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Sample records for optimizing oral medications

  1. Oral medications.

    PubMed

    Glaser, Dee Anna

    2014-10-01

    Primary hyperhidrosis commonly affects the axillae, palms, soles, scalp, face, and groin. Patients may have multiple areas involved making localized therapy challenging. Systemic therapy may be necessary and can be used as monotherapy or combined with other hyperhidrosis treatments for optimal outcomes. Systemic therapy can also be used to treat secondary hyperhidrosis and compensatory hyperhidrosis. PMID:25152346

  2. Optimization and Evaluation of Desloratadine Oral Strip: An Innovation in Paediatric Medication

    PubMed Central

    Singh, Harmanpreet; Kaur, Mandeep

    2013-01-01

    Patients, especially children, are the most difficult to treat in all groups of population mainly because they can not swallow the solid dosage form. Due to this reason they are often prescribed liquid dosage forms. But these formulations have their own disadvantages (lack of dose accuracy during administration, spitting by children, spillage, lack of stability, difficulty in transportation, etc.). Oral strip technology is one such technology to surpass these disadvantages. Desloratadine, a descarboethoxy derivative of loratadine, is a second generation antihistaminic drug approved for usage in allergic rhinitis among paediatric population and is available in markets as suspension. An attempt has been made to design and optimize the oral strip containing desloratadine as an active ingredient. Oral strip was optimized with the help of optimal experimental design using polymer concentration, plasticizer type, and plasticizer concentration as independent variables. Prepared oral strips were evaluated for physicochemical parameter, mechanical strength parameters, disintegration time, dissolution, surface pH, and moisture sorption tendency. Optimized formulation was further evaluated by scanning electron microscopy, moisture content, and histological alteration in oral mucosa. Accelerated stability studies were also carried out for optimized formulations. Results were analysed with the help of various statistical tools at P < 0.05 and P < 0.01. PMID:24235887

  3. Optimizing Medical Kits for Spaceflight

    NASA Technical Reports Server (NTRS)

    Keenan, A. B,; Foy, Millennia; Myers, G.

    2014-01-01

    The Integrated Medical Model (IMM) is a probabilistic model that estimates medical event occurrences and mission outcomes for different mission profiles. IMM simulation outcomes describing the impact of medical events on the mission may be used to optimize the allocation of resources in medical kits. Efficient allocation of medical resources, subject to certain mass and volume constraints, is crucial to ensuring the best outcomes of in-flight medical events. We implement a new approach to this medical kit optimization problem. METHODS We frame medical kit optimization as a modified knapsack problem and implement an algorithm utilizing a dynamic programming technique. Using this algorithm, optimized medical kits were generated for 3 different mission scenarios with the goal of minimizing the probability of evacuation and maximizing the Crew Health Index (CHI) for each mission subject to mass and volume constraints. Simulation outcomes using these kits were also compared to outcomes using kits optimized..RESULTS The optimized medical kits generated by the algorithm described here resulted in predicted mission outcomes more closely approached the unlimited-resource scenario for Crew Health Index (CHI) than the implementation in under all optimization priorities. Furthermore, the approach described here improves upon in reducing evacuation when the optimization priority is minimizing the probability of evacuation. CONCLUSIONS This algorithm provides an efficient, effective means to objectively allocate medical resources for spaceflight missions using the Integrated Medical Model.

  4. Oral flora of elderly patients following acute medical admission.

    PubMed

    Preston, A J; Gosney, M A; Noon, S; Martin, M V

    1999-01-01

    The human oral microflora is diverse and is usually predominately composed of Gram-positive bacteria. It is uncommon to find Gram-negative bacilli (GNB) in healthy mouths. The incidence of infection with GNB rises in institutionalised, frail elderly subjects. There is also evidence of an association between intra-oral GNB presence and denture wearing. There have been few studies which have investigated intra-oral GNB carriage in acutely ill elderly patients. The aim of this study was to evaluate the oral flora of a group of elderly patients during an acute medical admission and to investigate any associations between the oral microflora and existing medical or oral factors. A total of 28 patients (17 females and 11 males; age: 74-93 years) on a care for the elderly ward were studied. Epidemiological data, detailed medical histories and oral examinations were undertaken. In addition, oral swabs of the palate area were taken to determine their oral flora. Twelve (43%) of the patients had GNB in their oral cavities. These patients were suffering from a variety of medical conditions and were on various drug regimes. There was a correlation between oral GNB presence and denture use. There was no association between GNB presence and denture hygiene. As oropharyngeal GNB colonisation can be associated with infections such as aspiration pneumonia, it is important in patients at risk that intra-oral organisms are identified and managed.

  5. Avoiding Medication Errors: Reducing Harm in Residents Using Oral Anticoagulants.

    PubMed

    Grissinger, Matthew; Gaunt, Michael J; Rich, Darryl S

    2016-01-01

    Medication errors involving oral anticoagulants have led to serious adverse events, including hemorrhage, treatment failures leading to thromboembolic events, and death. This article will highlight medication errors that may arise during the use of oral anticoagulants and provide risk-reduction strategies to address the potential for error and patient harm. PMID:27250070

  6. Medical Imaging of Oral and Oropharyngeal Cancer.

    PubMed

    Anderson, Susan M

    2015-01-01

    Oral cancer is associated with documented risk factors, yet no comprehensive screening program is in place in the United States for early detection of the disease. Oral cancer often is diagnosed in more advanced stages, resulting in a poor prognosis. Dental practitioners and radiographers play an important role in the management of the disease and in helping to improve the quality of life for people who have oral cancer. This article discusses types of oral and oropharyngeal cancer, their diagnosis, treatment options, and the role of dental imaging in patients with these cancers. PMID:26538220

  7. Optimizing medication safety in the home.

    PubMed

    LeBlanc, Raeanne Genevieve; Choi, Jeungok

    2015-06-01

    Medication safety among community-dwelling older adults in the United States is an ongoing health issue impacting health outcomes, chronic disease management, and aging in place at home. This article describes a medication safety improvement project that aimed to: (1) Increase the ability of participants to manage medications, (2) Identify and make necessary medication changes, (3) Create an accurate up-to-date medication list to be available in the home, and (4) Provide communication between the primary care provider, participant, and case manager. An in-home medication assessment was completed for 25 participants using an evidence-based medication management software system. This process was used to review medications; identify medication-related problems; create a shared medication list; and convey this information to the primary care provider, case manager, and client while addressing needed medication changes. Educational interventions on management and understanding of medications were provided to participants to emphasize the correct use of medications and use of a personal medication record. Outcome improvements included provision of an accurate medication list, early identification of medication-related problems, identification of drug duplication, and identification of medication self-management challenges that can be useful for optimizing medication safety-related home healthcare and inform future interventions. PMID:26034822

  8. Recognizing and overcoming potential barriers to oral medications for MS.

    PubMed

    Moses, Harold

    2014-10-01

    Three FDA-approved oral medications are available for the treatment of relapsing forms of multiple sclerosis: fingolimod, teriflunomide, and dimethyl fumarate. While injection and IV treatments have proven to be beneficial, these newer oral agents also offer positive outcomes for patients. Numerous barriers exist, though, for these oral agents, including the unknown long-term efficacy and safety and potential side effects. Despite possible side effects, oral agents provide convenience, ease of use, and the elimination of injection/IV administration-site pain. To ensure MS patients receive the most appropriate individualized care, clinicians should present all of the available treatment options to both newly diagnosed and established patients. PMID:25373133

  9. Oral cancer knowledge, behavior, and attitude among osteopathic medical students.

    PubMed

    McCready, Zachary R; Kanjirath, Preetha; Jham, Bruno C

    2015-06-01

    Approximately 21,000 osteopathic medical students were enrolled in the USA in 2012-2013. These future physicians are being educated with an emphasis on a holistic or patient-centered approach, with a focus on preventive care. Considering the importance of preventive care and early diagnosis in the outcomes of oral malignancies, our goal in this study was to assess the knowledge, behavior, and attitude of osteopathic medical students in relation to oral cancer. To this end, 204 second-year (Y2) and 194 fourth-year (Y4) medical students were invited to participate in an electronic survey. Forty-one Y2 and 44 Y4 students agreed to participate (20 and 22% response rate, respectively). The results showed that most Y2 and Y4 students were knowledgeable in certain areas (demographic features, important risk factors, and histologic feature), but deficient in others (clinical presentation, association of human papillomavirus (HPV) with oropharyngeal cancers, and screening recommendations). Head, neck, and oral examination habits were reported as being performed occasionally. Overall, students reported feeling uninformed about oral cancer and showed an interest in receiving further education on the subject. Our findings confirm that an overall improvement in oral cancer education in the medical curriculum is needed. Interprofessional collaboration between dental and medical schools may prove to be a valid approach to achieve this goal, which may possibly lead to increased detection of early oral cancerous lesions and, ultimately, improved mortality rates. PMID:24882439

  10. Improving oral medication management in home health agencies.

    PubMed

    Shearer, Janelle

    2009-03-01

    This study focused on home health agency characteristics and evidence-based practices that could have an impact on the ability to improve the home health outcome-based quality improvement measure: improvement in the management of oral medications. The findings of this Quality Improvement Organization-approved study suggest that there are organizational characteristics and evidence-based practices associated with better rates for this outcome measure. Organizational characteristics include belonging to a healthcare system that is hospital based, not-for-profit part of a network focused on quality, and intentionally working on the oral medications outcome. Evidence-based practices include use of reminder strategies, phone follow-up interventions, repeat patient education about medications at subsequent home care visits, and use of medication simplification strategies for patients receiving multiple medications.

  11. HEVC optimizations for medical environments

    NASA Astrophysics Data System (ADS)

    Fernández, D. G.; Del Barrio, A. A.; Botella, Guillermo; García, Carlos; Meyer-Baese, Uwe; Meyer-Baese, Anke

    2016-05-01

    HEVC/H.265 is the most interesting and cutting-edge topic in the world of digital video compression, allowing to reduce by half the required bandwidth in comparison with the previous H.264 standard. Telemedicine services and in general any medical video application can benefit from the video encoding advances. However, the HEVC is computationally expensive to implement. In this paper a method for reducing the HEVC complexity in the medical environment is proposed. The sequences that are typically processed in this context contain several homogeneous regions. Leveraging these regions, it is possible to simplify the HEVC flow while maintaining a high-level quality. In comparison with the HM16.2 standard, the encoding time is reduced up to 75%, with a negligible quality loss. Moreover, the algorithm is straightforward to implement in any hardware platform.

  12. Optimizing Medical Kits for Space Flight

    NASA Technical Reports Server (NTRS)

    Minard, Charles G.; FreiredeCarvalho, Mary H.; Iyengar, M. Sriram

    2010-01-01

    The Integrated Medical Model (IMM) uses Monte Carlo methodologies to predict the occurrence of medical events, their mitigation, and the resources required during space flight. The model includes two modules that utilize output from a single model simulation to identify an optimized medical kit for a specified mission scenario. This poster describes two flexible optimization routines built into SAS 9.1. The first routine utilizes a systematic process of elimination to maximize (or minimize) outcomes subject to attribute constraints. The second routine uses a search and mutate approach to minimize medical kit attributes given a set of outcome constraints. There are currently 273 unique resources identified that are used to treat at least one of 83 medical conditions currently in the model.

  13. Knowledge and Attitude of Medical Nurses toward Oral Health and Oral Health Care of Pregnant Women

    PubMed Central

    Sharif, Suzana; Saddki, Norkhafizah; Yusoff, Azizah

    2016-01-01

    Background This study assessed the knowledge and attitudes of medical nurses regarding oral health and oral health care of pregnant women. Methods This cross sectional study of 133 nurses in the district of Tumpat, Kelantan (Malaysia) used self-administered questionnaires. Results Most nurses knew that dental plaque is associated with periodontal disease (97.7%). However, most nurses erroneously believed that tooth decay (86.5%) and excessive sugar consumption (87.2%) led to periodontal disease. About half of the nurses knew about the relationship between periodontal disease of pregnant women and low birth weight (43.6%) and preterm birth (48.9%). Many nurses had the misconception that the developing foetus draws calcium from the mothers’ teeth (78.2%). Most nurses had good attitudes toward improving their oral health knowledge (97.0%) and agreed they should help to deliver oral health education to pregnant women (94.0%). Age, length of service as a nurse, and length of service in antenatal care had no effect on the scores for the nurses’ knowledge and attitude regarding oral health and oral health care of pregnant women. Conclusion Medical nurses had limited knowledge about oral health of pregnant women and had some misunderstandings about oral health, although they had good attitudes. Age, length of service as a nurse, and length service in antenatal care had no effect on the knowledge and attitude scores of the nurses. PMID:27540327

  14. Utilization of Compounded Medications in an Oral Medicine Practice.

    PubMed

    Stock, Shannon; Rubino, Katie; Woo, Sook-Bin; Margolis, Arthur; Thomas, Irena; Aboalela, Ali; thomas Ali; Treister, Nathaniel

    2016-01-01

    For many oral medicine conditions, the use of compounded topical therapies that are locally absorbed and act directly at the affected site can provide greater efficacy compared with systemically delivered medications while minimizing systemic side effects. The objective of this study was to characterize the utilization and costs associated with the use of compounded medications in an academic, hospital-based oral medicine practice. This was a retrospective analysis of outpatients treated at the Center for Oral Disease at Brigham and Women's Hospital (Boston, Massachusetts) during the five-year period from November 2006 through November 2011. Patient prescription and payment information were obtained from the pharmacy's patient database. Variables included prescription compound, number of prescriptions refilled, prescription cost, and payment contributions from insurance and patients. An electronic medical record review was conducted to obtain patient demographics and diagnoses. There were 510 unique perscriptions corresponding to 423 patients filled during the study period. Four distinct medications comprised the majority (479/510; 94%) of prescriptions filled. The vast majority (94%) of prescriptions filled were at least partially paid for by insurance, with median patient co-pays ranging from $21 (clonazepam solution) to $34 (ketoprofen cream). Compound medications provide an affordable, flexible therapeutic option for patients being treated for a variety of oral medicine conditions. PMID:27323426

  15. Generalized nonconvex optimization for medical image segmentation

    NASA Astrophysics Data System (ADS)

    Mitra, Sunanda; Joshi, Sujit

    2000-06-01

    Design of a generalized technique for medical image segmentation is a challenging task. Currently a number of approaches are being investigated for 2-D and 3-D medical image segmentation for diagnostic and research applications. The methodology used in this work is aimed at obtaining a generalized solution of non-convex optimization problems by including a structural constraint of mass or density and the concept of additivity properties of entropy to a recently developed statistical approach to clustering and classification. The original computationally intensive procedure is made more efficient both in processing time and accuracy by employing a new similarity parameter for generating the initial clusters that are updated by minimizing an energy function relating the image entropy and expected distortion. The application of the computationally intensive yet generalized solution to nonconvex optimization to a limited set of medical images has resulted in excellent segmentation when compared to other clustering based segmentation approaches. The addition of the parametric approach to determine the initial number of clusters allows significant reduction in processing time and better design of automated segmentation procedure. This research work generalizes a deterministic annealing i.e. a specific statistical approach to solve nonconvex optimization problems by developing a more efficient technique applicable to nonconvex optimization problems (getting trapped in local minima). However, the DA approach is extremely computationally intensive for applications such as image segmentation. The new integrated approach developed in this work allows this optimization technique to be used for medical image segmentation.

  16. Oral antioxidants for radioprotection during medical imaging examinations

    NASA Astrophysics Data System (ADS)

    Velauthapillai, Nivethan

    The oncogenic effect of ionizing radiation (IR) is clearly established and occurs in response to DNA damage. Many diagnostic imaging exams make use of IR and the oncogenic risk of IR-based imaging has been calculated. We hypothesized that the DNA damage sustained from IR exposure during medical imaging exams could be reduced by pre-medicating patients with antioxidants. First, we tested and validated a method for measuring DNA double-strand breaks (DSBs) in peripheral blood mononuclear cells (PBMCs) exposed to low doses of ionizing radiation. Afterwards, we conducted a pilot clinical study in which we administered oral antioxidants to patients undergoing bone scans, prior to radiotracer injection. We showed that oral antioxidant pre-medication reduced the number of DSBs in PBMCs induced by radiotracer injection. Our study shows proof-of-principle for this simple and inexpensive approach to radioprotection in the clinical setting.

  17. Medical Optimization Network for Space Telemedicine Resources

    NASA Technical Reports Server (NTRS)

    Rubin, D.; Shah, R. V.; Kerstman, E. L.; Reyes, D.; Mulcahy, R.; Antonsen, E.

    2017-01-01

    INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system. Beyond the traditional limitations in mass, power, and volume, consideration must be given to other factors such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. As NASA develops the medical system for an exploration mission, it must have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources (MONSTR) was developed over the past year for this reason, and is now a system for managing data pertaining to medical resources and their relative importance when addressing medical conditions. METHODS: The MONSTR web application with a Microsoft SQL database backend was developed and made accessible to Tableau v9.3 for analysis and visualization. The database was initially populated with a list of medical conditions of concern for an exploration mission taken from the Integrated Medical Model (IMM), a probabilistic model designed to quantify in-flight medical risk. A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program compiled a list diagnostic and treatment medical resources required to address best- and worst-case scenarios of each medical condition using a terrestrial standard of care and entered this data into the system. This list included both tangible resources (e.g. medical equipment, medications) and intangible resources (e.g. clinical skills required to perform a procedure). The physician team then assigned criticality values to each instance of a resource, representing the importance of that resource to diagnosing or treating its associated condition(s). Medical condition probabilities of occurrence during a Mars mission were pulled from the IMM and imported into the MONSTR database for use within a resource criticality-weighting algorithm. DISCUSSION

  18. Comparative Effectiveness of Oral Medications for Pulmonary Arterial Hypertension.

    PubMed

    Igarashi, Ataru; Inoue, Sachie; Ishii, Tomonori; Tsutani, Kiichiro; Watanabe, Hiroshi

    2016-07-27

    Pulmonary arterial hypertension (PAH) is a disease that imposes a significant burden on patients. Although multiple treatment options for PAH are available, head-to-head comparisons are difficult to conduct. Network meta-analysis (NMA) can be a useful alternative for direct comparison to estimate the relative effectiveness of multiple treatments. The objective of the present study was to conduct a systematic review and NMA to evaluate the relative effectiveness among oral PAH medications.Data collection was performed by searching the Cochrane Central Register of Controlled Trials (CENTRAL) and Ichushi-Web. Randomized controlled trials (RCTs) assessing at least 1 of the following 3 outcome measurements; 6-minute walk distance test (6MWD), WHO functional class (WHOFC), and mean pulmonary artery pressure (mPAP) were included (PROSPERO registration number: CRD42015016557). Outcomes were evaluated by estimating the differences in the mean change from baseline or by estimating the odds ratios. Analyses were performed using WinBUGS 1.4.3.Seven double-blind RCTs were eligible. NMA results showed similar improvements in 6MWD for all medications assessed. Bosentan and sildenafil caused a statistically significant improvement in WHOFC compared to other medications.The relative effectiveness of oral PAH medications could be compared using NMA, which suggested the superiority of bosentan and sildenafil in the improvement of WHOFC. PMID:27385603

  19. Comparison of Written and Oral Examinations in a Baccalaureate Medical-Surgical Nursing Course.

    ERIC Educational Resources Information Center

    Rushton, Patricia; Eggett, Dennis

    2003-01-01

    Of four groups of medical-surgical nurses, 55 took one final and three midterm written exams, 150 took one each (written), 45 took an oral final, 92 took both written and oral, and 47 took a written test with licensure questions and an oral final. Oral exams resulted in higher scores, more effective study habits, and increased application. (SK)

  20. Optimized zein nanospheres for improved oral bioavailability of atorvastatin

    PubMed Central

    Hashem, Fahima M; Al-Sawahli, Majid M; Nasr, Mohamed; Ahmed, Osama AA

    2015-01-01

    Background This work focuses on the development of atorvastatin utilizing zein, a natural, safe, and biocompatible polymer, as a nanosized formulation in order to overcome the poor oral bioavailability (12%) of the drug. Methods Twelve experimental runs of atorvastatin–zein nanosphere formula were formulated by a liquid–liquid phase separation method according to custom fractional factorial design to optimize the formulation variables. The factors studied were: weight % of zein to atorvastatin (X1), pH (X2), and stirring time (X3). Levels for each formulation variable were designed. The selected dependent variables were: mean particle size (Y1), zeta potential (Y2), drug loading efficiency (Y3), drug encapsulation efficiency (Y4), and yield (Y5). The optimized formulation was assayed for compatibility using an X-ray diffraction assay. In vitro diffusion of the optimized formulation was carried out. A pharmacokinetic study was also done to compare the plasma profile of the atorvastatin–zein nanosphere formulation versus atorvastatin oral suspension and the commercially available tablet. Results The optimized atorvastatin–zein formulation had a mean particle size of 183 nm, a loading efficiency of 14.86%, and an encapsulation efficiency of 29.71%. The in vitro dissolution assay displayed an initial burst effect, with a cumulative amount of atorvastatin released of 41.76% and 82.3% after 12 and 48 hours, respectively. In Wistar albino rats, the bioavailability of atorvastatin from the optimized atorvastatin–zein formulation was 3-fold greater than that from the atorvastatin suspension and the commercially available tablet. Conclusion The atorvastatin–zein nanosphere formulation improved the oral delivery and pharmacokinetic profile of atorvastatin by enhancing its oral bioavailability. PMID:26150716

  1. Remembrance of conversations past: oral advance statements about medical treatment.

    PubMed Central

    Sommerville, A.

    1995-01-01

    Polls show increasing public interest in advance statements or directives about medical treatment ("living wills") but that few people, apart from Jehovah's Witnesses, carry such documents. Patients' firm, witnessed oral decisions are often sufficient to aid clinical decision making but should still be recorded in medical notes. Without documentation, dilemmas arise when others claim to know patients' views on the basis of past unrecorded conversations and demand withdrawal of treatment when patients are not terminally ill and cannot speak for themselves. Legal and ethical considerations oblige doctors to act in the best interests of an incapacitated patient; these considerations are now formally defined in draft legislation as including consideration of the patient's past wishes. The practicalities of ascertaining the strength and validity of such wishes from conversations reported second hand are complex. The paucity of legal and ethical guidance on reported oral advance statements makes debate imperative and renders the alternative of having designated surrogate decision makers increasingly attractive. Images p1664-a PMID:7795460

  2. Optimizing the clinical pharmacology of tuberculosis medications.

    PubMed

    Egelund, E F; Alsultan, A; Peloquin, C A

    2015-10-01

    Tuberculosis (TB) treatment has changed little in the past 40 years. The current standard therapy requires four drugs for 2 months followed by two drugs for 4 months. This "short-course" regimen is not based on optimized pharmacokinetic and pharmacodynamic properties, but empiric evidence. A review of existing data suggests that pharmacokinetic variability with isoniazid and rifampin is greater than previously thought, and that efficacy is not as good as traditionally reported. Adding new drugs to the current regimen will be costly and time-consuming. Maximizing the efficacy of the current medications is a less expensive and more feasible option. This article reviews the current potential of the first-line TB drugs (rifamycins, isoniazid, pyrazinamide, and ethambutol) as well as the fluoroquinolones to introduce a true short-course TB regimen.

  3. The Partnership of Medical Genetics and Oral and Maxillofacial Surgery When Evaluating Craniofacial Anomalies.

    PubMed

    Lin, Angela E

    2015-12-01

    A medical geneticist who has an interest in craniofacial anomalies forms a natural partnership with an oral and maxillofacial surgeon, which facilitates patient care. Using complementary diagnostic and therapeutic skills, the search for a recognizable pattern can lead to a syndrome diagnosis. After the initial examination, there is usually genetic testing to confirm the clinical diagnosis. Once established, care coordination and genetic counseling can be provided for the parents and the patient. Enrolling the patient into a research study could be helpful to understand the diagnosis but, in some circumstances, might not have immediate clinical relevance. A multidisciplinary craniofacial team is generally necessary for long-term management. This article discusses illustrative patients evaluated from 2007 through 2011 with the senior oral and maxillofacial surgeon at the Massachusetts General Hospital (Leonard B. Kaban, DMD, MD). These include single patients with the Nablus mask-like facies syndrome and auriculo-condylar syndrome and a series of 20 patients with Gorlin syndrome followed by a multispecialty team. A successful collaboration between a medical geneticist and an oral and maxillofacial surgeon optimizes the treatment of patients with craniofacial anomalies.

  4. The Partnership of Medical Genetics and Oral and Maxillofacial Surgery When Evaluating Craniofacial Anomalies.

    PubMed

    Lin, Angela E

    2015-12-01

    A medical geneticist who has an interest in craniofacial anomalies forms a natural partnership with an oral and maxillofacial surgeon, which facilitates patient care. Using complementary diagnostic and therapeutic skills, the search for a recognizable pattern can lead to a syndrome diagnosis. After the initial examination, there is usually genetic testing to confirm the clinical diagnosis. Once established, care coordination and genetic counseling can be provided for the parents and the patient. Enrolling the patient into a research study could be helpful to understand the diagnosis but, in some circumstances, might not have immediate clinical relevance. A multidisciplinary craniofacial team is generally necessary for long-term management. This article discusses illustrative patients evaluated from 2007 through 2011 with the senior oral and maxillofacial surgeon at the Massachusetts General Hospital (Leonard B. Kaban, DMD, MD). These include single patients with the Nablus mask-like facies syndrome and auriculo-condylar syndrome and a series of 20 patients with Gorlin syndrome followed by a multispecialty team. A successful collaboration between a medical geneticist and an oral and maxillofacial surgeon optimizes the treatment of patients with craniofacial anomalies. PMID:26608141

  5. Formulation, optimization and evaluation of levocetirizine dihyrochloride oral thin strip.

    PubMed

    Patel, J Gunjan; Modi, A Darshan

    2012-03-01

    The aim of present research was to develop a fast releasing oral polymeric film, with good mechanical properties, instant disintegration and dissolution, producing an acceptable taste when placed on tongue. Solvent casting method was used to prepare oral films. Levocetirizine dihydrochloride, an antihistaminic was incorporated to relieve the symptoms of allergic rhinitis. The polymers selected were HPMC E 15 and PVA. Propylene glycol was the plasticizers used. Nine batches of films with drug were prepared using different combinations of polymers and plasticizer concentration. The resultant films were evaluated for weight variation, content uniformity, folding endurance, thickness, surface pH, in vitro disintegration and in vitro dissolution. The optimized films which disintegrated in less than 30 sec, releasing 85-98% of drug within 2 minutes. The percentage release was varying with concentration of plasticizer and polymer. The films made with HPMC: PVA (1:2) released 96% of drug in 1 min, which was the best release amongst all. PMID:23066198

  6. Optimizing Outcomes of Oral Therapy for Patients With Erectile Dysfunction

    PubMed Central

    Barada, James H

    2003-01-01

    The evaluation and treatment of erectile dysfunction (ED) differs from that of many medical conditions. An intimate dialogue between the patient and physician must be established for accurate assessment of ED severity and successful therapy. Patient and partner education on the nuances of oral phosphodiesterase inhibitor therapy is important to maximize treatment success with this currently first-line therapy. Realistic expectations for the erectile response and patience are necessary to resume satisfactory sexual functioning. Relationship issues or partner resistance can contribute to a suboptimal erectile response to therapy, in which case the patient may benefit from sexual therapy referral. PMID:16985980

  7. Selecting the optimal oral antihistamine for patients with allergic rhinitis.

    PubMed

    Lehman, Jeffrey M; Blaiss, Michael S

    2006-01-01

    Allergic rhinitis (AR) is now recognised as a global health problem that affects 10-30% of adults and up to 40% of children. Each year, millions of patients seek treatment from their healthcare provider. However, the prevalence of AR maybe significantly underestimated because of misdiagnosis, under diagnosis and failure of patients to seek medical attention. In addition to the classical symptoms such as sneezing, nasal pruritus, congestion and rhinorrhoea, it is now recognised that AR has a significant impact on quality of life (QOL). This condition can lead to sleep disturbance as a result of nasal congestion, which leads to significant impairment in daily activities such as work and school. Traditionally, AR has been subdivided into seasonal AR (SAR) or perennial AR (PAR). SAR symptoms usually appear during a specific season in which aeroallergens are present in the outdoor air such as tree and grass pollen in the spring and summer and weed pollens in the autumn (fall); and PAR symptoms are present year-round and are triggered by dust mite, animal dander, indoor molds and cockroaches. Oral histamine H(1)-receptor antagonists (H(1) antihistamines) are one of the most commonly prescribed medications for the treatment of AR. There are several oral H(1) antihistamines available and it is important to know the pharmacology, such as administration interval, onset of action, metabolism and conditions that require administration adjustments. When prescribing oral H(1) antihistamines, the healthcare provider must take into account the clinical efficacy and weigh this against the risk of adverse effects from the agent. In addition to the clinical efficacy, potential for improvement in QOL with a particular treatment should also be considered.

  8. National Medical School Matching Program: optimizing outcomes

    PubMed Central

    Eltorai, Adam EM; Daniels, Alan H

    2016-01-01

    The medical school admissions process is inefficient and costly to both applicants and medical schools. For the many rejected applicants, this process represents a costly, unproductive use of time. For medical schools, numerous applications are reviewed that ultimately do not yield matriculants, representing a substantial inefficiency. In order to streamline the process and reduce costs, we propose the development of a national medical school matching program. PMID:27445512

  9. A Randomized, Controlled Trial to Assess the Efficacy of Arthroscopic Debridement in Combination with Oral Medication Versus Oral Medication in Patients with Gouty Knee Arthritis.

