and/or stenting of strictures, relieves clinical symptoms and improves a cholestatic enzyme profile. However, endoscopic therapy is limited to patients in advanced stages of PSC with biliary obstruction.

  14. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Medical charged-particle radiation therapy system...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system...) intended for use in radiation therapy. This generic type of device may include signal analysis and...

  15. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical charged-particle radiation therapy system...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system...) intended for use in radiation therapy. This generic type of device may include signal analysis and...

  16. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Medical charged-particle radiation therapy system...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system...) intended for use in radiation therapy. This generic type of device may include signal analysis and...

  17. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Medical charged-particle radiation therapy system...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system...) intended for use in radiation therapy. This generic type of device may include signal analysis and...

  18. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Medical charged-particle radiation therapy system...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system...) intended for use in radiation therapy. This generic type of device may include signal analysis and...

  19. Medical Therapy Versus Laparoscopic Surgical Treatment for Ulcer Disease.

    PubMed

    Fletcher

    1994-09-01

    The development of low morbidity vagotomy and H2 antagonists in the early 1970s began the debate as to which was the most appropriate treatment for uncomplicated duodenal ulcer. A review of Australian Medicare and Pharmaceutical Benefits Scheme data shows that medical treatment in this country was the preferred option. In the past 12 years, vagotomies have decreased 15-fold while, in the same period, H2 antagonist prescriptions have increased from 0 to 2.5 million per year, doubling in the past 3 years, and currently costs $96 million per year or 6.7% of the country's entire pharmaceutical budget. Similarly, upper gastrointestinal tract endoscopies have increased, costing $15 million per year, doubling in the past 6 years and representing a cost almost equivalent to all other upper gastrointestinal procedures combined. Despite known efficacy and recommendations for use, triple therapy for Heliobacter species is not being used with prescriptions for surface agents actually decreasing to 40,000 per year. A review of the outcome of medical and surgical therapy shows that this expense is not justified; surgery would be more costeffective than medicine at 2 years and safer than medicine after 4 years as a result of complications from failed medical treatment. This margin of benefit is predicted to be greater with laparoscopic vagotomy. Failed medical treatment needs to be redefined by limiting H2 antagonists to a 6-week course. Recurrences or failures are than evaluated endoscopically and those diagnosed with having chronic duoderal ulcers have biopsies taken. Heliobacter pylori positive patients are treated with triple therapy. Failures, recurrences, and originally H pylori negative patients have laparoscopic vagotomy. For such a trial protocol to be evaluated, it requires the long-term use of H2 antagonists to be restricted and laparoscopic vagotomists to document the efficacy of their surgery, including gastric secretion tests. PMID:10401050

  20. Predicting relapse following medical therapy for Graves' disease

    SciTech Connect

    McKillop, J.H.; Wilson, R.; Pearson, D.W.; Cuthbert, G.F.; Jenkins, C.; Caine, S.; Thomson, J.A.

    1984-01-01

    In 40 patients with Graves' disease (35 female, 5 male; mean age at presentation = 38 yrs) the authors examined the ability of thyroidal /sup 99m/Tc uptake and serum thyroid stimulating immunoglobins (TSI) to identify patients who would relapse after a course of medical therapy. Serum TSI and 20 minute thyroidal /sup 99m/Tc uptake were estimated every 3 months during a 12 month course of carbimazole and tri iodothyronine. TSI levels were estimated by inhibition of receptor binding and expressed as an index (normal value <25). 17 patients (Group 1) remained biochemically euthyroid for at least 1 year after cessation of therapy. 23 (Group II) developed recurrent thyrotoxicosis. Thyroid hormone level did not differ between Groups I and II at presentation. /sup 99m/Tc uptake did not differ significantly in the two groups at presentation and overlap of values persisted throughout therapy. 3 patients had undetectable TSI levels at presentation and throughout follow-up. In the remaining 37, TSI levels at presentation were significantly higher in Group II and all 7 patients with initial values >80 relapsed. After 12 months therapy a TSI level of >25 was present in 1 Group I patient and 16 Group II patients who had detectable TSI at presentation. /sup 99m/Tc uptake was a poor predictor of relapse of thyrotoxicosis. A very high TSI level at presentation (>80) was associated with relapse. An abnormal TSI on completion of 12 months medical therapy had a sensitivity of 86% and a specificity of 94% for prediction of relapse of thyrotoxicosis in the subsequent year.

  1. The Morphometrical and Histopathological Changes which were Observed after Topical Ozone Therapy on an Exophytic Fibrous Gingival Lesion: A Case Report.

    PubMed

    Patel, Punit Vaibhav; Gujjari, Sheela Kumar

    2013-06-01

    We are presenting 2 cases where ozone therapy was used in the form of ozonated oil on an exophytic fibrous gingival lesion. A 42-years female patient was selected, who presented with a mild to moderately painful, exophytic, fibrous lesion on the upper anterior gingiva. This gingival lesion was treated with 2ml of ozonated oil, thrice daily for one week. After the ozone therapy, the postoperative outcomes were measured and analyzed. Finally, the lesion was subjected to an excisional biopsy and a histopathological evaluation. After the ozone therapy, the patient revealed that there was less pain. On examination of the lesion, an improvement was observed in the clinical sign of the inflammation and also a reduction in the surface ulceration. During the final biopsy, less bleeding was observed. The morphometrical analysis showed a reduction in the size of the lesion. The histopathological analysis showed a reduction in the collagen fibres and in the inflammatory cells in the connective tissue stroma. Topical ozone therapy provides potential benefits for the treatment of exophytic gingival lesions. The observed benefits in present case report needs to be verified in future with well-controlled clinical trials.

  2. Synchrotron Radiation Therapy from a Medical Physics point of view

    NASA Astrophysics Data System (ADS)

    Prezado, Y.; Adam, J. F.; Berkvens, P.; Martinez-Rovira, I.; Fois, G.; Thengumpallil, S.; Edouard, M.; Vautrin, M.; Deman, P.; Bräuer-Krisch, E.; Renier, M.; Elleaume, H.; Estève, F.; Bravin, A.

    2010-07-01

    Synchrotron radiation (SR) therapy is a promising alternative to treat brain tumors, whose management is limited due to the high morbidity of the surrounding healthy tissues. Several approaches are being explored by using SR at the European Synchrotron Radiation Facility (ESRF), where three techniques are under development Synchrotron Stereotactic Radiation Therapy (SSRT), Microbeam Radiation Therapy (MRT) and Minibeam Radiation Therapy (MBRT). The sucess of the preclinical studies on SSRT and MRT has paved the way to clinical trials currently in preparation at the ESRF. With this aim, different dosimetric aspects from both theoretical and experimental points of view have been assessed. In particular, the definition of safe irradiation protocols, the beam energy providing the best balance between tumor treatment and healthy tissue sparing in MRT and MBRT, the special dosimetric considerations for small field dosimetry, etc will be described. In addition, for the clinical trials, the definition of appropiate dosimetry protocols for patients according to the well established European Medical Physics recommendations will be discussed. Finally, the state of the art of the MBRT technical developments at the ESRF will be presented. In 2006 A. Dilmanian and collaborators proposed the use of thicker microbeams (0.36-0.68 mm). This new type of radiotherapy is the most recently implemented technique at the ESRF and it has been called MBRT. The main advantage of MBRT with respect to MRT is that it does not require high dose rates. Therefore it can be more easily applied and extended outside synchrotron sources in the future.

  3. Synchrotron Radiation Therapy from a Medical Physics point of view

    SciTech Connect

    Prezado, Y.; Berkvens, P.; Braeuer-Krisch, E.; Renier, M.; Bravin, A.; Adam, J. F.; Martinez-Rovira, I.; Fois, G.; Thengumpallil, S.; Edouard, M.; Deman, P.; Vautrin, M.

    2010-07-23

    Synchrotron radiation (SR) therapy is a promising alternative to treat brain tumors, whose management is limited due to the high morbidity of the surrounding healthy tissues. Several approaches are being explored by using SR at the European Synchrotron Radiation Facility (ESRF), where three techniques are under development Synchrotron Stereotactic Radiation Therapy (SSRT), Microbeam Radiation Therapy (MRT) and Minibeam Radiation Therapy (MBRT).The sucess of the preclinical studies on SSRT and MRT has paved the way to clinical trials currently in preparation at the ESRF. With this aim, different dosimetric aspects from both theoretical and experimental points of view have been assessed. In particular, the definition of safe irradiation protocols, the beam energy providing the best balance between tumor treatment and healthy tissue sparing in MRT and MBRT, the special dosimetric considerations for small field dosimetry, etc will be described. In addition, for the clinical trials, the definition of appropiate dosimetry protocols for patients according to the well established European Medical Physics recommendations will be discussed. Finally, the state of the art of the MBRT technical developments at the ESRF will be presented. In 2006 A. Dilmanian and collaborators proposed the use of thicker microbeams (0.36-0.68 mm). This new type of radiotherapy is the most recently implemented technique at the ESRF and it has been called MBRT. The main advantage of MBRT with respect to MRT is that it does not require high dose rates. Therefore it can be more easily applied and extended outside synchrotron sources in the future.

  4. Clinical considerations for an effective medical therapy in Wilson's disease.

    PubMed

    Weiss, Karl Heinz; Stremmel, Wolfgang

    2014-05-01

    Wilson's disease is an autosomal recessively inherited copper overload disorder that leads to hepatic and/or neurologic symptoms. More than a century after the first description of Wilson's disease, the available medical treatment options have not been standardized. The efficacy of the commonly used drugs is satisfactory for hepatic disease, but disappointing in the neurologic patients, including the risk of neurologic deterioration after the initiation of chelation therapy. An approach to overcome this problem is the careful and systematic assessment of biochemical response patterns and the quantitative monitoring of symptoms using validated rating scales. Standardized dosage strategies that address changes in copper pools might improve adherence and reduce side effects. Such an approach may reduce long-term morbidity. In this paper, we discuss considerations for an effective medical treatment and requirements for future studies in Wilson's disease.

  5. Home iv antibiotic therapy through a medical day care unit.

    PubMed

    Gourdeau, M; Deschênes, L; Caron, M; Desmarais, M

    1993-05-01

    An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin) were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%). The duration of out-patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient-days). Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days). Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient-day was $66 compared with $375 for in-hospital therapy. This program proved to be safe, efficient, and cost-effective.

  6. Home iv antibiotic therapy through a medical day care unit

    PubMed Central

    Gourdeau, Marie; Deschênes, Louise; Caron, Martine; Desmarais, Marc

    1993-01-01

    An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin) were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%). The duration of out-patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient-days). Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days). Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient-day was $66 compared with $375 for in-hospital therapy. This program proved to be safe, efficient, and cost-effective. PMID:22346440

  7. Traditional Chinese medical comprehensive therapy for cancer-related fatigue.

    PubMed

    Yang, Lu; Li, Tian-Tian; Chu, Yu-Ting; Chen, Ke; Tian, Shao-Dan; Chen, Xin-Yi; Yang, Guo-Wang

    2016-01-01

    Cancer-related fatigue (CRF) is a common and one of the most severe symptom in the period of onset, diagnosis, treatment and rehabilitation process of cancer. But there are no confirmed measures to relieve this problem at present. Traditional Chinese medical comprehensive therapy has its advantages in dealing with this condition. Based on the research status of CRF, the following problems have been analyzed and solved: the term of CRF has been defined and recommended, and the definition has been made clear; the disease mechanism is proposed, i.e. healthy qi has been impaired in the long-term disease duration, in the process of surgery, chemotherapy, radiotherapy and biology disturbing; it is clear that the clinical manifestations are related to six Chinese medicine patterns: decreased functioning of the Pi (Spleen) and Wei (Stomach), deficiency of the Pi with dampness retention, deficiency of the Xin (Heart) and Pi, disharmony between the Gan (Liver) and Pi, deficiency of the Pi and Shen (Kidney), and deficiency of the Fei (Lung) and Shen. Based on its severity, the mild patients are advised to have non-drug psychological intervention and sleep treatment in cooperation with appropriate exercise; diet therapy are recommended to moderate patients together with sleep treatment and acupuncture, severe patients are recommended to have herbal treatment based on pattern differentiation together with physiological sleep therapy.

  8. Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis

    PubMed Central

    Chimowitz, Marc I.; Lynn, Michael J.; Derdeyn, Colin P.; Turan, Tanya N.; Fiorella, David; Lane, Bethany F.; Janis, L. Scott; Lutsep, Helmi L.; Barnwell, Stanley L.; Waters, Michael F.; Hoh, Brian L.; Hourihane, J. Maurice; Levy, Elad I.; Alexandrov, Andrei V.; Harrigan, Mark R.; Chiu, David; Klucznik, Richard P.; Clark, Joni M.; McDougall, Cameron G.; Johnson, Mark D.; Pride, G. Lee; Torbey, Michel T.; Zaidat, Osama O.; Rumboldt, Zoran; Cloft, Harry J.

    2012-01-01

    Background Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly being treated with percutaneous transluminal angioplasty and stenting (PTAS) to prevent recurrent stroke. However, PTAS has not been compared with medical management in a randomized trial. Methods We randomly assigned patients who had a recent transient ischemic attack or stroke attributed to stenosis of 70 to 99% of the diameter of a major intracranial artery to aggressive medical management alone or aggressive medical management plus PTAS with the use of the Wingspan stent system. The primary end point was stroke or death within 30 days after enrollment or after a revascularization procedure for the qualifying lesion during the follow-up period or stroke in the territory of the qualifying artery beyond 30 days. Results Enrollment was stopped after 451 patients underwent randomization, because the 30-day rate of stroke or death was 14.7% in the PTAS group (nonfatal stroke, 12.5%; fatal stroke, 2.2%) and 5.8% in the medical-management group (nonfatal stroke, 5.3%; non–stroke-related death, 0.4%) (P = 0.002). Beyond 30 days, stroke in the same territory occurred in 13 patients in each group. Currently, the mean duration of follow-up, which is ongoing, is 11.9 months. The probability of the occurrence of a primary end-point event over time differed significantly between the two treatment groups (P = 0.009), with 1-year rates of the primary end point of 20.0% in the PTAS group and 12.2% in the medical-management group. Conclusions In patients with intracranial arterial stenosis, aggressive medical management was superior to PTAS with the use of the Wingspan stent system, both because the risk of early stroke after PTAS was high and because the risk of stroke with aggressive medical therapy alone was lower than expected. (Funded by the National Institute of Neurological Disorders and Stroke and others; SAMMPRIS ClinicalTrials.gov number, NCT00576693.) PMID

  9. Medical factors influencing decision making regarding radiation therapy for breast cancer

    PubMed Central

    Dilaveri, Christina A; Sandhu, Nicole P; Neal, Lonzetta; Neben-Wittich, Michelle A; Hieken, Tina J; Mac Bride, Maire Brid; Wahner-Roedler, Dietlind L; Ghosh, Karthik

    2014-01-01

    Radiation therapy is an important and effective adjuvant therapy for breast cancer. Numerous health conditions may affect medical decisions regarding tolerance of breast radiation therapy. These factors must be considered during the decision-making process after breast-conserving surgery or mastectomy for breast cancer. Here, we review currently available evidence focusing on medical conditions that may affect the patient–provider decision-making process regarding the use of radiation therapy. PMID:25429241

  10. Comparison of Intrauterine Antibiotics versus Ozone Medical Use in Sheep with Retained Placenta and Following Obstetric Assistance.

    PubMed

    Đuričić, D; Valpotić, H; Žura Žaja, I; Samardžija, M

    2016-08-01

    This study outlines a new approach to reproductive tract treatment using ozone foam spray for certain ovine obstetrical problems, such as retained foetal membranes and possible uterine infections following obstetric assistance (OA), in comparison with classical antibiotics treatments. The study was conducted on 256 ewes from 11 sheep farms in north-western Croatia. A total of 139 ewes were diagnosed with dystocia (DT) and 49 with retention of placenta (RP). Ewes with RP were treated either with ozone foam spray (Riger spray G; Novagen(®) ) applied into the body of the uterus for 2-3 s (first or RPO group; n = 24) or with two foaming, intrauterine tablets of oxytetracycline hydrochloride (Geomycin(®) F) (second or RPA group; n = 25). The third and fourth groups consisted of ewes that received OA for dystocia (including ringwomb, foetal oversize and assistance of abnormal position and posture). The third group (DTO; n = 70) was treated with ozone foam spray, while ewes in fourth group (DTA; n = 69) were treated with antibiotics. The ewes in the control group (CTL) with physiological puerperium were randomly selected (n = 70) from all herds. Transrectal ultrasonography (transversal diameter of uterine horns) was used for the control of uterus regression on days 2 and 25 after parturition. There was a difference in transversal uterine horn diameter in the RP groups, that is RPO and RPA (5.40 ± 0.53 cm vs. 5.43 ± 0.40 cm), ewes with dystocia, that is DTO and DTA (5.37 ± 0.49 cm vs. 5.54 ± 0.60 cm) and ewes from the CTL group (4.98 ± 0.35 cm) one day after parturition. Average transversal uterine diameter of all groups at day 25 post-partum was 1.80 ± 0.15 cm. The intrauterine ozone treatment in ewes with RP and after manual obstetrics attained similar results to spontaneously delivered ewes (CTL group), showed as the physiological regression of the uterus with a similar transversal diameter without the presence of lochia in the

  11. [Medical expulsive therapy facilitated by alpha 1 adrenoceptor antagonist].

    PubMed

    Itoh, Yasunori; Niimi, Kazuhiro; Hirose, Yasuhiko

    2011-10-01

    In 2002, speedy elimination of ureterolithiasis in the lower part of ureter was first reported with the alpha 1 blocker. Thereafter, there are a lot of reports including meta-analysis about tamsulosin. In 2011 EAU Guidelines on Urolithiasis, it is the most important to establish effective MET (medical expulsive therapy) to facilitate spontaneous stone passage. Alpha 1 blockers are the preferred agents for MET. As a basic evidence for MET, we reported that alpha 1a and 1d AR subtype mRNA was highly expressed in the human ureter and that alpha 1A AR is the main participant in the human ureteral contraction. It is published newly in Japanese Guidelines on Urolithiasis revised edition to schedule to be published soon. PMID:21960238

  12. Integrating Medication Therapy Management Education into a Core Pharmacy Curriculum.

    PubMed

    Poole, Traci M; Kodali, Leela; Pace, Adam C

    2016-05-25

    Objective. To describe the design of a core course directed at improving confidence and competence of students to perform medication therapy management (MTM) services. Design. Using the American Pharmacists Association (APhA) certificate training program framework, a core course was developed to teach MTM concepts to third-year student pharmacists. Using deep learning and authentic assignments, course instructors attempted to improve student confidence and readiness to provide MTM services. Assessment. Student ability to meet course objectives was evaluated by examinations and the APhA MTM program self-assessment. Students had an overall success rate of 93% on all three assessments. Student perceptions of confidence, competence, and importance of performing MTM services were measured using a survey instrument with 56 Likert-type items. Students completing both surveys reported significantly increased confidence and competence. Conclusion. Integrating MTM-specific education into the core curriculum increased student pharmacists' perceived competence and confidence to perform MTM services. PMID:27293237

  13. Therapies for obesity and medication-associated weight gain.

    PubMed

    Howland, Robert H

    2013-05-01

    Compared to the general population, individuals with psychiatric illness, especially serious and chronic mood and psychotic disorders, are more likely to be overweight or obese, have higher rates of weight-related medical conditions, and have greater non-suicide mortality rates. Lorcaserin (Belviq(®)), phentermine/topiramate combination (Qsymia(®)), and bupropion/naltrexone combination have been demonstrated to be effective for the treatment of obesity, as an adjunct to a reduced-calorie diet and physical activity, although their absolute safety has yet to be established with more widespread use or longer use. Bariatric surgery is an effective approach for morbid obesity, but careful psychiatric assessment before and follow up after surgery is necessary. Behavioral lifestyle interventions to promote weight loss are effective and should be implemented along with or instead of drug therapies or surgery. PMID:23590816

  14. Medical Nutrition Therapy in Hospitalized Patients with Diabetes

    PubMed Central

    Gosmanov, Aidar R.

    2013-01-01

    Medical nutrition therapy (MNT) plays an important role in management of hyperglycemia in hospitalized patients with diabetes mellitus. The goals of inpatient MNT are to optimize glycemic control, to provide adequate calories to meet metabolic demands, and to create a discharge plan for follow-up care. All patients with and without diabetes should undergo nutrition assessment on admission with subsequent implementation of physiologically sound caloric support. The use of a consistent carbohydrate diabetes meal-planning system has been shown to be effective in facilitating glycemic control in hospitalized patients with diabetes. This system is based on the total amount of carbohydrate offered rather than on specific calorie content at each meal, which facilitates matching the prandial insulin dose to the amount of carbohydrate consumed. In this article, we discuss general guidelines for the implementation of appropriate MNT in hospitalized patients with diabetes. PMID:21997598

  15. Integrating Medication Therapy Management Education into a Core Pharmacy Curriculum

    PubMed Central

    Kodali, Leela; Pace, Adam C.

    2016-01-01

    Objective. To describe the design of a core course directed at improving confidence and competence of students to perform medication therapy management (MTM) services. Design. Using the American Pharmacists Association (APhA) certificate training program framework, a core course was developed to teach MTM concepts to third-year student pharmacists. Using deep learning and authentic assignments, course instructors attempted to improve student confidence and readiness to provide MTM services. Assessment. Student ability to meet course objectives was evaluated by examinations and the APhA MTM program self-assessment. Students had an overall success rate of 93% on all three assessments. Student perceptions of confidence, competence, and importance of performing MTM services were measured using a survey instrument with 56 Likert-type items. Students completing both surveys reported significantly increased confidence and competence. Conclusion. Integrating MTM-specific education into the core curriculum increased student pharmacists’ perceived competence and confidence to perform MTM services. PMID:27293237

  16. Chapter III: Management of cardiovascular risk factors and medical therapy.

    PubMed

    Diehm, N; Schmidli, J; Setacci, C; Ricco, J-B; de Donato, G; Becker, F; Robert-Ebadi, H; Cao, P; Eckstein, H H; De Rango, P; Teraa, M; Moll, F L; Dick, F; Davies, A H; Lepäntalo, M; Apelqvist, J

    2011-12-01

    Critical limb ischaemia (CLI) is a particularly severe manifestation of lower limb atherosclerosis posing a major threat to both limb and life of affected patients. Besides arterial revascularisation, risk-factor modification and administration of antiplatelet therapy is a major goal in the treatment of CLI patients. Key elements of cardiovascular risk management are smoking cessation and treatment of hyperlipidaemia with dietary modification or statins. Moreover, arterial hypertension and diabetes mellitus should be adequately treated. In CLI patients not suitable for arterial revascularisation or subsequent to unsuccessful revascularisation, parenteral prostanoids may be considered. CLI patients undergoing surgical revascularisation should be treated with beta blockers. At present, neither gene nor stem-cell therapy can be recommended outside clinical trials. Of note, walking exercise is contraindicated in CLI patients due to the risk of worsening pre-existing or causing new ischaemic wounds. CLI patients are oftentimes medically frail and exhibit significant comorbidities. Co-existing coronary heart and carotid as well as renal artery disease should be managed according to current guidelines. Considering the above-mentioned treatment goals, interdisciplinary treatment approaches for CLI patients are warranted. Aim of the present manuscript is to discuss currently existing evidence for both the management of cardiovascular risk factors and treatment of co-existing disease and to deduct specific treatment recommendations. PMID:22172471

  17. Stroke: advances in medical therapy and acute stroke intervention.

    PubMed

    Barrett, Kevin M; Lal, Brajesh K; Meschia, James F

    2015-10-01

    Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythmia. Some accepted ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic therapy, and surgical techniques. Intra-arterial therapy, particularly with stent retrievers after intravenous tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in ischemic stroke management and prevention where equipoise remains.

  18. Medical Therapy of Pulmonary Neuroendocrine Neoplasms: Targeted, Symptomatic and Chemotherapy.

    PubMed

    Ferolla, Piero

    2015-01-01

    Whenever feasible, surgery represents the treatment of choice for pulmonary neuroendocrine neoplasms (NENs). In patients with hypersecreting tumors, wide metastatic spread or those not candidates for a surgical treatment, medical therapies may assure a control of the secretory pattern and slow the rate of tumor growth. No specific trials have been designed so far for pulmonary NENs and the first randomized trial entirely dedicated to thoracic NENs (the LUNA trial) is ongoing. International scientific society guidelines (ESMO and NANETS) and recommendations (ENETS) are therefore necessarily based on expert experience, on the subgroup analysis of large multicenter trials not focused on pulmonary NENs, and on the analysis of small retrospective series. Somatostatin analogs represent the therapy of choice in the presence of associated carcinoid syndrome and ectopic acromegaly and a reasonable first-line in slow-progressing tumors. Due to the low rate of proliferation, platinum-based chemotherapy is generally reserved to rapidly progressing tumors. Temozolomide alone or in association has shown activity in small retrospective series or monocentric trials - larger multicenter trials will better define its efficacy. Everolimus alone or in combination with somatostatin analogs has shown activity in the subgroup analysis of a large multicenter trial (RADIANT II). Many other drugs have shown activity in the preclinical models but, at the moment, no prospective and randomized data are available. PMID:26303713

  19. Anonymization of DICOM electronic medical records for radiation therapy.

    PubMed

    Newhauser, Wayne; Jones, Timothy; Swerdloff, Stuart; Newhauser, Warren; Cilia, Mark; Carver, Robert; Halloran, Andy; Zhang, Rui

    2014-10-01

    Electronic medical records (EMR) and treatment plans are used in research on patient outcomes and radiation effects. In many situations researchers must remove protected health information (PHI) from EMRs. The literature contains several studies describing the anonymization of generic Digital Imaging and Communication in Medicine (DICOM) files and DICOM image sets but no publications were found that discuss the anonymization of DICOM radiation therapy plans, a key component of an EMR in a cancer clinic. In addition to this we were unable to find a commercial software tool that met the minimum requirements for anonymization and preservation of data integrity for radiation therapy research. The purpose of this study was to develop a prototype software code to meet the requirements for the anonymization of radiation therapy treatment plans and to develop a way to validate that code and demonstrate that it properly anonymized treatment plans and preserved data integrity. We extended an open-source code to process all relevant PHI and to allow for the automatic anonymization of multiple EMRs. The prototype code successfully anonymized multiple treatment plans in less than 1min/patient. We also tested commercial optical character recognition (OCR) algorithms for the detection of burned-in text on the images, but they were unable to reliably recognize text. In addition, we developed and tested an image filtering algorithm that allowed us to isolate and redact alpha-numeric text from a test radiograph. Validation tests verified that PHI was anonymized and data integrity, such as the relationship between DICOM unique identifiers (UID) was preserved. PMID:25147130

  20. Medication Therapy Management Services Provided by Student Pharmacists

    PubMed Central

    Hata, Micah; Klotz, Roger; Sylvies, Rick; Hess, Karl; Schwartzman, Emmanuelle; Scott, James

    2012-01-01

    Objectives. To evaluate the impact of student pharmacists delivering medication therapy management (MTM) services during an elective advanced pharmacy practice experience (APPE). Methods. Student pharmacists provided MTM services at community pharmacy APPE sites, documented their recommendations, and then made follow-up telephone calls to patients to determine the impact of the MTM provided. Students were surveyed about the MTM experience. Results. Forty-seven students provided MTM services to 509 patients over 2 years and identified 704 drug-related problems (average of 1.4 problems per patient). About 53% of patients relayed the recommendations to their physician and 205 (75%) physicians accepted the recommendations. Eighty-eight percent of patients reported feeling better about their medications after receiving MTM services. A majority of the students perceived their provision of MTM services as valuable to their patients. Conclusions. Providing MTM services to patients in a pharmacy practice setting allowed student pharmacists to apply skills learned in the doctor of pharmacy (PharmD) curriculum. PMID:22544968

  1. Challenges to Integrating Pharmacogenetic Testing into Medication Therapy Management

    PubMed Central

    Allen LaPointe, Nancy M.; Moaddeb, Jivan

    2015-01-01

    Background Some have proposed the integration of pharmacogenetic (PGx) testing into medication therapy management (MTM) to enable further refinement of treatment(s) to reduce risk of adverse responses and improve efficacy. PGx testing involves the analysis of genetic variants associated with therapeutic or adverse response and may be useful in enhancing the ability to identify ineffective and/or harmful drugs or drug combinations. This “enhanced” MTM might also reduce patient concerns about side effects and increase confidence that the medication is effective, addressing two key factors that impact patient adherence - concern and necessity. However, the feasibility and effectiveness of the integration of PGx testing into MTM in clinical practice has not yet been determined. Objectives In this paper, we consider some of the challenges to the integration and delivery of PGx testing in MTM services. What is already known about this subject While the addition of pharmacogenetic testing has been suggested, little literature exists exploring the challenges or feasibility of doing so. PMID:25803768

  2. The role of combination medical therapy in benign prostatic hyperplasia.

    PubMed

    Greco, K A; McVary, K T

    2008-12-01

    To review key trials of monotherapy and combination therapy of alpha(1)-adrenergic receptor antagonists (alpha(1)-ARAs), 5alpha-reductase inhibitors (5alphaRIs) and anti-muscarinic agents in the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). To assess the safety and efficacy of combination therapies for LUTS associated with BPH, a search of the MEDLINE and Cochrane databases (1976-2008) was conducted for relevant trials and reviews using the terms benign prostatic hyperplasia, lower urinary tract symptoms, alpha(1)-adrenergic receptor antagonists, 5alpha-reductase inhibitors, anti-muscarinics, anticholinergics, combination therapy, alfuzosin, doxazosin, tamsulosin, terazosin, dutasteride, finasteride, tolterodine, flavoxate, propiverine, oxybutynin, erectile dysfunction, sildenafil, vardenafil and tadalafil. Data from the Medical Therapy of Prostatic Symptoms (MTOPS) study indicated a role for long-term use of alpha(1)-ARAs and 5alphaRIs in combination. In the MTOPS study, combination therapy with the alpha(1)-ARA doxazosin and the 5alphaRI finasteride was significantly more effective than either component alone in reducing symptoms (P=0.006 vs doxazosin monotherapy; P<0.001 vs finasteride monotherapy) and in lowering the rate of clinical progression (P<0.001 vs either monotherapy). These findings were confirmed by the 2-year preliminary results of the Combination of Avodart and Tamsulosin study. In this study, combination therapy of the alpha(1)-ARA tamsulosin and the 5alphaRI dutasteride resulted in a significantly greater decrease in International Prostate Symptom Score (IPSS) when compared with either monotherapy. Several recent trials have studied the efficacy of combining alpha(1)-ARAs and anti-muscarinic agents in the treatment of BPH. These studies have found this combination to result in statistically significant benefits in quality of life scores, patient satisfaction, urinary frequency, storage

  3. Comparative effectiveness of Mitraclip plus medical therapy versus medical therapy alone in high-risk surgical patients: a comprehensive review.

    PubMed

    Gonzalez, Fernando Matias; Finch, Aureliano Paolo; Armeni, Patrizio; Boscolo, Paola Roberta; Tarricone, Rosanna

    2015-07-01

    In recent years, Mitraclip has become available as a treatment option for mitral regurgitation in high-risk surgical patients. Focusing on the incremental effectiveness of Mitraclip versus the current standard of care, this article provides a comparative review of the evidence on Mitraclip and standard medical therapy (MT) in high-risk mitral regurgitation patients. Evidence was retrieved from seven major databases. Results suggest that Mitraclip presents a high safety profile and a good middle-term effectiveness performance. Evidence on long-term effectiveness is limited both for Mitraclip and MT. Few studies allow a comparison with MT and comparative results on different endpoints are mixed. Therefore, the available evidence does not conclusively inform whether or under which circumstances Mitraclip should be preferred over MT in the treatment of high-risk patients. Head-to-head real-world studies would be needed, as they would provide great and timely insights to support policy decisions when medical devices are at stake. PMID:26051009

  4. Case Study: Successful Medication Withdrawal Using Cognitive-Behavioral Therapy for a Preadolescent with OCD

    ERIC Educational Resources Information Center

    Sallinen, Bethany J.; Nangle, Douglas W.; O'Grady, April C.

    2004-01-01

    The aim of this study was to evaluate the effectiveness of the addition of manual-based cognitive-behavioral therapy to a medication regimen of clomipramine and fluoxetine and the withdrawal of medication during cognitive-behavioral therapy. The participant was an 11-year-old girl with symptoms of obsessive thoughts about germs and illness and…

  5. 10 CFR 50.21 - Class 104 licenses; for medical therapy and research and development facilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...; for medical therapy and research and development facilities. A class 104 license will be issued, to an... useful in the conduct of research and development activities of the types specified in section 31 of the... 10 Energy 1 2010-01-01 2010-01-01 false Class 104 licenses; for medical therapy and research...

  6. Contributions of medical family therapy to the changing health care system.

    PubMed

    Doherty, William J; McDaniel, Susan H; Hepworth, Jeri

    2014-09-01

    Medical family therapy is a form of professional practice that uses a biopsychosocial approach and systemic family therapy principles in the collaborative treatment of individuals and families dealing with medical problems. It emerged out of the experience of family therapists working in primary medical care settings in the 1980s and 1990s. This article describes how contemporary medical family therapy can contribute to a transformed health care system in four areas: the patient experience of health care, the health of the population, the containment of health care costs, and enhanced practice environments.

  7. Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients: Need for a Systematic Approach

    PubMed Central

    Cardone, Katie E.; Manley, Harold J.; St. Peter, Wendy L.; Shaffer, Rachel; Somers, Michael; Mehrotra, Rajnish

    2013-01-01

    Summary Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model. PMID:23990162

  8. Medication reconciliation and therapy management in dialysis-dependent patients: need for a systematic approach.

    PubMed

    Pai, Amy Barton; Cardone, Katie E; Manley, Harold J; St Peter, Wendy L; Shaffer, Rachel; Somers, Michael; Mehrotra, Rajnish

    2013-11-01

    Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model.

  9. Paired-eye comparison of medical therapies for glaucoma

    PubMed Central

    Solish, Alfred M; James, Friedericke; Walt, John G; Chiang, Tina H

    2010-01-01

    Objective To evaluate efficacy and patient preference retrospectively among intraocular pressure (IOP)-lowering prostamide and prostaglandin medications in a real-world clinical setting. Methods Chart review of patients with uncontrolled glaucoma or ocular hypertension seen at a private practice clinic (n = 55) who received bimatoprost 0.03% once daily in one eye and either travoprost 0.004% or latanoprost 0.005% once daily in the fellow eye. IOP was evaluated at the initial visit and at a follow-up visit scheduled 4–6 weeks later. At the follow-up visit, each patient discussed the clinical results with their physician, chose which medication they preferred to continue using, and were queried regarding the reason for their choice. This paired-eye comparison method is used routinely in clinical practice to assess clinical response and involve patients in decisions regarding treatment. Change in mean IOP from baseline and patient medication choice were the outcome measures. Results Bimatoprost-treated eyes (n = 52) had a mean IOP reduction of 2.7 mmHg and travoprost-treated eyes (n = 47) had an average decrease of 1.7 mmHg (P = 0.230). Bimatoprost significantly reduced mean IOP (from 19.8 mmHg at baseline to 17.1 mmHg at follow-up, P < 0.0001), as did travoprost (from 19.4 mmHg at baseline to 17.7 mmHg at follow-up, P = 0.009). Latanoprost-treated eyes were excluded from the efficacy analysis due to small sample size (n = 5). For continued therapy, patients chose bimatoprost over travoprost by a factor of 2.4 to 1. Of the 15 patients who gave a reason for their choice, 80% said their decision was based primarily on IOP change. Conclusions Bimatoprost and travoprost were efficacious in reducing IOP among patients with uncontrolled glaucoma and ocular hypertension. Patients preferred bimatoprost over travoprost when trialed in fellow eyes. PMID:20957060

  10. Does adherence therapy improve medication adherence among patients with schizophrenia? A systematic review.

    PubMed

    Hegedüs, Anna; Kozel, Bernd

    2014-12-01

    Non-adherence to medication is highly prevalent in patients with schizophrenia. Adherence therapy aims to improve medication adherence of these patients by applying techniques of cognitive behavioural therapy, psycho-education, and motivational interviewing. Even though adherence therapy is frequently discussed and researched, its effectiveness is still uncertain. This paper aims to review the effectiveness of adherence therapy on the medication adherence of patients with schizophrenia. To this end, six electronic databases were systematically searched for randomized, controlled trials on adherence therapy from January 2002 to March 2013. Four trials met the inclusion criteria and were incorporated into the review. The findings suggest that adherence therapy does not improve patients' medication adherence in comparison to treatment as usual or a control intervention. However, all the studies reviewed showed high-adherence ratings at baseline. Thus, further well-designed studies that target adherence therapy to patients who are non-adherent to their medication are needed for a more profound understanding of its effectiveness. In addition, if adherence therapy is aimed not only at improving medication adherence, but also to reach an agreement whereby the patient's decision not to take his medication is accepted, the shared decision-making process needs to be assessed as well.

  11. Simulated Medication Therapy Management Activities in a Pharmacotherapy Laboratory Course

    PubMed Central

    Thorpe, Joshua M.; Trapskin, Kari

    2011-01-01

    Objective. To measure the impact of medication therapy management (MTM) learning activities on students’ confidence and intention to provide MTM using the Theory of Planned Behavior. Design. An MTM curriculum combining lecture instruction and active-learning strategies was incorporated into a required pharmacotherapy laboratory course. Assessment. A validated survey instrument was developed to evaluate student confidence and intent to engage in MTM services using the domains comprising the Theory of Planned Behavior. Confidence scores improved significantly from baseline for all items (p < 0.00), including identification of billable services, documentation, and electronic billing. Mean scores improved significantly for all Theory of Planned Behavior items within the constructs of perceived behavioral control and subjective norms (p < 0.05). At baseline, 42% of students agreed or strongly agreed that they had knowledge and skills to provide MTM. This percentage increased to 82% following completion of the laboratory activities. Conclusion. Implementation of simulated MTM activities in a pharmacotherapy laboratory significantly increased knowledge scores, confidence measures, and scores on Theory of Planned Behavior constructs related to perceived behavioral control and subjective norms. Despite these improvements, intention to engage in future MTM services remained unchanged. PMID:21829269

  12. Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trial

    PubMed Central

    Williams, Adrian; Gill, Steven; Varma, Thelekat; Jenkinson, Crispin; Quinn, Niall; Mitchell, Rosalind; Scott, Richard; Ives, Natalie; Rick, Caroline; Daniels, Jane; Patel, Smitaa; Wheatley, Keith

    2010-01-01

    Summary Background Surgical intervention for advanced Parkinson's disease is an option if medical therapy fails to control symptoms adequately. We aimed to assess whether surgery and best medical therapy improved self-reported quality of life more than best medical therapy alone in patients with advanced Parkinson's disease. Methods The PD SURG trial is an ongoing randomised, open-label trial. At 13 neurosurgical centres in the UK, between November, 2000, and December, 2006, patients with Parkinson's disease that was not adequately controlled by medical therapy were randomly assigned by use of a computerised minimisation procedure to immediate surgery (lesioning or deep brain stimulation at the discretion of the local clinician) and best medical therapy or to best medical therapy alone. Patients were analysed in the treatment group to which they were randomised, irrespective of whether they received their allocated treatment. The primary endpoint was patient self-reported quality of life on the 39-item Parkinson's disease questionnaire (PDQ-39). Changes between baseline and 1 year were compared by use of t tests. This trial is registered with Current Controlled Trials, number ISRCTN34111222. Findings 366 patients were randomly assigned to receive immediate surgery and best medical therapy (183) or best medical therapy alone (183). All patients who had surgery had deep brain stimulation. At 1 year, the mean improvement in PDQ-39 summary index score compared with baseline was 5·0 points in the surgery group and 0·3 points in the medical therapy group (difference −4·7, 95% CI −7·6 to −1·8; p=0·001); the difference in mean change in PDQ-39 score in the mobility domain between the surgery group and the best medical therapy group was −8·9 (95% CI −13·8 to −4·0; p=0·0004), in the activities of daily living domain was −12·4 (−17·3 to −7·5; p<0·0001), and in the bodily discomfort domain was −7·5 (−12·6 to −2·4; p=0·004). Differences

  13. Prophylaxis and therapeutic potential of ozone in buiatrics: Current knowledge.

    PubMed

    Đuričić, Dražen; Valpotić, Hrvoje; Samardžija, Marko

    2015-08-01

    Ozone therapy has been in use since 1896 in the USA. As a highly reactive molecule, ozone may inactivate bacteria, viruses, fungi, yeasts and protozoans, stimulate the oxygen metabolism of tissue, treat diseases, activate the immune system, and exhibit strong analgesic activity. More recently, ozone has been used in veterinary medicine, particularly in buiatrics, but still insufficiently. Medical ozone therapy has shown effectiveness as an alternative to the use of antibiotics, which are restricted to clinical use and have been withdrawn from non-clinical use as in-feed growth promoters in animal production. This review is an overview of current knowledge regarding the preventive and therapeutic effects of ozone in ruminants for the treatment of puerperal diseases and improvement in their fertility. In particular, ozone preparations have been tested in the treatment of reproductive tract lesions, urovagina and pneumomovagina, metritis, endometritis, fetal membrane retention and mastitis, as well as in the functional restoration of endometrium in dairy cows and goats. In addition, the preventive use of the intrauterine application of ozone has been assessed in order to evaluate its effectiveness in improving reproductive efficiency in dairy cows. No adverse effects were observed in cows and goats treated with ozone preparations. Moreover, there is a lot of evidence indicating the advantages of ozone preparation therapy in comparison to the application of antibiotics. However, there are certain limitations on ozone use in veterinary medicine and buiatrics, such as inactivity against intracellular microbes and selective activity against the same bacterial species, as well as the induction of tissue inflammation through inappropriate application of the preparation.

  14. Ozonated olive oils and the troubles.

    PubMed

    Uysal, Bulent

    2014-01-01

    One of the commonly used methods for ozone therapy is ozonated oils. Most prominent type of used oils is extra virgin olive oil. But still, each type of unsaturated oils may be used for ozonation. There are a lot of wrong knowledge on the internet about ozonated oils and its use as well. Just like other ozone therapy studies, also the studies about ozone oils are inadequate to avoid incorrect knowledge. Current data about ozone oil and its benefits are produced by supplier who oversees financial interests and make misinformation. Despite the rapidly increasing ozone oil sales through the internet, its quality and efficacy is still controversial. Dozens of companies and web sites may be easily found to buy ozonated oil. But, very few of these products are reliable, and contain sufficiently ozonated oil. This article aimed to introduce the troubles about ozonated oils and so to inform ozonated oil users. PMID:26401346

  15. Trends in Medicare Part D Medication Therapy Management Eligibility Criteria

    PubMed Central

    Wang, Junling; Shih, Ya-Chen Tina; Qin, Yolanda; Young, Theo; Thomas, Zachary; Spivey, Christina A.; Solomon, David K.; Chisholm-Burns, Marie

    2015-01-01

    Background To increase the enrollment rate of medication therapy management (MTM) programs in Medicare Part D plans, the US Centers for Medicare & Medicaid Services (CMS) lowered the allowable eligibility thresholds based on the number of chronic diseases and Part D drugs for Medicare Part D plans for 2010 and after. However, an increase in MTM enrollment rates has not been realized. Objectives To describe trends in MTM eligibility thresholds used by Medicare Part D plans and to identify patterns that may hinder enrollment in MTM programs. Methods This study analyzed data extracted from the Medicare Part D MTM Programs Fact Sheets (2008–2014). The annual percentages of utilizing each threshold value of the number of chronic diseases and Part D drugs, as well as other aspects of MTM enrollment practices, were analyzed among Medicare MTM programs that were established by Medicare Part D plans. Results For 2010 and after, increased proportions of Medicare Part D plans set their eligibility thresholds at the maximum numbers allowable. For example, in 2008, 48.7% of Medicare Part D plans (N = 347:712) opened MTM enrollment to Medicare beneficiaries with only 2 chronic disease states (specific diseases varied between plans), whereas the other half restricted enrollment to patients with a minimum of 3 to 5 chronic disease states. After 2010, only approximately 20% of plans opened their MTM enrollment to patients with 2 chronic disease states, with the remaining 80% restricting enrollment to patients with 3 or more chronic diseases. Conclusion The policy change by CMS for 2010 and after is associated with increased proportions of plans setting their MTM eligibility thresholds at the maximum numbers allowable. Changes to the eligibility thresholds by Medicare Part D plans might have acted as a barrier for increased MTM enrollment. Thus, CMS may need to identify alternative strategies to increase MTM enrollment in Medicare plans. PMID:26380030

  16. Nanoscintillators for microscopic diagnostics of biological and medical objects and medical therapy.

    PubMed

    Klassen, Nikolay V; Kedrov, Victor V; Ossipyan, Yuri A; Shmurak, Semen Z; Shmyt Ko, Ivan M; Krivko, Oksana A; Kudrenko, Elena A; Kurlov, Vladimir N; Kobelev, Nikolay P; Kiselev, Aleksander P; Bozhko, Sergei I

    2009-03-01

    The main focus of this paper is the description of qualitatively new facilities for diagnostics of biological and medical objects and medical therapy obtained by applications of nanocrystalline scintillators. These facilities are based on abilities of nanoscintillators to selective conjugation with various biomolecular objects and noticeable variations of their atomic structures, X-ray diffraction (XRD) patterns, and light-emission characteristics induced by modifications of conditions on their external surfaces. Experimental results presented in this paper provide development of detection in vivo just inside a living organism of various viruses, cancer cells, and other pathological macromolecules by means of scanning X-ray diffractometry of nanoparticles introduced into the body. These data are produced by selective adsorption of pathological bioobjects by these nanoparticles and subsequent modifications of their XRD patterns. Application of narrow collimated X-ray beams and new types of X-ray detector matrices providing microscopic spatial resolution due to usage of nanoscintillators enables determination of the regions where these pathologies are localized with high accuracy. The procedure of detection of pathological organelles by this method improves possibilities for effective destruction of these pathologies by low-dose X-ray irradiation of the places of their localization. High effectiveness of this X-ray destruction is provided by concentrated absorption of X-ray quanta by the nanoscintillators and direct transfer of the absorbed energy to the pathological objects that are attached to the absorbing particles. Constructions of 3-D radiation detector matrices providing necessary microscopic spatial and angular resolutions of X-ray imaging are described on the basis of nanoscintillators, fiber light guides, and microcapillary matrices. PMID:19304500

  17. 78 FR 61363 - Correction-Scientific Information Request on Medication Therapy Management

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-03

    ... Medication Therapy Management The original date of publication for this Federal Register notice was September 17, 2013, 78 FR 57159. On this publication, the Web site that appears under ADDRESSES is incorrect...

  18. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center

    PubMed Central

    Dion, Liza J.; Cutshall, Susanne M.; Rodgers, Nancy J.; Hauschulz, Jennifer L.; Dreyer, Nikol E.; Thomley, Barbara S.; Bauer, Brent

    2015-01-01

    Background: Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. Methods: A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. Results: The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. Conclusions: The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment. PMID

  19. Cognitive-Behavioral Therapy for HIV Medication Adherence and Depression

    ERIC Educational Resources Information Center

    Safren, Steven A.; Hendriksen, Ellen S.; Mayer, Kenneth H.; Mimiaga, Matthew J.; Pickard, Robert; Otto, Michael W.

    2004-01-01

    For patients with HIV, depression is a common, distressing condition that can interfere with a critical self-care behavior--adherence to antiretroviral therapy. The present study describes a cognitive-behavioral treatment designed to integrate cognitive-behavioral therapy for depression with our previously tested approach to improving adherence to…

  20. Old medications and new targeted therapies in systemic sclerosis.

    PubMed

    Nagaraja, Vivek; Denton, Christopher P; Khanna, Dinesh

    2015-11-01

    SSc is a multiorgan disease with significant morbidity that is associated with poor health-related quality of life. Treatment of this condition is often organ based and non-curative. However, there are newer, potentially disease-modifying therapies available to treat certain aspects of the disease. This review focuses on old and new therapies in the management of SSc in clinical practice.

  1. Tall girls: the social shaping of a medical therapy.

    PubMed

    Lee, Joyce M; Howell, Joel D

    2006-10-01

    During the latter half of the 20th century, estrogen therapy was administered to prevent otherwise healthy girls with tall stature from becoming tall adults by inhibiting further linear growth. We explore how decisions to treat tall girls with estrogen were influenced by both scientific knowledge and sociologic norms. Estrogen therapy represented the logical application of scientific knowledge regarding the role of estrogen for closure of the growth plates, but it also reflected prevailing societal and political beliefs about what it meant to be a tall girl. We discuss the rise and fall in popularity of this therapy and suggest that insight into the present-day treatment of short stature can be gained by comparing the use of estrogen therapy for tall girls with the use of growth hormone therapy for short boys. We suggest that this case study illustrates how scientific knowledge is always created and applied within a particular social context. PMID:17018462

  2. Therapy 101: A Psychotherapy Curriculum for Medical Students

    ERIC Educational Resources Information Center

    Aboul-Fotouh, Frieda; Asghar-Ali, Ali Abbas

    2010-01-01

    Objective: This pilot project, designed and taught by a resident, created a curriculum to introduce medical students to the practice of psychotherapy. Medical students who are knowledgeable about psychotherapy can become physicians who are able to refer patients to psychotherapeutic treatments. A search of the literature did not identify a…

  3. Inclusion of Medical-Legal Issues in Entry-Level Occupational and Physical Therapy Curricula.

    ERIC Educational Resources Information Center

    Ekelman, Beth A.; Goodman, Glenn; Dal Bello-Haas, Vanina

    2000-01-01

    Directors of 47 occupational therapy (OT) and 65 physical therapy (PT) accredited entry-level programs responded to a survey by indicating their support for inclusion of medical-legal issues in the curriculum. Only 40% of OT and 52% of PT directors believed lawyers should deliver instruction; most felt their faculty were qualified to teach these…

  4. System and method for delivery of neutron beams for medical therapy

    DOEpatents

    Nigg, David W.; Wemple, Charles A.

    1999-01-01

    A neutron delivery system that provides improved capability for tumor control during medical therapy. The system creates a unique neutron beam that has a bimodal or multi-modal energy spectrum. This unique neutron beam can be used for fast-neutron therapy, boron neutron capture therapy (BNCT), or both. The invention includes both an apparatus and a method for accomplishing the purposes of the invention.

  5. System and method for delivery of neutron beams for medical therapy

    DOEpatents

    Nigg, D.W.; Wemple, C.A.

    1999-07-06

    A neutron delivery system that provides improved capability for tumor control during medical therapy is disclosed. The system creates a unique neutron beam that has a bimodal or multi-modal energy spectrum. This unique neutron beam can be used for fast-neutron therapy, boron neutron capture therapy (BNCT), or both. The invention includes both an apparatus and a method for accomplishing the purposes of the invention. 5 figs.

  6. Germ-line gene therapy and the medical imperative.

    PubMed

    Munson, Ronald; Davis, Lawrence H

    1992-06-01

    Somatic cell gene therapy has yielded promising results. If germ cell gene therapy can be developed, the promise is even greater: hundreds of genetic diseases might be virtually eliminated. But some claim the procedure is morally unacceptable. We thoroughly and sympathetically examine several possible reasons for this claim but find them inadequate. There is no moral reason, then, not to develop and employ germ-line gene therapy. Taking the offensive, we argue next that medicine has a prima facie moral obligation to do so.

  7. Optimizing proton therapy at the LBL medical accelerator

    SciTech Connect

    Alonso, J.

    1992-03-01

    This Grant has marked the beginning of a multi-year study process expected to lead to design and construction of at least one, possibly several hospital-based proton therapy facilities in the United States.

  8. Optimizing proton therapy at the LBL medical accelerator. Final report

    SciTech Connect

    Alonso, J.

    1992-03-01

    This Grant has marked the beginning of a multi-year study process expected to lead to design and construction of at least one, possibly several hospital-based proton therapy facilities in the United States.

  9. POTENTIAL OF HERBAL MEDICINES IN MODERN MEDICAL THERAPY

    PubMed Central

    Said, Hakim Mohammed

    1984-01-01

    The author discusses in this paper the potentialities of Herbal medicine in modern therapy. Also he throws some light on the importance of natural drugs which bring about cure without generation side-effects. PMID:22557447

  10. Radiation accidents and nuclear energy: medical consequences and therapy.

    PubMed

    Champlin, R E; Kastenberg, W E; Gale, R P

    1988-11-01

    After the accidents at Chernobyl, the Soviet Union, and in Goiania, Brazil, there is increasing concern about the medical risks from radiation accidents. This overview summarizes the principles of nuclear energy, the biologic effects of accidental radiation exposure, the emergency response to nuclear accidents, and approaches to treating radiation injuries. Also discussed are the related issues of reactor safety, the disposal of radioactive waste, and the proliferation of nuclear weapons. With the increasing use of radioactive materials for power, weapons, and medical diagnostics, the medical community needs to understand the health consequences of radiation exposure.

  11. Use of complementary therapies and non-prescribed medication in patients with Parkinson's disease

    PubMed Central

    Ferry, P; Johnson, M; Wallis, P

    2002-01-01

    Patients with Parkinson's disease resort to complementary therapy and non-prescribed medication in the hope of improving their quality of life. In the US 40% of patients with Parkinson's disease reported the use of at least one form of complementary therapy for Parkinson's disease. Data for the UK are limited. A structured questionnaire was administered to consecutive patients attending a Parkinson's disease clinic. Patients were excluded if they were cognitively impaired, if they were living in an institution, or if they declined to take part. The participants were asked about current and previous use of complementary therapy in general and Parkinson's disease in particular and were presented with an extensive list of complementary therapies and non-prescribed medications. The response rate was 90% and 80 patients met the inclusion criteria. Fifty four per cent (n=44) reported the use of at least one form of complementary therapy or non-prescribed medication either for Parkinson's disease or for some other indication, of whom 31 (38.7% of the total sample) used it solely for the treatment of Parkinson's disease. The most commonly used complementary therapies for Parkinson's disease were massage (n=9) and aromatherapy (n=8). Non-prescribed medication was mainly used for indications other than Parkinson's disease and the commonest drugs used were simple analgesics (n=7), cod liver oil (n=5), and multivitamins (n=4). The use of complementary therapy for Parkinson's disease correlated significantly (Pearson's r=0.44, p=0.01) with a younger age at diagnosis of Parkinson's disease. Comorbidity correlated significantly with complementary therapy use for indications other than Parkinson's disease (Pearson's r=0.29, p= 0.01). The use of complementary therapy for Parkinson's disease in this UK based clinic closely mimics that in the US. Non-pharmacological complementary therapy is mainly used for Parkinson's disease, while non-prescribed medication is more commonly used for

  12. Client-Centered Advocacy: Every Occupational Therapy Practitioner's Responsibility to Understand Medical Necessity.

    PubMed

    Stover, Alyson D

    2016-01-01

    Occupational therapy practitioners must advocate for clients in multiple ways. The Occupational Therapy Practice Framework: Domain and Process as well as the Occupational Therapy Code of Ethics lend support to advocacy. Recognizing one's responsibility to provide advocacy for clients is different from knowing how to provide that advocacy. One aspect of health care affected by the Patient Protection and Affordable Care Act (ACA) is the definition and implementation of medical necessity. This article outlines some major concepts around medical necessity, particularly in relation to the passage of the ACA, and outlines guidance on how to advocate effectively to meet both individual and community needs.

  13. An art therapy in-service program model for medical students and residents.

    PubMed

    Miller, Rebecca Beers

    2010-01-01

    This paper examines the author's experience implementing an art therapy in-service program into the training of medical students and residents in an urban hospital teaching facility. Emphasis is placed on specific aspects of planning and implementation, including formal and informal assessment, as well as methods of engaging medical students in art therapy experientials relevant to their experience as helping professionals. Benefits and challenges encountered throughout the process are also discussed. This paper is based on a presentation given at the 36th annual American Art Therapy Association conference. PMID:20539921

  14. Client-Centered Advocacy: Every Occupational Therapy Practitioner's Responsibility to Understand Medical Necessity.

    PubMed

    Stover, Alyson D

    2016-01-01

    Occupational therapy practitioners must advocate for clients in multiple ways. The Occupational Therapy Practice Framework: Domain and Process as well as the Occupational Therapy Code of Ethics lend support to advocacy. Recognizing one's responsibility to provide advocacy for clients is different from knowing how to provide that advocacy. One aspect of health care affected by the Patient Protection and Affordable Care Act (ACA) is the definition and implementation of medical necessity. This article outlines some major concepts around medical necessity, particularly in relation to the passage of the ACA, and outlines guidance on how to advocate effectively to meet both individual and community needs. PMID:27548855

  15. An art therapy in-service program model for medical students and residents.

    PubMed

    Miller, Rebecca Beers

    2010-01-01

    This paper examines the author's experience implementing an art therapy in-service program into the training of medical students and residents in an urban hospital teaching facility. Emphasis is placed on specific aspects of planning and implementation, including formal and informal assessment, as well as methods of engaging medical students in art therapy experientials relevant to their experience as helping professionals. Benefits and challenges encountered throughout the process are also discussed. This paper is based on a presentation given at the 36th annual American Art Therapy Association conference.