    PubMed

    Wang, Xin; Wanyan, Pingping; Wang, Jian Min; Tian, Jin Hui; Hu, Long; Shen, Xi Ping; Yang, Ke Hu

    2015-12-01

    Gouty knee arthritis refers to a form of inflammatory diseases caused by deposits of needle-like crystals of uric acid in knee joint. The aim of this study was to assess the efficacy and safety of arthroscopic debridement in combination with oral medication versus oral medication alone for the treatment of gouty knee arthritis. A total of 60 patients with gouty knee arthritis were randomized to receive either arthroscopic surgery in combination with oral medication or oral medication alone. Efficacy was assessed with the angle of motion, functions, and visual analog scale (VAS). These indices were measured prior to treatment and at 2, 4, 12, 24, and 48 weeks posttreatment. Surgery- and medication-related complications were observed. Significant differences in flexion and extension of the knee joint, lymphoma scores, and VAS were detected between the two groups at 2, 4, and 12 weeks posttreatment (P < 0.05) but not at weeks 24 and 48 posttreatment (P > 0.05) . Significant differences in these indices were detected at different time points in each group (P < 0.05), except between weeks 24 and 48 (P > 0.05). Arthroscopic surgery in combination with oral medication is superior to single oral medication in the flexion and extension of the knee joint, lymphoma scores, and pain relief (VAS) before 24 weeks, although no statistical differences were detected in the efficacy after 24 weeks, and in medication-related safety between the two groups. Although arthroscopic debridement cannot replace systemic uric acid-lowering treatments such as medication and dietary control, it is still an effective approach. PMID:26730077

  10. A Randomized, Controlled Trial to Assess the Efficacy of Arthroscopic Debridement in Combination with Oral Medication Versus Oral Medication in Patients with Gouty Knee Arthritis.

    PubMed

    Wang, Xin; Wanyan, Pingping; Wang, Jian Min; Tian, Jin Hui; Hu, Long; Shen, Xi Ping; Yang, Ke Hu

    2015-12-01

    Gouty knee arthritis refers to a form of inflammatory diseases caused by deposits of needle-like crystals of uric acid in knee joint. The aim of this study was to assess the efficacy and safety of arthroscopic debridement in combination with oral medication versus oral medication alone for the treatment of gouty knee arthritis. A total of 60 patients with gouty knee arthritis were randomized to receive either arthroscopic surgery in combination with oral medication or oral medication alone. Efficacy was assessed with the angle of motion, functions, and visual analog scale (VAS). These indices were measured prior to treatment and at 2, 4, 12, 24, and 48 weeks posttreatment. Surgery- and medication-related complications were observed. Significant differences in flexion and extension of the knee joint, lymphoma scores, and VAS were detected between the two groups at 2, 4, and 12 weeks posttreatment (P < 0.05) but not at weeks 24 and 48 posttreatment (P > 0.05) . Significant differences in these indices were detected at different time points in each group (P < 0.05), except between weeks 24 and 48 (P > 0.05). Arthroscopic surgery in combination with oral medication is superior to single oral medication in the flexion and extension of the knee joint, lymphoma scores, and pain relief (VAS) before 24 weeks, although no statistical differences were detected in the efficacy after 24 weeks, and in medication-related safety between the two groups. Although arthroscopic debridement cannot replace systemic uric acid-lowering treatments such as medication and dietary control, it is still an effective approach.

  11. Knowledge of oral cancer among recently graduated medical and dental professionals in Amman, Jordan.

    PubMed

    Alami, Arwa Yousef; El Sabbagh, Rula F; Hamdan, Abdelhameed

    2013-10-01

    Oral cancer is a devastating disease, and despite advances in treatment, the survival rate remains low. Early diagnosis can improve survival and outcomes. Delayed referrals are often due to the inadequate knowledge of general health professionals. The aim of this study was to assess the knowledge of oral cancer among recently graduated dental and medical professionals interested in working in a cancer center in Amman, Jordan. The study was conducted using a questionnaire to assess the knowledge of risk factors and the ability to correctly identify the oral lesions most commonly associated with oral cancer. A total of 112 individuals completed the questionnaire. The results revealed an inadequate level of knowledge of oral cancer among the study population, with significant differences between the dental and medical professionals. This study suggests there is a need for improvement of the undergraduate curriculum in oral cancer in both medical and dental schools in Jordan and for the provision of postgraduate and continuing education on this topic.

  12. Mass and Volume Optimization of Space Flight Medical Kits

    NASA Technical Reports Server (NTRS)

    Keenan, A. B.; Foy, Millennia Hope; Myers, Jerry

    2014-01-01

    Resource allocation is a critical aspect of space mission planning. All resources, including medical resources, are subject to a number of mission constraints such a maximum mass and volume. However, unlike many resources, there is often limited understanding in how to optimize medical resources for a mission. The Integrated Medical Model (IMM) is a probabilistic model that estimates medical event occurrences and mission outcomes for different mission profiles. IMM simulates outcomes and describes the impact of medical events in terms of lost crew time, medical resource usage, and the potential for medically required evacuation. Previously published work describes an approach that uses the IMM to generate optimized medical kits that maximize benefit to the crew subject to mass and volume constraints. We improve upon the results obtained previously and extend our approach to minimize mass and volume while meeting some benefit threshold. METHODS We frame the medical kit optimization problem as a modified knapsack problem and implement an algorithm utilizing dynamic programming. Using this algorithm, optimized medical kits were generated for 3 mission scenarios with the goal of minimizing the medical kit mass and volume for a specified likelihood of evacuation or Crew Health Index (CHI) threshold. The algorithm was expanded to generate medical kits that maximize likelihood of evacuation or CHI subject to mass and volume constraints. RESULTS AND CONCLUSIONS In maximizing benefit to crew health subject to certain constraints, our algorithm generates medical kits that more closely resemble the unlimited-resource scenario than previous approaches which leverage medical risk information generated by the IMM. Our work here demonstrates that this algorithm provides an efficient and effective means to objectively allocate medical resources for spaceflight missions and provides an effective means of addressing tradeoffs in medical resource allocations and crew mission success

  13. Constant optimization of oral drug absorption kinetics in the compartment absorption and transit models using particle swarm optimization algorithm

    NASA Astrophysics Data System (ADS)

    Prabowo, K.; Sumaryada, T.; Kartono, A.

    2016-01-01

    Simulation of predictive modeling oral drug namely Compartment Absorption and Transit (CAT) using Particle Swarm Optimization (PSO) algorithm has been performed. This research will be carried out optimization of kinetic constant value oral drug use PSO algorithm to obtain the best global transport constant values for CAT equation that can predict drug concentration in plasma. The value of drug absorption rate constant for drug atenolol 25 mg is k10, k12, k21, k13 and k31 with each value is 0.8562, 0.3736, 0.2191, 0.4334 and 1.000 have been obtained thus raising the value of the coefficient of determination of a model CAT. From the experimental data plasma drug concentrations used are Atenolol, the coefficient of determination (R2) obtained from simulations atenolol 25 mg (PSO) was 81.72% and 99.46%. Better correlation between the dependent variable as the drug concentration and explanatory variables such as mass medication, plasma volume, and rate of absorption of the drug has increased in CAT models using PSO algorithm. Based on the results of CAT models fit charts can predict drug concentration in plasma.

  14. Can oral fluid cannabinoid testing monitor medication compliance and/or cannabis smoking during oral THC and oromucosal Sativex administration?

    PubMed Central

    Lee, Dayong; Karschner, Erin L.; Milman, Garry; Barnes, Allan J.; Goodwin, Robert S.; Huestis, Marilyn A.

    2012-01-01

    OBJECTIVES We characterize cannabinoid disposition in oral fluid (OF) after Dronabinol, synthetic oral Δ9-tetrahydrocannabinol (THC), and Sativex, a cannabis-extract oromucosal spray, and evaluate whether smoked cannabis relapse or Sativex compliance can be identified with OF cannabinoid monitoring. METHODS 5 and 15 mg synthetic oral THC, low (5.4 mg THC, 5.0 mg cannabidiol (CBD)) and high (16.2 mg THC, 15.0 mg CBD) dose Sativex, and placebo were administered in random order (n=14). Oral fluid specimens were collected for 10.5h after dosing and analyzed for THC, CBD, cannabinol (CBN), and 11-nor-9-carboxy-THC (THCCOOH). RESULTS After oral THC, OF THC concentrations decreased over time from baseline, reflecting residual THC excretion from previously self-administered smoked cannabis. CBD and CBN also were rarely detected. After Sativex, THC, CBD and CBN increased greatly, peaking at 0.25–1h. Median CBD/THC and CBN/THC ratios were 0.82–1.34 and 0.04–0.06, respectively, reflecting cannabinoids’ composition in Sativex. THCCOOH/THC ratios within 4.5h post Sativex were ≤1.6 pg/ng, always lower than after oral THC and placebo. THCCOOH/THC ratios increased throughout each dosing session. CONCLUSIONS Lack of measurable THC, CBD and CBN in OF following oral THC, and high OF CBD/THC ratios after Sativex distinguish oral and sublingual drug delivery routes from cannabis smoking. Low THCCOOH/THC ratios suggest recent Sativex and smoked cannabis exposure. These data indicate that OF cannabinoid monitoring can document compliance with Sativex pharmacotherapy, and identify relapse to smoked cannabis during oral THC medication but not Sativex treatment, unless samples were collected shortly after smoking. PMID:23146820

  15. Solutions for medical databases optimal exploitation

    PubMed Central

    Branescu, I; Purcarea, VL; Dobrescu, R

    2014-01-01

    The paper discusses the methods to apply OLAP techniques for multidimensional databases that leverage the existing, performance-enhancing technique, known as practical pre-aggregation, by making this technique relevant to a much wider range of medical applications, as a logistic support to the data warehousing techniques. The transformations have practically low computational complexity and they may be implemented using standard relational database technology. The paper also describes how to integrate the transformed hierarchies in current OLAP systems, transparently to the user and proposes a flexible, “multimodel" federated system for extending OLAP querying to external object databases. PMID:24653769

  16. Oral Medications: Proper Use and Administration. Book 1, Bosnian and Russian. Book 2, Nuer and Spanish.

    ERIC Educational Resources Information Center

    Anoka County Community Health and Environmental Services, Coon Rapids, MN.

    These two guides provide information in English, Bosnian, Russian, Nuer, and Spanish on the proper use and administration of oral medications. Topics covered include the reasons for taking medication, information on the prescription label, following special instructions, asking questions of the pharmacist, safe storage of medicine, child-proof…

  17. Lipid nanoparticles for oral delivery of raloxifene: optimization, stability, in vivo evaluation and uptake mechanism.

    PubMed

    Ravi, Punna Rao; Aditya, N; Kathuria, Himanshu; Malekar, Srinivas; Vats, Rahul

    2014-05-01

    Raloxifene HCl (RLX) shows low oral bioavailability (<2%) in humans due to poor aqueous solubility and extensive (>90%) metabolism in gut. Lipid nanoparticles (SLN) with glyceryl tribehenate were designed to enhance drug's oral bioavailability. Box-Bhenken design was used to optimize manufacturing conditions. Optimized SLN had particle size of 167±3nm and high encapsulation efficiency (>92%). Oral bioavailability of RLX from SLN was improved by 3.24 folds compared to free RLX in female Wistar rats. Both clathrin and caveolae mediated endocytosis pathways were involved in the uptake of SLN. Lymphatic transport inhibitor, cycloheximide significantly reduced oral bioavailability of SLN. PMID:24378615

  18. The Oral History Program: II. Personal views of health sciences librarianship and the Medical Library Association.

    PubMed Central

    McKenzie, D; Pifalo, V

    1998-01-01

    The Medical Library Association Oral History Program uses accepted oral history techniques to collect and preserve interviews with members. The original taped interviews and transcripts are kept in the Medical Library Association archives and made available for research purposes; edited copies of the interviews are distributed through the National Network of Libraries of Medicine, and members are encouraged to borrow and read the histories. Summaries of forty-three interviews provide personal views on health sciences librarianship and the Medical Library Association. PMID:9681172

  19. The Oral History Program: III. Personal views of health sciences librarianship and the Medical Library Association.

    PubMed Central

    McKenzie, D; Pifalo, V

    1998-01-01

    The Medical Library Association Oral History Program uses accepted oral history techniques to collect and preserve interviews with members. The original taped interviews and transcripts are kept in the Medical Library Association archives and made available for research purposes; edited copies of the interviews are distributed through the National Network of Libraries of Medicine, and members are encouraged to borrow and read the histories. Summaries of forty-three interviews provide personal views on health sciences librarianship and the Medical Library Association. PMID:9803287

  20. The Oral History Program: I. Personal views of health sciences librarianship and the Medical Library Association.

    PubMed Central

    McKenzie, D; Pifalo, V

    1998-01-01

    The Medical Library Association Oral History Program uses accepted oral history techniques to collect and preserve interviews with members. The original taped interviews and transcripts are kept in the Medical Library Association archives and made available for research purposes; edited copies of the interviews are distributed through the National Network of Libraries of Medicine, and members are encouraged to borrow and read the histories. Summaries of forty-three interviews provide personal views on health sciences librarianship and the Medical Library Association. PMID:9578936

  1. 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

  2. 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.

  3. Dispositional optimism, self-framing and medical decision-making.

    PubMed

    Zhao, Xu; Huang, Chunlei; Li, Xuesong; Zhao, Xin; Peng, Jiaxi

    2015-03-01

    Self-framing is an important but underinvestigated area in risk communication and behavioural decision-making, especially in medical settings. The present study aimed to investigate the relationship among dispositional optimism, self-frame and decision-making. Participants (N = 500) responded to the Life Orientation Test-Revised and self-framing test of medical decision-making problem. The participants whose scores were higher than the middle value were regarded as highly optimistic individuals. The rest were regarded as low optimistic individuals. The results showed that compared to the high dispositional optimism group, participants from the low dispositional optimism group showed a greater tendency to use negative vocabulary to construct their self-frame, and tended to choose the radiation therapy with high treatment survival rate, but low 5-year survival rate. Based on the current findings, it can be concluded that self-framing effect still exists in medical situation and individual differences in dispositional optimism can influence the processing of information in a framed decision task, as well as risky decision-making.

  4. Dispositional optimism, self-framing and medical decision-making.

    PubMed

    Zhao, Xu; Huang, Chunlei; Li, Xuesong; Zhao, Xin; Peng, Jiaxi

    2015-03-01

    Self-framing is an important but underinvestigated area in risk communication and behavioural decision-making, especially in medical settings. The present study aimed to investigate the relationship among dispositional optimism, self-frame and decision-making. Participants (N = 500) responded to the Life Orientation Test-Revised and self-framing test of medical decision-making problem. The participants whose scores were higher than the middle value were regarded as highly optimistic individuals. The rest were regarded as low optimistic individuals. The results showed that compared to the high dispositional optimism group, participants from the low dispositional optimism group showed a greater tendency to use negative vocabulary to construct their self-frame, and tended to choose the radiation therapy with high treatment survival rate, but low 5-year survival rate. Based on the current findings, it can be concluded that self-framing effect still exists in medical situation and individual differences in dispositional optimism can influence the processing of information in a framed decision task, as well as risky decision-making. PMID:24849872

  5. The Parity Paradigm: Can Legislation Help Reduce the Cost Burden of Oral Anticancer Medications?

    PubMed

    Kircher, Sheetal M; Meeker, Caitlin R; Nimeiri, Halla; Geynisman, Daniel M; Zafar, S Yousuf; Shankaran, Veena; de Souza, Jonas; Wong, Yu-Ning

    2016-01-01

    Over the last decade, there has been increased development and use of oral anticancer medications, which sometimes leads to high cost sharing for patients. Drug parity laws require insurance plans to cover oral anticancer medications with the same cost sharing as intravenous/injected chemotherapy or have a capped limit on out-of-pocket costs. There are currently 36 enacted state laws (plus the District of Columbia) addressing drug parity, but no federal laws. In this policy perspective piece, we discuss the history, opportunities, and limitations of drug parity laws in oncology. We also discuss the implications of provisions of the Affordable Care Act and other proposed policy reforms on financing oral chemotherapy. PMID:26797241

  6. Optimal embedding for shape indexing in medical image databases.

    PubMed

    Qian, Xiaoning; Tagare, Hemant D

    2005-01-01

    Fast retrieval using organ shapes is crucial in medical image databases since shape is a clinically prominent feature. In this paper, we propose that 2-D shapes in medical image databases can be indexed by embedding them into a vector space and using efficient vector space indexing. An optimal shape space embedding is proposed for this purpose. Experimental results of indexing vertebral shapes in the NHANES II database are presented. The results show that vector space indexing following embedding gives superior performance than metric indexing.

  7. Design and Optimization of Renin Inhibitors: Orally Bioavailable Alkyl Amines

    SciTech Connect

    Tice, C.; Xu, Z; Yuan, J; Simpson, R; Cacatian, S; Flaherty, P; Zhao, W; Guo, J

    2009-01-01

    Structure-based drug design led to the identification of a novel class of potent, low MW alkylamine renin inhibitors. Oral administration of lead compound 21l, with MW of 508 and IC{sub 50} of 0.47 nM, caused a sustained reduction in mean arterial blood pressure in a double transgenic rat model of hypertension.

  8. Comparison of SGA oral medications and a long-acting injectable SGA: the PROACTIVE study.

    PubMed

    Buckley, Peter F; Schooler, Nina R; Goff, Donald C; Hsiao, John; Kopelowicz, Alexander; Lauriello, John; Manschreck, Theo; Mendelowitz, Alan J; Miller, Del D; Severe, Joanne B; Wilson, Daniel R; Ames, Donna; Bustillo, Juan; Mintz, Jim; Kane, John M

    2015-03-01

    Until relatively recently, long-acting injectable (LAI) formulations were only available for first-generation antipsychotics and their utilization decreased as use of oral second-generation antipsychotics (SGA) increased. Although registry-based naturalistic studies show LAIs reduce rehospitalization more than oral medications in clinical practice, this is not seen in recent randomized clinical trials. PROACTIVE (Preventing Relapse Oral Antipsychotics Compared to Injectables Evaluating Efficacy) relapse prevention study incorporated efficacy and effectiveness features. At 8 US academic centers, 305 patients with schizophrenia or schizoaffective disorder were randomly assigned to LAI risperidone (LAI-R) or physician's choice oral SGAs. Patients were evaluated during the 30-month study by masked, centralized assessors using 2-way video, and monitored biweekly by on-site clinicians and assessors who knew treatment assignment. Relapse was evaluated by a masked Relapse Monitoring Board. Differences between LAI-R and oral SGA treatment in time to first relapse and hospitalization were not significant. Psychotic symptoms and Brief Psychiatric Rating Scale total score improved more in the LAI-R group. In contrast, the LAI group had higher Scale for Assessment of Negative Symptoms Alogia scale scores. There were no other between-group differences in symptoms or functional improvement. Despite the advantage for psychotic symptoms, LAI-R did not confer an advantage over oral SGAs for relapse or rehospitalization. Biweekly monitoring, not focusing specifically on patients with demonstrated nonadherence to treatment and greater flexibility in changing medication in the oral treatment arm, may contribute to the inability to detect differences between LAI and oral SGA treatment in clinical trials. PMID:24870446

  9. Targeting Oral and Cultural Proficiency for Medical Personnel: An Examination of Current Medical Spanish Textbooks

    ERIC Educational Resources Information Center

    Hardin, Karol

    2012-01-01

    Demand for medical Spanish courses has grown with the rising needs of Spanish-speaking patients in the United States, but while there is no shortage of beginning medical Spanish textbooks, very few target the intermediate level. This article examines eighteen medical Spanish texts published in the last twenty years with respect to seven factors:…

  10. Optimization of orally bioavailable alkyl amine renin inhibitors

    SciTech Connect

    Xu, Zhenrong; Cacatian, Salvacion; Yuan, Jing; Simpson, Robert D.; Jia, Lanqi; Zhao, Wei; Tice, Colin M.; Flaherty, Patrick T.; Guo, Joan; Ishchenko, Alexey; Singh, Suresh B.; Wu, Zhongren; McKeever, Brian M.; Scott, Boyd B.; Bukhtiyarov, Yuri; Berbaum, Jennifer; Mason, Jennifer; Panemangalore, Reshma; Cappiello, Maria Grazia; Bentley, Ross; Doe, Christopher P.; Harrison, Richard K.; McGeehan, Gerard M.; Dillard, Lawrence W.; Baldwin, John J.; Claremon, David A.

    2010-09-17

    Structure-guided drug design led to new alkylamine renin inhibitors with improved in vitro and in vivo potency. Lead compound 21a, has an IC{sub 50} of 0.83 nM for the inhibition of human renin in plasma (PRA). Oral administration of 21a at 10 mg/kg resulted in >20 h reduction of blood pressure in a double transgenic rat model of hypertension.

  11. Underlying construct of empathy, optimism, and burnout in medical students

    PubMed Central

    Vergare, Michael; Isenberg, Gerald; Cohen, Mitchell; Spandorfer, John

    2015-01-01

    Objectives This study was designed to explore the underlying construct of measures of empathy, optimism, and burnout in medical students. Methods Three instruments for measuring empathy (Jefferson Scale of Empathy, JSE); Optimism (the Life Orientation Test-Revised, LOT-R); and burnout (the Maslach Burnout Inventory, MBI, which includes three scales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment) were administered to 265 third-year students at Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University. Data were subjected to factor analysis to examine relationships among measures of empathy, optimism, and burnout in a multivariate statistical model.  Results Factor analysis (principal component with oblique rotation) resulted in two underlying constructs, each with an eigenvalue greater than one. The first factor involved “positive personality attributes” (factor coefficients greater than .58 for measures of empathy, optimism, and personal accomplishment). The second factor involved “negative personality attributes” (factor coefficients greater than .78 for measures of emotional exhaustion, and depersonalization). Conclusions Results confirmed that an  association exists between empathy in the context of patient care and personality characteristics that are conducive to relationship building, and considered to be  “positive personality attributes,” as opposed to personality characteristics that are considered as “negative personality attributes” that are detrimental to interpersonal relationships. Implications for the professional development of physicians-in-training and in-practice are discussed. PMID:25633650

  12. In their own words: oral histories of Medical Library Association past presidents*

    PubMed Central

    Epstein, Barbara A.

    2016-01-01

    Objective The purpose of this lecture was to review the development of the Medical Library Association (MLA) oral history program and to highlight the oral histories of thirty-seven past MLA presidents to identify themes of common interest and relevance to current MLA members. Methods The lecture focused on three main topics discussed in many of the interviews: the presidents' backgrounds and how they came to be medical librarians, how MLA developed as an organization as a reflection of the growth of medical libraries, and the presidents' predictions and advice about the future. Results MLA presidents came from varied backgrounds and locales. As MLA grew from a small, intimate group into a multifaceted organization with a professional management staff, the workload of the presidents changed in scope. One recurring theme in the presidential oral histories was the power differential between men and women in the organization and the profession. MLA presidents reminisced about notable annual meetings and praised the positive impact of the organization on members' professional and personal lives. Conclusions The lecture concludes with recommendations to the organization to increase the availability of the oral histories by providing online access for future interviews and to pay careful attention to their long-term preservation. PMID:26807047

  13. Oral inflammation and infection, and chronic medical diseases: implications for the elderly.

    PubMed

    Scannapieco, Frank A; Cantos, Albert

    2016-10-01

    Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults. PMID:27501498

  14. Oral Medications for Diabetes in Pregnancy: Use in a Rural Population.

    PubMed

    Thorkelson, Shelley Jayne; Anderson, Kristi R

    2016-05-01

    IN BRIEF The oral agents glyburide and metformin are both recommended by many professional societies for the treatment of gestational diabetes mellitus (GDM). Both therapeutic modalities have published safety and efficacy data, but there remains much debate among experts. Providers need a clear treatment plan for GDM based on a predictable level of clinical success in obtaining treatment goals. The proper selection of ideal candidates is paramount in achieving clinical success with the use of these medications in the treatment of GDM. This article presents clinical strategies for using oral agents in the management of GDM based on a pragmatic approach taken in a group of rural Native American women. PMID:27182179

  15. Assessment of Medical Risks and Optimization of their Management using Integrated Medical Model

    NASA Technical Reports Server (NTRS)

    Fitts, Mary A.; Madurai, Siram; Butler, Doug; Kerstman, Eric; Risin, Diana

    2008-01-01

    The Integrated Medical Model (IMM) Project is a software-based technique that will identify and quantify the medical needs and health risks of exploration crew members during space flight and evaluate the effectiveness of potential mitigation strategies. The IMM Project employs an evidence-based approach that will quantify probability and consequences of defined in-flight medical risks, mitigation strategies, and tactics to optimize crew member health. Using stochastic techniques, the IMM will ultimately inform decision makers at both programmatic and institutional levels and will enable objective assessment of crew health and optimization of mission success using data from relevant cohort populations and from the astronaut population. The objectives of the project include: 1) identification and documentation of conditions that may occur during exploration missions (Baseline Medical Conditions List [BMCL), 2) assessment of the likelihood of conditions in the BMCL occurring during exploration missions (incidence rate), 3) determination of the risk associated with these conditions and quantify in terms of end states (Loss of Crew, Loss of Mission, Evacuation), 4) optimization of in-flight hardware mass, volume, power, bandwidth and cost for a given level of risk or uncertainty, and .. validation of the methodologies used.

  16. Oral medications regarding their safety and efficacy in the management of patent ductus arteriosus

    PubMed Central

    Oncel, Mehmet Yekta; Erdeve, Omer

    2016-01-01

    Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants which is inversely related to birth weight and gestational age. Cyclooxygenase inhibitors such as indomethacin and ibuprofen which block the prostaglandin conversion from arachidonic acid are the most commonly used drugs for ductal closure. This review focuses on the safety and efficacy oral medications in the management of PDA in preterm infants. Ibuprofen seems to be the first choice due to its higher safety profile, as it is associated with fewer gastrointestinal and renal side effects when compared to indomethacin. PDA closure rates are better with oral than with intravenous ibuprofen probably due to the pharmacokinetic of the drug. However, these medications were reported to be associated with several adverse including transient renal failure, gastrointestinal bleeding and perforation, hyperbilirubinemia and platelet dysfunction. Paracetamol seems be an alternative to PDA therapy with lower adverse events and side effects. PMID:26862505

  17. Formulation development of oral controlled release tablets of hydralazine: optimization of drug release and bioadhesive characteristics.

    PubMed

    Singh, Bhupinder; Pahuja, Sonia; Kapil, Rishi; Ahuja, Naveen

    2009-03-01

    The current study involves development of oral bioadhesive hydrophilic matrices of hydralazine hydrochloride, and optimization of their in vitro drug release profile and ex vivo bioadhesion against porcine gastric mucosa. A 32 central composite design was employed to systematically optimize the drug delivery formulations containing two polymers, viz., carbomer and hydroxypropyl methyl cellulose. Response surface plots were drawn and optimum formulations were selected by brute force searches. Validation of the formulation optimization study indicated a very high degree of prognostic ability. The study successfully undertook the development of an optimized once-a-day formulation of hydralazine with excellent bioadhesive and controlled release characteristics.

  18. Contemporary and optimal medical management of peripheral arterial disease.

    PubMed

    Tattersall, Matthew C; Johnson, Heather M; Mason, Peter J

    2013-08-01

    Atherosclerotic lower extremity peripheral arterial disease (PAD) is a highly prevalent condition associated with a significant increase in risk of all-cause mortality and cardiovascular morbidity and mortality. PAD is underdiagnosed and undertreated. Treatment is focused on (1) lowering cardiovascular risk and cardiovascular disease event rates and (2) improvement in symptoms and quality of life. Multidisciplinary and intersociety guidelines guide optimal medical therapy. Substantial evidence supports implementation of tobacco cessation counseling and pharmacotherapy to help achieve tobacco abstinence, antiplatelet therapy, HMG-CoA reductase inhibitors (statins) therapy, and antihypertensive therapy for the purpose of lowering cardiovascular event rates and improving survival.

  19. Direct drug analysis from oral fluid using medical swab touch spray mass spectrometry.

    PubMed

    Pirro, Valentina; Jarmusch, Alan K; Vincenti, Marco; Cooks, R Graham

    2015-02-25

    Fourteen common drugs of abuse were identified in spiked oral fluid (ng mL(-1) levels), analyzed directly from medical swabs using touch spray mass spectrometry (TS-MS), exemplifying a rapid test for drug detection. Multiple stages of mass analysis (MS(2) and MS(3)) provided identification and detection limits sought by international forensic and toxicological societies, Δ(9)-THC and buprenorphine excluded. The measurements were made using a medical swab as both the sampling probe and means of ionization. The adaptation of medical swabs for TS-MS analysis allows non-invasive and direct sampling of neat oral fluid. Data acquisition was rapid, seconds per drug, and MS(3) ensured reliable identification of illicit drugs. The reported data were acquired to investigate (i) ionization of common drugs from commercial swabs, (ii) ion intensity over spray duration, and (iii) dynamic range, all as initial steps in development of a quantitative method. The approach outlined is intended for point-of-care drug testing using oral fluid in clinical applications as well as in situ settings, viz. in forensic applications. The proof-of-concept results presented will require extension to other controlled substances and refinement in analytical procedures to meet clinical/legal requirements. PMID:25702273

  20. Direct drug analysis from oral fluid using medical swab touch spray mass spectrometry.

    PubMed

    Pirro, Valentina; Jarmusch, Alan K; Vincenti, Marco; Cooks, R Graham

    2015-02-25

    Fourteen common drugs of abuse were identified in spiked oral fluid (ng mL(-1) levels), analyzed directly from medical swabs using touch spray mass spectrometry (TS-MS), exemplifying a rapid test for drug detection. Multiple stages of mass analysis (MS(2) and MS(3)) provided identification and detection limits sought by international forensic and toxicological societies, Δ(9)-THC and buprenorphine excluded. The measurements were made using a medical swab as both the sampling probe and means of ionization. The adaptation of medical swabs for TS-MS analysis allows non-invasive and direct sampling of neat oral fluid. Data acquisition was rapid, seconds per drug, and MS(3) ensured reliable identification of illicit drugs. The reported data were acquired to investigate (i) ionization of common drugs from commercial swabs, (ii) ion intensity over spray duration, and (iii) dynamic range, all as initial steps in development of a quantitative method. The approach outlined is intended for point-of-care drug testing using oral fluid in clinical applications as well as in situ settings, viz. in forensic applications. The proof-of-concept results presented will require extension to other controlled substances and refinement in analytical procedures to meet clinical/legal requirements.

  1. Consensus Guidelines for Oral Dosing of Primarily Renally Cleared Medications in Older Adults

    PubMed Central

    Hanlon, Joseph T.; Aspinall, Sherrie L.; Semla, Todd P.; Weisbord, Steven D.; Fried, Linda F.; Good, C. Bernie; Fine, Michael J.; Stone, Roslyn A.; Pugh, Mary Jo V.; Rossi, Michelle I.; Handler, Steven M.