  16. Eligibility For And Enrollment In Medicare Part D Medication Therapy Management Programs Varies By Plan Sponsor.

    PubMed

    Stuart, Bruce; Hendrick, Franklin B; Shen, Xian; Dai, Mingliang; Tom, Sarah E; Dougherty, J Samantha; Miller, Laura M

    2016-09-01

    Medicare Part D prescription drug plans must offer medication therapy management to beneficiaries with multiple chronic conditions and high drug expenditures. However, plan sponsors have considerable latitude in setting eligibility criteria. Newly available data indicate that enrollment rates in medication therapy management among stand-alone prescription drug plans and Medicare Advantage drug plans averaged only 10 percent in 2012. The enrollment variation across plan sponsors-from less than 0.2 percent to more than 57.0 percent-was associated with the restrictiveness of their eligibility criteria. For example, enrollment was 16.4 percent in plans requiring two chronic conditions versus 9.2 percent in plans requiring three, and 12.7 percent in plans requiring the use of any Part D drug versus 4.4 percent in plans requiring the use of drugs in specific classes. This variation represents inequities in access to medication therapy management across plans and results in missed opportunities for interventions that might improve therapeutic outcomes and reduce spending. The new Part D Enhanced Medication Therapy Management model of the Centers for Medicare and Medicaid Services has the potential to significantly increase the impact of medication therapy management by aligning financial incentives with improvements in medication use and encouraging innovation. PMID:27605635

  17. “Keeping the Boogie Man Away”: Medication Self-Management among Women Receiving Anastrozole Therapy

    PubMed Central

    Wickersham, Karen; Happ, Mary Beth; Bender, Catherine M.

    2012-01-01

    The oral hormonal agent anastrozole improves clinical outcomes for women with breast cancer, but women have difficulty taking it for the five-year course. The unique medication-taking experiences related to self-management of anastrozole therapy for women with early stage breast cancer are not known. Our purpose was to describe the medication-taking experiences for postmenopausal women with early stage breast cancer who were prescribed a course of anastrozole therapy. Twelve women aged 58 to 67 years, midway through therapy, participated in audio-recorded interviews. Women's medication-taking experiences involved a belief in their importance and an imperative to take anastrozole. We found that women's side effect experiences, particularly menopausal symptoms, were significant, but only one woman stopped anastrozole due to side effects. Medication-taking included routinization interconnected with remembering/forgetting and a storage strategy. Some women noted a mutual medication-taking experience with their spouse, but most felt taking anastrozole was something they had to do alone. Our results provide insight into the way some women with early stage breast cancer manage their hormonal therapy at approximately the midpoint of treatment. Next steps should include examinations of patient-provider communication, potential medication-taking differences between pre- and postmenopausal women, and the effects of medication-taking on clinical outcomes. PMID:23326655

  18. Graphene-based nanovehicles for photodynamic medical therapy.

    PubMed

    Li, Yan; Dong, Haiqing; Li, Yongyong; Shi, Donglu

    2015-01-01

    Graphene and its derivatives such as graphene oxide (GO) have been widely explored as promising drug delivery vehicles for improved cancer treatment. In this review, we focus on their applications in photodynamic therapy. The large specific surface area of GO facilitates efficient loading of the photosensitizers and biological molecules via various surface functional groups. By incorporation of targeting ligands or activatable agents responsive to specific biological stimulations, smart nanovehicles are established, enabling tumor-triggering release or tumor-selective accumulation of photosensitizer for effective therapy with minimum side effects. Graphene-based nanosystems have been shown to improve the stability, bioavailability, and photodynamic efficiency of organic photosensitizer molecules. They have also been shown to behave as electron sinks for enhanced visible-light photodynamic activities. Owing to its intrinsic near infrared absorption properties, GO can be designed to combine both photodynamic and photothermal hyperthermia for optimum therapeutic efficiency. Critical issues and future aspects of photodynamic therapy research are addressed in this review.

  19. Fertility preservation for boys and adolescents facing sterilizing medical therapy

    PubMed Central

    Hussein, Ahmed A.; Tran, Nam D.

    2014-01-01

    Improvements in childhood cancer survival have allowed boys and their families to increasingly focus on quality of life after therapy, particularly their future ability to father children. Treatments should maintain comprehensive cancer care goals and consider the long-term quality of life of these children. While semen cryopreservation is a well-established method of fertility preservation for post-pubertal children, the use of cryopreserved pre-treatment testicular tissue represents a promising, yet experimental method of fertility preservation for prepubertal males facing sterilizing therapy. Healthcare providers should counsel families about the fertility risks of therapy, discuss or refer patients for standard fertility preservation options, and consider experimental approaches to fertility preservation while being mindful of the ethical questions these treatments raise. PMID:26816794

  20. [DGRW-update: exercise therapy in medical rehabilitation--effects, quality, perspectives].

    PubMed

    Pfeifer, K; Sudeck, G; Brüggemann, S; Huber, G

    2010-08-01

    Exercise therapy constitutes the better part of rehabilitative treatment. However, in rehabilitation research the scientific analysis of exercise therapy only plays a minor role. Taking the theoretical model of rehabilitation and the International Classification of Functioning, Disability and Health (ICF) into account, we propose a heuristic model of aims and effects of exercise therapy and define a system of methodological target setting. This system offers a background for an expanded scientific discussion about biopsychosocial determinants and effects of exercise therapy as well as quality development and the evaluation of exercise treatment concepts within and across indications in the context of multimodal medical rehabilitation. PMID:20677118

  1. Medical Skepticism and Complementary Therapy Use among Older Rural African-Americans and Whites

    PubMed Central

    Bell, Ronny A.; Grzywacz, Joseph G.; Quandt, Sara A.; Neiberg, Rebecca; Lang, Wei; Nguyen, Ha; Altizer, Kathryn P.; Arcury, Thomas A.

    2013-01-01

    Purpose This study documents demographic, health, and complementary therapy (CT) correlates of medical skepticism among rural older adults. Methods Older (≥65 years) African Americans and Whites in rural North Carolina (N=198) were interviewed. Medical skepticism was assessed using the four items from the Medical Expenditure Survey. Bivariate associations between medical skepticism and demographic and health characteristics and CT use were assessed, and independent effects on CT use. Findings Positive responses to medical skepticism questions ranged from 19.7% (can overcome illness without help) to 59.6% (believes own behavior determines their health). Medical skepticism indicators were associated with few demographic and health characteristics, and one CT category. Conclusions This study shows a high degree of medical skepticism among rural older adults, but limited associations with demographic and health characteristics and CT use. Further research is needed to understand relationships of attitudes towards conventional care and CT use in this population. PMID:23728044

  2. Fostering a culture of interprofessional education for radiation therapy and medical dosimetry students

    SciTech Connect

    Lavender, Charlotte Miller, Seth; Church, Jessica; Chen, Ronald C.; Muresan, Petronella A.; Adams, Robert D.

    2014-04-01

    A less-studied aspect of radiation therapy and medical dosimetry education is experiential learning through attendance at interprofessional conferences. University of North Carolina radiation therapy and medical dosimetry students regularly attended morning conferences and daily pretreatment peer review, including approximately 145 hours of direct interaction with medical attending physicians and residents, medical physicists, and other faculty. We herein assessed the effect of their participation in these interprofessional conferences on knowledge and communication. The students who graduated from our radiation therapy and medical dosimetry programs who were exposed to the interprofessional education initiative were compared with those who graduated in the previous years. The groups were compared with regard to their knowledge (as assessed by grades on end-of-training examinations) and team communication (assessed via survey). The results for the 2 groups were compared via exact tests. There was a trend for the examination scores for the 2012 cohort to be higher than for the 2007 to 2011 groups. Survey results suggested that students who attended the interprofessional education sessions were more comfortable speaking with attending physicians, residents, physicists, and faculty compared with earlier students who did not attend these educational sessions. Interprofessional education, particularly vertical integration, appears to provide an enhanced educational experience both in regard to knowledge (per the examination scores) and in building a sense of communication (via the survey results). Integration of interprofessional education into radiation therapy and medical dosimetry educational programs may represent an opportunity to enrich the learning experience in multiple ways and merits further study.

  3. Electron beam ion sources for use in second generation synchrotrons for medical particle therapy.

    PubMed

    Zschornack, G; Ritter, E; Schmidt, M; Schwan, A

    2014-02-01

    Cyclotrons and first generation synchrotrons are the commonly applied accelerators in medical particle therapy nowadays. Next generation accelerators such as Rapid Cycling Medical Synchrotrons (RCMS), direct drive accelerators, or dielectric wall accelerators have the potential to improve the existing accelerator techniques in this field. Innovative accelerator concepts for medical particle therapy can benefit from ion sources which meet their special requirements. In the present paper we report on measurements with a superconducting Electron Beam Ion Source, the Dresden EBIS-SC, under the aspect of application in combination with RCMS as a well proven technology. The measurements indicate that this ion source can offer significant advantages for medical particle therapy. We show that a superconducting EBIS can deliver ion pulses of medically relevant ions such as protons, C(4 +) and C(6 +) ions with intensities and frequencies required for RCMS [S. Peggs and T. Satogata, "A survey of Hadron therapy accelerator technology," in Proceedings of PAC07, BNL-79826- 2008-CP, Albuquerque, New Mexico, USA, 2007; A. Garonna, U. Amaldi et al., "Cyclinac medical accelerators using pulsed C(6 +)/H2(+) ion sources," in Proceedings of EBIST 2010, Stockholm, Sweden, July 2010]. Ion extraction spectra as well as individual ion pulses have been measured. For example, we report on the generation of proton pulses with up to 3 × 10(9) protons per pulse and with frequencies of up to 1000 Hz at electron beam currents of 600 mA.

  4. Graphene-based nanovehicles for photodynamic medical therapy

    PubMed Central

    Li, Yan; Dong, Haiqing; Li, Yongyong; Shi, Donglu

    2015-01-01

    Graphene and its derivatives such as graphene oxide (GO) have been widely explored as promising drug delivery vehicles for improved cancer treatment. In this review, we focus on their applications in photodynamic therapy. The large specific surface area of GO facilitates efficient loading of the photosensitizers and biological molecules via various surface functional groups. By incorporation of targeting ligands or activatable agents responsive to specific biological stimulations, smart nanovehicles are established, enabling tumor-triggering release or tumor-selective accumulation of photosensitizer for effective therapy with minimum side effects. Graphene-based nanosystems have been shown to improve the stability, bioavailability, and photodynamic efficiency of organic photosensitizer molecules. They have also been shown to behave as electron sinks for enhanced visible-light photodynamic activities. Owing to its intrinsic near infrared absorption properties, GO can be designed to combine both photodynamic and photothermal hyperthermia for optimum therapeutic efficiency. Critical issues and future aspects of photodynamic therapy research are addressed in this review. PMID:25848263

  5. The use of medical orders in acute care oxygen therapy.

    PubMed

    Wong, Ming; Elliott, Malcolm

    The life of every living organism is sustained by the presence of oxygen and the acute deprivation of oxygen will, therefore, result in hypoxia and ultimately death. Although oxygen is normally present in the air, higher concentrations are required to treat many disease processes. Oxygen is therefore considered to be a drug requiring a medical prescription and is subject to any law that covers its use and prescription. Administration is typically authorized by a physician following legal written instructions to a qualified nurse. This standard procedure helps prevent incidence of misuse or oxygen deprivation which could worsen the patients hypoxia and ultimate outcome. Delaying the administration of oxygen until a written medical prescription is obtained could also have the same effect. Clearly, defined protocols should exist to allow for the legal administration of oxygen by nurses without a physicians order because any delay in administering oxygen to patients can very well lead to their death. PMID:19377391

  6. Argon gas: a potential neuroprotectant and promising medical therapy.

    PubMed

    Nowrangi, Derek S; Tang, Jiping; Zhang, John H

    2014-02-17

    Argon is a noble gas element that has demonstrated narcotic and protective abilities that may prove useful in the medical field. The earliest records of argon gas have exposed its ability to exhibit narcotic symptoms at hyperbaric pressures greater than 10 atmospheres with more recent evidence seeking to display argon as a potential neuroprotective agent. The high availability and low cost of argon provide a distinct advantage over using similarly acting treatments such as xenon gas. Argon gas treatments in models of brain injury such as in vitro Oxygen-Glucose-Deprivation (OGD) and Traumatic Brain Injury (TBI), as well as in vivo Middle Cerebral Artery Occlusion (MCAO) have largely demonstrated positive neuroprotective behavior. On the other hand, some warning has been made to potential negative effects of argon treatments in cases of ischemic brain injury, where increases of damage in the sub-cortical region of the brain have been uncovered. Further support for argon use in the medical field has been demonstrated in its use in combination with tPA, its ability as an organoprotectant, and its surgical applications. This review seeks to summarize the history and development of argon gas use in medical research as mainly a neuroprotective agent, to summarize the mechanisms associated with its biological effects, and to elucidate its future potential.

  7. Medication-Related Osteonecrosis of Jaws: A Low-Level Laser Therapy and Antimicrobial Photodynamic Therapy Case Approach

    PubMed Central

    Minamisako, Mariana Comparotto; Lisboa, Mariáh Luz; Mariela Rodríguez Cordeiro, Mabel; Grando, Liliane Janete

    2016-01-01

    Medication-related osteonecrosis of the jaws (MRONJ) can be considered an inability of the alveolar bone to respond to an injury, which frequently leads to severe local and systemic complications. Once the problem is installed, dentist must use all therapeutic approaches recommended. This manuscript reports a successful management of MRONJ handled with antibiotics, conservative debridement, low-level laser therapy (LLLT), and photodynamic therapy (PDT) up to 12 months. As healing of MRONJ may be very slow, combined therapeutic approaches are required. Besides the recommended conventional treatment protocol, LLLT and PDT are important tools to contribute to healing and improvement of patient's quality of life.

  8. Medication-Related Osteonecrosis of Jaws: A Low-Level Laser Therapy and Antimicrobial Photodynamic Therapy Case Approach

    PubMed Central

    Minamisako, Mariana Comparotto; Lisboa, Mariáh Luz; Mariela Rodríguez Cordeiro, Mabel; Grando, Liliane Janete

    2016-01-01

    Medication-related osteonecrosis of the jaws (MRONJ) can be considered an inability of the alveolar bone to respond to an injury, which frequently leads to severe local and systemic complications. Once the problem is installed, dentist must use all therapeutic approaches recommended. This manuscript reports a successful management of MRONJ handled with antibiotics, conservative debridement, low-level laser therapy (LLLT), and photodynamic therapy (PDT) up to 12 months. As healing of MRONJ may be very slow, combined therapeutic approaches are required. Besides the recommended conventional treatment protocol, LLLT and PDT are important tools to contribute to healing and improvement of patient's quality of life. PMID:27668100

  9. Medication-Related Osteonecrosis of Jaws: A Low-Level Laser Therapy and Antimicrobial Photodynamic Therapy Case Approach.

    PubMed

    Minamisako, Mariana Comparotto; Ribeiro, Guilherme Henrique; Lisboa, Mariáh Luz; Mariela Rodríguez Cordeiro, Mabel; Grando, Liliane Janete

    2016-01-01

    Medication-related osteonecrosis of the jaws (MRONJ) can be considered an inability of the alveolar bone to respond to an injury, which frequently leads to severe local and systemic complications. Once the problem is installed, dentist must use all therapeutic approaches recommended. This manuscript reports a successful management of MRONJ handled with antibiotics, conservative debridement, low-level laser therapy (LLLT), and photodynamic therapy (PDT) up to 12 months. As healing of MRONJ may be very slow, combined therapeutic approaches are required. Besides the recommended conventional treatment protocol, LLLT and PDT are important tools to contribute to healing and improvement of patient's quality of life. PMID:27668100

  10. Karlson ozone sterilizer. Final report

    SciTech Connect

    Karlson, E.

    1984-05-07

    The authors have a functional sterilization system employing ozone as a sterilization agent. This final report covers the work that led to the first medical sterilizer using ozone as the sterilizing agent. The specifications and the final design were set by hospital operating room personnel and public safety standards. Work on kill tests using bacteria, viruses and fungi determined the necessary time and concentration of ozone necessary for sterilization. These data were used in the Karlson Ozone Sterilizer to determine the length of the steps of the operating cycle and the concentration of ozone to be used. 27 references.

  11. Economic Evaluation of Endoscopic Sinus Surgery versus Continued Medical Therapy for Refractory Chronic Rhinosinusitis

    PubMed Central

    Rudmik, Luke; Soler, Zachary M.; Mace, Jess C.; Schlosser, Rodney J.; Smith, Timothy L.

    2014-01-01

    Objective To evaluate the long-term cost-effectiveness of endoscopic sinus surgery (ESS) compared to continued medical therapy for patients with refractory chronic rhinosinusitis (CRS). Study Design Cohort-style Markov decision tree economic evaluation Methods The economic perspective was the US third party payer with a 30 year time horizon. The two comparative treatment strategies were: 1) ESS followed by appropriate postoperative medical therapy and 2) continued medical therapy alone. Primary outcome was the incremental cost per quality adjusted life year (QALY). Costs were discounted at a rate of 3.5% in the reference case. Multiple sensitivity analyses were performed including differing time-horizons, discounting scenarios, and a probabilistic sensitivity analysis (PSA). Results The reference case demonstrated that the ESS strategy cost a total of $48,838.38 and produced a total of 20.50 QALYs. The medical therapy alone strategy cost a total of $28,948.98 and produced a total of 17.13 QALYs. The incremental cost effectiveness ratio (ICER) for ESS versus medical therapy alone is $5,901.90 per QALY. The cost-effectiveness acceptability curve from the PSA demonstrated that there is 74% certainty that the ESS strategy is the most cost-effective decision for any willingness to pay threshold greater then $25,000. The time horizon analysis suggests that ESS becomes the cost-effective intervention within the 3rd year after surgery. Conclusion Results from this study suggest that employing an ESS treatment strategy is the most cost-effective intervention compared to continued medical therapy alone for the long-term management of patients with refractory CRS. PMID:25186499

  12. Predictors of Medication-Related Problems Among Medicaid Patients Participating in a Pharmacist-Provided Telephonic Medication Therapy Management Program

    PubMed Central

    Snyder, Margie E.; Frail, Caitlin K.; Jaynes, Heather; Pater, Karen S.; Zillich, Alan J.

    2015-01-01

    Study Objective To identify predictors of medication-related problems (MRPs) among Medicaid patients participating in a telephonic medication therapy management (MTM) program. Design Retrospective analysis of data from patients enrolled in a previously published study Data Sources Two Medicaid administrative claims file databases (for healthcare utilization and prescription dispensing information) and one pharmacy organization file for MTM program information. Patients Seven hundred twelve adult Medicaid patients who participated in a statewide pharmacist-provided telephone-based MTM program and who received an initial medication therapy review. Measurements and Main Results The primary dependent variable was the number of MRPs detected during the initial medication therapy review. Secondary dependent variables were the detection of one or more MRPs related to indication, effectiveness, safety, and adherence. Predictor variables were selected a priori that, from the literature and our own practice experiences, were hypothesized as being potentially associated with MRPs: demographics, comorbidities, medication use, and healthcare utilization. Bivariate analyses were performed, and multivariable models were constructed. All predictor variables with significant associations (defined a priori as p<0.1) with the median number of MRPs detected were then entered into a three-block multiple linear regression model. The overall model was significant (p<0.001, R2= 0.064). Significant predictors of any MRPs (p<0.05) were total number of medications, obesity, dyslipidemia, and one or more emergency department visits in the past 3 months. For indication-related MRPs, the model was significant (p<0.001, R2= 0.049), and predictors included female sex, obesity, dyslipidemia, and total number of medications (p<0.05). For effectiveness-related MRPs, the model was significant (p<0.001, R2= 0.054), and predictors included bone disease and dyslipidemia (p<0.05). For safety-related MRPs

  13. Hospital based superconducting cyclotron for neutron therapy: Medical physics perspective

    NASA Astrophysics Data System (ADS)

    Yudelev, M.; Burmeister, J.; Blosser, E.; Maughan, R. L.; Kota, C.

    2001-12-01

    The neutron therapy facility at the Gershenson Radiation Oncology Center, Harper University Hospital in Detroit has been operational since September 1991. The d(48.5)+Be beam is produced in a gantry mounted superconducting cyclotron designed and built at the National Superconducting Cyclotron Laboratory (NSCL). Measurements were performed in order to obtain the physical characteristics of the neutron beam and to collect the data necessary for treatment planning. This included profiles of the dose distribution in a water phantom, relative output factors and the design of various beam modifiers, i.e., wedges and tissue compensators. The beam was calibrated in accordance with international protocol for fast neutron dosimetry. Dosimetry and radiobiology intercomparions with three neutron therapy facilities were performed prior to clinical use. The radiation safety program was established in order to monitor and reduce the exposure levels of the personnel. The activation products were identified and the exposure in the treatment room was mapped. A comprehensive quality assurance (QA) program was developed to sustain safe and reliable operation of the unit at treatment standards comparable to those for conventional photon radiation. The program can be divided into three major parts: maintenance of the cyclotron and related hardware; QA of the neutron beam dosimetry and treatment delivery; safety and radiation protection. In addition the neutron beam is used in various non-clinical applications. Among these are the microdosimetric characterization of the beam, the effects of tissue heterogeneity on dose distribution, the development of boron neutron capture enhanced fast neutron therapy and variety of radiobiology experiments.

  14. [Dyslipidemia management with medical nutrition therapy: current status and perspectives].

    PubMed

    Sucato, Vincenzo; Triolo, Oreste Fabio; Bronte, Enrico; Trovato, Rosaria Linda; Tona, Giuseppe Riccardo; Novo, Salvatore

    2013-09-01

    In Italy, patients with dyslipidemia account for 15-20% of the adult population with major healthcare and socio-economic impact. According to the ESC/EAS guidelines for the management of dyslipidemias, desirable cholesterol and triglyceride levels can be achieved with a synergy between drug treatment and adequate diet therapy. However, what diets should be adopted? In this review article, different types of dietary treatments are compared, with a special focus on diet education. The new scientific frontier of nutrigenetics is also discussed.

  15. LED-array light source for medical therapy

    NASA Astrophysics Data System (ADS)

    Schlager, Kenneth J.; Ignatius, Ronald W.

    1993-07-01

    Light emitting diode (LED) array light sources currently in development offer an alternative to laser light sources in a wide range of medical applications. Previously developed as light sources for research in photosynthesis in plant growth experimentation, LED arrays have produced an average continuous output of 4 - 6 watts at a wavelength of 660 nm. This output is equivalent to the terrestrially sensed output of the sun at this wavelength at high noon. LED chips are arrayed on an alumina tile substrate that may be formed to provide optical power focused on a specified target area.

  16. [TCM/aciipuncture therapy and medical insurance support in Switzerland].

    PubMed

    Tian, Kaiyu; Yuan, Lisa

    2015-08-01

    Based on the expeienes in th acdemic exchanges in Switzerland and relevant data, the development of TCM/acupuncture in Switzerland, Swiss medical insurance system and the acceptance to TCM/acupuncture were introduced in the paper. The case analysis was applied to explain the reimbursement, proportion and additional conditions of Obligatory Basic Insurance and Supplementary Alternative Insurance on TCM/acupuncture; Additionally, in the paper, the certification and registration from EMR, ASCA and NVS for the TCM physician were introduced, which is required to the recognition by insurance companies. All of these provide the guarantee for the positive development of TCM/acupuncture in Switzerland.

  17. Intramedullary spinal neurocysticercosis treated successfully with medical therapy.

    PubMed

    Ahmed, Shameem; Paul, Siba Prosad

    2014-12-01

    Neurocysticercosis caused by Taenia solium and is a common parasitic disease of the cental nervous system. It usually presents with seizures, headaches, progressively worsening focal neurologic symptoms, visual disturbances, loss of bladder control, etc. However, acute onset symptoms may also be seen. MRI scans can accurately diagnose spinal or cerebral lesions and is also helpful in monitoring progress while on treatment. Albendazole is currently the drug of choice along with steroids for medical management of neurocysticercosis. The case of intramedullary spinal neurocysticercosis was treated with praziquantel.

  18. Empirical medical therapy in idiopathic male infertility: Promise or panacea?

    PubMed Central

    Jung, Jae Hung

    2014-01-01

    Male factors account for 20%-50% of cases of infertility and in 25% of cases, the etiology of male infertility is unknown. Effective treatments are well-established for hypogonadotropic hypogonadism, male accessory gland infection, retrograde ejaculation, and positive antisperm antibody. However, the appropriate treatment for idiopathic male infertility is unclear. Empirical medical treatment (EMT) has been used in men with idiopathic infertility and can be divided into two categories based on the mode of action: hormonal treatment and antioxidant supplementation. Hormonal medications consist of gonadotropins, androgens, estrogen receptor blockers, and aromatase inhibitors. Antioxidants such as vitamins, zinc, and carnitines have also been widely used to reduce oxidative stress-induced spermatozoa damage. Although scientifically acceptable evidence of EMT is limited because of the lack of large, randomized, controlled studies, recent systematic reviews with meta-analyses have shown that the administration of gonadotropins, anti-estrogens, and oral antioxidants results in a significant increase in the live birth rate compared with control treatments. Therefore, all physicians who treat infertility should bear in mind that EMT can improve semen parameters and subsequent fertility potential through natural intercourse. PMID:25309854

  19. Superficially, longer, intermittent ozone theraphy in the treatment of the chronic, infected wounds.

    PubMed

    Białoszewski, Dariusz; Kowalewski, Michał

    2003-10-30

    Background. Ozone therapy - i.e. the treatment of patients by a mixture of oxygen and ozone - has been used for many years as a method ancillary to basic treatment, especially in those cases in which traditional treatment methods do not give satisfactory results, e.g. skin loss in non-healing wounds, ulcers, pressure sores, fistulae, etc. Material and methods. In the Department of Phisiotherapy of the Medical Faculty and the Department of the Orthopedics and Traumatology of the Locomotor System at the Medical University of Warsaw in the period from January 2001 until November 2002, 23 patients with heavy,chronic, antibiotic resistants septic complications after trauma, surgical procedures and secundary skin infetions were treated with ozone. The ozone therapy was administered using an authorial technique of superficially, longer, intermittent ozone application. Results. In the wounds of the all experienced patients the inhibition of septic processes and wound healing was much faster than normal. Conclusions. Our data confirm the advantages wich result from the technique of superficially, longer, intermittent ozone theraphy in combined treatment for septic complications in the soft tissue, especially in the locomotor system. These technique makes posttraumatic infections and promotes quicker healing of post-surgical and post-traumal complications - chronic septic infections. This method also lowers the cost of antibiotic therapy and is sometimes the only available auxiliary technique to support surgical procedures.

  20. Minimally invasive eyelid care in dermatology: medical, laser, and cosmetic therapies.

    PubMed

    Fathi, Ramin; Pfeiffer, Margaret L; Tsoukas, Maria

    2015-01-01

    There is a high demand for facial aesthetic enhancement, and the periorbital region is one of the first areas to show signs of aging. Many nonsurgical therapies exist to tackle these problems. These therapies are becoming more efficacious while reducing postprocedural recovery time. The goal is to restore the natural youthful appearance rather than to create an effect that differs from the patient's appearance earlier in life. Eyelid care, and cosmetic dermatology in general, intends to restore balance and symmetry. We discuss the initial consultation, relevant anatomy for the dermatologist, and medical, laser and cosmetic therapies.

  1. Growth Hormone Tumor Histological Subtypes Predict Response to Surgical and Medical Therapy

    PubMed Central

    Kiseljak-Vassiliades, Katja; Carlson, Nichole E.; Borges, Manuel T.; Kleinschmidt-DeMasters, B.K.; Lillehei, Kevin O.; Kerr, Janice M.; Wierman, Margaret E.

    2014-01-01

    Purpose Growth hormone (GH) pituitary tumors are associated with significant morbidity and mortality. Current treatments, including surgery and medical therapy with somatostatin analogues (SSA), dopamine agonists and/or a GH receptor antagonist, result in disease remission in approximately half of patients. Predictors of GH tumor response to different therapies have been incompletely defined based on histologic subtype, particularly densely (DG) versus sparsely (SG) granulated adenomas. The aim of this study was to examine our own institutional experience with GH adenomas and correlate how subtype related to clinical parameters as well as response to surgery and medical therapies. Methods A retrospective chart review of 101 acromegalic patients operated by a single neurosurgeon was performed. Clinical data were correlated with histologic subtype and disease control, as defined by IGF-1 levels, and random growth hormone levels in response to surgery and/or medical therapies. Results SG tumors, compared to DG, occurred in younger patients (p=0.0010), were 3-fold larger (p=0.0030), but showed no differences in tumor-invasion characteristics (p=0.12). DG tumors had a higher rate of remission in response to surgery compared to SG, 65.7% vs. 14.3% (p<0.0001), as well as to medical therapy with SSAs (68.8% for DG vs. 28.6% for SG tumors; p=0.028). SG tumors not controlled with SSAs consistently responded to a switch to, or addition of, a GH receptor antagonist. Conclusions Histological GH tumor subtyping implicates a different clinical phenotype and biologic behavior, and provides prognostic significance for surgical success and response to medical therapies. PMID:25129651

  2. An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain.

    PubMed

    Apuzzo, Dario; Giotti, Chiara; Pasqualetti, Patrizio; Ferrazza, Paolo; Soldati, Paola; Zucco, Gesualdo M

    2014-01-01

    Acute low back pain (LBP) is the fifth most common reason for physician visits and about nine out of ten adults experience back pain at some point in their life. In a large number of patients LBP is associated with disc herniation (DH). Recently, oxygen-ozone (O2O3) therapy has been used successfully in the treatment of LBP, reducing pain after the failure of other conservative treatments. The aim of this study was to assess the effects of O2O3 therapy in back pain rehabilitation, comparing three groups of patients suffering from chronic back pain associated with DH submitted to three different treatments: intramuscular O2O3 infiltrations, global postural An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain re-education (GPR), or a combination of the two (O2O3+GPR). The data show that pain severity before treatment was significantly lower in the patients treated with GPR alone (VAS score 7.4) than in the O2O3+GPR patients (VAS score 8.5) and the O2O3 patients (VAS score 8.6). At the end of treatment, pain severity was lower in the O2O3 patients than in the GPR-alone patients. After some years of follow-up only the difference between O2O3+GPR and GPR-alone remained significant. PMID:25014047

  3. Surface Ozone in Kiev

    NASA Astrophysics Data System (ADS)

    Shavrina, A. V.; Mikulskaya, I. A.; Kiforenko, S. I.; Blum, O. B.; Sheminova, V. A.; Veles, A. A.

    The study of total ozone over Kiev and its concentration changes with height in the troposphere has been made on the base of ground-based observations with the infrared Fourier-spectrometer in the Main Astronomical Observatory of National Academy of Sciences of Ukraine (MAO NASU) as part of ESA-NIVR-KNMI project no 2907 "OMI validation by ground based remote sensing: ozone columns and atmospheric profiles "(2005-2008) [1,2,4]. Ground-level ozone in Kiev for an episode of its high concentrations in August 2000 was also simulated with the model of urban air pollution UAM-V [5,6]. In 2008 the satellite data Aura-OMI on profiles of ozone in the atmosphere OMO3PR became available (http://disc.sci.gsfc.nasa.gov/ Aura/data-holdings/OMI/ omo3pr_v003.shtml). They include ozone content in the lower layer of the atmosphere, beginning from 2005, which can be used to evaluate the ground-level ozone in all cities of Ukraine. The comparison of the data of ozone air pollution in Kiev (ozone - the pollutant of the first class of danger) and medical statistics data of of respiratory system (RS) diseases of the city population was carried out with the package "Statistica". A regression analysis, prognostic regression modelling, and retrospective prognosis of the epidemiological situation with respect to RS pathologies in Kiev in 2000-2006 were performed.

  4. An Introductory Pharmacy Practice Experience Based on a Medication Therapy Management Service Model

    PubMed Central

    Huynh, Donna; Brandt, Nicole

    2011-01-01

    Objective. To implement and evaluate an introductory pharmacy practice experience (IPPE) based on the medication therapy management (MTM) service model. Design. Patient Care 2 is an IPPE that introduces third-year pharmacy students to the MTM service model. Students interacted with older adults to identify medication-related problems and develop recommendations using core MTM elements. Course outcome evaluations were based on number of documented medication-related problems, recommendations, and student reviews. Assessment. Fifty-seven older adults participated in the course. Students identified 52 medication-related problems and 66 medical problems, and documented 233 recommendations relating to health maintenance and wellness, pharmacotherapy, referrals, and education. Students reported having adequate experience performing core MTM elements. Conclusion. Patient Care 2 may serve as an experiential learning model for pharmacy schools to teach the core elements of MTM and provide patient care services to the community. PMID:21829256

  5. 10 CFR 50.21 - Class 104 licenses; for medical therapy and research and development facilities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Class 104 licenses; for medical therapy and research and development facilities. 50.21 Section 50.21 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION FACILITIES Classification and Description of Licenses § 50.21 Class 104...

  6. 10 CFR 50.21 - Class 104 licenses; for medical therapy and research and development facilities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Class 104 licenses; for medical therapy and research and development facilities. 50.21 Section 50.21 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION FACILITIES Classification and Description of Licenses § 50.21 Class 104...

  7. 10 CFR 50.21 - Class 104 licenses; for medical therapy and research and development facilities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Class 104 licenses; for medical therapy and research and development facilities. 50.21 Section 50.21 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION FACILITIES Classification and Description of Licenses § 50.21 Class 104...

  8. A Study of Mathematics Needed for Dental Laboratory Technology, Medical Laboratory Technology, and Respiratory Therapy.

    ERIC Educational Resources Information Center

    Roberts, Keith J.

    A study was conducted to determine what mathematics skills were needed for Dental Laboratory Technology, Medical Laboratory Technology, and Respiratory Therapy. Data obtained from studies, course outlines, textbooks, and reports were used to construct a 79-item mathematics skill questionnaire. This questionnaire was administered to employers,…

  9. Comparing Two Cooperative Small Group Formats Used with Physical Therapy and Medical Students

    ERIC Educational Resources Information Center

    D'Eon, Marcel; Proctor, Peggy; Reeder, Bruce

    2007-01-01

    This study compared "Structured Controversy" (a semi-formal debate like small group activity) with a traditional open discussion format for medical and physical therapy students. We found that those students who had participated in Structured Controversy changed their personal opinion on the topic more than those who were in the Open Discussion…

  10. National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module III. Shock and Fluid Therapy.

    ERIC Educational Resources Information Center

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This instructor's lesson plan guide on shock and fluid therapy is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Six units of study are presented: (1) body fluids, electrolytes and their effect on the body, and the general principles of fluid and acid base balances; (2) characteristics of…

  11. Teaching Electroconvulsive Therapy to Medical Students: Effects of Instructional Method on Knowledge and Attitudes

    ERIC Educational Resources Information Center

    Warnell, Ronald L.; Duk, Anthony D.; Christison, George W.; Haviland, Mark G.

    2005-01-01

    Objective: To compare the effects of learning about electroconvulsive therapy (ECT) via live observation to learning via an instructional videotape. Method: During their psychiatry clerkship, 122 medical students were randomized using these two educational methods, and their ECT knowledge and attitudes were assessed during the first and last weeks…

  12. Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression

    ERIC Educational Resources Information Center

    Fournier, Jay C.; DeRubeis, Robert J.; Shelton, Richard C.; Hollon, Steven D.; Amsterdam, Jay D.; Gallop, Robert

    2009-01-01

    A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In this article, the authors seek to identify the variables that were associated with response across both treatments as well as variables that predicted…

  13. Medical Family Therapy for a Woman with End-stage Crohn's Disease and Her Son.

    ERIC Educational Resources Information Center

    McDaniel, Susan H.; Harkness, Jennifer L.; Epstein, Ronald M.

    2001-01-01

    Medical family therapy grew out of the experiences of family therapists working with other professionals to provide comprehensive, integrated healthcare for patients. This is the story of one such patient and provides an account of the experience through quotes from videotaped sessions and electronic mail communications that occurred throughout…

  14. The evaluation of gastroesophageal reflux before and after medical therapies

    SciTech Connect

    Malmud, L.S.; Fisher, R.S.

    1981-07-01

    Gastroesophageal scintigraphy is a quantitative technique that can be employed to detect and quantitate gastroesophageal reflux before and after the application of therapeutic modalities, including change in body position, bethanechol, atropine, antacids, and antacid-alginate compounds. Five groups of 10-15 patients each were studied before and after using each therapeutic modality and before and after atropine. The results were compared to the patient's symptomatology and to the acid reflux test. Gastroesophageal scintigraphy was performed following oral administration of 300 microCi 99mTc-sulfur colloid in 300 ml acidified orange juice. Thirty-second gamma camera images were obtained as the gastroesophageal gradient was increased from approximately 10 to 35 mm Hg at 5 mm Hg increments using an inflatable abdominal binder. Data were processed using a digital computer. Reflux was reduced by change in position from recumbent to upright, and by the use of subcutaneous bethanechol, oral antacid, or oral antacidalginate compound. Atropine increased reflux. Gastroesophageal scintigraphy is more sensitive than fluoroscopy, correlates well with clinical symptomatology, and is a reliable and convenient technique for the quantitative estimation of reflux before and after therapy.

  15. Gains in employment status following antidepressant medication or cognitive therapy for depression

    PubMed Central

    Fournier, Jay C.; DeRubeis, Robert J.; Amsterdam, Jay; Shelton, Richard C.; Hollon, Steven D.

    2015-01-01

    Background Depression can adversely affect employment status. Aims To examine whether there is a relative advantage of cognitive therapy or antidepressant medication in improving employment status following treatment, using data from a previously reported trial. Method Random assignment to cognitive therapy (n = 48) or the selective serotonin reuptake inhibitor paroxetine (n = 93) for 4 months; treatment responders were followed for up to 24 months. Differential effects of treatment on employment status were examined. Results At the end of 28 months, cognitive therapy led to higher rates of full-time employment (88.9%) than did antidepressant medication among treatment responders (70.8%), χ21 = 5.78, P = 0.02, odds ratio (OR) = 5.66, 95% CI 1.16–27.69. In the shorter-term, the main effect of treatment on employment status was not significant following acute treatment (χ21 = 1.74, P = 0.19, OR = 1.77, 95% CI 0.75–4.17); however, we observed a site×treatment interaction (χ21 = 6.87, P = 0.009) whereby cognitive therapy led to a higher rate of full-time employment at one site but not at the other. Conclusions Cognitive therapy may produce greater improvements in employment v. medication, particularly over the longer term. PMID:24925985

  16. Pediatric glaucoma medical therapy: who more accurately reports medication adherence, the caregiver or the child?

    PubMed Central

    Moore, Daniel B; Neustein, Rebecca F; Jones, Sarah K; Robin, Alan L; Muir, Kelly W

    2015-01-01

    As they grow older, most children with glaucoma must eventually face the transition to self-administering medications. We previously reported factors associated with better or worse medication adherence in children with glaucoma, using an objective, electronic monitor. Utilizing the same data set, the purpose of the current study was to determine whose report (the caregiver’s or the child’s) corresponded better with electronically monitored adherence. Of the 46 participants (22 girls), the mean age of children primarily responsible, and caregiver primarily responsible for medication administration was 15±2 and 10±2 years, respectively. For the children whose caregiver regularly administered the eyedrops, the caregiver’s assessment of drop adherence was associated with measured adherence (P=0.012), but the child’s was not (P=0.476). For the children who self-administered eyedrops, neither the child’s (P=0.218) nor the caregiver’s (P=0.395) assessment was associated with measured percent adherence. This study highlights potential errors when relying on self-reporting of compliance in patients and caregivers with pediatric glaucoma, particularly when the child is responsible for administering their own eyedrops. Frank discussions about the importance of medication adherence and how to improve compliance may help both the child and caregiver better communicate with the treating provider. PMID:26648687

  17. Encountering Challenges with the EU Regulation on Advance Therapy Medical Products.

    PubMed

    Mansnérus, Juli

    2015-12-01

    This article aims at analysing how well the Advanced Therapy Medical Product Regulation (EC) No. 1394/2007 (ATMP Regulation) meets the needs of small and medium-sized enterprises (SMES), academia and public tissue establishments developing advanced therapy medical products (ATMPS). Benefits and shortcomings of the ATMP Regulation are identified, and possible amendments are proposed to accelerate the translation of research into advanced therapies and to facilitate the commercialisation of ATMPS whilst ensuring safety. It was set up as a lex specialis to ensure the free movement of ATMPS within the EU in order to facilitate their access to the internal market and to foster the competitiveness of European pharmaceutical companies, while guaranteeing the highest level protection of public health. Since the adoption of the ATMP Regulation in late 2008, only 5 ATMPS have been granted marketing authorisations thus far. Hence, there is a need to analyse whether the ATMP Regulation meets its objectives. PMID:26665690

  18. Encountering Challenges with the EU Regulation on Advance Therapy Medical Products.

    PubMed

    Mansnérus, Juli

    2015-12-01

    This article aims at analysing how well the Advanced Therapy Medical Product Regulation (EC) No. 1394/2007 (ATMP Regulation) meets the needs of small and medium-sized enterprises (SMES), academia and public tissue establishments developing advanced therapy medical products (ATMPS). Benefits and shortcomings of the ATMP Regulation are identified, and possible amendments are proposed to accelerate the translation of research into advanced therapies and to facilitate the commercialisation of ATMPS whilst ensuring safety. It was set up as a lex specialis to ensure the free movement of ATMPS within the EU in order to facilitate their access to the internal market and to foster the competitiveness of European pharmaceutical companies, while guaranteeing the highest level protection of public health. Since the adoption of the ATMP Regulation in late 2008, only 5 ATMPS have been granted marketing authorisations thus far. Hence, there is a need to analyse whether the ATMP Regulation meets its objectives.

  19. The charisma and deception of reparative therapies: when medical science beds religion.

    PubMed

    Grace, André P

    2008-01-01

    In this article, I examine the history and resurgence of interest in sexual reorientation or reparative therapies. I begin with a critique of the contemporary "ex-gay" movement, interrogating Exodus as the prototype of a politico-religious transformational ministry that works to "cure" homosexuals, and examine how Exodus utilizes ex-gay testimony to deceive harried homosexuals looking for escape from the effects of internalized and cultural homophobia. Next, I investigate how reparative therapies function as orthodox treatments that charismatically meld conservative religious perspectives with medical science to produce a pseudoscience promising to treat homosexuality effectively. In this regard, I assess the ongoing debate regarding gay-affirming versus reparative therapies by first looking at the history of medicalizing homosexuality and then surveying the debate spurred by Robert L. Spitzer's research. I conclude with a consideration of research needed to measure whether efficacious change in sexual orientation is possible.

  20. Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Acute Treatment of Adults with Major Depression

    ERIC Educational Resources Information Center

    Dimidjian, Sona; Hollon, Steven D.; Dobson, Keith S.; Schmaling, Karen B.; Kohlenberg, Robert J.; Addis, Michael E.; Gallop, Robert; McGlinchey, Joseph B.; Markley, David K.; Gollan, Jackie K.; Atkins, David C.; Dunner, David L.; Jacobson, Neil S.

    2006-01-01

    Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have…

  1. European Code against Cancer 4th Edition: Medical exposures, including hormone therapy, and cancer.

    PubMed

    Friis, Søren; Kesminiene, Ausrele; Espina, Carolina; Auvinen, Anssi; Straif, Kurt; Schüz, Joachim

    2015-12-01

    The 4th edition of the European Code against Cancer recommends limiting - or avoiding when possible - the use of hormone replacement therapy (HRT) because of the increased risk of cancer, nevertheless acknowledging that prescription of HRT may be indicated under certain medical conditions. Current evidence shows that HRT, generally prescribed as menopausal hormone therapy, is associated with an increased risk of cancers of the breast, endometrium, and ovary, with the risk pattern depending on factors such as the type of therapy (oestrogen-only or combined oestrogen-progestogen), duration of treatment, and initiation according to the time of menopause. Carcinogenicity has also been established for anti-neoplastic agents used in cancer therapy, immunosuppressants, oestrogen-progestogen contraceptives, and tamoxifen. Medical use of ionising radiation, an established carcinogen, can provide major health benefits; however, prudent practices need to be in place, with procedures and techniques providing the needed diagnostic information or therapeutic gain with the lowest possible radiation exposure. For pharmaceutical drugs and medical radiation exposure with convincing evidence on their carcinogenicity, health benefits have to be balanced against the risks; potential increases in long-term cancer risk should be considered in the context of the often substantial and immediate health benefits from diagnosis and/or treatment. Thus, apart from HRT, no general recommendations on reducing cancer risk were given for carcinogenic drugs and medical radiation in the 4th edition of European Code against Cancer. It is crucial that the application of these measures relies on medical expertise and thorough benefit-risk evaluation. This also pertains to cancer-preventive drugs, and self-medication with aspirin or other potential chemopreventive drugs is strongly discouraged because of the possibility of serious, potentially lethal, adverse events.

  2. European Code against Cancer 4th Edition: Medical exposures, including hormone therapy, and cancer.

    PubMed

    Friis, Søren; Kesminiene, Ausrele; Espina, Carolina; Auvinen, Anssi; Straif, Kurt; Schüz, Joachim

    2015-12-01

    The 4th edition of the European Code against Cancer recommends limiting - or avoiding when possible - the use of hormone replacement therapy (HRT) because of the increased risk of cancer, nevertheless acknowledging that prescription of HRT may be indicated under certain medical conditions. Current evidence shows that HRT, generally prescribed as menopausal hormone therapy, is associated with an increased risk of cancers of the breast, endometrium, and ovary, with the risk pattern depending on factors such as the type of therapy (oestrogen-only or combined oestrogen-progestogen), duration of treatment, and initiation according to the time of menopause. Carcinogenicity has also been established for anti-neoplastic agents used in cancer therapy, immunosuppressants, oestrogen-progestogen contraceptives, and tamoxifen. Medical use of ionising radiation, an established carcinogen, can provide major health benefits; however, prudent practices need to be in place, with procedures and techniques providing the needed diagnostic information or therapeutic gain with the lowest possible radiation exposure. For pharmaceutical drugs and medical radiation exposure with convincing evidence on their carcinogenicity, health benefits have to be balanced against the risks; potential increases in long-term cancer risk should be considered in the context of the often substantial and immediate health benefits from diagnosis and/or treatment. Thus, apart from HRT, no general recommendations on reducing cancer risk were given for carcinogenic drugs and medical radiation in the 4th edition of European Code against Cancer. It is crucial that the application of these measures relies on medical expertise and thorough benefit-risk evaluation. This also pertains to cancer-preventive drugs, and self-medication with aspirin or other potential chemopreventive drugs is strongly discouraged because of the possibility of serious, potentially lethal, adverse events. PMID:26390952

  3. Neuronal dysfunction and medical therapy in heart failure: can an imaging biomarker help to "personalize" therapy?

    PubMed

    Wessler, Benjamin S; Udelson, James E

    2015-06-01

    (123)I-metaiodobenzylguanidine ((123)I-MIBG) imaging is a tool for evaluating one of the fundamental pathophysiologic abnormalities seen in heart failure (HF), that of an upregulated sympathetic nervous system and its effect on the myocardium. Although this imaging technique offers information about prognosis for patients treated with contemporary guideline-based HF therapies and improves risk stratification, there are neither rigorous nor sufficient outcome data to suggest that this imaging tool can guide therapeutic decision making or better target subsets of patients with HF for particular therapies.

  4. Neuronal dysfunction and medical therapy in heart failure: can an imaging biomarker help to "personalize" therapy?

    PubMed

    Wessler, Benjamin S; Udelson, James E

    2015-06-01

    (123)I-metaiodobenzylguanidine ((123)I-MIBG) imaging is a tool for evaluating one of the fundamental pathophysiologic abnormalities seen in heart failure (HF), that of an upregulated sympathetic nervous system and its effect on the myocardium. Although this imaging technique offers information about prognosis for patients treated with contemporary guideline-based HF therapies and improves risk stratification, there are neither rigorous nor sufficient outcome data to suggest that this imaging tool can guide therapeutic decision making or better target subsets of patients with HF for particular therapies. PMID:26033899

  5. Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy

    PubMed Central

    Kimmick, Gretchen; Edmond, Sara N.; Bosworth, Hayden B.; Peppercorn, Jeffrey; Marcom, Paul K.; Blackwell, Kimberly; Keefe, Francis J.; Shelby, Rebecca A.

    2016-01-01

    Purpose To explore how symptoms and psychosocial factors are related to intentional and unintentional non-adherent medication taking behaviors. Methods Included were postmenopausal women with hormone receptor positive, stage I-IIIA breast cancer, who had completed surgery, chemotherapy, and radiation, and were taking endocrine therapy. Self-administered, standardized measures were completed during a routine clinic visit: Brief Fatigue Inventory, Brief Pain Inventory, Menopause Specific Quality of Life Questionnaire, Functional Assessment of Cancer Therapy General and Neurotoxicity scales, and Self-Efficacy for Appropriate Medication Use Scale. Regression analyses were performed to determine the degree to which demographic, medical, symptom, and psychosocial variables, explain intentional, such as changing one’s doses or stopping medication, and unintentional, such as forgetting to take one’s medication, non-adherent behaviors. Results Participants were 112 women: mean age 64 (SD=9) years; 81% white; mean time from surgery 40 (SD=28) months; 49% received chemotherapy (39% including a taxane); mean time on endocrine therapy, 35 (SD=29.6) months; 82% taking an aromatase inhibitor. Intentional and unintentional non-adherent behaviors were described in 33.9% and 58.9% of participants, respectively. Multivariate analysis showed that higher self-efficacy for taking medication was associated with lower levels of unintentional (p=0.002) and intentional (p=0.004) non-adherent behaviors. The presence of symptoms (p=0.03) and lower self-efficacy for physician communication (p=0.009) were associated with higher levels of intentional non-adherent behaviors. Conclusions These results suggest that women who report greater symptoms, lower self-efficacy for communicating with their physician, and lower self-efficacy for taking their medication are more likely to engage in both intentional and unintentional non-adherent behaviors. PMID:26189978

  6. The Association of Adherence to Antiretroviral Therapy with Healthcare Utilization and Costs for Medical Care

    PubMed Central

    Gardner, Edward M.; Maravi, Moises E.; Rietmeijer, Cornelis; Davidson, Arthur J.; Burman, William J.

    2009-01-01

    Background The association between antiretroviral adherence, healthcare utilization and medical costs has not been well studied. Objective To examine the relationship of adherence to antiretroviral medications to healthcare utilization and healthcare costs. Methods A retrospective cohort study was conducted using data from 325 previously antiretroviral medication-naive HIV-infected individuals initiating first antiretroviral therapy from 1997 through 2003. The setting was an inner-city safety net hospital and HIV clinic in the US. Adherence was assessed using pharmacy refill data. The average wholesale price was used for prescription costs. Healthcare utilization data and medical costs were obtained from the hospital billing database, and differences according to quartile of adherence were compared using analysis of variance (ANOVA). Multivariate logistic regression was used to assess predictors of higher annual medical costs. Sensitivity analyses were used to examine alternative antiretroviral pricing schemes. The perspective was that of the healthcare provider, and costs were in year 2005 values. Results In 325 patients followed for a mean (± SD) 3.2 (1.9) years, better adherence was associated with lower healthcare utilization but higher total medical costs. Annual non-antiretroviral medical costs were $US7612 in the highest adherence quartile versus $US10 190 in the lowest adherence quartile. However, antiretroviral costs were significantly higher in the highest adherence quartile ($US17 513 vs $US8690), and therefore the total annual medical costs were also significantly higher in the highest versus lowest adherence quartile ($US25 125 vs $US18 880). In multivariate analysis, for every 10% increase in adherence, the odds of having annual medical costs in the highest versus lowest quartile increased by 87% (odds ratio 1.87; 95% CI 1.45, 2.40). In sensitivity analyses, very low antiretroviral prices (as seen in resource-limited settings) inverted this

  7. Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression

    PubMed Central

    Fournier, Jay C.; DeRubeis, Robert J.; Shelton, Richard C.; Hollon, Steven D.; Amsterdam, Jay D.; Gallop, Robert

    2009-01-01

    A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate-to-severely depressed outpatients. In this article, we seek to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks. Chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three prescriptive variables were identified: marriage, unemployment, and having experienced a greater number of recent life events predicted superior response to cognitive therapy compared to antidepressant medications. Thus, six markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The three prognostic variables identify subgroups that might benefit from alternative treatment strategies; the three prescriptive variables identify groups who appear to respond particularly well to cognitive therapy. PMID:19634969

  8. Surviving with lung cancer: medication-taking and oral targeted therapy.

    PubMed

    Wickersham, Karen E; Happ, Mary Beth; Bender, Catherine M; Engberg, Sandra J; Tarhini, Ahmad; Erlen, Judith A

    2014-01-01

    Oral epidermal growth factor receptor inhibitors (EGFRIs) improve survival for non-small cell lung cancer (NSCLC) patients; however, medication-taking implications are unknown. We used grounded theory to explore the process of medication-taking for NSCLC patients receiving oral EGFRIs. Thirty-two interviews were conducted for 13 participants purposively selected for gender, race/ethnicity, age, time in therapy, dose reductions, and therapy discontinuation and theoretically sampled for age and health insurance carrier. The study produced a grounded theory, Surviving with Lung Cancer, in which participants framed EGFRI therapy within recognition of NSCLC as a life-limiting illness without cure. Medication-taking was a "window" into participants' process of surviving with metastatic cancer that included deciding and preparing to take EGFRIs and treating lung cancer as a chronic condition. Our results contribute to understanding how NSCLC patients view themselves in the context of a life-limiting illness and support development of a theoretically-based intervention to improve medication-taking with EGFRIs.

  9. Surviving with Lung Cancer: Medication-Taking and Oral Targeted Therapy

    PubMed Central

    WICKERSHAM, Karen E.; HAPP, Mary Beth; BENDER, Catherine M.; ENGBERG, Sandra J.; TARHINI, Ahmad; ERLEN, Judith A.

    2014-01-01

    Oral epidermal growth factor receptor inhibitors (EGFRIs) improve survival for non-small cell lung cancer (NSCLC) patients; however, medication-taking implications are unknown. We used grounded theory to explore the process of medication-taking for NSCLC patients receiving oral EGFRIs. Thirty-two interviews were conducted for 13 participants purposively selected for gender, race/ethnicity, age, time in therapy, dose reductions, and therapy discontinuation and theoretically sampled for age and health insurance carrier. The study produced a grounded theory, Surviving with Lung Cancer, in which participants framed EGFRI therapy within recognition of NSCLC as a life-limiting illness without cure. Medication-taking was a “window” into participants’ process of surviving with metastatic cancer that included deciding and preparing to take EGFRIs and treating lung cancer as a chronic condition. Our results contribute to understanding how NSCLC patients view themselves in the context of a life-limiting illness and support development of a theoretically-based intervention to improve medication-taking with EGFRIs. PMID:24702721

  10. Nontraditional or noncentralized models of diabetes care: medication therapy management services.

    PubMed

    Chawla, Sweta

    2011-11-01

    Medication therapy management (MTM)services were introduced in the mid-2000s as part of Medicare Part D--the prescription drug benefit. Key goals of MTM services are to counsel patients to improve understanding of their medications, improve medication adherence, detect adverse drug reactions and patterns of improper drug use. MTM services are becoming well established in pharmacy practice. Pharmacists can help improve outcomes by following patient progress between physician visits, utilizing their clinical expertise to monitor and manage diabetes medication plans, educating patients on disease, lifestyle,and adherence issues. Although referral by a physician/health care professional (HCP) is not required for MTM provided by a pharmacist, the physician/HCP needs to be contacted for anything that requires a change in management

  11. Complex antithrombotic therapy: determinants of patient preference and impact on medication adherence

    PubMed Central

    Abraham, Neena S; Naik, Aanand D; Street, Richard L; Castillo, Diana L; Deswal, Anita; Richardson, Peter A; Hartman, Christine M; Shelton, George; Fraenkel, Liana

    2015-01-01

    Purpose For years, older patients have been prescribed multiple blood-thinning medications (complex antithrombotic therapy [CAT]) to decrease their risk of cardiovascular events. These therapies, however, increase risk of adverse bleeding events. We assessed patient-reported trade-offs between cardioprotective benefit, gastrointestinal bleeding risk, and burden of self-management using adaptive conjoint analysis (ACA). As ACA could be a clinically useful tool to obtain patient preferences and guide future patient-centered care, we examined the clinical application of ACA to obtain patient preferences and the impact of ACA on medication adherence. Patients and methods An electronic ACA survey led 201 respondents through medication risk–benefit trade-offs, revealing patients’ preferences for the CAT risk/benefit profile they valued most. The post-ACA prescription regimen was categorized as concordant or discordant with elicited preferences. Adherence was measured using VA pharmacy refill data to measure persistence of use prior to and 1 year following preference-elicitation. Additionally, we analyzed qualitative interviews of 56 respondents regarding their perception of the ACA and the preference elicitation experience. Results Participants prioritized 5-year cardiovascular benefit over preventing adverse events. Medication side effects, medication-associated activity restrictions, and regimen complexity were less important than bleeding risk and cardioprotective benefit. One year after the ACA survey, a 15% increase in adherence was observed in patients prescribed a preference-concordant CAT strategy. An increase of only 6% was noted in patients prescribed a preference-discordant strategy. Qualitative interviews showed that the ACA exercise contributed to increase inpatient activation, patient awareness of preferences, and patient engagement with clinicians about treatment decisions. Conclusion By working through trade-offs, patients actively clarified their

  12. Report on disaster medical operations with acupuncture/massage therapy after the great East Japan earthquake.

    PubMed

    Takayama, Shin; Kamiya, Tetsuharu; Watanabe, Masashi; Hirano, Atsushi; Matsuda, Ayane; Monma, Yasutake; Numata, Takehiro; Kusuyama, Hiroko; Yaegashi, Nobuo

    2012-01-01

    The Great East Japan Earthquake inflicted immense damage over a wide area of eastern Japan with the consequent tsunami. Department of Traditional Asian Medicine, Tohoku University, started providing medical assistance to the disaster-stricken regions mainly employing traditional Asian therapies.We visited seven evacuation centers in Miyagi and Fukushima Prefecture and provided acupuncture/massage therapy. While massage therapy was performed manually, filiform needles and press tack needles were used to administer acupuncture. In total, 553 people were treated (mean age, 54.0 years; 206 men, 347 women). Assessment by interview showed that the most common complaint was shoulder/back stiffness. The rate of therapy satisfaction was 92.3%. Many people answered that they experienced not only physical but also psychological relief.At the time of the disaster, acupuncture/massage therapy, which has both mental and physical soothing effects, may be a therapeutic approach that can be effectively used in combination with Western medical practices. PMID:22563235

  13. Ozone the one and only drug.

    PubMed

    Alberto, Pepa Osvaldo

    2011-01-01

    Experience based on evidence shows the use of one drug over time.Ozone has great therapeutic properties. Nowadays, hardly anyone questions its effectiveness.We treated 270 patients with discal hernia of one or multiple levels in a minimally invasive way and under fluoroscopic control in real time, between 1 and 7 ml intradiscal and 3 ml periganglionic, in a concentration of 30 mg/ml of a mixture of oxygen and ozone as the one and only drug.A second group was created, out of which 120 patients were treated with physiatric and kinetic treatment (magnetotherapy) prior to any other type of treatment, whether surgical or minimally invasive.The time period was 3 months. All the patients were followed up from April 2004 to July 2008 with the MacNab, VAS and Owestry scales. We obtained 86% of excellent results, 12% satisfactory results, and 2% poor results.To sum up, we can say that ozone therapy has opened up a new future in the medical field.Discussions go on. New effects, new concentrations and the combination with bioenergetic therapies are the future in the treatment for backaches. PMID:21107951

  14. In-depth Medical Nutrition Therapy for a Woman with Diabetes: From Pregnancy to Delivery

    PubMed Central

    2016-01-01

    Diabetes in pregnancy is associated with higher rates of miscarriage, pre-eclampsia, preterm labor, and fetal malformation. To prevent these obstetric and perinatal complications, women with diabetes have to control levels of blood sugar, both prior to and during pregnancy. Thus, individualized medical nutrition therapy for each stage of pregnancy is essential. We provided in-depth medical nutrition therapy to a 38-year-old pregnant woman with diabetes at all stages of pregnancy up to delivery. She underwent radiation therapy after surgery for breast cancer and was diagnosed with diabetes. At the time of diagnosis, her glycated hemoglobin level was 8.3% and she was planning her pregnancy. She started taking an oral hypoglycemic agent and received education regarding the management of diabetes and preconception care. She became pregnant while maintaining a glycated hemoglobin level of less than 6%. We provided education program for diabetes management during the pregnancy, together with insulin therapy. She experienced weight loss and ketones were detected; furthermore, she was taking in less than the recommended amount of foods for the regulation of blood sugar levels. By giving emotional support, we continued the counseling and achieved not only glycemic control but also instilled an appreciation of the importance of appropriate weight gain and coping with difficulties. Through careful diabetes management, the woman had a successful outcome for her pregnancy, other than entering preterm labor at 34 weeks. This study implicated that the important things in medical nutrition therapy for pregnant women with diabetes are frequent follow-up care and emotional approach through the pregnancy process. PMID:27812519

  15. Surgical management of Gorham-Stout disease of the pelvis refractory to medical and radiation therapy.

    PubMed

    Karim, S Mohammed; Colman, Matthew C; Cipriani, Nicole A; Nielsen, G Petur; Schwab, Joseph H; Hornicek, Francis J

    2015-11-01

    Gorham-Stout disease (GSD) is a rare condition characterized by spontaneous idiopathic bone resorption that can affect any part of the skeleton. Treatment is aimed at halting osteolysis and alleviating complications associated with bone loss. Often this can be achieved via observation and supportive management, medical treatment, and/or radiation therapy. We report a case of GSD of the pelvis that was refractory to medical and radiation therapy and was managed successfully with surgery. A 30-year-old man presented to our clinic 3 years after being diagnosed at an outside institution with GSD of the pelvis that was managed with medical treatments and radiation therapy. Despite aggressive, multimodality treatment, he was unable to ambulate without crutches and was in significant pain. The patient opted for intralesional surgery and spinopelvic fusion. Sixteen months after surgery, the patient had only mild pain and was able to ambulate with a cane. Very few cases have been reported of GSD involving the pelvis that necessitated surgical management. Significant functional impairment can occur as a result of pelvic osteolysis, and traditional management strategies focused on halting resorption may not be adequate. Surgical stabilization of the affected areas is an important treatment strategy for patients who have exhausted other options.

  16. Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial.

    PubMed Central

    Speckens, A. E.; van Hemert, A. M.; Spinhoven, P.; Hawton, K. E.; Bolk, J. H.; Rooijmans, H. G.

    1995-01-01

    OBJECTIVE--To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care. DESIGN--Randomised controlled trial with follow up assessments six and 12 months after the baseline evaluation. SETTING--General medical outpatient clinic in a university hospital. SUBJECTS--An intervention group of 39 patients and a control group of 40 patients. INTERVENTIONS--The intervention group received between six and 16 sessions of cognitive behavioural therapy. Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aimed at breaking the vicious cycles of the symptoms and their consequences. The control group received optimised medical care. MAIN OUTCOME MEASURES--The degree of change, frequency and intensity of the presenting symptoms, psychological distress, functional impairment, hypochondriacal beliefs and attitudes, and (at 12 months of follow up) number of visits to the general practitioner. RESULTS--At six months of follow up the intervention group reported a higher recovery rate (odds ratio 0.40; 95% confidence interval 0.16 to 1.00), a lower mean intensity of the physical symptoms (difference -1.2; -2.0 to -0.3), and less impairment of sleep (odds ratio 0.38; 0.15 to 0.94) than the controls. After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms (0.32; 0.13 to 0.77), limitations in social (0.35; 0.14 to 0.85) and leisure (0.36; 0.14 to 0.93) activities, and illness behaviour (difference -2.5; -4.6 to -0.5). At 12 months of follow up the differences between the groups were largely maintained. CONCLUSION--Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms. PMID:7496281

  17. A urinary test procedure for identification of cannabidiol in patients undergoing medical therapy with marijuana.

    PubMed

    Wertlake, Paul T; Henson, Michael D

    2016-01-01

    Marijuana is classified by the Drug Enforcement Agency (DEA) as Schedule I, drugs having no accepted medical value. Twenty-three states and the District of Columbia have legalized medical marijuana. This conflict inhibits physicians from prescribing marijuana and the systematic study of marijuana in medical care. This study concerns the use of the clinical laboratory as a resource for physicians recommending cannabidiol (CBD) to patients, or for patients using medical marijuana. Marijuana containing delta-9-tetrahydrocannabinol (THC) is psychoactive. CBD is not psychoactive. CBD is reported to have medical benefit for seizure control, neurologic disorders including multiple sclerosis, neuropathic pain and pain associated with cancer. Use of opiates leads to increasing dosage over time that may cause respiratory depression. The Medical Board of California has termed this a serious public health crisis of addiction, overdose, and death. Is it feasible that CBD might alleviate persistent, severe pain and therefore diminished opiate use? Further study is needed to determine medical effectiveness of CBD including the effect on concurrent opiate therapy due to competition for receptor sites. This study is the application of a gas chromatography mass spectrometry procedure adapted for use in our laboratory, to detect CBD in urine. The intended use is as a tool for physicians to assess that marijuana being used by a patient is of a composition likely to be medically effective. A law ensuring physicians freedom from federal prosecution would provide confidence essential to formal study of medical uses of marijuana and treatment of clinical problems. Detection of CBD in a urine sample would be a convenient test for such confirmation. PMID:26929665

  18. A urinary test procedure for identification of cannabidiol in patients undergoing medical therapy with marijuana

    PubMed Central

    Wertlake, Paul T; Henson, Michael D

    2016-01-01

    Marijuana is classified by the Drug Enforcement Agency (DEA) as Schedule I, drugs having no accepted medical value. Twenty-three states and the District of Columbia have legalized medical marijuana. This conflict inhibits physicians from prescribing marijuana and the systematic study of marijuana in medical care. This study concerns the use of the clinical laboratory as a resource for physicians recommending cannabidiol (CBD) to patients, or for patients using medical marijuana. Marijuana containing delta-9-tetrahydrocannabinol (THC) is psychoactive. CBD is not psychoactive. CBD is reported to have medical benefit for seizure control, neurologic disorders including multiple sclerosis, neuropathic pain and pain associated with cancer. Use of opiates leads to increasing dosage over time that may cause respiratory depression. The Medical Board of California has termed this a serious public health crisis of addiction, overdose, and death. Is it feasible that CBD might alleviate persistent, severe pain and therefore diminished opiate use? Further study is needed to determine medical effectiveness of CBD including the effect on concurrent opiate therapy due to competition for receptor sites. This study is the application of a gas chromatography mass spectrometry procedure adapted for use in our laboratory, to detect CBD in urine. The intended use is as a tool for physicians to assess that marijuana being used by a patient is of a composition likely to be medically effective. A law ensuring physicians freedom from federal prosecution would provide confidence essential to formal study of medical uses of marijuana and treatment of clinical problems. Detection of CBD in a urine sample would be a convenient test for such confirmation. PMID:26929665

  19. A urinary test procedure for identification of cannabidiol in patients undergoing medical therapy with marijuana.

    PubMed

    Wertlake, Paul T; Henson, Michael D

    2016-01-01

    Marijuana is classified by the Drug Enforcement Agency (DEA) as Schedule I, drugs having no accepted medical value. Twenty-three states and the District of Columbia have legalized medical marijuana. This conflict inhibits physicians from prescribing marijuana and the systematic study of marijuana in medical care. This study concerns the use of the clinical laboratory as a resource for physicians recommending cannabidiol (CBD) to patients, or for patients using medical marijuana. Marijuana containing delta-9-tetrahydrocannabinol (THC) is psychoactive. CBD is not psychoactive. CBD is reported to have medical benefit for seizure control, neurologic disorders including multiple sclerosis, neuropathic pain and pain associated with cancer. Use of opiates leads to increasing dosage over time that may cause respiratory depression. The Medical Board of California has termed this a serious public health crisis of addiction, overdose, and death. Is it feasible that CBD might alleviate persistent, severe pain and therefore diminished opiate use? Further study is needed to determine medical effectiveness of CBD including the effect on concurrent opiate therapy due to competition for receptor sites. This study is the application of a gas chromatography mass spectrometry procedure adapted for use in our laboratory, to detect CBD in urine. The intended use is as a tool for physicians to assess that marijuana being used by a patient is of a composition likely to be medically effective. A law ensuring physicians freedom from federal prosecution would provide confidence essential to formal study of medical uses of marijuana and treatment of clinical problems. Detection of CBD in a urine sample would be a convenient test for such confirmation.

  20. [Use of complimentary medical therapies in HIV/AIDS in Switzerland].

    PubMed

    Brauchli, P; Reuteler, I; Bürki, B; Saller, R

    1996-07-27

    The aim of the present survey was to evaluate the incidence and spectrum of complementary therapies among HIV-infected persons in Switzerland. Under the auspices of the SATG (Swiss Aids Treatment Group), a 13-page questionnaire was created to gather data on socio-demographics, stage of HIV infection, current regimes on opportunistic infections and antiretroviral medication, current and past use of complementary treatments, and reasons for choosing and terminating complementary therapies. Approximately 640 questionnaires in French and German were distributed among HIV-infected subjects. Distributing organizations were People with Aids (P.W.A.), the University Hospital Zurich and the regional "Aids-Hilfe" institutions. With 129 questionnaires returned, the feedback was about 20%. More than 80% of participants used at least one complementary therapy. Each person currently used four therapies (median) from a spectrum of more than 60 specific complementary treatments. The following treatments were used by more than 25% of respondents: vitamins, special diets, food supplements, physical exercise, meditation, phytotherapy, homeopathy, and psychotherapy. 47% of participants took either antiretroviral medication, prophylaxis against opportunistic infections, or both.

  1. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly.

    PubMed

    Christofides, Elena A

    2016-01-01

    In acromegaly, achieving biochemical control (growth hormone [GH] level <1.0 ng/mL and age- and sex-normalized levels of insulin-like growth factor 1 [IGF-1]) through timely diagnosis and appropriate treatment provides an opportunity to improve patient outcomes. Diagnosis of acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. PMID:27471378

  2. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

    PubMed Central

    Christofides, Elena A

    2016-01-01

    In acromegaly, achieving biochemical control (growth hormone [GH] level <1.0 ng/mL and age- and sex-normalized levels of insulin-like growth factor 1 [IGF-1]) through timely diagnosis and appropriate treatment provides an opportunity to improve patient outcomes. Diagnosis of acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. PMID:27471378

  3. Adherence to Antihypertensive Therapy and Elevated Blood Pressure: Should We Consider the Use of Multiple Medications?

    PubMed Central

    Hedna, Khedidja; Hakkarainen, Katja M.; Gyllensten, Hanna; Jönsson, Anna K.; Andersson Sundell, Karolina; Petzold, Max; Hägg, Staffan

    2015-01-01

    Background Although a majority of patients with hypertension require a multidrug therapy, this is rarely considered when measuring adherence from refill data. Moreover, investigating the association between refill non-adherence to antihypertensive therapy (AHT) and elevated blood pressure (BP) has been advocated. Objective Identify factors associated with non-adherence to AHT, considering the multidrug therapy, and investigate the association between non-adherence to AHT and elevated BP. Methods A retrospective cohort study including patients with hypertension, identified from a random sample of 5025 Swedish adults. Two measures of adherence were estimated by the proportion of days covered method (PDC≥80%): (1) Adherence to any antihypertensive medication and, (2) adherence to the full AHT regimen. Multiple logistic regressions were performed to investigate the association between sociodemographic factors (age, sex, education, income), clinical factors (user profile, number of antihypertensive medications, healthcare use, cardiovascular comorbidities) and non-adherence. Moreover, the association between non-adherence (long-term and a month prior to BP measurement) and elevated BP was investigated. Results Non-adherence to any antihypertensive medication was higher among persons < 65 years (Odds Ratio, OR 2.75 [95% CI, 1.18–6.43]) and with the lowest income (OR 2.05 [95% CI, 1.01–4.16]). Non-adherence to the full AHT regimen was higher among new users (OR 2.04 [95% CI, 1.32–3.15]), persons using specialized healthcare (OR 1.63, [95% CI, 1.14–2.32]), and having multiple antihypertensive medications (OR 1.85 [95% CI, 1.25–2.75] and OR 5.22 [95% CI, 3.48–7.83], for 2 and ≥3 antihypertensive medications, respectively). Non-adherence to any antihypertensive medication a month prior to healthcare visit was associated with elevated BP. Conclusion Sociodemographic factors were associated with non-adherence to any antihypertensive medication while clinical

  4. An Advanced Pharmacy Practice Experience in a Student-Staffed Medication Therapy Management Call Center

    PubMed Central

    Hall, Anna M.; Roane, Teresa E.; Mistry, Reena

    2012-01-01

    Objective. To describe the implementation of an advanced pharmacy practice experience (APPE) in medication therapy management (MTM) designed to contribute to student pharmacists’ confidence and abilities in providing MTM. Design. Sixty-four student pharmacists provided MTM services during an APPE in a communication and care center. Assessment. Students conducted 1,495 comprehensive medication reviews (CMRs) identifying 6,056 medication-related problems. Ninety-eight percent of the students who completed a survey instrument (52 of 53) following the APPE expressed that they had the necessary knowledge and skills to provide MTM services. Most respondents felt that pharmacist participation in providing Medicare MTM could move the profession of pharmacy forward and that pharmacists will have some role in deciding the specific provisions of the Medicare MTM program (92% and 91%, respectively). Conclusion. Students completing the MTM APPE received patient-centered experiences that supplemented their confidence, knowledge, and skill in providing MTM services in the future. PMID:22919086

  5. Conjunctival modifications induced by medical and surgical therapies in patients with glaucoma.

    PubMed

    Mastropasqua, Leonardo; Agnifili, Luca; Mastropasqua, Rodolfo; Fasanella, Vincenzo

    2013-02-01

    Lowering intra-ocular pressure, either medically or surgically, is the proven strategy to control glaucoma, though profound changes to the ocular surface and conjunctiva are caused. Toxicity and allergy initiated by medical therapy induce modifications, which progressively worsen with the length of treatment and number of drugs. Conjunctival changes lead to symptoms of ocular surface disease, reduced quality of life, reduced therapeutic compliance and increased risk of surgical failure. Surgery modifies conjunctiva by inducing bleb formation in fistulizing techniques, and by activating secondary aqueous humour outflow pathways, such as trans-scleral routes, in both filtration and bleb-less approaches. The use of unpreserved medications, limitation of intra-operative conjunctival damage and development of bleb-less surgery are advisable.

  6. Interventional therapy procedures assisted by medical imaging and simulation. The experience of U 703 Inserm (Lille France).

    PubMed

    Vermandel, M; Betrouni, N; Rousseau, J; Dubois, P

    2007-01-01

    Since the early 1990s, minimally invasive techniques have been increasingly used in ever more and diversified fields of application. These techniques have some shared characteristics (predominant role of medical imaging, intensive use of new communication technologies, a multidisciplinary medical and scientific framework, etc.) but also shared specific problems (high-tech tools unfamiliar to the medical users, a major and long period of time for technological development, unavailability of training systems, difficulties in obtaining regulatory approval). For a long time, our Laboratory of Medical Physics (U 703 Inserm) has developed an innovative research activity in biomedical engineering in the field of assisted therapy, medical imaging and medical simulation. This paper presents the general context of interventional therapy procedures assisted by image and simulation and describes our scientific activities based on realistic objectives close to medical practice.

  7. Differences in Medical Therapy Goals for Children With Severe Traumatic Brain Injury— An International Study

    PubMed Central

    Bell, Michael J.; Adelson, P. David; Hutchison, James S.; Kochanek, Patrick M.; Tasker, Robert C.; Vavilala, Monica S.; Beers, Sue R.; Fabio, Anthony; Kelsey, Sheryl F.; Wisniewski, Stephen R.

    2015-01-01

    Objectives To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury. Design A survey of the goals from representatives of the international centers. Setting Thirty-two pediatric traumatic brain injury centers in the United States, United Kingdom, France, and Spain. Patients None. Interventions None. Measurements and Main Results A survey instrument was developed that required free-form responses from the centers regarding their usual practice goals for topics of intracranial hypertension therapies, hypoxia/ischemia prevention and detection, and metabolic support. Cerebrospinal fluid diversion strategies varied both across centers and within centers, with roughly equal proportion of centers adopting a strategy of continuous cerebrospinal fluid diversion and a strategy of no cerebrospinal fluid diversion. Use of mannitol and hypertonic saline for hyperosmolar therapies was widespread among centers (90.1% and 96.9%, respectively). Of centers using hypertonic saline, 3% saline preparations were the most common but many other concentrations were in common use. Routine hyperventilation was not reported as a standard goal and 31.3% of centers currently use Pbo2 monitoring for cerebral hypoxia. The time to start nutritional support and glucose administration varied widely, with nutritional support beginning before 96 hours and glucose administration being started earlier in most centers. Conclusions There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study

  8. Competence of medical students in communicating drug therapy: Value of role-play demonstrations

    PubMed Central

    Tayem, Yasin I.; Altabtabaei, Abdulaziz S.; Mohamed, Mohamed W.; Arrfedi, Mansour M.; Aljawder, Hasan S.; Aldebous, Fahad A.; James, Henry; Al Khaja, Khalid A. J.; Sequeira, Reginald P.

    2016-01-01

    Objectives: This study used role-play demonstrations to train medical students to communicate drug therapy and evaluated the perceptions on this instructional approach. Materials and Methods: The second-year medical students who attended a prescription writing session (n = 133), participated in this study. Prescription communication was introduced by using role-play demonstrations. Participant's perceptions were explored by a self-administered questionnaire and focus group discussion. The academic achievement of attendees and nonattendees was compared with an objective structured performance evaluation (OSPE) station that tested students’ competence in this skill. Results: Most attendees responded to the questionnaire (81.2%). Almost all respondents expressed their desire to have similar demonstrations in other units. A large proportion of participants reported that role-play demonstrations helped them develop their communication skills, in general, confidence to communicate drug-related information in a prescription, and the ability to explain the aim of drug therapy to patients. Most trainees thought also that they developed skills to communicate instructions on drug use including drug dose, frequency of administration, duration of therapy, adverse drug reactions, and warnings. During the focus group interviews, students thought that role-play was useful but would be more beneficial if conducted frequently in small group as part of the curriculum implementation. The majority of students also reported improved competence in writing a complete prescription. Analysis of attendees and nonattendees grades in the OSPE showed that the former scored higher than the latter group (P = 0.016). Conclusions: Role-play demonstrations were well accepted by medical students and led to the development of their competence in communicating drug therapy to patients. PMID:26997720

  9. [Physical therapy, orthosis and occupational therapy in medical and surgical rheumatologic hand diseases].

    PubMed

    Dumitrache, Alina; Sanchez, Katherine; Esnouf, Servane; Roren, Alexandra; Vidal, Jean; Rannou, François; Poiraudeau, Serge; Lefèvre-Colau, Marie-Martine

    2013-12-01

    Hand pathology can cause functional disability and deterioration in the quality of life by altering the grip and therefore, it requires a complex approach by a multidisciplinary team, including physiotherapists and occupational therapists. Orthoses are an important part of the treatment of these pathologies. A thorough understanding of the pathogenesis of lesions and their risk of progression to deformities is required for an appropriate use. Their fabrication by a specialized therapist and also their monitoring assure a good compliance. Their effectiveness depends on the patient adherence, for which information and education are essential. The role of physiotherapist is to establish a personalised rehabilitation program, including passive and active exercises and also the prevention of joint stiffness. The main goal after surgery is to initiate an early active motion in order to decrease the risk of adhesions without compromising the suture by the use of a splint. The role of occupational therapist is important all along the treatment period, from the early rehabilitation to the moment of return to home environment. The literature search shows that there is a lack of good methodological clinical studies in order to assess the effectiveness and the costs of this medical treatment.

  10. Medical therapy for rheumatic heart disease: is it time to be proactive rather than reactive?

    PubMed

    Rajamannan, Nalini M; Antonini-Canterin, Francesco; Moura, Luis; Zamorano, Jose L; Rosenhek, Raphael A; Best, Patricia Jm; Lloyd, Margaret A; Rocha-Goncalves, F; Chandra, Sarat; Alfieri, Ottavio; Lancellotti, Patrizio; Tornos, Pilar; Baliga, Ragavendra R; Wang, Andrew; Bashore, Thomas; Ramakrishnan, S; Spargias, Konstantinos; Shuvy, Mony; Beeri, Ronen; Lotan, Chaim; Suwaidi, Jassim Al; Bahl, Vinay; Pierard, Luc A; Maurer, Gerald; Nicolosi, Gian Luigi; Rahimtoola, Shahbudin H; Chopra, K; Pandian, Natesa G

    2009-01-01

    Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time. The potential for statin therapy in slowing the progression of valvular heart disease is still controversial. Retrospective studies have shown that medical therapy is beneficial for patients with calcific aortic stenosis and recently for rheumatic valve disease. However, the prospective randomized clinical trials have been negative to date. This article discusses the epidemiologic risk factors, basic science, retrospective and prospective studies in valvular heart disease and a future clinical trial to target RHD with statin therapy to slow the progression of this disease. Recent epidemiological studies have revealed the risk factors associated with valvular disease include male gender, smoking, hypertension and elevated serum cholesterol and are similar to the risk factors for vascular atherosclerosis. An increasing number of models of experimental hypercholesterolemia demonstrate features of atherosclerosis in the aortic valve (AV), which are similar to the early stages of vascular atherosclerotic lesions. Calcification, the end stage process of the disease, must be understood as a prognostic indicator in the modification of this cellular process before it is too late. This is important in calcific aortic stenosis as well as in rheumatic valve disease. There are a growing number of studies that describe similar pathophysiologic molecular markers in the development of rheumatic valve disease as in calcific aortic stenosis. In summary, these findings suggest that medical therapies may have a potential role in patients in the early stages of this disease process to slow the progression of RHD affecting the valves. This review will summarize the potential for statin therapy for this patient population.

  11. Medical Therapy for Rheumatic Heart Disease: Is it time to be Proactive rather than Reactive?

    PubMed Central

    Rajamannan, Nalini M.; Antonini-Canterin, Francesco; Moura, Luis; Zamorano, José L.; Rosenhek, Raphael A.; Best, Patricia JM.; Lloyd, Margaret A.; Rocha-Gonçalves, F.; Chandra, Sarat; Alfieri, Ottavio; Lancellotti, Patrizio; Tornos, Pilar; Baliga, Ragavendra R; Wang, Andrew; Bashore, Thomas; Ramakrishnan, S; Spargias, Konstantinos; Shuvy, Mony; Beeri, Ronen; Lotan, Chaim; Suwaidi, Jassim Al; Bahl, Vinay; Pierard, Luc A.; Maurer, Gerald; Nicolosi, Gian Luigi; Rahimtoola, Shahbudin H.; Chopra, H. K.; Pandian, Natesa G.

    2014-01-01

    Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time. The potential for statin therapy in slowing the progression of valvular heart disease is still controversial. Retrospective studies have shown that medical therapy is beneficial for patients with calcific aortic stenosis and recently for rheumatic valve disease. However, the prospective randomized clinical trials have been negative to date. This article discusses the epidemiologic risk factors, basic science, retrospective and prospective studies in valvular heart disease and a future clinical trial to target RHD with statin therapy to slow the progression of this disease. Recent epidemiological studies have revealed the risk factors associated with valvular disease include male gender, smoking, hypertension and elevated serum cholesterol and are similar to the risk factors for vascular atherosclerosis. An increasing number of models of experimental hypercholesterolemia demonstrate features of atherosclerosis in the aortic valve (AV), which are similar to the early stages of vascular atherosclerotic lesions. Calcification, the end stage process of the disease, must be understood as a prognostic indicator in the modification of this cellular process before it is too late. This is important in calcific aortic stenosis as well as in rheumatic valve disease. There are a growing number of studies that describe similar pathophysiologic molecular markers in the development of rheumatic valve disease as in calcific aortic stenosis. In summary, these findings suggest that medical therapies may have a potential role in patients in the early stages of this disease process to slow the progression of RHD affecting the valves. This review will summarize the potential for statin therapy for this patient population. PMID:19729684

  12. Position of the American Dietetic Association: integration of medical nutrition therapy and pharmacotherapy.

    PubMed

    2003-10-01

    It is the position of the American Dietetic Association that the application of medical nutrition therapy (MNT) and lifestyle counseling as a part of the Nutrition Care Process is an integral component of the medical treatment for management of specific disease states and conditions and should be the initial step in the management of these situations. If optimal control cannot be achieved with MNT alone and concurrent pharmacotherapy is required, then The Association promotes a team approach to care for clients receiving concurrent MNT and pharmacotherapy and encourages active collaboration among dietetics professionals and other members of the health care team. There are a number of medical conditions, many of them chronic, that will respond to MNT and, therefore, MNT should be the first intervention for these conditions. In addition to being a vital element of the optimal management and control of these conditions, MNT is also a cost-effective method of management. However, because of the long-term nature of these conditions, concurrent pharmacotherapy may become necessary to achieve or maintain optimal control. In cases where this is necessary, MNT should continue to be an integral component of the therapy because it may complement or enhance the therapeutic effectiveness of pharmacotherapy, thereby reducing or eliminating the need for multiple medications. The utilization of a coordinated multidisciplinary team approach is critical to the success of the concurrent use of MNT and pharmacotherapy because of the long-term duration of the treatments, the necessity of monitoring compliance and effectiveness, and the likelihood of multiple medication-nutrient interactions.

  13. Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Prevention of Relapse and Recurrence in Major Depression

    ERIC Educational Resources Information Center

    Dobson, Keith S.; Hollon, Steven D.; Dimidjian, Sona; Schmaling, Karen B.; Kohlenberg, Robert J.; Gallop, Robert J.; Rizvi, Shireen L.; Gollan, Jackie K.; Dunner, David L.; Jacobson, Neil S.

    2008-01-01

    This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior…

  14. Augmenting Antidepressant Medication Treatment of Depressed Women with Emotionally Focused Therapy for Couples: A Randomized Pilot Study

    ERIC Educational Resources Information Center

    Denton, Wayne H.; Wittenborn, Andrea K.; Golden, Robert N.

    2012-01-01

    This is the first study to evaluate adding emotionally focused therapy for couples (EFT) to antidepressant medication in the treatment of women with major depressive disorder and comorbid relationship discord. Twenty-four women and their male partners were randomized to 6 months of medication management alone (MM) or MM augmented with EFT (MM +…

  15. The New Radiation Therapy Clinical Practice: The Emerging Role of Clinical Peer Review for Radiation Therapists and Medical Dosimetrists

    SciTech Connect

    Adams, Robert D.; Marks, Lawrence B.; Pawlicki, Todd; Hayman, James; Church, Jessica

    2010-01-01

    The concept of peer review for radiation therapists and medical dosimetrists has been studied very little in radiation oncology practice. The purpose of this manuscript is to analyze the concept of peer review in the clinical setting for both radiation therapists and medical dosimetrists. The literature reviewed both the percentages and causes of radiation therapy deviations. The results indicate that peer review can be both implemented and evaluated into both the radiation therapist and medical dosimetrist clinical practice patterns.

  16. The new radiation therapy clinical practice: the emerging role of clinical peer review for radiation therapists and medical dosimetrists.

    PubMed

    Adams, Robert D; Marks, Lawrence B; Pawlicki, Todd; Hayman, James; Church, Jessica

    2010-01-01

    The concept of peer review for radiation therapists and medical dosimetrists has been studied very little in radiation oncology practice. The purpose of this manuscript is to analyze the concept of peer review in the clinical setting for both radiation therapists and medical dosimetrists. The literature reviewed both the percentages and causes of radiation therapy deviations. The results indicate that peer review can be both implemented and evaluated into both the radiation therapist and medical dosimetrist clinical practice patterns. PMID:21055612

  17. Herbal pharmacology and medical therapy in the People's Republic of China.

    PubMed

    Lasagna, L

    1975-12-01

    A scientific delegation visited the People's Republic of China for the purpose of assessing the current status of herbal pharmacology and medicine there. China is attempting to wed traditional and Western medicine so as to take advantage of the potential contributions of both. This wedding seems possible at the empiric level despite theoretical contradictions. Traditional remedies are widely prescribed, but the actual impact of such medication on disease is difficult to assess, because of the failure of the Chinese up until now to evaluate such remedies by modern clinical trial methodology. All Western drugs are readily available in China, and indeed are manufactured for export as well as for use within the country. The current chinese approach to the patient-doctor relation, and some novel ideas with regard to both medical and surgical therapy pose provocative questions for Western physicians.

  18. Herbal pharmacology and medical therapy in the People's Republic of China.

    PubMed

    Lasagna, L

    1975-12-01

    A scientific delegation visited the People's Republic of China for the purpose of assessing the current status of herbal pharmacology and medicine there. China is attempting to wed traditional and Western medicine so as to take advantage of the potential contributions of both. This wedding seems possible at the empiric level despite theoretical contradictions. Traditional remedies are widely prescribed, but the actual impact of such medication on disease is difficult to assess, because of the failure of the Chinese up until now to evaluate such remedies by modern clinical trial methodology. All Western drugs are readily available in China, and indeed are manufactured for export as well as for use within the country. The current chinese approach to the patient-doctor relation, and some novel ideas with regard to both medical and surgical therapy pose provocative questions for Western physicians. PMID:1200537

  19. Physical evaluation system to determine medical risk and indicated dental therapy modifications.

    PubMed

    McCarthy, F M; Malamed, S F

    1979-08-01

    The physical evaluation system allows the practitioner to rapidly classify each patient according to medical risk and thus to provide dental treatment comfortably and safely. The evaluation system serves as a guide to the level of dental therapy, deisions of management, and modification of treatment for the medically compromised patient. Extensive use of the ADA physical status classification system in dentistry would allow meaningful studies of morbidity and mortality that are related to various management protocols and could conceivably have an impact on insurance schedules associated with psychosedation modalities and general anethesia on an out patient basis. A physical evaluation system cannot substitute for knowledge and good judgment. Recommended categories of physical status and modification of treatment should not be considered as absolutes, but as guides. Wheras the guidelines may appear to be inflexible, they should not be considered as such. Deviation from recommendations is often justified and is expected.

  20. Disparity implications of the Medicare medication therapy management eligibility criteria: a literature review.

    PubMed

    Munshi, Kiraat D; Shih, Ya-Chen T; Brown, Lawrence M; Dagogo-Jack, Samuel; Wan, Jim Y; Wang, Junling

    2013-04-01

    The emphasis on eliminating racial and ethnic disparities in healthcare has received national attention, with various policy initiatives addressing this problem and proposing solutions. However, in the current economic era requiring tight monetary constraints, emphasis is increasingly being placed on economic efficiency, which often conflicts with the equality doctrine upon which many policies have been framed. The authors' review aims to highlight the disparity implications of one such policy provision - the predominantly utilization-based eligibility criteria for medication therapy management services under Medicare Part D - by identifying studies that have documented racial and ethnic disparities in health status and the use of and spending on prescription medications. Future design and evaluation of various regulations and legislations employing utilization-based eligibility criteria must use caution in order to strike an equity-efficiency balance. PMID:23570431

  1. [Pharmacological tolerance to medical therapy of organophosphate poisoning and ways of tolerance management].

    PubMed

    Iudin, M A; Bykov, V N; Chepur, S V; Sarana, A M; Tsygan, V N; Anokhin, A G

    2014-05-01

    Authors consider causes of low efficiency of antidote therapy and ways of pharmacological tolerance management during medical treatment of organophosphate poisoning. One of the promising ways is a preventive antidote on the base of enzyme agents and allosteric modulators of a cholinesterase activity. Authors showed a expediency of a study of new acetylcholinesterase reactivators, its compositions and ways of drug delivery. Authors specified ways of searching for anticonvulsants from classes of quick-closing benzodiatines and NMDA-antagonists. Authors defined ways of improvement of methods of special antidotes delivery with targeted transport system. Authors made an assumption about the necessity of symptomatic treatment.

  2. Growth hormone therapy for Prader-Willi and Down syndromes: a post-modern medical dilemma.

    PubMed

    Lantos, J D

    2000-04-01

    Post-modernism means the end of traditional certainties. In this paper, growth hormone (GH) is conceptualized as a post-modern medical therapy. It is used in the treatment of conditions that are not traditional diseases, for indications that are not precisely defined. Down syndrome and Prader-Willi syndrome represent two clinical conditions in which GH can possibly be used. It is argued that the difference between the two syndromes instructs us as to the principles that might guide appropriate use of GH in the future. In particular, for children, the more GH treatment can be shown to produce benefits other than increased height, the more justifiable its use will be.

  3. Machine learning approach to optimizing combined stimulation and medication therapies for Parkinson’s disease

    PubMed Central

    Shamir, Reuben R.; Dolber, Trygve; Noecker, Angela M.; Walter, Benjamin L.; McIntyre, Cameron C.

    2015-01-01

    Background Deep brain stimulation (DBS) of the subthalamic region is an established therapy for advanced Parkinson’s disease (PD). However, patients often require time-intensive postoperative management to balance their coupled stimulation and medication treatments. Given the large and complex parameter space associated with this task, we propose that clinical decision support systems (CDSS) based on machine learning algorithms could assist in treatment optimization. Objective Develop a proof-of-concept implementation of a CDSS that incorporates patient-specific details on both stimulation and medication. Methods Clinical data from 10 patients, and 89 post-DBS surgery visits, were used to create a prototype CDSS. The system was designed to provide three key functions: 1) information retrieval; 2) visualization of treatment, and; 3) recommendation on expected effective stimulation and drug dosages, based on three machine learning methods that included support vector machines, Naïve Bayes, and random forest. Results Measures of medication dosages, time factors, and symptom-specific preoperative response to levodopa were significantly correlated with postoperative outcomes (p<0.05) and their effect on outcomes was of similar magnitude to that of DBS. Using those results, the combined machine learning algorithms were able to accurately predict 86% (12/14) of the motor improvement scores at one year after surgery. Conclusions Using patient-specific details, an appropriately parameterized CDSS could help select theoretically optimal DBS parameter settings and medication dosages that have potential to improve the clinical management of PD patients. PMID:26140956

  4. Comparison of surgical septal myectomy to medical therapy alone in patients with hypertrophic cardiomyopathy and syncope.

    PubMed

    Orme, Nicholas M; Sorajja, Paul; Dearani, Joseph A; Schaff, Hartzell V; Gersh, Bernard J; Ommen, Steve R

    2013-02-01

    The presence of syncope despite medical therapy in patients with hypertrophic cardiomyopathy (HC) is considered an indication for surgical myectomy; however, no study has examined the long-term effects on recurrent syncope and survival after surgery in these patients. We examined 239 patients with HC and a history of syncope who had undergone surgical myectomy (mean age 48 ± 17 years; 56% men). The patients were age- and gender-matched to patients with HC and syncope who were treated medically without myectomy (mean age 51 ± 16 years; 59% men). The median follow-up period was 4.7 years (0.8, 11.3). The recurrence rate of syncope was 11% in the myectomy patients and 40% in the medical group (p <0.0001). Multiple episodes of syncope, left ventricular outflow tract obstruction, and recent syncope were identified as baseline predictors of recurrent syncope. Survival free of all-cause mortality was greater for patients who had undergone surgical myectomy than for the medically treated patients (10-year estimate 82 ± 4% vs 69 ± 4%; p = 0.01). In conclusion, surgical myectomy in patients with HC and a history of syncope was associated with a reduction in recurrent syncope and increased survival.

  5. Ozonated saline shows activity against planktonic and biofilm growing Staphylococcus aureus in vitro: a potential irrigant for infected wounds.

    PubMed

    Al-Saadi, Hayder; Potapova, Inga; Rochford, Edward Tj; Moriarty, Thomas F; Messmer, Peter

    2016-10-01

    Infections associated with deep wounds require extensive surgical and medical care. New adjunctive treatments are required to aid in the eradication of the bacterial biofilms found on infected wounds and, in particular, any underlying hardware. Ozone has been used as a safe and efficient disinfectant in water treatment plants for many years. The purpose of this study is to investigate the anti-biofilm potential of ozonated saline against biofilms of Staphylococcus aureus, a microorganism commonly implicated in wound infections. A custom-made bacterial biofilm bioreactor was used to grow S. aureus biofilms on discs of medical grade titanium alloy. An ozone generator was connected in-line and biofilms and planktonic bacteria were exposed to ozone in saline. Cytotoxicity was assessed against primary ovine osteoblasts in the same system. In tests against planktonic S. aureus, a 99% reduction in bacterial numbers was detected within 15 minutes of exposure. S. aureus biofilms were significantly more resistant to ozone, although complete eradication of the biofilm was eventually achieved within 5 hours. Ozonated saline was not found to be cytotoxic to primary ovine osteoblasts. Ozonated saline may be suitable as an adjuvant therapy to treat patients as an instillation fluid for wound irrigation and sterilisation.

  6. An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain

    PubMed Central

    Apuzzo, Dario; Giotti, Chiara; Pasqualetti, Patrizio; Ferrazza, Paolo; Soldati, Paola; Zucco, Gesualdo M.

    2014-01-01

    Summary Acute low back pain (LBP) is the fifth most common reason for physician visits and about nine out of ten adults experience back pain at some point in their life. In a large number of patients LBP is associated with disc herniation (DH). Recently, oxygen-ozone (O2O3) therapy has been used successfully in the treatment of LBP, reducing pain after the failure of other conservative treatments. The aim of this study was to assess the effects of O2O3 therapy in back pain rehabilitation, comparing three groups of patients suffering from chronic back pain associated with DH submitted to three different treatments: intramuscular O2O3 infiltrations, global postural re-education (GPR), or a combination of the two (O2O3+GPR). The data show that pain severity before treatment was significantly lower in the patients treated with GPR alone (VAS score 7.4) than in the O2O3+GPR patients (VAS score 8.5) and the O2O3 patients (VAS score 8.6). At the end of treatment, pain severity was lower in the O2O3 patients than in the GPR-alone patients. After some years of follow-up only the difference between O2O3+GPR and GPR-alone remained significant. PMID:25014047

  7. A Review of Pharmacological Interactions Between HIV or HCV Medications and Opioid Agonist Therapy: Implications and Management for Clinical Practice

    PubMed Central

    Bruce, R. Douglas; Moody, David E.; Altice, Frederick L.; Gourevitch, Marc N.; Friedland, Gerald H.

    2014-01-01

    Global access to opioid agonist therapy and HIV/HCV treatment is expanding but when used concurrently, problematic pharmacokinetic and pharmacodynamic interactions may occur. Review of articles from 1966 into 2012 in Medline using the following keywords: HIV, AIDS, HIV therapy, HCV, HCV therapy, antiretroviral therapy, HAART, drug interactions, methadone, and buprenorphine. Additionally, abstracts from national and international meetings and a review of conference proceedings were conducted; selected reports were reviewed as well. The metabolism of both opioid and antiretroviral therapies, description of their known interactions, and clinical implications and management of these interactions are reviewed. Important pharmacokinetic and pharmacodynamic drug interactions affecting either methadone or HIV medications have been demonstrated within each class of antiretroviral agents. Drug interactions between methadone, buprenorphine and HIV medications are known and may have important clinical consequences. Clinicians must be alert to these interactions and have a basic knowledge regarding their management. PMID:23656339

  8. Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil.

    PubMed

    Edmonds, Alexander; Sanabria, Emilia

    2014-01-01

    This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

  9. Impact of medical therapy on atheroma volume measured by different cardiovascular imaging modalities.

    PubMed

    Sinno, Mohamad C N; Al-Mallah, Mouaz

    2010-01-01

    Atherosclerosis is a systemic disease that affects most vascular beds. The gold standard of atherosclerosis imaging has been invasive intravascular ultrasound (IVUS). Newer noninvasive imaging modalities like B-mode ultrasound, cardiac computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) have been used to assess these vascular territories with high accuracy and reproducibility. These imaging modalities have lately been used for the assessment of the atherosclerotic plaque and the response of its volume to several medical therapies used in the treatment of patients with cardiovascular disease. To study the impact of these medications on atheroma volume progression or regression, imaging modalities have been used on a serial basis providing a unique opportunity to monitor the effect these antiatherosclerotic strategies exert on plaque burden. As a result, studies incorporating serial IVUS imaging, quantitative coronary angiography (QCA), B-mode ultrasound, electron beam computed tomography (EBCT), and dynamic contrast-enhanced magnetic resonance imaging have all been used to evaluate the impact of therapeutic strategies that modify cholesterol and blood pressure on the progression/regression of atherosclerotic plaque. In this review, we intend to summarize the impact of different therapies aimed at halting the progression or even result in regression of atherosclerotic cardiovascular disease evaluated by different imaging modalities. PMID:20672024

  10. Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil

    PubMed Central

    Edmonds, Alexander; Sanabria, Emilia

    2014-01-01

    This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity. PMID:25175295

  11. Impact of Medical Therapy on Atheroma Volume Measured by Different Cardiovascular Imaging Modalities

    PubMed Central

    Sinno, Mohamad C. N.; Al-Mallah, Mouaz

    2010-01-01

    Atherosclerosis is a systemic disease that affects most vascular beds. The gold standard of atherosclerosis imaging has been invasive intravascular ultrasound (IVUS). Newer noninvasive imaging modalities like B-mode ultrasound, cardiac computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) have been used to assess these vascular territories with high accuracy and reproducibility. These imaging modalities have lately been used for the assessment of the atherosclerotic plaque and the response of its volume to several medical therapies used in the treatment of patients with cardiovascular disease. To study the impact of these medications on atheroma volume progression or regression, imaging modalities have been used on a serial basis providing a unique opportunity to monitor the effect these antiatherosclerotic strategies exert on plaque burden. As a result, studies incorporating serial IVUS imaging, quantitative coronary angiography (QCA), B-mode ultrasound, electron beam computed tomography (EBCT), and dynamic contrast-enhanced magnetic resonance imaging have all been used to evaluate the impact of therapeutic strategies that modify cholesterol and blood pressure on the progression/regression of atherosclerotic plaque. In this review, we intend to summarize the impact of different therapies aimed at halting the progression or even result in regression of atherosclerotic cardiovascular disease evaluated by different imaging modalities. PMID:20672024

  12. Uncertainty in medicine: meanings of menopause and hormone replacement therapy in medical textbooks.

    PubMed

    Niland, Patricia; Lyons, Antonia C

    2011-10-01

    Menopause is understood, portrayed, and experienced in diverse ways. The dominant biomedical perspective medicalizes menopause as a biological 'hormone deficiency' requiring 'treatment' with hormone replacement therapy (HRT). Alternative perspectives view menopause as discursively located within particular socio-historical times and places, or privilege women's embodied experiences of menopause. We argue that the meanings of menopause and HRT should be debated within a context where the biological and the social, or the body and culture, intersect. The present study examined international medical student textbooks as sites of current biomedical knowledge, communicated for a new generation of health professionals. We undertook a Foucauldian discourse analysis on eight widely-used, international medical textbooks across physiology, pathology and pharmacology subject areas to identify the ways in which menopause and HRT are portrayed. Our results showed that menopause continues to be represented through dominant culturally infused 'failure' discourses and is portrayed as a 'precursor to disease' with HRT as the treatment. However, this knowledge is somewhat destabilized by a discourse of 'uncertainty and speculation' regarding the physiology of menopause and the potential effects of HRT. Knowledge about menopause, osteoporosis, and HRT was constructed as tentative, but the 'quest' for new knowledge was constructed as on the verge of 'exciting discoveries'. We argue that bio-social understandings of menopause and HRT, and their medical uncertainties, need to be addressed in medical curricula to ensure that doctors engage with midlife women in appropriate and positive ways, especially given the increased call for women's involvement in decision-making at this time.

  13. Adjunctive psychotropic medications during electroconvulsive therapy in the treatment of depression, mania, and schizophrenia.

    PubMed

    Haskett, Roger F; Loo, Colleen

    2010-09-01

    Current guidelines regarding concomitant antidepressants during electroconvulsive therapy (ECT) are inconsistent. Although the American Psychiatric Association Task Force on ECT discouraged combination antidepressant treatment, owing to the minimal evidence for enhanced efficacy and concern about increased adverse effects, combination treatment is recommended and considered routine for many practitioners in the United States and other parts of the world. Considering the increasing levels of treatment resistance among patients referred for ECT and the high relapse rate after acute ECT, the role of concomitant antidepressant pharmacotherapy during ECT should be reevaluated. More research, however, is needed to explore the impact of administering specific antidepressants during acute and maintenance ECT (M-ECT), on antidepressant efficacy and cognitive adverse effects. This will require appropriately controlled studies of ECT medication combinations that include attention to a range of cognitive function measures and clinical response. In addition, the role of combination ECT and psychotropic medication in the treatment of mania and schizophrenia continues to receive attention, particularly in those patients who have shown inadequate responses to psychotropic medication alone. Although there is insufficient evidence to support the routine addition of antipsychotic medications to ECT during the treatment of acute mania, the literature suggests that it is unnecessary to discontinue antipsychotic medication when ECT is added to the treatment of a manic patient that has been unresponsive to pharmacological treatment. Despite the lack of well-controlled studies, the existing literature suggests that combination ECT and antipsychotic treatment is a useful option for patients with schizophrenia who are unresponsive to pharmacological interventions alone, and its adverse effect profile does not seem different from that seen with ECT alone.

  14. Optimal management for alcoholic liver disease: Conventional medications, natural therapy or combination?

    PubMed Central

    Kim, Moon-Sun; Ong, Madeleine; Qu, Xianqin

    2016-01-01

    Alcohol consumption is the principal factor in the pathogenesis of chronic liver diseases. Alcoholic liver disease (ALD) is defined by histological lesions on the liver that can range from simple hepatic steatosis to more advanced stages such as alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and liver failure. As one of the oldest forms of liver injury known to humans, ALD is still a leading cause of liver-related morbidity and mortality and the burden is exerting on medical systems with hospitalization and management costs rising constantly worldwide. Although the biological mechanisms, including increasing of acetaldehyde, oxidative stress with induction of cytochrome p450 2E1, inflammatory cytokine release, abnormal lipid metabolism and induction of hepatocyte apoptosis, by which chronic alcohol consumption triggers serious complex progression of ALD is well established, there is no universally accepted therapy to prevent or reverse. In this article, we have briefly reviewed the pathogenesis of ALD and the molecular targets for development of novel therapies. This review is focused on current therapeutic strategies for ALD, including lifestyle modification with nutrition supplements, available pharmacological drugs and new agents that are under development, liver transplantation, application of complementary medicines, and their combination. The relevant molecular mechanisms of each conventional medication and natural agent have been reviewed according to current available knowledge in the literature. We also summarized efficacy vs safety on conventional and herbal medicines which are specifically used for the prevention and treatment of ALD. Through a system review, this article highlighted that the combination of pharmaceutical drugs with naturally occurring agents may offer an optimal management for ALD and its complications. It is worthwhile to conduct large-scale, multiple centre clinical trials to further prove the safety and benefits for

  15. The proton therapy nozzles at Samsung Medical Center: A Monte Carlo simulation study using TOPAS

    NASA Astrophysics Data System (ADS)

    Chung, Kwangzoo; Kim, Jinsung; Kim, Dae-Hyun; Ahn, Sunghwan; Han, Youngyih

    2015-07-01

    To expedite the commissioning process of the proton therapy system at Samsung Medical Center (SMC), we have developed a Monte Carlo simulation model of the proton therapy nozzles by using TOol for PArticle Simulation (TOPAS). At SMC proton therapy center, we have two gantry rooms with different types of nozzles: a multi-purpose nozzle and a dedicated scanning nozzle. Each nozzle has been modeled in detail following the geometry information provided by the manufacturer, Sumitomo Heavy Industries, Ltd. For this purpose, the novel features of TOPAS, such as the time feature or the ridge filter class, have been used, and the appropriate physics models for proton nozzle simulation have been defined. Dosimetric properties, like percent depth dose curve, spreadout Bragg peak (SOBP), and beam spot size, have been simulated and verified against measured beam data. Beyond the Monte Carlo nozzle modeling, we have developed an interface between TOPAS and the treatment planning system (TPS), RayStation. An exported radiotherapy (RT) plan from the TPS is interpreted by using an interface and is then translated into the TOPAS input text. The developed Monte Carlo nozzle model can be used to estimate the non-beam performance, such as the neutron background, of the nozzles. Furthermore, the nozzle model can be used to study the mechanical optimization of the design of the nozzle.

  16. Use of complementary and alternative medical therapy by patients with primary brain tumors.

    PubMed

    Armstrong, Terri S; Gilbert, Mark R

    2008-05-01

    The use of complementary and alternative medicine (CAM) is increasing. CAM includes mind-body interventions, biologically based therapies, energy therapies, and body-based methods. Primary brain tumors arise within the brain and have a poor prognosis when malignant. Even patients with benign tumors suffer neurologic and systemic symptoms as a result of the tumor or its treatment. CAM is used by 30% of brain tumor patients, who often do not report its use to their physician. Herbal medicines may affect the metabolism of prescribed medications or produce adverse effects that may be attributed to other causes. In patients with systemic cancer, mind-body modalities such as meditation and relaxation therapy have been shown to be helpful in reducing anxiety and pain; acupuncture and hypnotherapy may also reduce both pain and nausea. Recent preclinical studies have reported that ginseng, Scutellaria baicalensis, and Angelica sinensis may promote apoptosis of tumor cells or exercise antiangiogenic effects. Further studies are needed to evaluate the impact of CAM on symptom control or tumor growth in this vulnerable patient population.

  17. Medical therapy reduces microbiota diversity and evenness in surgically recalcitrant chronic rhinosinusitis

    PubMed Central

    Liu, Cindy M.; Soldanova, Katerina; Nordstrom, Lora; Dwan, Michael G.; Moss, Owain L.; Contente-Cuomo, Tania L.; Keim, Paul; Price, Lance B.; Lane, Andrew P.

    2014-01-01

    Background Chronic rhinosinusitis is a highly prevalent and heterogeneous condition frequently treated with antibiotics and corticosteroid therapy. However, the effect of medical therapy on sinus microbiota remains unknown. Methods We enrolled CRS participants (n = 6) with patent maxillary antrostomies and active mucosal inflammation, who had not received antibiotics or corticosteroids in the previous eight weeks. A pre- and post-treatment maxillary sinus swab was collected, from which DNA was extracted, pyrosequenced, and analyzed using Naïve Bayesian Classifier and ecological analyses. Results Four participants showed significant improvement in endoscopic appearance. The shifts in microbiota in response to therapy were highly individualized. There was no single common microbiota profile among participants with similar clinical outcomes, but overall there was significant decrease in microbiota diversity (t(5) = 2.05, p = 0.10) and evenness (t(5) = 2.28, p = 0.07) after treatment. Conclusions Our findings strongly correlate with earlier studies that examined the impact of antibiotics on human microbiota. We observed that post-treatment, participants frequently became colonized by taxa that are less susceptible to the prescribed antibiotics. Our findings highlight the challenge in seeking generalizable diagnostic and therapeutic options in CRS, particularly regarding microbiological response and outcomes. PMID:23843343

  18. Management of gastroesophageal reflux disease: medications, surgery, or endoscopic therapy? (Current status and trends).

    PubMed

    Zhi, Xu-ting; Kavic, Stephen M; Park, Adrian E

    2005-01-01

    Gastroesophageal reflux disease (GERD) is a common chronic disorder in the Western world. The basic cause of GERD has been well characterized--the fundamental defect is a loss of integrity of the gastroesophageal barrier. What is less clear is the most appropriate means of addressing this reflux. GERD has a variety of symptoms, ranging from typical presentations of heartburn and regurgitation (without esophagitis) to atypical presentations, such as severe erosive esophagitis and its associated complications. Because of its symptomatic diversity, physicians may select from a variety of therapeutic approaches. Medical therapy aims at decreasing acidity by suppressing proton secretion and has been well established. Available medications include antacids and alginates, H2-receptor antagonists, motility agents, and proton pump inhibitors (PPIs). Antireflux surgery, commonly performed laparoscopically, aims at reinforcing and repairing the defective barrier through plication of the gastric fundus. The earliest performed successful procedures were the Nissen and Toupet fundoplications, to which several modifications have since been made. It has been demonstrated in preliminary studies and long-term outcomes of such open surgery and preliminary studies of such laparoscopic surgery that antireflux surgery is an effective approach, with overall outcomes superior to those achieved with medications. The precise indications for the surgical treatment of patients with GERD, however, remain controversial. In recent years, endoscopic intraluminal antireflux approaches have attracted the attention of physicians, surgeons, and commercial companies, especially after the approval of two endoscopic intraluminal methods by the United States FDA in 2000. The common element is prevention of acid reflux by construction of a functional or controlled barrier in the lower esophageal sphincter zone. Three main methods are currently employed: endoscopic intraluminal valvuloplasty, endoscopic

  19. Metacognitive therapy (MCT+) in patients with psychosis not receiving antipsychotic medication: A case study

    PubMed Central

    Balzan, Ryan P.; Galletly, Cherrie

    2015-01-01

    Background: Psychotherapies for psychosis typically aim to develop an awareness of the implausible content of a delusion or target the underlying cognitive biases (i.e., problematic thinking styles, such as hasty decisions and illusory control) that foster and maintain delusional beliefs. A recently designed individual-based treatment entitled metacognitive therapy (MCT+) combines these two approaches. Emerging evidence suggests individualized MCT+, when used concurrently with antipsychotic medication, may be an effective psychological treatment for reducing delusional symptoms. However, it remains to be tested whether MCT+ can be effective in patients with active delusions who are not currently receiving psychotropic drugs. Method: We present two cases (one patient with schizophrenia and the other with delusional disorder) experiencing active delusions who underwent 4-weeks of intensive MCT+, without concurrent antipsychotic medication (minimum 6-months unmedicated). Baseline and 6-week follow-up data are presented on a variety of measures assessing delusion symptom severity (i.e., PANSS, PSYRATS, SAPS), clinical insight, and cognitive bias propensity. Results: After 4-weeks of MCT+, both patients showed substantial reduction in delusional symptoms, reported improved clinical insight, and were less prone to making illusory correlations. Conclusions: The presented case studies provide preliminary evidence for the feasibility of MCT+ in treating patients not taking, or resistant to, antipsychotic medication. PMID:26217283

  20. Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults.