    2008-01-01

    Objectives To establish consensus oral dosing guidelines for primarily renally cleared medications prescribed for older adults. Design Two-round modified Delphi Survey. Participants Expert panel of 11 geriatric clinical pharmacists. Measurements After a comprehensive literature search and review by the investigative group of 6 physicians (2 from general internal medicine, 2 nephrologists, 2 geriatricians), 45 dosing recommendations for 30 medications at various levels of renal function were created. The expert panel rated their agreement with each of these 45 dosing recommendations using a 5-point Likert scale (1= strongly disagree to 5=strongly agree). Recommendation-specific means and 95% confidence intervals were estimated. Consensus was defined as a lower 95% confidence limit of >4.0 for the recommendation –specific mean score. Results The response rate was 81.8% (9/11) for the first round. All respondents that completed the first round also completed the second round. The expert panel reached consensus on 26 recommendations involving 18 (60%) medications. For 10 medications (chlorpropamide, colchicine, cotrimoxazole, glyburide, meperidine, nitrofurantoin, probenecid, propoxyphene, spironolactone, and triamterene), the consensus recommendation was not to use the medication in older adults below a specified level of renal function (e.g., creatinine clearance < 30 ml/min). For the remaining 8 medications (acyclovir, amantadine, ciprofloxacin, gabapentin, memantine, ranitidine, rimantadine, and valacyclovir), specific recommendations for dose reduction or interval extension were made. Conclusion An expert panel of geriatric clinical pharmacists was able to reach consensus agreement on a number of oral medications that are primarily renally cleared. PMID:19170784

  2. Oral Medication

    MedlinePlus

    > Find Us On Facebook Twitter Pinterest Youtube Instagram Diabetes Stops Here Blog Online Community Site Menu Are You at Risk? Diagnosis Lower Your Risk Risk Test Alert Day Prediabetes My Health Advisor Tools to ...

  3. Glossitis and tongue trauma subsequent to administration of an oral medication, using an udder infusion cannula, in a horse

    PubMed Central

    Fuller, Mark C.; Abutarbush, Sameeh M.

    2007-01-01

    A 10-year-old gelding was presented with a tongue that had swelled immediately after oral administration of oxfendazole, using an udder infusion cannula. The tongue appeared to have been punctured inadvertently. The horse recovered after treatment with intravenous fluid, antibiotics, and anti-inflammatory drugs. Administering oral medication by this method should be discouraged. PMID:17824329

  4. 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.

  5. 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

  6. Optimal embedding for shape indexing in medical image databases.

    PubMed

    Qian, Xiaoning; Tagare, Hemant D; Fulbright, Robert K; Long, Rodney; Antani, Sameer

    2010-06-01

    This paper addresses the problem of indexing shapes in medical image databases. Shapes of organs are often indicative of disease, making shape similarity queries important in medical image databases. Mathematically, shapes with landmarks belong to shape spaces which are curved manifolds with a well defined metric. The challenge in shape indexing is to index data in such curved spaces. One natural indexing scheme is to use metric trees, but metric trees are prone to inefficiency. This paper proposes a more efficient alternative. We show that it is possible to optimally embed finite sets of shapes in shape space into a Euclidean space. After embedding, classical coordinate-based trees can be used for efficient shape retrieval. The embedding proposed in the paper is optimal in the sense that it least distorts the partial Procrustes shape distance. The proposed indexing technique is used to retrieve images by vertebral shape from the NHANES II database of cervical and lumbar spine X-ray images maintained at the National Library of Medicine. Vertebral shape strongly correlates with the presence of osteophytes, and shape similarity retrieval is proposed as a tool for retrieval by osteophyte presence and severity. Experimental results included in the paper evaluate (1) the usefulness of shape similarity as a proxy for osteophytes, (2) the computational and disk access efficiency of the new indexing scheme, (3) the relative performance of indexing with embedding to the performance of indexing without embedding, and (4) the computational cost of indexing using the proposed embedding versus the cost of an alternate embedding. The experimental results clearly show the relevance of shape indexing and the advantage of using the proposed embedding.

  7. Application of oral history to contemporary history of medicine in Korea: with a focus on medical scientists.

    PubMed

    Kim, Ock-Joo

    2013-08-01

    The oral history helps researchers to fill the gap in historical documents in research on the contemporary history of medicine in Korea. More and more studies in history of contemporary medicine in Korea have come out using oral history of doctors and patients. Based upon the author's research on development of neurosurgery in late 20th century Korea, this paper discusses how to apply oral history to contemporary history of medicine, focusing on oral history of doctors in Korea. In this paper the author describes how to do and use oral history of key doctors and medical scientists in the contemporary history of medicine in Korea. The oral history can be a powerful tool to complement the written documents as following. First, from their interview, doctors and medical scientists often provide valuable information which historians cannot get from documents and written sources. As intelligent interviewees, they not only understand the purpose of research but also help actively the historianresearcher- interviewer. Second, the oral history facilitates further searches and often it leads to more findings of informants, and written and image material. More often than not, doctors and medical scientists do their own research on the topic and provide the historian with valuable historical source material from their laboratories, bedsides, family and friends. Third, interviews with medical scientists and oral material produced by doctors and medical scientists helped the researcher to understand and interpret the papers and written documents. Fourth, the subjective stories told by the medical scientists provide perspectives and historical source as narrative truth. Before a historian attempts to use the oral material as complementary historial evidence, he or she needs to cross-check the validity and of objectivity of the oral material. Oral material is produced through bidirectional intersubjective interaction between the interviewer and interviewee, and critical reflection

  8. A survey of reading, writing, and oral communication skills in North American veterinary medical colleges.

    PubMed

    Hendrix, C M; Thompson, I K; Mann, C J

    2001-01-01

    In the 1989 report by the Pew National Veterinary Education Program (PNVEP), communication skills topped the list of characteristics the veterinary graduate should possess in order to function effectively in the twenty-first century. To determine the reading, writing, and oral communication requirements and opportunities in veterinary curricula in the US and Canada, and to determine the perceived communication tasks that might be commonly required of practicing veterinarians in the next century, we sent a 15-item communications skills questionnaire to the academic deans of the 31 veterinary curricula in the US and Canada. The results reinforce the importance of communication skills in veterinary medicine, as detailed by the PNVEP over 10 years ago. Based on the responses to our questionnaire and on our own experiences with veterinary medical students, we make several recommendations to enhance communication instruction in veterinary medical curricula.

  9. In vitro analysis of the cariogenic and erosive potential of paediatric antitussive liquid oral medications.

    PubMed

    Cavalcanti, Alessandro L; De Sousa, Rayanne I M; Clementino, Marayza A; Vieira, Fernando F; Cavalcanti, Christiane L; Xavier, Alidianne F C

    2012-04-01

    We evaluated in vitro the cariogenic and erosive potential of antitussive liquid oral medications for paediatric use. Fifteen paediatric liquid antitussives were sampled. The endogenous pH was evaluated by potentiometry, titratable acidity was measured according to the method adopted by the Association of Official Analytical Chemists, total soluble solids content (TSSC) readings were performed by Brix refractometry using the Abbé refractometer, and the total sugar content was determined according to the Fehling methodology. The experiments were performed in triplicate and the obtained data were entered in the Excel software, analyzed and presented by descriptive statistics (means and standard deviations). Endogenous pH values ranged from 2.49 ± 0.09 (Iodetox®) to 6.75 ± 0.005 (Carbocysteine®) and twelve medications showed pHs below the critical value of 5.5 for enamel demineralization. Iodetox® (0.021 ± 0.01) presented the lowest titratable acidity and Aerofrin® (1.171 ± 0.01) presented the highest titratable acidity. Celergin® presented the highest TSSC (62.26 ± 0.40) and Acetyleysteine® (100 mg granules bags) presented the lowest TSSC (3.25 ± 0.43). Only 5 medications contained sugar, with total sugar content ranging from 35.93% ± 6.65 (Iodetox®) to 59.60% DP ± 6.66 (Celergin®). The paediatric antitussive medications showed low endogenous pH, some of them even below the critical value for enamel dissolution (pH<5.5). These antitussives are potentially cariogenic and erosive to dental structures if used frequently because of the high titratable acidity and high sugar concentration, especially when adequate oral clearance is not performed after administration of each dose.

  10. Primary oral health service provision in Aboriginal Medical Services-based dental clinics in Western Australia.

    PubMed

    Kruger, Estie; Perera, Irosha; Tennant, Marc

    2010-01-01

    Australians living in rural and remote areas have poorer access to dental care. This situation is attributed to workforce shortages, limited facilities and large distances to care centres. Against this backdrop, rural and remote Indigenous (Aboriginal) communities in Western Australia seem to be more disadvantaged because evidence suggests they have poorer oral health than non-Indigenous people. Hence, provision of dental care for Aboriginal populations in culturally appropriate settings in rural and remote Western Australia is an important public health issue. The aim of this research was to compare services between the Aboriginal Medical Services (AMS)-based clinics and a typical rural community clinic. A retrospective analysis of patient demographics and clinical treatment data was undertaken among patients who attended the dental clinics over a period of 6 years from 1999 to 2004. The majority of patients who received dental care at AMS dental clinics were Aboriginal (95.3%), compared with 8% at the non-AMS clinic. The rate of emergency at the non-AMS clinic was 33.5%, compared with 79.2% at the AMS clinics. The present study confirmed that more Indigenous patients were treated in AMS dental clinics and the mix of dental care provided was dominated by emergency care and oral surgery. This indicated a higher burden of oral disease and late utilisation of dental care services (more focus on tooth extraction) among rural and remote Indigenous people in Western Australia.

  11. Optimal grid point selection for improved nonrigid medical image registration

    NASA Astrophysics Data System (ADS)

    Fookes, Clinton; Maeder, Anthony

    2004-05-01

    Non-rigid image registration is an essential tool required for overcoming the inherent local anatomical variations that exist between medical images acquired from different individuals or atlases, among others. This type of registration defines a deformation field that gives a translation or mapping for every pixel in the image. One popular local approach for estimating this deformation field, known as block matching, is where a grid of control points are defined on an image and are each taken as the centre of a small window. These windows are then translated in the second image to maximise a local similarity criterion. This generates two corresponding sets of control points for the two images, yielding a sparse deformation field. This sparse field can then be propagated to the entire image using well known methods such as the thin-plate spline warp or simple Gaussian convolution. Previous block matching procedures all utilise uniformly distributed grid points. This results in the generation of a sparse deformation field containing displacement estimates at uniformly spaced locations. This neglects to make use of the evidence that block matching results are dependent on the amount of local information content. That is, results are better in regions of high information when compared to regions of low information. Consequently, this paper presents a solution to this drawback by proposing the use of a Reversible Jump Markov Chain Monte Carlo (RJMCMC) statistical procedure to optimally select grid points of interest. These grid points have a greater concentration in regions of high information and a lower concentration in regions of small information. Results show that non-rigid registration can by improved by using optimally selected grid points of interest.

  12. Association between patients’ beliefs and oral antidiabetic medication adherence in a Chinese type 2 diabetic population

    PubMed Central

    Wu, Ping; Liu, Naifeng

    2016-01-01

    Purpose The objective of this study was to identify, using the theory of planned behavior (TPB), patients’ beliefs about taking oral antidiabetic drugs (OADs) as prescribed, and to measure the correlations between beliefs and medication adherence. Patients and methods We performed a cross-sectional study of type 2 diabetic patients using structured questionnaires in a Chinese tertiary hospital. A total of 130 patients were enrolled to be interviewed about TPB variables (behavioral, normative, and control beliefs) relevant to medication adherence. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Spearman’s rank correlation was used to assess the association between TPB and MMAS-8. Logistic regression analysis was performed to examine the relationship between different variables and MMAS-8, with statistical significance determined at P<0.05. Results From 130 eligible Chinese patients with an average age of 60.6 years and a male proportion of 50.8%, a nonsignificant relationship between behavioral, normative, and the most facilitating control beliefs and OAD adherence was found in our study. Having the OADs on hand (P=0.037) was the only facilitating control belief associated with adherence behavior. Being away from home or eating out (P=0.000), not accepting the disease (P=0.000), ignorance of life-long drug adherence (P=0.038), being busy (P=0.001), or poor memory (P=0.008) were control belief barriers found to be correlated with poor adherence. TPB is the only important determinant influencing OAD adherence among all the factors (P=0.011). Conclusion The results indicate that the TPB model could be used to examine adherence to OADs. One facilitating control belief, and most of the barrier control beliefs of TPB were related to medication adherence among Chinese type 2 diabetes inpatients. It will be helpful to understand patients’ self-medication and provide methods to develop instruments for identifying

  13. [Patients' preferences for nurses' nonverbal expressions of warmth during nursing rounds and administration of oral medication].

    PubMed

    Kim, H S; Kim, M S

    1990-12-01

    Nursing involves deep human interpersonal relationships between nurses and patients. But in modern Korea, the nurse-patient relationship tends to be ritualistic and mechanestic. Patients usually express the hope that nurses be more tender and kind. Patients expect nurses to express their warmth especially through nonverbal behaviour. This study was conducted to identify patients' preferences for nurse's nonverbal expressions of warmth. Through the confirmation of these preferences, nurses may learn how to enhance their interpersonal relationships with patients. Subjects for the study were 73 patients who had been admitted to a university teaching hospital for at least three days and agreed to be interviewed by the investigator. The interactions were studied nonverbal expressions of warmth during nursing rounds and administration of oral medication. The interview schedule was especially designed by the investigator to measure the nurse's posture, the distance between the nurse and the patient, the nurse's eye contact, facial expression, hand motion and head nodding. Data analysis included frequencies, percentages and X2-test. The results of this study may be summerized as follows: 1. Patient's preferences for nurse's nonverbal expressions of warmth during nursing rounds. Preferred nurse's posture was sitting (50.7%) or standing (49.3%) opposite the patient. Preferred distance between the nurse and the patient was close to the bed (93.2%), less than 1m. Preferred eye contact was directed to the patient's eyes or their affected part (41.1%). Preferred facial expression was a smile (97.3%). Preferred hand motions were light gestures (41.1%). Patients preferred head nodding which approved their own opinions (69.9%). 2. Patient's preferences for nurse's nonverbal expressions of warmth during administration of oral medication. Preferred nurse's posture was standing and waiting to confirm that the medication had been taken (58.9%). Preferred distance from the patient was

  14. Microwave-based medical diagnosis using particle swarm optimization algorithm

    NASA Astrophysics Data System (ADS)

    Modiri, Arezoo

    This dissertation proposes and investigates a novel architecture intended for microwave-based medical diagnosis (MBMD). Furthermore, this investigation proposes novel modifications of particle swarm optimization algorithm for achieving enhanced convergence performance. MBMD has been investigated through a variety of innovative techniques in the literature since the 1990's and has shown significant promise in early detection of some specific health threats. In comparison to the X-ray- and gamma-ray-based diagnostic tools, MBMD does not expose patients to ionizing radiation; and due to the maturity of microwave technology, it lends itself to miniaturization of the supporting systems. This modality has been shown to be effective in detecting breast malignancy, and hence, this study focuses on the same modality. A novel radiator device and detection technique is proposed and investigated in this dissertation. As expected, hardware design and implementation are of paramount importance in such a study, and a good deal of research, analysis, and evaluation has been done in this regard which will be reported in ensuing chapters of this dissertation. It is noteworthy that an important element of any detection system is the algorithm used for extracting signatures. Herein, the strong intrinsic potential of the swarm-intelligence-based algorithms in solving complicated electromagnetic problems is brought to bear. This task is accomplished through addressing both mathematical and electromagnetic problems. These problems are called benchmark problems throughout this dissertation, since they have known answers. After evaluating the performance of the algorithm for the chosen benchmark problems, the algorithm is applied to MBMD tumor detection problem. The chosen benchmark problems have already been tackled by solution techniques other than particle swarm optimization (PSO) algorithm, the results of which can be found in the literature. However, due to the relatively high level

  15. The roles of hope and optimism on posttraumatic growth in oral cavity cancer patients.

    PubMed

    Ho, Samuel; Rajandram, Rama Krsna; Chan, Natalie; Samman, Nabil; McGrath, Colman; Zwahlen, Roger Arthur

    2011-02-01

    To investigate the association of the positive coping strategies, hope and optimism, on posttraumatic growth (PTG) in oral cavity (OC) cancer patients. A retrospective cross-sectional study was conducted and performed in the outpatient station of the Oral and Maxillofacial Surgery at the University of Hong Kong, Hong Kong SAR, PR China. Fifty patients successfully treated for OC cancer were recruited after their informed consents had been obtained during the review clinic. During their regular follow-up controls in the outpatient clinic, the patients compiled the posttraumatic growth inventory (PTGI) questionnaire, hope scale (HS) and the life orientation scale-revised (LOT-R). Hope and optimism correlated significantly positive with PTG and accounting together for a 25% variance of posttraumatic growth. Hope positively correlated with posttraumatic growth (r=.49, p<.001) as well as optimism (r=.31, p<.05). When compared to unmarried patients, married patients showed high levels of PTG and hope (married participants: mean=53.15, SD=11.04; unmarried participants: mean=41.00, SD=6.36; t (48)=2.403, p<.05). Hope and optimism represent important indicators for PTG in OC cancer patients. An intact dyad relationship seems to be important for hope and consecutive higher levels of PTG when compared to unmarried patients. Supportive psychological treatment strategies related to these two coping factors might be beneficial for OC cancer patients.

  16. Oral surgery in Norwegian general dental practice--a survey. Extent, scope, referrals, emergencies, and medically compromised patients.

    PubMed

    Berge, T I

    1992-02-01

    A questionnaire containing 37 questions concerning oral surgery and oral medicine was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. From the 20 questions included in this paper the following conclusions were drawn: Norwegian general practitioners perform a substantial number and diversity of procedures in the field of oral surgery and oral medicine. The predictor variables sex, age, geographic location, and type of practice (private/public) showed by multiple classification analysis only limited correlation with the amount and diversity of procedures. On average, 12.3 patients were referred per practitioner per year to specialists in oral surgery. The indicated need for orthognathic consultations was 0.75 patient per year per practitioner. Serious emergencies demanding referral seldom occurred. Each month 6.6 medically compromised patients were seen in general practice, among which cardiovascular disorders dominated. PMID:1533083

  17. Curcumin-Loaded Lipid Cubic Liquid Crystalline Nanoparticles: Preparation, Optimization, Physicochemical Properties and Oral Absorption.

    PubMed

    He, Xiuli; Li, Qinghua; Liu, Xiuju; Wu, Guangsheng; Zhai, Guangxi

    2015-08-01

    In order to improve the oral absorption of curcumin, curcumin-loaded lipid cubic liquid crystalline nanoparticles were prepared and evaluated in vitro and in vivo. The hot and high-pressure homogenization method was used to prepare the nanoparticles. The formulation and process were optimized by uniform design with drug loading and entrapment efficiency as index, and physicochemical properties were also investigated. Spherical nanoparticles were observed under transmission electron microscope (TEM), with average particle size of 176.1 nm, zeta potential of -25.19 mV, average drug loading of (1.5 ± 0.2)% and entrapment efficiency of (95 ± 1.8)%. The in vitro release of curcumin from the nanoparticle formulation showed a sustained property, while the pharmacokinetics results after oral administration of curcumin loaded lipid cubic liquid crystalline nanoparticles in rat showed that the oral absorption of curcumin fitted one-compartment model and relative bioavailability was 395.56% when compared to crude curcumin. It can be concluded from these results that the lipid cubic liquid crystalline nanoparticles, as carriers, can markedly improve the oral absorption of curcumin.

  18. Development and optimization of ifosfamide nanostructured lipid carriers for oral delivery using response surface methodology

    NASA Astrophysics Data System (ADS)

    Velmurugan, Ramaiyan; Selvamuthukumar, Subramanian

    2016-02-01

    The research focuses on the development and optimization of ifosfamide nanostructured lipid carriers for oral delivery with the application of response surface methodology. The objectives of the study were to develop a formulation for ifosfamide to be delivered orally, overcome the instability of the drug in acidic environment during oral administration, to sustain the release, drug leakage during storage and low loading capacity. A modified solvent diffusion method in aqueous system was applied to prepare nanostructured lipid nanoparticles. Hydrophilic polymers such as chitosan and sodium alginate were used as coating materials. Glycerol mono oleate and oleic acid were used as solid and liquid lipid, respectively. Poloxamer is used as stabilizers. The central composite rotatable design consisting of three-factored factorial design with three levels was used in this study. The physiochemical characterization included evaluation of surface morphology, particle size and surface charge of the drug in the delivery system. The in vitro drug release, entrapment and drug loading efficiency and as well as the storage stability were evaluated. The results showed that the optimal formulation was composed of drug/lipid ratio of 1:3, organic/aqueous phase ratio of 1:10 and concentration of surfactant of 1 % w/v. Ifosfamide nanostructured lipid carrier under the optimized conditions gave rise to the entrapment efficiency of 77 %, drug loading of 6.14 %, mean diameter of 223 nm and zeta potential value of -25 mV. Transmission electron microscopy analysis showed spherical particles. The in vitro experiment proved that ifosfamide from the delivery system released gradually over the period of 72 h. Sodium alginate cross-linked chitosan nanostructured lipid carrier demonstrated enhanced stability of ifosfamide, high entrapment efficiency and sustained release.

  19. Respiratory syncytial virus fusion inhibitors. Part 4: optimization for oral bioavailability.

    PubMed

    Yu, Kuo-Long; Sin, Ny; Civiello, Rita L; Wang, X Alan; Combrink, Keith D; Gulgeze, H Belgin; Venables, Brian L; Wright, J J Kim; Dalterio, Richard A; Zadjura, Lisa; Marino, Anthony; Dando, Sandra; D'Arienzo, Celia; Kadow, Kathleen F; Cianci, Christopher W; Li, Zhufang; Clarke, Junius; Genovesi, Eugene V; Medina, Ivette; Lamb, Lucinda; Colonno, Richard J; Yang, Zheng; Krystal, Mark; Meanwell, Nicholas A

    2007-02-15

    A series of benzimidazole-based inhibitors of respiratory syncytial virus (RSV) fusion were optimized for antiviral potency, membrane permeability and metabolic stability in human liver microsomes. 1-Cyclopropyl-1,3-dihydro-3-[[1-(4-hydroxybutyl)-1H-benzimidazol-2-yl]methyl]-2H-imidazo[4,5-c]pyridin-2-one (6m, BMS-433771) was identified as a potent RSV inhibitor demonstrating good bioavailability in the mouse, rat, dog and cynomolgus monkey that demonstrated antiviral activity in the BALB/c and cotton rat models of infection following oral administration.

  20. The Integrated Medical Model - Optimizing In-flight Space Medical Systems to Reduce Crew Health Risk and Mission Impacts

    NASA Technical Reports Server (NTRS)

    Kerstman, Eric; Walton, Marlei; Minard, Charles; Saile, Lynn; Myers, Jerry; Butler, Doug; Lyengar, Sriram; Fitts, Mary; Johnson-Throop, Kathy

    2009-01-01

    The Integrated Medical Model (IMM) is a decision support tool used by medical system planners and designers as they prepare for exploration planning activities of the Constellation program (CxP). IMM provides an evidence-based approach to help optimize the allocation of in-flight medical resources for a specified level of risk within spacecraft operational constraints. Eighty medical conditions and associated resources are represented in IMM. Nine conditions are due to Space Adaptation Syndrome. The IMM helps answer fundamental medical mission planning questions such as What medical conditions can be expected? What type and quantity of medical resources are most likely to be used?", and "What is the probability of crew death or evacuation due to medical events?" For a specified mission and crew profile, the IMM effectively characterizes the sequence of events that could potentially occur should a medical condition happen. The mathematical relationships among mission and crew attributes, medical conditions and incidence data, in-flight medical resources, potential clinical and crew health end states are established to generate end state probabilities. A Monte Carlo computational method is used to determine the probable outcomes and requires up to 25,000 mission trials to reach convergence. For each mission trial, the pharmaceuticals and supplies required to diagnose and treat prevalent medical conditions are tracked and decremented. The uncertainty of patient response to treatment is bounded via a best-case, worst-case, untreated case algorithm. A Crew Health Index (CHI) metric, developed to account for functional impairment due to a medical condition, provides a quantified measure of risk and enables risk comparisons across mission scenarios. The use of historical in-flight medical data, terrestrial surrogate data as appropriate, and space medicine subject matter expertise has enabled the development of a probabilistic, stochastic decision support tool capable of

  1. [Ways to optimize working conditions of medical personnel servicing modern hi-tech medical equipment].

    PubMed

    Kravchenko, O K

    2007-01-01

    The author analyzed health state of medical personnel through various parameters. Hygienic characteristics of work conditions for medical personnel subjected to physical factors when servicing modern hi-tech medical equipment are presented. Occupational groups at high risk are defined. The article covers main directions in improving work conditions and preserving health for medical personnel in these groups.

  2. Osmolality, pH, and compatibility of selected oral liquid medications with an enteral nutrition product.

    PubMed

    Klang, Mark; McLymont, Veronica; Ng, Nicole

    2013-09-01

    When selecting medication for feeding tube administration, the liquid formulation is selected, so as to avoid obstructions that may occur from incompletely crushing a solid dosage form. Liquid medications can present issues of intolerance and compatibility when administered via a feeding tube. A predictor of intolerance is the liquid's osmolarity, and a predicator of compatibility is the liquid's pH value. This study examines 62 liquid formulations for their osmolality, pH, and physical compatibility with enteral nutrition (EN) formulas. These medications were selected as being the most commonly dispensed liquid medications from our outpatient pharmacy department. This study measures osmolality using freezing point depression. Depending on the dose, the osmotic load of a liquid medication may cause cramping and diarrhea. The pH value is predictive of potential interactions with the EN formula. Many drugs are weak bases and require acidic vehicles for optimal stability. The acidic liquids are especially reactive with enteral formulas that contain intact proteins. The result of this interaction can result in an occlusion of the feeding tube as the proteins form a gel-like clog. This study combined the liquid medication directly with the EN formula to determine the potential for feeding tube occlusion. Some drugs formed a solid mass in the test tube immediately, whereas others only presented granules, which may later contribute to obstructing the feeding tube. The prescriber should be aware of the potential impact of their choice in formulation, both in terms of the gastrointestinal tolerance and potential for interaction with coadministered nutrition. PMID:23329786

  3. Comparison of Dental Caries Experience in Children Suffering From Epilepsy with and without Administration of Long Term Liquid Oral Medication

    PubMed Central

    Bhadravathi, Manjunath Chaluvaiah; Kumar, Adarsh; Narang, Ridhi; Gupta, Ambika; Singh, Harneet

    2016-01-01

    Introduction Sucrose is added as sweetening agent in liquid oral medication (LOM) to mask the acrid taste of medicines which may be potentially cariogenic. Many children under long term LOM therapy for treatment of epilepsy may be susceptible to dental caries. Aim To assess and compare dental caries experience in children under long term liquid oral medication with those not under such medication among 2-12 years old children suffering from epilepsy. Materials and Methods A cross-sectional study was undertaken on a total of 84 children aged 2–12 years, who were suffering from epilepsy receiving liquid oral medication for more than 3 months were selected (study group) and for comparison 106 children of similar age group and disease but on other forms of medication were included as control group. Dental caries was assessed using DMFT/DMFS (Decayed, Missing, Fillled Teeth / Surfaces), dmft/dft and dmfs/dfs indices. One-way ANOVA and t-test were used with p-value fixed at 0.05. Univariate logistic regression was applied. Results Children on LOM were at increased risk of dental caries than those with other forms of medications (OR: 2.55, 95% CI (2.37-4.15) p=0.000, HS). Caries prevalence was high in the study group (76.1%) when compared to control group (55.6%). Conclusion Long term use of liquid medicines containing sucrose is a risk factor for dental caries among children with epilepsy. PMID:27504416

  4. Formulation and optimization of raloxifene-loaded solid lipid nanoparticles to enhance oral bioavailability.

    PubMed

    Tran, Tuan Hiep; Ramasamy, Thiruganesh; Cho, Hyuk Jun; Kim, Yong Il; Poudel, Bijay Kumar; Choi, Han-Gon; Yong, Chul Soon; Kim, Jong Oh

    2014-07-01

    The main aim of this study was to improve the oral bioavailability of raloxifene (RXF), a selective estrogen receptor modulator, by incorporation into solid lipid nanoparticles (SLN). RXF-loaded SLN was prepared by homogenization-sonication technique and characterized through physicochemical, pharmacokinetic, and cytotoxicity studies. The optimized SLN formulation exhibited a spherical shape with average size around 140 nm, easing its transport across the lymphatic system. Augmentation in the profiles of C(max) (308%) and AUC (270%) indicated a significant enhancement in the rate and extent of bioavailability by SLN formulations compared to free drug. In vitro cytotoxicity study performed in NIH-3T3 cells revealed that RXF-SLN was cytocompatible, and SLN remained unchanged during the freeze-drying process. Furthermore, the optimized formulation was quite stable at room temperature for more than two months, exemplifying its superior performance. In conclusion, SLN provides a promising platform for the pronounced enhancement of RXF bioavailability. PMID:24757949

  5. Nonadherence of Oral Antihyperglycemic Medication Will Increase Risk of End-Stage Renal Disease

    PubMed Central

    Chang, Po-Ya; Chien, Li-Nien; Lin, Yuh-Feng; Chiou, Hung-Yi; Chiu, Wen-Ta

    2015-01-01

    Abstract Poor glycemic control is related to an increased risk of end-stage renal disease (ESRD). This study investigated the association between medication adherence and the risk of ESRD in patients with newly diagnosed diabetes mellitus. In this population-based cohort study, we used the Taiwan National Health Insurance Research Database (NHIRD) to identify 559,864 patients with newly diagnosed or treated diabetes mellitus who were ages from 20 to 85 years between 2001 and 2008. We identified 1695 patients with ESRD during the study period. The mean follow-up time of the patients with ESRD was 5.7 years. Time-dependent Cox proportional hazards regression was performed to estimate the hazard ratios for ESRD among the patients with newly diagnosed diabetes mellitus. After adjustment for various covariates, nonadherence to oral antihyperglycemic medication (OAM) was associated with a higher risk of ESRD compared with adherence to OAM (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.01–1.23). The effects of nonadherence to OAM on the risk of ESRD were significant for patients without hypertension, without gout, without chronic kidney disease, undergoing OAM polytherapy, and undergoing metformin polytherapy (HR [95% CIs], 1.18 [1.00–1.39], 1.13 [1.02–1.26], 1.17 [1.03–1.33], 1.22 [1.08–1.38], and 1.13 [1.02–1.25], respectively). In conclusion, nonadherence to OAM therapy is associated with ESRD. Adherence to medication therapy can prevent the progressive loss of renal function and ESRD for patients with diabetes. PMID:26632708

  6. Population Pharmacokinetics and Dose Optimization of Mycophenolic Acid in HCT Recipients Receiving Oral Mycophenolate Mofetil

    PubMed Central

    Li, H; Mager, D E; Sandmaier, B M; Maloney, D G; Bemer, M J; McCune, J S

    2012-01-01

    We sought to create a population pharmacokinetic model for total mycophenolic acid (MPA), to study the effects of different covariates on MPA pharmacokinetics, to create a limited sampling schedule (LSS) to characterize MPA exposure (i.e., area under the curve or AUC) with maximum a posteriori Bayesian estimation, and to simulate an optimized dosing scheme for allogeneic hematopoietic cell transplantation (HCT) recipients. 4,496 MPA concentration-time points from 408 HCT recipients were analyzed retrospectively using a nonlinear mixed effects modeling approach. MPA pharmacokinetics was characterized with a two-compartment model with first-order elimination and a time-lagged first-order absorption process. Concomitant cyclosporine and serum albumin were significant covariates. The median MPA clearance and volume of the central compartment were 24.2 L/hr and 36.4 L, respectively, for a 70 kg patient receiving tacrolimus with a serum albumin of 3.4 g/dL. Dosing simulations indicated that higher oral MMF doses are needed with concomitant cyclosporine, which increases MPA clearance by 33.8%. The optimal LSS was immediately before and at 0.25, 1.25, 2, and 4hr after oral MMF administration. MPA AUC in an individual HCT recipient can be accurately estimated using a five-sample LSS and maximum a posteriori Bayesian estimation. PMID:23382105

  7. Population pharmacokinetics and dose optimization of mycophenolic acid in HCT recipients receiving oral mycophenolate mofetil.