    PubMed

    Wetherell, Julie Loebach; Petkus, Andrew J; White, Kamila S; Nguyen, Hoang; Kornblith, Sander; Andreescu, Carmen; Zisook, Sidney; Lenze, Eric J

    2013-07-01

    OBJECTIVE Generalized anxiety disorder is common among older adults and leads to diminished health and cognitive functioning. Although antidepressant medications are efficacious, many elderly individuals require augmentation treatment. Furthermore, little is known about maintenance strategies for older people. The authors examined whether sequenced treatment combining pharmacotherapy and cognitive-behavioral therapy (CBT) boosts response and prevents relapse in older adults with generalized anxiety disorder. METHOD Participants were individuals at least 60 years of age with generalized anxiety disorder (N=73) who were recruited from outpatient clinics at three sites. Participants received 12 weeks of open-label escitalopram and were then randomly assigned to one of four conditions: 16 weeks of escitalopram (10-20 mg/day) plus modular CBT, followed by 28 weeks of maintenance escitalopram; escitalopram alone, followed by maintenance escitalopram; escitalopram plus CBT, followed by pill placebo; and escitalopram alone, followed by placebo. RESULTS Escitalopram augmented with CBT increased response rates on the Penn State Worry Questionnaire but not on the Hamilton Anxiety Rating Scale compared with escitalopram alone. Both escitalopram and CBT prevented relapse compared with placebo. CONCLUSIONS This study demonstrates effective strategies for treatment of generalized anxiety disorder in older adults. The sequence of antidepressant medication augmented with CBT leads to worry reduction in the short-term. Continued medication prevents relapse, but for many individuals, CBT would allow sustained remission without requiring long-term pharmacotherapy. PMID:23680817

  1. Antidepressant Medication Augmented With Cognitive-Behavioral Therapy for Generalized Anxiety Disorder in Older Adults

    PubMed Central

    Wetherell, Julie Loebach; Petkus, Andrew J.; White, Kamila S.; Nguyen, Hoang; Kornblith, Sander; Andreescu, Carmen; Zisook, Sidney; Lenze, Eric J.

    2014-01-01

    Objective Generalized anxiety disorder is common among older adults and leads to diminished health and cognitive functioning. Although antidepressant medications are efficacious, many elderly individuals require augmentation treatment. Furthermore, little is known about maintenance strategies for older people. The authors examined whether sequenced treatment combining pharmacotherapy and cognitive-behavioral therapy (CBT) boosts response and prevents relapse in older adults with generalized anxiety disorder. Method Participants were individuals at least 60 years of age with generalized anxiety disorder (N=73) who were recruited from outpatient clinics at three sites. Participants received 12 weeks of open-label escitalopram and were then randomly assigned to one of four conditions:16 weeks of escitalopram (10–20 mg/day) plus modular CBT, followed by 28 weeks of maintenance escitalopram; escitalopram alone, followed by maintenance escitalopram; escitalopram plus CBT, followed by pill placebo; and escitalopram alone, followed by placebo. Results Escitalopram augmented with CBT increased response rates on the Penn State Worry Questionnaire but not on the Hamilton Anxiety Rating Scale compared with escitalopram alone. Both escitalopram and CBT prevented relapse compared with placebo. Conclusions This study demonstrates effective strategies for treatment of generalized anxiety disorder in older adults. The sequence of antidepressant medication augmented with CBT leads to worry reduction in the short-term. Continued medication prevents relapse, but for many individuals, CBT would allow sustained remission without requiring long-term pharmacotherapy. PMID:23680817

  2. Method of sterilization using ozone

    NASA Technical Reports Server (NTRS)

    Murphy, Oliver J. (Inventor); Hitchens, G. Duncan (Inventor)

    2002-01-01

    Methods of using ozone have been developed which sterilize instruments and medical wastes, oxidize, organics found in wastewater, clean laundry, break down contaminants in soil into a form more readily digested by microbes, kill microorganisms present in food products, and destroy toxins present in food products. The preferred methods for killing microorganism and destroying toxins use pressurized, humidified, and concentrated ozone produced by an electrochemical cell.

  3. Ozone decomposition

    PubMed Central

    Batakliev, Todor; Georgiev, Vladimir; Anachkov, Metody; Rakovsky, Slavcho

    2014-01-01

    Catalytic ozone decomposition is of great significance because ozone is a toxic substance commonly found or generated in human environments (aircraft cabins, offices with photocopiers, laser printers, sterilizers). Considerable work has been done on ozone decomposition reported in the literature. This review provides a comprehensive summary of the literature, concentrating on analysis of the physico-chemical properties, synthesis and catalytic decomposition of ozone. This is supplemented by a review on kinetics and catalyst characterization which ties together the previously reported results. Noble metals and oxides of transition metals have been found to be the most active substances for ozone decomposition. The high price of precious metals stimulated the use of metal oxide catalysts and particularly the catalysts based on manganese oxide. It has been determined that the kinetics of ozone decomposition is of first order importance. A mechanism of the reaction of catalytic ozone decomposition is discussed, based on detailed spectroscopic investigations of the catalytic surface, showing the existence of peroxide and superoxide surface intermediates. PMID:26109880

  4. Ozone decomposition.

    PubMed

    Batakliev, Todor; Georgiev, Vladimir; Anachkov, Metody; Rakovsky, Slavcho; Zaikov, Gennadi E

    2014-06-01

    Catalytic ozone decomposition is of great significance because ozone is a toxic substance commonly found or generated in human environments (aircraft cabins, offices with photocopiers, laser printers, sterilizers). Considerable work has been done on ozone decomposition reported in the literature. This review provides a comprehensive summary of the literature, concentrating on analysis of the physico-chemical properties, synthesis and catalytic decomposition of ozone. This is supplemented by a review on kinetics and catalyst characterization which ties together the previously reported results. Noble metals and oxides of transition metals have been found to be the most active substances for ozone decomposition. The high price of precious metals stimulated the use of metal oxide catalysts and particularly the catalysts based on manganese oxide. It has been determined that the kinetics of ozone decomposition is of first order importance. A mechanism of the reaction of catalytic ozone decomposition is discussed, based on detailed spectroscopic investigations of the catalytic surface, showing the existence of peroxide and superoxide surface intermediates. PMID:26109880

  5. Polar ozone

    NASA Technical Reports Server (NTRS)

    Solomon, S.; Grose, W. L.; Jones, R. L.; Mccormick, M. P.; Molina, Mario J.; Oneill, A.; Poole, L. R.; Shine, K. P.; Plumb, R. A.; Pope, V.

    1990-01-01

    The observation and interpretation of a large, unexpected ozone depletion over Antarctica has changed the international scientific view of stratospheric chemistry. The observations which show the veracity, seasonal nature, and vertical structure of the Antarctic ozone hole are presented. Evidence for Arctic and midlatitude ozone loss is also discussed. The chemical theory for Antarctic ozone depletion centers around the occurrence of polar stratospheric clouds (PSCs) in Antarctic winter and spring; the climatology and radiative properties of these clouds are presented. Lab studies of the physical properties of PSCs and the chemical processes that subsequently influence ozone depletion are discussed. Observations and interpretation of the chemical composition of the Antarctic stratosphere are described. It is shown that the observed, greatly enhanced abundances of chlorine monoxide in the lower stratosphere are sufficient to explain much if not all of the ozone decrease. The dynamic meteorology of both polar regions is given, interannual and interhemispheric variations in dynamical processes are outlined, and their likely roles in ozone loss are discussed.

  6. Ozone decomposition.

    PubMed

    Batakliev, Todor; Georgiev, Vladimir; Anachkov, Metody; Rakovsky, Slavcho; Zaikov, Gennadi E

    2014-06-01

    Catalytic ozone decomposition is of great significance because ozone is a toxic substance commonly found or generated in human environments (aircraft cabins, offices with photocopiers, laser printers, sterilizers). Considerable work has been done on ozone decomposition reported in the literature. This review provides a comprehensive summary of the literature, concentrating on analysis of the physico-chemical properties, synthesis and catalytic decomposition of ozone. This is supplemented by a review on kinetics and catalyst characterization which ties together the previously reported results. Noble metals and oxides of transition metals have been found to be the most active substances for ozone decomposition. The high price of precious metals stimulated the use of metal oxide catalysts and particularly the catalysts based on manganese oxide. It has been determined that the kinetics of ozone decomposition is of first order importance. A mechanism of the reaction of catalytic ozone decomposition is discussed, based on detailed spectroscopic investigations of the catalytic surface, showing the existence of peroxide and superoxide surface intermediates.

  7. Naturalistic Outcomes of Evidence-Based Therapies for Borderline Personality Disorder at a Medical University Clinic.

    PubMed

    Gregory, Robert J; Sachdeva, Shilpa

    2016-01-01

    Dialectical behavior therapy (DBT) and dynamic deconstructive psychotherapy (DDP) are listed in the National Registry of Evidence-Based Programs and Practices based on their performances in randomized controlled trials. However, little is known about their effectiveness in real-world settings. In the present study, the authors observed the naturalistic outcomes of 68 clients with borderline personality disorder (BPD) who were treated at a medical university clinic by experienced therapists using either comprehensive DBT (n = 25) or DDP (n = 27), with 16 clients treated with unstructured psychotherapy serving as a control. We found both DBT and DDP achieved significant reductions in symptoms of BPD, depression, and disability by 12 months of treatment, and showed effect sizes consistent with controlled trials. However, attrition from DBT was high and DDP obtained better outcomes than DBT (d = .53). Larger effectiveness studies are needed to replicate these findings, delineate common and unique treatment processes, and determine therapist and patient characteristics predicting positive outcomes. PMID:27329405

  8. Complementary and alternative medical therapies for interstitial cystitis: an update from the United States.

    PubMed

    Atchley, Megan Danielle; Shah, Nima M; Whitmore, Kristene E

    2015-12-01

    The diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) has shifted from organ-specific to a multifactorial, multidisciplinary and individualized approach. Patients with refractory and debilitating symptoms may respond to complementary and alternative medical treatments (CAM). Through CAM therapies, practitioners assist the patient to be at the center of their care, empowering them to be emotionally and physically involved. Multi-disciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy and pain medicine, is also identified to be the crux of adequate management of patients with chronic pelvic pain because of its variable etiology. The purpose of this review is to emphasize these changes and discuss management strategies.

  9. The inflammatory reflex and the role of complementary and alternative medical therapies.

    PubMed

    Oke, Stacey L; Tracey, Kevin J

    2009-08-01

    The body's first defense against invading pathogens or tissue injury is the innate immune system. Since excessive immune responses can be damaging, anti-inflammatory mechanisms function to control the pro-inflammatory response and prevent injury. The cholinergic anti-inflammatory pathway is a neural mechanism that suppresses the innate inflammatory response. Knowledge concerning innervation of the immune system offers a unique opportunity to explore previously unrecognized techniques to treat disease. It also enables consideration of the neurological basis of complementary and alternative medical therapies, such as meditation and acupuncture. This evolving area of research has implications for the pathogenesis of chronic inflammatory conditions including inflammatory bowel disease, rheumatoid arthritis, type 2 diabetes, and other conditions of excessive cytokine release.

  10. Complementary and alternative medical therapies for interstitial cystitis: an update from the United States

    PubMed Central

    Atchley, Megan Danielle; Shah, Nima M.

    2015-01-01

    The diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) has shifted from organ-specific to a multifactorial, multidisciplinary and individualized approach. Patients with refractory and debilitating symptoms may respond to complementary and alternative medical treatments (CAM). Through CAM therapies, practitioners assist the patient to be at the center of their care, empowering them to be emotionally and physically involved. Multi-disciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy and pain medicine, is also identified to be the crux of adequate management of patients with chronic pelvic pain because of its variable etiology. The purpose of this review is to emphasize these changes and discuss management strategies. PMID:26816868

  11. Medical and Psychological Risks and Consequences of Long-Term Opioid Therapy in Women

    PubMed Central

    Darnall, Beth D.; Stacey, Brett R.; Chou, Roger

    2016-01-01

    Background Long-term opioid use has increased substantially over the past decade for U.S. women. Women are more likely than men to have a chronic pain condition, to be treated with opioids, and may receive higher doses. Prescribing trends persist despite limited evidence to support the long-term benefit of this pain treatment approach. Purpose To review the medical and psychological risks and consequences of long-term opioid therapy in women. Method Scientific literature containing relevant keywords and content were reviewed. Results and Conclusions Long-term opioid use exposes women to unique risks, including endocrinopathy, reduced fertility, neonatal risks, as well as greater risk for polypharmacy, cardiac risks, poisoning and unintentional overdose, among other risks. Risks for women appear to vary by age and psychosocial factors may be bidirectionally related to opioid use. Gaps in understanding and priorities for future research are highlighted. PMID:22905834

  12. Role of Medical Nutrition Therapy in the Management of Gestational Diabetes Mellitus.

    PubMed

    Moreno-Castilla, Cristina; Mauricio, Didac; Hernandez, Marta

    2016-04-01

    Medical nutrition therapy (MNT) plays an important role in the management of gestational diabetes mellitus (GDM), and accordingly, it has a significant impact on women and newborns. The primary objective of MNT is to ensure adequate pregnancy weight gain and fetus growth while maintaining euglycemia and avoiding ketones. However, the optimal diet (energy content, macronutrient distribution, its quality and amount, among others) remains an outstanding question. Overall, the nutritional requirements of GDM are similar for all pregnancies, but special attention is paid to carbohydrates. Despite the classical intervention of restricting carbohydrates, the latest evidence, although limited, seems to favor a low-glycemic index diet. There is general agreement in the literature about caloric restrictions in the case of being overweight or obese. Randomized controlled trials are necessary to investigate the optimal MNT for GDM; this knowledge could yield health benefits and cost savings.

  13. Stones in the common bile duct: experience with medical dissolution therapy.

    PubMed Central

    Somerville, K. W.; Ellis, W. R.; Whitten, B. H.; Balfour, T. W.; Bell, G. D.

    1985-01-01

    Thirty-one patients with radiolucent common bile duct stones received medical treatment. Nineteen had Rowachol, a terpene preparation, eight (42%) achieving complete stone disappearance within 3 to 48 months. Fifteen (including 3 of the above) took Rowachol with bile acid (chenodeoxycholic in 11, ursodeoxycholic in 4) for 3 to 60 months: 11 (73%) achieved complete dissolution within 18 months. Persistent symptoms and complications settled on conservative management: 8 (25%) patients required admission (2 biliary colic, 1 obstructive jaundice, 4 cholangitis, 1 pancreatitis). One patient died of a myocardial infarction during recovery from pancreatitis; the other continued treatment, 2 achieving complete dissolution/disappearance. Oral dissolution therapy with Rowachol and bile acids should be considered when endoscopic sphincterotomy or surgery is not feasible, but careful attention to potential complications is required while stones persist. PMID:4022860

  14. Efficacy and safety of tamsulosin as a medical expulsive therapy for stones in children

    PubMed Central

    Aldaqadossi, Hussein A.; Shaker, Hossam; Saifelnasr, Mohammed; Gaber, Mohammed

    2015-01-01

    Objectives To evaluate the efficacy of tamsulosin for promoting ureteric stone expulsion in children, based on the confirmed efficacy of tamsulosin as a medical expulsive therapy in adults. Patients and methods From February 2010 to July 2013, 67 children presenting with a distal ureteric stone of <1 cm as assessed on unenhanced computed tomography were included in the study. The patients were randomised into two groups, with group 1 (33 patients) receiving tamsulosin 0.4 mg and ibuprofen, and group 2 (34) receiving ibuprofen only. They were followed up for 4 weeks. Endoscopic intervention was indicated for patients with uncontrolled pain, recurrent urinary tract infection, hypersensitivity to tamsulosin and failure of stone passage after 4 weeks of conservative treatment. Results Sixty-three patients completed the study. There were no statistically significant differences between the groups in patient age, body weight and stone size, the mean (SD) of which was 6.52 (1.8) mm in group 1 vs. 6.47 (1.79) mm in group 2 (P = 0.9). The mean (SD) time to stone expulsion in group 1 was 7.7 (1.9) days, vs. 18 (1.73) days in group 2 (P < 0.001). The analgesic requirement (mean number of ketorolac injections) in group 1 was significantly less than in group 2, at 0.55 (0.8) vs. 1.8 (1.6) (P < 0.001). The stone-free rate was 87% in group 1 and 63% in group 2 (P = 0.025). Conclusions Tamsulosin used as a medical expulsive therapy for children with ureteric stones is safe and effective, as it facilitates spontaneous expulsion of the stone. PMID:26413330

  15. Tamsulosin versus tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study

    PubMed Central

    Shrestha, Anil; Acharya, Ganesh Bhakta; Basnet, Robin Bahadur; Shah, Arvind Kumar; Shrestha, Parash Mani

    2016-01-01

    Purpose This study aimed to compare the safety and efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteral stones. Materials and Methods This prospective randomized study was conducted at the Department of Urology of Bir Hospital over a period of 12 months in patients with distal ureteral stones sized 5 to 10 mm. Patients were randomly divided into 2 groups: group A received tamsulosin 0.4 mg and group B received tadalafil 10 mg at bedtime for 2 weeks. Stone expulsion rate, number of ureteric colic episodes and pain score, analgesic requirements, and adverse drug effects were noted in both groups. Statistical analyses were performed by using Student t-test and chi-square test. Results Altogether 85 patients, 41 in group A and 44 in group B, were enrolled in the study. The patients' average age was 31.72±12.63 years, and the male-to-female ratio was 1.5:1. Demographic profiles, stone size, and baseline investigations were comparable between the 2 groups. The stone expulsion rate was significantly higher in the tadalafil group than in the tamsulosin group (84.1% vs. 61.0%, p=0.017). Although the occurrence of side effects was higher with tadalafil, this difference was not significant (p=0.099). There were no serious adverse effects. Conclusions Tadalafil has a significantly higher stone expulsion rate than tamsulosin when used as a medical expulsive therapy for distal ureteral stones sized 5–10 mm. Both drugs are safe, effective, and well tolerated with minor side effects. PMID:27617317

  16. Tamsulosin versus tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study

    PubMed Central

    Shrestha, Anil; Acharya, Ganesh Bhakta; Basnet, Robin Bahadur; Shah, Arvind Kumar; Shrestha, Parash Mani

    2016-01-01

    Purpose This study aimed to compare the safety and efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteral stones. Materials and Methods This prospective randomized study was conducted at the Department of Urology of Bir Hospital over a period of 12 months in patients with distal ureteral stones sized 5 to 10 mm. Patients were randomly divided into 2 groups: group A received tamsulosin 0.4 mg and group B received tadalafil 10 mg at bedtime for 2 weeks. Stone expulsion rate, number of ureteric colic episodes and pain score, analgesic requirements, and adverse drug effects were noted in both groups. Statistical analyses were performed by using Student t-test and chi-square test. Results Altogether 85 patients, 41 in group A and 44 in group B, were enrolled in the study. The patients' average age was 31.72±12.63 years, and the male-to-female ratio was 1.5:1. Demographic profiles, stone size, and baseline investigations were comparable between the 2 groups. The stone expulsion rate was significantly higher in the tadalafil group than in the tamsulosin group (84.1% vs. 61.0%, p=0.017). Although the occurrence of side effects was higher with tadalafil, this difference was not significant (p=0.099). There were no serious adverse effects. Conclusions Tadalafil has a significantly higher stone expulsion rate than tamsulosin when used as a medical expulsive therapy for distal ureteral stones sized 5–10 mm. Both drugs are safe, effective, and well tolerated with minor side effects.

  17. Ozone variability

    NASA Astrophysics Data System (ADS)

    Duetsch, H. U.

    1983-09-01

    The annual and long-term variations in the atmospheric ozone layer were examined on the basis of 55 yr of data taken at Aroya, Switzerland and 25 yr of data gathered by the global ozone network. Attention was given to annual and biennial variations, which showed that the midlatitude peak concentration was affected by a quasi-biennial variation of the tropical stratospheric circulation. Smaller scale circulation patterns were dominant in the lower stratosphere, although an observed negative trend of the total ozone was equally distributed between the troposphere and 24 km altitude. The global ozone increase detected in the 1960s was possible due to general circulation alterations, but may also have been influenced by injection of NO(x) into the atmosphere during atomic bomb testing.

  18. Impact of Pharmacist-Provided Medication Therapy Management on Healthcare Quality and Utilization in Recently Discharged Elderly Patients

    PubMed Central

    Haag, Jordan D.; Davis, Amanda Z.; Hoel, Robert W.; Armon, Jeffrey J.; Odell, Laura J.; Dierkhising, Ross A.; Takahashi, Paul Y.

    2016-01-01

    Background The optimization of medication use during care transitions represents an opportunity to improve overall health-related outcomes. The utilization of clinical pharmacists during care transitions has demonstrated benefit, although the optimal method of integration during the care transition process remains unclear. Objective To evaluate the impact of pharmacist-provided telephonic medication therapy management (MTM) on care quality in a care transitions program (CTP) for high-risk older adults. Methods This prospective, randomized, controlled study was conducted from December 8, 2011, through October 25, 2012, in a primary care work group at a tertiary care academic medical center in the midwestern United States. High-risk elderly (aged ≥60 years) patients were randomized to a pharmacist-provided MTM program via telephone or to usual care within an existing outpatient CTP. The primary outcome was the quality of medication prescribing and utilization based on the Screening Tool to Alert Doctors to the Right Treatment (START) and the Screening Tool of Older Persons’ Prescriptions (STOPP) scores. The secondary outcomes were medication utilization using a modified version of the Medication Appropriateness Index, hospital resource utilization within 30 days of discharge, and drug therapy problems. Results Of 222 eligible high-risk patients, 25 were included in the study and were randomized to the pharmacist MTM intervention (N = 13) or to usual care (N = 12). No significant differences were found between the 2 groups in medications meeting the STOPP or START criteria. At 30-day follow-up, no significant differences were found between the 2 cohorts in medication utilization quality indicators or in hospital utilization. At 30-day follow-up, 3 (13.6%) patients had an emergency department visit or a hospital readmission since discharge. In all, 22 patients completed the study. Medication underuse was common, with 20 START criteria absent medications evident for

  19. Impact of Pharmacist-Provided Medication Therapy Management on Healthcare Quality and Utilization in Recently Discharged Elderly Patients

    PubMed Central

    Haag, Jordan D.; Davis, Amanda Z.; Hoel, Robert W.; Armon, Jeffrey J.; Odell, Laura J.; Dierkhising, Ross A.; Takahashi, Paul Y.

    2016-01-01

    Background The optimization of medication use during care transitions represents an opportunity to improve overall health-related outcomes. The utilization of clinical pharmacists during care transitions has demonstrated benefit, although the optimal method of integration during the care transition process remains unclear. Objective To evaluate the impact of pharmacist-provided telephonic medication therapy management (MTM) on care quality in a care transitions program (CTP) for high-risk older adults. Methods This prospective, randomized, controlled study was conducted from December 8, 2011, through October 25, 2012, in a primary care work group at a tertiary care academic medical center in the midwestern United States. High-risk elderly (aged ≥60 years) patients were randomized to a pharmacist-provided MTM program via telephone or to usual care within an existing outpatient CTP. The primary outcome was the quality of medication prescribing and utilization based on the Screening Tool to Alert Doctors to the Right Treatment (START) and the Screening Tool of Older Persons’ Prescriptions (STOPP) scores. The secondary outcomes were medication utilization using a modified version of the Medication Appropriateness Index, hospital resource utilization within 30 days of discharge, and drug therapy problems. Results Of 222 eligible high-risk patients, 25 were included in the study and were randomized to the pharmacist MTM intervention (N = 13) or to usual care (N = 12). No significant differences were found between the 2 groups in medications meeting the STOPP or START criteria. At 30-day follow-up, no significant differences were found between the 2 cohorts in medication utilization quality indicators or in hospital utilization. At 30-day follow-up, 3 (13.6%) patients had an emergency department visit or a hospital readmission since discharge. In all, 22 patients completed the study. Medication underuse was common, with 20 START criteria absent medications evident for

  20. Ozone, Tropospheric

    NASA Technical Reports Server (NTRS)

    Fishman, Jack

    1995-01-01

    In the early part of the 20th century, ground-based and balloon-borne measurements discovered that most of atmosphere's ozone is located in the stratosphere with highest concentrations located between 15 and 30 km (9,3 and 18.6 miles). For a long time, it was believed that tropospheric ozone originated from the stratosphere and that most of it was destroyed by contact with the earth's surface. Ozone, O3, was known to be produced by the photo-dissociation of molecular oxygen, O2, a process that can only occur at wavelengths shorter than 242 nm. Because such short-wave-length radiation is present only in the stratosphere, no tropospheric ozone production is possible by this mechanism. In the 1940s, however, it became obvious that production of ozone was also taking place in the troposphere. The overall reaction mechanism was eventually identified by Arie Haagen-Smit of the California Institute of Technology, in highly polluted southern California. The copious emissions from the numerous cars driven there as a result of the mass migration to Los Angeles after World War 2 created the new unpleasant phenomenon of photochemical smog, the primary component of which is ozone. These high levels of ozone were injuring vegetable crops, causing women's nylons to run, and generating increasing respiratory and eye-irritation problems for the populace. Our knowledge of tropospheric ozone increased dramatically in the early 1950s as monitoring stations and search centers were established throughout southern California to see what could be done to combat this threat to human health and the environment.

  1. Disparities in medication therapy in patients with heart failure across the State of Hawai'i.

    PubMed

    Goo, Roy Alan; Ma, Carolyn; Juarez, Deborah Taira

    2015-01-01

    The purpose of this study is to evaluate if heart failure patients in Hawai'i are receiving recommended standard therapy of a select beta-blocker in combination with an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB), and to determine if a gap in quality of care exists between the different regions within the state. A retrospective claims-based analysis of all adult patients (age > 18 years of age) with CHF who were enrolled in a large health plan in Hawai'i was performed (n = 24,149). Data collected included the presence of pharmaceutical claims for ACEI, ARBs and select β-blockers, region of residence, gender, and age. Multivariable logistic regression was used to examine whether there were regional differences in Hawai'i related to medication usage, after adjustment for age and gender. Results showed that only 28.4 % of patients were placed on the recommended therapy of an ACEI or ARB and a select β-blocker with significant differences being found between different regions. Further research is needed to better understand factors affecting regional differences in prescribing patterns. PMID:25628976

  2. Review on the demographic and social impact of methadone-medication therapy on Malaysian patients.

    PubMed

    Manan, Mohamed Mansor; Ali, Salmiah Mohd; Khan, Muhammad Anwar Nawab; Jafarian, Sara; Hameed, Mohammed Abdul

    2013-07-01

    This study is an observational cross-sectional study aimed to examine the possible demographic and social characteristics of patients enrolled at the Methadone Maintenance Therapy Adherence Clinic (MMTAC) in Malaysia. Medical records from year 2009 - 2011 were Reviewed. Demographic, social characteristics and laboratory examinations such as age, gender, race, clinic attendances and urine analysis were recorded. Subjects were selected by means of convenient sampling but based on the specified inclusion and exclusion criteria. Data were analyzed by either Chi-square test, Fisher's exact test Mann-Whitney U-test, with the limit of significance was set at p < 0.05. Demographically, this study found that the ratio of Malays, Chinese and Indian enrolled to the MMTAC program is similar to the distribution of races in Malaysia. Their starting age for drug use was between 14-35 years and the age to enrolment between 30-58 years. Socially, many are unemployed, lowly educated and married. Most are drug users with a high percentage of HCV accompanied with impaired liver function. Retention rate was 87% but illicit drug use was at 57.50%. However, percentage of employment increased significantly after therapy. The study managed to identify several demographical and social distributions of patients attending the MMTAC. Although attendance rate was high, many were on illicit drug use. Nevertheless, employment rate improved significantly.

  3. Retention in care and medication adherence: current challenges to antiretroviral therapy success.

    PubMed

    Holtzman, Carol W; Brady, Kathleen A; Yehia, Baligh R

    2015-04-01

    Health behaviors such as retention in HIV medical care and adherence to antiretroviral therapy (ART) pose major challenges to reducing new HIV infections, addressing health disparities, and improving health outcomes. Andersen's Behavioral Model of Health Service Use provides a conceptual framework for understanding how patient and environmental factors affect health behaviors and outcomes, which can inform the design of intervention strategies. Factors affecting retention and adherence among persons with HIV include patient predisposing factors (e.g., mental illness, substance abuse), patient-enabling factors (e.g., social support, reminder strategies, medication characteristics, transportation, housing, insurance), and healthcare environment factors (e.g., pharmacy services, clinic experiences, provider characteristics). Evidence-based recommendations for improving retention and adherence include (1) systematic monitoring of clinic attendance and ART adherence; (2) use of peer or paraprofessional navigators to re-engage patients in care and help them remain in care; (3) optimization of ART regimens and pharmaceutical supply chain management systems; (4) provision of reminder devices and tools; (5) general education and counseling; (6) engagement of peer, family, and community support groups; (7) case management; and (8) targeting patients with substance abuse and mental illness. Further research is needed on effective monitoring strategies and interventions that focus on improving retention and adherence, with specific attention to the healthcare environment. PMID:25792300

  4. The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons.

    PubMed

    Culbert, Gabriel J; Bazazi, Alexander R; Waluyo, Agung; Murni, Astia; Muchransyah, Azalia P; Iriyanti, Mariska; Finnahari; Polonsky, Maxim; Levy, Judith; Altice, Frederick L

    2016-05-01

    Negative attitudes toward HIV medications may restrict utilization of antiretroviral therapy (ART) in Indonesian prisons where many people living with HIV (PLH) are diagnosed and first offered ART. This mixed-method study examines the influence of medication attitudes on ART utilization among HIV-infected Indonesian prisoners. Randomly-selected HIV-infected male prisoners (n = 102) completed face-to-face in-depth interviews and structured surveys assessing ART attitudes. Results show that although half of participants utilized ART, a quarter of those meeting ART eligibility guidelines did not. Participants not utilizing ART endorsed greater concerns about ART efficacy, safety, and adverse effects, and more certainty that ART should be deferred in PLH who feel healthy. In multivariate analyses, ART utilization was independently associated with more positive ART attitudes (AOR = 1.09, 95 % CI 1.03-1.16, p = 0.002) and higher internalized HIV stigma (AOR = 1.03, 95 % CI 1.00-1.07, p = 0.016). Social marketing of ART is needed to counteract negative ART attitudes that limit ART utilization among Indonesian prisoners. PMID:26400080

  5. Retention in Care and Medication Adherence: Current Challenges to Antiretroviral Therapy Success

    PubMed Central

    Holtzman, Carol W.; Brady, Kathleen A.; Yehia, Baligh R.

    2015-01-01

    Health behaviors, such as retention in HIV medical care and adherence to antiretroviral therapy (ART), pose major challenges to reducing new HIV infections, addressing health disparities, and improving health outcomes. Andersen's Behavioral Model of Health Service Use provides a conceptual framework for understanding how patient and environmental factors affect health behaviors and outcomes, which can inform the design of intervention strategies. Factors affecting retention and adherence among persons with HIV include patient predisposing factors (e.g. mental illness, substance abuse), patient enabling factors (e.g. social support, reminder strategies, medication characteristics, transportation, housing, insurance), and health care environment factors (e.g. pharmacy services, clinic experiences, provider characteristics). Evidence-based recommendations for improving retention and adherence include 1) systematic monitoring of clinic attendance and ART adherence; 2) use of peer or paraprofessional navigators to re-engage patients in care and help them remain in care; 3) optimization of ART regimens and pharmaceutical supply chain management systems 4) provision of reminder devices and tools; 5) general education and counseling; 6) engagement of peer, family, and community support groups; 7) case management; and 8) targeting patients with substance abuse and mental illness. Further research is needed on effective monitoring strategies and interventions that focus on improving retention and adherence, with specific attention to the health care environment. PMID:25792300

  6. A medical manipulator system with lasers in photodynamic therapy of port wine stains.

    PubMed

    Wang, Xingtao; Tian, Chunlai; Duan, Xingguang; Gu, Ying; Huang, Naiyan

    2014-01-01

    Port wine stains (PWS) are a congenital malformation and dilation of the superficial dermal capillary. Photodynamic therapy (PDT) with lasers is an effective treatment of PWS with good results. However, because the laser density is uneven and nonuniform, the treatment is carried out manually by a doctor thus providing little accuracy. Additionally, since the treatment of a single lesion can take between 30 and 60 minutes, the doctor can become fatigued after only a few applications. To assist the medical staff with this treatment method, a medical manipulator system (MMS) was built to operate the lasers. The manipulator holds the laser fiber and, using a combination of active and passive joints, the fiber can be operated automatically. In addition to the control input from the doctor over a human-computer interface, information from a binocular vision system is used to guide and supervise the operation. Clinical results are compared in nonparametric values between treatments with and without the use of the MMS. The MMS, which can significantly reduce the workload of doctors and improve the uniformity of laser irradiation, was safely and helpfully applied in PDT treatment of PWS with good therapeutic results. PMID:25302297

  7. A medical manipulator system with lasers in photodynamic therapy of port wine stains.

    PubMed

    Wang, Xingtao; Tian, Chunlai; Duan, Xingguang; Gu, Ying; Huang, Naiyan

    2014-01-01

    Port wine stains (PWS) are a congenital malformation and dilation of the superficial dermal capillary. Photodynamic therapy (PDT) with lasers is an effective treatment of PWS with good results. However, because the laser density is uneven and nonuniform, the treatment is carried out manually by a doctor thus providing little accuracy. Additionally, since the treatment of a single lesion can take between 30 and 60 minutes, the doctor can become fatigued after only a few applications. To assist the medical staff with this treatment method, a medical manipulator system (MMS) was built to operate the lasers. The manipulator holds the laser fiber and, using a combination of active and passive joints, the fiber can be operated automatically. In addition to the control input from the doctor over a human-computer interface, information from a binocular vision system is used to guide and supervise the operation. Clinical results are compared in nonparametric values between treatments with and without the use of the MMS. The MMS, which can significantly reduce the workload of doctors and improve the uniformity of laser irradiation, was safely and helpfully applied in PDT treatment of PWS with good therapeutic results.

  8. The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons.

    PubMed

    Culbert, Gabriel J; Bazazi, Alexander R; Waluyo, Agung; Murni, Astia; Muchransyah, Azalia P; Iriyanti, Mariska; Finnahari; Polonsky, Maxim; Levy, Judith; Altice, Frederick L

    2016-05-01

    Negative attitudes toward HIV medications may restrict utilization of antiretroviral therapy (ART) in Indonesian prisons where many people living with HIV (PLH) are diagnosed and first offered ART. This mixed-method study examines the influence of medication attitudes on ART utilization among HIV-infected Indonesian prisoners. Randomly-selected HIV-infected male prisoners (n = 102) completed face-to-face in-depth interviews and structured surveys assessing ART attitudes. Results show that although half of participants utilized ART, a quarter of those meeting ART eligibility guidelines did not. Participants not utilizing ART endorsed greater concerns about ART efficacy, safety, and adverse effects, and more certainty that ART should be deferred in PLH who feel healthy. In multivariate analyses, ART utilization was independently associated with more positive ART attitudes (AOR = 1.09, 95 % CI 1.03-1.16, p = 0.002) and higher internalized HIV stigma (AOR = 1.03, 95 % CI 1.00-1.07, p = 0.016). Social marketing of ART is needed to counteract negative ART attitudes that limit ART utilization among Indonesian prisoners.

  9. Antiretroviral Therapy Use, Medication Adherence, and Viral Suppression Among PLWHA with Panic Symptoms.

    PubMed

    Sam, Tanyka Suzanne; Hutton, Heidi E; Lau, Bryan; McCaul, Mary E; Keruly, Jeanne; Moore, Richard; Chander, Geetanjali

    2015-11-01

    Panic symptoms are prevalent among PLWHAs, yet few studies have examined their relationship with HIV outcomes. Using data from an observational cohort study in Baltimore, MD, we examined the association between panic symptoms and antiretroviral therapy (ART) use, medication adherence, and viral suppression. Data were analyzed using generalized estimating equations and adjusted for age, sex, race/ethnicity, cocaine and/or heroin use, clinic enrollment time, alcohol use, and depressive symptoms. Between June 2010 and September 2012, 1195 individuals participated in 2080 audio computer assisted interviews; 9.9 % (n = 118) of individuals endorsed current panic symptoms. In multivariate analysis, panic symptoms were associated with decreased ART use (IRR 0.94; p = 0.05). Panic symptoms were neither associated with medication adherence nor viral suppression. These findings were independent of depressive symptoms and substance use. Panic symptoms are under-recognized in primary care settings and present an important barrier to ART use. Further studies investigating the reasons for this association are needed.

  10. Antiretroviral Therapy Use, Medication Adherence, and Viral Suppression Among PLWHA with Panic Symptoms.

    PubMed

    Sam, Tanyka Suzanne; Hutton, Heidi E; Lau, Bryan; McCaul, Mary E; Keruly, Jeanne; Moore, Richard; Chander, Geetanjali

    2015-11-01

    Panic symptoms are prevalent among PLWHAs, yet few studies have examined their relationship with HIV outcomes. Using data from an observational cohort study in Baltimore, MD, we examined the association between panic symptoms and antiretroviral therapy (ART) use, medication adherence, and viral suppression. Data were analyzed using generalized estimating equations and adjusted for age, sex, race/ethnicity, cocaine and/or heroin use, clinic enrollment time, alcohol use, and depressive symptoms. Between June 2010 and September 2012, 1195 individuals participated in 2080 audio computer assisted interviews; 9.9 % (n = 118) of individuals endorsed current panic symptoms. In multivariate analysis, panic symptoms were associated with decreased ART use (IRR 0.94; p = 0.05). Panic symptoms were neither associated with medication adherence nor viral suppression. These findings were independent of depressive symptoms and substance use. Panic symptoms are under-recognized in primary care settings and present an important barrier to ART use. Further studies investigating the reasons for this association are needed. PMID:25903506

  11. Validation of a Patient-Level Medication Regimen Complexity Index as a Possible Tool to Identify Patients for Medication Therapy Management Intervention

    PubMed Central

    Hirsch, Jan D; Metz, Kelli R; Hosokawa, Patrick W; Libby, Anne M

    2014-01-01

    Background The Medication Regimen Complexity Index (MRCI) is a 65-item instrument that can be used to quantify medication regimen complexity at the patient level, capturing all prescribed and over-the-counter medications. Although the MRCI has been used in several studies, the narrow scope of the initial validation limits application at a population or clinical practice level. Purpose To conduct a MRCI validation pertinent to the desired clinical use to identify patients for medication therapy management interventions. Methods An expert panel of clinical pharmacists ranked medication regimen complexity for two samples of cases: a single-disease cohort (diabetes mellitus) and a multiple-disease cohort (diabetes mellitus, hypertension, human immunodeficiency virus infection, geriatric depression). Cases for expert panel review were selected from 400 ambulatory clinic patients, and each case description included data that were available via claims or electronic medical records (EMRs). Construct validity was assessed using patient-level MRCI scores, medication count, and additional patient data. Concordance was evaluated using weighted κ agreement statistic, and correlations were determined using Spearman rank-order correlation coefficient (ρ) or Kendall τ. Results Moderate to good concordance between patient-level MRCI scores and expert medication regimen complexity ranking was observed (claims data, consensus ranking: single-disease cohort 0.55, multiple disease cohort 0.63). In contrast, only fair to moderate concordance was observed for medication count (single-disease cohort 0.33, multiple-disease cohort 0.48). Adding more-detailed administration directions from EMR data did not improve concordance. MRCI convergent validity was supported by strong correlations with medication count (all cohorts 0.90) and moderate correlations with morbidity measures (e.g., all cohorts; number of comorbidities 0.46, Chronic Disease Score 0.46). Nonsignificant correlation

  12. Contingent Valuation and Pharmacists' Acceptable Levels of Compensation for Medication Therapy Management Services

    PubMed Central

    Wang, Junling; Hong, Song Hee

    2012-01-01

    Background Pharmacists' acceptable level of compensation for medication therapy management (MTM) services needs to be determined using various economic evaluation techniques. Objectives Using contingent valuation method, determine pharmacists' acceptable levels of compensation for MTM services. Methods A mailing survey was used to elicit Tennessee (US) pharmacists' acceptable levels of compensation for a 30-minute MTM session for a new patient with 2 medical conditions, 8 medications, and an annual drug cost of $2,000. Three versions of a series of double-bounded, closed-ended, binary discrete choice questions were asked of pharmacists for their willingness-to-accept (WTA) for an original monetary value ($30, $60, or $90) and then follow-up higher or lower value depending on their responses to the original value. A Kaplan-Meier approach was taken to analyze pharmacists' WTA, and Cox's proportional hazards model was used to examine the effects of pharmacist characteristics on their WTA. Results Three hundred and forty-eight pharmacists responded to the survey. Pharmacists' WTA for the given MTM session had a mean of $63.31 and median of $60. The proportions of pharmacists willing to accept $30, $60, and $90 for the given MTM session were 30.61%, 85.19%, and 91.01%, respectively. Pharmacists' characteristics had statistically significant association with their WTA rates. Conclusions Pharmacists' WTA for the given MTM session is higher than current Medicare MTM programs' compensation levels of $15 to $50 and patients' willingness-to-pay of less than $40. Besides advocating for higher MTM compensation levels by third-party payers, pharmacists also may need to charge patients to reach sufficient compensation levels for MTM services. PMID:22436583

  13. 21 CFR 801.415 - Maximum acceptable level of ozone.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Conference of Governmental Industrial Hygienists. (e) The method and apparatus specified in 40 CFR part 50... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Maximum acceptable level of ozone. 801.415 Section... level of ozone. (a) Ozone is a toxic gas with no known useful medical application in...

  14. 21 CFR 801.415 - Maximum acceptable level of ozone.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Conference of Governmental Industrial Hygienists. (e) The method and apparatus specified in 40 CFR part 50... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Maximum acceptable level of ozone. 801.415 Section... level of ozone. (a) Ozone is a toxic gas with no known useful medical application in...

  15. 21 CFR 801.415 - Maximum acceptable level of ozone.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Conference of Governmental Industrial Hygienists. (e) The method and apparatus specified in 40 CFR part 50... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Maximum acceptable level of ozone. 801.415 Section... level of ozone. (a) Ozone is a toxic gas with no known useful medical application in...

  16. Interprofessional collaborative model for medication therapy management (MTM) services to improve health care access and quality for underserved populations.

    PubMed

    Truong, Hoai-An; Groves, C Nicole; Congdon, Heather Brennan; Botchway, Rosemary; Dang, Diem-Thanh Tanya; Clark, Nancy Ripp; Zarfeshan, Faramarz

    2012-08-01

    As part of the Health Resources and Services Administration Patient Safety and Clinical Pharmacy Services Collaborative (PSPC), an interprofessional model with medication therapy management documentation and outcomes tracking tools (MTM-DOTT) is established to improve health care access and quality for underserved populations. Despite limitations, there have been positive outcomes and national recognitions.

  17. The Process of Change in Cognitive Therapy for Depression when Combined with Antidepressant Medication: Predictors of Early Intersession Symptom Gains

    ERIC Educational Resources Information Center

    Strunk, Daniel R.; Cooper, Andrew A.; Ryan, Elizabeth T.; DeRubeis, Robert J.; Hollon, Steven D.

    2012-01-01

    Objective: Previous studies of cognitive therapy (CT) for depression have examined therapist adherence and the therapeutic alliance as predictors of subsequent symptom change. However, little is known about these CT process variables when CT is delivered in combination with antidepressant medication. Method: In a sample of 176 depressed…

  18. Predictors and Moderators of Response to Cognitive Behavioral Therapy and Medication for the Treatment of Binge Eating Disorder

    ERIC Educational Resources Information Center

    Grilo, Carlos M.; Masheb, Robin M.; Crosby, Ross D.

    2012-01-01

    Objective: To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED). Method: 108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors,…

  19. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial

    PubMed Central

    White, PD; Goldsmith, KA; Johnson, AL; Potts, L; Walwyn, R; DeCesare, JC; Baber, HL; Burgess, M; Clark, LV; Cox, DL; Bavinton, J; Angus, BJ; Murphy, G; Murphy, M; O'Dowd, H; Wilks, D; McCrone, P; Chalder, T; Sharpe, M

    2011-01-01

    Summary Background Trial findings show cognitive behaviour therapy (CBT) and graded exercise therapy (GET) can be effective treatments for chronic fatigue syndrome, but patients' organisations have reported that these treatments can be harmful and favour pacing and specialist health care. We aimed to assess effectiveness and safety of all four treatments. Methods In our parallel-group randomised trial, patients meeting Oxford criteria for chronic fatigue syndrome were recruited from six secondary-care clinics in the UK and randomly allocated by computer-generated sequence to receive specialist medical care (SMC) alone or with adaptive pacing therapy (APT), CBT, or GET. Primary outcomes were fatigue (measured by Chalder fatigue questionnaire score) and physical function (measured by short form-36 subscale score) up to 52 weeks after randomisation, and safety was assessed primarily by recording all serious adverse events, including serious adverse reactions to trial treatments. Primary outcomes were rated by participants, who were necessarily unmasked to treatment assignment; the statistician was masked to treatment assignment for the analysis of primary outcomes. We used longitudinal regression models to compare SMC alone with other treatments, APT with CBT, and APT with GET. The final analysis included all participants for whom we had data for primary outcomes. This trial is registered at http://isrctn.org, number ISRCTN54285094. Findings We recruited 641 eligible patients, of whom 160 were assigned to the APT group, 161 to the CBT group, 160 to the GET group, and 160 to the SMC-alone group. Compared with SMC alone, mean fatigue scores at 52 weeks were 3·4 (95% CI 1·8 to 5·0) points lower for CBT (p=0·0001) and 3·2 (1·7 to 4·8) points lower for GET (p=0·0003), but did not differ for APT (0·7 [−0·9 to 2·3] points lower; p=0·38). Compared with SMC alone, mean physical function scores were 7·1 (2·0 to 12·1) points higher for CBT (p=0·0068) and 9·4

  20. Effectiveness of ozone against periodontal pathogenic microorganisms.

    PubMed

    Huth, Karin C; Quirling, Martina; Lenzke, Stefanie; Paschos, Ekaterini; Kamereck, Klaus; Brand, Korbinian; Hickel, Reinhard; Ilie, Nicoleta

    2011-06-01

    Ozone has been proposed as an adjunct antiseptic in periodontitis therapy. The aim of this study was to investigate the antimicrobial effectiveness of gaseous/aqueous ozone, in comparison with that of the established antiseptic chlorhexidine digluconate (CHX), against periodontal microorganisms. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Parvimonas micra in planktonic or biofilm cultures were exposed, for 1 min, to gaseous ozone, aqueous ozone, CHX, or phosphate-buffered saline (control). None of the agents was able to substantially reduce the A. actinomycetemcomitans count in biofilm cultures. In contrast, P. gingivalis, T. forsythia, and P. micra could be eliminated by 2% CHX or by ozone gas at 53 gm(-3) . Significantly greater antimicrobial effects were observed against planktonic cultures than against biofilm-associated bacteria. The rate of killing was influenced by the species of bacteria, and by the type and concentration of agent. There were no significant differences in the effectiveness of aqueous ozone (20 μg ml(-1) ) or gaseous ozone (≥ 4 gm(-3) ) compared with 2% CHX but they were more effective than 0.2% CHX. Therefore, high-concentrated gaseous and aqueous ozone merit further investigation as antiseptics in periodontitis therapy. A safe system for applying gaseous ozone into the periodontal pocket that avoids inhalation still needs to be developed.

  1. Outcome of anthroposophic medication therapy in chronic disease: A 12-month prospective cohort study

    PubMed Central

    Hamre, Harald J; Witt, Claudia M; Glockmann, Anja; Ziegler, Renatus; Kienle, Gunver S; Willich, Stefan N; Kiene, Helmut

    2008-01-01

    Background Anthroposophic medications (AMED) are prescribed in 56 countries. Objective To study clinical outcomes in patients prescribed AMED for chronic disease. Design Prospective cohort study. Setting 110 medical practices in Germany. Participants 665 consecutive outpatients aged 1–71 years, prescribed AMED for mental, respiratory, musculoskeletal, neurological, genitourinary, and other chronic diseases. Main outcomes Disease and Symptom Scores (physicians’ and patients’ assessment, 0–10) and SF-36. Results During the first six months, an average of 1.5 AMED per patient was used, in total 652 different AMED. Origin of AMED was mineral (8.0% of 652 AMED), botanical (39.0%), zoological (7.2%), chemically defined (13.0%), and mixed (33.0%). From baseline to six-month-follow-up, all outcomes improved significantly: Disease Score improved by mean 3.15 points (95% confidence interval 2.97–3.34, p < 0.001), Symptom Score by 2.43 points (2.23–2.63, p < 0.001), SF-36 Physical Component Summary by 3.04 points (2.16–3.91, p < 0.001), and SF-36 Mental Component Summary by 5.75 points (4.59–6.92, p < 0.001). All improvements were maintained at 12-month follow-up. Improvements were similar in adult men and women, in children, and in patients not using adjunctive therapies. Conclusion Outpatients using AMED for chronic disease had long-term reduction of disease severity and improvement of quality of life. PMID:19920891

  2. Effects of Medicare Part D on Disparity Implications of Medication Therapy Management Eligibility Criteria

    PubMed Central

    Wang, Junling; Qiao, Yanru; Shih, Ya-Chen Tina; Jamison, JoEllen Jarrett; Spivey, Christina A.; Li, Liyuan; Wan, Jim Y.; White-Means, Shelley I.; Dagogo-Jack, Samuel; Cushman, William C.; Chisholm-Burns, Marie

    2014-01-01

    Background Previous studies have shown that there were greater racial and ethnic disparities among individuals who were ineligible for medication therapy management (MTM) services than among MTM-eligible individuals before the implementation of Medicare Part D in 2006. Objective To determine whether the implementation of Medicare Part D in 2006 correlates to changes in racial and ethnic disparities among MTM-ineligible and MTM-eligible beneficiaries. Methods Data from the Medicare Current Beneficiary Survey were analyzed in this retrospective observational analysis. To examine potential racial and ethnic disparities, non-Hispanic whites were compared with non-Hispanic blacks and Hispanics. Three aspects of disparities were analyzed, including health status, health services utilization and costs, and medication utilization patterns. A generalized difference-in-differences analysis was used to examine the changes in difference in disparities between MTM-ineligible and MTM-eligible individuals from 2004–2005 to 2007–2008 relative to changes from 2001–2002 and 2004–2005. Various multivariate regressions were used based on the types of dependent variables. A main analysis and several sensitivity analyses were conducted to represent the ranges of MTM eligibility thresholds used by Medicare Part D plans in 2010. Results The main analysis showed that Part D implementation was not associated with reductions in greater racial and ethnic disparities among MTM-ineligible than MTM-eligible Medicare beneficiaries. The main analysis suggests that after Part D implementation, Medicare MTM eligibility criteria may not consistently improve the existing racial and ethnic disparities in health status, health services utilization and costs, and medication utilization. By contrast, several sensitivity analyses showed that Part D implementation did correlate with a significant reduction in greater racial disparities among the MTM-ineligible group than the MTM-eligible group in

  3. Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction

    PubMed Central

    Mentz, Robert J; Fiuzat, Mona; Shaw, Linda K; Farzaneh-Far, Afshin; M O'Connor, Christopher; Borges-Neto, Salvador

    2015-01-01

    Objective Nuclear imaging data demonstrate that revascularisation leads to favourable effects on ischaemia burden and improved outcomes compared with medical therapy (MT). In patients with heart failure (HF), the effects of MT versus revascularisation on ischaemia change and its independent prognostic significance requires investigation. Methods From the Duke Databank, we performed a retrospective analysis of 278 consecutive patients with coronary artery disease (CAD) and ejection fraction (EF) ≤40%, who underwent 2 serial myocardial perfusion scans between 1993 and 2009. Ischaemia change was calculated for patients undergoing MT alone, or revascularisation. Cox proportional hazards regression modelling was used to identify factors associated with death/myocardial infarction (MI). Results The magnitude of ischeamia reduction was greater with revascularisation than with MT alone (median change of −6% vs 0%, p<0.001). With revascularisation, more patients experienced ≥5% ischaemia reduction compared with MT (52% vs 25%, p<0.01) and a similar percentage experienced ≥5% ischaemia worsening (13% vs 18%, p=0.37). After risk adjustment, ≥5% ischaemia worsening was associated with decreased death/MI (HR=0.58; 95% CI 0.36 to 0.96). Conclusions In patients with HF with CAD, revascularisation improves long-term ischaemia burden compared with MT. Ischaemia worsening on nuclear imaging was associated with reduced risk of death/MI, potentially related to development of ischaemic viable myocardium as opposed to scar tissue. PMID:26339498

  4. [Cost-effective medical therapy of hepatitis C employing novel compensation models - pay for cure].

    PubMed

    Foerster, F; Wörns, M A; Galle, P R; Schattenberg, J M

    2015-12-01

    Direct acting antivirals (DAAs) have increased cure rates for chronic hepatitis C infection up to nearly 100 %. At the same time treatment costs have risen significantly. Treating all HCV infected patients in Germany with DAAs would generate medication costs ranging between 19 and 37 billion EUR depending on the drug regimen used. Expenses in patients who fail to respond to treatment would amount to approximately 0.9 to 2.15 billion EUR. In difficult to treat patient populations that are characterized by prior failure to treatment or advanced liver disease, lost drug expenses are particularly high due to lower cure rates and longer treatment duration. Outcome-based reimbursement schemes are used to improve the quality of care and to reduce costs in the health care system. In Germany, disease management programs have been implemented for defined chronic diseases. However, drug reimbursement is still based on packages sold (pay for pill). In this context, it would be appealing to link reimbursement and treatment success (pay for cure) in order to reward successful treatment, limit lost drug spending and develop a shared risk environment that would involve all concerned parties. Under the assumption that 20,000 patients with HCV are treated each year in Germany and that cure rates are 95.4 %, the saved treatment costs would amount up to 45 and 107 million EUR per year. By this approach, economic incentives to withhold therapy from difficult to treat patients could be avoided. PMID:26666278

  5. Transcatheter valve therapy registry is a model for medical device innovation and surveillance.

    PubMed

    Carroll, John D; Shuren, Jeff; Jensen, Tamara Syrek; Hernandez, John; Holmes, David; Marinac-Dabic, Danica; Edwards, Fred H; Zuckerman, Bram D; Wood, Larry L; Kuntz, Richard E; Mack, Michael J

    2015-02-01

    Heart valve diseases are increasingly prevalent, especially in people older than age seventy. Many of these elderly people have other comorbid conditions, making them poor candidates for surgical treatment of heart valve diseases. Since 2011 such patients have been eligible to receive new nonsurgical heart valve treatments approved by the Food and Drug Administration (FDA) and covered by Medicare. This article examines the Transcatheter Valve Therapy Registry, which captures clinical information on all US patients undergoing new nonsurgical heart valve treatments. The registry has patient-level data from more than 27,000 patients treated with the novel devices. Patient- and procedure-related data are gathered from hospitals, patient-reported outcomes are assessed pre- and postprocedure, and longer-term data on mortality and repeat hospitalization are provided by linking the registry's data to Medicare patient data. The registry is a model of collaboration among professional societies, the FDA, the Centers for Medicare and Medicaid Services, hospitals, patients, and the medical device industry. It has been used to support Medicare coverage decisions, expand device indications, provide comprehensive device surveillance, and establish national quality benchmarks. Beyond having it serve as a collaborative model, future goals for the registry include shortening the FDA-approval timeline for devices, providing data for decision-making tools for patients, and public reporting of hospital performance. PMID:25646114

  6. Integrative medical therapy: examination of meditation's therapeutic and global medicinal outcomes via nitric oxide (review).

    PubMed

    Stefano, George B; Esch, Tobias

    2005-10-01

    Relaxation techniques are part of the integrative medicine movement that is of growing importance for mainstream medicine. Complementary medical therapies have the potential to affect many physiological systems. Repeatedly studies show the benefits of the placebo response and relaxation techniques in the treatment of hypertension, cardiac arrhythmias, chronic pain, insomnia, anxiety and mild and moderate depression, premenstrual syndrome, and infertility. In itself, relaxation is characterized by a decreased metabolism, heart rate, blood pressure, and rate of breathing as well as an increase in skin temperature. Relaxation approaches, such as progressive muscle relaxation, autogenic training, meditation and biofeedback, are effective in lowering systolic and diastolic blood pressure in hypertensive patients by a significant margin. Given this association with changes in vascular tone, we have hypothesized that nitric oxide, a demonstrated vasodilator substance, contribute to physiological activity of relaxation approaches. We examined the scientific literature concerning the disorders noted earlier for their nitric oxide involvement in an attempt to provide a molecular rationale for the positive effects of relaxation approaches, which are physiological and cognitive process. We conclude that constitutive nitric oxide may crucially contribute to potentially beneficial outcomes and effects in diverse pathologies, exerting a global healing effect.

  7. Medical expulsive therapy for ureteral stones: where do we go from here?

    PubMed

    Somani, Bhaskar K; Aboumarzouk, Omar; Traxer, Olivier; Baard, Joyce; Kamphuis, Guido; de la Rosette, Jean

    2016-10-01

    Despite two decades of clinical use, the effectiveness of medical expulsive therapy (MET) for the noninvasive management of patients with ureteral stones has, in the past year, been called into in question. The primary aim of MET is to expedite stone passage, although it has also shown effectiveness in reducing time to stone passage, thus reducing the incidence of colic episodes, improving stone clearance and improving patients' quality of life. At least 11 systematic reviews and meta-analyses have been published showing clinical benefits of MET; however, the results of these analyses have been challenged by data from two randomized controlled, multicentre trials with large patient cohorts, thus providing higher quality evidence that MET is ineffective in patients with ureteral stones. Results of the various systematic reviews and meta-analyses have suggested that MET is effective, however, such analyses incorporate the biases and limitations of smaller cohort studies, resulting in their conclusions being based upon lower-quality evidence. Evidence for the use of MET for small (<5 mm) distal ureteral stones has weakened based on clinical trial data published in 2015. However, MET might remain effective in the management of larger ureteral stones (>5 mm).

  8. Medical nutrition therapy for hypercholesterolemia positively affects patient satisfaction and quality of life outcomes.

    PubMed

    Delahanty, Linda M; Hayden, Doug; Ammerman, Alice; Nathan, David M

    2002-01-01

    Following a heart-healthy diet to lower cholesterol levels is often assumed to be difficult, to be burdensome, and to have a negative impact on quality of life (QOL). The purpose of this study was to evaluate the impact of medical nutrition therapy (MNT) versus usual care (UC) for hypercholesterolemia on patient satisfaction and QOL. Ninety ambulatory care patients (60 men and 30 women), age 28 to 66, were randomly assigned to receive either MNT from dietitians using a National Cholesterol Education Program-based protocol or UC from their physicians. Patients who received MNT reported no difference in QOL related to the taste or enjoyment of food compared with UC patients. However, the MNT group reported initial improvements in QOL related to the convenience and cost of following a low-fat diet when compared with the UC group. The MNT group also reported significant and lasting improvements in perceived QOL related to self-care compared with the UC group. MNT patients were more satisfied with the interaction at visits, knowledge and ability to manage their cholesterol, eating habits, appearance, time spent exercising, and life in general. Moreover, MNT patients did not report any negative impact related to following a low-fat diet in regard to feeling restricted by diet; interference with lifestyle activities; or difficulty planning, purchasing, or preparing meals or eating away from home. Contrary to popular belief there is no apparent reduction but rather an improvement in some measures of QOL and patient satisfaction with MNT for hypercholesterolemia.

  9. Genetic Variation (CHRNA5), Medication (Combination Nicotine Replacement Therapy vs. Varenicline) and Smoking Cessation*

    PubMed Central

    Chen, Li-Shiun; Baker, Timothy B.; Jorenby, Douglas; Piper, Megan; Saccone, Nancy; Johnson, Eric; Breslau, Naomi; Hatsukami, Dorothy; Carney, Robert M.; Bierut, Laura J.

    2015-01-01

    Objective Recent evidence suggests that the efficacy of smoking cessation pharmacotherapy can vary across patients based on their genotypes. This study tests whether the coding variant rs16969968 in the CHRNA5 nicotinic receptor gene predicts the effects of combination nicotine replacement therapy (cNRT) and varenicline on treatment outcomes. Method In two randomized smoking cessation trials comparing cNRT vs. placebo, and varenicline vs. placebo, we used logistic regression to model associations between CHRNA5 rs16969968 and abstinence at end of treatment. Results For abstinence at end of treatment, there was an interaction between cNRT and rs16969968 (X2=8.15, df=2, omnibus-p=0.017 for the interaction); individuals with the high-risk AA genotype were more likely to benefit from cNRT. In contrast, varenicline increased abstinence, but its effect did not vary with CHRNA5. However, the genetic effects differed between the placebo control groups across two trials (wald=3.94, df=1, p=0.047), this non-replication can alter the interpretation of pharmacogenetic findings. Conclusions Results from two complementary smoking cessation trials demonstrate inconsistent genetic results in the placebo arms. This evidence highlights the need to compare the most effective pharmacotherapies with the same placebo control to establish pharmacogenetic evidence to aid decisions on medication choice for patients trying to quit smoking. PMID:26142345

  10. Correlates of Medical Nutrition Therapy and Cardiovascular Outcomes in Youth with Type 1 Diabetes

    PubMed Central

    The, Natalie S.; Crandell, Jamie L.; Thomas, Joan; Couch, Sarah C.; Shah, Amy S.; Maahs, David M; Dabelea, Dana; Marcovina, Santica M.; D'Agostino, Ralph B.; Mayer-Davis, Elizabeth J.

    2013-01-01

    Objective To examine whether the types of medical nutrition therapies (MNTs) taught to and used by youth with type 1 diabetes (T1D) varies by socio-demographic characteristics and cardiovascular (CVD) risk factors Design Cross-sectional study Setting The SEARCH for Diabetes in Youth study is a population-based cohort of individuals with clinical diagnosed diabetes Participants 1,191 individuals with T1D Main Outcome Measures Types of MNTs and frequency of use Analysis Bivariate analysis and multivariate linear regression (P<0.05) Results More race/ethnic minorities (vs. whites), individuals with parents

  11. Medical expulsive therapy for ureteral stones: where do we go from here?

    PubMed

    Somani, Bhaskar K; Aboumarzouk, Omar; Traxer, Olivier; Baard, Joyce; Kamphuis, Guido; de la Rosette, Jean

    2016-10-01

    Despite two decades of clinical use, the effectiveness of medical expulsive therapy (MET) for the noninvasive management of patients with ureteral stones has, in the past year, been called into in question. The primary aim of MET is to expedite stone passage, although it has also shown effectiveness in reducing time to stone passage, thus reducing the incidence of colic episodes, improving stone clearance and improving patients' quality of life. At least 11 systematic reviews and meta-analyses have been published showing clinical benefits of MET; however, the results of these analyses have been challenged by data from two randomized controlled, multicentre trials with large patient cohorts, thus providing higher quality evidence that MET is ineffective in patients with ureteral stones. Results of the various systematic reviews and meta-analyses have suggested that MET is effective, however, such analyses incorporate the biases and limitations of smaller cohort studies, resulting in their conclusions being based upon lower-quality evidence. Evidence for the use of MET for small (<5 mm) distal ureteral stones has weakened based on clinical trial data published in 2015. However, MET might remain effective in the management of larger ureteral stones (>5 mm). PMID:27480950

  12. Intensive Family-Based Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: Applications for Treatment of Medication Partial- or Nonresponders

    ERIC Educational Resources Information Center

    Marien, Wendi E.; Storch, Eric A.; Geffken, Gary R.; Murphy, Tanya K.

    2009-01-01

    Serotonin reuptake inhibitor medications and cognitive-behavioral therapy (CBT) are both effective treatments for pediatric obsessive-compulsive disorder (OCD). Despite recommendations that youth with OCD be treated with CBT alone or together with serotonin reuptake inhibitor medication, many youth are treated with medication alone or with non-CBT…

  13. The Antarctic Ozone Hole

    ERIC Educational Resources Information Center

    Jones, Anna E.

    2008-01-01

    Since the mid 1970s, the ozone layer over Antarctica has experienced massive destruction during every spring. In this article, we will consider the atmosphere, and what ozone and the ozone layer actually are. We explore the chemistry responsible for the ozone destruction, and learn about why conditions favour ozone destruction over Antarctica. For…

  14. 42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Screening for potential drug therapy problems due to therapeutic duplication. (ii) Age/gender-related... dosage or duration of drug therapy. (vi) Drug-allergy contraindications. (vii) Clinical abuse/misuse....

  15. The use of the intraooperative ozone - theraphy as prophylaxis of infections in surgery of locomotor system with special regard to total hip plasty - a preliminary study.

    PubMed

    Białoszewski, Dariusz

    2003-12-30

    Background. Ozone therapy - i.e. the treatment of patients by a mixture of oxygen and ozone - has been used for many years as a method ancillary to basic treatment, especially in those cases in which traditional treatment methods do not give satisfactory results. As it is widely known, ozone has antiseptic properties, specially on bacteria, ozone therapy has been used as a method of safeguarding tissues intraoperatively against infection with pathogenic hospital bacteria.
    Material and methods. The investigation was carried out in the Chair and Department of Orthopedics and Traumatology of the Locomotor System at the Medical University in Warsaw. For investigative procedures a prototype of apparatus for intraoperative ozone therapy was built and own method of administration of ozone was devised. The Bioethics Commission of the Medical University in Warsaw agreed to the proposed procedures. From 3rd June to November 2003 this technique was administered to 83 patients who underwent total hip plasty with and without cement. The control group contained 80 patients who underwent similar procedures in 2003 without ozone therapy prophylaxis.
    Results. No negative influence of the technique was observed during operative procedure. No adverse effects were observed in patients i.e.: wound inflammation, increase of postoperative pain, latency to early rehabilitation and elongation of hospital stay. In the observed group no septic complications were noted.
    The evaluated prototype received a sympathetic reaction from the surgeons and middle medical staff. Troubleshooting of the prototype was minor and mainly due to misuse of the prototype.
    After preliminary investigation we can state that the prototype is safe to the patients and user-friendly to the medical staff.
    In the control group of 80 hip plasty two early septic complications were observed. The observation time of both groups was 4.6 months mean.
    Conclusions. The usefulness of the

  16. Clinical trials of boron neutron capture therapy [in humans] [at Beth Israel Deaconess Medical Center][at Brookhaven National Laboratory

    SciTech Connect

    Wallace, Christine

    2001-05-29

    Assessment of research records of Boron Neutron Capture Therapy was conducted at Brookhaven National Laboratory and Beth Israel Deaconess Medical Center using the Code of Federal Regulations, FDA Regulations and Good Clinical Practice Guidelines. Clinical data were collected from subjects' research charts, and differences in conduct of studies at both centers were examined. Records maintained at Brookhaven National Laboratory were not in compliance with regulatory standards. Beth Israel's records followed federal regulations. Deficiencies discovered at both sites are discussed in the reports.

  17. Medication-Taking Practices of Patients on Antiretroviral HIV Therapy: Control, Power, and Intentionality.

    PubMed

    Muessig, Kathryn E; Panter, Abigail T; Mouw, Mary S; Amola, Kemi; Stein, Kathryn E; Murphy, Joseph S; Maiese, Eric M; Wohl, David A

    2015-11-01

    Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) is crucial for health, but patients face numerous challenges achieving sustained lifetime adherence. We conducted six focus groups with 56 PLWH regarding ART adherence barriers and collected sociodemographics and ART histories. Participants were recruited through clinics and AIDS service organizations in North Carolina. Dedoose software was used to support thematic analysis. Participants were 59% male, 77% black, aged 23-67 years, and living with HIV 4-20 years. Discussions reflected the fluid, complex nature of ART adherence. Maintaining adherence required participants to indefinitely assert consistent control across multiple areas including: their HIV disease, their own bodies, health care providers, and social systems (e.g., criminal justice, hospitals, drug assistance programs). Participants described limited control over treatment options, ART's impact on their body, and inconsistent access to ART and subsequent inability to take ART as prescribed. When participants felt they had more decision-making power, intentionally choosing whether and how to take ART was not exclusively a decision about best treating HIV. Instead, through these decisions, participants tried to regain some amount of power and control in their lives. Supportive provider relationships assuaged these struggles, while perceived side-effects and multiple co-morbidities further complicated adherence. Adherence interventions need to better convey adherence as a continuous, changing process, not a fixed state. A perspective shift among care providers could also help address negative consequences of the perceived power struggles and pressures that may drive patients to exert control via intentional medication taking practices.

  18. Pharmacists’ perceptions of advancing public health priorities through medication therapy management

    PubMed Central

    2016-01-01

    Background: Public health priorities can be addressed by pharmacists through channels such as medication therapy management (MTM) to optimize patient and population outcomes. However, no studies have specifically assessed pharmacists’ perceptions of addressing public health priorities through MTM. Objective: The objective of this study was to assess pharmacists’ opinions regarding the feasibility and appropriateness of addressing seven areas of public health priority through MTM services to impact public health in direct patient care settings. Methods: An anonymous 37-question electronic survey was conducted to evaluate Ohio pharmacists’ opinions of advancing seven public health priorities identified from Healthy People 2020 (family planning, preconception care, smoking cessation, immunizations, nutrition/biometric wellness assessments, point-of-care testing, fall prevention) through MTM activities; to identify potential barriers; and to collect demographic information. The cross-sectional survey was sent to a random sample of 500 pharmacists registered with the Ohio State Board of Pharmacy. Results: Seventy-six pharmacists responded to the survey, resulting in a 16% response rate. On average, it took respondents 5-10 minutes to complete the survey. The majority of respondents thought that each of the seven public health priorities were “important” or “very important” to patient health; the most commonly identified areas included smoking cessation, immunizations, and fall prevention (97.5%). When asked to indicate which of the seven areas they thought they could potentially have a role to provide services through MTM, on average pharmacists picked 4 of the priority areas. Only 6.6% indicated there was no role for pharmacists to provide MTM services for any of the listed categories. Staffing, time, and reimbursement represented the most commonly perceived barriers for pharmacists in providing MTM services. Fifty-seven percent indicated an interest in

  19. Predictors and Outcomes of Routine Versus Optimal Medical Therapy in Stable Coronary Heart Disease.

    PubMed

    Chun, Soohun; Qiu, Feng; Austin, Peter C; Ko, Dennis T; Mamdani, Muhammad; Wijeysundera, Duminda N; Czarnecki, Andrew; Bennell, Maria C; Wijeysundera, Harindra C

    2015-09-01

    Although randomized studies have shown optimal medical therapy (OMT) to be as efficacious as revascularization in stable coronary heart disease (CHD), the application of OMT in routine practice is suboptimal. We sought to understand the predictors of receiving OMT in stable CHD and its impact on clinical outcomes. All patients with stable CHD based on coronary angiography from October 2008 to September 2011 were identified in Ontario, Canada. OMT was defined as concurrent use of β blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statin. Aspirin use was not part of the OMT definition because of database limitations. Multivariable hierarchical logistic models identified predictors of OMT in the 12 months after angiography. Cox proportional hazard models with time-varying covariates for OMT and revascularization status examined differences in death and nonfatal myocardial infarction (MI). In these models, patients transitioned among 4 mutually exclusive treatment groups: no OMT and no revascularization, no OMT and revascularization, OMT and no revascularization, OMT and revascularization. Our cohort had 20,663 patients. Over a mean period of 2.5 years, 8.7% had died. Only 61% received OMT within 12 months. The strongest predictor of receiving OMT at 12 months was OMT before the angiogram (odds ratio 14.40, 95% confidence interval [CI] 13.17 to 15.75, p <0.001). Relative to no OMT and nonrevascularized patients, patients on OMT and revascularized had the greatest reduction in mortality (hazard ratio 0.52, 95% CI 0.45 to 0.60, p <0.001) and nonfatal MI (hazard ratio 0.74, 95% CI 0.64 to 0.84, p <0.001). In conclusion, our study highlights the low rate of OMT in stable CHD. Patients who received both OMT and revascularization achieved the greatest reduction in mortality and nonfatal MI. PMID:26119653

  20. Predictive parameters for medical expulsive therapy in ureteral stones: a critical evaluation.

    PubMed

    Sahin, Cahit; Eryildirim, Bilal; Kafkasli, Alper; Coskun, Alper; Tarhan, Fatih; Faydaci, Gokhan; Sarica, Kemal

    2015-06-01

    To evaluate the predictive value of some certain radiological as well as stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in ureteral stones. A total 129 patients receiving MET for 5 to 10 mm ureteral stones were evaluated. Patients were divided into two subgroups where MET was successful in 64 cases (49.61%) and unsuccessful in 65 cases (50.39%). Prior to management, stone size, location, position in the ureter, degree of hydronephrosis, diameter of ureteral lumen proximal to the stone, ureteral wall thickness along with patient's demographics including body mass index (BMI) values were evaluated and recorded. The possible predictive values of these parameters for stone expulsion (and stone expulsion time) were evaluated in a comparative manner between two groups. The overall mean patient age and stone size values were 38.02 ± 0.94 years and 40.31 ± 1.13 mm(2), respectively. Regarding the predictive values of these parameters for MET-success, while stone size and localization, degree of hydronephrosis, proximal ureteral diameter and ureteral wall thickness were found to be highly predictive for MET-success, patients age, BMI values and stone density had no predictive value on this aspect. Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in an effective manner. With this approach unnecessary use of these drugs that may cause a delay for stone removal will be avoided and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized.

  1. Pre-treatment Anxiety Predicts Patterns of Change in Cognitive Behavioral Therapy and Medications for Depression

    PubMed Central

    Forand, Nicholas R.; DeRubeis, Robert J.

    2014-01-01

    Objective Some studies report that initial anxiety is associated with equivocal or negative effects in depression treatment. In contrast, at least four studies of cognitive behavioral therapy (CBT) report that anxiety predicts greater or more rapid change in depression. Further exploration is needed to clarify the relationship between initial anxiety and depression change. Questions include the relationship between anxiety and patterns of change and time to relapse, as well the specificity effects to CBT. Method The study assessed the relation of Beck Anxiety Inventory anxiety scores to early rapid change and overall change in Beck Depression Inventory-II depression scores during acute depression treatment. Participants were 178 individuals enrolled in a randomized controlled trial of CBT versus medications (ADM) for moderate to severe depression. They were 58% female and 83% Caucasian, with an average age of 40 (SD = 11.5). Thirty four percent (34%) were married or cohabitating. Hierarchical linear models including quadratic growth parameters were used to model change. The relation of anxiety to the probability of post-treatment relapse was also examined. Results Findings indicate that higher levels of anxiety predict early rapid change, but not overall change, in both CBT and ADM. However, patients with higher levels of intake anxiety evidenced increased risk for relapse after CBT. Conclusions Early rapid change predicted by anxiety occurs across different treatment conditions, but this early rapid response is not indicative of positive overall outcome in all cases. These findings might indicate that anxiety predicts a response to non-specific “common factors” of treatment. PMID:23647285

  2. [Optimization of postoperative medical therapy of infective endocarditis in patients with congenital valvular heart disease].

    PubMed

    Chistyakov, I S; Medvedev, A P; Pichugin, V V

    2016-01-01

    The purpose of this study was to evaluate the effectiveness of combined surgical and medical treatment of infective endocarditis in patients with congenital valvular heart disease when included in a regimen of the drug Reamberin. In this regard, the analysis of the effectiveness of a combination regimen of 74 patients with valvular congenital heart diseases complicated with infective endocarditis. Given the indications for surgical correction operative technique features and possible technical difficulties in carrying out such operations, due to the inflammatory changes and tissue destruction, and ways to overcome them. For the correction of metabolic disorders in the postoperative period, 47 patients (main group) was appointed Reamberin: once, intravenous drip 400 ml/day during the first 5 days after surgery. 27 patients (control group) was conducted infusion therapy depending on the severity of the condition according to the classical scheme. In addition to standard clinical and laboratory examination, to assess the effectiveness of Reamberin was investigated catalase activity of CPK in blood serum in the dynamics of observation (1, 3 and 5 days after surgery). It is revealed that surgical approach, used in complex treatment of patients with valvular congenital heart diseases, including reorganization of the cavities of the heart, increasing the frequency of joints and the use of reinforcing strips of synthetic material that prevents the cutting of sutures through the inflamed tissue has achieved good short-and long-term results. Infective endocarditis and destruction of the valvular annulus fibrosus the use of a frame of strips of polytetrafluoroethylene allows you to restore its integrity and to implant a mechanical prosthesis. The inclusion in the regimen of patients with infective endocarditis complicated by cardiac insufficiency in the early postoperative period the drug Reamberin improves the efficiency of treatment by a more rapid restoration of the normal

  3. Comparative efficacy of tadalafil versus tamsulosin as the medical expulsive therapy in lower ureteric stone: a prospective randomized trial

    PubMed Central

    Mylarappa, Prasad; Aggarwal, Kuldeep; Patil, Avinash; Joshi, Prarthan; Desigowda, Ramesh

    2016-01-01

    Introduction In recent years, medical expulsive therapy has been used in the management of distal ureteric stones as a supplement to conservative treatment. Therefore, we conducted a prospective randomized study to evaluate the possible role of tadalafil individually in comparison with proven tamsulosin therapy in ureteric stone expulsion. The aim of this study is to compare the safety and efficacy of a phosphodiesterase-5 inhibitor (tadalafil) and an α-1 blocker (tamsulosin) as medical expulsive therapy for distal ureteric calculi. Material and methods Between August 2014 and October 2015, 207 patients who presented with distal ureteric stones of size 5–10 mm were randomly divided into two groups: tadalafil (Group A) and tamsulosin (Group B). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up, endoscopic treatment and adverse effects of drugs were noted. Both groups were compared for normally distributed data by percentage, analysis of variance, and T-test. All the classified and categorical data were analyzed for both groups using the chi-square test. Results A statistically significant expulsion rate of 84.0% in Group A compared with 68.0% in Group B (P value = 0.0130), and shorter stone expulsion time in Group A (14.7±3.8) in comparison to Group B (16.8 ±4.5) was observed. Statistically significant differences were noted in renal colic episodes and analgesic requirement in Group A than Group B. No serious adverse effects were noted. Conclusions Tadalafil is safe, efficacious, and well tolerated as medical expulsive therapy for distal ureteric stones. This study showed that tadalafil increases ureteric stone expulsion quite significantly along with better control of pain and significantly lower analgesic requirement. PMID:27551555

  4. Religiously integrated cognitive behavioral therapy: a new method of treatment for major depression in patients with chronic medical illness.

    PubMed

    Pearce, Michelle J; Koenig, Harold G; Robins, Clive J; Nelson, Bruce; Shaw, Sally F; Cohen, Harvey J; King, Michael B

    2015-03-01

    Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients' spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive-behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155

  5. Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness

    PubMed Central

    Pearce, Michelle J.; Koenig, Harold G.; Robins, Clive J.; Nelson, Bruce; Shaw, Sally F.; Cohen, Harvey J.; King, Michael B.

    2015-01-01

    Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients’ spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive–behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155

  6. A digital health solution for using and managing medications: wirelessly observed therapy.

    PubMed

    DiCarlo, Lorenzo; Moon, Greg; Intondi, Allison; Duck, Robert; Frank, Jeremy; Hafazi, Hooman; Behzadi, Yashar; Robertson, Timothy; Costello, Ben; Savage, George; Zdeblick, Mark

    2012-01-01

    Taking oral medication on a prescribed schedule can be a nuisance, especially for elderly individuals and busy people with lots of things on their minds. Nonetheless, taking medication as prescribed is important for maintaining health and well-being. In cases where medication use is part of a clinical trial, taking prescribed medication is important to the entire investigation and outcome of the study, including the determination of whether a drug is effective and safe.

  7. Chronic pelvic pain syndrome: reduction of medication use after pelvic floor physical therapy with an internal myofascial trigger point wand.

    PubMed

    Anderson, Rodney U; Harvey, Richard H; Wise, David; Nevin Smith, J; Nathanson, Brian H; Sawyer, Tim

    2015-03-01

    This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03). PMID:25708131

  8. Chronic pelvic pain syndrome: reduction of medication use after pelvic floor physical therapy with an internal myofascial trigger point wand.

    PubMed

    Anderson, Rodney U; Harvey, Richard H; Wise, David; Nevin Smith, J; Nathanson, Brian H; Sawyer, Tim

    2015-03-01

    This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

  9. Earth's Endangered Ozone

    ERIC Educational Resources Information Center

    Panofsky, Hans A.

    1978-01-01

    Included are (1) a discussion of ozone chemistry; (2) the effects of nitrogen fertilizers, fluorocarbons, and high level aircraft on the ozone layer; and (3) the possible results of a decreasing ozone layer. (MR)

  10. Medical therapy of stricturing Crohn’s disease: what the gut can learn from other organs - a systematic review

    PubMed Central

    2014-01-01

    Crohn’s disease (CD) is a chronic remitting and relapsing disease. Fibrostenosing complications such as intestinal strictures, stenosis and ultimately obstruction are some of its most common long-term complications. Despite recent advances in the pathophysiological understanding of CD and a significant improvement of anti-inflammatory therapeutics, medical therapy for stricturing CD is still inadequate. No specific anti-fibrotic therapy exists and the incidence rate of strictures has essentially remained unchanged. Therefore, the current therapy of established fibrotic strictures comprises mainly endoscopic dilation as well as surgical approaches. However, these treatment options are associated with major complications as well as high recurrence rates. Thus, a specific anti-fibrotic therapy for CD is urgently needed. Importantly, there is now a growing body of evidence for prevention as well as effective medical treatment of fibrotic diseases of other organs such as the skin, lung, kidney and liver. In face of the similarity of molecular mechanisms of fibrogenesis across these organs, translation of therapeutic approaches from other fibrotic diseases to the intestine appears to be a promising treatment strategy. In particular transforming growth factor beta (TGF-β) neutralization, selective tyrosine kinase inhibitors, blockade of components of the renin-angiotensin system, IL-13 inhibitors and mammalian target of rapamycin (mTOR) inhibitors have emerged as potential drug candidates for anti-fibrotic therapy and may retard progression or even reverse established intestinal fibrosis. However, major challenges have to be overcome in the translation of novel anti-fibrotics into intestinal fibrosis therapy, such as the development of appropriate biomarkers that predict the development and accurately monitor therapeutic responses. Future clinical studies are a prerequisite to evaluate the optimal timing for anti-fibrotic treatment approaches, to elucidate the best

  11. Ozone crisis

    SciTech Connect

    Roan, S.

    1989-01-01

    The author presents an account of the depletion of the atmosphere's ozone layer since the discovery of the phenomenon 15 years ago. The book recounts the flight to ban chlorofluorocarbons (CFC's) and describes the science, the people, and the politics involved, up to the March 1988 international treaty restricting CFC production. It surveys the media's coverage, describes the struggle for remedies, and offers a prognosis for the future.

  12. [An electronic medical record information system of DICOM-RT module-based in radiation therapy].

    PubMed

    Xia, Deguo; Zhou, Linghong; Lei, Li

    2012-06-01

    Electronic medical records (EMR) is the clinical diagnosis, guiding intervention and digital medical service record of outpatient, hospital patients (or care object) in medical institution. And it is the complete, detailed clinical information resource which has produced and recorded in all previous medical treatments. Radiotherapy electronic medical records contain texts, images and graphics, therefore the information is more complicated. This paper proposes an EMR information system based on DICOM-RT standard, through the use of seven objects of DICOM-RT to achieve the information exchange and sharing between different systems, equipments, convenient radiotherapy treatment data management, improve the efficiency of radiation treatment.

  13. A Review of the Properties and Applications of Ozone in Endodontics: An Update

    PubMed Central

    Mohammadi, Zahed; Shalavi, Sousan; Soltani, Mohammad Karim; Asgary, Saeed

    2013-01-01

    Ozone is a triatomic molecule consisting of three oxygen atoms. It is applied to oral tissues in the forms of ozonated water, ozonated olive oil and oxygen/ozone gas. This paper presents a brief review on the chemistry of ozone as well as its medical and dental applications focusing on its use in endodontics. Ozone’s antimicrobial activity, its effect on dentin bonding, toxicity and contra-indications are also reviewed. PMID:23717326

  14. Off-label use of medical products in radiation therapy: Summary of the Report of AAPM Task Group No. 121

    SciTech Connect

    Thomadsen, Bruce R.; Thompson, Heaton H. II; Jani, Shirish K.; and others

    2010-05-15

    approval process, along with manufacturers' responsibilities, labeling, marketing and promotion, and off-label use. This is an educational and descriptive report and does not contain prescriptive recommendations. This report addresses the role of the medical physicist in clinical situations involving off-label use. Case studies in radiation therapy are presented. Any mention of commercial products is for identification only; it does not imply recommendations or endorsements of any of the authors or the AAPM. The full report, containing extensive background on off-label use with several appendices, is available on the AAPM website (http://www.aapm.org/pubs/reports/).

  15. Impact of initial topical medical therapy on short-term quality of life in newly diagnosed patients with primary glaucoma

    PubMed Central

    Arora, Vishal; Bali, Shveta Jindal; Gupta, Sanjeev Kumar; Vashisht, Praveen; Agarwal, Tushar; Sreenivas, Vishnubhatla; Dada, Tanuj

    2015-01-01

    Purpose: To evaluate the impact of initial topical medical therapy on newly diagnosed glaucoma patients using the Indian Vision Function Questionnaire (IND-VFQ33). Patients and Methods: The IND-VFQ33 was used to evaluate the quality of life (QoL) in 62 newly diagnosed patients with moderate to severe primary glaucoma and 60 healthy controls. IND-VFQ33 is a 33 item QoL assessment tool with three domains: General functioning, psychosocial impact and visual symptoms. The glaucoma patients were started on medical therapy and the QoL assessment was repeated after 3 months. Results: Glaucoma patients (mean age: 55.6 ± 9.6 years, range 40–77 years) and controls (mean age: 54.9 ± 6.7 years, 42–73 years) were matched with respect to age (P = 0.72), gender (P = 0.91) and literacy (P = 0.18). Glaucoma patients had significantly worse QoL as compared to controls at baseline across all the three domains (P < 0.001). 3 months after initiation of treatment, the overall QoL life significantly worsened from baseline with a decrease in general functioning (P < 0.001) and psychosocial impact (P = 0.041). Visual acuity in better eye significantly co-related to poor QoL at baseline (P < 0.001) and at 3 months (P = 0.04). In addition, the use of >2 topical medications significantly co-related to poor QoL at 3 months (P = 0.01). Conclusions: Evaluation using the IND-VFQ33 revealed that newly diagnosed glaucoma patients have a significant worsening of QoL after initiation of topical ocular hypotensive therapy. This should be an important consideration when educating patients about the disease and its therapy. PMID:26265642

  16. Technical aspects of boron neutron capture therapy at the BNL Medical Research Reactor

    SciTech Connect

    Holden, N.E.; Rorer, D.C.; Patti, F.J.; Liu, H.B.; Reciniello, R.; Chanana, A.D.

    1997-07-01

    The Brookhaven Medical Research Reactor, BMRR, is a 3 MW heterogeneous, tank-type, light water cooled and moderated, graphite reflected reactor, which was designed for biomedical studies. Early BNL work in Boron Neutron Capture Therapy (BNCT) used a beam of thermal neutrons for experimental treatment of brain tumors. Research elsewhere and at BNL indicated that higher energy neutrons would be required to treat deep seated brain tumors. Epithermal neutrons would be thermalized as they penetrated the brain and peak thermal neutron flux densities would occur at the depth of brain tumors. One of the two BMRR thermal port shutters was modified in 1988 to include plates of aluminum and aluminum oxide to provide an epithermal port. Lithium carbonate in polyethylene was added in 1991 around the bismuth port to reduce the neutron flux density coming from outside the port. To enhance the epithermal neutron flux density, the two vertical thimbles A-3 (core edge) and E-3 (in core) were replaced with fuel elements. There are now four fuel elements of 190 grams each and 28 fuel elements of 140 grams each for a total of 4.68 kg of {sup 235}U in the core. The authors have proposed replacing the epithermal shutter with a fission converter plate shutter. It is estimated that the new shutter would increase the epithermal neutron flux density by a factor of seven and the epithermal/fast neutron ratio by a factor of two. The modifications made to the BMRR in the past few years permit BNCT for brain tumors without the need to reflect scalp and bone flaps. Radiation workers are monitored via a TLD badge and a self-reading dosimeter during each experiment. An early concern was raised about whether workers would be subject to a significant dose rate from working with patients who have been irradiated. The gamma ray doses for the representative key personnel involved in the care of the first 12 patients receiving BNCT are listed. These workers did not receive unusually high exposures.

  17. A review of current research in microwave resonance therapy: novel opportunities in medical treatment.

    PubMed

    Jovanović-Ignjatić, Z; Raković, D

    1999-01-01

    Microwave Resonance Therapy (MRT) is a novel medical treatment, which represents a synthesis of the ancient Chinese traditional knowledge in medicine (acupuncture) and recent breakthroughs in biophysics. By affecting the appropriate acupuncture points by the generation of high frequency microwaves (52-78 GHz), remarkable clinical results are being achieved in surgery, orthopedic and traumatology, cardiovascular disorders, urology, gynecology, dermatology, gastroenterology, pulmology, upper respiratory tract, cardiology, neurology, and oncology during the last decade--the MRT being contraindicated only in the cases of acute pain in the abdomen demanding an operation, pregnancy, and menstruation cycle. In this paper the quantum-like macroscopic biophysical basis of the MRT and its technical details are elaborated too, offering a new insight in the mechanisms of the assembling gap junction hemichannels upon the internal microwave (MW) electromagnetic field spatio-temporal maximums at the temporary position of the acupuncture system, and, hence, the very biophysical nature of the temporary psychosomatic health or disease. The quantum-like coherent characteristics of the MRT (sharply-resonant sensory response of the disordered organism, extremely low-intensity and low-energy non-thermal biologically efficient MW radiation, and negligible MW energy losses down acupuncture meridians) might be viewed as a consequence of the existence of biological nonlocal selfconsistent macroscopic quantum potentials, which can give rise to nonlinear coherent EM MW long-range maser-like excitations of biological nonlinear absorption medium with the cells as active centers--with acupuncture meridians related to eigenfrequencies and spatio-temporal eigenwaves distributions of every individual biological quantum system. This suggests that a healthy condition might be considered as an absolute minimum (ground state) of the nonlocal selfconsistent macroscopic quantum potential of the organism

  18. Medical Music Therapy: A Model Program for Clinical Practice, Education, Training and Research

    ERIC Educational Resources Information Center

    Standley, Jayne

    2005-01-01

    This monograph evolved from the unique, innovative partnership between the Florida State University Music Therapy Program and Tallahassee Memorial HealthCare. Its purpose is to serve as a model for music therapy educators, students, clinicians, and the hospital administrators who might employ them. This book should prove a valuable resource for…

  19. Assessing the effectiveness of pharmacist- directed medication therapy management in improving diabetes outcomes in patients with poorly controlled diabetes

    PubMed Central

    Skinner, Jeannine S.; Poe, Brett; Hopper, Rebecca; Boyer, Alaina; Wilkins, Consuelo H.

    2015-01-01

    Purpose The purpose of this study was to compare medication adherence rates and type 2 diabetes mellitus (T2DM) health outcomes in a sample of underserved patients with suboptimally controlled T2DM (HbA1C>7%) who had received pharmacist-directed medication therapy management (MTM) to those who had not received MTM. Methods A retrospective review of 100 patient records was conducted. For the MTM group, a pharmacist engaged patients in patient-centered services to optimize therapeutic outcomes. Non-MTM patients received usual care. Outcomes were HbA1C, medication adherence, blood pressure, lipids and creatinine. Group comparisons on clinical outcomes were analyzed before and after matching MTM and non-MTM patients on demographic characteristics. Results Before matching, the MTM group had a higher rate of medication adherence than the non-MTM group. Hemoglobin A1C levels were lower in the MTM group compared to the non-MTM group. Similarly, low density lipoprotein (LDL) cholesterol were lower in the MTM group compared to the non-MTM group. After matching, medication adherence rate remained higher in the MTM group than the non-MTM group. Similarly, HbA1C levels remained lower in the MTM group than the non-MTM group. Conclusions There is a paucity of research focused on behavioral interventions for improving health outcomes in underserved communities. Our results advance the existing literature by demonstrating a positive association between pharmacist-directed MTM, medication adherence, and glycemic control in a sample of underserved patients with suboptimally controlled T2DM. A prospective pharmacy intervention and examination of long-term effects of MTM on medication adherence and T2DM health outcomes in this population is warranted. PMID:26009557

  20. Men Who Have Sex with Men in Peru: Acceptability of Medication-Assisted Therapy for Treating Alcohol Use Disorders

    PubMed Central

    Brown, Shan-Estelle; Vagenas, Panagiotis; Konda, Kelika A.; Clark, Jesse L.; Lama, Javier R.; Gonzales, Pedro; Sanchez, Jorge; Duerr, Ann C.; Altice, Frederick L.

    2015-01-01

    In Peru, the HIV epidemic is concentrated in men who have sex with men (MSM) and transgender women (TGW). Multiple studies correlate alcohol use disorders (AUDs) with risky sexual behaviors among Peruvian MSM. Qualitative research was used to inform a clinical trial on the acceptability of medication-assisted therapies (MAT) to assist management of AUDs and improve antiretroviral therapy (ART) adherence among MSM/TGW in Peru. Three focus groups involving HIV-infected or HIV-uninfected MSM/TGW (n=26) with AUDs (AUDIT≥ 8) were transcribed, translated from Spanish into English, and analyzed using thematic content analysis. Despite having an AUD, participants considered themselves as “social” drinkers, minimized their drinking behaviors, and differed about whether or not alcohol problems could be treated. Participants expressed skepticism about medication for treating AUDs. Three concepts emerged as necessary components of a treatment program for alcohol problems: cost, family support, and the potential to drink less alcohol without attaining total abstinence. This study reveals important areas of education to increase potential acceptability of a medication for treating AUDs among MSM/TGW. Given the social conditions and knowledge base of the participants, MAT using naltrexone may be a beneficial strategy for MSM with AUDs. PMID:25787988

  1. 42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-utilization and under-utilization of prescribed medications; and (3) Provides CMS with information concerning... examination of claims data and other records, through computerized drug claims processing and information retrieval systems, in order to identify patterns of inappropriate or medically unnecessary care...

  2. Faster Remission of Chronic Depression with Combined Psychotherapy and Medication than with Each Therapy Alone

    ERIC Educational Resources Information Center

    Manber, Rachel; Kraemer, Helena C.; Arnow, Bruce A.; Trivedi, Madhukar H.; Rush, A. John; Thase, Michael E.; Rothbaum, Barbara O.; Klein, Daniel N.; Kocsis, James H.; Gelenberg, Alan J.; Keller, Martin E.

    2008-01-01

    The main aim of the present novel reanalysis of archival data was to compare the time to remission during 12 weeks of treatment of chronic depression following antidepressant medication (n = 218), psychotherapy (n = 216), and their combination (n = 222). Cox regression survival analyses revealed that the combination of medication and psychotherapy…

  3. Percutaneous closure versus medical therapy alone for cryptogenic stroke patients with a patent foramen ovale: meta-analysis of randomized controlled trials.

    PubMed

    Pickett, Christopher A; Villines, Todd C; Ferguson, Michael A; Hulten, Edward A

    2014-08-01

    Of cryptogenic stroke patients younger than 55 years of age, up to 61% have had a patent foramen ovale (PFO). Observational studies have revealed reductions in recurrent neurologic events through PFO closure versus medical therapy, and randomized controlled trials have shown nonsignificant trends toward benefit. We systematically searched for randomized controlled trials of percutaneous PFO closure with medical therapy versus medical therapy alone in patients with cryptogenic stroke and performed a meta-analysis of treatment outcomes. The primary endpoint was combined death, stroke, and transient ischemic attack. We included 3 trials. Of 2,303 total patients, 1,150 underwent PFO closure and 1,153 received medical therapy (median follow-up period, 2.6 yr). The pooled incidence of the primary endpoint was 1.2 events per 100 patient-years in the closure group (95% confidence interval [CI], 0.2-2.3) and 1.8 in the therapy group (95% CI, 0.7-2.9) (P=0.32); the number needed to treat was 167 (range, 100-500). The corresponding pooled hazard ratio was 0.67 (95% CI, 0.44-1.01; P=0.054) in favor of closure. Closure was associated with an increased risk of atrial fibrillation: relative risk=3.51 (95% CI, 1.44-8.55; P=0.006). When stratified by device, use of the Amplatzer™ PFO Occluder resulted in significant stroke-prevention benefit over medical therapy alone: hazard ratio=0.44 (95% CI, 0.21-0.95; P=0.037). When compared with medical therapy alone, PFO closure with medical therapy showed a trend toward a decreased hazard of combined events, although the absolute event reduction was small and the number needed to treat was high.

  4. Electrochemical production of ozone and hydrogen peroxide

    NASA Technical Reports Server (NTRS)

    Murphy, Oliver J. (Inventor); Hitchens, G. Duncan (Inventor)

    1999-01-01

    Methods of using ozone have been developed which sterilize instruments and medical wastes, oxidize organics found in wastewater, clean laundry, break down contaminants in soil into a form more readily digested by microbes, kill microorganisms present in food products, and destroy toxins present in food products. The preferred methods for killing microorganisms and destroying toxins use pressurized, humidified, and concentrated ozone produced by an electrochemical cell.

  5. Issues in Stratospheric Ozone Depletion.

    NASA Astrophysics Data System (ADS)

    Lloyd, Steven Andrew

    Following the announcement of the discovery of the Antarctic ozone hole in 1985 there have arisen a multitude of questions pertaining to the nature and consequences of polar ozone depletion. This thesis addresses several of these specific questions, using both computer models of chemical kinetics and the Earth's radiation field as well as laboratory kinetic experiments. A coupled chemical kinetic-radiative numerical model was developed to assist in the analysis of in situ field measurements of several radical and neutral species in the polar and mid-latitude lower stratosphere. Modeling was used in the analysis of enhanced polar ClO, mid-latitude diurnal variation of ClO, and simultaneous measurements of OH, HO_2, H_2 O and O_3. Most importantly, such modeling was instrumental in establishing the link between the observed ClO and BrO concentrations in the Antarctic polar vortex and the observed rate of ozone depletion. The principal medical concern of stratospheric ozone depletion is that ozone loss will lead to the enhancement of ground-level UV-B radiation. Global ozone climatology (40^circS to 50^ circN latitude) was incorporated into a radiation field model to calculate the biologically accumulated dosage (BAD) of UV-B radiation, integrated over days, months, and years. The slope of the annual BAD as a function of latitude was found to correspond to epidemiological data for non-melanoma skin cancers for 30^circ -50^circN. Various ozone loss scenarios were investigated. It was found that a small ozone loss in the tropics can provide as much additional biologically effective UV-B as a much larger ozone loss at higher latitudes. Also, for ozone depletions of > 5%, the BAD of UV-B increases exponentially with decreasing ozone levels. An important key player in determining whether polar ozone depletion can propagate into the populated mid-latitudes is chlorine nitrate, ClONO_2 . As yet this molecule is only indirectly accounted for in computer models and field

  6. Increasing adherence to topical therapy in psoriasis through use of solution medication.

    PubMed

    Hill, Dane; Farhangian, Michael E; Feldman, Steven R

    2016-01-01

    Patient outcomes and clinical improvement are closely related to topical medication adherence, and is especially important in chronic dermatological diseases such as psoriasis. About one-fifth of patients undergoing topical treatment were dissatisfied with its convenience for various reasons. Providers can help increase adherence through selecting the correct medication vehicle, involving family members or friends in the patient's mediation application, and explaining likely side effects to the patient prior to use of the medication. Increased inherence will lead to better psoriasis disease control. PMID:27617530

  7. Ozone Hole Over Antarctica

    NASA Technical Reports Server (NTRS)

    2002-01-01

    These images from the Total Ozone Mapping Spectrometer (TOMS) show the progressive depletion of ozone over Antarctica from 1979 to 1999. This 'ozone hole' has extended to cover an area as large as 10.5 million square miles in September 1998. The previous record of 10.0 million square miles was set in 1996. The Antarctic ozone hole develops each year between late August and early October. Regions with higher levels of ozone are shown in red. NASA and NOAA instruments have been measuring Antarctic ozone levels since the early 1970s. Large regions of depleted ozone began to develop over Antarctica in the early 1980s. Ozone holes of substantial size and depth are likely to continue to form during the next few years, scientists hope to see a reduction in ozone loss as levels of ozone-destroying CFCs (chlorofluorocarbons) are gradually reduced. Credit: Images by Greg Shirah, NASA Goddard Space Flight Center Scientific Visualization Studio

  8. The Antarctic ozone hole

    NASA Technical Reports Server (NTRS)

    Molina, Mario J.

    1988-01-01

    Observations of Antarctic ozone levels and the discovery of a hole in the Antarctic region are examined. The effects of chlorofluorocarbons (CFCs) on the level of stratospheric ozone are analyzed. Three cycles explaining the cause of ozone depletion in the poles are proposed. A comparison of field data and proposed depletion cycles reveals that the chemical origin of the ozone hole is due to CFCs. The potential global effects of the Antarctic ozone hole are discussed.

  9. [The new possibility of therapy for medical personnel with metabolic syndrome].

    PubMed

    Bakumov, P A; Zerniukova, E A; Grechkina, E R

    2013-01-01

    The possibility of magnesium deficiency correction was investigated in medical personnel with metabolic syndrome. It was shown that treatment with drugs containing magnesium leads to a decrease the cholesterol level.

  10. A Retrospective Analysis of Direct Medical Cost and Cost of Drug Therapy in Hospitalized Patients at Private Hospital in Western India

    PubMed Central

    Kumbar, Shivaprasad Kalakappa

    2015-01-01

    Background Pharmacoeconomics is analytical tool to know cost of hospitalization and its effect on health care system and society. In India, apart from the government health services, private sector also play big role to provide health care services. Objective To study the direct medical cost and cost of drug therapy in hospitalized patients at private hospital. Materials and Methods A retrospective study was conducted at private hospital in a metro city of Western India. Total 400 patients’ billing records were selected randomly for a period from 01/01/2013 to 31/12/2014. Data were collected from medical record of hospital with permission of medical director of hospital. Patients’ demographic profile age, sex, diagnosis and various costs like ICU charge, ventilator charge, diagnostic charge, etc. were noted in previously formed case record form. Data were analysed by Z, x2 and unpaired t-test. Result Patients were divided into less than 45 years and more than 45 year age group. They were divided into medical and surgical patients according to their admission in medical or surgical ward. Mortality, Intensive Care Unit (ICU) admission, patients on ventilator were significantly (p<0.05) higher in medical patients. Direct medical cost, ward bed charge, ICU bed charge, ventilator charge and cost of drug therapy per patient were significantly (p<0.05) higher in medical patients while operation theatre and procedural charge were significantly (p<0.05) higher in surgical patients. Cost of fibrinolytics, anticoagulants, cardiovascular drugs were significantly (p<0.05) higher in medical patients. Cost of antimicrobials, proton pump inhibitors (PPIs), antiemetics, analgesics, were significantly (p<0.05) higher in surgical patients. Conclusion Ward bed charge, ICU bed charge, ventilator charge accounted more than one third cost of direct medical cost in all the patients. Cost of drug therapy was one fourth of direct medical cost. Antimicrobials cost accounted 33% of cost

  11. The efficacy of withdrawal therapy in subjects with chronic daily headache and medication overuse following prophylaxis with topiramate and amitriptyline.

    PubMed

    Valguarnera, Fabio; Tanganelli, Paolo

    2010-06-01

    Management of patients affected by chronic daily headache (CDH) with medication overuse constitutes one of the most important unresolved problems. The uncertainty regarding the classification and the prophylaxis are a remarkable part of this problem. Objectives are to: (1) to evaluate the efficacy of withdrawal therapy following prophylaxis with topiramate and amitriptyline in a population affected by CDH and medication overuse with follow-up at 1 (T1), 3 (T2) and 6 (T3) months; (2) to identify which group of the Silberstein's CDH classification (1994) may benefit from this protocol. Inclusion criteria are patients with CDH (headache for more >15 days/month for at least 3 consecutive months) and medication overuse according with IHS second edition (8.2 group); exclusion criteria are patients with secondary headache. All patients included in the study were hospitalized for 1 week. Type of overuse: combination of medications, 38%; analgesics, 29%; triptans, 29%; opioids, 2%; ergotamines, 2%. During hospitalization the following protocol was applied: desametasone 4 mg i.v./day for 1 week, diazepam 6 mg/day for 10 days and prophylaxis with amitriptylin plus topiramate. This prophylaxis was protracted for at least 6 months. The dosages assumed ranged for amitriptylin from 10 to 20 mg/day and for topiramate from 50 to 100 mg/day. In the last 4 years 105 patients with CDH (age 24-89 years; f 96; m 9) were admitted to the hospital. The protocol was applied in 52 patients (age, 29-65 years; f 49; m 3). At T1, 89% of the patients did not fall again into medication overuse; at T2, 64%; and at T3,45% of the patients remained free from overuse. According to the Silberstein' proposal at T1, 93% of the subjects was affected by transformed migraine; and 7% by tension-type headache. At T3, all the patients free from overuse were affected by transformed migraine. Our data suggest that the patients affected by CDH and medication overuse benefit from withdrawal therapy performed

  12. Cupping therapy: A prudent remedy for a plethora of medical ailments.

    PubMed

    Mehta, Piyush; Dhapte, Vividha

    2015-07-01

    Since ancient times, complementary and alternative medicine (CAM; bǔ chōng yǔ tì dài yī xué) have played an important role in human health and welfare. Many therapeutic approaches in healthcare outside the realm of conventional medicine persist in various parts of the world. There is considerable scientific and commercial potential in CAM, which needs to be explored precisely. Cupping therapy ( bá guàn liáo fǎ), one of the CAM, is practiced across the world. This therapy is believed to act by correcting imbalances in the internal bio field, such as by restoring the flow of "Qi (qì)". Cupping involves applying a heated cup to generate a partial vacuum that mobilizes the blood flow and promotes effective healing. This review outlines various tools and techniques of cupping therapy. PMID:26151023

  13. Alcohol-antiretroviral therapy interactive toxicity beliefs and daily medication adherence and alcohol use among people living with HIV.

    PubMed

    Pellowski, Jennifer A; Kalichman, Seth C; Kalichman, Moira O; Cherry, Chauncey

    2016-08-01

    Alcohol-antiretroviral therapy (ART) interactive toxicity beliefs reflect perceived adverse outcomes of mixing alcohol and ART. Previous research has shown a significant relationship between alcohol-ART interactive toxicity beliefs and ART non-adherence, over and above other correlates of non-adherence such as human immunodeficiency virus (HIV)symptoms and frequency of alcohol use. Most past studies have collected data over extended periods and have not determined if alcohol use and missed medications occur at the day-level among people holding interactive toxicity beliefs. Previous daily analyses, however, have been limited by self-reported adherence and relatively short periods of observation. To address these gaps in the literature, men and women living with HIV in Atlanta, GA, were enrolled in a 45-day observational cohort study. Daily alcohol use was collected using two-way interactive text message surveys and daily adherence was collected via the Wisepill device. Fifty-seven participants completed a measure of alcohol-ART interactive toxicity beliefs and contributed 2565 days of daily data. Participants who endorsed high levels of interactive toxicity beliefs had significantly more days when they missed doses of medication. Alcohol-antiretroviral toxicity beliefs predicted missing doses of medication on days when participants were drinking and on days when they were not drinking. Multilevel multivariate regressions showed that these toxicity beliefs predicted daily missed doses of medication over and above quantity of alcohol consumed, depression and general medication concerns. This study replicates and extends previous literature and indicates the necessity of addressing alcohol-ART toxicity beliefs within adherence interventions.

  14. Utilization of medical treatments and adherence to antiretroviral therapy among HIV-positive adults with histories of childhood sexual abuse.

    PubMed

    Meade, Christina S; Hansen, Nathan B; Kochman, Arlene; Sikkema, Kathleen J

    2009-04-01

    HIV is a chronic, life-threatening illness that necessitates regular and consistent medical care. Childhood sexual abuse (CSA) is a common experience among HIV-positive adults and may interfere with treatment utilization. This study examined rates and correlates of treatment utilization among HIV-positive adults with CSA enrolled in a coping intervention trial in New York City. The baseline assessment included measures of treatment utilization, mental health, substance abuse, and other psychosocial factors. In 2002-2004, participants (50% female, 69% African-American, M = 42.3 +/- 6.8 years old) were recruited. Nearly all (99%) received HIV medical care. However, 20% had no outpatient visits and 24% sought emergency services in the past 4 months. Among 184 participants receiving antiretroviral therapy (ART), 22% were less than 90% adherent in the past week. In a multivariable logistic regression model, no outpatient treatment was associated with African American race (AOR = 3.46 [1.42-8.40]), poor social support (AOR = 1.59 [1.03-2.45]), and abstinence from illicit drug use (AOR = 0.37 [0.16-0.85]). Emergency service utilization was associated with HIV symptoms (AOR = 2.30 [1.22-4.35]), binge drinking (AOR=2.92 (1.18-7.24)), and illicit drug use (AOR = 1.98 [1.02-3.85]). Poor medication adherence was associated with trauma symptoms (AOR = 2.64 [1.07-6.75]) and poor social support (AOR = 1.82 [1.09-2.97]). In sum, while participants had access to HIV medical care, a sizable minority did not adhere to recommended guidelines and thus may not be benefiting optimally from treatment. Interventions targeting HIV-positive adults with CSA histories may need to address trauma symptoms, substance abuse, and poor social support that interfere with medical treatment utilization and adherence.

  15. Successful Elimination of Ascaris lumbricoides from the Gallbladder by Conservative Medical Therapy.

    PubMed

    Misra, Manish Kumar; Singh, Sarabjeet; Bhagat, Tripta Sethi

    2013-06-01

    Migration of Ascaris lumbricoides into the gallbladder is rare, unlike ascariasis of the bile duct and when it does occur, treatment is generally by endoscopic or surgical extraction. We describe a case of the successful treatment of gallbladder ascariasis with conservative therapy.

  16. Antarctic Ozone Hole, 2000

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Each spring the ozone layer over Antarctica nearly disappears, forming a 'hole' over the entire continent. The hole is created by the interaction of some man-made chemicals-freon, for example-with Antarctica's unique weather patterns and extremely cold temperatures. Ozone in the stratosphere absorbs ultraviolet radiation from the sun, thereby protecting living things. Since the ozone hole was discovered many of the chemicals that destroy ozone have been banned, but they will remain in the atmosphere for decades. In 2000, the ozone hole grew quicker than usual and exceptionally large. By the first week in September the hole was the largest ever-11.4 million square miles. The top image shows the average total column ozone values over Antarctica for September 2000. (Total column ozone is the amount of ozone from the ground to the top of the atmosphere. A relatively typical measurement of 300 Dobson Units is equivalent to a layer of ozone 0.12 inches thick on the Earth's surface. Levels below 220 Dobson Units are considered to be significant ozone depletion.) The record-breaking hole is likely the result of lower than average ozone levels during the Antarctic fall and winter, and exceptionally cold temperatures. In October, however (bottom image), the hole shrank dramatically, much more quickly than usual. By the end of October, the hole was only one-third of it's previous size. In a typical year, the ozone hole does not collapse until the end of November. NASA scientists were surprised by this early shrinking and speculate it is related to the region's weather. Global ozone levels are measured by the Total Ozone Mapping Spectrometer (TOMS). For more information about ozone, read the Earth Observatory's ozone fact sheet, view global ozone data and see these ozone images. Images by Greg Shirah, NASA GSFC Scientific Visualization Studio.

  17. Cost effectiveness of percutaneous closure versus medical therapy for cryptogenic stroke in patients with a patent foramen ovale.

    PubMed

    Pickett, Christopher A; Villines, Todd C; Ferguson, Michael A; Hulten, Edward A

    2014-11-15

    In patients with patent foramen ovales (PFOs) and cryptogenic stroke, observational studies have demonstrated reductions in recurrent neurologic events with transcatheter PFO closure compared with medical therapy. Randomized controlled trials and meta-analyses have shown a trend toward benefit with device closure. The cost-effectiveness of PFO closure has not been described. Therefore, a detailed cost analysis was performed using pooled weighted outcome and complication rates from published randomized controlled trials, Medicare cost tables, and wholesale medication prices. Incremental cost per life-year gained and per quality-adjusted life-year (QALY) gained by PFO closure was calculated. The commonly accepted cost-effectiveness threshold of <$50,000/quality-adjusted life-year gained was used. At 2.6 years (the mean duration of randomized controlled trial follow-up), PFO closure was more costly ($16,213, 95% confidence interval [CI] $15,753 to $16,749) per patient, with a cost of $103,607 (95% CI $5,826 to $2,544,750) per life-year gained. The expenditure to prevent 1 combined end point (transient ischemic attack, stroke, and death) at 2.6 years was $1.09 million (95% CI $1.04 million to $1.20 million). Modeling the costs of medical treatment prospectively, PFO closure reached cost-effectiveness (<$50,000/quality-adjusted life-year gained) at 2.6 years (95% CI 1.5 to 44.2). At 30.2 years (95% CI 28.2 to 36.2), the per patient mean cost of medical therapy exceeded that of PFO closure. In conclusion, PFO closure is associated with higher expenditures related to procedural costs; however, this increase may be offset over time by reduced event rates and costs of long-term medical treatment in patients who undergo transcatheter PFO closure. In younger patients typical of cryptogenic stroke, PFO closure may be cost effective in the long term.

  18. Cost effectiveness of percutaneous closure versus medical therapy for cryptogenic stroke in patients with a patent foramen ovale.