    PubMed

    Li, H; Mager, D E; Sandmaier, B M; Maloney, D G; Bemer, M J; McCune, J S

    2013-04-01

    We sought to create a population pharmacokinetic model for total mycophenolic acid (MPA), to study the effects of different covariates on MPA pharmacokinetics, to create a limited sampling schedule (LSS) to characterize MPA exposure (i.e., area under the curve or AUC) with maximum a posteriori Bayesian estimation, and to simulate an optimized dosing scheme for allogeneic hematopoietic cell transplantation (HCT) recipients. Four thousand four hundred ninety-six MPA concentration-time points from 408 HCT recipients were analyzed retrospectively using a nonlinear mixed effects modeling approach. MPA pharmacokinetics was characterized with a two-compartment model with first-order elimination and a time-lagged first-order absorption process. Concomitant cyclosporine and serum albumin were significant covariates. The median MPA clearance (CL) and volume of the central compartment were 24.2 L/hour and 36.4 L, respectively, for a 70 kg patient receiving tacrolimus with a serum albumin of 3.4 g/dL. Dosing simulations indicated that higher oral MMF doses are needed with concomitant cyclosporine, which increases MPA CL by 33.8%. The optimal LSS was immediately before and at 0.25 hours, 1.25 hours, 2 hours, and 4 hours after oral mycophenolate mofetil administration. MPA AUC in an individual HCT recipient can be accurately estimated using a five-sample LSS and maximum a posteriori Bayesian estimation.

  8. Population pharmacokinetics and dose optimization of mycophenolic acid in HCT recipients receiving oral mycophenolate mofetil.

    PubMed

    Li, H; Mager, D E; Sandmaier, B M; Maloney, D G; Bemer, M J; McCune, J S

    2013-04-01

    We sought to create a population pharmacokinetic model for total mycophenolic acid (MPA), to study the effects of different covariates on MPA pharmacokinetics, to create a limited sampling schedule (LSS) to characterize MPA exposure (i.e., area under the curve or AUC) with maximum a posteriori Bayesian estimation, and to simulate an optimized dosing scheme for allogeneic hematopoietic cell transplantation (HCT) recipients. Four thousand four hundred ninety-six MPA concentration-time points from 408 HCT recipients were analyzed retrospectively using a nonlinear mixed effects modeling approach. MPA pharmacokinetics was characterized with a two-compartment model with first-order elimination and a time-lagged first-order absorption process. Concomitant cyclosporine and serum albumin were significant covariates. The median MPA clearance (CL) and volume of the central compartment were 24.2 L/hour and 36.4 L, respectively, for a 70 kg patient receiving tacrolimus with a serum albumin of 3.4 g/dL. Dosing simulations indicated that higher oral MMF doses are needed with concomitant cyclosporine, which increases MPA CL by 33.8%. The optimal LSS was immediately before and at 0.25 hours, 1.25 hours, 2 hours, and 4 hours after oral mycophenolate mofetil administration. MPA AUC in an individual HCT recipient can be accurately estimated using a five-sample LSS and maximum a posteriori Bayesian estimation. PMID:23382105

  9. Optimal Oral Antithrombotic Regimes for Patients with Acute Coronary Syndrome: A Network Meta-Analysis

    PubMed Central

    Ye, Yicong; Xie, Hongzhi; Zeng, Yong; Zhao, Xiliang; Tian, Zhuang; Zhang, Shuyang

    2014-01-01

    Objective We performed a network meta-analysis to investigate the optimal antithrombotic regime by indirectly comparing new antithrombotic regimes (new P2Y12 inhibitors plus aspirin or novel oral anticoagulants on top of traditional dual antiplatelet therapy [DAPT]) in patients with acute coronary syndrome (ACS). Methods A systematic search of MEDLINE, EMBASE, and the Cochrane databases was performed to identify all phase 3 randomized controlled trials (RCTs) involving novel oral anticoagulants or oral P2Y12 inhibitors in patients with ACS. Major adverse cardiac events (MACE) were regarded as the efficacy endpoint, and thrombolysis in myocardial infarction (TIMI) major bleeding events were used as the safety endpoint. The net clinical benefit was calculated as the sum of MACE and TIMI major bleeding events. Results Five phase 3 RCTs with 64,476 ACS patients were included. Although there were no significant differences among new antithrombotic regimes, rivaroxaban 5 mg twice daily plus traditional DAPT might be the most effective in reducing the incidence of MACE, accompanying the highest risk of TIMI major bleeding. Ticagrelor plus aspirin presented slight advantage on the net clinical benefit over other new antithrombotic regimes, with the highest probability of being the best regimes for net clinical benefit (35.0%), followed by prasugrel plus aspirin (28.0%), and rivaroxaban 2.5 mg twice daily plus traditional DAPT (19.5%). Conclusion Novel antithrombotic regime with ticagrelor plus aspirin brings a larger clinical benefit in comparison with other regimes, suggesting that it may be the optimal antithrombotic regime for patients with ACS. PMID:24614630

  10. Evaluating and optimizing oral formulations of live bacterial vaccines using a gastro-small intestine model.

    PubMed

    de Barros, João M S; Costabile, Adele; Charalampopoulos, Dimitrios; Khutoryanskiy, Vitaliy V; Edwards, Alexander D

    2016-05-01

    Gastrointestinal (GI) models that mimic physiological conditions in vitro are important tools for developing and optimizing biopharmaceutical formulations. Oral administration of live attenuated bacterial vaccines (LBV) can safely and effectively promote mucosal immunity but new formulations are required that provide controlled release of optimal numbers of viable bacterial cells, which must survive gastrointestinal transit overcoming various antimicrobial barriers. Here, we use a gastro-small intestine gut model of human GI conditions to study the survival and release kinetics of two oral LBV formulations: the licensed typhoid fever vaccine Vivotif comprising enteric coated capsules; and an experimental formulation of the model vaccine Salmonella Typhimurium SL3261 dried directly onto cast enteric polymer films and laminated to form a polymer film laminate (PFL). Neither formulation released significant numbers of viable cells when tested in the complete gastro-small intestine model. The poor performance in delivering viable cells could be attributed to a combination of acid and bile toxicity plus incomplete release of cells for Vivotif capsules, and to bile toxicity alone for PFL. To achieve effective protection from intestinal bile in addition to effective acid resistance, bile adsorbent resins were incorporated into the PFL to produce a new formulation, termed BR-PFL. Efficient and complete release of 4.4×10(7) live cells per dose was achieved from BR-PFL at distal intestinal pH, with release kinetics controlled by the composition of the enteric polymer film, and no loss in viability observed in any stage of the GI model. Use of this in vitro GI model thereby allowed rational design of an oral LBV formulation to maximize viable cell release. PMID:26969261

  11. Value of Pharmacist Medication Interviews on Optimizing the Electronic Medication Reconciliation Process

    PubMed Central

    Varma, Arjun; Boro, Maureen; Korman, Nancy

    2014-01-01

    Purpose: Few studies have explored the impact of using different methods for obtaining accurate medication histories on medication safety. This study was conducted to compare the accuracy and clinical impact of pharmacist medication histories obtained by electronic medical record review (EMRR) alone with those obtained by direct interviews combined with EMRR. Method: This 18-week prospective study included patients who were admitted to the Inpatient Medicine Service at the study institution and who had a pharmacist-conducted medication reconciliation EMRR within 48 hours of hospital admission. A chart review was performed to collect data to determine whether differences existed in the number of discrepancies, recommendations, and medication errors between the EMRR alone group compared to the EMRR combined with the patient interview group. Results: Five hundred thirteen discrepancies were identified with the EMRR group compared to 986 from the combined EMRR and patient interview group (P < .001). Significantly more recommendations were made in the combination interview group compared to the EMRR alone group (260 vs 97; P < .001). Fewer medication errors were identified for the EMRR alone group compared to the combination interview group (55 vs 134; P < .001). The most common errors were omitted medications followed by extra dose/failure to discontinue therapy and wrong dose/frequency errors. Conclusion: Pharmacist-conducted admission medication interviews combined with EMRR can potentially identify harmful medication discrepancies and prevent medication errors. PMID:24958970

  12. The Association Between Patient-Reported and Objective Oral Anticancer Medication Adherence Measures: A Systematic Review

    PubMed Central

    Atkinson, Thomas M.; Rodríguez, Vivian M.; Gordon, Mallorie; Avildsen, Isabelle K.; Emanu, Jessica C.; Jewell, Sarah T.; Anselmi, Kimberly A.; Ginex, Pamela K.

    2016-01-01

    Problem Identification Oral anticancer medication (OAM) use has been steadily increasing, leading to several patient benefits. A notable challenge for nurses is accurate monitoring of patient OAM regimens because nonadherence is associated with poor health outcomes and decreased survival. Currently, no gold standard measure of OAM adherence exists. The authors conducted a systematic review of the association between objective and patient-reported measures of OAM adherence. Literature Search A systematic electronic literature search was conducted using PubMed, EMBASE, Scopus, PsycINFO®, Cochrane Library, Web of Science, and CINAHL® databases through November 2014. Data Evaluation Articles were independently reviewed to determine whether they included an original characterization of the level of association between objective and patient-reported measures of OAM adherence. Synthesis From a total of 11,135 articles retrieved, eight studies met inclusion criteria. Objective adherence was primarily assessed using pill counts or Medication Event Monitoring System (MEMSCap™). Patient-reported adherence was most commonly assessed using study-specific questionnaires. Significant positive correlations were observed between objective and patient-reported adherence across most studies, with three studies reporting higher rates of adherence via patient reporting. Conclusions Despite variation in the OAMs and measures used, patient-reported adherence rates were equal to or higher than objective adherence measures across studies. Social desirability bias may be a concern; however, given the significant concordance observed, using patient-reported methods in future studies of OAM adherence may be justified. Implications for Nursing This review provides evidence to support nursing use of patient-reported measures to accurately monitor OAM adherence and potentially improve the quality of patient–provider communication. PMID:27541550

  13. Improving the Safety of Oral Chemotherapy at an Academic Medical Center

    PubMed Central

    Casella, Erica; Capozzi, Donna; McGettigan, Suzanne; Gangadhar, Tara C.; Schuchter, Lynn; Myers, Jennifer S.

    2016-01-01

    Purpose: Over the last decade, the use of oral chemotherapy (OC) for the treatment of cancer has dramatically increased. Despite their route of administration, OCs pose many of the same risks as intravenous agents. In this quality improvement project, we sought to examine our current process for the prescription of OC at the Abramson Cancer Center of the University of Pennsylvania and to improve on its safety. Methods: A multidisciplinary team that included oncologists, advanced-practice providers, and pharmacists was formed to analyze the current state of our OC practice. Using Lean Six Sigma quality improvement tools, we identified a lack of pharmacist review of the OC prescription as an area for improvement. To address these deficiencies, we used our electronic medical system to route OC orders placed by treating providers to an oncology-specific outpatient pharmacist at the Abramson Cancer Center for review. Results: Over 7 months, 63 orders for OC were placed for 45 individual patients. Of the 63 orders, all were reviewed by pharmacists, and, as a result, 22 interventions were made (35%). Types of interventions included dosage adjustment (one of 22), identification of an interacting drug (nine of 22), and recommendations for additional drug monitoring (12 of 22). Conclusion: OC poses many of the same risks as intravenous chemotherapy and should be prescribed and reviewed with the same oversight. At our institution, involvement of an oncology-trained pharmacist in the review of OC led to meaningful interventions in one third of the orders. PMID:26733627

  14. Development and optimization of taste-masked orally disintegrating tablets (ODTs) of clindamycin hydrochloride.

    PubMed

    Cantor, Stuart L; Khan, Mansoor A; Gupta, Abhay

    2015-01-01

    The purpose of this research was to develop an orally disintegrating tablet (ODT) dosage form containing taste-masked beads of clindamycin HCl. Several formulation strategies were evaluated and a taste-masked ODT of clindamycin HCl was prepared without the use of a waxy cushioning agent. Clindamycin HCl (ca. 46% w/w) was coated onto microcrystalline cellulose beads (Cellets® 200) followed by the addition of a taste-masking layer of amino methacrylate copolymer, NF (Eudragit EPO® (EPO)) coating suspension. The efficiency of both the drug coating process and the taste-masking polymer coating process, as well as the taste masking ODTs was determined using potency and drug release analysis. Magnesium stearate was found to be advantageous over talc in improving the efficiency of the EPO coating suspension. A response surface methodology using a Box-Behnken design for the tablets revealed compression force and levels of both disintegrant and talc to be the main factors influencing the ODT properties. Blending of talc to the EPO-coated beads was found to be the most critical factor in ensuring that ODTs disintegrate within 30 s. The optimized ODTs formulation also showed negligible (<0.5%) drug release in 1 min using phosphate buffer, pH 6.8 (which is analogous to the residence time and pH in the oral cavity). By carefully adjusting the levels of coating polymers, the amounts of disintegrant and talc, as well as the compression force, robust ODTs can be obtained to improve pediatric and geriatric patient compliance for clindamycin oral dosage forms. PMID:25000481

  15. Evaluation of the optimal oral antihistamine for patients with allergic rhinitis.

    PubMed

    Meltzer, Eli O

    2005-09-01

    Because of its bothersome symptoms, allergic rhinitis (AR) is 1 of the top 10 reasons for patient visits to primary care physicians. This highly prevalent disease also results in loss of productivity, both at work and in school. Oral antihistamines are one of the most frequently prescribed medications for the management of AR and, with several agents available, it is important to discern the specific benefits and detriments of each. To assess the differences in efficacy and safety factors among antihistamines, the Individual therapeutic window of each agent can be used as a comparative reference tool because it defines the dose range over which an antihistamine is efficacious and free of adverse effects. As such, the therapeutic window includes both undesired effects, such as sedation, and desired properties, such as rapid onset of action, long duration of efficacy, broad age range of applicability, and potential to Improve quality of life. Therefore, agents with broad therapeutic windows, based on both efficacy and safety, are expected to be more favorable; this therapeutic window should be understood by the primary care physician when prescribing a medication.

  16. Bioastronautics: optimizing human performance through research and medical innovations.

    PubMed

    Williams, David R

    2002-10-01

    A strategic use of resources is essential to achieving long-duration space travel and understanding the human physiological changes in space, including the roles of food and nutrition in space. To effectively address the challenges of space flight, the Bioastronautics Initiative, undertaken in 2001, expands extramural collaboration and leverages unique capabilities of the scientific community and the federal government, all the while applying this integrated knowledge to Earth-based problems. Integral to the National Aeronautics and Space Administration's missions in space is the reduction of risk of medical complications, particularly during missions of long duration. Cumulative medical experience and research provide the ability to develop evidence-based medicine for prevention, countermeasures, and treatment modalities for space flight. The early approach applied terrestrial clinical judgment to predict medical problems in space. Space medicine has evolved to an evidence-based approach with the use of biomedical data gathered and lessons learned from previous space flight missions to systematically aid in decision making. This approach led, for example, to the determination of preliminary nutritional requirements for space flight, and it aids in the development of nutrition itself as a countermeasure to support nutritional mitigation of adaptation to space.

  17. Bioastronautics: optimizing human performance through research and medical innovations

    NASA Technical Reports Server (NTRS)

    Williams, David R.

    2002-01-01

    A strategic use of resources is essential to achieving long-duration space travel and understanding the human physiological changes in space, including the roles of food and nutrition in space. To effectively address the challenges of space flight, the Bioastronautics Initiative, undertaken in 2001, expands extramural collaboration and leverages unique capabilities of the scientific community and the federal government, all the while applying this integrated knowledge to Earth-based problems. Integral to the National Aeronautics and Space Administration's missions in space is the reduction of risk of medical complications, particularly during missions of long duration. Cumulative medical experience and research provide the ability to develop evidence-based medicine for prevention, countermeasures, and treatment modalities for space flight. The early approach applied terrestrial clinical judgment to predict medical problems in space. Space medicine has evolved to an evidence-based approach with the use of biomedical data gathered and lessons learned from previous space flight missions to systematically aid in decision making. This approach led, for example, to the determination of preliminary nutritional requirements for space flight, and it aids in the development of nutrition itself as a countermeasure to support nutritional mitigation of adaptation to space.

  18. Trends in self-medication for dental conditions among patients attending oral health outreach programs in coastal Karnataka, India

    PubMed Central

    Simon, Arun K.; Rao, Ashwini; Rajesh, Gururaghavendran; Shenoy, Ramya; Pai, Mithun B. H.

    2015-01-01

    Objectives: To determine the prevalence, pattern, and awareness of self-medication practices among patients presenting at oral health outreach programs in coastal Karnataka, India. Materials and Methods: The cross-sectional study, based on an interview conducted in randomly selected 400 study subjects from the patients presenting at these oral health outreach programs. Data were collected regarding demographic information and the interview schedule consisting of 14 questions was administered. Results: Prevalence of self-medication was 30%. Respondents’ gender (χ2 = 5.095, P < 0.05), occupation (χ2 = 10.215, P < 0.05), the time from the last dental visit (χ2 = 8.108, P < 0.05), recommendation of drug(s) to family members or friends (χ2 = 75.565, P < 0.001), and the likelihood of self-medication in the next 6 months (χ2 = 80.999, P < 0.001) were significantly associated with self-medication. Male respondents were less likely to have undertaken self-medication (odds ratio = 0.581 [0.361, 0.933]). The frequently self-medicated drug was analgesics (42.5%) for toothache (69.2%). The regression model explained 39.4% (Nagelkerke R2) of the variance in self-medication practices. Conclusions: Prevalence of self-medication was 30% with demographic influence. Hence, this study highlights the policy implications for drug control by government agencies and stresses on the need for dental health education to discourage irrational drug use. PMID:26600642

  19. Monte Carlo studies for medical imaging detector optimization

    NASA Astrophysics Data System (ADS)

    Fois, G. R.; Cisbani, E.; Garibaldi, F.

    2016-02-01

    This work reports on the Monte Carlo optimization studies of detection systems for Molecular Breast Imaging with radionuclides and Bremsstrahlung Imaging in nuclear medicine. Molecular Breast Imaging requires competing performances of the detectors: high efficiency and high spatial resolutions; in this direction, it has been proposed an innovative device which combines images from two different, and somehow complementary, detectors at the opposite sides of the breast. The dual detector design allows for spot compression and improves significantly the performance of the overall system if all components are well tuned, layout and processing carefully optimized; in this direction the Monte Carlo simulation represents a valuable tools. In recent years, Bremsstrahlung Imaging potentiality in internal radiotherapy (with beta-radiopharmaceuticals) has been clearly emerged; Bremsstrahlung Imaging is currently performed with existing detector generally used for single photon radioisotopes. We are evaluating the possibility to adapt an existing compact gamma camera and optimize by Monte Carlo its performance for Bremsstrahlung imaging with photons emitted by the beta- from 90 Y.

  20. Optimal perioperative medical management of the vascular surgery patient.

    PubMed

    Singh, Saket; Maldonado, Yasdet; Taylor, Mark A

    2014-09-01

    Perioperative medical management of patients undergoing vascular surgery can be challenging because they represent the surgical population at highest risk. β-Blockers should be continued perioperatively in patients already taking them preoperatively. Statins may be used in the perioperative period in patients who are not on statin therapy preoperatively. Institutional guidelines should be used to guide insulin replacement. Recent research suggests that measurement of troponins may provide some risk stratification in clinically stable patients following vascular surgery. Multimodal pain therapy including nonopioid strategies is necessary to improve the efficacy of pain relief and decrease the risk of side effects and complications. PMID:25113724

  1. Design Optimization and In Vitro-In Vivo Evaluation of Orally Dissolving Strips of Clobazam

    PubMed Central

    Bala, Rajni; Khanna, Sushil; Pawar, Pravin

    2014-01-01

    Clobazam orally dissolving strips were prepared by solvent casting method. A full 32 factorial design was applied for optimization using different concentration of film forming polymer and disintegrating agent as independent variable and disintegration time, % cumulative drug release, and tensile strength as dependent variable. In addition the prepared films were also evaluated for surface pH, folding endurance, and content uniformity. The optimized film formulation showing the maximum in vitro drug release, satisfactory in vitro disintegration time, and tensile strength was selected for bioavailability study and compared with a reference marketed product (frisium5 tablets) in rabbits. Formulation (F6) was selected by the Design-expert software which exhibited DT (24 sec), TS (2.85 N/cm2), and in vitro drug release (96.6%). Statistical evaluation revealed no significant difference between the bioavailability parameters of the test film (F6) and the reference product. The mean ratio values (test/reference) of Cmax (95.87%), tmax (71.42%), AUC0−t (98.125%), and AUC0−∞ (99.213%) indicated that the two formulae exhibited comparable plasma level-time profiles. PMID:25328709

  2. Video-based feedback of oral clinical presentations reduces the anxiety of ICU medical students: a multicentre, prospective, randomized study

    PubMed Central

    2014-01-01

    Background Oral presentations of clinical cases by medical students during medical rounds in hospital wards are a source of anxiety and little is known about how this anxiety can be alleviated. The objective of this study was to investigate whether video-based feedback of public oral presentations can reduce anxiety in 4th year medical students. Methods Multicentre randomized study conducted in six intensive care units (ICU) and emergency departments (ED) in France over a 9-month period in 2012. One hundred and forty two 4th year medical students were randomized to two groups: intervention and control. Students in the intervention group were recorded while making an oral presentation of a patient during morning ward rounds, followed by video-based feedback. Students in the control group conducted presented classical oral presentations without being filmed and with no formal feedback. Anxiety levels during a public oral presentation were assessed using the Spielberger State Anxiety Inventory (STAI-S). The primary outcome was the difference in STAI-S scores between groups at the beginning and at the end of a 3-month ICU or ED internship. Results Seventy four students were randomized to the ‘video-based feedback’ group and 68 were randomized to the control group. In both groups, STAI-S scores were significantly lower after 3 months of internship. However, the reduction in STAI-S scores was significantly greater in the “video-based feedback” group than in controls (-9.2 ± 9.3 vs. –4.6 ± 8.2, p = 0.024. Compared to the control group, significantly fewer students with high-level anxiety were observed in the “video-based feedback” group after 3 months of internship (68 vs. 28%, p <0.001). Conclusions Compared to “usual practice”, video-assisted oral feedback reduced anxiety and significantly decreased the proportion of students experiencing severe anxiety. PMID:24885005

  3. Optimize Use of Space Research and Technology for Medical Devices

    NASA Technical Reports Server (NTRS)

    Minnifield, Nona K.

    2012-01-01

    systems, and cutting-edge component technologies to conduct a wide range of scientific observations and measurements. These technologies are also considered for practical applications that benefit society in remarkable ways. At NASA Goddard, the technology transfer initiative promotes matching technologies from Earth and space science needs to targeted industry sectors. This requires clear knowledge of industry needs and priorities and social demands. The process entails matching mature technologies where there are known innovation challenges and good opportunities for matching technology needs. This requires creative thinking and takes commitment of time and resources. Additionally, we also look at applications for known hot industry or societal needs. Doing so has given us occasion to host discussions with representatives from industry, academia, government organizations, and societal special interest groups about the application of NASA Goddard technologies for devices used in medical monitoring and detection tools. As a result, partnerships have been established. Innovation transpired when new products were enabled because of NASA Goddard research and technology programs.

  4. Bee Swarm Optimization for Medical Web Information Foraging.

    PubMed

    Drias, Yassine; Kechid, Samir; Pasi, Gabriella

    2016-02-01

    The present work is related to Web intelligence and more precisely to medical information foraging. We present here a novel approach based on agents technology for information foraging. An architecture is proposed, in which we distinguish two important phases. The first one is a learning process for localizing the most relevant pages that might interest the user. This is performed on a fixed instance of the Web. The second takes into account the openness and the dynamicity of the Web. It consists on an incremental learning starting from the result of the first phase and reshaping the outcomes taking into account the changes that undergoes the Web. The whole system offers a tool to help the user undertaking information foraging. We implemented the system using a group of cooperative reactive agents and more precisely a colony of artificial bees. In order to validate our proposal, experiments were conducted on MedlinePlus, a benchmark dedicated for research in the domain of Health. The results are promising either for those related to Web regularities and for the response time, which is very short and hence complies the real time constraint. PMID:26590978

  5. Bee Swarm Optimization for Medical Web Information Foraging.

    PubMed

    Drias, Yassine; Kechid, Samir; Pasi, Gabriella

    2016-02-01

    The present work is related to Web intelligence and more precisely to medical information foraging. We present here a novel approach based on agents technology for information foraging. An architecture is proposed, in which we distinguish two important phases. The first one is a learning process for localizing the most relevant pages that might interest the user. This is performed on a fixed instance of the Web. The second takes into account the openness and the dynamicity of the Web. It consists on an incremental learning starting from the result of the first phase and reshaping the outcomes taking into account the changes that undergoes the Web. The whole system offers a tool to help the user undertaking information foraging. We implemented the system using a group of cooperative reactive agents and more precisely a colony of artificial bees. In order to validate our proposal, experiments were conducted on MedlinePlus, a benchmark dedicated for research in the domain of Health. The results are promising either for those related to Web regularities and for the response time, which is very short and hence complies the real time constraint.

  6. Integrated Medical Model (IMM) Optimization Version 4.0 Functional Improvements

    NASA Technical Reports Server (NTRS)

    Arellano, John; Young, M.; Boley, L.; Garcia, Y.; Saile, L.; Walton, M.; Kerstman, E.; Reyes, D.; Goodenow, D. A.; Myers, J. G.

    2016-01-01

    The IMMs ability to assess mission outcome risk levels relative to available resources provides a unique capability to provide guidance on optimal operational medical kit and vehicle resources. Post-processing optimization allows IMM to optimize essential resources to improve a specific model outcome such as maximization of the Crew Health Index (CHI), or minimization of the probability of evacuation (EVAC) or the loss of crew life (LOCL). Mass and or volume constrain the optimized resource set. The IMMs probabilistic simulation uses input data on one hundred medical conditions to simulate medical events that may occur in spaceflight, the resources required to treat those events, and the resulting impact to the mission based on specific crew and mission characteristics. Because IMM version 4.0 provides for partial treatment for medical events, IMM Optimization 4.0 scores resources at the individual resource unit increment level as opposed to the full condition-specific treatment set level, as done in version 3.0. This allows the inclusion of as many resources as possible in the event that an entire set of resources called out for treatment cannot satisfy the constraints. IMM Optimization version 4.0 adds capabilities that increase efficiency by creating multiple resource sets based on differing constraints and priorities, CHI, EVAC, or LOCL. It also provides sets of resources that improve mission-related IMM v4.0 outputs with improved performance compared to the prior optimization. The new optimization represents much improved fidelity that will improve the utility of the IMM 4.0 for decision support.

  7. Statistical Optimization of Oral Vancomycin-Eudragit RS Nanoparticles Using Response Surface Methodology.

    PubMed

    Delf Loveymi, Badir; Jelvehgari, Mitra; Zakeri-Milani, Parvin; Valizadeh, Hadi

    2012-01-01

    A Box-Behnken design with three replicates was used for preparation and evaluation of Eudragit vancomycin (VCM) nanoparticles prepared by double emulsion. The purpose of this work was to optimize VCM nanoparticles to improve the physicochemical properties. Nanoparticles were formed by using W1/O/W2 double-emulsion solvent evaporation method using Eudragit RS as a retardant material. Full factorial design was employed to study the effect of independent variables, RPM (X1), amount of emulsifier (X2), stirring rate (X3), volume of organic phase (X4) and volume of aqueous phase (X5), on the dependent variables as production yield, encapsulation efficiency and particle size. The optimum condition for VCM nanoparticles preparation was 1:2 drug to polymer ratio, 0.2 (%w/w) amount of emulsifier , 25 mL (volume of organic phase), 25 mL (volume of aqueous phase), 3 min (time of stirring) and 26000 RPM. RPM and emulsifier concentrations were the effective factors on the drug loading (R2 = 90.82). The highest entrapment efficiency was obtained when the ratio of drug to polymer was 1:3. Zeta (ζ) potential of the nanoparticles was fairly positive in molecular level. In vitro release study showed two phases: an initial burst for 0.5 h followed by a very slow release pattern during a period of 24 h. The release of VCM was influenced by the drug to polymer ratio and particle size and was found to be diffusion controlled. The best-fit release kinetic was achieved with Peppas model. In conclusion, the VCM nanoparticle preparations showed optimize formulation, which can be useful for oral administrations.