    PubMed

    Pickett, Christopher A; Villines, Todd C; Ferguson, Michael A; Hulten, Edward A

    2014-11-15

    In patients with patent foramen ovales (PFOs) and cryptogenic stroke, observational studies have demonstrated reductions in recurrent neurologic events with transcatheter PFO closure compared with medical therapy. Randomized controlled trials and meta-analyses have shown a trend toward benefit with device closure. The cost-effectiveness of PFO closure has not been described. Therefore, a detailed cost analysis was performed using pooled weighted outcome and complication rates from published randomized controlled trials, Medicare cost tables, and wholesale medication prices. Incremental cost per life-year gained and per quality-adjusted life-year (QALY) gained by PFO closure was calculated. The commonly accepted cost-effectiveness threshold of <$50,000/quality-adjusted life-year gained was used. At 2.6 years (the mean duration of randomized controlled trial follow-up), PFO closure was more costly ($16,213, 95% confidence interval [CI] $15,753 to $16,749) per patient, with a cost of $103,607 (95% CI $5,826 to $2,544,750) per life-year gained. The expenditure to prevent 1 combined end point (transient ischemic attack, stroke, and death) at 2.6 years was $1.09 million (95% CI $1.04 million to $1.20 million). Modeling the costs of medical treatment prospectively, PFO closure reached cost-effectiveness (<$50,000/quality-adjusted life-year gained) at 2.6 years (95% CI 1.5 to 44.2). At 30.2 years (95% CI 28.2 to 36.2), the per patient mean cost of medical therapy exceeded that of PFO closure. In conclusion, PFO closure is associated with higher expenditures related to procedural costs; however, this increase may be offset over time by reduced event rates and costs of long-term medical treatment in patients who undergo transcatheter PFO closure. In younger patients typical of cryptogenic stroke, PFO closure may be cost effective in the long term. PMID:25248812

  19. Combination of medical and surgical therapy for pleuropneumonia in a horse.

    PubMed Central

    Dechan, J

    1997-01-01

    Medical management was unable to prevent the development of an extrapulmonary abscess in a 10-year-old Thoroughbred gelding with anaerobic pleuropneumonia. Intercostal thoracostomy achieved drainage of the abscess. Resolution of the abscess and subsequent bronchopleural fistulas was monitored by ultrasonography and video-endoscopy. The horse returned to training 4 mo after discharge. PMID:9262860

  20. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 5. CPR, Oxygen Therapy. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the fifth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains two sections covering the following course content; cardiopulmonary resuscitation (CPR) (including artificial ventilation, foreign body obstructions, adjunctive equipment and special techniques, artificial…

  1. The Wisconsin Pharmacy Quality Collaborative--a team-based approach to optimizing medication therapy outcomes.

    PubMed

    Horstmann, Erika; Trapskin, Kari; Wegner, Mark V

    2014-06-01

    The Wisconsin Pharmacy Quality Collaborative is an initiative of the Pharmacy Society of Wisconsin, which connects community pharmacists with patients, physicians, and health plans to improve the quality and reduce the cost of medication use across Wisconsin. In 2012, the Pharmacy Society of Wisconsin received a $4.1 million Health Care Innovation Award from the Centers for Medicare and Medicaid Services to expand the Wisconsin Pharmacy Quality Collaborative statewide. The aims of the Health Care Innovation Award are to help reduce health care costs in Wisconsin by over $20 million and improve health and health outcomes during the 3-year project period. Methods include implementing a redesign of community pharmacy practices and facilitating medication management services, which include intervention-based services and comprehensive medication review and assessment visits for eligible commercial and Wisconsin Medicaid members. The goals of the project are to: (1) improve medication use among participating patients; (2) improve patient safety; (3) reduce health care costs for participating patients and payers; and (4) establish partnerships between pharmacists and physicians to enhance health outcomes.

  2. Successful resolution of a preputial prolapse in an alpaca using medical therapy.

    PubMed

    Koziol, Jennifer H; Edmondson, Misty A; Wolfe, Dwight F; Bayne, Jenna E

    2015-07-01

    A 2-year-old intact male alpaca was presented for a post-breeding preputial prolapse of 5 days duration. The internal lamina of the prepuce was prolapsed approximately 6 cm and the exposed preputial epithelium was edematous and necrotic. Following 7 days of medical treatment, resolution of the preputial prolapse was achieved.

  3. Successful resolution of a preputial prolapse in an alpaca using medical therapy

    PubMed Central

    Koziol, Jennifer H.; Edmondson, Misty A.; Wolfe, Dwight F.; Bayne, Jenna E.

    2015-01-01

    A 2-year-old intact male alpaca was presented for a post-breeding preputial prolapse of 5 days duration. The internal lamina of the prepuce was prolapsed approximately 6 cm and the exposed preputial epithelium was edematous and necrotic. Following 7 days of medical treatment, resolution of the preputial prolapse was achieved. PMID:26130840

  4. Long-Term Effect of a Short Interprofessional Education Interaction between Medical and Physical Therapy Students

    ERIC Educational Resources Information Center

    Sytsma, Terin T.; Haller, Elizabeth P.; Youdas, James W.; Krause, David A.; Hellyer, Nathan J.; Pawlina, Wojciech; Lachman, Nirusha

    2015-01-01

    Medicine is increasingly focused on team-based practice as interprofessional cooperation leads to better patient care. Thus, it is necessary to teach teamwork and collaboration with other health care professionals in undergraduate medical education to ensure that trainees entering the workforce are prepared to work in teams. Gross anatomy provides…

  5. Factors influencing medication adherence beliefs and self-efficacy in persons naive to antiretroviral therapy: a multicenter, cross-sectional study.

    PubMed

    Reynolds, Nancy R; Testa, Marcia A; Marc, Linda G; Chesney, Margaret A; Neidig, Judith L; Smith, Scott R; Vella, Stefano; Robbins, Gregory K

    2004-06-01

    It is widely recognized that adherence to antiretroviral therapy is critical to long-term treatment success, yet rates of adherence to antiretroviral medications are frequently subtherapeutic. Beliefs about antiretroviral therapy and psychosocial characteristics of HIV-positive persons naive to therapy may influence early experience with antiretroviral medication adherence and therefore could be important when designing programs to improve adherence to antiretroviral therapy. As part of a multicenter AIDS Clinical Trial Group (ACTG 384) study, 980 antiretroviral-naive subjects (82% male, 47% White, median age 36 years, and median CD4 cell count 278 cells/mm3) completed a self-administered questionnaire prior to random treatment assignment of initial antiretroviral medications. Measures of symptom distress, general health and well-being, and personal and situational factors including demographic characteristics, social support, self-efficacy, depression, stress, and current adherence to (nonantiretroviral) medications were recorded. Associations among variables were explored using correlation and regression analyses. Beliefs about the importance of antiretroviral adherence and ability to take antiretroviral medications as directed (adherence self-efficacy) were generally positive. Fifty-six percent of the participants were "extremely sure" of their ability to take all medications as directed and 48% were "extremely sure" that antiretroviral nonadherence would cause resistance, but only 37% were as sure that antiretroviral therapy would benefit their health. Less-positive beliefs about antiretroviral therapy adherence were associated with greater stress, depression, and symptom distress. More-positive beliefs about antiretroviral therapy adherence were associated with better scores on health perception, functional health, social-emotional-cognitive function, social support, role function, younger age, and higher education (r values = 0.09-0.24, all p < .001). Among

  6. Cupping therapy: A prudent remedy for a plethora of medical ailments

    PubMed Central

    Mehta, Piyush; Dhapte, Vividha

    2015-01-01

    Since ancient times, complementary and alternative medicine (CAM; 補充與替代醫學 bǔ chōng yǔ tì dài yī xué) have played an important role in human health and welfare. Many therapeutic approaches in healthcare outside the realm of conventional medicine persist in various parts of the world. There is considerable scientific and commercial potential in CAM, which needs to be explored precisely. Cupping therapy (拔罐療法 bá guàn liáo fǎ), one of the CAM, is practiced across the world. This therapy is believed to act by correcting imbalances in the internal bio field, such as by restoring the flow of “Qi (氣qì)”. Cupping involves applying a heated cup to generate a partial vacuum that mobilizes the blood flow and promotes effective healing. This review outlines various tools and techniques of cupping therapy. PMID:26151023

  7. Boron neutron capture therapy of malignant brain tumors at the Brookhaven Medical Research Reactor

    SciTech Connect

    Joel, D.D.; Coderre, J.A.; Chanana, A.D.

    1996-12-31

    Boron neutron capture therapy (BNCT) is a bimodal form of radiation therapy for cancer. The first component of this treatment is the preferential localization of the stable isotope {sup 10}B in tumor cells by targeting with boronated compounds. The tumor and surrounding tissue is then irradiated with a neutron beam resulting in thermal neutron/{sup 10}B reactions ({sup 10}B(n,{alpha}){sup 7}Li) resulting in the production of localized high LET radiation from alpha and {sup 7}Li particles. These products of the neutron capture reaction are very damaging to cells, but of short range so that the majority of the ionizing energy released is microscopically confined to the vicinity of the boron-containing compound. In principal it should be possible with BNCT to selectively destroy small nests or even single cancer cells located within normal tissue. It follows that the major improvements in this form of radiation therapy are going to come largely from the development of boron compounds with greater tumor selectivity, although there will certainly be advances made in neutron beam quality as well as the possible development of alternative sources of neutron beams, particularly accelerator-based epithermal neutron beams.

  8. A Randomized, Controlled Pragmatic Trial of Telephonic Medication Therapy Management to Reduce Hospitalization in Home Health Patients

    PubMed Central

    Zillich, Alan J; Snyder, Margie E; Frail, Caitlin K; Lewis, Julie L; Deshotels, Donny; Dunham, Patrick; Jaynes, Heather A; Sutherland, Jason M

    2014-01-01

    Objective To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing hospitalizations among home health patients. Setting Forty randomly selected, geographically diverse home health care centers in the United States. Design Two-stage, randomized, controlled trial with 60-day follow-up. All Medicare- insured home health care patients were eligible to participate. Twenty-eight consecutive patients within each care center were recruited and randomized to usual care or MTM intervention. The MTM intervention consisted of the following: (1) initial phone call by a pharmacy technician to verify active medications; (2) pharmacist-provided medication regimen review by telephone; and (3) follow-up pharmacist phone calls at day seven and as needed for 30 days. The primary outcome was 60-day all-cause hospitalization. Data Collection Data were collected from in-home nursing assessments using the OASIS-C. Multivariate logistic regression modeled the effect of the MTM intervention on the probability of hospitalization while adjusting for patients’ baseline risk of hospitalization, number of medications taken daily, and other OASIS-C data elements. Principal Findings A total of 895 patients (intervention n = 415, control n = 480) were block-randomized to the intervention or usual care. There was no significant difference in the 60-day probability of hospitalization between the MTM intervention and control groups (Adjusted OR: 1.26, 95 percent CI: 0.89–1.77, p = .19). For patients within the lowest baseline risk quartile (n = 232), the intervention group was three times more likely to remain out of the hospital at 60 days (Adjusted OR: 3.79, 95 percent CI: 1.35–10.57, p = .01) compared to the usual care group. Conclusions This MTM intervention may not be effective for all home health patients; however, for those patients with the lowest-risk profile, the MTM intervention prevented patients from being hospitalized at 60 days. PMID

  9. Medical criteria for active physical therapy. Physician guidelines for patient participation in a program of functional electrical rehabilitation.

    PubMed

    Phillips, C A

    1987-10-01

    Medical guidelines are presented by which the physician may evaluate a patient for participation in a program of active physical therapy (A.P.T.). A.P.T. system modalities are introduced and defined as: a) isokinetic leg trainer, b) stationary bicycle ergometer, c) outdoor exercise bicycle, and d) Functional Electrical Stimulation (F.E.S.)--Orthosis for ambulation. The physiological responses to these F.E.S. exercise modalities are reviewed. Initial and interim patient evaluations are discussed. The initial patient evaluation includes a history, physical examination, lab tests, and a report summary, all of which culminate in an F.E.S. exercise prescription. The interim patient evaluation is performed for continuation-termination purposes as well as to progress the patient through the various F.E.S. exercise modalities. Specific F.E.S. exercise progression criteria are summarized. The medical criteria are presented with respect to both patient participation in the F.E.S. exercise program and patient monitoring during the exercise itself. Specific medical criteria for patient participation in A.P.T. are organized around eight functional categories: a) level of neurological injury, b) muscular system, c) skeletal system, subdivided into bone criteria and joint criteria, d) cardiovascular system, e) respiratory system, f) urogenital system, g) cutaneous system, and h) psychological system. The medical criteria for patient monitoring during F.E.S. exercise are discussed with respect to: a) cardiovascular monitoring, b) objective patient monitoring, and c) F.E.S. exercise system monitoring. The article concludes with a discussion of informed consent when applied to an emerging treatment modality.

  10. Improving the economic and humanistic outcomes for diabetic patients: making a case for employer-sponsored medication therapy management

    PubMed Central

    Pinto, Sharrel L; Kumar, Jinender; Partha, Gautam; Bechtol, Robert A

    2013-01-01

    Background The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees. Methods Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman’s test was used to determine changes in outcomes due to the nonparametric nature of the data. Results The mean number of visits to a physician’s office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed. Conclusion Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program. PMID:23610526

  11. Ozone Trend Detectability

    NASA Technical Reports Server (NTRS)

    Campbell, J. W. (Editor)

    1981-01-01

    The detection of anthropogenic disturbances in the Earth's ozone layer was studied. Two topics were addressed: (1) the level at which a trend in total ozoning is detected by existing data sources; and (2) empirical evidence in the prediction of the depletion in total ozone. Error sources are identified. The predictability of climatological series, whether empirical models can be trusted, and how errors in the Dobson total ozone data impact trend detectability, are discussed.

  12. Ozone Layer Observations

    NASA Technical Reports Server (NTRS)

    McPeters, Richard; Bhartia, P. K. (Technical Monitor)

    2002-01-01

    The US National Aeronautics and Space Administration (NASA) has been monitoring the ozone layer from space using optical remote sensing techniques since 1970. With concern over catalytic destruction of ozone (mid-1970s) and the development of the Antarctic ozone hole (mid-1980s), long term ozone monitoring has become the primary focus of NASA's series of ozone measuring instruments. A series of TOMS (Total Ozone Mapping Spectrometer) and SBUV (Solar Backscatter Ultraviolet) instruments has produced a nearly continuous record of global ozone from 1979 to the present. These instruments infer ozone by measuring sunlight backscattered from the atmosphere in the ultraviolet through differential absorption. These measurements have documented a 15 Dobson Unit drop in global average ozone since 1980, and the declines in ozone in the antarctic each October have been far more dramatic. Instruments that measure the ozone vertical distribution, the SBUV and SAGE (Stratospheric Aerosol and Gas Experiment) instruments for example, show that the largest changes are occurring in the lower stratosphere and upper troposphere. The goal of ozone measurement in the next decades will be to document the predicted recovery of the ozone layer as CFC (chlorofluorocarbon) levels decline. This will require a continuation of global measurements of total column ozone on a global basis, but using data from successor instruments to TOMS. Hyperspectral instruments capable of measuring in the UV will be needed for this purpose. Establishing the relative roles of chemistry and dynamics will require instruments to measure ozone in the troposphere and in the stratosphere with good vertical resolution. Instruments that can measure other chemicals important to ozone formation and destruction will also be needed.

  13. Review article: Medical decision models of Helicobacter pylori therapy to prevent gastric cancer.

    PubMed

    Sonnenberg, A; Inadomi, J M

    1998-02-01

    The aim of the present article is to study the utility of Helicobacter pylori eradication programmes in decreasing the incidence of gastric cancer. Three types of decision models are employed to pursue this aim, i.e. decision tree, present value, and declining exponential approximation of life expectancy (DEALE). 1) A decision tree allows one to model the interaction of multiple variables in great detail and to calculate the marginal cost, as well as the marginal cost-benefit ratio, of a preventive strategy. The cost of gastric cancer, the efficacy of H. pylori therapy in preventing cancer, and the cumulative probability of developing gastric cancer exert the largest influence on the marginal cost of cancer prevention. The high cost of future gastric cancer and a high efficacy of therapy make screening for H. pylori and its eradication the preferred strategy. 2) The present value is an economic method to adjust future costs or benefits to their current value using a discount rate and the length of time between now and a given time point in the future. It accounts for the depreciation of money and all material values over time. During childhood, the present value of future gastric cancer is very low. Vaccination of children to prevent gastric cancer would need to be very inexpensive to be practicable. Cancer prevention becomes a feasible option, only if the time period between the preventive measures and the occurrence of gastric cancer can be made relatively short. 3) The DEALE provides a means to calculate the increase in life expectancy that would occur, if death from a particular disease became preventable. Life expectancy of the general population is hardly affected by gastric cancer. For life expectancy to increase appreciably by vaccination or antibiotic therapy directed against H. pylori infection, these interventions would need to be focused towards a sub-population with an a priori high risk for gastric cancer.

  14. [Two chapters from the medical history of this century: antibacterial therapy].

    PubMed

    Bol, P

    1999-02-13

    The antibiotic era brought adequate therapies for bacterial infections and began with the introduction of sulphonamides (discovered earlier by Domagk) in 1935 and penicillins (discovered earlier by Fleming) in the course of World War II. Notwithstanding the usual description as 'discoveries', they were the fruits of systematic investigations for chemicals with antibacterial properties and little or no toxicity for the host. Despite the role of serendipity in the discovery of penicillin, the bactericidal moulds that Fleming observed had fallen on fertile soil: a laboratory where the search for antibacterial drugs had been going on for years. PMID:10221100

  15. OPTIMIZATION OF THE EPITHERMAL NEUTRON BEAM FOR BORON NEUTRON CAPTURE THERAPY AT THE BROOKHAVEN MEDICAL RESEARCH REACTOR.

    SciTech Connect

    HU,J.P.; RORER,D.C.; RECINIELLO,R.N.; HOLDEN,N.E.

    2002-08-18

    Clinical trials of Boron Neutron Capture Therapy for patients with malignant brain tumor had been carried out for half a decade, using an epithermal neutron beam at the Brookhaven's Medical Reactor. The decision to permanently close this reactor in 2000 cut short the efforts to implement a new conceptual design to optimize this beam in preparation for use with possible new protocols. Details of the conceptual design to produce a higher intensity, more forward-directed neutron beam with less contamination from gamma rays, fast and thermal neutrons are presented here for their potential applicability to other reactor facilities. Monte Carlo calculations were used to predict the flux and absorbed dose produced by the proposed design. The results were benchmarked by the dose rate and flux measurements taken at the facility then in use.

  16. Ozone Antimicrobial Efficacy

    EPA Science Inventory

    Ozone is a potent germicide that has been used extensively for water purification. In Europe, 90 percent of the municipal water systems are treated with ozone, and in France, ozone has been used to treat drinking water since 1903. However, there is limited information on the bioc...

  17. Attitudes of Israeli Rheumatologists to the Use of Medical Cannabis as Therapy for Rheumatic Disorders

    PubMed Central

    Ablin, Jacob N.; Elkayam, Ori; Fitzcharles, Mary-Ann

    2016-01-01

    Background While medical cannabis has been used for thousands of years in the treatment of pain and other symptoms, evidence-based use is limited and practitioners face multiple areas of uncertainty regarding the rational use of these compounds. Nonetheless, an increasing public interest and advocacy in favor of medical cannabis is causing the issue to be encountered ever more frequently by physicians in different fields of medicine and particularly in rheumatology. In view of this situation, we have surveyed the attitudes of Israeli rheumatologists to the use of medical cannabis. Objectives As rheumatologists are specialized in caring for patients presenting with musculoskeletal complaints, the confidence of rheumatologists’ knowledge of cannabinoids was surveyed. Methods All members of the Israeli Society of Rheumatology were surveyed by e-mail for their confidence and knowledge of cannabinoids and their perceived competence to prescribe herbal cannabis. Results A total of 23 out of 119 (19.3%) Israeli rheumatologists approached returned the questionnaire. Three-quarters of responders were not confident about their knowledge of cannabinoid molecules or ability to write a prescription for herbal cannabis, and 78% were not confident to write a prescription for herbal cannabis; 74% of responders held the opinion that there was some role for cannabinoids in the management of rheumatic disease. Conclusion Israeli rheumatologists lack confidence in their knowledge of cannabinoids in general, yet are open to the possibility of introducing this treatment. Additional data and guidance are necessary in order to allow rational utilization of cannabinoids for management of rheumatic pain. PMID:27101219

  18. Ozone drinking water treatment handbook

    SciTech Connect

    Rice, R.G.

    1990-01-01

    This book explains how ozone can be used to provide primary disinfection, while minimizing halogenated by-products. This is of use to those who design pilot plant studies in full scale ozone plants-and those who employ ozone and regulatory personnel. Detailed section on components of an ozonization system outlines feed gas preparation (air and oxygen), ozone generation, ozone contacting, ozone off gas destruction, monitoring and control of ozonation systems, engineering aspects of ozone, cost factors in ozone technology, case histories (European and U.S.).

  19. A randomized pragmatic trial of primary care based pharmacist-physician collaborative medication therapy management for hypertension

    PubMed Central

    Hirsch, Jan D.; Steers, Neil; Adler, David S.; Kuo, Grace M.; Morello, Candis M.; Lang, Megan; Singh, Renu F.; Wood, Yelena; Kaplan, Robert M.; Mangione, Carol M.

    2014-01-01

    Purpose A collaborative pharmacist-physician (PharmD-MD) team approach to medication therapy management (MTM), with pharmacists initiating and changing medications at separate office visits, holds promise for cost-effective management of blood pressure (BP), but has not been evaluated in many systematic trials. The primary objective of this study was to examine BP control for hypertensive patients managed by a newly formed PharmD-MD MTM team vs. versus usual care (UC) in a university primary care clinic. Methods This was a randomized, pragmatic, clinical trial of hypertensive patients randomly selected for the PharmD-MD MTM team or UC. In the PharmD-MD MTM group pharmacists managed drug therapy initiation, monitoring, medication adjustments, biometric assessments, laboratory tests, and patient education. In the UC group, patients continued to see their primary care provider (PCP). Participants were age 18 years or over, diagnosed with hypertension, most recent BP ≥140/90 mmHg or ≥130/80 mmHg if co-diagnosed with diabetes mellitus, on at least one anti-hypertensive medication, and English speaking. Primary outcome was the difference in mean change in systolic BP (SBP) at 6 months. Secondary outcomes included percent achieving therapeutic BP goal, mean change in diastolic BP, LDL and HDL cholesterol. Findings A total of 75 patients were in the PharmD-PCP MTM group and 91 in the UC group. Mean reduction in SBP was significantly greater in the PharmD-PCP MTM group at 6 months [−7.1 (SD=19.4) vs. +1.6 (SD=21.0) mm Hg, (p=0.008)] but the difference was no longer statistically significant at 9 months [−5.2 (SD=16.9) vs. −1.7 (SD=17.7) mmHg, (p=0.22)] based on intent to treat analysis. In the intervention group, a greater percentage of patients who continued to see the MTM pharmacist vs. those who returned to their PCP were at goal at 6 months (88.5% vs. 63.6%) and 9 months (78.9% vs. 47.4%). No significant difference in change of LDL or HDL was detected at 6 or

  20. Patient and Family Perceptions of Physical Therapy in the Medical Intensive Care Unit

    PubMed Central

    Sottile, Peter D; Nordon-Craft, Amy; Malone, Daniel; Schenkman, Margaret; Moss, Marc

    2015-01-01

    Purpose Patient and family member perceptions of physical therapy (PT) in the intensive care unit and the factors that influence their degree of satisfaction have not been described. Methods A panel of experts developed a questionnaire that assessed patient and family perceptions of PT. Critically ill patients and their family members were asked to complete the survey. Patient and family member scores were compared and stratified by age, gender, and mechanical ventilation for greater than 14 days compared to 14 days or less. Results A total of 55 patients and 49 family members completed the survey. Patients and family members reported that PT was necessary and beneficial to recovery, despite associating PT with difficulty, exertion, and discomfort. Patient perceptions were similar regardless of age or gender. Family members underestimated a patient's enjoyment of PT (p=0.03). For individuals who required prolonged mechanical ventilation (>14 days), patients reported that PT was more difficult (p=0.03), less enjoyable (p=0.049), and family members reported PT as causing greater discomfort (p=0.005). Additionally, family members of patients who required prolonged mechanical ventilation felt that PT was less beneficial (p=0.01). Conclusions Physical therapy is perceived as necessary and beneficial to recovery by critically ill patients and family members. PMID:26038155

  1. Medical decision analysis for first-line therapy of chronic myeloid leukemia.

    PubMed

    Rochau, Ursula; Sroczynski, Gaby; Wolf, Dominik; Schmidt, Stefan; Conrads-Frank, Annette; Jahn, Beate; Saverno, Kim; Brixner, Diana; Radich, Jerald; Gastl, Guenther; Siebert, Uwe

    2014-08-01

    Several tyrosine kinase inhibitors (TKIs) are approved for the treatment of chronic myeloid leukemia (CML). Our goal was to develop a clinical decision-analytic model for evaluation of the long-term effectiveness of different therapy regimens. We developed a Markov cohort model with a lifelong time horizon for first-line treatment with imatinib, dasatinib or nilotinib. Seven strategies including combinations of TKIs, chemotherapy and stem cell transplant were evaluated. The model was parameterized using published trial data, the Austrian CML registry and practice patterns estimated by experts. Health outcomes evaluated were life-years (LYs) and quality-adjusted LYs (QALYs). Based on our decision analysis, dasatinib following nilotinib failure was the most effective treatment in terms of LYs (19.8 LYs) and QALYs (16.1 QALYs). Sensitivity analyses showed that the ranking of strategies was mostly influenced by the duration of first- and second-line therapies. Our results may support decision-making regarding the sequential application of TKIs. PMID:24160847

  2. A randomised trial of lung sealant versus medical therapy for advanced emphysema

    PubMed Central

    Come, Carolyn E.; Kramer, Mordechai R.; Dransfield, Mark T.; Abu-Hijleh, Muhanned; Berkowitz, David; Bezzi, Michela; Bhatt, Surya P.; Boyd, Michael B.; Cases, Enrique; Chen, Alexander C.; Cooper, Christopher B.; Flandes, Javier; Gildea, Thomas; Gotfried, Mark; Hogarth, D. Kyle; Kolandaivelu, Kumaran; Leeds, William; Liesching, Timothy; Marchetti, Nathaniel; Marquette, Charles; Mularski, Richard A.; Pinto-Plata, Victor M.; Pritchett, Michael A.; Rafeq, Samaan; Rubio, Edmundo R.; Slebos, Dirk-Jan; Stratakos, Grigoris; Sy, Alexander; Tsai, Larry W.; Wahidi, Momen; Walsh, John; Wells, J. Michael; Whitten, Patrick E.; Yusen, Roger; Zulueta, Javier J.; Criner, Gerard J.; Washko, George R.

    2016-01-01

    Uncontrolled pilot studies demonstrated promising results of endoscopic lung volume reduction using emphysematous lung sealant (ELS) in patients with advanced, upper lobe predominant emphysema. We aimed to evaluate the safety and efficacy of ELS in a randomised controlled setting. Patients were randomised to ELS plus medical treatment or medical treatment alone. Despite early termination for business reasons and inability to assess the primary 12-month end-point, 95 out of 300 patients were successfully randomised, providing sufficient data for 3- and 6-month analysis. 57 patients (34 treatment and 23 control) had efficacy results at 3 months; 34 (21 treatment and 13 control) at 6 months. In the treatment group, 3-month lung function, dyspnoea, and quality of life improved significantly from baseline when compared to control. Improvements persisted at 6 months with >50% of treated patients experiencing clinically important improvements, including some whose lung function improved by >100%. 44% of treated patients experienced adverse events requiring hospitalization (2.5-fold more than control, p=0.01), with two deaths in the treated cohort. Treatment responders tended to be those experiencing respiratory adverse events. Despite early termination, results show that minimally invasive ELS may be efficacious, yet significant risks (probably inflammatory) limit its current utility. PMID:25837041

  3. Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?

    PubMed

    Miras, A D; le Roux, C W

    2014-03-01

    The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. These include dietary interventions, orlistat, lorcaserin, phentermine/topiramate, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, pramlintide, dapagliflozin, the duodenal-jejunal bypass liner, gastric pacemakers and gastric balloons. We conclude that, based on the most recent trials, we cannot fully mimic the clinical or physiological effects of surgery; however, we are getting closer. A 'medical bypass' may not be as far in the future as we previously thought, as the physician's armamentarium against obesity and type 2 diabetes has recently got stronger through the use of specific dietary modifications, novel medical devices and pharmacotherapy. Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals. PMID:24213310

  4. Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?

    PubMed

    Miras, A D; le Roux, C W

    2014-03-01

    The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. These include dietary interventions, orlistat, lorcaserin, phentermine/topiramate, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, pramlintide, dapagliflozin, the duodenal-jejunal bypass liner, gastric pacemakers and gastric balloons. We conclude that, based on the most recent trials, we cannot fully mimic the clinical or physiological effects of surgery; however, we are getting closer. A 'medical bypass' may not be as far in the future as we previously thought, as the physician's armamentarium against obesity and type 2 diabetes has recently got stronger through the use of specific dietary modifications, novel medical devices and pharmacotherapy. Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals.

  5. A systematic review on the effectiveness of medical training therapy for subacute and chronic low back pain.

    PubMed

    Scharrer, M; Ebenbichler, G; Pieber, K; Crevenna, R; Gruther, W; Zorn, C; Grimm-Stieger, M; Herceg, M; Keilani, M; Ammer, K

    2012-09-01

    Medical training therapy (MTT) to improve muscular strength and endurance follows evidence based guidelines and is increasingly recommended to patients suffering from subacute and chronic back pain (LBP). This study investigated whether MTT was effective in reducing pain and improving function in patients with subacute or chronic LBP. Data sources were MEDLINE, EMBASE, CINAHL, Pedro, Cochrane Central Register of Controlled Trials. We included RCTs that examined exercise or MTT in adult patients with LBP compared to placebo, no intervention or other interventions. Study outcomes had to include at least one of the following: pain intensity; functional status, absenteeism. Two independent reviewers performed quality assessment. Visual analogue scale ratings ranging from 0-10 MTT quantified the MTT aspects of the intervention. Studies with rating scores >7.5 were included. We identified only 2 studies that examined the effectiveness of MTT. Both trials, one was of high quality, found MTT to decrease pain and improve function significantly better than therapy of uncertain effectiveness. There is moderate evidence that would support the effectiveness of MTT in the treatment chronic LBP. Future high quality RCT will have to clarify whether MTT is effective and would be superior to other forms of therapeutic exercise. PMID:22820818

  6. Successful Medical Therapy for Hypophosphatemic Rickets due to Mitochondrial Complex I Deficiency Induced de Toni-Debré-Fanconi Syndrome

    PubMed Central

    Bowden, Sasigarn A.; Patel, Hiren P.; Beebe, Allan; McBride, Kim L.

    2013-01-01

    Primary de Toni-Debré-Fanconi syndrome is a non-FGF23-mediated hypophosphatemic disorder due to a primary defect in renal proximal tubule cell function resulting in hyperphosphaturia, renal tubular acidosis, glycosuria, and generalized aminoaciduria. The orthopaedic sequela and response to treatment of this rare disorder are limited in the literature. Herein we report a long term followup of a 10-year-old female presenting at 1 year of age with rickets initially misdiagnosed as vitamin D deficiency rickets. She was referred to the metabolic bone and genetics clinics at 5 years of age with severe genu valgum deformities of 24 degrees and worsening rickets. She had polyuria, polydipsia, enuresis, and bone pain. Diagnosis of hypophosphatemic rickets due to de Toni-Debré-Fanconi syndrome was subsequently made. Respiratory chain enzyme analysis identified a complex I mitochondrial deficiency as the underlying cause. She was treated with phosphate (50–70 mg/kg/day), calcitriol (30 ng/kg/day), and sodium citrate with resolution of bone pain and normal growth. By 10 years of age, her genu valgus deformities were 4 degrees with healing of rickets. Her excellent orthopaedic outcome despite late proper medical therapy is likely due to the intrinsic renal tubular defect that is more responsive to combined alkali, phosphate, and calcitriol therapy. PMID:24386581

  7. Anal fistula with foot extension—Treated by kshara sutra (medicated seton) therapy: A rare case report

    PubMed Central

    Ramesh, P. Bhat

    2013-01-01

    INTRODUCTION An ‘anal’ fistula is a track which communicates anal canal or rectum and usually is in continuity with one or more external openings. Distant communication from rectum is rare. It is a challenging disease because of its recurrence especially, with high level and distant communications. Ksharasutra (medicated seton) therapy is being practiced in India with high success rate (recurrence of 3.33%) in the management of complicated anal fistula. PRESENTATION OF CASE A 56 year old man presented with recurrent boils in the left lower limb at different places from thigh to foot. He underwent repeated incision and drainage at different hospitals. Examination revealed sinus with discharge and multiple scars on left lower limb from thigh up to foot. Suspecting anal fistula, MRI was advised which revealed a long cutaneous fistula from rectum to left lower limb. Patient was treated with Ksharasutra therapy. Within 6 months of treatment whole tract was healed completely. DISCUSSION Sushrutha (500BC) was the first to explain the role of surgical excision and use of kshara sutra for the management of anal fistula. Ksharasutra therapy showed least recurrence. Fistula from rectum to foot is of extremely rare variety. Surgical treatment of anal fistula requires hospitalization, regular post-operative care, is associated with a significant risk of recurrence (0.7–26.5%) and a high risk of impaired continence (5–40%). CONCLUSION Rectal fistula communicating till foot may be a very rare presentation in proctology practice. Kshara sutra treatment was useful in treating this condition, with minimal surgical intervention with no recurrence. PMID:23702360

  8. Prognostic implications of optimal medical therapy in patients undergoing percutaneous coronary intervention for acute coronary syndrome in octogenarians.

    PubMed

    Anzai, Atsushi; Maekawa, Yuichiro; Kodaira, Masaki; Mogi, Satoshi; Arai, Takahide; Kawakami, Takashi; Kanazawa, Hideaki; Hayashida, Kentaro; Yuasa, Shinsuke; Kawamura, Akio; Fukuda, Keiichi

    2015-03-01

    The proportion of elderly acute coronary syndrome (ACS) patients who receive optimal medical therapy (OMT) after percutaneous coronary intervention (PCI) and whether OMT affects their long-term outcomes remain unclear. We retrospectively investigated 405 ACS patients who underwent stent implantation between 2005 and 2009, and compared the outcomes between patients <80 years of age vs. ≥80 years of age. The prescription rate of the recommended medical agents for ACS in both groups during hospitalization and 2 years after admission was also retrieved. Among the enrolled study population, 75 patients (19%) were aged ≥80 years. These elderly patients had a higher 2-year mortality compared with patients aged <80 years group. The prescription rate of beta-blockers, angiotensin-blocking drugs, and statins tended to be lower in patients aged ≥80 years than in those aged <80 years. Furthermore, among patients ≥80 years of age, those who received OMT had better clinical outcome of 2-year mortality compared to those without OMT. Elderly patients with ACS treated by PCI are at substantially higher risk of adverse events than younger patients. However, they are less likely to receive OMT. PCI with OMT might improve the clinical outcomes of elderly ACS patients.

  9. Evaluation of a Pilot Medication-Assisted Therapy Program in Kazakhstan: Successes, Challenges, and Opportunities for Scaleup

    PubMed Central

    Boltaev, Azizbek A.; Deryabina, Anna P.; Kusainov, Almas; Howard, Andrea A.

    2012-01-01

    Study Aims. Evaluate the quality and effectiveness of the medication-assisted therapy (MAT) pilot in Kazakhstan and review implementation context and related challenges. Methods. We performed a desk review of MAT policy and program documents and reviewed medical records at three MAT sites in Kazakhstan. MAT patients (n = 93) were interviewed to assess their perceptions of the program and its impact on their health, criminal, drug use, and HIV risk related behaviors as well as expenditures on nonprescribed psychoactive drugs. Persons injecting drugs who are not in treatment, MAT program staff, and other stakeholders were interviewed to obtain their perspectives on MAT. Results. Legislation supports introducing MAT as a standard of care for treatment of opioid dependence; however, its progress has been hampered by active opposition. Inadequate access and coverage, insufficient supply management, scarce infrastructure of narcological facilities, limited opportunities for staff development, and restrictive methadone dispensing policies compromise the quality of the intervention and limit its potential benefits. There were significant reductions in criminal, drug use, and HIV risk related behaviors in patients receiving MAT. Conclusions. The MAT pilot in Kazakhstan demonstrated its feasibility and effectiveness in the local context and is recommended for scaleup throughout the country. PMID:23289082

  10. Enhancing human-animal relationships through veterinary medical instruction in animal-assisted therapy and animal-assisted activities.

    PubMed

    Schaffer, Caroline Brunsman

    2008-01-01

    Instruction in animal-assisted therapy (AAT) and animal-assisted activities (AAAs) teaches veterinary medical students to confidently and assertively maximize the benefits and minimize the risks of this union of animals and people. Instruction in AAT/AAA also addresses requirements by the American Veterinary Medical Association Council on Education that accredited schools/colleges of veterinary medicine include in their standard curriculum the topics of the human-animal bond, behavior, and the contributions of the veterinarian to the overall public and professional health care teams. Entry-level veterinarians should be prepared to: (1) assure that animals who provide AAT/AAA are healthy enough to visit nursing homes, hospitals, or other institutions; (2) promote behavior testing that selects animals who will feel safe, comfortable, and connected; (3) advise facilities regarding infection control and ways to provide a safe environment where the animals, their handlers, and the people being visited will not be injured or become ill; and (4) advocate for their patients and show compassion for their clients when animals are determined to be inappropriate participants in AAT/AAA programs. This article presents AAT/AAA terminology, ways in which veterinarians can advocate for AAT/AAA, the advantages of being involved in AAT/AAA, a model AAT/AAA practicum from Tuskegee University's School of Veterinary Medicine (TUSVM), and examples of co-curricular activities in AAT/AAA by TUSVM's student volunteers.

  11. Inferior Vena Cava Filter Placement during Pregnancy: An Adjuvant Option When Medical Therapy Fails

    PubMed Central

    Serrano, Fátima; Torres, Rita; Borges, Augusta

    2013-01-01

    The authors present a case of a 27-year-old multiparous woman, with multiple thrombophilia, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter. At 15th week of gestation, following an acute deep venous thrombosis of the right inferior limb, anticoagulant therapy with low-molecular-weight heparin (LMWH) was instituted without improvement in her clinical status. Subsequently, at 18 weeks of pregnancy, LMWH was switched to warfarin. At 30th week of gestation, the maintenance of high thrombotic risk was the premise for placement of an inferior vena cava filter for prophylaxis of pulmonary embolism during childbirth and postpartum. There were no complications and a vaginal delivery was accomplished at 37 weeks of gestation. Venal placement of inferior vena cava filters is an attractive option as prophylaxis for pulmonary embolism during pregnancy. PMID:23781361

  12. Medical Therapies of Amblyopia: Translational Research to Expand Our Treatment Armamentarium.

    PubMed

    Gore, Charlotte; Wu, Carolyn

    2016-01-01

    Amblyopia is a developmental brain disorder in which vision is lost due to asymmetric or inadequate visual stimulation early in life. Although amblyopia is responsive to treatment if therapy is initiated early, treatment of older children and adults is usually unsuccessful due to closure of a window of cortical brain plasticity. Extensive basic research has been devoted to understanding modulators in shaping the visual cortex during the critical period of plasticity, and to providing potential clinical applications of neurotransmitters in the treatment of amblyopia. Current pharmacological treatments are reviewed from basic science research extending into clinical use, focusing on the acetylcholinesterase inhibitor donezepil, serotonin receptor inhibitor fluoxetine, dopamine precursors carbidopa-levodopa, and catecholamine modulator citicoline. PMID:26959141

  13. Laser-based optoelectronic system for therapy by medical treatment of cardiovascular diseases

    NASA Astrophysics Data System (ADS)

    Chtchoupak, Oleg S.; Shpilevoj, Boris N.; Zapaeva, Natlia L.

    1996-01-01

    The method and design of a system for the laser treatment of ischemic heart disease is presented. Our conceptual approach to the development of the system is based on the theoretical and experimental works of the east and west scientists about positive influence of low intensity laser irradiation in the near infrared range by treatment of cardiovascular diseases. The method and system allow active influence on the subepicardial collateral blood circulation with near infrared (NIR) laser irradiation in wavelength ranges of 0.86-1.06 mkm. The presented technique makes it possible to achieve a higher effectiveness of treatment due to individual choice of radiation parameters on the basis of analysis of the patient conditions before and after laser therapy and due to simultaneous affection at several points of the human body. Finally, results of the tests are presented, which prove given methods.

  14. Antiretroviral Therapy and Viral Suppression Among Foreign-Born HIV-Infected Persons Receiving Medical Care in the United States

    PubMed Central

    Myers, Tanya R.; Lin, Xia; Skarbinski, Jacek

    2016-01-01

    Abstract Immigrants to the United States are more likely to be diagnosed with human immunodeficiency virus (HIV) infection compared with native-born persons. Navigating access to healthcare in the United States can be challenging for foreign-born persons, and HIV treatment outcomes may be suboptimal for these persons. We compared characteristics of and assessed disparities in clinical outcomes of foreign-born persons in care for HIV in the United States. The Medical Monitoring Project is a complex sample, cross-sectional survey designed to be nationally representative of HIV-infected adults receiving medical care in the United States. Using data from 2009, 2010, and 2011, we conducted descriptive analyses and multivariable logistic regression to assess associations between foreign-born status and antiretroviral therapy (ART) prescription, and between foreign-born status and viral suppression. In all, 13.4% of HIV-infected persons were self-identified as foreign-born; the most common regions of birth were Central America and Mexico (45.4%) and the Caribbean (16.0%). Nearly 90% of foreign-born persons were diagnosed with HIV after entry into the United States. Compared with US-born persons, foreign-born persons were more likely to be younger, Hispanic, less educated, and uninsured. The prevalence of ART prescription (prevalence ratio 1.00; 95% confidence interval 0.98–1.02) was not significantly different between foreign-born and US-born persons. A higher percentage of foreign-born persons achieved viral suppression compared with US-born persons (prevalence ratio 1.05; 95% confidence interval 1.00–1.09). No major disparities in ART prescription and viral suppression were found between foreign-born and US-born HIV-infected persons receiving medical care, despite higher percentages being uninsured. PMID:26986128

  15. Effect of Cognitive Therapy With Antidepressant Medications vs Antidepressants Alone on the Rate of Recovery in Major Depressive Disorder

    PubMed Central

    Hollon, Steven D.; DeRubeis, Robert J.; Fawcett, Jan; Amsterdam, Jay D.; Shelton, Richard C.; Zajecka, John; Young, Paula R.; Gallop, Robert

    2015-01-01

    IMPORTANCE Antidepressant medication (ADM) is efficacious in the treatment of depression, but not all patients achieve remission and fewer still achieve recovery with ADM alone. OBJECTIVE To determine the effects of combining cognitive therapy (CT) with ADM vs ADM alone on remission and recovery in major depressive disorder (MDD). DESIGN, SETTING, AND PARTICIPANTS A total of 452 adult outpatients with chronic or recurrent MDD participated in a trial conducted in research clinics at 3 university medical centers in the United States. The patients were randomly assigned to ADM treatment alone or CT combined with ADM treatment. Treatment was continued for up to 42 months until recovery was achieved. INTERVENTIONS Antidepressant medication with or without CT. MAIN OUTCOMES AND MEASURES Blind evaluations of recovery with a modified version of the 17-item Hamilton Rating Scale for Depression and the Longitudinal Interval Follow-up Evaluation. RESULTS Combined treatment enhanced the rate of recovery vs treatment with ADM alone (72.6% vs 62.5%; t451 = 2.45; P = .01; hazard ratio [HR], 1.33; 95% CI, 1.06–1.68; number needed to treat [NNT], 10; 95% CI, 5–72). This effect was conditioned on interactions with severity (t451 = 1.97; P = .05; NNT, 5) and chronicity (χ2 = 7.46; P = .02; NNT, 6) such that the advantage for combined treatment was limited to patients with severe, nonchronic MDD (81.3% vs 51.7%; n = 146; t145 = 3.96; P = .001; HR, 2.34; 95% CI, 1.54–3.57; NNT, 3; 95% CI, 2–5). Fewer patients dropped out of combined treatment vs ADM treatment alone (18.9% vs 26.8%; t451 = −2.04; P = .04; HR, 0.66; 95% CI, 0.45–0.98). Remission rates did not differ significantly either as a main effect of treatment or as an interaction with severity or chronicity. Patients with comorbid Axis II disorders took longer to recover than did patients without comorbid Axis II disorders regardless of the condition (P = .01). Patients who received combined treatment reported fewer

  16. Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris

    PubMed Central

    Won, Hoyoun; Her, Ae-Young; Kim, Byeong-Keuk; Kim, Yong Hoon; Shin, Dong-Ho; Kim, Jung-Sun; Ko, Young-Guk; Choi, Donghoon; Kwon, Hyuck Moon; Jang, Yangsoo

    2016-01-01

    Purpose Data comparing the clinical benefits of medical treatment with those of percutaneous coronary intervention (PCI) in an elderly population with angina pectoris are limited. Therefore, we evaluated the efficacy of elective PCI versus optimal medical treatment (OMT) in elderly patients (between 75 and 84 years old) with angina pectoris. Materials and Methods One hundred seventy-seven patients with significant coronary artery stenosis were randomly assigned to either the PCI group (n=90) or the OMT group (n=87). The primary outcome was a composite of major adverse events in the 1-year follow-up period that included cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and stroke. Results Major adverse events occurred in 5 patients (5.6%) of the PCI group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no significant differences between the PCI group and the OMT group in cardiac death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval (CI) 0.041–5.019, p=0.520], myocardial infarction (HR 0.399; 95% CI 0.039–4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057–14.709, p=0.952). However, the PCI group showed a significant preventive effect of the composite of major adverse events (HR 0.288; 95% CI 0.106–0.785, p=0.015) and against the need for coronary revascularization (HR 0.157; 95% CI 0.035–0.703, p=0.016). Conclusion Elective PCI reduced major adverse events and was found to be an effective treatment modality in elderly patients with angina pectoris and significant coronary artery stenosis, compared to OMT. PMID:26847290

  17. The first private-hospital based proton therapy center in Korea; status of the Proton Therapy Center at Samsung Medical Center

    PubMed Central

    Chung, Kwangzoo; Kim, Jinsung; Ahn, Sung Hwan; Ju, Sang Gyu; Jung, Sang Hoon; Chung, Yoonsun; Cho, Sungkoo; Jo, Kwanghyun; Shin, Eun Hyuk; Hong, Chae-Seon; Shin, Jung Suk; Park, Seyjoon; Kim, Dae-Hyun; Kim, Hye Young; Lee, Boram; Shibagaki, Gantaro; Nonaka, Hideki; Sasai, Kenzo; Koyabu, Yukio; Choi, Changhoon; Huh, Seung Jae; Ahn, Yong Chan; Pyo, Hong Ryull; Lim, Do Hoon; Park, Hee Chul; Park, Won; Oh, Dong Ryul; Noh, Jae Myung; Yu, Jeong Il; Song, Sanghyuk; Lee, Ji Eun; Lee, Bomi; Choi, Doo Ho

    2015-01-01

    Purpose The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. Materials and Methods The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. Results The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. Conclusion The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015. PMID:26756034

  18. A randomised trial of adaptive pacing therapy, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome (PACE): statistical analysis plan

    PubMed Central

    2013-01-01

    Background The publication of protocols by medical journals is increasingly becoming an accepted means for promoting good quality research and maximising transparency. Recently, Finfer and Bellomo have suggested the publication of statistical analysis plans (SAPs).The aim of this paper is to make public and to report in detail the planned analyses that were approved by the Trial Steering Committee in May 2010 for the principal papers of the PACE (Pacing, graded Activity, and Cognitive behaviour therapy: a randomised Evaluation) trial, a treatment trial for chronic fatigue syndrome. It illustrates planned analyses of a complex intervention trial that allows for the impact of clustering by care providers, where multiple care-providers are present for each patient in some but not all arms of the trial. Results The trial design, objectives and data collection are reported. Considerations relating to blinding, samples, adherence to the protocol, stratification, centre and other clustering effects, missing data, multiplicity and compliance are described. Descriptive, interim and final analyses of the primary and secondary outcomes are then outlined. Conclusions This SAP maximises transparency, providing a record of all planned analyses, and it may be a resource for those who are developing SAPs, acting as an illustrative example for teaching and methodological research. It is not the sum of the statistical analysis sections of the principal papers, being completed well before individual papers were drafted. Trial registration ISRCTN54285094 assigned 22 May 2003; First participant was randomised on 18 March 2005. PMID:24225069

  19. Ozone and the stratosphere

    NASA Technical Reports Server (NTRS)

    Shimazaki, Tatsuo

    1987-01-01

    It is shown that the stratospheric ozone is effective in absorbing almost all radiation below 300 nm at heights below 300 km. The distribution of global ozone in the troposphere and the lower stratosphere, and the latitudinal variations of the total ozone column over four seasons are considered. The theory of the ozone layer production is discussed together with catalytic reactions for ozone loss and the mechanisms of ozone transport. Special attention is given to the anthropogenic perturbations, such as SST exhaust gases and freon gas from aerosol cans and refrigerators, that may cause an extensive destruction of the stratospheric ozone layer and thus have a profound impact on the world climate and on life.

  20. Treatment-Specific Changes in Decentering Following Mindfulness-Based Cognitive Therapy versus Antidepressant Medication or Placebo for Prevention of Depressive Relapse

    ERIC Educational Resources Information Center

    Bieling, Peter J.; Hawley, Lance L.; Bloch, Richard T.; Corcoran, Kathleen M.; Levitan, Robert D.; Young, L. Trevor; MacQueen, Glenda M.; Segal, Zindel V.

    2012-01-01

    Objective: To examine whether metacognitive psychological skills, acquired in mindfulness-based cognitive therapy (MBCT), are also present in patients receiving medication treatments for prevention of depressive relapse and whether these skills mediate MBCT's effectiveness. Method: This study, embedded within a randomized efficacy trial of MBCT,…

  1. Comparison of the Efficacy of Electromyographic Biofeedback, Cognitive-Behavioral Therapy, and Conservative Medical Interventions in the Treatment of Chronic Musculoskeletal Pain.

    ERIC Educational Resources Information Center

    Flor, Herta; Birbaumer, Niels

    1993-01-01

    Patients who suffered from chronic back pain or temporomandibular pain were randomly assigned to either electromyographic biofeedback, cognitive behavioral therapy, or conservative medical treatment groups. Biofeedback showed the most improvement at posttreatment and the only lasting significant effect. Analysis of attrition showed a significant…

  2. An Open Trial of Intensive Family Based Cognitive-Behavioral Therapy in Youth with Obsessive-Compulsive Disorder Who Are Medication Partial Responders or Nonresponders

    ERIC Educational Resources Information Center

    Storch, Eric A.; Lehmkuhl, Heather D.; Ricketts, Emily; Geffken, Gary R.; Marien, Wendi; Murphy, Tanya K.

    2010-01-01

    This study reports an open-trial of family-based cognitive-behavioral therapy (CBT) in children and adolescents with obsessive-compulsive disorder (OCD). Thirty primarily Caucasian youth with OCD (range = 7-19 years; 15 girls) who were partial responders or nonresponders to two or more medication trials that were delivered either serially or…

  3. Predictors and Moderators of Response to Cognitive Behavioral Therapy and Medication for the Treatment of Binge Eating Disorder

    ERIC Educational Resources Information Center

    Grilo, Carlos M.; Masheb, Robin M.; Crosby, Ross D.

    2012-01-01

    Objective: To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED). Method: 108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors,…

  4. Dynamic infrared imaging for biological and medical applications in Boron neutron capture therapy

    NASA Astrophysics Data System (ADS)

    Santa Cruz, Gustavo A.; González, Sara J.; Dagrosa, Alejandra; Schwint, Amanda E.; Carpano, Marina; Trivillin, Verónica A.; Boggio, Esteban F.; Bertotti, José; Marín, Julio; Monti Hughes, Andrea; Molinari, Ana J.; Albero, Miguel

    2011-05-01

    Boron Neutron Capture Therapy (BNCT) is a treatment modality, currently focused on the treatment of cancer, which involves a tumor selective 10B compound and a specially tuned neutron beam to produce a lethal nuclear reaction. BNCT kills target cells with microscopic selectivity while sparing normal tissues from potentially lethal doses of radiation. In the context of the Argentine clinical and research BNCT projects at the National Atomic Energy Commission and in a strong collaboration with INVAP SE, we successfully implemented Dynamic Infrared Imaging (DIRI) in the clinical setting for the observation of cutaneous melanoma patients and included DIRI as a non invasive methodology in several research protocols involving small animals. We were able to characterize melanoma lesions in terms of temperature and temperature rate-of-recovery after applying a mild cold thermal stress, distinguishing melanoma from other skin pigmented lesions. We observed a spatial and temporal correlation between skin acute reactions after irradiation, the temperature pattern and the dose distribution. We studied temperature distribution as a function of tumor growth in mouse xenografts, observing a significant correlation between tumor temperature and drug uptake; we investigated temperature evolution in the limbs of Wistar rats for a protocol of induced rheumatoid arthritis (RA), DIRI being especially sensitive to RA induction even before the development of clinical signs and studied surface characteristics of tumors, precancerous and normal tissues in a model of oral cancer in the hamster cheek pouch.

  5. Eosinophilic esophagitis: dilate or medicate? A cost analysis model of the choice of initial therapy.

    PubMed

    Kavitt, R T; Penson, D F; Vaezi, M F

    2014-07-01

    Eosinophilic esophagitis (EoE) is an increasingly recognized clinical entity. The optimal initial treatment strategy in adults with EoE remains controversial. The aim of this study was to employ a decision analysis model to determine the less costly option between the two most commonly employed treatment strategies in EoE. We constructed a model for an index case of a patient with biopsy-proven EoE who continues to be symptomatic despite proton-pump inhibitor therapy. The following treatment strategies were included: (i) swallowed fluticasone inhaler (followed by esophagogastroduodenoscopy [EGD] with dilation if ineffective); and (ii) EGD with dilation (followed by swallowed fluticasone inhaler if ineffective). The time horizon was 1 year. The model focused on cost analysis of initial treatment strategies. The perspective of the healthcare payer was used. Sensitivity analyses were performed to assess the robustness of the model. For every patient whose symptoms improved or resolved with the strategy of fluticasone first followed by EGD, if necessary, it cost an average of $1078. Similarly, it cost an average of $1171 per patient if EGD with dilation was employed first. Sensitivity analyses indicated that initial treatment with fluticasone was the less costly strategy to improve dysphagia symptoms as long as the effectiveness of fluticasone remains at or above 0.62. Swallowed fluticasone inhaler (followed by EGD with dilation if necessary) is the more economical initial strategy when compared with EGD with dilation first.

  6. Multiscale registration of medical images based on edge preserving scale space with application in image-guided radiation therapy

    NASA Astrophysics Data System (ADS)

    Li, Dengwang; Li, Hongsheng; Wan, Honglin; Chen, Jinhu; Gong, Guanzhong; Wang, Hongjun; Wang, Liming; Yin, Yong

    2012-08-01

    Mutual information (MI) is a well-accepted similarity measure for image registration in medical systems. However, MI-based registration faces the challenges of high computational complexity and a high likelihood of being trapped into local optima due to an absence of spatial information. In order to solve these problems, multi-scale frameworks can be used to accelerate registration and improve robustness. Traditional Gaussian pyramid representation is one such technique but it suffers from contour diffusion at coarse levels which may lead to unsatisfactory registration results. In this work, a new multi-scale registration framework called edge preserving multiscale registration (EPMR) was proposed based upon an edge preserving total variation L1 norm (TV-L1) scale space representation. TV-L1 scale space is constructed by selecting edges and contours of images according to their size rather than the intensity values of the image features. This ensures more meaningful spatial information with an EPMR framework for MI-based registration. Furthermore, we design an optimal estimation of the TV-L1 parameter in the EPMR framework by training and minimizing the transformation offset between the registered pairs for automated registration in medical systems. We validated our EPMR method on both simulated mono- and multi-modal medical datasets with ground truth and clinical studies from a combined positron emission tomography/computed tomography (PET/CT) scanner. We compared our registration framework with other traditional registration approaches. Our experimental results demonstrated that our method outperformed other methods in terms of the accuracy and robustness for medical images. EPMR can always achieve a small offset value, which is closer to the ground truth both for mono-modality and multi-modality, and the speed can be increased 5-8% for mono-modality and 10-14% for multi-modality registration under the same condition. Furthermore, clinical application by adaptive

  7. Environmental Determinants of Chronic Disease and Medical Approaches: Recognition, Avoidance, Supportive Therapy, and Detoxification

    PubMed Central

    Sears, Margaret E.; Genuis, Stephen J.

    2012-01-01

    The World Health Organization warns that chronic, noncommunicable diseases are rapidly becoming epidemic worldwide. Escalating rates of neurocognitive, metabolic, autoimmune and cardiovascular diseases cannot be ascribed only to genetics, lifestyle, and nutrition; early life and ongoing exposures, and bioaccumulated toxicants may also cause chronic disease. Contributors to ill health are summarized from multiple perspectives—biological effects of classes of toxicants, mechanisms of toxicity, and a synthesis of toxic contributors to major diseases. Healthcare practitioners have wide-ranging roles in addressing environmental factors in policy and public health and clinical practice. Public health initiatives include risk recognition and chemical assessment then exposure reduction, remediation, monitoring, and avoidance. The complex web of disease and environmental contributors is amenable to some straightforward clinical approaches addressing multiple toxicants. Widely applicable strategies include nutrition and supplements to counter toxic effects and to support metabolism; as well as exercise and sweating, and possibly medication to enhance excretion. Addressing environmental health and contributors to chronic disease has broad implications for society, with large potential benefits from improved health and productivity. PMID:22315626

  8. New Directions: Ozone-initiated reaction products indoors may be more harmful than ozone itself

    NASA Astrophysics Data System (ADS)

    Weschler, Charles J.