  8. Precision medical communication to optimize stakeholder information exchange: a '4M-Quadrant' approach.

    PubMed

    Ashkenazy, Rebecca

    2016-07-01

    Personalized and precision medicine concepts have transformed the healthcare delivery environment from research and development to commercialization. Precision medical communication (PMC) represents a strategy to maximize personalized healthcare elements in medical-related exchanges to optimize value from the activity for the associated stakeholders. It is a discipline of developing the right message through the right mechanism at the right moment to the right healthcare member. PMC enhances the value of information exchange among stakeholders because it integrates data, analytics, and environmental and medical insights to efficiently disseminate more precise content to specified audiences in a balanced and compliant manner. PMID:27032622

  9. Precision medical communication to optimize stakeholder information exchange: a '4M-Quadrant' approach.

    PubMed

    Ashkenazy, Rebecca

    2016-07-01

    Personalized and precision medicine concepts have transformed the healthcare delivery environment from research and development to commercialization. Precision medical communication (PMC) represents a strategy to maximize personalized healthcare elements in medical-related exchanges to optimize value from the activity for the associated stakeholders. It is a discipline of developing the right message through the right mechanism at the right moment to the right healthcare member. PMC enhances the value of information exchange among stakeholders because it integrates data, analytics, and environmental and medical insights to efficiently disseminate more precise content to specified audiences in a balanced and compliant manner.

  10. Medical Devices; Ophthalmic Devices; Classification of the Oral Electronic Vision Aid. Final order.

    PubMed

    2015-09-22

    The Food and Drug Administration (FDA) is classifying the oral electronic vision aid into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the oral electronic vision aid's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

  11. Optimal allocation of the limited oral cholera vaccine supply between endemic and epidemic settings

    PubMed Central

    Moore, Sean M.; Lessler, Justin

    2015-01-01

    The World Health Organization (WHO) recently established a global stockpile of oral cholera vaccine (OCV) to be preferentially used in epidemic response (reactive campaigns) with any vaccine remaining after 1 year allocated to endemic settings. Hence, the number of cholera cases or deaths prevented in an endemic setting represents the minimum utility of these doses, and the optimal risk-averse response to any reactive vaccination request (i.e. the minimax strategy) is one that allocates the remaining doses between the requested epidemic response and endemic use in order to ensure that at least this minimum utility is achieved. Using mathematical models, we find that the best minimax strategy is to allocate the majority of doses to reactive campaigns, unless the request came late in the targeted epidemic. As vaccine supplies dwindle, the case for reactive use of the remaining doses grows stronger. Our analysis provides a lower bound for the amount of OCV to keep in reserve when responding to any request. These results provide a strategic context for the fulfilment of requests to the stockpile, and define allocation strategies that minimize the number of OCV doses that are allocated to suboptimal situations. PMID:26423441

  12. Optimal allocation of the limited oral cholera vaccine supply between endemic and epidemic settings.

    PubMed

    Moore, Sean M; Lessler, Justin

    2015-10-01

    The World Health Organization (WHO) recently established a global stockpile of oral cholera vaccine (OCV) to be preferentially used in epidemic response (reactive campaigns) with any vaccine remaining after 1 year allocated to endemic settings. Hence, the number of cholera cases or deaths prevented in an endemic setting represents the minimum utility of these doses, and the optimal risk-averse response to any reactive vaccination request (i.e. the minimax strategy) is one that allocates the remaining doses between the requested epidemic response and endemic use in order to ensure that at least this minimum utility is achieved. Using mathematical models, we find that the best minimax strategy is to allocate the majority of doses to reactive campaigns, unless the request came late in the targeted epidemic. As vaccine supplies dwindle, the case for reactive use of the remaining doses grows stronger. Our analysis provides a lower bound for the amount of OCV to keep in reserve when responding to any request. These results provide a strategic context for the fulfilment of requests to the stockpile, and define allocation strategies that minimize the number of OCV doses that are allocated to suboptimal situations.

  13. Comparing the Effects of Yoga & Oral Calcium Administration in Alleviating Symptoms of Premenstrual Syndrome in Medical Undergraduates

    PubMed Central

    Bharati, Mehta

    2016-01-01

    Introduction: Medical undergraduates are heavily burdened by their curriculum. The females, in addition, suffer from vivid affective or somatic premenstrual syndrome (PMS) symptoms such as bloating, mastalgia, insomnia, fatigue, mood swings, irritability, and depression. The present study was proposed to attenuate the symptoms of PMS by simple lifestyle measures like yoga and/or oral calcium. Methods: 65 medical female students (18-22 years) with a regular menstrual cycle were asked to self-rate their symptoms, along with their severity, in a validated questionnaire for two consecutive menstrual cycles. Fifty-eight students were found to have PMS. Twenty girls were given yoga training (45 minutes daily, five days a week, for three months). Another group of 20 was given oral tablets of calcium carbonate daily (500 mg, for three months) and rest 18 girl served as control group. Data were analyzed by SPSS ver.13 software. Results: The yoga and calcium groups showed a significant decrease in number and severity of premenstrual symptoms whereas in the control group there was not the significant difference. Conclusion: Encouraging a regular practice of yoga or taking a tablet of calcium daily in the medical schools can decrease the symptoms of premenstrual syndrome. PMID:27752483

  14. Optimal evaluation of infectious medical waste disposal companies using the fuzzy analytic hierarchy process

    SciTech Connect

    Ho, Chao Chung

    2011-07-15

    Ever since Taiwan's National Health Insurance implemented the diagnosis-related groups payment system in January 2010, hospital income has declined. Therefore, to meet their medical waste disposal needs, hospitals seek suppliers that provide high-quality services at a low cost. The enactment of the Waste Disposal Act in 1974 had facilitated some improvement in the management of waste disposal. However, since the implementation of the National Health Insurance program, the amount of medical waste from disposable medical products has been increasing. Further, of all the hazardous waste types, the amount of infectious medical waste has increased at the fastest rate. This is because of the increase in the number of items considered as infectious waste by the Environmental Protection Administration. The present study used two important findings from previous studies to determine the critical evaluation criteria for selecting infectious medical waste disposal firms. It employed the fuzzy analytic hierarchy process to set the objective weights of the evaluation criteria and select the optimal infectious medical waste disposal firm through calculation and sorting. The aim was to propose a method of evaluation with which medical and health care institutions could objectively and systematically choose appropriate infectious medical waste disposal firms.

  15. Optimal evaluation of infectious medical waste disposal companies using the fuzzy analytic hierarchy process.

    PubMed

    Ho, Chao Chung

    2011-07-01

    Ever since Taiwan's National Health Insurance implemented the diagnosis-related groups payment system in January 2010, hospital income has declined. Therefore, to meet their medical waste disposal needs, hospitals seek suppliers that provide high-quality services at a low cost. The enactment of the Waste Disposal Act in 1974 had facilitated some improvement in the management of waste disposal. However, since the implementation of the National Health Insurance program, the amount of medical waste from disposable medical products has been increasing. Further, of all the hazardous waste types, the amount of infectious medical waste has increased at the fastest rate. This is because of the increase in the number of items considered as infectious waste by the Environmental Protection Administration. The present study used two important findings from previous studies to determine the critical evaluation criteria for selecting infectious medical waste disposal firms. It employed the fuzzy analytic hierarchy process to set the objective weights of the evaluation criteria and select the optimal infectious medical waste disposal firm through calculation and sorting. The aim was to propose a method of evaluation with which medical and health care institutions could objectively and systematically choose appropriate infectious medical waste disposal firms.

  16. [Assessment of the efficacy of new medical technology (exemplified by instruments used in oral medicine)].

    PubMed

    Izmaĭlov, A Kh; Biktagirov, I A; Al'meev, N G

    1988-01-01

    A conclusion on the necessity of developing methodological materials for estimating the efficacy of new medical technique was made on the basis of comparative analysis of principal propositions of a cost-effective estimation of treatment-and-prophylactic service in health care system, publications on cost effectiveness of new medical technique as well as the examples of calculated efficacy of introduced stomatological tooling.

  17. Optimization of the multi-turn injection efficiency for a medical synchrotron

    NASA Astrophysics Data System (ADS)

    Kim, J.; Yoon, M.; Yim, H.

    2016-09-01

    We present a method for optimizing the multi-turn injection efficiency for a medical synchrotron. We show that for a given injection energy, the injection efficiency can be greatly enhanced by choosing transverse tunes appropriately and by optimizing the injection bump and the number of turns required for beam injection. We verify our study by applying the method to the Korea Heavy Ion Medical Accelerator (KHIMA) synchrotron which is currently being built at the campus of Dongnam Institute of Radiological and Medical Sciences (DIRAMS) in Busan, Korea. First the frequency map analysis was performed with the help of the ELEGANT and the ACCSIM codes. The tunes that yielded good injection efficiency were then selected. With these tunes, the injection bump and the number of turns required for injection were then optimized by tracking a number of particles for up to one thousand turns after injection, beyond which no further beam loss occurred. Results for the optimization of the injection efficiency for proton ions are presented.

  18. Improved particle swarm optimization algorithm for android medical care IOT using modified parameters.

    PubMed

    Sung, Wen-Tsai; Chiang, Yen-Chun

    2012-12-01

    This study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimization (PSO) method is proposed to efficiently enhance physiological multi-sensors data fusion measurement precision in the Internet of Things (IOT) system. Improved PSO (IPSO) includes: inertia weight factor design, shrinkage factor adjustment to allow improved PSO algorithm data fusion performance. The Android platform is employed to build multi-physiological signal processing and timely medical care of things analysis. Wireless sensor network signal transmission and Internet links allow community or family members to have timely medical care network services.

  19. Improved particle swarm optimization algorithm for android medical care IOT using modified parameters.

    PubMed

    Sung, Wen-Tsai; Chiang, Yen-Chun

    2012-12-01

    This study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimization (PSO) method is proposed to efficiently enhance physiological multi-sensors data fusion measurement precision in the Internet of Things (IOT) system. Improved PSO (IPSO) includes: inertia weight factor design, shrinkage factor adjustment to allow improved PSO algorithm data fusion performance. The Android platform is employed to build multi-physiological signal processing and timely medical care of things analysis. Wireless sensor network signal transmission and Internet links allow community or family members to have timely medical care network services. PMID:22492176

  20. Optimization of a Novel Non-invasive Oral Sampling Technique for Zoonotic Pathogen Surveillance in Nonhuman Primates

    PubMed Central

    Smiley Evans, Tierra; Barry, Peter A.; Gilardi, Kirsten V.; Goldstein, Tracey; Deere, Jesse D.; Fike, Joseph; Yee, JoAnn; Ssebide, Benard J; Karmacharya, Dibesh; Cranfield, Michael R.; Wolking, David; Smith, Brett; Mazet, Jonna A. K.; Johnson, Christine K.

    2015-01-01

    Free-ranging nonhuman primates are frequent sources of zoonotic pathogens due to their physiologic similarity and in many tropical regions, close contact with humans. Many high-risk disease transmission interfaces have not been monitored for zoonotic pathogens due to difficulties inherent to invasive sampling of free-ranging wildlife. Non-invasive surveillance of nonhuman primates for pathogens with high potential for spillover into humans is therefore critical for understanding disease ecology of existing zoonotic pathogen burdens and identifying communities where zoonotic diseases are likely to emerge in the future. We developed a non-invasive oral sampling technique using ropes distributed to nonhuman primates to target viruses shed in the oral cavity, which through bite wounds and discarded food, could be transmitted to people. Optimization was performed by testing paired rope and oral swabs from laboratory colony rhesus macaques for rhesus cytomegalovirus (RhCMV) and simian foamy virus (SFV) and implementing the technique with free-ranging terrestrial and arboreal nonhuman primate species in Uganda and Nepal. Both ubiquitous DNA and RNA viruses, RhCMV and SFV, were detected in oral samples collected from ropes distributed to laboratory colony macaques and SFV was detected in free-ranging macaques and olive baboons. Our study describes a technique that can be used for disease surveillance in free-ranging nonhuman primates and, potentially, other wildlife species when invasive sampling techniques may not be feasible. PMID:26046911

  1. Proliposomes containing a bile salt for oral delivery of Ginkgo biloba extract: Formulation optimization, characterization, oral bioavailability and tissue distribution in rats.

    PubMed

    Zheng, Bin; Teng, Lirong; Xing, Gaoyang; Bi, Ye; Yang, Shuang; Hao, Fei; Yan, Guodong; Wang, Xinmei; Lee, Robert J; Teng, Lesheng; Xie, Jing

    2015-09-18

    Proliposomes containing a bile salt were developed to improve the oral bioavailability of Ginkgo biloba extract (GbE). GbE loaded proliposomes (P-GbE) were successfully prepared by spray drying method. The formulation was optimized using the response surface methodology. FE-SEM, DSC, and FT-IR were used to study the surface morphology and molecular state of proliposomes, and demonstrated key interactions between the formulation ingredients. In vitro studies showed delayed release and enhanced dissolution of Ginkgo flavonoids and terpene lactones from GbE proliposomes. Proliposomes significantly enhanced GbE absorption in the gastrointestinal tract and decreased its elimination. The bioavailabilities of quercetin, kaempferol, isorhmnetin, ginkgolide A, ginkgolide B and ginkgolide C from proliposomes relative to the control were 245%, 211%, 264%, 203%, 333%, and 294%, respectively. Proliposomes were shown to selectively deliver GbE to critical target tissues. In conclusion, development of proliposomes formulation for GbE solved the problem of its poor oral bioavailability, prolonged its duration of action, and increased drug distribution in critical tissues, especially in the brain, therefore, warrant further investigation.

  2. A heuristic method for finding the optimal number of clusters with application in medical data.

    PubMed

    Bayati, Hamidreza; Davoudi, Heydar; Fatemizadeh, Emad

    2008-01-01

    In this paper, a heuristic method for determining the optimal number of clusters is proposed. Four clustering algorithms, namely K-means, Growing Neural Gas, Simulated Annealing based technique, and Fuzzy C-means in conjunction with three well known cluster validity indices, namely Davies-Bouldin index, Calinski-Harabasz index, Maulik-Bandyopadhyay index, in addition to the proposed index are used. Our simulations evaluate capability of mentioned indices in some artificial and medical datasets. PMID:19163761

  3. Learning from colleagues about healthcare IT implementation and optimization: lessons from a medical informatics listserv.

    PubMed

    Adams, Martha B; Kaplan, Bonnie; Sobko, Heather J; Kuziemsky, Craig; Ravvaz, Kourosh; Koppel, Ross

    2015-01-01

    Communication among medical informatics communities can suffer from fragmentation across multiple forums, disciplines, and subdisciplines; variation among journals, vocabularies and ontologies; cost and distance. Online communities help overcome these obstacles, but may become onerous when listservs are flooded with cross-postings. Rich and relevant content may be ignored. The American Medical Informatics Association successfully addressed these problems when it created a virtual meeting place by merging the membership of four working groups into a single listserv known as the "Implementation and Optimization Forum." A communication explosion ensued, with thousands of interchanges, hundreds of topics, commentaries from "notables," neophytes, and students--many from different disciplines, countries, traditions. We discuss the listserv's creation, illustrate its benefits, and examine its lessons for others. We use examples from the lively, creative, deep, and occasionally conflicting discussions of user experiences--interchanges about medication reconciliation, open source strategies, nursing, ethics, system integration, and patient photos in the EMR--all enhancing knowledge, collegiality, and collaboration.

  4. [OPTIMIZATION THE LEVEL OF INTENSIVELY IN PHYSICAL EDUCATION FOR PUPILS OF THE SPECIAL MEDICAL CONTINGENT].

    PubMed

    Ivashchenko, S N

    2014-01-01

    This article describes an original technique, designed tooptimize the level of intensity of physical activity used in the course of routine physical edication in classes for pupils of the specialized medical groups. The basis of this technique is the principles evaluate the response of students of special medical group to progressively increasing exercise test with which sets the optimal level of activity for each of the students with the features of the state of his health. The practical application of this method allows you to install exactly the level of exercise used in the course of the lessons of physical education in special medical groups, which improves the health of students with variations in health status, and does not increase the likelihood of any complications of their diseases.

  5. Optimization of isoxazoline amide benzoxaboroles for identification of a development candidate as an oral long acting animal ectoparasiticide.

    PubMed

    Zhang, Yong-Kang; Plattner, Jacob J; Easom, Eric E; Akama, Tsutomu; Zhou, Yasheen; White, W Hunter; Defauw, Jean M; Winkle, Joseph R; Balko, Terry W; Cao, Jianxin; Ge, Zhixin; Yang, Jianzhang

    2016-07-01

    Novel isoxazoline amide benzoxaboroles were designed and synthesized to optimize the ectoparasiticide activity of this chemistry series against ticks and fleas. The study identified an orally bioavailable molecule, (S)-N-((1-hydroxy-3,3-dimethyl-1,3-dihydrobenzo[c][1,2]oxaborol-6-yl)methyl)-2-methyl-4-(5-(3,4,5-trichlorophenyl)-5-(trifluoromethyl)-4,5-dihydroisoxazol-3-yl)benzamide (23), with a favorable pharmacodynamics profile in dogs (Cmax=7.42ng/mL; Tmax=26.0h; terminal half-life t1/2=127h). Compound 23, a development candidate, demonstrated 100% therapeutic effectiveness within 24h of treatment, with residual efficacy of 97% against American dog ticks (Dermacentor variabilis) on day 30 and 98% against cat fleas (Ctenocephalides felis) on day 32 after a single oral dose at 25mg/kg in dogs.

  6. 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

  7. Sexual Function and the Use of Medical Devices or Drugs to Optimize Potency After Prostate Brachytherapy

    SciTech Connect

    Whaley, J. Taylor; Levy, Lawrence B.; Swanson, David A.; Pugh, Thomas J.; Kudchadker, Rajat J.; Bruno, Teresa L.; Frank, Steven J.

    2012-04-01

    Purpose: Prospective evaluation of sexual outcomes after prostate brachytherapy with iodine-125 seeds as monotherapy at a tertiary cancer care center. Methods and Materials: Subjects were 129 men with prostate cancer with I-125 seed implants (prescribed dose, 145 Gy) without supplemental hormonal or external beam radiation therapy. Sexual function, potency, and bother were prospectively assessed at baseline and at 1, 4, 8, and 12 months using validated quality-of-life self-assessment surveys. Postimplant dosimetry values, including dose to 10% of the penile bulb (D10), D20, D33, D50, D75, D90, and penile volume receiving 100% of the prescribed dose (V100) were calculated. Results: At baseline, 56% of patients recorded having optimal erections; at 1 year, 62% of patients with baseline erectile function maintained optimal potency, 58% of whom with medically prescribed sexual aids or drugs. Variables associated with pretreatment-to-posttreatment decline in potency were time after implant (p = 0.04) and age (p = 0.01). Decline in urinary function may have been related to decline in potency. At 1 year, 69% of potent patients younger than 70 years maintained optimal potency, whereas 31% of patients older than 70 maintained optimal potency (p = 0.02). Diabetes was related to a decline in potency (p = 0.05), but neither smoking nor hypertension were. For patients with optimal potency at baseline, mean sexual bother scores had declined significantly at 1 year (p < 0.01). Sexual potency, sexual function, and sexual bother scores failed to correlate with any dosimetric variable tested. Conclusions: Erections firm enough for intercourse can be achieved at 1 year after treatment, but most men will require medical aids to optimize potency. Although younger men were better able to maintain erections firm enough for intercourse than older men, there was no correlation between potency, sexual function, or sexual bother and penile bulb dosimetry.

  8. Medical Castration Using the Investigational Oral GnRH Antagonist TAK-385 (Relugolix): Phase 1 Study in Healthy Males

    PubMed Central

    Shi, Hongliang; Faessel, Hélène M.; Saad, Fred

    2015-01-01

    Context: TAK-385 is a highly selective, oral, nonpeptide GnRH antagonist being investigated as a possible prostate cancer treatment. Objective: The objectives were to evaluate safety, tolerability, pharmacokinetics, and pharmacodynamics of TAK-385 on LH and testosterone. Design, Setting, and Participants: This was a three-part, randomized, double-blind, placebo-controlled, phase 1 dose-escalation study in 176 healthy male UK volunteers. Interventions: Part 1, single doses of TAK-385 (0 [placebo], 80, 120, 180, or 360 mg). Part 2, 14-day TAK-385 (0, 20, 40, 80, or 180 mg) daily. Part 3, 28-day TAK-385 (40 [with loading dose], 60, 80, or 160 mg) or placebo daily. Parts 2 and 3 included men aged 40–75 years. Main Outcome Measures: Main outcome measures included plasma concentrations of TAK-385, LH, and testosterone. Results: Oral TAK-385 was readily absorbed, and steady state was reached in ≤14 days. Food reduced TAK-385 systemic exposure by 47–52%. Mean serum testosterone levels declined ≤6 hours after TAK-385 administration. Loading doses up to 360 mg on day 1 or 360 mg on day 1 followed by 240 mg on day 2 reduced the time to achieve castrate testosterone levels from ≥7 to <3 days. TAK-385 doses ≥80 mg/d achieved sustained medical castration and trough TAK-385 concentrations >4 ng/mL. After discontinuation of TAK-385 on day 28, testosterone levels normalized in most subjects in ≤ 28 days. Common adverse events included bradycardia, headache, and hot flush (all grade ≤2). Conclusions: Oral TAK-385 (40–180 mg/d) was well tolerated and effectively lowered testosterone in healthy men. Planned phase 2 doses in men with hormone-sensitive prostate cancer are 80 and 120 mg/d. PMID:26502357

  9. Impact of oral antipsychotic medication adherence on healthcare resource utilization among schizophrenia patients with Medicare coverage.

    PubMed

    Offord, Steve; Lin, Jay; Wong, Bruce; Mirski, Dario; Baker, Ross A

    2013-12-01

    Nonadherence to antipsychotic medications is widespread and compromises the outcome of patients with schizophrenia. Using the MarketScan Medicare claims database, this study examined the impact of medication adherence on healthcare utilization among Medicare insured schizophrenia patients. The study population was separated into two cohorts defined by medication adherence, one with a medication possession ratio (MPR) ≥0.7 (high adherence) and the other with a MPR <0.7(low adherence). Of the 354 patients identified, 126 (36 %) had high adherence (mean ± SD MPR 0.94 ± 0.09) and 228 (64 %) had low adherence (MPR 0.24 ± 0.19). All cause hospitalizations (0.68 vs. 0.44; p = 0.015) and length of stay (LOS) (7.0 vs. 2.6 days; p = 0.005), and relapse hospitalizations (0.22 vs. 0.11; p = 0.028) and LOS (3.2 vs. 0.7 days; p = 0.027) were greater among patients with low adherence. Low adherent Medicare insured patients with schizophrenia require significantly more inpatient care and represent a patient population in which effective interventions are needed to improve disease management.

  10. "You have no good blood in your body". Oral communication in sixteenth-century physicians' medical practice.

    PubMed

    Stolberg, Michael

    2015-01-01

    In his personal notebooks, the little known Bohemian physician Georg Handsch (1529-c. 1578) recorded, among other things, hundreds of vernacular phrases and expressions he and other physicians used in their oral interaction with patients and families. Based primarily on this extraordinary source, this paper traces the terms, concepts and images to which sixteenth-century physicians resorted when they explained the nature of a patient's disease and justified their treatment. At the bedside and in the consultation room, Handsch and his fellow physicians attributed most diseases to a local accumulation of impure, putrid or otherwise pathological humours. The latter were commonly said to result, in turn, from an insufficient concoction and assimilation of food and drink in the stomach and the liver or from an obstruction of the humoral flow inside the body and across its borders. By contrast, other notions and explanatory models, which had a prominent place in contemporary learned medical writing, hardly played a role at all in the physicians' oral communication. Specific disease terms were rarely used, a mere imbalance of the four natural humours in the body was almost never inculpated, and the patient's personal life-style and other non-naturals did not attract much attention either. These striking differences between the ways in which physicians explained the patients' diseases in their daily practice and the explanatory models we find in contemporary textbooks, are attributed, above all, to the physicians' precarious situation in the early modern medical marketplace. Since dissatisfied patients were quick to turn to another healer, physicians had to explain the disease and justify their treatment in a manner that was comprehensible to ordinary lay people and in line with their expectations and beliefs, which, at the time, revolved almost entirely around notions of impurity and evacuation.

  11. “You Have No Good Blood in Your Body”. Oral Communication in Sixteenth-Century Physicians’ Medical Practice

    PubMed Central

    Stolberg, Michael

    2015-01-01

    In his personal notebooks, the little known Bohemian physician Georg Handsch (1529–c. 1578) recorded, among other things, hundreds of vernacular phrases and expressions he and other physicians used in their oral interaction with patients and families. Based primarily on this extraordinary source, this paper traces the terms, concepts and images to which sixteenth-century physicians resorted when they explained the nature of a patient’s disease and justified their treatment. At the bedside and in the consultation room, Handsch and his fellow physicians attributed most diseases to a local accumulation of impure, putrid or otherwise pathological humours. The latter were commonly said to result, in turn, from an insufficient concoction and assimilation of food and drink in the stomach and the liver or from an obstruction of the humoral flow inside the body and across its borders. By contrast, other notions and explanatory models, which had a prominent place in contemporary learned medical writing, hardly played a role at all in the physicians’ oral communication. Specific disease terms were rarely used, a mere imbalance of the four natural humours in the body was almost never inculpated, and the patient’s personal life-style and other non-naturals did not attract much attention either. These striking differences between the ways in which physicians explained the patients’ diseases in their daily practice and the explanatory models we find in contemporary textbooks, are attributed, above all, to the physicians’ precarious situation in the early modern medical marketplace. Since dissatisfied patients were quick to turn to another healer, physicians had to explain the disease and justify their treatment in a manner that was comprehensible to ordinary lay people and in line with their expectations and beliefs, which, at the time, revolved almost entirely around notions of impurity and evacuation. PMID:25498438

  12. Development of Sub-optimal Airway Protocols for the International Space Station (ISS) by the Medical Operation Support Team (MOST)

    NASA Technical Reports Server (NTRS)

    Polk, James D.; Parazynski, Scott; Kelly, Scott; Hurst, Victor, IV; Doerr, Harold K.

    2007-01-01

    Airway management techniques are necessary to establish and maintain a patent airway while treating a patient undergoing respiratory distress. There are situations where such settings are suboptimal, thus causing the caregiver to adapt to these suboptimal conditions. Such occurrences are no exception aboard the International Space Station (ISS). As a result, the NASA flight surgeon (FS) and NASA astronaut cohorts must be ready to adapt their optimal airway management techniques for suboptimal situations. Based on previous work conducted by the Medical Operation Support Team (MOST) and other investigators, the MOST had members of both the FS and astronaut cohorts evaluate two oral airway insertion techniques for the Intubating Laryngeal Mask Airway (ILMA) to determine whether either technique is sufficient to perform in suboptimal conditions within a microgravity environment. Methods All experiments were conducted in a simulated microgravity environment provided by parabolic flight aboard DC-9 aircraft. Each participant acted as a caregiver and was directed to attempt both suboptimal ILMA insertion techniques following a preflight instruction session on the day of the flight and a demonstration of the technique by an anesthesiologist physician in the simulated microgravity environment aboard the aircraft. Results Fourteen participants conducted 46 trials of the suboptimal ILMA insertion techniques. Overall, 43 of 46 trials (94%) conducted were properly performed based on criteria developed by the MOST and other investigators. Discussion The study demonstrated the use of airway management techniques in suboptimal conditions relating to space flight. Use of these techniques will provide a crew with options for using the ILMA to manage airway issues aboard the ISS. Although it is understood that the optimal method for patient care during space flight is to have both patient and caregiver restrained, these techniques provide a needed backup should conditions not present

  13. Sleep, fatigue, and medical training: setting an agenda for optimal learning and patient care.

    PubMed

    Buysse, Daniel J; Barzansky, Barbara; Dinges, David; Hogan, Eileen; Hunt, Carl E; Owens, Judith; Rosekind, Mark; Rosen, Raymond; Simon, Frank; Veasey, Sigrid; Wiest, Francine

    2003-03-15

    collaboration. By working together to address the problems of sleep and fatigue in its own trainees, the medical field can provide a valuable legacy to patients and to future generations of healthcare providers--a legacy or optimal medical education, healthy doctors, and healthy patients.

  14. The GOCCLES® medical device is effective in detecting oral cancer and dysplasia in dental clinical setting. Results from a multicentre clinical trial.

    PubMed

    Moro, A; De Waure, C; Di Nardo, F; Spadari, F; Mignogna, M D; Giuliani, M; Califano, L; Giannì, A B; Cardarelli, L; Celentano, A; Bombeccari, G; Pelo, S

    2015-12-01

    The purpose of this study is to demonstrate that the GOCCLES® medical device allows proper autofluorescence examination of the oral mucosa in a dental care setting. This is a non-randomised multicentre clinical trial on consecutive patients at risk for oral cancer. Patients underwent a classical naked eye inspection of the oral cavity followed by autofluorescence examination wearing the GOCCLES® spectacles while the light from a dental curing light irradiated the oral mucosa. Lesions were defined as visible potentially malignant lesions and/or fluorescence loss areas. All persisting lesions underwent excisional or incisional biopsy. Sixty-one patients were enrolled. Data from 64 biopsies were analysed. Of the 62 lesions identified by the device, 31 were true positives. The device identified 31 of 32 true positive lesions. One lesion (an invasive carcinoma) was not visible to the naked eye. The device identified all lesions classified as moderate dysplasia to invasive cancer. In 56.7% of cases, true positive lesions showed greater extension when observed through the device. The GOCCLES® medical device allowed the direct visualisation of fluorescence loss in patients suffering from mild to severe dysplasia and in situ to invasive oral cancer. It allowed autofluorescence examination with each source of light used during the study. These results suggest that the role of the autofluorescence visualisation is that of a complementary inspection following naked eye examination when dealing with patients at risk for oral cancer. The device allows detection of otherwise invisible lesions and otherwise impossible complete resections. PMID:26900252

  15. Perceived unmet need for oral treatment among a national population of HIV-positive medical patients: social and clinical correlates.