    2004-10-01

    Epidemiological studies have found associations between ozone concentrations measured at outdoor monitoring stations and certain adverse health outcomes. As a recent example, Gent et al. (2003, Journal of the American Medical Association 290, 1859-1867) have observed an association between ozone levels and respiratory symptoms as well as the use of maintenance medication by 271 asthmatic children living in Connecticut and the Springfield area of Massachusetts. In another example, Gilliland et al. (2001, Epidemiology 12, 43-54) detected an association between short-term increases in ozone levels and increased absences among 4th grade students from 12 southern California communities during the period from January to June 1996. Although children may spend a significant amount of time outdoors, especially during periods when ozone levels are elevated, they spend a much larger fraction of their time indoors. I hypothesize that exposure to the products of ozone-initiated indoor chemistry is more directly responsible for the health effects observed in the cited epidemiological studies than is exposure to outdoor ozone itself.

  9. Medical documentation, bioanalytical evidence of an accidental human exposure to sulfur mustard and general therapy recommendations.

    PubMed

    Steinritz, Dirk; Striepling, Enno; Rudolf, Klaus-Dieter; Schröder-Kraft, Claudia; Püschel, Klaus; Hullard-Pulstinger, Andreas; Koller, Marianne; Thiermann, Horst; Gandor, Felix; Gawlik, Michael; John, Harald

    2016-02-26

    Sulfur mustard (SM) is a chemical warfare agent (CWA) that was first used in World War I and in several military conflicts afterwards. The threat by SM is still present even today due to remaining stockpiles, old and abandoned remainders all over the world as well as to its ease of synthesis. CWA are banned by the Chemical Weapons Convention (CWC) interdicting their development, production, transport, stockpiling and use and are subjected to controlled destruction. The present case report describes an accidental exposure of three workers that occurred during the destruction of SM. All exposed workers presented a characteristic SM-related clinical picture that started about 4h after exposure with erythema and feeling of tension of the skin at the upper part of the body. Later on, superficial blister and a burning phenomenon of the affected skin areas developed. Similar symptoms occurred in all three patients differing severity. One patient presented sustained skin affections at the gluteal region while another patient came up with affections of the axilla and genital region. Fortunately, full recovery was observed on day 56 after exposure except some little pigmentation changes that were evident even on day 154 in two of the patients. SM-exposure was verified for all three patients using bioanalytical GC MS and LC MS/MS based methods applied to urine and plasma. Urinary biotransformation products of the β-lyase pathway were detected until 5 days after poisoning whereas albumin-SM adducts could be found until day 29 underlining the beneficial role of adduct detection for post-exposure verification. In addition, we provide general recommendations for management and therapy in case of SM poisoning.

  10. Medical documentation, bioanalytical evidence of an accidental human exposure to sulfur mustard and general therapy recommendations.

    PubMed

    Steinritz, Dirk; Striepling, Enno; Rudolf, Klaus-Dieter; Schröder-Kraft, Claudia; Püschel, Klaus; Hullard-Pulstinger, Andreas; Koller, Marianne; Thiermann, Horst; Gandor, Felix; Gawlik, Michael; John, Harald

    2016-02-26

    Sulfur mustard (SM) is a chemical warfare agent (CWA) that was first used in World War I and in several military conflicts afterwards. The threat by SM is still present even today due to remaining stockpiles, old and abandoned remainders all over the world as well as to its ease of synthesis. CWA are banned by the Chemical Weapons Convention (CWC) interdicting their development, production, transport, stockpiling and use and are subjected to controlled destruction. The present case report describes an accidental exposure of three workers that occurred during the destruction of SM. All exposed workers presented a characteristic SM-related clinical picture that started about 4h after exposure with erythema and feeling of tension of the skin at the upper part of the body. Later on, superficial blister and a burning phenomenon of the affected skin areas developed. Similar symptoms occurred in all three patients differing severity. One patient presented sustained skin affections at the gluteal region while another patient came up with affections of the axilla and genital region. Fortunately, full recovery was observed on day 56 after exposure except some little pigmentation changes that were evident even on day 154 in two of the patients. SM-exposure was verified for all three patients using bioanalytical GC MS and LC MS/MS based methods applied to urine and plasma. Urinary biotransformation products of the β-lyase pathway were detected until 5 days after poisoning whereas albumin-SM adducts could be found until day 29 underlining the beneficial role of adduct detection for post-exposure verification. In addition, we provide general recommendations for management and therapy in case of SM poisoning. PMID:26321678

  11. Assessment of Assistance in Smoking Cessation Therapy by Pharmacies in Collaboration with Medical Institutions- Implementation of a Collaborative Drug Therapy Management Protocol Based on a Written Agreement between Physicians and Pharmacists.

    PubMed

    Watanabe, Fumiyuki; Shinohara, Kuniko; Dobashi, Akira; Amagai, Kenji; Hara, Kazuo; Kurata, Kaori; Iizima, Hideo; Shimakawa, Kiyoshi; Shimada, Masahiko; Abe, Sakurako; Takei, Keiji; Kamei, Miwako

    2016-01-01

    This study built a protocol for drug therapy management (hereinafter "the protocol") that would enable continuous support from the decision making of smoking cessation therapy to the completion of therapy through the collaboration of physicians and community pharmacists, after which we evaluated whether the use of this protocol would be helpful to smoking cessation therapy. This study utilized the "On the Promotion of Team-Based Medical Care", a Notification by the Health Policy Bureau as one of the resources for judgment, and referred to collaborative drug therapy management (CDTM) in the United States. After the implementation of this protocol, the success rate of smoking cessation at the participating medical institutions rose to approximately 70%, approximately 28-point improvement compared to the rate before the implementation. In addition to the benefits of the standard smoking cessation program, this result may have been affected by the intervention of pharmacists, who assisted in continuing cessation by advising to reduce drug dosage as necessary approximately one week after the smoking cessation, when side effects and the urge to smoke tend to occur. Additionally, the awareness survey for the intervention group revealed that all respondents, including patients who failed to quit smoking, answered that they were satisfied to the question on general satisfaction. The question about the reason for successful cessation revealed that the support by pharmacists was as important as, or more important than, that by physicians and nurses. This infers that the pharmacists' active engagement in drug therapy for individual patients was favorably acknowledged.

  12. Assessment of Assistance in Smoking Cessation Therapy by Pharmacies in Collaboration with Medical Institutions- Implementation of a Collaborative Drug Therapy Management Protocol Based on a Written Agreement between Physicians and Pharmacists.

    PubMed

    Watanabe, Fumiyuki; Shinohara, Kuniko; Dobashi, Akira; Amagai, Kenji; Hara, Kazuo; Kurata, Kaori; Iizima, Hideo; Shimakawa, Kiyoshi; Shimada, Masahiko; Abe, Sakurako; Takei, Keiji; Kamei, Miwako

    2016-01-01

    This study built a protocol for drug therapy management (hereinafter "the protocol") that would enable continuous support from the decision making of smoking cessation therapy to the completion of therapy through the collaboration of physicians and community pharmacists, after which we evaluated whether the use of this protocol would be helpful to smoking cessation therapy. This study utilized the "On the Promotion of Team-Based Medical Care", a Notification by the Health Policy Bureau as one of the resources for judgment, and referred to collaborative drug therapy management (CDTM) in the United States. After the implementation of this protocol, the success rate of smoking cessation at the participating medical institutions rose to approximately 70%, approximately 28-point improvement compared to the rate before the implementation. In addition to the benefits of the standard smoking cessation program, this result may have been affected by the intervention of pharmacists, who assisted in continuing cessation by advising to reduce drug dosage as necessary approximately one week after the smoking cessation, when side effects and the urge to smoke tend to occur. Additionally, the awareness survey for the intervention group revealed that all respondents, including patients who failed to quit smoking, answered that they were satisfied to the question on general satisfaction. The question about the reason for successful cessation revealed that the support by pharmacists was as important as, or more important than, that by physicians and nurses. This infers that the pharmacists' active engagement in drug therapy for individual patients was favorably acknowledged. PMID:27592827

  13. Molecular Storage of Ozone in a Clathrate Hydrate: An Attempt at Preserving Ozone at High Concentrations

    PubMed Central

    Nakajima, Takahiro; Kudo, Taisuke; Ohmura, Ryo; Takeya, Satoshi; Mori, Yasuhiko H.

    2012-01-01

    This paper reports an experimental study of the formation of a mixed O3+ O2+ CO2 hydrate and its frozen storage under atmospheric pressure, which aimed to establish a hydrate-based technology for preserving ozone (O3), a chemically unstable substance, for various industrial, medical and consumer uses. By improving the experimental technique that we recently devised for forming an O3+ O2+ CO2 hydrate, we succeeded in significantly increasing the fraction of ozone contained in the hydrate. For a hydrate formed at a system pressure of 3.0 MPa, the mass fraction of ozone was initially about 0.9%; and even after a 20-day storage at −25°C and atmospheric pressure, it was still about 0.6%. These results support the prospect of establishing an economical, safe, and easy-to-handle ozone-preservation technology of practical use. PMID:23139794

  14. Neutron dosimetry, moderated energy spectrum, and neutron capture therapy for californium-252 medical sources

    NASA Astrophysics Data System (ADS)

    Rivard, Mark Joseph

    Examination of neutron dosimetry for 252Cf has been conducted using calculative and experimental means. Monte Carlo N-Particle (MCNP) transport code was used in a distributed computing environment as a parallel virtual machine (PVM) to determine the absorbed neutron dose and neutron energy spectrum from 252Cf in a variety of clinically relevant materials. Herein, a Maxwellian spectrum was used to model the 252Cf neutron emissions within these materials. 252Cf mixed-field dosimetry of Applicator Tube (AT) type sources was measured using 1.0 and 0.05 cm3 tissue-equivalent ion chambers and a miniature GM counter. A dosimetry protocol was formulated similar that of ICRU 45. The 252Cf AT neutron dosimetry was determined in the cylindrical coordinate system formalism recommended by the AAPM Task Group 43. These results demonstrated the overwhelming dependence of dosimetry on the source geometry factor as there was no significant neutron attenuation within the source or encapsulation. Gold foils and TLDs were used to measure the thermal flux in the vicinity of 252Cf AT sources to compare with the results calculated using MCNP. As the fast neutron energy spectrum did not markedly changed at increasing distances from the AT source, neutron dosimetry results obtained with paired ion chambers using fixed sensitivity factors agreed well with MCNP results and those in the literature. Calculations of moderated 252Cf neutron energy spectrum with various loadings of 10B and 157Gd were performed, in addition to analysis of neutron capture therapy dosimetry with these isotopes. Radiological concerns such as personnel exposure and shielding of 252Cf emissions were examined. Feasibility of a high specific-activity 252Cf HDR source was investigated through radiochemical and metallurgical studies using stand-ins such as Tb, Gd and 249Cf. Issues such as capsule burst strength due to helium production for a variety of proposed HDR sources were addressed. A recommended 252Cf source

  15. Evaluation of Prescriber Responses to Pharmacist Recommendations Communicated by Fax in a Medication Therapy Management Program (MTMP)

    PubMed Central

    Perera, Prasadini N.; Guy, Mignonne C.; Sweaney, Ashley M.; Boesen, Kevin P.

    2016-01-01

    BACKGROUND As defined by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, medication therapy management programs (MTMPs) must be designed to decrease adverse drug events and improve patient outcomes by promoting appropriate medication use. WellPoint Inc. contracted with the pharmacist-run University of Arizona College of Pharmacy Medication Management Center (UA MMC) to provide a pilot telephone-based MTMP to approximately 5,000 high-risk beneficiaries from among its nearly 2 million Medicare prescription drug plan (PDP) beneficiaries. Eligibility for the program was determined by a minimum of 2 of 6 chronic diseases (dyslipidemia, cardiovascular disease, depression, diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease; at least 1 of the latter 2 diseases must be present), at least 3 Part-D covered medications, and greater than $4,000 per year in predicted drug spending. In addition to these criteria, WellPoint Inc. used the Johns Hopkins adjusted clinical groups (ACG) predictive model to identify the high-risk beneficiaries to be enrolled in the program. Medication therapy reviews were conducted for these patients. If any medication-related problems (MRPs) were identified, the patient’s prescribers were contacted via a fax communication with recommendation(s) to resolve these MRPs. The UA MMC fax interventions were categorized as cost saving, guideline adherence, or safety concerns. OBJECTIVES To (a) determine prescriber responses to pharmacist-initiated recommendations in an MTMP for the 3 intervention categories, (b) compare prescriber responses between intervention categories, and (c) compare prescriber response by prescriber type (primary care physician [PCP] vs. specialist) within each intervention category. METHODS A retrospective analysis of pharmacist-initiated interventions from August through December 2008 was performed using data collected from the UA MMC database. Data were collected on

  16. Historical Trend of Racial and Ethnic Disparities in Meeting Medicare Medication Therapy Management Eligibility Criteria in Non-Medicare Population

    PubMed Central

    Wang, Junling; Surbhi, Satya; Zhang, Zhiping; Spivey, Christina A.; Chisholm-Burns, Marie

    2014-01-01

    Background Prior research examining racial and ethnic disparities in meeting Medicare medication therapy management (MTM) eligibility criteria among the non-Medicare population suggests minorities have lower likelihood of being eligible than non-Hispanic Whites (Whites). However, such research has not examined trends in disparities and whether these disparities may be expected to decrease over time based on historical data. Objectives To examine trends in MTM eligibility disparities among the non-Medicare population from 1996-1997 to 2009-2010. Methods This retrospective observational analysis used Medical Expenditure Panel Survey data from the study periods. The MTM eligibility criteria used by health insurance plans in 2008 and 2010 were analyzed. Trends in disparities were examined by including interaction terms between dummy variables for 2009-2010 and non-Hispanic Blacks (Blacks)/Hispanics in a logistic regression. The effect of interaction was estimated on both the multiplicative and additive terms. Main and sensitivity analyses were conducted to represent the ranges of the Medicare MTM eligibility thresholds used by health insurance plans. Results According to the main analysis, Blacks and Hispanics were less likely to be eligible than Whites for both sets of eligibility criteria in 1996-1997 and in 2009-2010. Trend analysis for both sets of criteria found that on the multiplicative term, there were generally no significant changes in disparities between Whites and Blacks/Hispanics from 1996-1997 to 2009-2010. Interaction on the additive term found evidence that disparities between Whites and Blacks/Hispanics may have increased from 1996-1997 to 2009-2010 (e.g., in the main analysis between Whites and Hispanics for 2010 eligibility criteria: difference in odds= -0.03, 95% CI: [-0.03]-[-0.02]). Conclusions Racial and ethnic minorities in the non-Medicare population experience persistent and often increasing disparities in meeting MTM eligibility criteria

  17. Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia.

    PubMed

    Lim, Phei Ching; Lim, Kelvin; Embee, Zubaidah Che; Hassali, Mohamed Azmi; Thiagarajan, Anuradha; Khan, Tahir Mehmood

    2016-03-01

    Involvement of pharmacists in improving medication adherence among diabetic patients is recognized globally. In Malaysian healthcare system, pharmacists are also operating health services i.e. Diabetes Medication Therapy Adherence Clinic (DMTAC). This study aimed to assess the clinical outcomes of patients managed by pharmacists (DMTAC), in a Malaysian hospital setting. This was an open labelled randomised study. Type 2 diabetes patients with HbA1c ≥8% were recruited and arbitrarily divided into the intervention group (usual care plus DMTAC) and the non-intervention group (usual care only). Those enrolled in the intervention group were scheduled for follow-up for eight consecutive visits. Improvements in lab results were compared longitudinally (pre and post analysis) between the groups. Data analysis was done using PASW 18® version. A total of 76 patients were enrolled, with 39 patients in the intervention group and 37 patients in the non-intervention group. Mean HbA1c (-0.90% vs. -0.08%, p=0.011) and fasting blood glucose levels (-3.45 mmol.l vs. +0.79 mmol/l, p=0.002) reduced significantly between the intervention group vs. non-intervention group. Total cholesterol and low-density lipoprotein cholesterol (LDL-C) were also significantly reduced in the intervention group (TC -0.34 mmol/l, p=0.018) (LDL -0.45 mmol/l, p=0.001). In conclusion, pharmacists managed DMTAC significantly improved glycaemic control and lipid profile of diabetic patients. PMID:27087103

  18. Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia.

    PubMed

    Lim, Phei Ching; Lim, Kelvin; Embee, Zubaidah Che; Hassali, Mohamed Azmi; Thiagarajan, Anuradha; Khan, Tahir Mehmood

    2016-03-01

    Involvement of pharmacists in improving medication adherence among diabetic patients is recognized globally. In Malaysian healthcare system, pharmacists are also operating health services i.e. Diabetes Medication Therapy Adherence Clinic (DMTAC). This study aimed to assess the clinical outcomes of patients managed by pharmacists (DMTAC), in a Malaysian hospital setting. This was an open labelled randomised study. Type 2 diabetes patients with HbA1c ≥8% were recruited and arbitrarily divided into the intervention group (usual care plus DMTAC) and the non-intervention group (usual care only). Those enrolled in the intervention group were scheduled for follow-up for eight consecutive visits. Improvements in lab results were compared longitudinally (pre and post analysis) between the groups. Data analysis was done using PASW 18® version. A total of 76 patients were enrolled, with 39 patients in the intervention group and 37 patients in the non-intervention group. Mean HbA1c (-0.90% vs. -0.08%, p=0.011) and fasting blood glucose levels (-3.45 mmol.l vs. +0.79 mmol/l, p=0.002) reduced significantly between the intervention group vs. non-intervention group. Total cholesterol and low-density lipoprotein cholesterol (LDL-C) were also significantly reduced in the intervention group (TC -0.34 mmol/l, p=0.018) (LDL -0.45 mmol/l, p=0.001). In conclusion, pharmacists managed DMTAC significantly improved glycaemic control and lipid profile of diabetic patients.

  19. [Development of clinical radiology in the Military field therapy Department of the Military Medical Academy (the 90th anniversary of the birth of G. I. Alekseyev)].

    PubMed

    Khalimov, Iu Sh; Vlasenko, A N; Matveev, S Iu

    2012-08-01

    On August 18, 2012, 90 years have passed since the birth of the former head of the Military field therapy Department of The Military-Medical Academy named after S. M. Kirov--the main radiologist of the Ministry of Defence of Russian Federation, the corresponding member of the Soviet Union Academy of Medical Science and the Russian Academy of Medical Science, the major- general of a medical service G. I. Alekseyev, who had been working in the department since its foundation till the last day of his life. Being the head of the department for twelve years, G. I. Alekseyev made a considerable contribution to the formation and development of native military radiology, training of medical and scientific skilled specialists. Professor G. I. Alekseyev's scientific ideas and views in the sphere of radiology were realized and developed in further educational, research and medical work of the department. Nowadays the staff of the Military field therapy Department remembers G. I. Alekseyev with special gratitude and appreciation and successfully realizes his ideas and plans in work.

  20. End-of-life discontinuation of destination therapy with cardiac and ventilatory support medical devices: physician-assisted death or allowing the patient to die?

    PubMed Central

    2010-01-01

    Background Bioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die." Discussion Advances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used for permanent support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death. Summary Destination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in

  1. Radiation therapy of tumors of the brainstem and midbrain in children: experience of the Joint Center for Radiation Therapy and Children's Hospital Medical Center (1971-1981).

    PubMed

    Eifel, P J; Cassady, J R; Belli, J A

    1987-06-01

    Between 1971 and 1981, 79 previously untreated children with proven or presumed gliomas of the brainstem or midbrain were seen and treated at the Joint Center for Radiation Therapy and Children's Hospital Medical Center in Boston. Twenty-seven patients had tumors of the thalamus and midbrain (Group I) and 52 had lesions of the pons or medulla (Group II). Overall 5- and 10-year survivals were 50% and 41% respectively. Eighty percent of deaths occurred within 2 years of treatment. Eighty-six percent of the children (69/79) had clinical improvement or stabilization of disease after treatment. Group I patients had a 5-year survival of 73% which was significantly greater than that of Group II patients (38%) (p = 0.007). Children who presented with hypothalamic tumors in association with a diencephalic syndrome or other growth abnormality appeared to have had a better prognosis with 6/6 (100%) surviving without evidence of disease. Age at presentation was not correlated with prognosis. Of 10 children less than 3 years of age at presentation and treatment, 6 are alive (60%) at 2, 3, 7, 9, 10, and 12 years after treatment. The functional results in this group have been good--all six are leading apparently normal lives in regular schools with minor or no apparent neurologic deficits. Although these children will require long term follow-up to determine whether cures have actually been achieved, it appears that the majority achieve some benefit, that a significant proportion enjoy long term survival, and that very young children may be treated successfully with minimal radiation-induced neurologic sequela.

  2. [Ozone exposure and asthma].

    PubMed

    Kleis, S; Louis, R; Bartsch, P

    2003-03-01

    Ozone is a pollutant the production of which depends on weather conditions and car engine combustion. Numerous epidemiological studies have indicated that high ozone levels correlated with morbidity in asthma. Experimental studies have shown that exposure of healthy subjects and asthmatics to ozone levels comparable to those measured in ambient air during hot summer days can generate respiratory symptoms, neutrophilic airways inflammation and lung function impairment. Lung function changes following ozone exposure are more pronounced in asthmatics and are dependent on the duration and intensity of exposure, a previous exposure and the nutritional status of the subjects. The airway epithelial cell layer is likely to play a pivotal role in initiating the inflammatory process following ozone exposure. Control of ambient air ozone levels must be a target for public health authorities.

  3. Biological effects of ozone

    SciTech Connect

    Lippmann, M. )

    1989-09-01

    Tropospheric ozone, a classic anthropogenic air pollutant, is going to remain a troublesome byproduct of contemporary civilization for many decades. We have known for some time that the hydrocarbons and nitrogen oxides from motor vehicles, together with actinic radiation, account for local and regional photochemistry leading to prolonged afternoon ozone peaks. We also now know that agricultural burning and intensive animal husbandry elevate regional and mesoscale concentrations of ozone and its precursors, and that remote background levels of ozone have been rising steadily throughout this century. The changes we will have to make in emission controls to appreciably reduce current tropospheric ozone levels will have profound effects on our transportation systems, consumer products, and lifestyles. As a society, we will have to make difficult choices about the levels of ozone-associated health, welfare, and natural system damage we will tolerate, or conversely, how much we are willing to pay for controls which can minimize the damage.

  4. Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Controlled Trial

    PubMed Central

    Guille, Constance; Zhao, Zhuo; Krystal, John; Nichols, Breck; Brady, Kathleen; Sen, Srijan

    2016-01-01

    Importance In the United States, approximately one physician dies by suicide every day. Training physicians are at particularly high risk, with suicidal ideation increasing over four-fold during the first three months of internship year. Despite this dramatic increase, very few efforts have been made to prevent the escalation of suicidal thoughts among training physicians. Objective To assess the effectiveness of a Web-based Cognitive Behavioral Therapy (wCBT) program delivered prior to the start of internship year in the prevention of suicidal ideation in medical interns. Design, Setting and Participants A randomized controlled trial conducted at two university hospitals with 199 interns from multiple specialties during academic years 2009-10 or 2011-12. Interventions Interns were randomly assigned to study groups (wCBT, n=100; attention-control group (ACG), n=99), and completed study activities lasting 30-minutes each week for four weeks prior to starting internship year. Subjects assigned to wCBT completed online-CBT modules and subjects assigned to ACG received emails with general information about depression, suicidal thinking and local mental health providers. Main Outcome Measure The Patient Health Questionnaire (PHQ-9) was employed to assess suicidal ideation (i.e., “thoughts that you would be better off dead, or hurting yourself in some way”) prior to the start of intern year and at 3-month intervals throughout the year. Results 62.2% (199/320) of individuals agreed to take part in the study. During at least one time point over the course of internship year 12% (12/100) of interns assigned to wCBT endorsed suicidal ideation, compared to 21%(21/99) of interns assigned to ACG. After adjusting for covariates identified a priori that have previously shown to increase the risk for suicidal ideation, interns assigned to wCBT were 60% less likely to endorse suicidal ideation during internship year (RR: 0.40, 95% CI 0.17-0.91; p=0.03), compared to those

  5. HIV-Related Medical Admissions to a South African District Hospital Remain Frequent Despite Effective Antiretroviral Therapy Scale-Up

    PubMed Central

    Meintjes, Graeme; Kerkhoff, Andrew D.; Burton, Rosie; Schutz, Charlotte; Boulle, Andrew; Van Wyk, Gavin; Blumenthal, Liz; Nicol, Mark P.; Lawn, Stephen D.

    2015-01-01

    Abstract The public sector scale-up of antiretroviral therapy (ART) in South Africa commenced in 2004. We aimed to describe the hospital-level disease burden and factors contributing to morbidity and mortality among hospitalized HIV-positive patients in the era of widespread ART availability. Between June 2012 and October 2013, unselected patients admitted to medical wards at a public sector district hospital in Cape Town were enrolled in this cross-sectional study with prospective follow-up. HIV testing was systematically offered and HIV-infected patients were systematically screened for TB. The spectrum of admission diagnoses among HIV-positive patients was documented, vital status at 90 and 180 days ascertained and factors independently associated with death determined. Among 1018 medical admissions, HIV status was ascertained in 99.5%: 60.1% (n = 609) were HIV-positive and 96.1% (n = 585) were enrolled. Of these, 84.4% were aware of their HIV-positive status before admission. ART status was naive in 35.7%, current in 45.0%, and interrupted in 19.3%. The most frequent primary clinical diagnoses were newly diagnosed TB (n = 196, 33.5%), other bacterial infection (n = 100, 17.1%), and acquired immunodeficiency syndrome (AIDS)-defining illnesses other than TB (n = 64, 10.9%). By 90 days follow-up, 175 (29.9%) required readmission and 78 (13.3%) died. Commonest causes of death were TB (37.2%) and other AIDS-defining illnesses (24.4%). Independent predictors of mortality were AIDS-defining illnesses other than TB, low hemoglobin, and impaired renal function. HIV still accounts for nearly two-thirds of medical admissions in this South African hospital and is associated with high mortality. Strategies to improve linkage to care, ART adherence/retention and TB prevention are key to reducing HIV-related hospitalizations in this setting. PMID:26683950

  6. The Antarctic ozone hole

    NASA Technical Reports Server (NTRS)

    Stolarski, Richard S.

    1988-01-01

    Processes that may be responsible for the thinning in the ozone layer above the South Pole are described. The chlorine catalytic cycle which destroys ozone is described, as are the major types of reactions that are believed to interfere with this cycle by forming chlorine reservoirs. The suspected contributions of polar stratospheric clouds to these processes are examined. Finally, the possibility that the ozone hole may be due more to a shift in atmospheric dynamics than to chemical destruction is addressed.

  7. Changes in stratospheric ozone.

    PubMed

    Cicerone, R J

    1987-07-01

    The ozone layer in the upper atmosphere is a natural feature of the earth's environment. It performs several important functions, including shielding the earth from damaging solar ultraviolet radiation. Far from being static, ozone concentrations rise and fall under the forces of photochemical production, catalytic chemical destruction, and fluid dynamical transport. Human activities are projected to deplete substantially stratospheric ozone through anthropogenic increases in the global concentrations of key atmospheric chemicals. Human-induced perturbations may be occurring already.

  8. Antiradiation UV Vaccine: UV Radiation, Biological effects, lesions and medical management - immune-therapy and immune-protection.

    NASA Astrophysics Data System (ADS)

    Popov, Dmitri; Jones, Jeffrey; Maliev, Slava

    Key Words: Ultraviolet radiation,Standard Erythema Dose(SED), Minimal Erythema Dose(MED), Sun Burns, Solar Dermatitis, Sun Burned Disease, DNA Damage,Cell Damage, Antiradiation UV Vaccine, Immune-Prophylaxis of Sun Burned Diseases, Immune-Prophylaxis of Sun Burns, Immune-Therapy of Sun-Burned Disease and Sun Burns,Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), Toxic Epidermal Necrolysis(TEN). Introduction: High doses of UV generated by solar source and artificial sources create an exposure of mammals and other species which can lead to ultraviolet(UV)radiation- associated disease (including erythema, epilation, keratitis, etc.). UV radiation belongs to the non-ionizing part of the electromagnetic spectrum and ranges between 100 nm and 400 nm with 100 nm having been chosen arbitrarily as the boundary between non-ionizing and ionizing radiation, however EMR is a spectrum and UV can produce molecular ionization. UV radiation is conventionally categorized into 3 areas: UV-A (>315-400 nm),UV-B (>280-315 nm)and UV-C (>100-280 nm) [IARC,Working Group Reports,2005] An important consequence of stratospheric ozone depletion is the increased transmission of solar ultraviolet (UV)radiation to the Earth's lower atmosphere and surface. Stratospheric ozone levels have been falling, in certain areas, for the past several decades, so current surface ultraviolet-B (UV-B) radiation levels are thought to be close to their modern day maximum. [S.Madronich et al.1998] Overexposure of ultraviolet radiation a major cause of skin cancer including basal cell carcinoma (BCC), squamous cell carcinoma (SCC) { collectively referred to as “non-melanoma" skin cancer (NMSC) and melanoma as well, with skin cancers being the most common cancer in North America. [Armstrong et al. 1993, Gallagher et al. 2005] Methods and Experimental Design: Our experiments and testing of a novel UV “Antiradiation Vaccine” have employed a wide variety of laboratory animals which include : Chinchilla

  9. Antiradiation UV Vaccine: UV Radiation, Biological effects, lesions and medical management - immune-therapy and immune-protection.

    NASA Astrophysics Data System (ADS)

    Popov, Dmitri; Jones, Jeffrey; Maliev, Slava

    Key Words: Ultraviolet radiation,Standard Erythema Dose(SED), Minimal Erythema Dose(MED), Sun Burns, Solar Dermatitis, Sun Burned Disease, DNA Damage,Cell Damage, Antiradiation UV Vaccine, Immune-Prophylaxis of Sun Burned Diseases, Immune-Prophylaxis of Sun Burns, Immune-Therapy of Sun-Burned Disease and Sun Burns,Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), Toxic Epidermal Necrolysis(TEN). Introduction: High doses of UV generated by solar source and artificial sources create an exposure of mammals and other species which can lead to ultraviolet(UV)radiation- associated disease (including erythema, epilation, keratitis, etc.). UV radiation belongs to the non-ionizing part of the electromagnetic spectrum and ranges between 100 nm and 400 nm with 100 nm having been chosen arbitrarily as the boundary between non-ionizing and ionizing radiation, however EMR is a spectrum and UV can produce molecular ionization. UV radiation is conventionally categorized into 3 areas: UV-A (>315-400 nm),UV-B (>280-315 nm)and UV-C (>100-280 nm) [IARC,Working Group Reports,2005] An important consequence of stratospheric ozone depletion is the increased transmission of solar ultraviolet (UV)radiation to the Earth's lower atmosphere and surface. Stratospheric ozone levels have been falling, in certain areas, for the past several decades, so current surface ultraviolet-B (UV-B) radiation levels are thought to be close to their modern day maximum. [S.Madronich et al.1998] Overexposure of ultraviolet radiation a major cause of skin cancer including basal cell carcinoma (BCC), squamous cell carcinoma (SCC) { collectively referred to as “non-melanoma" skin cancer (NMSC) and melanoma as well, with skin cancers being the most common cancer in North America. [Armstrong et al. 1993, Gallagher et al. 2005] Methods and Experimental Design: Our experiments and testing of a novel UV “Antiradiation Vaccine” have employed a wide variety of laboratory animals which include : Chinchilla

  10. Interprofessional education in gross anatomy: experience with first-year medical and physical therapy students at Mayo Clinic.

    PubMed

    Hamilton, Steven S; Yuan, Brandon J; Lachman, Nirusha; Hellyer, Nathan J; Krause, David A; Hollman, John H; Youdas, James W; Pawlina, Wojciech

    2008-01-01

    Interprofessional education (IPE) in clinical practice is believed to improve outcomes in health care delivery. Integrating teaching and learning objectives through cross discipline student interaction in basic sciences has the potential to initiate interprofessional collaboration at the early stages of health care education. Student attitudes and effectiveness of IPE in the context of a combined gross anatomy course for first-year students in Doctor of Physical Therapy (DPT) and Doctor of Medicine (MD) degrees curricula were evaluated. Integrated teams of MD and DPT students participated in part of the gross anatomy dissection course at Mayo Medical School. A survey was administered to 42 MD and 28 DPT students that assessed their attitudes toward IPE and cooperation among health care professionals. Pre- and post-experience surveys were evaluated. Positive comments were related to opportunities for developing a better understanding of the nature and scope of each other's programs, encouraging teamwork and communication, mutual respect, and reducing the perceptual divide between disciplines. Ninety-two percent of the students agreed that interprofessional learning would help them in becoming a more effective member of the health care team. This initial experience with IPE in gross anatomy provides a basis for continued development of interdisciplinary educational strategies.

  11. Photoluminescence and photothermal effect of Fe{sub 3}O{sub 4} nanoparticles for medical imaging and therapy

    SciTech Connect

    Sadat, M. E.; Kaveh Baghbador, Masoud; Wagner, H. P.; Mast, David B. E-mail: donglu.shi@uc.edu; Dunn, Andrew W.; Ewing, Rodney C.; Zhang, Jiaming; Xu, Hong; Pauletti, Giovanni M.; Shi, Donglu E-mail: donglu.shi@uc.edu

    2014-09-01

    Photoluminescence (PL) of Fe{sub 3}O{sub 4} nanoparticle was observed from the visible to near-infrared (NIR) range by laser irradiation at 407 nm. PL spectra of ∼10 nm diameter Fe{sub 3}O{sub 4} nanoparticles organized in different spatial configuration, showed characteristic emissions with a major peak near 560 nm, and two weak peaks near 690 nm and 840 nm. Different band gap energies were determined for these Fe{sub 3}O{sub 4} nanoparticle samples corresponding to, respectively, the electron band structures of the octahedral site (2.2 eV) and the tetrahedral site (0.9 eV). Photothermal effect of Fe{sub 3}O{sub 4} nanoparticles was found to be associated with the photoluminescence emissions in the NIR range. Also discussed is the mechanism responsible for the photothermal effect of Fe{sub 3}O{sub 4} nanoparticles in medical therapy.

  12. Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial

    PubMed Central

    Huijbers, Marloes J.; Spinhoven, Philip; Spijker, Jan; Ruhé, Henricus G.; van Schaik, Digna J. F.; van Oppen, Patricia; Nolen, Willem A.; Ormel, Johan; Kuyken, Willem; van der Wilt, Gert Jan; Blom, Marc B. J.; Schene, Aart H.; Rogier, A.; Donders, T.; Speckens, Anne E. M.

    2016-01-01

    Background Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied. Aims To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM. Method A multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov: NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n = 249), were randomly allocated to either discontinue (n = 128) or continue (n = 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and depression severity. Results The difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in depression severity. Conclusions Our findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT. PMID:26892847

  13. Double-Blinding and Bias in Medication and Cognitive-Behavioral Therapy Trials for Major Depressive Disorder.

    PubMed

    Berger, Douglas

    2015-01-01

    While double-blinding is a crucial aspect of study design in an interventional clinical trial of medication for a disorder with subjective endpoints such as major depressive disorder, psychotherapy clinical trials, particularly cognitive-behavioral therapy trials, cannot be double-blinded. This paper highlights the evidence-based medicine problem of double-blinding in the outcome research of a psychotherapy and opines that psychotherapy clinical trials should be called, "partially-controlled clinical data" because they are not double-blinded. The implications for practice are, 1. For practitioners to be clear with patients the level of rigor to which interventions have been studied, 2. For authors of psychotherapy outcome studies to be clear that the problem in the inability to blind a psychotherapy trial severely restricts the validity of any conclusions that can be drawn, and 3. To petition National Health Insurance plans to use caution in approving interventions studied without double-blinded confirmatory trials as they may lead patients to avoid other treatments shown to be effective in double-blinded trials.

  14. A comparison of nifedipine and tamsulosin as medical expulsive therapy for the management of lower ureteral stones without ESWL.

    PubMed

    Cao, Dehong; Yang, Lu; Liu, Liangren; Yuan, Haichao; Qian, Shenqiang; Lv, Xiao; Han, Pin; Wei, Qiang

    2014-01-01

    Administration of nifedipine or tamsulosin has been suggested to augment stone expulsion rates. We aimed to compare the stone expulsion rates and adverse effects associated with the use of nifedipine or tamsulosin as medical expulsive therapy (MET) for the management of lower ureteral stones (LUS) without extracorporeal shock wave lithotripsy (ESWL) via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from the Medline, EMBASE, Cochrane CENTRAL, and Google Scholar databases. Finally, a total of 7 RCTs with 3897 patients were included. Our meta-analysis showed that tamsulosin could significantly increase the stone expulsion rate relative to nifedipine in patients with LUS (random-effects model; risk ratio [RR] = 0.81; 95% confidence interval [CI] = 0.75-0.88; P < 0.00001). The subgroup analysis indicated no statistically significant difference between the drugs with regard to minor or major adverse effects (fixed-effect model; RR = 1.19, 95% CI = 0.91-1.54, P = 0.20; and RR = 1.63, 95% CI = 0.22-11.82, P = 0.63, respectively). This meta-analysis demonstrated that tamsulosin was more effective than nifedipine in patients with LUS, as evidenced by the higher stone expulsion rate. Tamsulosin treatment should therefore be considered for patients with LUS.

  15. Managing complex therapies outside hospitals. An analysis of GPs practices of how to support medication at home.

    PubMed

    Piras, Enrico Maria; Miele, Francesco; Bruni, Attila; Coletta, Claudio; Zanutto, Alberto

    2014-01-01

    Support systems for the management of prescriptions are commonplace in hospitals, whilst they are rarely found in general practice. This exploratory study draws on a qualitative survey conducted with focus groups to investigate the information needs of General Practitioners (GPs) in regard to the therapeutic management of complex patients, the purpose being to identify possible areas of application. The question addressed is whether the systems existing in hospitals can be usefully adapted and used by GPs or if a different approach needs to be adopted to design other tools. The analysis shows that the information needs of GPs relative to medication management are significantly different from those of their hospital colleagues because the former are not directly responsible for the administration but instead operate within a care network on which they cannot exercise direct control. This study suggests that support systems for therapy management should be designed on the assumption that it derives from cooperative work by a heterogeneous network of actors, and therefore with functionalities intended to satisfy the coordination needs of all the actors involved in the process.

  16. Adsorption air cleaning from ozone.

    PubMed

    Baltrenas, Pranas; Paliulis, Dainius; Vasarevicius, Saulius; Simaitis, Ramutis

    2003-01-01

    Not much has been written about air cleaning from ozone. The aim of this paper was to demonstrate the possibility of adsorption air cleaning from ozone. The second aim was to investigate the dependence of the efficiency of ozone removal from the air on the height of the adsorber layer and on concentrations of ozone, and to obtain empirical formulas for calculating the efficiency of ozone treatment. Equipment for air cleaning from ozone and nitrogen and sulphur dioxides is suggested.

  17. Acne vulgaris in the context of complex medical co-morbities: the management of severe acne vulgaris in a female with retinitis pigmentosa - utilizing pulse dye laser in conjunction with medical therapy.

    PubMed

    Shariff, Ayesha; Keck, Laura; Zlotoff, Barrett

    2014-03-17

    Acne vulgaris is a pervasive inflammatory disorder of the skin, with multiple etiologies and treatment options. Although first-line therapies exist, it is often the case that a patient will present with an underlying disorder that prohibits the use of most currently accepted treatment modalities. We present a patient with severe acne vulgaris and a history of retinitis pigmentosa who was treated with 595 nanometer pulsed dye laser therapy, in conjunction with therapeutic alternatives to first-line acne medications. Our patient exhibited a significant and sustained improvement with the combined use of 595 nanometer pulsed dye laser, Yaz (drospirenone-ethinyl estradiol), dapsone, topical metronidazole, sodium-sulfacetamide wash, and topical azelaic acid. The positive results in this case, suggest that this combined treatment modality may serve as an example of a safe and effective treatment alternative in the management of acne vulgaris complicated by medical co-morbidities that contraindicate the use of most first-line treatment options.

  18. Intensive Family-Based Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: Applications for Treatment of Medication Partial- or Nonresponders

    PubMed Central

    Marien, Wendi E.; Storch, Eric A.; Geffken, Gary R.; Murphy, Tanya K.

    2011-01-01

    Serotonin reuptake inhibitor medications and cognitive-behavioral therapy (CBT) are both effective treatments for pediatric obsessive-compulsive disorder (OCD). Despite recommendations that youth with OCD be treated with CBT alone or together with serotonin reuptake inhibitor medication, many youth are treated with medication alone or with non-CBT psychotherapy initially. Although effective, symptom remission with medication alone is rare (e.g., only 21.4% of youth achieved remission with sertraline in the Pediatric OCD Treatment Study, 2004) and residual symptoms often remain (e.g., 58% of subjects in the March et al. [1998] sertraline trial were not considered treatment responders). This paper reviews the literature on the efficacy of CBT for pediatric OCD, particularly as it relates to the treatment of youth with prior inadequate response to medication. It also describes an intensive, family-based CBT program for children and adolescents with OCD and support for its efficacy among those with prior partial- or nonresponse to medication. Finally, we present a case study of an adolescent girl with OCD who participated in the intensive treatment program after having limited benefit from medication and non-CBT psychotherapy and experienced a favorable response. PMID:24174866

  19. Medical Acoustics

    NASA Astrophysics Data System (ADS)

    Beach, Kirk W.; Dunmire, Barbrina

    Medical acoustics can be subdivided into diagnostics and therapy. Diagnostics are further separated into auditory and ultrasonic methods, and both employ low amplitudes. Therapy (excluding medical advice) uses ultrasound for heating, cooking, permeablizing, activating and fracturing tissues and structures within the body, usually at much higher amplitudes than in diagnostics. Because ultrasound is a wave, linear wave physics are generally applicable, but recently nonlinear effects have become more important, even in low-intensity diagnostic applications.

  20. The Antarctic Ozone Hole.

    ERIC Educational Resources Information Center

    Stolarski, Richard S.

    1988-01-01

    Discusses the Airborne Antarctic Ozone Experiment (1987) and the findings of the British Antarctic Survey (1985). Proposes two theories for the appearance of the hole in the ozone layer over Antarctica which appears each spring; air pollution and natural atmospheric shifts. Illustrates the mechanics of both. Supports worldwide chlorofluorocarbon…

  1. Ozone and temperature trends

    NASA Technical Reports Server (NTRS)

    Stolarski, Richard S.; Fioletov, Vitali; Bishop, Lane; Godin, Sophie; Bojkov, Rumen D.; Kirchhoff, Volker; Chanin, Marie-Lise; Zawodny, Joseph M.; Zerefos, Christos S.; Chu, William

    1991-01-01

    An update of the extensive reviews of the state of knowledge of measured ozone trends published in the Report of the International Ozone Trends Panel is presented. The update contains a review of progress since these reports, including reviewing of the ozone records, in most cases through March 1991. Also included are some new, unpublished reanalyses of these records including a complete reevaluation of 29 stations located in the former Soviet Union. The major new advance in knowledge of the measured ozone trend is the existence of independently calibrated satellite data records from the Total Ozone Mapping Spectrometer (TOMS) and Stratospheric Aerosol and Gas Experiment (SAG) instruments. These confirm many of the findings, originally derived from the Dobson record, concerning northern mid-latitude changes in ozone. We now have results from several instruments, whereas the previously reported changes were dependent on the calibration of a single instrument. This update will compare the ozone records from many different instruments to determine whether or not they provide a consistent picture of the ozone change that has occurred in the atmosphere. The update also briefly considers the problem of stratospheric temperature change. As in previous reports, this problem received significantly less attention, and the report is not nearly as complete. This area needs more attention in the future.

  2. Saving Our Ozone Shield.

    ERIC Educational Resources Information Center

    Lacoste, Beatrice

    1992-01-01

    Discusses the introduction and continued use of chlorofluorocarbons (CFCs) as related to stratospheric ozone depletion. Presents the characteristics of CFCs conducive to the chemical reaction with ozone, the history of CFC use and detection of related environmental problems, health hazards, and alternatives to CFC use. (MCO)

  3. Polar Ozone Workshop. Abstracts

    NASA Technical Reports Server (NTRS)

    Aikin, Arthur C.

    1988-01-01

    Results of the proceedings of the Polar Ozone Workshop held in Snowmass, CO, on May 9 to 13, 1988 are given. Topics covered include ozone depletion, ozonometry, polar meteorology, polar stratospheric clouds, remote sensing of trace gases, atmospheric chemistry and dynamical simulations.

  4. Observing trends in total ozone and extreme ozone events

    NASA Astrophysics Data System (ADS)

    Balcerak, Ernie

    2014-05-01

    The ozone layer in the stratosphere has been recovering since the 1989 Montreal Protocol reduced the use of ozone-destroying chlorofluorocarbons. Fitzka et al. observed trends in total ozone levels and the vertical distribution of ozone at Hoher Sonnblick, a mountain in Austria, from 1994 to 2011.

  5. Ozone in equatorial latitudes

    NASA Astrophysics Data System (ADS)

    Martini, L.; Zimmermann, G.; Trinkkeller, B.

    The presence of ozone in the atmosphere protects the biosphere against harmful solar UV radiation. The ozone distribution in the atmosphere is maintained on the basis of a complex system of reactions. The amount of atmospheric ozone might be reduced as a consequence of human activities. Such reduction in the atmospheric ozone could affect climate and biological processes on earth. As a part of plans for a further enhancement of the global surveillance of the atmospheric ozone layer, a series of radiation experiments concerning the quartz-ultraviolet region were conducted as a joint project of the German Democratic Republic and the USSR. The experiments had the objective to measure the radiative flux of the solar UV radiation and to determine absorption and dispersion of the radiation in the upper atmosphere. The investigation included the launching of 12 rockets from a research vessel in the Indian Ocean near the equator and 34 balloon flights.

  6. Ozone: A Multifaceted Molecule with Unexpected Therapeutic Activity.

    PubMed

    Zanardi, I; Borrelli, E; Valacchi, G; Travagli, V; Bocci, V

    2016-01-01

    A comprehensive outline for understanding and recommending the therapeutic use of ozone in combination with established therapy in diseases characterized by a chronic oxidative stress is currently available. The view of the absolute ozone toxicity is incorrect, because it has been based either on lung or on studies performed in artificial environments that do not correspond to the real antioxidant capacity of body compartments. In fact, ozone exerts either a potent toxic activity or it can stimulate biological responses of vital importance, analogously to gases with prospective therapeutic value such as NO, CO, H2S, H2, as well as O2 itself. Such a crucial difference has increasingly become evident during the last decade. The purpose of this review is to explain the aspects still poorly understood, highlighting the divergent activity of ozone on the various biological districts. It will be clarified that such a dual effect does not depend only upon the final gas concentration, but also on the particular biological system where ozone acts. The real significance of ozone as adjuvant therapeutic treatment concerns severe chronic pathologies among which are cardiovascular diseases, chronic obstructive pulmonary diseases, multiple sclerosis, and the dry form of age-related macular degeneration. It is time for a full insertion of ozone therapy within pharmaceutical sciences, responding to all the requirements of quality, efficacy and safety, rather than as either an alternative or an esoteric approach.

  7. Update on medical and regulatory issues pertaining to compounded and FDA-approved drugs, including hormone therapy

    PubMed Central

    Pinkerton, JoAnn V.; Pickar, James H.

    2016-01-01

    Abstract Objective: We review the historical regulation of drug compounding, concerns about widespread use of non-Food and Drug Admiistration (FDA)-approved compounded bioidentical hormone therapies (CBHTs), which do not have proper labeling and warnings, and anticipated impact of the 2013 Drug Quality and Security Act (DQSA) on compounding. Methods: US government websites were searched for documents concerning drug compounding regulation and oversight from 1938 (passage of Federal Food, Drug, and Cosmetic Act [FDCA]) through 2014, including chronologies, Congressional testimony, FDA guidelines and enforcements, and reports. The FDCA and DQSA were reviewed. PubMed and Google were searched for articles on compounded drugs, including CBHT. Results: Congress explicitly granted the FDA limited oversight of compounded drugs in a 1997 amendment to the FDCA, but the FDA has encountered obstacles in exercising that authority. After 64 patient deaths and 750 adversely affected patients from the 2012 meningitis outbreak due to contaminated compounded steroid injections, Congress passed the DQSA, authorizing the FDA to create a voluntary registration for facilities that manufacture and distribute sterile compounded drugs in bulk and reinforcing FDCA regulations for traditional compounding. Given history and current environment, concerns remain about CBHT product regulation and their lack of safety and efficacy data. Conclusions: The DQSA and its reinforcement of §503A of the FDCA solidifies FDA authority to enforce FDCA provisions against compounders of CBHT. The new law may improve compliance and accreditation by the compounding industry; support state and FDA oversight; and prevent the distribution of misbranded, adulterated, or inconsistently compounded medications, and false and misleading claims, thus reducing public health risk. PMID:26418479

  8. Medication possession ratio associated with short-term virologic response in individuals initiating antiretroviral therapy in Namibia.

    PubMed

    Hong, Steven Y; Jerger, Logan; Jonas, Anna; Badi, Alfons; Cohen, Steven; Nachega, Jean B; Parienti, Jean-Jacques; Tang, Alice M; Wanke, Christine; Terrin, Norma; Pereko, Dawn; Blom, Abraham; Trotter, Andrew B; Jordan, Michael R

    2013-01-01

    The visual-analogue scale (VAS), Likert item (rating scale), pills identification test (PIT), and medication possession ratio (MPR) provide estimates of antiretroviral therapy (ART) adherence which correlate with HIV viral suppression. These simple adherence measures are inexpensive and easy to administer; however, require validation and adjustment prior to implementation. The objective of this study was to define the optimal adherence assessment measure in Namibia to identify patients at risk for sub-optimal adherence and poor virologic response 6 months after ART initiation. We conducted a cross-sectional survey in HIV-infected adults receiving ART for 6-12 months prior to the adherence assessment. Adherence measures included 30-day VAS, 30-day Likert item, self-reported treatment interruptions, PIT, and MPR. Association of adherence measures with 6-month HIV-1 RNA level was assessed using two thresholds (1000 copies/mL and 5000 copies/mL). Adherence was assessed in 236 patients, mean age 37.3 years, 54% female. Mean adherence was 98.1% by 30-day VAS, 84.7% by 30-day Likert item, 97.0% by self-reported treatment interruptions, 90.6% by PIT, and 98.8% by MPR. Agreement between adherence measures was poor using kappa statistic. 76% had HIV-1 RNA <1000 copies/ml, and 88% had HIV-1 RNA <5000 copies/ml. MPR (continuous) was associated with viral suppression <5000 copies/ml (p = 0.036). MPR <75% was associated with virologic failure at ≥5000 copies/ml with OR 3.89 (1.24, 12.21), p = 0.013. Adherence was high with all measures. Only MPR, was associated with short-term virologic response, suggesting its cross-culturally utility for early identification of patients at high risk for virologic failure.

  9. Electroconvulsive Therapy Added to Non-Clozapine Antipsychotic Medication for Treatment Resistant Schizophrenia: Meta-Analysis of Randomized Controlled Trials.

    PubMed

    Zheng, Wei; Cao, Xiao-Lan; Ungvari, Gabor S; Xiang, Ying-Qiang; Guo, Tong; Liu, Zheng-Rong; Wang, Yuan-Yuan; Forester, Brent P; Seiner, Stephen J; Xiang, Yu-Tao

    2016-01-01

    This meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of the combination of electroconvulsive therapy (ECT) and antipsychotic medication (except for clozapine) versus the same antipsychotic monotherapy for treatment-resistant schizophrenia (TRS). Two independent investigators extracted data for a random effects meta-analysis and pre-specified subgroup and meta-regression analyses. Weighted and standard mean difference (WMD/SMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated. Eleven studies (n = 818, duration = 10.2±5.5 weeks) were identified for meta-analysis. Adjunctive ECT was superior to antipsychotic monotherapy regarding (1) symptomatic improvement at last-observation endpoint with an SMD of -0.67 (p<0.00001; I(2) = 62%), separating the two groups as early as weeks 1-2 with an SMD of -0.58 (p<0.00001; I(2) = 0%); (2) study-defined response (RR = 1.48, p<0.0001) with an NNT of 6 (CI = 4-9) and remission rate (RR = 2.18, p = 0.0002) with an NNT of 8 (CI = 6-16); (3) PANSS positive and general symptom sub-scores at endpoint with a WMD between -3.48 to -1.32 (P = 0.01 to 0.009). Subgroup analyses were conducted comparing double blind/rater-masked vs. open RCTs, those with and without randomization details, and high quality (Jadad≥adadup analyses were Jadad<3) studies. The ECT-antipsychotic combination caused more headache (p = 0.02) with an NNH of 6 (CI = 4-11) and memory impairment (p = 0.001) with an NNH of 3 (CI = 2-5). The use of ECT to augment antipsychotic treatment (clozapine excepted) can be an effective treatment option for TRS, with increased frequency of self-reported memory impairment and headache. PMID:27285996

  10. New medical therapy: hyperbarics.

    PubMed

    Savage, Scott

    2010-03-01

    This article reviews the essentials hyperbaric medicine. Specifically, we review the basic mechanism of action, the six most common indications for treatment, methods of accessing care, typical treatment concerns, and effectiveness of hyperbaric medicine. PMID:20373643

  11. Proton Beam Therapy for Patients With Medically Inoperable Stage I Non-Small-Cell Lung Cancer at the University of Tsukuba

    SciTech Connect

    Nakayama, Hidetsugu; Sugahara, Shinji; Tokita, Mari; Satoh, Hiroaki; Tsuboi, Koji; Ishikawa, Shigemi; Tokuuye, Koichi

    2010-10-01

    Purpose: To evaluate in a retrospective review the role of proton beam therapy for patients with medically inoperable Stage I non-small-cell lung cancer (NSCLC). Patients and Methods: From November 2001 to July 2008, 55 medically inoperable patients with Stage I NSCLC were treated with proton beam therapy. A total of 58 (T1/T2, 30/28) tumors were treated. The median age of study participants was 77 years (range, 52-86 years). A total dose of 66 GyE in 10 fractions was given to peripherally located tumors and 72.6 GyE in 22 fractions to centrally located tumors. Results: The rates (95% confidence interval) of overall and progression-free survival of all patients and of local control of all tumors at 2 years were 97.8% (93.6-102.0%), 88.7% (77.9-99.5%), and 97.0% (91.1-102.8%), respectively. There was no statistically significant difference in progression-free rate between T1 and T2 tumors (p = 0.87). Two patients (3.6%) had deterioration in pulmonary function, and 2 patients (3.6%) had Grade 3 pneumonitis. Conclusion: Proton beam therapy was effective and well tolerated in medically inoperable patients with Stage I NSCLC.

  12. Treatment of internal carotid artery dissection with Willis covered stent: A case report of recurrent limb weakness and no response to medical therapy

    PubMed Central

    CAI, XUELI; GUAN, JIANHONG; REN, SHAOJUN; WEI, YIXIN; PENG, XIAO; QIU, WEIWEN; CHEN, JUN

    2016-01-01

    Internal carotid artery dissection (ICAD) is a major cause of ischemic stroke in young and middle-aged patients. Patients may be asymptomatic or present with symptoms ranging from headache and neck pain to severe cerebral ischemic events. Conventional treatment is medical anticlotting therapy or involves the use of interventional tools, such as endovascular treatment. Anticoagulation or antiplatelet therapy are the primary treatment modalities used to prevent thromboembolic complications from arterial dissections, however, they are unsuitable in certain cases of dissecting aneurysms. In the current study reports the case of a 52-year-old male patient presenting with the primary complaint of left limb weakness. Computed tomography angiography revealed a right ICAD located in the oropharyngeal segment. Subsequently, digital subtraction angiography was performed to assess the oropharyngeal segment. Antithrombotic therapy resulted in no improvement; therefore, endovascular treatment with the insertion of a Willis covered stent was performed, resulting in an improved outcome. PMID:27168838

  13. The Hole in the Ozone Layer.

    ERIC Educational Resources Information Center

    Hamers, Jeanne S.; Jacob, Anthony T.

    This document contains information on the hole in the ozone layer. Topics discussed include properties of ozone, ozone in the atmosphere, chlorofluorocarbons, stratospheric ozone depletion, effects of ozone depletion on life, regulation of substances that deplete the ozone layer, alternatives to CFCs and Halons, and the future of the ozone layer.…

  14. Fundamentals of ISCO Using Ozone

    EPA Science Inventory

    In situ chemical oxidation (ISCO) using ozone involves the introduction of ozone gas (O3) into the subsurface to degrade organic contaminants of concern. Ozone is tri-molecular oxygen (O2) that is a gas under atmospheric conditions and is a strong oxidant. Ozone may react with ...