    PubMed Central

    Marcus, M; Freed, J R; Coulter, I D; Der-Martirosian, C; Cunningham, W; Andersen, R; Garcia, I; Schneider, D A; Maas, W R; Bozzette, S A; Shapiro, M F

    2000-01-01

    OBJECTIVES: This study examines social, behavioral, and clinical correlates of perceived unmet need for oral health care for people with HIV infection. METHODS: Baseline in-person interviews with 2864 individuals were conducted with the HIV Cost and Services Utilization Study cohort, a nationally representative probability sample of HIV-infected persons in medical care. Bivariate and logistic regression analyses were conducted, with unmet need in the last 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. RESULTS: We estimate that 19.3% of HIV-infected medical patients (n = 44,550) had a perceived unmet need for dental care in the last 6 months. The odds of having unmet dental needs were highest for those on Medicaid in states without dental benefits (odds ratio [OR] = 2.21), for others with no dental insurance (OR = 2.26), for those with incomes under $5000 (OR = 2.20), and for those with less than a high school education (OR = 1.83). Low CD4 count was not significant. CONCLUSIONS: Perceived unmet need was related more to social and economic factors than to stage of infection. An expansion of dental benefits for those on Medicaid might reduce unmet need for dental care. PMID:10897183

  16. Impact of Modernising Medical Careers on basic surgical training and experience of oral and maxillofacial higher surgical trainees.

    PubMed

    Dhanda, Jagtar; Opie, Niel; Webster, Keith; Tanday, Ajit; Mumtaz, Shadaab; Visram, Semina

    2011-01-01

    Modernising Medical Careers (MMC) is a programme for change that aims to improve the quality of patients' care through improvement in postgraduate medical education and training. Its introduction had far reaching affects and many shortcoming due to its failure to take into account the craft specialties. The aim of this paper is to illustrate the impact of MMC on oral and maxillofacial surgical (OMFS) training. An online questionnaire was distributed to OMFS trainees, and data were gathered about current position, year of training, duration and specialties worked during basic surgical training, stage of completion of examinations and courses, and overall satisfaction with training. Comparisons were made between those who had been trained before and after MMC was introduced. Ninety-five trainees (68%) responded. Of these 66 (69%) had basic surgical training before the introduction of MMC and 29 (31%) afterwards. MMC shortened overall time spent on basic surgical training of OMFS trainees by half, to only 1 year. There were similarities between the two groups in terms of the range of specialties experienced. MMC also resulted in more trainees starting higher surgical training without their Membership of the Royal College of Surgeons. There was greater satisfaction with BST for the pre-MMC group than the post-MMC group. It is hoped that the recent changes to training that were implemented after this study will address some of the shortcomings that we have identified.

  17. Optimal medication dosing in patients with diabetes mellitus and chronic kidney disease.

    PubMed

    MacCallum, Lori

    2014-10-01

    Diabetes mellitus is the leading cause of chronic kidney disease (CKD) in Canada. As rates of diabetes rise, so does the prevalence of CKD. Diabetes and CKD are chronic diseases that require multiple medications for their management. Many of the anticipated effects of these medications are altered by the physiologic changes that occur in CKD. Failure to individualize drug dosing in this population may lead to toxicity or decreased therapeutic response, leading to treatment failure. At times this can be challenging for a multitude of reasons, including the limitations of available calculations for estimating renal function, inconsistent dosing recommendations and the lack of dosing recommendations for some medications. Clinicians caring for these patients need to consider an approach of individualized drug therapy that will ensure optimal outcomes. The better understanding that clinicians have of these challenges, the more effective they will be at using the available information as a guide together with their own professional judgement to make appropriate dosing changes. This article discusses the following: 1) physiologic changes that occur in CKD and its impact on drug dosing; 2) advantages and disadvantages of various calculations used for estimating renal function; 3) pharmacokinetic and pharmacodynamic changes of some commonly used medications in diabetes, and finally, 4) an approach to individualized drug dosing for this patient population.

  18. One-year adherence to oral antihyperglycemic medication and risk prediction of patient outcomes for adults with diabetes mellitus

    PubMed Central

    Huber, Carola A.; Rapold, Roland; Brüngger, Beat; Reich, Oliver; Rosemann, Thomas

    2016-01-01

    Abstract Medication adherence is essential in preventing adverse intermediate outcomes, but little is known on hard outcomes. The aims of this study were to determine the 1-year adherence to oral antihyperglycemic drugs (OADs) and to predict the risk of subsequent health outcomes among (non)adherent patients with diabetes. Using a large Swiss healthcare claims database from 2011 to 2014, we identified all patients aged ≥18 years with diabetes and treated with at least 1 OAD prescription. Adherence to OADs was measured as the proportion of days covered (PDC) over 1 year and subdivided into 2 categories: adherent (PDC ≥ 80%), nonadherent (PDC < 80%). We estimated the relative risk of hospitalization and mortality at follow-up using multivariate Cox proportional hazard models. Based on a sample of 26,713 patients, adherence to OADs was quite low: 42% of the patients achieved a PDC of ≥80% during the 1-year observation period. A 7% reduction in the hospitalization risk and a 10% reduction in the risk of mortality could be observed in adherent patients compared to nonadherent patients (hazard ratio [HR], 0.93 [95% CI, 0.89–0.97]; HR, 0.90 [95% CI, 0.82–0.99]). Subgroup analysis showed that an intensified diabetes therapy had no significant influence on the risk of both outcomes in adherent patients. Poor medication adherence increases the risk of subsequent hospitalizations and premature mortality in patient with diabetes, regardless of disease severity and comorbidities. This emphasizes the need for an earlier identification of patients with poor medication adherence. The awareness of physicians and patients regarding the importance of adherence in diabetes treatment should be increased. PMID:27368004

  19. [Role of classical oral glucose-lowering medications in current treatment].

    PubMed

    Carramiñana Barrera, F C

    2014-07-01

    Classical oral glucose were discovered in the mid twentieth century. Despite the time elapsed since then and the lack of large studies to support the use of some of these drugs, they continue to be employed, are indicated in all clinical practice guidelines and consensus documents and, overall, remain among the most widely prescribed drugs in the national health system. The main arguments for their continued use are their widespread and prolonged prescription, their effectiveness, and cost. Their main disadvantages have always been and continue to be their adverse gastrointestinal effects, weight gain, the risk of hypoglycemia and other adverse effects, which have encouraged the development of new glucose-lowering drugs with an improved pharmacological profile that would cover the various mechanisms of hyperglycemia. Currently, deep knowledge of glucose-lowering drugs is required in the patient-centered management of diabetes. Furthermore, this knowledge should be adapted to each individual patient to acquire the experience necessary to achieve effective metabolic control, delay the development of chronic complications, and improve the quality of life and life expectancy of patients with diabetes.

  20. Cyclodextrin multicomponent complexation and controlled release delivery strategies to optimize the oral bioavailability of vinpocetine.

    PubMed

    Ribeiro, Laura S S; Falcão, Amílcar C; Patrício, João A B; Ferreira, Domingos C; Veiga, Francisco J B

    2007-08-01

    In the present work, to maintain a suitable blood level of vinpocetine (VP) for a long period of time, VP-cyclodextrin-tartaric acid multicomponent complexes were prepared and formulated in hydroxypropylmethylcellulose matrix tablets. In vitro and in vivo performances of these formulations were investigated over a VP immediate release dosage form. Solubility studies were performed to evaluate the drug pH solubilization profile and to assess the effect of multicomponent complexation on VP solubility. The drug release process was investigated using United States Pharmacopeia apparatus 3 and a comparative oral pharmacokinetic study was subsequently undertaken in rabbits. Solubility studies denoted the pH-solubility dependence of VP and solubility improvement attained by complexation. Dissolution results showed controlled and almost complete release behavior of VP over a 12-h period from complex hydroxypropylmethylcellulose-based formulations. A clear difference between the pharmacokinetic patterns of VP immediate release and VP complex-based formulations was revealed. The area under the plasma concentration-time curve after oral administration of complex-based formulations was 2.1-2.9 times higher than that for VP immediate release formulation. Furthermore, significant differences found for mean residence time, elimination half-life, and elimination rate constant values corroborated prolonged release of VP from complex-based formulations. These results suggest that the oral bioavailability of VP was significantly improved by both multicomponent complexation and controlled release delivery strategies. PMID:17530626

  1. Pharmacokinetic study of enrofloxacin in Nile tilapia (Oreochromis niloticus) after a single oral administration in medicated feed.

    PubMed

    Teles, J A; Castello Branco, L C; Del Bianchi, M; Pilarski, F; Reyes, F G R

    2016-04-01

    The objective of this study was to evaluate the disposition kinetics of enrofloxacin (ENR) in the plasma and its distribution in the muscle tissue of Nile tilapia (Oreochromis niloticus) after a single oral dose of 10 mg/kg body weight via medicated feed. The fish were kept at a temperature between 28 and 30 °C. The collection period was between 30 min and 120 h after administration of the drug. The samples were analyzed by high-performance liquid chromatography with a fluorescence detector (HPLC-FLD). The ENR was slowly absorbed and eliminated from the plasma (Cmax = 1.24 ± 0.37 μg/mL; Tmax = 8 h; T1/2Ke  = 19.36 h). ENR was efficiently distributed in the muscle tissue and reached maximum values (2.17 ± 0.74 μg/g) after 8 h. Its metabolite, ciprofloxacin (CIP), was detected and quantified in the plasma (0.004 ± 0.005 μg/mL) and muscle (0.01 ± 0.011 μg/g) for up to 48 h. After oral administration, the mean concentration of ENR in the plasma was well above the minimum inhibitory concentrations (MIC50 ) for most bacteria already isolated from fish except for Streptococcus spp. This way the dose used in this study allowed for concentrations in the blood to treat the diseases of tilapia. PMID:26270353

  2. Novel self-nanoemulsifying drug delivery systems (SNEDDS) for oral delivery of cinnarizine: design, optimization, and in-vitro assessment.

    PubMed

    Shahba, Ahmad Abdul-Wahhab; Mohsin, Kazi; Alanazi, Fars Kaed

    2012-09-01

    Due to its extreme lipophilicity, the oral delivery of cinnarizine (CN) encounters several problems such as poor aqueous solubility and pH-dependent dissolution, which result in low and erratic bioavailability. The current study aims to design self-nanoemulsifying drug delivery systems (SNEDDS) of CN that circumvent such obstacles. Equilibrium solubility of CN was determined in a range of anhydrous and diluted lipid-based formulations. Dynamic dispersion tests were carried out to investigate the efficiency of drug release and magnitude of precipitation that could occur upon aqueous dilution. Droplet sizes of selected formulations, upon (1:1,000) aqueous dilution, were presented. The optimal formulations were enrolled in subsequent dissolution studies. The results showed that increasing lipid chain length and surfactant lipophilicity raised the formulation solvent capacity, while adding co-solvents provoked a negative influence. The inclusion of mixed glycerides and/or hydrophilic surfactants improved the drug release efficiency. Generally, no significant precipitation was observed upon aqueous dilution of the formulations. Five formulations were optimal in terms of their superior self-emulsifying efficiency, drug solubility, dispersion characteristics, and lower droplet size. Furthermore, the optimal formulations showed superior dissolution profile compared to the marketed (Stugeron®) tablet. Most importantly, they could resist the intensive precipitation observed with the marketed tablet upon shifting from acidic to alkaline media. However, SNEDDS containing medium-chain mixed glycerides showed the highest drug release rate and provide great potential to enhance the oral CN delivery. Accordingly, the lipid portion seems to be the most vital component in designing CN self-nanoemulsifying systems. PMID:22760454

  3. Effect of a dedicated oral care program on periodontal status of medically compromised patients at the Toronto Rehabilitation Institute Dental Clinic.

    PubMed

    Schlosser, Robert; Hebbes, Trudy

    2016-01-01

    Medically compromised patients attending the dental clinic at the Toronto Rehabilitation Institute have considerable gingival inflammation and breath odor. The objective of this study was to evaluate the effect of toothbrushing on the periodontal status of these patients and to determine if there were any additional benefit in combining brushing with an application of an antibiotic rinse. During the first 7 days of the study, the teeth of 11 participants were brushed twice a day by a dental hygienist using a soft-bristle suction toothbrush without toothpaste. Soft interproximal brushes were used to clean interproximal surfaces from the facial aspect. During the second week, facial and interproximal cleaning were repeated in the same patients, but the toothbrush and interproximal brush were dipped in 10-mL of a solution consisting of water and 40 mg/mL of metronidazole with nystatin. Each patient underwent an oral examination and biofilm sampling at baseline, after brushing without toothpaste (week 1), and after brushing with antibiotic solution (week 2). After week 1, tissues improved substantially, and there was a notable change in the biofilm on the teeth. The addition of an antibiotic solution increased healing and resulted in a further decrease in oral biofilm. Medically compromised patients would benefit considerably from a treatment regimen of antibiotic solution to decrease oral infection followed by a daily oral care program of brushing and interdental cleaning to maintain healthy oral tissues. PMID:27367641

  4. Optimizing perioperative outcomes for older patients with rheumatoid arthritis undergoing arthroplasty: emphasis on medication management.

    PubMed

    Goodman, Susan M

    2015-05-01

    Patients with rheumatoid arthritis continue to undergo arthroplasty despite widespread use of potent disease-modifying drugs (DMARDs), including the biologic tumor necrosis-α inhibitors. In fact, over 80 % of RA patients are taking DMARDs or biologics at the time of arthroplasty. While many RA-specific factors including disease activity and disability may contribute to the increase in infection in RA patients undergoing arthroplasty, immunosuppressant medications may also play a role. As the age of patients with RA undergoing arthroplasty is rising, and the incidence of arthroplasty among the older population is increasing, optimal perioperative management of DMARDs and biologics in older patients with RA is an increasing challenge. Although evidence is sparse, most evidence supports withholding tumor necrosis-α inhibitors and other biologics prior to surgery based on the dosing interval, and continuing methotrexate and hydroxychloroquine through the perioperative period. There is no consensus regarding leflunomide, and rituximab risk does not appear related to the interval between infusion and surgery. This paper reviews arthroplasty outcomes including complications in patients with RA, and discusses the rationale for strategies for the optimal medication management of DMARDs and biologics in the perioperative period to minimize complications and improve outcomes.

  5. Adaptive Virtual Reality Training to Optimize Military Medical Skills Acquisition and Retention.

    PubMed

    Siu, Ka-Chun; Best, Bradley J; Kim, Jong Wook; Oleynikov, Dmitry; Ritter, Frank E

    2016-05-01

    The Department of Defense has pursued the integration of virtual reality simulation into medical training and applications to fulfill the need to train 100,000 military health care personnel annually. Medical personnel transitions, both when entering an operational area and returning to the civilian theater, are characterized by the need to rapidly reacquire skills that are essential but have decayed through disuse or infrequent use. Improved efficiency in reacquiring such skills is critical to avoid the likelihood of mistakes that may result in mortality and morbidity. We focus here on a study testing a theory of how the skills required for minimally invasive surgery for military surgeons are learned and retained. Our adaptive virtual reality surgical training system will incorporate an intelligent mechanism for tracking performance that will recognize skill deficiencies and generate an optimal adaptive training schedule. Our design is modeling skill acquisition based on a skill retention theory. The complexity of appropriate training tasks is adjusted according to the level of retention and/or surgical experience. Based on preliminary work, our system will improve the capability to interactively assess the level of skills learning and decay, optimizes skill relearning across levels of surgical experience, and positively impact skill maintenance. Our system could eventually reduce mortality and morbidity by providing trainees with the reexperience they need to help make a transition between operating theaters. This article reports some data that will support adaptive tutoring of minimally invasive surgery and similar surgical skills. PMID:27168575

  6. Improving Oral Bioavailability of Sorafenib by Optimizing the "Spring" and "Parachute" Based on Molecular Interaction Mechanisms.

    PubMed

    Liu, Chengyu; Chen, Zhen; Chen, Yuejie; Lu, Jia; Li, Yuan; Wang, Shujing; Wu, Guoliang; Qian, Feng

    2016-02-01

    Sorafenib is a clinically important oral tyrosine kinase inhibitor for the treatment of various cancers. However, the oral bioavailability of sorafenib tablet (Nexavar) is merely 38-49% relative to the oral solution, due to the low aqueous solubility of sorafenib and its relatively high daily dose. It is desirable to improve the oral bioavailability of sorafenib to expand the therapeutic window, reduce the drug resistance, and enhance patient compliance. In this study, we observed that the solubility of sorafenib could be increased ∼50-fold in the coexistence of poly(vinylpyrrolidone-vinyl acetate) (PVP-VA) and sodium lauryl sulfate (SLS), due to the formation of PVP-VA/SLS complexes at a lower critical aggregation concentration. The enhanced solubility provided a faster initial sorafenib dissolution rate, analogous to a forceful "spring" to release drug into solution, from tablets containing both PVP-VA and SLS. However, SLS appears to impair the ability of PVP-VA to act as an efficient "parachute" to keep the drug in solution and maintain drug supersaturation. Using 2D (1)H NMR, (13)C NMR, and FT-IR analysis, we concluded that the solubility enhancement and supersaturation of sorafenib were achieved by PVP-VA/SLS complexes and PVP-VA/sorafenib interaction, respectively, both through molecular interactions hinged on the PVP-VA VA groups. Therefore, a balance between "spring" and "parachute" must be carefully considered in formulation design. To confirm the in vivo relevance of these molecular interaction mechanisms, we prepared three tablet formulations containing PVP-VA alone, SLS alone, and PVP-VA/SLS in combination. The USP II in vitro dissolution and dog pharmacokinetic in vivo evaluation showed clear differentiation between these three formulations, and also good in vitro-in vivo correlation. The formulation containing PVP-VA alone demonstrated the best bioavailability with 1.85-fold and 1.79-fold increases in Cmax and AUC, respectively, compared with the

  7. Improving Oral Bioavailability of Sorafenib by Optimizing the "Spring" and "Parachute" Based on Molecular Interaction Mechanisms.

    PubMed

    Liu, Chengyu; Chen, Zhen; Chen, Yuejie; Lu, Jia; Li, Yuan; Wang, Shujing; Wu, Guoliang; Qian, Feng

    2016-02-01

    Sorafenib is a clinically important oral tyrosine kinase inhibitor for the treatment of various cancers. However, the oral bioavailability of sorafenib tablet (Nexavar) is merely 38-49% relative to the oral solution, due to the low aqueous solubility of sorafenib and its relatively high daily dose. It is desirable to improve the oral bioavailability of sorafenib to expand the therapeutic window, reduce the drug resistance, and enhance patient compliance. In this study, we observed that the solubility of sorafenib could be increased ∼50-fold in the coexistence of poly(vinylpyrrolidone-vinyl acetate) (PVP-VA) and sodium lauryl sulfate (SLS), due to the formation of PVP-VA/SLS complexes at a lower critical aggregation concentration. The enhanced solubility provided a faster initial sorafenib dissolution rate, analogous to a forceful "spring" to release drug into solution, from tablets containing both PVP-VA and SLS. However, SLS appears to impair the ability of PVP-VA to act as an efficient "parachute" to keep the drug in solution and maintain drug supersaturation. Using 2D (1)H NMR, (13)C NMR, and FT-IR analysis, we concluded that the solubility enhancement and supersaturation of sorafenib were achieved by PVP-VA/SLS complexes and PVP-VA/sorafenib interaction, respectively, both through molecular interactions hinged on the PVP-VA VA groups. Therefore, a balance between "spring" and "parachute" must be carefully considered in formulation design. To confirm the in vivo relevance of these molecular interaction mechanisms, we prepared three tablet formulations containing PVP-VA alone, SLS alone, and PVP-VA/SLS in combination. The USP II in vitro dissolution and dog pharmacokinetic in vivo evaluation showed clear differentiation between these three formulations, and also good in vitro-in vivo correlation. The formulation containing PVP-VA alone demonstrated the best bioavailability with 1.85-fold and 1.79-fold increases in Cmax and AUC, respectively, compared with the

  8. Convex optimization of MRI exposure for mitigation of RF-heating from active medical implants

    NASA Astrophysics Data System (ADS)

    Córcoles, Juan; Zastrow, Earl; Kuster, Niels

    2015-09-01

    Local RF-heating of elongated medical implants during magnetic resonance imaging (MRI) may pose a significant health risk to patients. The actual patient risk depends on various parameters including RF magnetic field strength and frequency, MR coil design, patient’s anatomy, posture, and imaging position, implant location, RF coupling efficiency of the implant, and the bio-physiological responses associated with the induced local heating. We present three constrained convex optimization strategies that incorporate the implant’s RF-heating characteristics, for the reduction of local heating of medical implants during MRI. The study emphasizes the complementary performances of the different formulations. The analysis demonstrates that RF-induced heating of elongated metallic medical implants can be carefully controlled and balanced against MRI quality. A reduction of heating of up to 25 dB can be achieved at the cost of reduced uniformity in the magnitude of the B1+ field of less than 5%. The current formulations incorporate a priori knowledge of clinically-specific parameters, which is assumed to be available. Before these techniques can be applied practically in the broader clinical context, further investigations are needed to determine whether reduced access to a priori knowledge regarding, e.g. the patient’s anatomy, implant routing, RF-transmitter, and RF-implant coupling, can be accepted within reasonable levels of uncertainty.

  9. Convex optimization of MRI exposure for mitigation of RF-heating from active medical implants.

    PubMed

    Córcoles, Juan; Zastrow, Earl; Kuster, Niels

    2015-09-21

    Local RF-heating of elongated medical implants during magnetic resonance imaging (MRI) may pose a significant health risk to patients. The actual patient risk depends on various parameters including RF magnetic field strength and frequency, MR coil design, patient's anatomy, posture, and imaging position, implant location, RF coupling efficiency of the implant, and the bio-physiological responses associated with the induced local heating. We present three constrained convex optimization strategies that incorporate the implant's RF-heating characteristics, for the reduction of local heating of medical implants during MRI. The study emphasizes the complementary performances of the different formulations. The analysis demonstrates that RF-induced heating of elongated metallic medical implants can be carefully controlled and balanced against MRI quality. A reduction of heating of up to 25 dB can be achieved at the cost of reduced uniformity in the magnitude of the B(1)(+) field of less than 5%. The current formulations incorporate a priori knowledge of clinically-specific parameters, which is assumed to be available. Before these techniques can be applied practically in the broader clinical context, further investigations are needed to determine whether reduced access to a priori knowledge regarding, e.g. the patient's anatomy, implant routing, RF-transmitter, and RF-implant coupling, can be accepted within reasonable levels of uncertainty. PMID:26350025

  10. Learning from colleagues about healthcare IT implementation and optimization: lessons from a medical informatics listserv.

    PubMed

    Adams, Martha B; Kaplan, Bonnie; Sobko, Heather J; Kuziemsky, Craig; Ravvaz, Kourosh; Koppel, Ross

    2015-01-01

    Communication among medical informatics communities can suffer from fragmentation across multiple forums, disciplines, and subdisciplines; variation among journals, vocabularies and ontologies; cost and distance. Online communities help overcome these obstacles, but may become onerous when listservs are flooded with cross-postings. Rich and relevant content may be ignored. The American Medical Informatics Association successfully addressed these problems when it created a virtual meeting place by merging the membership of four working groups into a single listserv known as the "Implementation and Optimization Forum." A communication explosion ensued, with thousands of interchanges, hundreds of topics, commentaries from "notables," neophytes, and students--many from different disciplines, countries, traditions. We discuss the listserv's creation, illustrate its benefits, and examine its lessons for others. We use examples from the lively, creative, deep, and occasionally conflicting discussions of user experiences--interchanges about medication reconciliation, open source strategies, nursing, ethics, system integration, and patient photos in the EMR--all enhancing knowledge, collegiality, and collaboration. PMID:25486893

  11. Formulation and statistical optimization of self-microemulsifying drug delivery system of eprosartan mesylate for improvement of oral bioavailability.

    PubMed

    Dangre, Pankaj; Gilhotra, Ritu; Dhole, Shashikant

    2016-10-01

    The present investigation is aimed to design a statistically optimized self-microemulsifying drug delivery system (SMEDDS) of eprosartan mesylate (EM). Preliminary screening was carried out to find a suitable combination of various excipients for the formulation. A 3(2) full factorial design was employed to determine the effect of various independent variables on dependent (response) variables. The independent variables studied in the present work were concentration of oil (X 1) and the ratio of S mix (X 2), whereas the dependent variables were emulsification time (s), globule size (nm), polydispersity index (pdi), and zeta potential (mV), and the multiple linear regression analysis (MLRA) was employed to understand the influence of independent variables on dependent variables. Furthermore, a numerical optimization technique using the desirability function was used to develop a new optimized formulation with desired values of dependent variables. The optimized SMEDDS formulation of eprosartan mesylate (EMF-O) by the above method exhibited emulsification time, 118.45 ± 1.64 s; globule size, 196.81 ± 1.29 nm; zeta potential, -9.34 ± 1.2 mV, and polydispersity index, 0.354 ± 0.02. For the in vitro dissolution study, the optimized formulation (EMF-O) and pure drug were separately entrapped in the dialysis bag, and the study indicated higher release of the drug from EMF-O. In vivo pharmacokinetic studies in Wistar rats using PK solver software revealed 2.1-fold increment in oral bioavailability of EM from EMF-O, when compared with plain suspension of pure drug. PMID:27465619

  12. Oral health, taste, and olfaction.

    PubMed

    Ritchie, Christine S

    2002-11-01

    Oral health, taste, and smell are critical components to an older person's overall sense of well-being and quality of life. Oral health problems can cause pain and discomfort and can hinder the maintenance of a satisfying and nutritious diet. Loss of taste and smell interferes with pleasure derived from food and food-related activities. Attention should be given to preserving teeth and optimizing oral function. Likewise, close evaluation of older adults' medications may identify the causes of taste and smell disorders. In instances in which nutrient intake is inadequate and chemosensory perception is considered a likely contributor, a trial of flavor enhancers or monosodium glutamate may improve both quality and quantity of intake. Much more information is needed to understand the interrelationship between chemosensory perception, food intake regulatory mechanisms, and nutritional status. Multidisciplinary studies will be required to understand how to improve nutrition through manipulation of oral characteristics, taste, and smell.

  13. RP-HPLC analytical method development and optimization for quantification of donepezil hydrochloride in orally disintegrating tablet.

    PubMed

    Liew, Kai Bin; Peh, Kok Khiang; Fung Tan, Yvonne Tze

    2013-09-01

    An easy, fast and validated RV-HPLC method was invented to quantify donepezil hydrochloride in drug solution and orally disintegrating tablet. The separation was carried out using reversed phase C-18 column (Agilent Eclipse Plus C-18) with UV detection at 268 nm. Method optimization was tested using various composition of organic solvent. The mobile phase comprised of phosphate buffer (0.01M), methanol and acetonitrile (50:30:20, v/v) adjusted to pH 2.7 with phosphoric acid (80%) was found as the optimum mobile phase. The method showed intraday precision and accuracy in the range of 0.24% to -1.83% and -1.83% to 1.99% respectively, while interday precision and accuracy ranged between 1.41% to 1.81% and 0.11% to 1.90% respectively. The standard calibration curve was linear from 0.125 μg/mL to 16 μg/mL, with correlation coefficient of 0.9997±0.00016. The drug solution was stable under room temperature at least for 6 hours. System suitability studies were done. The average plate count was > 2000, tailing factor <1, and capacity factor of 3.30. The retention time was 5.6 min. The HPLC method was used to assay donepezil hydrochloride in tablet and dissolution study of in-house manufactured donepezil orally disintegrating tablet and original Aricept.

  14. Encapsulation and modified-release of thymol from oral microparticles as adjuvant or substitute to current medications.

    PubMed

    Rassu, G; Nieddu, M; Bosi, P; Trevisi, P; Colombo, M; Priori, D; Manconi, P; Giunchedi, P; Gavini, E; Boatto, G

    2014-10-15

    The aim of this study was to encapsulate, thymol, in natural polymers in order to obtain (i) taste masking effect and, then, enhancing its palatability and (ii) two formulations for systemic and local delivery of herbal drug as adjuvants or substitutes to current medications to prevent and treat several human and animal diseases. Microspheres based on methylcellulose or hydroxypropyl methylcellulose phthalate (HPMCP) were prepared by spray drying technique. Microparticles were in vitro characterized in terms of yield of production, drug content and encapsulation efficiency, particle size, morphology and drug release. Both formulations were in vivo orally administered and pharmacokinetic analysis was carried out. The polymers used affect the release and, then, the pharmacokinetic profile of thymol. Encapsulation into methylcellulose microspheres leads to short half/life but bioavailability remarkably increases compared to the free thymol. In contrast, enteric formulation based on HPMCP shows very limited systemic absorption. These formulations could be proposed as alternative or adjuvants for controlling pathogen infections in human or animal. In particular, methylcellulose microspheres can be used for thymol systemic administration at low doses and HPMCP particles for local treatment of intestinal infections. PMID:25442269

  15. Stealth Amphotericin B nanoparticles for oral drug delivery: In vitro optimization

    PubMed Central

    AL-Quadeib, Bushra T.; Radwan, Mahasen A.; Siller, Lidija; Horrocks, Benjamin; Wright, Matthew C.