  15. The Two Faces of Ozone.

    ERIC Educational Resources Information Center

    Monastersky, Richard

    1989-01-01

    Provides answers to questions regarding the ozone problem: (1) nature of ozone in the troposphere and stratosphere; (2) possibility of sending the excess ozone at ground level to the stratosphere; (3) possibility of producing pure ozone and carrying it to the stratosphere; and (4) banning chlorofluorocarbons. (YP)

  16. Measuring Adherence to Medication in Schizophrenia: The Relationship between Attitudes toward Drug Therapy and Plasma Levels of New-Generation Antipsychotics

    PubMed Central

    Yalcin-Siedentopf, Nursen; Wartelsteiner, Fabienne; Kaufmann, Alexandra; Biedermann, Falko; Edlinger, Monika; Kemmler, Georg; Rettenbacher, Maria A.; Widschwendter, Christian G.; Zernig, Gerald; Fleischhacker, W. Wolfgang

    2015-01-01

    Background: Nonadherence to medication is still a major problem in the treatment of schizophrenia. The current longitudinal study investigated whether the patients’ attitudes toward treatment correlated with the ratio of observed vs expected plasma levels of antipsychotic drugs as an objective measurement of adherence. Methods: Data of patients starting monotherapy with a new-generation antipsychotic were collected 2, 4, and 12 weeks after the initiation of treatment. Next to the assessment of patients’ attitudes toward medication by means of the Drug Attitude Inventory, the ratio of the observed vs expected plasma level was calculated. Antipsychotic-induced side effects were evaluated by means of the Udvalg for Kliniske Undersogelser Side Effect Rating Scale. Results: A total of 93 patients were eligible for statistical analysis. About one-half of the ratios of observed vs expected plasma levels ranged from 0.5 to 2 and were considered normal, whereas the other ratios were considered either too low (<0.5) or too high (>2). No consistent correlation between patients’ attitude toward drug therapy and the individual ratios of observed vs expected plasma levels of medication was detected. This finding was not affected by side effects. Conclusions: Our results highlight the importance of recognizing the complex nature of adherence to medication in schizophrenia patients. Importantly, we found no consistent correlation between subjective and objective measures of medication adherence. Therefore, monitoring adherence to medication remains a challenge in clinical practice. PMID:25522423

  17. [Report from the Committee for Advanced Therapies (CAT). Pitfalls on the way from concept to medical treatment with advanced therapy medicinal products].

    PubMed

    Reiss, M; Büttel, I C; Schneider, C K

    2011-07-01

    Advanced therapy medicinal products (ATMP) are highly innovative and complex medicines. They comprise gene therapy medicinal products, somatic cell therapy medicinal products, and tissue-engineered products (TEP). With the European Regulation on ATMP that came into force in 2008, a consolidated regulatory framework was created, where the Committee for Advanced Therapies (CAT) at the European Medicines Agency (EMA) plays a central role. This article discusses pitfalls and challenges that the CAT has experienced in its discussions of various procedures. Often ATMPs are developed by small and medium-sized enterprises (SME) which also face nonscientific challenges. The CAT wishes to meet these challenges on a scientific and regulatory level during its 2010-2015 work program.

  18. Stratospheric ozone depletion.

    PubMed

    Rowland, F Sherwood

    2006-05-29

    Solar ultraviolet radiation creates an ozone layer in the atmosphere which in turn completely absorbs the most energetic fraction of this radiation. This process both warms the air, creating the stratosphere between 15 and 50 km altitude, and protects the biological activities at the Earth's surface from this damaging radiation. In the last half-century, the chemical mechanisms operating within the ozone layer have been shown to include very efficient catalytic chain reactions involving the chemical species HO, HO2, NO, NO2, Cl and ClO. The NOX and ClOX chains involve the emission at Earth's surface of stable molecules in very low concentration (N2O, CCl2F2, CCl3F, etc.) which wander in the atmosphere for as long as a century before absorbing ultraviolet radiation and decomposing to create NO and Cl in the middle of the stratospheric ozone layer. The growing emissions of synthetic chlorofluorocarbon molecules cause a significant diminution in the ozone content of the stratosphere, with the result that more solar ultraviolet-B radiation (290-320 nm wavelength) reaches the surface. This ozone loss occurs in the temperate zone latitudes in all seasons, and especially drastically since the early 1980s in the south polar springtime-the 'Antarctic ozone hole'. The chemical reactions causing this ozone depletion are primarily based on atomic Cl and ClO, the product of its reaction with ozone. The further manufacture of chlorofluorocarbons has been banned by the 1992 revisions of the 1987 Montreal Protocol of the United Nations. Atmospheric measurements have confirmed that the Protocol has been very successful in reducing further emissions of these molecules. Recovery of the stratosphere to the ozone conditions of the 1950s will occur slowly over the rest of the twenty-first century because of the long lifetime of the precursor molecules.

  19. Stratospheric ozone depletion

    PubMed Central

    Rowland, F. Sherwood

    2006-01-01

    Solar ultraviolet radiation creates an ozone layer in the atmosphere which in turn completely absorbs the most energetic fraction of this radiation. This process both warms the air, creating the stratosphere between 15 and 50 km altitude, and protects the biological activities at the Earth's surface from this damaging radiation. In the last half-century, the chemical mechanisms operating within the ozone layer have been shown to include very efficient catalytic chain reactions involving the chemical species HO, HO2, NO, NO2, Cl and ClO. The NOX and ClOX chains involve the emission at Earth's surface of stable molecules in very low concentration (N2O, CCl2F2, CCl3F, etc.) which wander in the atmosphere for as long as a century before absorbing ultraviolet radiation and decomposing to create NO and Cl in the middle of the stratospheric ozone layer. The growing emissions of synthetic chlorofluorocarbon molecules cause a significant diminution in the ozone content of the stratosphere, with the result that more solar ultraviolet-B radiation (290–320 nm wavelength) reaches the surface. This ozone loss occurs in the temperate zone latitudes in all seasons, and especially drastically since the early 1980s in the south polar springtime—the ‘Antarctic ozone hole’. The chemical reactions causing this ozone depletion are primarily based on atomic Cl and ClO, the product of its reaction with ozone. The further manufacture of chlorofluorocarbons has been banned by the 1992 revisions of the 1987 Montreal Protocol of the United Nations. Atmospheric measurements have confirmed that the Protocol has been very successful in reducing further emissions of these molecules. Recovery of the stratosphere to the ozone conditions of the 1950s will occur slowly over the rest of the twenty-first century because of the long lifetime of the precursor molecules. PMID:16627294

  20. Stratospheric ozone depletion.

    PubMed

    Rowland, F Sherwood

    2006-05-29

    Solar ultraviolet radiation creates an ozone layer in the atmosphere which in turn completely absorbs the most energetic fraction of this radiation. This process both warms the air, creating the stratosphere between 15 and 50 km altitude, and protects the biological activities at the Earth's surface from this damaging radiation. In the last half-century, the chemical mechanisms operating within the ozone layer have been shown to include very efficient catalytic chain reactions involving the chemical species HO, HO2, NO, NO2, Cl and ClO. The NOX and ClOX chains involve the emission at Earth's surface of stable molecules in very low concentration (N2O, CCl2F2, CCl3F, etc.) which wander in the atmosphere for as long as a century before absorbing ultraviolet radiation and decomposing to create NO and Cl in the middle of the stratospheric ozone layer. The growing emissions of synthetic chlorofluorocarbon molecules cause a significant diminution in the ozone content of the stratosphere, with the result that more solar ultraviolet-B radiation (290-320 nm wavelength) reaches the surface. This ozone loss occurs in the temperate zone latitudes in all seasons, and especially drastically since the early 1980s in the south polar springtime-the 'Antarctic ozone hole'. The chemical reactions causing this ozone depletion are primarily based on atomic Cl and ClO, the product of its reaction with ozone. The further manufacture of chlorofluorocarbons has been banned by the 1992 revisions of the 1987 Montreal Protocol of the United Nations. Atmospheric measurements have confirmed that the Protocol has been very successful in reducing further emissions of these molecules. Recovery of the stratosphere to the ozone conditions of the 1950s will occur slowly over the rest of the twenty-first century because of the long lifetime of the precursor molecules. PMID:16627294

  1. Ozone - plant surface reactions an important ozone loss term?

    NASA Astrophysics Data System (ADS)

    Hansel, Armin; Jud, Werner; Fischer, Lukas; Canaval, Eva; Wohlfahrt, Georg; Tissier, Alain

    2015-04-01

    Elevated tropospheric ozone concentrations are considered a toxic threat to plants responsible for global crop losses with associated economic costs of several billions dollar per year. Plant injuries have been related to the uptake of ozone through stomatal pores and oxidative effects damaging the internal leaf tissue. But a striking question remains: How much ozone enters the plant through open stomata and how much ozone is lost by chemical reactions at the plant surface? Until now surface losses are estimated from measured total ozone deposition fluxes and calculated stomatal conductance values. While stomatal conductance of CO2 and H2O is well understood and extensively used in describing plant atmosphere gas exchange, stomatal conductance of ozone is not well known. Here we use different Nicotiana tabacum varieties and find that surface reactions of ozone with diterpenoids synthesized by glandular trichomes reduce ozone flux through open stomata. Our measurements reveal that fast ozone loss at the plant surface is accompanied with prompt release of oxygenated volatile compounds. In the ozone fumigation experiments of different Nicotiana tabacum varieties the release of specific volatile oxy-VOCs allowed to identify the semi volatile precursor compounds at the plant surface. Ozone fumigation experiments with Norway spruce (Picea abies) and Scots Pine (Pinus sylvestris), two common species in the Northern Hemisphere, show also a significant ozone loss at the plant surface for Picea abies. Fluid dynamic calculations of ozone transport in the diffusive leaf boundary layer reveal a vertical but no horizontal ozone gradient thus reducing ozone fluxes through the pores in case of efficient ozone scavenging plant surfaces. We explain this efficient ozone protection mechanism by the porous surface architecture of plants in combination with unsaturated semi-volatile compounds deposited at the plant surface. These results show that unsaturated semi-volatile compounds at

  2. Ozone Profiles and Tropospheric Ozone from Global Ozone Monitoring Experiment

    NASA Technical Reports Server (NTRS)

    Liu, X.; Chance, K.; Sioris, C. E.; Sparr, R. J. D.; Kuregm, T. P.; Martin, R. V.; Newchurch, M. J.; Bhartia, P. K.

    2003-01-01

    Ozone profiles are derived from backscattered radiances in the ultraviolet spectra (290-340 nm) measured by the nadir-viewing Global Ozone Monitoring Experiment using optimal estimation. Tropospheric O3 is directly retrieved with the tropopause as one of the retrieval levels. To optimize the retrieval and improve the fitting precision needed for tropospheric O3, we perform extensive wavelength and radiometric calibrations and improve forward model inputs. Retrieved O3 profiles and tropospheric O3 agree well with coincident ozonesonde measurements, and the integrated total O3 agrees very well with Earth Probe TOMS and Dobson/Brewer total O3. The global distribution of tropospheric O3 clearly shows the influences of biomass burning, convection, and air pollution, and is generally consistent with our current understanding.

  3. Polar Ozone Losses

    NASA Technical Reports Server (NTRS)

    Newman, Paul A.; Bhartia, P. K. (Technical Monitor)

    2001-01-01

    Since the discovery of the Antarctic ozone hole, a great deal of attention has been focused on the polar regions to both identify the chemistry and physics of the large losses, and to provide an understanding of the future of polar ozone. In this review talk, I will discuss the secular trends of ozone in both the Antarctic and Arctic regions, and I will review some of the principal research results of the last few years. In particular, I will emphasize some of the results from the SOLVE-THESEO 2000 campaign that occurred over the course of the winter of 1999-2000.

  4. Arctic ozone loss

    SciTech Connect

    Zurer, P.S.

    1989-03-06

    Scientists have returned from the first comprehensive probe of the Arctic stratosphere with unexpectedly dire results: The winter atmosphere in the north polar region is loaded with the same destructive chlorine compounds that cause the Antarctic ozone hole. Atmospheric researchers who only a few weeks ago were comforted by the thought that the warmer Northern Hemisphere is strongly protected from the processes that lead to massive losses of ozone during spring in Antarctica now see very little standing in the way of an Arctic ozone hole.

  5. Toxicity and Patterns of Failure of Adaptive/Ablative Proton Therapy for Early-Stage, Medically Inoperable Non-Small Cell Lung Cancer

    SciTech Connect

    Chang, Joe Y.; Komaki, Ritsuko; Wen, Hong Y.; De Gracia, Beth; Bluett, Jaques B.; McAleer, Mary F.; Swisher, Stephen G.; Cox, James D.

    2011-08-01

    Purpose: To analyze the toxicity and patterns of failure of proton therapy given in ablative doses for medically inoperable early-stage non-small cell lung cancer (NSCLC). Methods and Materials: Eighteen patients with medically inoperable T1N0M0 (central location) or T2-3N0M0 (any location) NSCLC were treated with proton therapy at 87.5 Gy (relative biological effectiveness) at 2.5 Gy /fraction in this Phase I/II study. All patients underwent treatment simulation with four-dimensional CT; internal gross tumor volumes were delineated on maximal intensity projection images and modified by visual verification of the target volume in 10 breathing phases. The internal gross tumor volumes with maximal intensity projection density was used to design compensators and apertures to account for tumor motion. Therapy consisted of passively scattered protons. All patients underwent repeat four-dimensional CT simulations during treatment to assess the need for adaptive replanning. Results: At a median follow-up time of 16.3 months (range, 4.8-36.3 months), no patient had experienced Grade 4 or 5 toxicity. The most common adverse effect was dermatitis (Grade 2, 67%; Grade 3, 17%), followed by Grade 2 fatigue (44%), Grade 2 pneumonitis (11%), Grade 2 esophagitis (6%), and Grade 2 chest wall pain (6%). Rates of local control were 88.9%, regional lymph node failure 11.1%, and distant metastasis 27.8%. Twelve patients (67%) were still alive at the last follow-up; five had died of metastatic disease and one of preexisting cardiac disease. Conclusions: Proton therapy to ablative doses is well tolerated and produces promising local control rates for medically inoperable early-stage NSCLC.

  6. [The use of physiotherapy tools in medical treatment. The use of heat, light, electric, magnetic, ultrasound and shock wave therapy as well as medical massage in Hungarian medical practice].

    PubMed

    Bálint, Géza; Bálint, Péter

    2013-12-01

    The authors overview the possible use of different modalities of passive physiotherapy in the Hungarian medical practice. These modalities can be used in most of the medical specialities as well as family practice, not only in the treatment of the musculoskeletal disorders and medical rehabilitation. PMID:24273289

  7. Controlled randomized clinical trial of spirituality integrated psychotherapy, cognitive-behavioral therapy and medication intervention on depressive symptoms and dysfunctional attitudes in patients with dysthymic disorder

    PubMed Central

    Ebrahimi, Amrollah; Neshatdoost, Hamid Taher; Mousavi, Seyed Ghafur; Asadollahi, Ghorban Ali; Nasiri, Hamid

    2013-01-01

    Background: Due to the controversy over efficacy of cognitive-behavioral therapy for chronic depression, recently, there has been an increasingly tendency toward therapeutic methods based on the cultural and spiritual approaches. The aim of this research was to compare efficacy of spiritual integrated psychotherapy (SIPT) and cognitive-behavioral therapy (CBT) on the intensity of depression symptoms and dysfunctional attitudes of patients with dysthymic disorder. Materials and Methods: This study had a mixed qualitative and quantitative design. In the first phase, SIPT model was prepared and, in the second phase, a double-blind random clinical trial was performed. Sixty-two patients with dysthymic disorder were selected from several centers include Nour and Alzahra Medical Center, Counseling Centers of Isfahan University of Medical Sciences and Goldis in Isfahan. The participants were randomly assigned to three experimental groups and one control group. The first group received 8 sessions treatment of SIPT, second groups also had 8 sessions of cognitive-behavioral therapy, which was specific to dysthymic disorder and third group were under antidepressant treatment. Beck depression inventory and dysfunctional attitudes scale were used to evaluate all the participants in four measurement stages. The data were analyzed using MANCOVA repeated measure method. Results: The results revealed that SIPT had more efficacy than medication based on both scales (P < 0.01); however, it was not different from CBT. SIPT was more effective on the modification of dysfunctional attitudes compared with CBT and medication (P < 0.05). Conclusion: These findings supported the efficacy of psychotherapy enriched with cultural capacities and religious teachings. PMID:24516853

  8. Effects of leisure activities and psychosocial support on medication adherence and clinic attendance among children on antiretroviral therapy

    PubMed Central

    Anígilájé, Emmanuel Adémólá; Dabit, Othniel Joseph; Tyovenda, Ruth Kashimana; Emebolu, Agnes Jane; Agbedeh, Augustine Aondohemba; Olutola, Ayodotun; Anígilájé, Omolara Olufunmilayo

    2014-01-01

    Background Optimal adherence to antiretroviral therapy (ART) and retention-in-care are essential in HIV management. Through a Kiddies’ Club (KC), the study aimed at assessing the impact of social leisures and psychosocial support on ART adherence and clinic attendance in a pediatric ART program. Methods This was a descriptive, longitudinal study, conducted at the Federal Medical Centre, Makurdi, Nigeria, from June 2011 to June 2012. It included 33 ART-experienced children and their caregivers. The study was supplemented with a qualitative focused group discussion, involving 12 discussants. ART adherence, clinic attendance, and clinical and immunoviralogical responses of the children to ART were noted at 6 months and at 12 months of follow-up. Results The children comprised 17 males and 16 females, with a median age of 5 years. Financial constraint was the most common reason given for losses to follow-up in quantitative (32/33, 96.9%) and qualitative (12/12, 100.0%) assessments. But, unavailability of means of transportation may still override the benefit that financial assistance can provide, as reported in the qualitative study. The baseline mean hemoglobin level (8.50 g/dL), median CD4 count (187.00 cells/mm3); median weight for height z-score (−0.395), and the median body mass index (15.40) increased significantly to respective values of 10.03 g/dL, 1,030.00 cells/mm3, −0.090, and 18.50, at 6 months (P-values: 0.000), and 10.47 g/dL, 1,203.00 cells/mm3, 0.420, and 19.20, at 12 months (P-values: 0.000). The baseline median viral load (45,678.00 copies/mL) also decreased significantly, to 200.00 copies/mL at 6 months and at 12 months (P-values: 0.000). There was no attrition from death or loss to follow-up, and adherence to ART was 100%, at 6 months and at 12 months of follow-up. Conclusion Through the KC, children were retained in care, with excellent adherence to ART, and good clinical and immunoviralogical responses to ART, even after being previously

  9. Electroconvulsive Therapy Added to Non-Clozapine Antipsychotic Medication for Treatment Resistant Schizophrenia: Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Zheng, Wei; Cao, Xiao-Lan; Ungvari, Gabor S.; Xiang, Ying-Qiang; Guo, Tong; Liu, Zheng-Rong; Wang, Yuan-Yuan; Forester, Brent P.; Seiner, Stephen J.; Xiang, Yu-Tao

    2016-01-01

    This meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of the combination of electroconvulsive therapy (ECT) and antipsychotic medication (except for clozapine) versus the same antipsychotic monotherapy for treatment-resistant schizophrenia (TRS). Two independent investigators extracted data for a random effects meta-analysis and pre-specified subgroup and meta-regression analyses. Weighted and standard mean difference (WMD/SMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated. Eleven studies (n = 818, duration = 10.2±5.5 weeks) were identified for meta-analysis. Adjunctive ECT was superior to antipsychotic monotherapy regarding (1) symptomatic improvement at last-observation endpoint with an SMD of -0.67 (p<0.00001; I2 = 62%), separating the two groups as early as weeks 1–2 with an SMD of -0.58 (p<0.00001; I2 = 0%); (2) study-defined response (RR = 1.48, p<0.0001) with an NNT of 6 (CI = 4–9) and remission rate (RR = 2.18, p = 0.0002) with an NNT of 8 (CI = 6–16); (3) PANSS positive and general symptom sub-scores at endpoint with a WMD between -3.48 to -1.32 (P = 0.01 to 0.009). Subgroup analyses were conducted comparing double blind/rater-masked vs. open RCTs, those with and without randomization details, and high quality (Jadad≥adadup analyses were Jadad<3) studies. The ECT-antipsychotic combination caused more headache (p = 0.02) with an NNH of 6 (CI = 4–11) and memory impairment (p = 0.001) with an NNH of 3 (CI = 2–5). The use of ECT to augment antipsychotic treatment (clozapine excepted) can be an effective treatment option for TRS, with increased frequency of self-reported memory impairment and headache. Trial registration CRD42014006689 (PROSPERO). PMID:27285996

  10. Ozone Correlative Measurements Workshop

    NASA Technical Reports Server (NTRS)

    Hilsenrath, E. (Editor)

    1985-01-01

    A study was conducted to determine the necessary parameters for the correlation of data on Earth ozone. Topics considered were: (1) measurement accuracy; (2) equipment considerations (SBUV); and (3) ground based measurements to support satellite data.

  11. CBT for Medication Adherence and Depression (CBT-AD) in HIV-Infected Patients Receiving Methadone Maintenance Therapy

    ERIC Educational Resources Information Center

    Soroudi, Nafisseh; Perez, Giselle K.; Gonzalez, Jeffrey S.; Greer, Joseph A.; Pollack, Mark H.; Otto, Michael W.; Safren, Steven A.

    2008-01-01

    For individuals with HIV who are current or former injection drug users, depression is a common, distressing condition that can interfere with a critical self-care behavior--adherence to antiretroviral therapy. The present study describes the feasibility and outcome, in a case series approach, of cognitive behavioral therapy to improve adherence…

  12. Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey.

    PubMed

    Vercheval, C; Gillet, M; Maes, N; Albert, A; Frippiat, F; Damas, P; Van Hees, T

    2016-09-01

    This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was conducted by repeated point prevalence survey (PPS) to audit the quality of documentation on antibiotic therapy in the medical records before and after a combined intervention strategy (implementation of guidelines, distribution of educational materials, educational outreach visits, group educational interactive sessions) from the antimicrobial stewardship team (AST) in the academic teaching hospital (CHU) of Liège, Belgium. The primary outcome measure was the documentation rate on three quality indicators in the computerized medical records: (1) indication for treatment, (2) antibiotics prescribed, and (3) duration or review date. Segmented regression analysis was used to analyze the ITS. The medical records of 2306 patients receiving antibiotics for an infection (1177 in the pre-intervention period and 1129 in the post-intervention period) were analyzed. A significant increase in mean percentages in the post-intervention period was observed as compared with the pre-intervention period for the three quality indicators (indication documented 83.4 ± 10.4 % vs. 90.3 ± 6.6 %, p = 0.0013; antibiotics documented 87.9 ± 9.0 % vs. 95.6 ± 5.1 %, p < 0.0001; and duration or review date documented 31.9 ± 15.4 % vs. 67.7 ± 15.2 %, p < 0.0001). The study demonstrated the successful implementation of a combined intervention strategy from the AST. This strategy was associated with significant changes in the documentation rate in the computerized medical records for the three quality indicators. PMID:27255220

  13. Medical nutrition therapy in adults with chronic kidney disease: integrating evidence and consensus into practice for the generalist registered dietitian nutritionist.

    PubMed

    Beto, Judith A; Ramirez, Wendy E; Bansal, Vinod K

    2014-07-01

    Chronic kidney disease is classified in stages 1 to 5 by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative depending on the level of renal function by glomerular filtration rate and, more recently, using further categorization depending on the level of glomerular filtration rate and albuminuria by the Kidney Disease Improving Global Outcomes initiative. Registered dietitian nutritionists can be reimbursed for medical nutrition therapy in chronic kidney disease stages 3 to 4 for specific clients under Center for Medicare and Medicaid Services coverage. This predialysis medical nutrition therapy counseling has been shown to both potentially delay progression to stage 5 (renal replacement therapy) and decrease first-year mortality after initiation of hemodialysis. The Joint Standards Task Force of the American Dietetic Association (now the Academy of Nutrition and Dietetics), the Renal Nutrition Dietetic Practice Group, and the National Kidney Foundation Council on Renal Nutrition collaboratively published 2009 Standards of Practice and Standards of Professional Performance for generalist, specialty, and advanced practice registered dietitian nutritionists in nephrology care. The purpose of this article is to provide an update on current recommendations for screening, diagnosis, and treatment of adults with chronic kidney disease for application in clinical practice for the generalist registered dietitian nutritionist using the evidence-based library of the Academy of Nutrition and Dietetics, published clinical practice guidelines (ie, National Kidney Foundation Council on Renal Nutrition, Renal Nutrition Dietetic Practice Group, Kidney Disease Outcomes Quality Initiative, and Kidney Disease Improving Global Outcomes), the Nutrition Care Process model, and peer-reviewed literature.

  14. The ozone backlash

    SciTech Connect

    Taubes, G.

    1993-06-11

    While evidence for the role of chlorofluorocarbons in ozone depletion grows stronger, researchers have recently been subjected to vocal public criticism of their theories-and their motives. Their understanding of the mechanisms of ozone destruction-especially the annual ozone hole that appears in the Antarctic-has grown stronger, yet everywhere they go these days, they seem to be confronted by critics attacking their theories as baseless. For instance, Rush Limbaugh, the conservative political talk-show host and now-best-selling author of The Way Things Ought to Be, regularly insists that the theory of ozone depletion by CFCs is a hoax: bladerdash and poppycock. Zoologist Dixy Lee Ray, former governor of the state of Washington and former head of the Atomic Energy Commission, makes the same argument in her book, Trashing the Planet. The Wall Street Journal and National Review have run commentaries by S. Fred Singer, a former chief scientists for the Department of Transportation, purporting to shoot holes in the theory of ozone depletion. Even the June issue of Omni, a magazine with a circulation of more than 1 million that publishes a mixture of science and science fiction, printed a feature article claiming to expose ozone research as a politically motivated scam.

  15. Characterisation of the thermoluminescence (TL) properties of tailor-made Ge-doped silica glass fibre for applications in medical radiation therapy dosimetry

    NASA Astrophysics Data System (ADS)

    Zahaimi, N. A.; Zin, H.; Mahdiraji, G. A.; Rahman, A. L. Abdul; Bradley, D. A.; Rahman, A. T. Abdul

    2014-11-01

    We have investigated the characterisation of new fabricated material Ge doped silica glass thermoluminescence TL dosimeter (Photonic Research Centre, University of Malaya) for medical radiation dosimetry at therapy energy. Previously, the dosimeter has been studied to provide ideal dosimetry system, suitable to ensure an accurate delivery of radiation doses to tumour tissue while minimising the amount of radiation administrated to healthy tissue. Both energies of photon and electron were used in this experiment for a dose range of 1 to 5 Gy. The various sizes of core diameter Ge doped silica glass (120, 241, 362, 483 and 604 μm) were exposed by using linear accelerator at Pantai Medical Centre. For both energies, the optical fibres were found to produce a flat response to a fixed photon and electron doses to within 4% (S.D) of the mean of the TL distribution. In terms of dose response, the fibres provide linear response over the range investigated, from a fraction of 1-5 Gy. The finding shows 120 μm fibres have 1.82 greater dose response than 604 pm fibres irradiated at 6 MV photon with a fixed dose of 3 Gy. While for electron energy 12 MeV, the response shows 120 μm fibres have 1.58 greater dose response compared to 604 μm fibres. The good responses are suitable to make these tailor-made doped silica fibres a promising TL material for use as a dosimetric system in medical radiation therapy.

  16. Speed and trajectory of changes of insomnia symptoms during acute treatment with cognitive–behavioral therapy, singly and combined with medication

    PubMed Central

    Morin, Charles M.; Beaulieu-Bonneau, Simon; Ivers, Hans; Vallières, Annie; Guay, Bernard; Savard, Josée; Mérette, Chantal

    2014-01-01

    Objectives To examine the speed and trajectory of changes in sleep/wake parameters during short-term treatment of insomnia with cognitive–behavioral therapy (CBT) alone versus CBT combined with medication; and to explore the relationship between early treatment response and post-treatment recovery status. Methods Participants were 160 adults with insomnia (mean age, 50.3 years; 97 women, 63 men) who underwent a six-week course of CBT, singly or combined with 10 mg zolpidem nightly. The main dependent variables were sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, and sleep quality, derived from sleep diaries completed daily by patients throughout the course of treatment. Results Participants treated with CBT plus medication exhibited faster sleep improvements as evidenced during the first week of treatment compared to those receiving CBT alone. Optimal sleep improvement was reached on average after only one week for the combined treatment compared to two to three weeks for CBT alone. Early treatment response did not reliably predict post-treatment recovery status. Conclusions Adding medication to CBT produces faster sleep improvement than CBT alone. However, the magnitude of early treatment response is not predictive of final response after the six-week therapy. Additional research is needed to examine mechanisms involved in this early treatment augmentation effect and its impact on long-term outcome. PMID:24831251

  17. Treating an HIV/AIDS Patient's PTSD and Medication Nonadherence with Cognitive-Behavioral Therapy: A Principle-Based Approach

    ERIC Educational Resources Information Center

    Chernoff, Robert A.

    2007-01-01

    HIV/AIDS patients with medication adherence problems are vulnerable to developing drug resistance, immune system degradation, and opportunistic infections. Poor adherence to antiretroviral medication regimens can be aggravated by psychiatric problems, including depression and posttraumatic stress disorder. This article presents the case study of a…

  18. [Deciphering the argots of the names of materia medica and its dosage in the Yi lin kou pu liu zhi mi shu (A Secret Medical Book of Six Therapies in Rhymes of Medical Professionals)].

    PubMed

    Zhou, Jian; Lin, Shiyi; Liu, Shijue

    2014-11-01

    Yi lin kou pu liu zhi mi shu (A Secret Medical Book of Six Therapies in Rhymes of Medical Professionals) was additionally compiled, supplemented and annotated by Zhou Sheng, a famous doctor of the Qing Dynasty, based on Yi lin kou pu (Rhymes of Medical Professionals) which was composed by Lu Qi. The book contains four volumes in total, dealing mainly with the miscellaneous diseases of internal medicine, as well as external medicine, gynecology, and pediatrics etc. The syndrome differentiation and treatment, prescriptions and medications in this book has its own characteristic with rather high academic value and practical significance. There were 20 drug names were deciphered by the argots, for instance, "you che" was the argot of golden thread, and "wu yue (May)" was the argot of medicinal evodia fruit, etc. In addition, the argots were often used to decipher numerals and quantifiers, for example, "su, qi, zi, qi, man" referring to 1, 2, 3, 4, 5 respectively, and "huo, pu, xiang, feng, lai" referring to 6, 7, 8, 9, 10 respectively, and "qing","zhong","xi" referring to qian, liang and fen respectively. Hence, deciphering of these argots could help to understand and apply these prescriptions correctly.

  19. [Deciphering the argots of the names of materia medica and its dosage in the Yi lin kou pu liu zhi mi shu (A Secret Medical Book of Six Therapies in Rhymes of Medical Professionals)].

    PubMed

    Zhou, Jian; Lin, Shiyi; Liu, Shijue

    2014-11-01

    Yi lin kou pu liu zhi mi shu (A Secret Medical Book of Six Therapies in Rhymes of Medical Professionals) was additionally compiled, supplemented and annotated by Zhou Sheng, a famous doctor of the Qing Dynasty, based on Yi lin kou pu (Rhymes of Medical Professionals) which was composed by Lu Qi. The book contains four volumes in total, dealing mainly with the miscellaneous diseases of internal medicine, as well as external medicine, gynecology, and pediatrics etc. The syndrome differentiation and treatment, prescriptions and medications in this book has its own characteristic with rather high academic value and practical significance. There were 20 drug names were deciphered by the argots, for instance, "you che" was the argot of golden thread, and "wu yue (May)" was the argot of medicinal evodia fruit, etc. In addition, the argots were often used to decipher numerals and quantifiers, for example, "su, qi, zi, qi, man" referring to 1, 2, 3, 4, 5 respectively, and "huo, pu, xiang, feng, lai" referring to 6, 7, 8, 9, 10 respectively, and "qing","zhong","xi" referring to qian, liang and fen respectively. Hence, deciphering of these argots could help to understand and apply these prescriptions correctly. PMID:25620357

  20. The Efficacy of Medical Treatment of Peyronie's Disease: Potassium Para-Aminobenzoate Monotherapy vs. Combination Therapy with Tamoxifen, L-Carnitine, and Phosphodiesterase Type 5 Inhibitor

    PubMed Central

    Park, Tae Yong; Jeong, Hyeong Guk; Park, Jong Jin; Chae, Ji Yun; Kim, Jong Wook; Oh, Mi Mi; Park, Hong Seok; Kim, Je Jong

    2016-01-01

    Purpose This study was designed to evaluate the efficacy of medical treatment of Peyronie's disease. Materials and Methods A total of 109 patients with Peyronie's disease who had been treated from January 2011 to December 2014 were retrospectively reviewed in this study. Forty-four patients (Group 1) were treated with 12 mg of potassium para-aminobenzoate daily. Sixty-five patients (Group 2) were treated with combination therapy: tamoxifen (20 mg) and acetyl-L-carnitine (300 mg) twice daily in addition to a phosphodiesterase type 5 inhibitor. Ability to perform sexual intercourse, pain during erection, size of plaque, and penile curvature angle were assessed. Results In Group 1, 30 of 44 patients (68.2%) discontinued treatment within 12 weeks, while 5 patients (7.7%) in Group 2 discontinued treatment. Pain during erection and plaque size were improved in both groups but showed no statistical difference due to the high dropout rate in Group 1. In both groups, penile curvature was improved, but demonstrated no statistical difference between the treatment groups. However, combination therapy demonstrated a better response rate in patients whose penile curvature angle was less than 30° (44.4% vs. 79.1%, p=0.048). The rate of successful sexual intercourse was significantly higher in Group 2 (42.8% vs. 78.3%, p=0.034). The number of patients who underwent surgical correction despite medical treatment was significantly higher in Group 1 (35.7% vs. 13.3%, p=0.048). Conclusions Early medical combination therapy in Peyronie's disease may present better results in patients whose curvature angle is less than 30°. PMID:27169128

  1. [Personnel requirements of medical radiation physics in radiotherapy in comparison to the current guidelines "radiation protection in medicine" : Special consideration of intensity-modulated radiation therapy].

    PubMed

    Leetz, H-K; Eipper, H H; Gfirtner, H; Schneider, P; Welker, K

    2014-08-01

    In 1994 and 1998 reports on staffing levels in medical radiation physics for radiation therapy were published by the "Deutsche Gesellschaft für Medizinische Physik" (DGMP, German Society for Medical Physics). Because of the technical and methodological progress, changes in recommended qualifications of staff and new governmental regulations, it was necessary to establish new staffing levels. The data were derived from a new survey in clinics. Some of the previously established results from the old reports were adapted to the new conditions by conversion.The staffing requirements were normalized to main components as in the earlier reports resulting in a simple method for calculation of staffing levels. The results were compared with the requirements in the "Richtlinie Strahlenschutz in der Medizin" (guidelines on radiation protection in medicine) and showed satisfactory agreement.

  2. Efficacy of Salvage Interferential Electrical Stimulation Therapy in Patients With Medication-Refractory Enuresis: A Pilot Study

    PubMed Central

    Lee, Hahn-Ey

    2013-01-01

    Purpose In pediatric patients with enuresis, the protocol for salvage therapy in patients in whom first-line therapy was not successful has not yet been established. Interferential electrical stimulation (IF-ES) therapy is advantageous because it is noninvasive and shows high compliance. We aimed to investigate the efficacy and safety of IF-ES therapy on pediatric enuresis in a pilot study. Methods We investigated 10 patients who underwent IF-ES therapy between August 2012 and March 2013 at our clinic. Patients with a history of previous treatment with desmopressin and anticholinergic agents for at least 3 months and those in whom alarm treatment previously failed or was refused by parents were eligible. Electrical current was given starting at approximately 20 mA and was increased until the patient complained of discomfort. Treatment was performed once a week, 20 minutes per treatment, 6 times per cycle. After each cycle, an interview was performed and voiding diaries were filled. The physician in charge evaluated improvement according to the International Children's Continence Society criteria. Results A final analysis was performed in 10 patients (5 male and 5 female patients) in whom therapy for nocturnal enuresis had failed. Eight patients had nonmonosymptomatic enuresis and 2 had monosymptomatic enuresis. The mean age of the patients was 8.5±2.4 years, and the mean number of treatments was 10.6±3.6 times. A full response was observed in 1 patient (10%); a good response, in 1 patient (10%); a partial response, in 7 patients (70%); and no response, in 1 patient (10%). Conclusions Our study demonstrated that IF-ES therapy can be a promising treatment for the future, is safe, and can benefit from appropriate clinical trials in carefully selected groups. IF-ES therapy is expected to be a safe and effective treatment modality for children with enuresis. PMID:24143293

  3. Proptosis as the presenting sign of giant prolactinoma in a prepubertal boy: successful resolution of hydrocephalus by use of medical therapy.

    PubMed

    Cackett, Peter; Eunson, Graeme; Bath, Louise; Mulvihill, Alan

    2012-12-01

    We report the case of a 13-year-old prepubertal boy who presented with a left-sided proptosis, bilateral papilloedema and hydrocephalus who was subsequently diagnosed with a giant prolactinoma invading the left orbit. He was commenced on dopamine receptor agonists in the form of quinagolide and cabergoline, and made an excellent response to medical therapy alone, with resolution of hydrocephalus, restoration of normal vision and a 98% reduction in serum prolactin. The rapid improvement achieved negated the requirement for surgery and this highlights the efficacy of the dopamine agonists in the management of giant prolactinomas, even in the presence of neurological symptoms.

  4. Long-Term Survival on Medical Therapy Alone after Blunt-Trauma Aortic Regurgitation: Report of a New Case with Summary of 95 Others

    PubMed Central

    Murata, Mitsushige; Mahara, Keitaro; Iwanaga, Shiro; Fukuda, Keiichi

    2016-01-01

    Aortic regurgitation resulting from blunt chest trauma has been reported only 95 times, to our knowledge. The noncoronary and right coronary cusps are the cardiac structures most often injured. Although the aortic leaflets can appear to be undamaged after nonpenetrating trauma, they can have pathologic abnormalities and insufficient function. Some cases of posttraumatic aortic regurgitation progress slowly. Aortic valve replacement is the optimal treatment. We present the case of a then-62-year-old man who has lived more than 5 years after blunt-trauma aortic regurgitation. His is the only case of long-term survival on medical therapy alone among the 96 cases summarized in this report. PMID:27777534

  5. Ozone Depletion by Hydrofluorocarbons

    NASA Astrophysics Data System (ADS)

    Hurwitz, M.; Fleming, E. L.; Newman, P. A.; Li, F.; Mlawer, E. J.; Cady-Pereira, K. E.; Bailey, R.

    2015-12-01

    Hydrofluorocarbons (HFCs) are second-generation replacements for the chlorofluorocarbons (CFCs), halons and other substances that caused the 'ozone hole'. Atmospheric concentrations of HFCs are projected to increase dramatically in the coming decades. Coupled chemistry-climate simulations forced by these projections show that HFCs will impact the global atmosphere in 2050. As strong radiative forcers, HFCs modulate atmospheric temperature, thereby changing ozone-destroying catalytic cycles and enhancing the stratospheric circulation. These changes lead to a weak depletion of stratospheric ozone. Sensitivity simulations with the NASA Goddard Space Flight Center (GSFC) 2D model show that HFC-125 is the most important contributor to atmospheric change in 2050, as compared with HFC-23, HFC-32, HFC-134a and HFC-143a. Incorporating the interactions between chemistry, radiation and dynamics, for a likely 2050 climate, ozone depletion potentials (ODPs) for HFCs range from 4.3x10-4 to 3.5x10-2; previously HFCs were assumed to have negligible ODPs since these species lack chlorine or bromine atoms. The ozone impacts of HFCs are further investigated with the Goddard Earth Observing System Chemistry-Climate Model (GEOSCCM). The GEOSCCM is a three-dimensional, fully coupled ocean-atmosphere model with interactive stratospheric chemistry. Sensitivity simulations in which CO2, CFC-11 and HCFC-22 are enhanced individually are used as proxies for the atmospheric response to the HFC concentrations expected by the mid-21st century. Sensitivity simulations provide quantitative estimates of the impacts of these greenhouse gases on global total ozone, and can be used to assess their effects on the recovery of Antarctic ozone.

  6. Ozonation of Canadian Athabasca asphaltene

    NASA Astrophysics Data System (ADS)

    Cha, Zhixiong

    Application of ozonation in the petrochemical industry for heavy hydrocarbon upgrading has not been sufficiently explored. Among heavy hydrocarbons, asphaltenes are the heaviest and the most difficult fractions for analysis and treatment. Therefore, ozonation of asphaltenes presents an interesting application in the petrochemical industry. Commercial application of ozonation in the petrochemical industry has three obstacles: availability of an ozone-resistant and environmentally friendly solvent, the precipitation of ozonation intermediates during reaction, and recovery of the solvent and separation of the ozonation products. Preliminary ozonation of Athabasca oil sands asphaltene in nonparticipating solvents encountered serious precipitation of the ozonation intermediates. The precipitated intermediates could be polymeric ozonides and intermolecular ozonides or polymeric peroxides. Because the inhomogeneous reaction medium caused low ozone efficiency, various participating solvents such as methanol and acetic acid were added to form more soluble hydroperoxides. The mass balance results showed that on average, one asphaltene molecule reacted with 12 ozone molecules through the electrophilic reaction and the subsequent decomposition of ozonation intermediates generated acetone extractable products. GC/MS analysis of these compounds indicated that the free radical reactions could be important for generation of volatile products. The extensively ozonated asphaltene in the presence of participating solvents were refluxed with methanol to generate more volatile products. GC/MS analysis of the methanol-esterified ozonation products indicated that most volatile products were aliphatic carboxylic acid esters generated through cleavage of substituents. Reaction kinetics study showed that asphaltene ozonation was initially a diffusion rate-controlled reaction and later developed to a chemical reaction rate-controlled reaction after depletion of the reactive aromatic sites

  7. Collaborative overview of randomised trials of antiplatelet therapy--III: Reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. Antiplatelet Trialists' Collaboration.

    PubMed Central

    1994-01-01

    OBJECTIVE--To determine the efficacy of antiplatelet therapy as prophylaxis against deep venous thrombosis or pulmonary embolism in surgical and high risk medical patients. DESIGN--Overviews of all randomised trials of antiplatelet therapy that could have been available by March 1990 and in which deep venous thrombosis was assessed systematically. SETTING--53 trials (total 8400 patients) of an average of two weeks of antiplatelet therapy versus control in general or orthopaedic surgery; nine trials (600 patients) of antiplatelet therapy versus control in other types of immobility; 18 trials (1000 patients) of one antiplatelet regimen versus another. RESULTS--Overall, a few weeks of antiplatelet therapy produced a highly significant (2P < 0.00001) reduction in deep venous thrombosis. 25% of patients allocated antiplatelet therapy versus 34% of appropriately adjusted controls had deep venous thrombosis detected by systematic fibrinogen scanning or venography, representing prevention in about 90 patients per 1000 allocated antiplatelet therapy. There was an even greater proportional reduction in pulmonary embolism: such emboli were detected among 47 (1.0%) antiplatelet allocated patients versus an adjusted control total of 129 (2.7%), representing prevention among about 17 patients per 1000 treated (2P < 0.00001). In analyses confined to surgical trials, the proportional reductions were similar and separately significant for nonfatal pulmonary embolism (0.7% antiplatelet therapy v 1.8% control; 2P < 0.00001) and for deaths attributed to pulmonary embolism (0.2% v 0.9%; 2P = 0.0001). There was a slight but non-significant excess of deaths from other causes (1.0% v 0.7%), which made the difference in total mortality nonsignificant, though still favourable (1.2% v 1.5%). Information on adding antiplatelet therapy to heparin was limited but, at least for pulmonary embolism, suggested more protection from the combination than from heparin alone. The proportional reduction

  8. [The effectiveness of ozonated water for hand washing before surgery].

    PubMed

    Isosu, T; Kan, K; Hayashi, T; Fujii, M

    2001-06-01

    Using an ozonated water-dispensing machine for sterilization of hands (Mediaqua MA-III; Core Medical Co., Ltd, Tokyo, Japan), we investigated the effectiveness of ozonated water as a disinfectant for hand washing before surgery. The effectiveness of this new hand-washing method, using 4 ppm of ozonated water, which is expected to have a short-term bactericidal effect, and 0.2% benzalkonium chloride/83% ethanol solution (Welpas), which is expected to have a long-term bactericidal effect, was compared with that of the conventional hand-washing method (Fürbringer's method using a scrubbing agent containing povidone-iodine). The results showed no significant differences in the numbers of live bacteria and exponential reduction rates in live bacteria. Thus, this new method for hand washing using ozonated water is an effective method for sterilization of the hands before surgery.

  9. Acne vulgaris in the context of complex medical co-morbities: the management of severe acne vulgaris in a female with retinitis pigmentosa - utilizing pulse dye laser in conjunction with medical therapy.

    PubMed

    Shariff, Ayesha; Keck, Laura; Zlotoff, Barrett

    2014-03-01

    Acne vulgaris is a pervasive inflammatory disorder of the skin, with multiple etiologies and treatment options. Although first-line therapies exist, it is often the case that a patient will present with an underlying disorder that prohibits the use of most currently accepted treatment modalities. We present a patient with severe acne vulgaris and a history of retinitis pigmentosa who was treated with 595 nanometer pulsed dye laser therapy, in conjunction with therapeutic alternatives to first-line acne medications. Our patient exhibited a significant and sustained improvement with the combined use of 595 nanometer pulsed dye laser, Yaz (drospirenone-ethinyl estradiol), dapsone, topical metronidazole, sodium-sulfacetamide wash, and topical azelaic acid. The positive results in this case, suggest that this combined treatment modality may serve as an example of a safe and effective treatment alternative in the management of acne vulgaris complicated by medical co-morbidities that contraindicate the use of most first-line treatment options. PMID:24656277

  10. The usefulness of ozone treatment in spinal pain

    PubMed Central

    Bocci, Velio; Borrelli, Emma; Zanardi, Iacopo; Travagli, Valter

    2015-01-01

    Objective The aim of this review is to elucidate the biochemical, molecular, immunological, and pharmaceutical mechanisms of action of ozone dissolved in biological fluids. Studies performed during the last two decades allow the drawing of a comprehensive framework for understanding and recommending the integration of ozone therapy for spinal pain. Methods An in-depth screening of primary sources of information online – via SciFinder Scholar, Google Scholar, and Scopus databases as well as Embase, PubMed, and the Cochrane Database of Systemic Reviews – was performed. In this review, the most significant papers of the last 25 years are presented and their proposals critically evaluated, regardless of the bibliometric impact of the journals. Results The efficacy of standard treatments combined with the unique capacity of ozone therapy to reactivate the innate antioxidant system is the key to correcting the oxidative stress typical of chronic inflammatory diseases. Pain pathways and control systems of algesic signals after ozone administration are described. Conclusion This paper finds favors the full insertion of ozone therapy into pharmaceutical sciences, rather than as either an alternative or an esoteric approach. PMID:26028964

  11. Recovery of the Ozone Layer: The Ozone Depleting Gas Index

    NASA Astrophysics Data System (ADS)

    Hofmann, David J.; Montzka, Stephen A.

    2009-01-01

    The stratospheric ozone layer, through absorption of solar ultraviolet radiation, protects all biological systems on Earth. In response to concerns over the depletion of the global ozone layer, the U.S. Clean Air Act as amended in 1990 mandates that NASA and NOAA monitor stratospheric ozone and ozone-depleting substances. This information is critical for assessing whether the Montreal Protocol on Substances That Deplete the Ozone Layer, an international treaty that entered into force in 1989 to protect the ozone layer, is having its intended effect of mitigating increases in harmful ultraviolet radiation. To provide the information necessary to satisfy this congressional mandate, both NASA and NOAA have instituted and maintained global monitoring programs to keep track of ozone-depleting gases as well as ozone itself. While data collected for the past 30 years have been used extensively in international assessments of ozone layer depletion science, the language of scientists often eludes the average citizen who has a considerable interest in the health of Earth's protective ultraviolet radiation shield. Are the ozone-destroying chemicals declining in the atmosphere? When will these chemicals decline to pre-ozone hole levels so that the Antarctic ozone hole might disappear? Will this timing be different in the stratosphere above midlatitudes?

  12. Children's Models of the Ozone Layer and Ozone Depletion.

    ERIC Educational Resources Information Center

    Christidou, Vasilia; Koulaidis, Vasilis

    1996-01-01

    The views of 40 primary students on ozone and its depletion were recorded through individual, semi-structured interviews. The data analysis resulted in the formation of a limited number of models concerning the distribution and role of ozone in the atmosphere, the depletion process, and the consequences of ozone depletion. Identifies five target…

  13. Ozone Contamination in Aircraft Cabins. Appendix A: Ozone toxicity

    NASA Technical Reports Server (NTRS)

    Melton, C. E.

    1979-01-01

    The recommendation that at various altitudes the amount of air with which ozone has mixed changes, thus changing the volume per volume relationship is discussed. The biological effects of ozone on human health and the amount of ozone necessary to produce symptoms were investigated.

  14. CONTRIBUTION TO INDOOR OZONE LEVELS OF AN OZONE GENERATOR

    EPA Science Inventory

    This report gives results of a study of a commonly used commercially available ozone generator, undertaken to determine its impact on indoor ozone levels. xperiment were conducted in a typical mechanically ventilated office and in a test house. he generated ozone and the in-room ...

  15. Inappropriateness of medication prescriptions about chronic kidney disease patients without dialysis therapy in a Chinese tertiary teaching hospital

    PubMed Central

    Yang, Ping; Chen, Na; Wang, Rong-Rong; Li, Lu; Jiang, Sai-Ping

    2016-01-01

    Background With the increasing incidence rate of chronic kidney disease (CKD), inappropriate use of medicine in CKD patients is an important issue, as it may cause adverse effects in patients and progression to chronic renal failure. Objective The aim of this study is to assess the frequency of inappropriate medicine use among CKD patients. Methods A cross-sectional study was conducted from November 1 to December 1, 2014 in a Chinese teaching tertiary hospital. All medication prescriptions for CKD patients with serum creatinine level above normal value were enrolled. The prescriptions, including unreasonable dosage, contraindicated, and cautiously used medicines in CKD patients, were evaluated and the related medications were also analyzed and classified. Results Two hundred and two patients were included, and a total of 1,733 lines of medication prescriptions were evaluated. The prevalence of inappropriate medication prescriptions in CKD patients was 15.18%, of which, unreasonable dosage (n=56), contraindicated (n=46), and cautiously used medicines (n=161) accounted for 3.23%, 2.65%, and 9.29%, respectively. Spearman’s rank correlation coefficient implied that there was a significant correlation between the severity of renal insufficiency and frequency of inappropriate medication prescriptions (P=0.02, r=0.056). Among the inappropriate medication prescriptions, nutraceutical and electrolytes (n=65, 24.71%), cardiovascular drugs (n=61, 23.19%), and antimicrobial drugs (n=55, 20.91%) represented the top three medicine categories in CKD patients. Conclusion The study confirmed that inappropriate medication prescriptions were prevalent in CKD patients. Improving the quality of medication prescriptions in CKD patients is necessary. PMID:27785039

  16. "OZONE SOURCE APPORTIONMENT IN CMAQ'

    EPA Science Inventory

    Ozone source attribution has been used to support various policy purposes including interstate transport (Cross State Air Pollution Rule) by U.S. EPA and ozone nonattainment area designations by State agencies. Common scientific applications include tracking intercontinental tran...

  17. Ozone Minimums, 1979 to 2013

    NASA Video Gallery

    Minimum concentration of ozone in the southern hemisphere for each year from 1979-2013 (there is no data from 1995). Each image is the day of the year with the lowest concentration of ozone. A grap...

  18. [Use of drug-free methods of treatment in comprehensive therapy of patients with stage II chronic lower limb ischaemia].

    PubMed

    Makarov, I V; Lukashova, A V

    2016-01-01

    Analysed herein are the results of treating a total of 139 patients presenting with stage II chronic lower limb ischaemia. The patients were subdivided into three groups, depending on the variant of treatment performed. Group One patients (n=57) received standard conservative therapy combined with ozone therapy, with the Group being further subdivided into two subgroups: patients of subgroup 1a (n=28) were subjected to intravenous administration of ozonated physiological solution (OPS), subgroup 1b patients (n=29) were given big autohemoozonetherapy (BAT). Group Two patients (n=62) underwent complex treatment including beside medical ozone gravitation therapy (GT). Group Two patients were also subdivided into two subgroups: subgroup 2a patients (n=31) received standard conservative therapy combined with OPS and GT, subgroup 2b patients (n=31) received standard conservative therapy in combination with BAT and GT. Group Three (Control Group) was composed of 20 patients receiving standard conservative therapy alone. The highest efficacy was observed in the subgroup of patients receiving OPS and GT, with the patients of this subgroup showing a statistically significant increase in the pain-free walking distance by 116.5% and in the ankle-brachial index by 49.2%, also demonstrating the most pronounced positive dynamics of lipid metabolism parameters: a decrease in total cholesterol by 21.3%, low density lipoproteins by 25.4%, very low density lipoproteins by 24.2% and triglycerides by 18.5%. Besides, a tendency was observed towards normalization of the haemostasis system indices: fibrinogen decreased by 21.8%, prothrombin index by 13%, fibrin monomer complexes retraction by 18.2%, and the clotting time increased by 20.7%. Hence, combined use of ozonated physiological solution and gravitation therapy in treatment of patients with stage II chronic lower limb ischaemia promotes a considerable increase in the pain-free walking distance and ankle-brachial index, as well as

  19. [Use of drug-free methods of treatment in comprehensive therapy of patients with stage II chronic lower limb ischaemia].

    PubMed

    Makarov, I V; Lukashova, A V

    2016-01-01

    Analysed herein are the results of treating a total of 139 patients presenting with stage II chronic lower limb ischaemia. The patients were subdivided into three groups, depending on the variant of treatment performed. Group One patients (n=57) received standard conservative therapy combined with ozone therapy, with the Group being further subdivided into two subgroups: patients of subgroup 1a (n=28) were subjected to intravenous administration of ozonated physiological solution (OPS), subgroup 1b patients (n=29) were given big autohemoozonetherapy (BAT). Group Two patients (n=62) underwent complex treatment including beside medical ozone gravitation therapy (GT). Group Two patients were also subdivided into two subgroups: subgroup 2a patients (n=31) received standard conservative therapy combined with OPS and GT, subgroup 2b patients (n=31) received standard conservative therapy in combination with BAT and GT. Group Three (Control Group) was composed of 20 patients receiving standard conservative therapy alone. The highest efficacy was observed in the subgroup of patients receiving OPS and GT, with the patients of this subgroup showing a statistically significant increase in the pain-free walking distance by 116.5% and in the ankle-brachial index by 49.2%, also demonstrating the most pronounced positive dynamics of lipid metabolism parameters: a decrease in total cholesterol by 21.3%, low density lipoproteins by 25.4%, very low density lipoproteins by 24.2% and triglycerides by 18.5%. Besides, a tendency was observed towards normalization of the haemostasis system indices: fibrinogen decreased by 21.8%, prothrombin index by 13%, fibrin monomer complexes retraction by 18.2%, and the clotting time increased by 20.7%. Hence, combined use of ozonated physiological solution and gravitation therapy in treatment of patients with stage II chronic lower limb ischaemia promotes a considerable increase in the pain-free walking distance and ankle-brachial index, as well as

  20. Patients' Beliefs About Medications are Associated with Stated Preference for Methadone, Buprenorphine, Naltrexone, or no Medication-Assisted Therapy Following Inpatient Opioid Detoxification.

    PubMed

    Uebelacker, Lisa A; Bailey, Genie; Herman, Debra; Anderson, Bradley; Stein, Michael

    2016-07-01

    Subsequent to initial opioid detoxification, people with opioid use disorder are typically advised to engage in follow-up treatment to prevent relapse. Medication-assisted treatments (MATs) - i.e., the opioid agonist methadone (MMT) or partial agonist/antagonist, buprenorphine/naltrexone (BUP) -- are the maintenance treatment options with the best research support for positive outcomes. A third MAT, injectable extended-release naltrexone (XR-NTX), was approved by the FDA for opioid dependence in 2010 and shows promise. However, relatively few eligible patients choose to initiate one of these MATs following initial detoxification treatment. Consistent with the health belief model, we hypothesized that beliefs about 1) efficacy of each MAT; 2) safety of each MAT; and 3) perceived consistency with being drug-free would predict stated patient preferences for a particular MAT or for no MAT. We also hypothesized that perceived structural barriers (e.g., time, transportation) would decrease the likelihood of stating a preference for a given MAT. To assess these hypotheses, we surveyed 372 people undergoing inpatient opioid detoxification treatment. Results supported hypotheses for all 3 sets of patient beliefs, with the patient group stating that they preferred a particular MAT having significantly more positive beliefs about that MAT relative to other groups (p<.001). The group that preferred "no MAT" had the most negative beliefs about all MATs. Perceived structural barriers were not related to stated preferences, except that people who preferred BUP were more likely to endorse barriers to MMT than any of the other 3 groups. Notably, a relatively high proportion (32%) of participants were most interested in XR-NTX despite a lack of prior experience with this medication. These results suggest that efforts to increase MAT enrollment following detoxification might benefit from including patient beliefs as one set of factors to assess and target for change. PMID:27211996