    2014-01-01

    Purpose Amphotericin B (AmB) is an effective anti-fungal and anti-leishmanial agent. However, AmB has low oral bioavailability (0.3%) and adverse effects (e.g., nephrotoxicity). The objectives of this study were to improve the oral bioavailability by entrapping AmB in pegylated (PEG) poly lactide co glycolide copolymer (PLGA–PEG) nanoparticles (NPs). The feasibility of different surfactants and stabilizers on the mean particle size (MPS) and entrapment efficiency were also investigated. Materials and methods NPs of AmB were prepared by a modified emulsification diffusion method employing a vitamin E derivative as a stabilizer. Physicochemical properties and particle size characterization were evaluated using Fourier Transform Infra-Red spectroscopy (FTIR), differential scanning calorimetry, scanning electron microscopy and transmission electron microscopy. Moreover, in vitro dissolution profiles were performed for all formulated AmB NPs. Results MPS of the prepared spherical particles of AmB ranged from 26.4 ± 2.9 to 1068 ± 489.8 nm. An increased stirring rate favored AmB NPs with a smaller MPS. There was a significant reduction in MPS, drug content and drug release, when AmB NPs were prepared using the diblock polymer PLGA–PEG with 15% PEG. Addition of three emulsifying agents poly vinyl pyrrolidone (PVP), Vitamin E (TPGS) and pluronic F-68 to AmB formulations led to a significant reduction in particle size and increase in drug entrapment efficiency (DEE) compared to addition of PVP alone. FTIR spectroscopy demonstrated a successful loading of AmB to pegylated PLGA–PEG copolymers. PLGA–PEG copolymer entrapment efficiency of AmB was increased up to 56.7%, with 92.7% drug yield. After a slow initial release, between 20% and 54% of AmB was released in vitro within 24 h phosphate buffer containing 2% sodium deoxycholate and were best fit Korsmeyer–Peppas model. In conclusion, PLGA–PEG diblock copolymer with 15% PEG produced a significant reduction

  16. Oral Contraceptive Pill and PCOS

    MedlinePlus

    ... Health Gynecology Medical Conditions Nutrition & Fitness Emotional Health PCOS: The Oral Contraceptive Pill Posted under Health Guides . ... of oral contraceptive pills for young women with PCOS? Regular and Lighter Periods: Oral contraceptive pills can ...

  17. The Comparative Effectiveness of Long-Acting Injectable vs. Oral Antipsychotic Medications in the Prevention of Relapse: A Case Study in CER in Psychiatry

    PubMed Central

    Kane, John M.; Kishimoto, Taishiro; Correll, Christoph U.

    2013-01-01

    Objective As psychopathology and social functioning can worsen with repeated psychotic episodes in schizophrenia, relapse prevention is critical. Because high non-adherence rates limit the efficacy of pharmacotherapy, the use of long-acting injectable antipsychotics (LAIs) is considered an important treatment option. To date, many studies comparing LAIs and oral antipsychotics have been conducted; however, the results are mixed, and careful interpretation of the data is required. Study Design Selective review of existing literature regarding LAIs. We especially focused the discussion on the impact of the design of studies with different approaches comparing LAIs and oral antipsychotics in preventing relapse. Result The results were diverse and were influenced by the design utilized, i.e., randomized controlled trials (RCTs) showed LAIs and oral antipsychotics to have similar effects, whereas mirror-image and some large cohort studies showed LAIs to be superior to oral antipsychotics. Conclusion Divergent results from studies using different methodologies creates a dilemma for comparative effectiveness research, and LAI studies may serve as an example of a situation where a conventional RCT is not the gold standard. Traditional RCTs generally increase adherence compared to clinical practice and, therefore, might not be well suited to detect differences between LAIs and oral medications, because any increase in adherence effects patients on oral medications more than those on LAIs and thus leads to an underestimation of any potential difference in effectiveness. A possible solution would be the implementation of a true effectiveness trial,. in which post-randomization involvement would be kept to a minimum to better reflect routine practice. PMID:23849151

  18. Feature extraction and segmentation in medical images by statistical optimization and point operation approaches

    NASA Astrophysics Data System (ADS)

    Yang, Shuyu; King, Philip; Corona, Enrique; Wilson, Mark P.; Aydin, Kaan; Mitra, Sunanda; Soliz, Peter; Nutter, Brian S.; Kwon, Young H.

    2003-05-01

    Feature extraction is a critical preprocessing step, which influences the outcome of the entire process of developing significant metrics for medical image evaluation. The purpose of this paper is firstly to compare the effect of an optimized statistical feature extraction methodology to a well designed combination of point operations for feature extraction at the preprocessing stage of retinal images for developing useful diagnostic metrics for retinal diseases such as glaucoma and diabetic retinopathy. Segmentation of the extracted features allow us to investigate the effect of occlusion induced by these features on generating stereo disparity mapping and 3-D visualization of the optic cup/disc. Segmentation of blood vessels in the retina also has significant application in generating precise vessel diameter metrics in vascular diseases such as hypertension and diabetic retinopathy for monitoring progression of retinal diseases.

  19. The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection

    PubMed Central

    Jin, Jing-fen; Zhu, Ling-ling; Chen, Meng; Xu, Hui-min; Wang, Hua-fen; Feng, Xiu-qin; Zhu, Xiu-ping; Zhou, Quan

    2015-01-01

    pharmacoeconomics because patient preference will ensure optimal treatment adherence and ultimately improve patient experience or satisfaction, while pharmacoeconomic concern will help alleviate nurse shortages and reduce overall health care costs. Besides the principles, the following detailed factors might affect the decision: patient characteristics-related factors (body mass index, age, sex, medical status [eg, renal impairment, comorbidities], personal attitudes toward safety and convenience, past experience, perception of current disease status, health literacy, and socioeconomic status), medication administration-related factors (anatomical site of injection, dose, frequency, formulation characteristics, administration time, indication, flexibility in the route of administration), and health care staff/institution-related factors (knowledge, human resources). Conclusion This updated review of findings of comparative studies of different injection routes will enrich the knowledge of safe, efficacious, economic, and patient preference-oriented medication administration as well as catching research opportunities in clinical nursing practice. PMID:26170642

  20. An optimized web-based approach for collaborative stereoscopic medical visualization

    PubMed Central

    Kaspar, Mathias; Parsad, Nigel M; Silverstein, Jonathan C

    2013-01-01

    Objective Medical visualization tools have traditionally been constrained to tethered imaging workstations or proprietary client viewers, typically part of hospital radiology systems. To improve accessibility to real-time, remote, interactive, stereoscopic visualization and to enable collaboration among multiple viewing locations, we developed an open source approach requiring only a standard web browser with no added client-side software. Materials and Methods Our collaborative, web-based, stereoscopic, visualization system, CoWebViz, has been used successfully for the past 2 years at the University of Chicago to teach immersive virtual anatomy classes. It is a server application that streams server-side visualization applications to client front-ends, comprised solely of a standard web browser with no added software. Results We describe optimization considerations, usability, and performance results, which make CoWebViz practical for broad clinical use. We clarify technical advances including: enhanced threaded architecture, optimized visualization distribution algorithms, a wide range of supported stereoscopic presentation technologies, and the salient theoretical and empirical network parameters that affect our web-based visualization approach. Discussion The implementations demonstrate usability and performance benefits of a simple web-based approach for complex clinical visualization scenarios. Using this approach overcomes technical challenges that require third-party web browser plug-ins, resulting in the most lightweight client. Conclusions Compared to special software and hardware deployments, unmodified web browsers enhance remote user accessibility to interactive medical visualization. Whereas local hardware and software deployments may provide better interactivity than remote applications, our implementation demonstrates that a simplified, stable, client approach using standard web browsers is sufficient for high quality three

  1. Oral complications of cancer therapies. Oral complications in the pediatric population

    SciTech Connect

    Leggott, P.J. )

    1990-01-01

    A number of acute oral complications may be associated with cancer therapy in children, but the extent and duration of these complications, and the most effective management techniques. have not been well described. The few studies differ in design, making comparisons difficult. Well-controlled, prospective clinical studies are needed to define the most effective strategies for the management of acute oral complications in children. However, it is clear that dental intervention prior to cancer therapy is an important factor in the optimal preparation of the patient. During cancer therapy, intensive supervised oral preventive protocols appear to be of benefit to the child's oral health, overall comfort, and well-being. Furthermore, the prevention of oral infection may significantly reduce the morbidity associated with cancer therapy. Long-term preventive oral care may help prevent dental disease and infection in medically compromised children and contribute to improving the quality of life. 41 references.

  2. Application of Innovative Methods to Optimize the Learning Process in Physics for Medical Students

    NASA Astrophysics Data System (ADS)

    Zlateva, Genoveva; Tsankova, Emilya

    2010-01-01

    Unlike chemistry and biology courses in the high schools which occupy the attention and interest of students as they need to achieve maximum results of examinations for admission in higher medical schools, physics remains away from their interest. Striving for awakening the interest of medical students to classes in physics and diversification of the learning process requires the continuous search of new forms of organization of this process in order to fulfill the main task of education: optimal development of each student, creating conditions for creative work with the highest possible productivity. Using innovations in teaching physics, aimed at the purpose of training in non-traditional way, transforms the passive learning in an active creative process. This allows rapid identification and compensation of gaps in the knowledge, which in turn leads to a rationalization and a more complete and lasting control of educational content. The aim of the study is analysis and evaluation of the effectiveness of the implementation of innovative educational methods to increase motivation and the quality of teaching physics to students of medicine. The discussion is based on the opinions expressed in surveys of students and results of various forms of feedback.

  3. Optimal distribution of medical backpacks and health surveillance assistants in Malawi

    PubMed Central

    Van Itallie, Elizabeth S.; Wu, Duo

    2014-01-01

    Despite recent progress, Malawi continues to perform poorly on key health indicators such as child mortality and life expectancy. These problems are exacerbated by a severe lack of access to health care. Health Surveillance Assistants (HSAs) help bridge this gap by providing community-level access to basic health care services. However, the success of these HSAs is limited by a lack of supplies and long distances between HSAs and patients. To address this issue, we used large-scale weighted p-median and capacitated facility location problems to create a scalable, three-tiered plan for optimal allocation of HSAs, HSA designated medical backpacks, and backpack resupply centers. Our analysis uses real data on the location and characteristics of hospitals, health centers, and the general population. In addition to offering specific recommendations for HSA, backpack, and resupply center locations, it provides general insights into the scope of the proposed HSA backpack program scale-up. In particular, it demonstrates the importance of local health centers to the resupply network. The proposed assignments are robust to changes in the underlying population structure, and could significantly improve access to medical supplies for both HSAs and patients. PMID:24293077

  4. Medical Dataset Classification: A Machine Learning Paradigm Integrating Particle Swarm Optimization with Extreme Learning Machine Classifier

    PubMed Central

    Subbulakshmi, C. V.; Deepa, S. N.

    2015-01-01

    Medical data classification is a prime data mining problem being discussed about for a decade that has attracted several researchers around the world. Most classifiers are designed so as to learn from the data itself using a training process, because complete expert knowledge to determine classifier parameters is impracticable. This paper proposes a hybrid methodology based on machine learning paradigm. This paradigm integrates the successful exploration mechanism called self-regulated learning capability of the particle swarm optimization (PSO) algorithm with the extreme learning machine (ELM) classifier. As a recent off-line learning method, ELM is a single-hidden layer feedforward neural network (FFNN), proved to be an excellent classifier with large number of hidden layer neurons. In this research, PSO is used to determine the optimum set of parameters for the ELM, thus reducing the number of hidden layer neurons, and it further improves the network generalization performance. The proposed method is experimented on five benchmarked datasets of the UCI Machine Learning Repository for handling medical dataset classification. Simulation results show that the proposed approach is able to achieve good generalization performance, compared to the results of other classifiers. PMID:26491713

  5. Optimal distribution of medical backpacks and health surveillance assistants in Malawi.

    PubMed

    Kunkel, Amber G; Van Itallie, Elizabeth S; Wu, Duo

    2014-09-01

    Despite recent progress, Malawi continues to perform poorly on key health indicators such as child mortality and life expectancy. These problems are exacerbated by a severe lack of access to health care. Health Surveillance Assistants (HSAs) help bridge this gap by providing community-level access to basic health care services. However, the success of these HSAs is limited by a lack of supplies and long distances between HSAs and patients. To address this issue, we used large-scale weighted p-median and capacitated facility location problems to create a scalable, three-tiered plan for optimal allocation of HSAs, HSA designated medical backpacks, and backpack resupply centers. Our analysis uses real data on the location and characteristics of hospitals, health centers, and the general population. In addition to offering specific recommendations for HSA, backpack, and resupply center locations, it provides general insights into the scope of the proposed HSA backpack program scale-up. In particular, it demonstrates the importance of local health centers to the resupply network. The proposed assignments are robust to changes in the underlying population structure, and could significantly improve access to medical supplies for both HSAs and patients.

  6. Atazanavir-loaded Eudragit RL 100 nanoparticles to improve oral bioavailability: optimization and in vitro/in vivo appraisal.

    PubMed

    Singh, Gurinder; Pai, Roopa S

    2016-01-01

    Atazanavir (ATV) is a HIV protease inhibitor. Due to its intense lipophilicity, the oral delivery of ATV encounters several problems such as poor aqueous solubility, pH-dependent dissolution, rapid first-pass metabolism in liver by CYP3A5, which result in low bioavailability. To overcome afore mentioned limitations, ATV-loaded Eudragit RL100 nanoparticles (ATV NPs) were prepared to enhance oral bioavailability. ATV NPs were prepared by nanoprecipitation method. The ATV NPs were systematically optimized (OPT) using 3(2) central composite design (CCD) and the OPT formulation located using overlay plot. The pharmacokinetic study of OPT formulation was investigated in male Wistar rats, and in-vitro/in-vivo correlation level was established. Intestinal permeability of OPT formulation was determined using in situ single pass perfusion (SPIP) technique. Transmission electron microscopy studies on OPT formulation demonstrated uniform shape and size of particles. Augmentation in the values of Ka (2.35-fold) and AUC0-24 (2.91-fold) indicated significant enhancement in the rate and extent of bioavailability by the OPT formulation compared to pure drug. Successful establishment of in vitro/in vivo correlation (IVIVC) Level A substantiated the judicious choice of the in vitro dissolution milieu for simulating the in vivo conditions. In situ SPIP studies ascribed the significant enhancement in absorptivity and permeability parameters of OPT formulation transport through the Peyer's patches. The studies, therefore, indicate the successful formulation development of NPs with distinctly improved bioavailability potential and can be used as drug carrier for sustained or prolonged drug release.

  7. Pseudo-outbreak of toxigenic Bacillus cereus isolated from stools of three patients with diarrhoea after oral administration of a probiotic medication.

    PubMed

    Kniehl, E; Becker, A; Forster, D H

    2003-09-01

    From December 2000 to January 2001 toxigenic Bacillus cereus was isolated from stools of three patients with diarrhoea at two tertiary hospitals in southwest Germany. Two cases with nosocomial diarrhoea were apparently epidemiologically related (same time and ward), a third case was unrelated with respect to time and location. In order to investigate the epidemiology of these three cases, clinical isolates and isolates from an unexpected, possible common source (probiotic medication) were compared by toxin assay, biotyping and randomly amplified polymorphic DNA (RAPD) analysis. The three clinical isolates, as well as the two isolates from different lots of the probiotic medication (Bactisubtil containing 'Bacillus IP 5832'; Cassella-med, Cologne, Germany), were indistinguishable by toxin assay, biotyping and RAPD, when compared with other distinguishable clinical B. cereus strains. As the diarrhoeal disease had begun before the probiotic medication had been administered to overcome it, the isolated B. cereus probably was at least initially, not the cause of the observed diarrhoeal disease. Isolation of toxigenic B. cereus from stools appeared to be a diagnostically misleading epiphenomenon after oral medication with the probiotic. We conclude, that probiotic medication with Bactisubtil (Bacillus IP 5832) may result in diagnostically misleading results when culturing stool specimens from patients with diarrhoea. The clonal identity of isolates may be misinterpreted as an outbreak. Stool specimens should be taken before start of probiotic treatment and clinicians should state probiotic medication when ordering stool examinations to allow correct interpretation of results. Nevertheless, it is noteworthy that a probiotic medication contains potentially toxigenic material.

  8. 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

  9. 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

  10. Ambient illumination revisited: A new adaptation-based approach for optimizing medical imaging reading environments

    SciTech Connect

    Chawla, Amarpreet S.; Samei, Ehsan

    2007-01-15

    Ambient lighting in soft-copy reading rooms is currently kept at low values to preserve contrast rendition in the dark regions of a medical image. Low illuminance levels, however, create inadequate viewing conditions and may also cause eye strain. This eye strain may be potentially attributed to notable variations in the luminance adaptation state of the reader's eyes when moving the gaze intermittently between the brighter display and darker surrounding surfaces. This paper presents a methodology to minimize this variation and optimize the lighting conditions of reading rooms by exploiting the properties of liquid crystal displays (LCDs) with low diffuse reflection coefficients and high luminance ratio. First, a computational model was developed to determine a global luminance adaptation value, L{sub adp}, when viewing a medical image on display. The model is based on the diameter of the pupil size, which depends on the luminance of the observed object. Second, this value was compared with the luminance reflected off surrounding surfaces, L{sub s}, under various conditions of room illuminance, E, different values of diffuse reflection coefficients of surrounding surfaces, R{sub s}, and calibration settings of a typical LCD. The results suggest that for typical luminance settings of current LCDs, it is possible to raise ambient illumination to minimize differences in eye adaptation, potentially reducing visual fatigue while also complying with the TG18 specifications for controlled contrast rendition. Specifically, room illumination in the 75-150 lux range and surface diffuse reflection coefficients in the practical range of 0.13-0.22 sr{sup -1} provide an ideal setup for typical LCDs. Future LCDs with lower diffuse reflectivity and with higher inherent luminance ratios can provide further improvement of ergonomic viewing conditions in reading rooms.

  11. Setting bioequivalence requirements for drug development based on preclinical data: optimizing oral drug delivery systems.

    PubMed

    Lipka, E; Amidon, G L

    1999-11-01

    The recently proposed Biopharmaceutics Classification System can be used to classify drugs and set standards for scale-up and post-approval changes as well as standards for in vitro/in vivo correlation for immediate and controlled release products. This classification scheme is based on determining the underlying process that is controlling the drug absorption rate and extent, namely, drug solubility and intestinal membrane permeability. Theoretical analysis and experimental results suggest that a permeability/solubility classification scheme can be used to set more rationale drug standards. In particular, high solubility/high permeability, rapidly dissolving drugs may be regulated on the basis of a single point rapid dissolution test while low solubility dissolution rate limited drugs can be regulated based on an in vitro dissolution test that reflects the in vivo dissolution process. This dissolution test may include multiple time points, media change, as well as surfactants in order to reflect the in vivo dissolution process and would be used by the manufacturer for requesting a waiver from a bioequivalence (BE) trial. For controlled release products, the regulation of bioequivalence standards is more complex due to the potential differences in position-dependent permeability/solubility and metabolism of drugs along the gastrointestinal tract. These differences may result in drug absorption rates that are highly transit time dependent. This paper will present the current status of the biopharmaceutic drug classification scheme, the underlying developed data base and its application to optimizing IR and CR products.

  12. Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension.

    PubMed

    Ajaj, Waleed; Goehde, Susanne C; Schneemann, Hubert; Ruehm, Stefan G; Debatin, Jörg F; Lauenstein, Thomas C

    2004-03-01

    The purpose of this study was to compare two osmotic carbohydrate sugar alcohols (mannitol 2.5% and sorbitol 2.5%, 2.0%, and 1.5% watery solutions) in combination with 0.2% locust bean gum (LBG) for small bowel distension for MR imaging. Small bowel distension was quantified on coronal 2D TrueFISP images by measuring the diameters of 16 small bowel loops in each of 12 healthy subjects (age range 31-55 years). Additionally, the grade of small bowel distension was rated qualitatively. Patient acceptance concerning nausea, vomiting, flatulence, and diarrhea was noted for each solution, and all results were compared by a Wilcoxon test or t test, respectively. The ingestion of water combined with LBG and either 2.5% mannitol or 2.0% sorbitol showed the best distension of the small bowel. The lowest side effect rate was observed following ingestion of sorbitol in a concentration of 2.0 and 1.5%. Based on these data, we recommend a combination of LBG and 2% sorbitol use for optimal bowel distension and minimal side effects resulting in enhanced patient acceptance. PMID:14634782

  13. Optimization of reference library used in content-based medical image retrieval scheme.

    PubMed

    Park, Sang Cheol; Sukthankar, Rahul; Mummert, Lily; Satyanarayanan, Mahadev; Zheng, Bin

    2007-11-01

    Building an optimal image reference library is a critical step in developing the interactive computer-aided detection and diagnosis (I-CAD) systems of medical images using content-based image retrieval (CBIR) schemes. In this study, the authors conducted two experiments to investigate (1) the relationship between I-CAD performance and size of reference library and (2) a new reference selection strategy to optimize the library and improve I-CAD performance. The authors assembled a reference library that includes 3153 regions of interest (ROI) depicting either malignant masses (1592) or CAD-cued false-positive regions (1561) and an independent testing data set including 200 masses and 200 false-positive regions. A CBIR scheme using a distance-weighted K-nearest neighbor algorithm is applied to retrieve references that are considered similar to the testing sample from the library. The area under receiver operating characteristic curve (Az) is used as an index to evaluate the I-CAD performance. In the first experiment, the authors systematically increased reference library size and tested I-CAD performance. The result indicates that scheme performance improves initially from Az= 0.715 to 0.874 and then plateaus when the library size reaches approximately half of its maximum capacity. In the second experiment, based on the hypothesis that a ROI should be removed if it performs poorly compared to a group of similar ROIs in a large and diverse reference library, the authors applied a new strategy to identify "poorly effective" references. By removing 174 identified ROIs from the reference library, I-CAD performance significantly increases to Az = 0.914 (p < 0.01). The study demonstrates that increasing reference library size and removing poorly effective references can significantly improve I-CAD performance.

  14. Medical imaging using ionizing radiation: Optimization of dose and image quality in fluoroscopy

    SciTech Connect

    Jones, A. Kyle; Balter, Stephen; Rauch, Phillip; Wagner, Louis K.

    2014-01-15

    The 2012 Summer School of the American Association of Physicists in Medicine (AAPM) focused on optimization of the use of ionizing radiation in medical imaging. Day 2 of the Summer School was devoted to fluoroscopy and interventional radiology and featured seven lectures. These lectures have been distilled into a single review paper covering equipment specification and siting, equipment acceptance testing and quality control, fluoroscope configuration, radiation effects, dose estimation and measurement, and principles of flat panel computed tomography. This review focuses on modern fluoroscopic equipment and is comprised in large part of information not found in textbooks on the subject. While this review does discuss technical aspects of modern fluoroscopic equipment, it focuses mainly on the clinical use and support of such equipment, from initial installation through estimation of patient dose and management of radiation effects. This review will be of interest to those learning about fluoroscopy, to those wishing to update their knowledge of modern fluoroscopic equipment, to those wishing to deepen their knowledge of particular topics, such as flat panel computed tomography, and to those who support fluoroscopic equipment in the clinic.

  15. Oral cenesthopathy.

    PubMed

    Umezaki, Yojiro; Miura, Anna; Watanabe, Motoko; Takenoshita, Miho; Uezato, Akihito; Toriihara, Akira; Nishikawa, Toru; Toyofuku, Akira

    2016-01-01

    Cenesthopathy is characterized by abnormal and strange bodily sensations and is classified as a 'delusional disorder, somatic type' or 'somatoform disorder' according to the DSM 5. The oral cavity is one of the frequent sites of cenesthopathy, thus the term 'oral cenesthopathy.' Patients with oral cenesthopathy complain of unusual sensations without corresponding abnormal findings in the oral area, such as excessive mucus secretion, a slimy sensation, or a feeling of coils or wires being present within the oral region. They usually visit multiple dentists rather than psychiatrists. Without a proper diagnosis, they repeatedly pursue unnecessary surgical procedures to remove their 'foreign body'. This sometimes creates a dilemma between the dentists and patients. The nosography of oral cenesthopathy has been discussed in some case reports and reviews but is overlooked in mainstream medicine. This review focuses on the various aspects of oral cenesthopathy. The estimated prevalence of cenesthopathy was 0.2 to 1.9 % in a study done at a Japanese university psychiatry clinic and 27 % in a study done at a Japanese psychosomatic dentistry clinic. Oral cenesthopathy do not have clear disposition, while some studies reported that elderly women were most commonly affected. Its pathophysiology has not been fully elucidated. However, recent studies have suggested a right > left asymmetrical pattern of the cerebral blood flow of patients with oral cenesthopathy. Antidepressants, antipsychotic drugs, electroconvulsive therapy, and psychotherapy might be effective in some cases, though it is known to be intractable. To date, the epidemiology, pathophysiology, etiology, classification and treatment of oral cenesthopathy are unknown due to the few reports on the disorder, though there are a few case reports. To overcome this difficult medical condition, clinico-statistical and case-control studies done under rigorous criteria and with a large sample size are required. PMID

  16. Enhanced oral bioavailability of acetylpuerarin by poly(lactide-co-glycolide) nanoparticles optimized using uniform design combined with response surface methodology

    PubMed Central

    Sun, Deqing; Xue, Aiying; Zhang, Bin; Xue, Xia; Zhang, Jie; Liu, Wenjie

    2016-01-01

    Acetylpuerarin (AP), an acetylated derivative of puerarin, shows brain-protective effects in animals. However, AP has low oral bioavailability because of its poor water solubility. The objective of this study was to design and develop poly(lactide-co-glycolide) (PLGA) nanoparticles (NPs) to enhance the oral bioavailability of AP. The NPs were prepared using a solvent diffusion method optimized via uniform design (UD) combined with response surface methodology (RSM) and characterized by their morphology, particle size, zeta (ζ)-potential, encapsulation efficiency (EE), drug loading (DL), and in vitro drug release. A pharmacokinetic study was conducted in Wistar rats administered a single oral dose of 30 mg/kg AP. The optimized NPs were spherical and uniform in shape, with an average particle size of 145.0 nm, a polydispersity index (PI) of 0.153, and a ζ-potential of −14.81 mV. The release of AP from the PLGA NPs showed an initial burst release followed by a sustained release, following Higuchi’s model. The EE and DL determined in the experiments were 90.51% and 17.07%, respectively. The area under the plasma concentration-time curve (AUC0−∞) of AP-PLGA-NPs was 6,175.66±350.31 h ng/mL, which was 2.75 times greater than that obtained from an AP suspension. This study showed that PLGA NPs can significantly enhance the oral bioavailability of AP. PMID:27382256

  17. Transmission of human papillomavirus DNA from patient to surgical masks, gloves and oral mucosa of medical personnel during treatment of laryngeal papillomas and genital warts.

    PubMed

    Ilmarinen, Taru; Auvinen, Eeva; Hiltunen-Back, Eija; Ranki, Annamari; Aaltonen, Leena-Maija; Pitkäranta, Anne

    2012-11-01

    The risk of occupational human papillomavirus (HPV) transmission from patient to medical personnel during laser vaporization procedures remains controversial. The purpose of this study was to determine the risk of HPV transmission from the patient to the protective surgical masks, gloves and oral mucosa of medical personnel during the treatment of laryngeal papillomas and genital warts. The study involved five male patients scheduled for the surgical treatment of laryngeal papillomas, and five male patients undergoing carbon dioxide (CO(2)) laser treatment for urethral warts. Oral mucosa specimens were obtained from the study patients and the employees pre- and postoperatively. Samples were collected from the HPV-infected patient tissue, and from the surgical masks and gloves used by the employees. A total of 120 samples were analyzed for the presence of HPV DNA by PCR, using the degenerated MY09/11/HMB01 primers. After the papilloma procedures, the surgeons' gloves tested HPV positive in one of the five cases and those of the surgical nurse in three of the five cases. After the treatment of genital warts, HPV DNA corresponding to the patient tissue specimens was present in all the samples obtained from the surgical gloves of the operators. All oral mucosa samples obtained from 18 different employees tested HPV negative, as did the surgical mask specimens. According to our study, HPV may contaminate protective equipment, most of all surgical gloves, but transmission of HPV DNA to medical personnel is unlikely to occur provided that protective surgical gloves and masks are applied and disposed of properly.

  18. Oral biopsy: oral pathologist's perspective.

    PubMed

    Kumaraswamy, K L; Vidhya, M; Rao, Prasanna Kumar; Mukunda, Archana

    2012-01-01

    Many oral lesions may need to be diagnosed by removing a sample of tissue from the oral cavity. Biopsy is widely used in the medical field, but the practice is not quite widespread in dental practice. As oral pathologists, we have found many artifacts in the tissue specimen because of poor biopsy technique or handling, which has led to diagnostic pitfalls and misery to both the patient and the clinician. This article aims at alerting the clinicians about the clinical faults arising preoperatively, intraoperatively and postoperatively while dealing with oral biopsy that may affect the histological assessment of the tissue and, therefore, the diagnosis. It also reviews the different techniques, precautions and special considerations necessary for specific lesions.

  19. [Contemporary reforms and optimization of medical examination committees in Russian Railways JSC].

    PubMed

    Kotenko, V A; Pfaf, V F; Chernov, o E

    2015-01-01

    The authors considered problems of restructurization and organization of medical examination committees in Russian Railways JSC, and their interlevel interactions. Detailed specification included documents circulation, order and terms of medical examination. Principles of conclusion on occupational fitness examination are specified. The article covers tasks of further development of occupational medical examination work in trade occupational medicine. PMID:25826882

  20. Monte Carlo study of photon beams from medical linear accelerators: Optimization, benchmark and spectra

    NASA Astrophysics Data System (ADS)

    Sheikh-Bagheri, Daryoush

    1999-12-01

    BEAM is a general purpose EGS4 user code for simulating radiotherapy sources (Rogers et al. Med. Phys. 22, 503-524, 1995). The BEAM code is optimized by first minimizing unnecessary electron transport (a factor of 3 improvement in efficiency). The efficiency of the uniform bremsstrahlung splitting (UBS) technique is assessed and found to be 4 times more efficient. The Russian Roulette technique used in conjunction with UBS is substantially modified to make simulations additionally 2 times more efficient. Finally, a novel and robust technique, called selective bremsstrahlung splitting (SBS), is developed and shown to improve the efficiency of photon beam simulations by an additional factor of 3-4, depending on the end- point considered. The optimized BEAM code is benchmarked by comparing calculated and measured ionization distributions in water from the 10 and 20 MV photon beams of the NRCC linac. Unlike previous calculations, the incident e - energy is known independently to 1%, the entire extra-focal radiation is simulated and e- contamination is accounted for. Both beams use clinical jaws, whose dimensions are accurately measured, and which are set for a 10 x 10 cm2 field at 110 cm. At both energies, the calculated and the measured values of ionization on the central-axis in the buildup region agree within 1% of maximum dose. The agreement is well within statistics elsewhere on the central-axis. Ionization profiles match within 1% of maximum dose, except at the geometrical edges of the field, where the disagreement is up to 5% of dose maximum. Causes for this discrepancy are discussed. The benchmarked BEAM code is then used to simulate beams from the major commercial medical linear accelerators. The off-axis factors are matched within statistical uncertainties, for most of the beams at the 1 σ level and for all at the 2 σ level. The calculated and measured depth-dose data agree within 1% (local dose), at about 1% (1 σ level) statistics, at all depths past

  1. [Ways of optimization of air-medical evacuation of wounded and ill patients during the armed conflict].

    PubMed

    An, R N; Ivantsov, V A; Shelepov, A M; Sidel'nikov, V O; Tiurin, M V; Adzhegitov, A Iu; Kravtsov, S N; Chmyrev, I V; Miliutin, D V

    2007-06-01

    The article is devoted to the experience of airmedical evacuation struck during operations in territory of the Chechen Republic of 1999-2002. We consider, that optimal medical-evacuation system in local wars, local fight actions and battles consists only two stages, then victim after first physician aid is evacuated to specialized medical unit. Own experience of preflight preparation and support is generalized and analysed at carrying out of airmedical evacuation of 928 critically wounded patients and the struck on tactical, operative and strategic levels during a confrontation in territory of the Chechen Republic (1999-2002).

  2. 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

  3. A randomized trial comparing in person and electronic interventions for improving adherence to oral medications in schizophrenia.

    PubMed

    Velligan, Dawn; Mintz, Jim; Maples, Natalie; Xueying, Li; Gajewski, Stephanie; Carr, Heather; Sierra, Cynthia

    2013-09-01

    Poor adherence to medication leads to symptom exacerbation and interferes with the recovery process for patients with schizophrenia. Following baseline assessment, 142 patients in medication maintenance at a community mental health center were randomized to one of 3 treatments for 9 months: (1) PharmCAT, supports including pill containers, signs, alarms, checklists and the organization of belongings established in weekly home visits from a PharmCAT therapist; (2) Med-eMonitor (MM), an electronic medication monitor that prompts use of medication, cues the taking of medication, warns patients when they are taking the wrong medication or taking it at the wrong time, record complaints, and, through modem hookup, alerts treatment staff of failures to take medication as prescribed; (3) Treatment as Usual (TAU). All patients received the Med-eMonitor device to record medication adherence. The device was programmed for intervention only in the MM group. Data on symptoms, global functioning, and contact with emergency services and police were obtained every 3 months. Repeated measures analyses of variance for mixed models indicated that adherence to medication was significantly better in both active conditions than in TAU (both p<0.0001). Adherence in active treatments ranged from 90-92% compared to 73% in TAU based on electronic monitoring. In-person and electronic interventions significantly improved adherence to medication, but that did not translate to improved clinical outcomes. Implications for treatment and health care costs are discussed.

  4. Advances in Oral Coagulants

    PubMed Central

    2013-01-01

    This article reviews current and future treatment practices concerning oral anticoagulants. In the second decade of the 21st millennium clinicians can finally treat thrombotic disease with long-awaited new oral anticoagulant medications. In addition, improvements have been made in managing warfarin, the traditional but far from obsolete medication. The first part of this review will cover current advances with warfarin treatment. The second portion will discuss specific active coagulation factor inhibitors, the new oral anticoagulants.

  5. Prospective study of the influence of psychological and medical factors on quality of life and severity of symptoms among patients with oral squamous cell carcinoma.

    PubMed

    Rana, M; Kanatas, A; Herzberg, P Y; Khoschdell, M; Kokemueller, H; Gellrich, N-C; Rana, M

    2015-04-01

    About 400,000 people worldwide are diagnosed with oral squamous cell carcinoma (SCC) annually, and the incidence is increasing. Many advanced carcinomas of the oral cavity require radical surgical treatment that can impair patient's quality of life (QoL) and severity of symptoms. We therefore aimed to identify coping strategies and disease-specific medical factors that affect QoL and severity of symptoms. Patients with oral SCC were asked to complete the Freiburg Questionnaire on Coping with Illness (FQCI), the University of Washington Quality of life Questionnaire (UW-QOL version 4), and the Brief Symptom Inventory (BSI) to measure psychological stress. We also assessed the impact of various factors on QoL and severity of symptoms, including stage and site of tumour, method of reconstruction, time of diagnosis, and social structure (age, sex, marital status, living arrangements, level of education, and employment). We enrolled a consecutive sample of 104 patients over a period of one year. Stepwise linear regression analyses indicated that both depressive coping and size of tumour had an adverse effect on QoL and severity of symptoms. Patients with high educational attainment and those who lived alone reported impaired QoL, and women experienced increased severity of symptoms. Impaired QoL and increased severity of symptoms were associated with a depressive style of coping, size of tumour, educational attainment, and living arrangements. It is important to identify these patients during treatment as they could benefit from psycho-oncological counselling.

  6. Oral candidiasis.

    PubMed

    Millsop, Jillian W; Fazel, Nasim

    2016-01-01

    Oral candidiasis (OC) is a common fungal disease encountered in dermatology, most commonly caused by an overgrowth of Candida albicans in the mouth. Although thrush is a well-recognized presentation of OC, it behooves clinicians to be aware of the many other presentations of this disease and how to accurately diagnose and manage these cases. The clinical presentations of OC can be broadly classified as white or erythematous candidiasis, with various subtypes in each category. The treatments include appropriate oral hygiene, topical agents, and systemic medications. This review focuses on the various clinical presentations of OC and treatment options.

  7. Optimal medical outcomes with limited liability: risk management principles for medical practices at the intersection of medicine, law, and business.

    PubMed

    Paterick, Timothy J; Paterick, Timothy E; Waterhouse, Blake E

    2007-01-01

    Physicians practice at the intersection of medicine, law, and business. Each discipline creates its own challenges for the practicing physician: to practice efficient, effective medicine; to limit potential liability; and to create a positive financial outcome. Those challenges increase with escalating costs and reduced reimbursements. In this paper, the common clinical presentation of chest pain has been used to create a paradigm to educate physicians to understand efficient and effective approaches to diagnosis and treatment, and how effective communication with patients and meticulous documentation of all medical encounters can limit the potential for liability. Ultimately, given today's reimbursement formulas, physicians must also understand the cost of testing, in relation to its benefits, in an attempt to yield a positive financial outcome.

  8. Prescription Factors Associated with Medication Non-adherence in Japan Assessed from Leftover Drugs in the SETSUYAKU-BAG Campaign: Focus on Oral Antidiabetic Drugs

    PubMed Central

    Koyanagi, Kaori; Kubota, Toshio; Kobayashi, Daisuke; Kihara, Taro; Yoshida, Takeo; Miisho, Takamasa; Miura, Tomoko; Sakamoto, Yoshiko; Takaki, Junichi; Seo, Takashi; Shimazoe, Takao

    2016-01-01

    Background: Medication adherence has an important influence on health outcomes in patients with chronic diseases. However, few studies have been performed in Japan to determine factors related to medication non-adherence. Objective: The aim of this study was to identify prescription factors related to medication non-adherence by investigating patient characteristics, all prescriptions, and prescriptions for oral antidiabetic drugs (OADs). Methods: A retrospective cross-sectional survey of prescription data about implementation of dosing regimen was performed at community pharmacies engaged in appropriate use of leftover drugs. We evaluated the amount of drugs originally prescribed and the reduced amount after use of leftover drugs, and then calculated prescription reduction ratio (PRR). We analyzed prescription factors contributing to non-adherence based on the PRR. Results: Prescription information for 1207 patients was reviewed, revealing that patients were non-adherent to 58% of prescriptions. Lack of a drug copayment, fewer concurrent drugs, and drugs not in single-dose packaging were associated with non-adherence. Among the 1207 patients, 234 prescriptions for diabetes and 452 OAD formulations were included. Forty-seven percent of prescriptions and 29% of the formulations were non-adherent. A higher dosing frequency and preprandial administration were associated with non-adherence. Among the OADs, adherence was lower for α-glucosidase inhibitors and biguanides than for sulfonylureas. Conclusions: Several factors related to patient characteristics, general drug prescriptions, and OAD prescriptions were associated with non-adherence. Further consideration will be needed to improve adherence to medication in Japan. Health care providers should perform more careful monitoring of adherence in patients with the factors identified by this study. PMID:27489544

  9. Design optimization of the sensor spatial arrangement in a direct magnetic field-based localization system for medical applications.

    PubMed

    Marechal, Luc; Shaohui Foong; Zhenglong Sun; Wood, Kristin L

    2015-08-01

    Motivated by the need for developing a neuronavigation system to improve efficacy of intracranial surgical procedures, a localization system using passive magnetic fields for real-time monitoring of the insertion process of an external ventricular drain (EVD) catheter is conceived and developed. This system operates on the principle of measuring the static magnetic field of a magnetic marker using an array of magnetic sensors. An artificial neural network (ANN) is directly used for solving the inverse problem of magnetic dipole localization for improved efficiency and precision. As the accuracy of localization system is highly dependent on the sensor spatial location, an optimization framework, based on understanding and classification of experimental sensor characteristics as well as prior knowledge of the general trajectory of the localization pathway, for design of such sensing assemblies is described and investigated in this paper. Both optimized and non-optimized sensor configurations were experimentally evaluated and results show superior performance from the optimized configuration. While the approach presented here utilizes ventriculostomy as an illustrative platform, it can be extended to other medical applications that require localization inside the body.

  10. Design optimization of the sensor spatial arrangement in a direct magnetic field-based localization system for medical applications.

    PubMed

    Marechal, Luc; Shaohui Foong; Zhenglong Sun; Wood, Kristin L

    2015-08-01

    Motivated by the need for developing a neuronavigation system to improve efficacy of intracranial surgical procedures, a localization system using passive magnetic fields for real-time monitoring of the insertion process of an external ventricular drain (EVD) catheter is conceived and developed. This system operates on the principle of measuring the static magnetic field of a magnetic marker using an array of magnetic sensors. An artificial neural network (ANN) is directly used for solving the inverse problem of magnetic dipole localization for improved efficiency and precision. As the accuracy of localization system is highly dependent on the sensor spatial location, an optimization framework, based on understanding and classification of experimental sensor characteristics as well as prior knowledge of the general trajectory of the localization pathway, for design of such sensing assemblies is described and investigated in this paper. Both optimized and non-optimized sensor configurations were experimentally evaluated and results show superior performance from the optimized configuration. While the approach presented here utilizes ventriculostomy as an illustrative platform, it can be extended to other medical applications that require localization inside the body. PMID:26736407

  11. Exposure to Child and Adolescent Psychiatry for Medical Students: Are There Optimal "Teaching Perspectives"?

    ERIC Educational Resources Information Center

    Hunt, Jeffrey; Barrett, Rowland; Grapentine, W. Lex; Liguori, Gina; Trivedi, Harsh K.

    2008-01-01

    Objectives: The ability to develop quality medical student exposures in child and adolescent psychiatry is critical to the professional development of these future physicians and to the growth of recruitment efforts into the field. This study identifies teaching perspectives among child and adolescent psychiatry faculty to determine whether there…

  12. 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.

  13. [Optimal coefficient of overlap of light spots during laser hardening of medical instruments].

    PubMed

    Stepanova, G A; Pogibenko, A V; Gerasev, G P

    1982-01-01

    The optimum coefficient of light spot intercepts in the course of laser hardening medical instruments is determined for the case when there are no unirradiated sites on the surface under treatment. The increase in the light spot diameter during irradiation has been shown to be followed by more rapid expansion of the hardened area in comparison with the one of the tempered zone.

  14. Molecular analysis of the microbiota in hard feces from healthy rabbits (Oryctolagus cuniculus) medicated with long term oral meloxicam

    PubMed Central

    2014-01-01

    Background Analgesia is often indicated in rabbits undergoing surgical procedures or suffering from various painful conditions and the most common adverse effects associated with NSAIDs occur in the gastrointestinal tract (GIT). The objective of this study was to determine the potential effect of long-term (21 days) meloxicam administration on the fecal bacterial microbiota in healthy rabbits. Samples of hard feces were collected from six rabbits treated with meloxicam (1 mg/kg orally once every 24 h) on days 0,6,14 and 21. Next generation sequencing of V4 16S rRNA gene products was performed. Results A total of 2589912 V4 rRNA gene sequences passed all quality control filters. Firmicutes predominated (82.0 ± 6.2%). Sixteen other phyla were also identified but other than Verrucomicrobia (4.4 ± 4.9%), all accounted for less than 1% of the identified sequences. Within Firmicutes, Clostridia was the dominant class, accounting for 76% of operational taxon units (OTUs). In general, there were only few differences observed between time points and different rabbits at the phylum level. A significant change was observed in the relative abundance of Proteobacteria over the 4 time points (P = 0.02). Conclusions The gastrointestinal tract of rabbits harbors dense and diverse microbiota. Significant alteration of the hard fecal microbiota does not appear to be a considerable adverse effect expected in rabbits treated for 21 days with oral meloxicam at a dose of 1 mg/kg. PMID:24618207

  15. Using optimization models to demonstrate the need for structural changes in training programs for surgical medical residents.

    PubMed

    Turner, Jonathan; Kim, Kibaek; Mehrotra, Sanjay; DaRosa, Debra A; Daskin, Mark S; Rodriguez, Heron E

    2013-09-01

    The primary goal of a residency program is to prepare trainees for unsupervised care. Duty hour restrictions imposed throughout the prior decade require that residents work significantly fewer hours. Moreover, various stakeholders (e.g. the hospital, mentors, other residents, educators, and patients) require them to prioritize very different activities, often conflicting with their learning goals. Surgical residents' learning goals include providing continuity throughout a patient's pre-, peri-, and post-operative care as well as achieving sufficient surgical experience levels in various procedure types and participating in various formal educational activities, among other things. To complicate matters, senior residents often compete with other residents for surgical experience. This paper features experiments using an optimization model and a real dataset. The experiments test the viability of achieving the above goals at a major academic center using existing models of delivering medical education and training to surgical residents. It develops a detailed multi-objective, two-stage stochastic optimization model with anticipatory capabilities solved over a rolling time horizon. A novel feature of the models is the incorporation of learning curve theory in the objection function. Using a deterministic version of the model, we identify bounds on the achievement of learning goals under existing training paradigms. The computational results highlight the structural problems in the current surgical resident educational system. These results further corroborate earlier findings and suggest an educational system redesign is necessary for surgical medical residents. PMID:23519945

  16. Using optimization models to demonstrate the need for structural changes in training programs for surgical medical residents.

    PubMed

    Turner, Jonathan; Kim, Kibaek; Mehrotra, Sanjay; DaRosa, Debra A; Daskin, Mark S; Rodriguez, Heron E

    2013-09-01

    The primary goal of a residency program is to prepare trainees for unsupervised care. Duty hour restrictions imposed throughout the prior decade require that residents work significantly fewer hours. Moreover, various stakeholders (e.g. the hospital, mentors, other residents, educators, and patients) require them to prioritize very different activities, often conflicting with their learning goals. Surgical residents' learning goals include providing continuity throughout a patient's pre-, peri-, and post-operative care as well as achieving sufficient surgical experience levels in various procedure types and participating in various formal educational activities, among other things. To complicate matters, senior residents often compete with other residents for surgical experience. This paper features experiments using an optimization model and a real dataset. The experiments test the viability of achieving the above goals at a major academic center using existing models of delivering medical education and training to surgical residents. It develops a detailed multi-objective, two-stage stochastic optimization model with anticipatory capabilities solved over a rolling time horizon. A novel feature of the models is the incorporation of learning curve theory in the objection function. Using a deterministic version of the model, we identify bounds on the achievement of learning goals under existing training paradigms. The computational results highlight the structural problems in the current surgical resident educational system. These results further corroborate earlier findings and suggest an educational system redesign is necessary for surgical medical residents.

  17. Discovery and Optimization of Quinazolinone-pyrrolopyrrolones as Potent and Orally Bioavailable Pan-Pim Kinase Inhibitors.

    PubMed

    Pettus, Liping H; Andrews, Kristin L; Booker, Shon K; Chen, Jie; Cee, Victor J; Chavez, Frank; Chen, Yuping; Eastwood, Heather; Guerrero, Nadia; Herberich, Bradley; Hickman, Dean; Lanman, Brian A; Laszlo, Jimmy; Lee, Matthew R; Lipford, J Russell; Mattson, Bethany; Mohr, Christopher; Nguyen, Yen; Norman, Mark H; Powers, David; Reed, Anthony B; Rex, Karen; Sastri, Christine; Tamayo, Nuria; Wang, Paul; Winston, Jeffrey T; Wu, Bin; Wu, Tian; Wurz, Ryan P; Xu, Yang; Zhou, Yihong; Tasker, Andrew S; Wang, Hui-Ling

    2016-07-14

    The high expression of proviral insertion site of Moloney murine leukemia virus kinases (Pim-1, -2, and -3) in cancers, particularly the hematopoietic malignancies, is believed to play a role in promoting cell survival and proliferation while suppressing apoptosis. The three isoforms of Pim protein appear largely redundant in their oncogenic functions. Thus, a pan-Pim kinase inhibitor is highly desirable. However, cell active pan-Pim inhibitors have proven difficult to develop because Pim-2 has a low Km for ATP and therefore requires a very potent inhibitor to effectively block the kinase activity at cellular ATP concentrations. Herein, we report a series of quinazolinone-pyrrolopyrrolones as potent and selective pan-Pim inhibitors. In particular, compound 17 is orally efficacious in a mouse xenograft model (KMS-12 BM) of multiple myeloma, with 93% tumor growth inhibition at 50 mg/kg QD upon oral dosing. PMID:27285051

  18. Trends in racial/ethnic disparities in medical and oral health, access to care, and use of services in US children: has anything changed over the years?

    PubMed Central

    2013-01-01

    Introduction The 2010 Census revealed the population of Latino and Asian children grew by 5.5 million, while the population of white children declined by 4.3 million from 2000-2010, and minority children will outnumber white children by 2020. No prior analyses, however, have examined time trends in racial/ethnic disparities in children’s health and healthcare. The study objectives were to identify racial/ethnic disparities in medical and oral health, access to care, and use of services in US children, and determine whether these disparities have changed over time. Methods The 2003 and 2007 National Surveys of Children’s Health were nationally representative telephone surveys of parents of 193,995 children 0-17 years old (N = 102,353 in 2003 and N = 91,642 in 2007). Thirty-four disparities indicators were examined for white, African-American, Latino, Asian/Pacific-Islander, American Indian/Alaskan Native, and multiracial children. Multivariable analyses were performed to adjust for nine relevant covariates, and Z-scores to examine time trends. Results Eighteen disparities occurred in 2007 for ≥1 minority group. The number of indicators for which at least one racial/ethnic group experienced disparities did not significantly change between 2003-2007, nor did the total number of specific disparities (46 in 2007). The disparities for one subcategory (use of services), however, did decrease (by 82%). Although 15 disparities decreased over time, two worsened, and 10 new disparities arose. Conclusions Minority children continue to experience multiple disparities in medical and oral health and healthcare. Most disparities persisted over time. Although disparities in use of services decreased, 10 new disparities arose in 2007. Study findings suggest that urgent policy solutions are needed to eliminate these disparities, including collecting racial/ethnic and language data on all patients, monitoring and publicly disclosing disparities data annually, providing

  19. Development of a mobile device optimized cross platform-compatible oral pathology and radiology spaced repetition system for dental education.

    PubMed

    Al-Rawi, Wisam; Easterling, Lauren; Edwards, Paul C

    2015-04-01

    Combining active recall testing with spaced repetition increases memory retention. The aim of this study was to evaluate and compare students' perception and utilization of an electronic spaced repetition oral pathology-radiology system in dental hygiene education and predoctoral dental education. The study employed an open-source suite of applications to create electronic "flashcards" that can be individually adjusted for frequency of repetition, depending on a user's assessment of difficulty. Accessible across multiple platforms (iOS, Android, Linux, OSX, Windows) as well as via any web-based browser, this framework was used to develop an oral radiology-oral pathology database of case-based questions. This system was introduced in two courses: sophomore oral pathology for dental students and sophomore radiology for dental hygiene students. Students were provided free software and/or mobile tablet devices as well as a database of 300 electronic question cards. Study participants were surveyed on frequency and extent of use. Perception-based surveys were used to evaluate their attitudes towards this technology. Of the eligible students, 12 of 22 (54.5%) dental hygiene and 49 of 107 (45.8%) dental students responded to the surveys. Adoption rates and student feedback were compared between the two groups. Among the respondents, acceptance of this technology with respect to educational usefulness was similar for the dental and dental hygiene students (median=5 on a five-point scale; dental hygiene interquartile range (IQR)=0; dental IQR=1). Only a minority of the survey respondents (25% dental, 33% dental hygiene) took advantage of one of the main benefits of this technology: automated spaced repetition. PMID:25838016

  20. Development of a mobile device optimized cross platform-compatible oral pathology and radiology spaced repetition system for dental education.

    PubMed

    Al-Rawi, Wisam; Easterling, Lauren; Edwards, Paul C

    2015-04-01

    Combining active recall testing with spaced repetition increases memory retention. The aim of this study was to evaluate and compare students' perception and utilization of an electronic spaced repetition oral pathology-radiology system in dental hygiene education and predoctoral dental education. The study employed an open-source suite of applications to create electronic "flashcards" that can be individually adjusted for frequency of repetition, depending on a user's assessment of difficulty. Accessible across multiple platforms (iOS, Android, Linux, OSX, Windows) as well as via any web-based browser, this framework was used to develop an oral radiology-oral pathology database of case-based questions. This system was introduced in two courses: sophomore oral pathology for dental students and sophomore radiology for dental hygiene students. Students were provided free software and/or mobile tablet devices as well as a database of 300 electronic question cards. Study participants were surveyed on frequency and extent of use. Perception-based surveys were used to evaluate their attitudes towards this technology. Of the eligible students, 12 of 22 (54.5%) dental hygiene and 49 of 107 (45.8%) dental students responded to the surveys. Adoption rates and student feedback were compared between the two groups. Among the respondents, acceptance of this technology with respect to educational usefulness was similar for the dental and dental hygiene students (median=5 on a five-point scale; dental hygiene interquartile range (IQR)=0; dental IQR=1). Only a minority of the survey respondents (25% dental, 33% dental hygiene) took advantage of one of the main benefits of this technology: automated spaced repetition.

  1. Phase II Randomized Controlled Trial of Combined Oral laxatives Medication for BOwel PREParation (COMBO-PREP study).

    PubMed

    Kim, Min Jung; Hong, Chang Won; Kim, Byung Chang; Park, Sung Chan; Han, Kyung Su; Joo, Jungnam; Oh, Jae Hwan; Sohn, Dae Kyung

    2016-02-01

    The combination of different laxatives at reduced volumes may benefit patients by enhancing efficacy for bowel cleansing and increasing tolerability. However, evidence regarding combined preparations is scarce. This study evaluated whether the combined preparations are associated with enhanced efficacy and tolerability. This randomized phase II study had a single-blind, parallel-arm design. Between December 2013 and September 2014, consecutive patients aged between 20 and 65 years and who required diagnostic colonoscopies were considered for inclusion. Patients were randomly allocated into 4 arms: sodium picosulfate and magnesium citrate (PMC) and polyethylene glycol (PEG) with ascorbic acid in a day-prior (PMC-PEG-DP), PMC and oral sodium phosphate (NaP) in a day-prior (PMC-NaP-DP), PMC and PEG with ascorbic acid in a split-dose (PMC-PEG-SD), and PMC and oral NaP in a split-dose (PMC-NaP-SD). Primary endpoint was the Aronchick scale, and Ottawa scale results by colon segment, patients' adverse gastrointestinal symptoms, and willingness to reuse the same agents were also recorded. Successful bowel preparation was defined as an "excellent" or "good" score on the Aronchick scale. A total of 236 patients were randomized and 229 patients received the planned colonoscopy. The rates of successful bowel preparation in the PMC-PEG-DP, PMC-NaP-DP, PMC-PEG-SD, and PMC-NaP-SD were 82.5%, 64.4%, 100%, and 100%, respectively. Excluding the failed PMC-NaP-DP group, all groups showed satisfactory rates of successful bowel preparation, and the mean Ottawa scores were significantly better in the PMC-PEG-SD and PMC-NaP-SD groups than in the PMC-PEG-DP group (P < 0.0001). The PMC-PEG-DP, PMC-NaP-DP, PMC-PEG-SD, and PMC-NaP-SD groups were similar in terms of rates of adverse gastrointestinal symptoms reported on a 5-point scale (P = 0.40) and willingness to reuse the same combined preparations (P = 0.55). PMC-PEG in a day-prior or split-dose and PMC-NaP in a split

  2. Phase II Randomized Controlled Trial of Combined Oral laxatives Medication for BOwel PREParation (COMBO-PREP study)

    PubMed Central

    Kim, Min Jung; Hong, Chang Won; Kim, Byung Chang; Park, Sung Chan; Han, Kyung Su; Joo, Jungnam; Oh, Jae Hwan; Sohn, Dae Kyung

    2016-01-01

    Abstract The combination of different laxatives at reduced volumes may benefit patients by enhancing efficacy for bowel cleansing and increasing tolerability. However, evidence regarding combined preparations is scarce. This study evaluated whether the combined preparations are associated with enhanced efficacy and tolerability. This randomized phase II study had a single-blind, parallel-arm design. Between December 2013 and September 2014, consecutive patients aged between 20 and 65 years and who required diagnostic colonoscopies were considered for inclusion. Patients were randomly allocated into 4 arms: sodium picosulfate and magnesium citrate (PMC) and polyethylene glycol (PEG) with ascorbic acid in a day-prior (PMC-PEG-DP), PMC and oral sodium phosphate (NaP) in a day-prior (PMC-NaP-DP), PMC and PEG with ascorbic acid in a split-dose (PMC-PEG-SD), and PMC and oral NaP in a split-dose (PMC-NaP-SD). Primary endpoint was the Aronchick scale, and Ottawa scale results by colon segment, patients’ adverse gastrointestinal symptoms, and willingness to reuse the same agents were also recorded. Successful bowel preparation was defined as an “excellent” or “good” score on the Aronchick scale. A total of 236 patients were randomized and 229 patients received the planned colonoscopy. The rates of successful bowel preparation in the PMC-PEG-DP, PMC-NaP-DP, PMC-PEG-SD, and PMC-NaP-SD were 82.5%, 64.4%, 100%, and 100%, respectively. Excluding the failed PMC-NaP-DP group, all groups showed satisfactory rates of successful bowel preparation, and the mean Ottawa scores were significantly better in the PMC-PEG-SD and PMC-NaP-SD groups than in the PMC-PEG-DP group (P < 0.0001). The PMC-PEG-DP, PMC-NaP-DP, PMC-PEG-SD, and PMC-NaP-SD groups were similar in terms of rates of adverse gastrointestinal symptoms reported on a 5-point scale (P = 0.40) and willingness to reuse the same combined preparations (P = 0.55). PMC-PEG in a day-prior or split-dose and PMC

  3. Anti-anxiety self-medication in rats: oral consumption of chlordiazepoxide and ethanol after reward devaluation.

    PubMed

    Manzo, Lidia; Donaire, Rocío; Sabariego, Marta; Papini, Mauricio R; Torres, Carmen

    2015-02-01

    Rats increased preference for ethanol after sessions of appetitive extinction, but not after acquisition (reinforced) sessions (Manzo et al., 2014). Drinking was not influenced by appetitive extinction in control groups with postsession access to water, rather than ethanol. Because ethanol has anxiolytic properties in tasks involving reward loss, these results were interpreted as anti-anxiety self-medication. The present experiment tested the potential for self-medication with the prescription anxiolytic chlordiazepoxide, a benzodiazepine with an addictive profile used in the treatment of anxiety disorders. To test this hypothesis, Wistar rats exposed to a 32-to-4% sucrose devaluation received a two-bottle, 2-h preference test immediately after consummatory training. One bottle contained 1 mg/kg of chlordiazepoxide, 2% ethanol, or water for different groups (the second bottle contained water for all groups). Three additional groups received the same postsession preference tests, but were exposed to 4% sucrose during consummatory training. Rats showed suppression of consummatory behavior after reward devaluation relative to unshifted controls. This effect was accompanied by a selective increase in preference for chlordiazepoxide and ethanol. Downshifted animals with access to water or unshifted controls with access to the anxiolytics failed to exhibit postsession changes in preference. Similar results were observed in terms of absolute consumption and consumption relative to body weight. This study shows for the first time that a prescription anxiolytic supports enhanced voluntary consumption during periods of emotional distress triggered by reward loss. Such anti-anxiety self-medication provides insights into the early stages of addictive behavior. PMID:25242284

  4. Anti-anxiety self-medication in rats: oral consumption of chlordiazepoxide and ethanol after reward devaluation.

    PubMed

    Manzo, Lidia; Donaire, Rocío; Sabariego, Marta; Papini, Mauricio R; Torres, Carmen

    2015-02-01

    Rats increased preference for ethanol after sessions of appetitive extinction, but not after acquisition (reinforced) sessions (Manzo et al., 2014). Drinking was not influenced by appetitive extinction in control groups with postsession access to water, rather than ethanol. Because ethanol has anxiolytic properties in tasks involving reward loss, these results were interpreted as anti-anxiety self-medication. The present experiment tested the potential for self-medication with the prescription anxiolytic chlordiazepoxide, a benzodiazepine with an addictive profile used in the treatment of anxiety disorders. To test this hypothesis, Wistar rats exposed to a 32-to-4% sucrose devaluation received a two-bottle, 2-h preference test immediately after consummatory training. One bottle contained 1 mg/kg of chlordiazepoxide, 2% ethanol, or water for different groups (the second bottle contained water for all groups). Three additional groups received the same postsession preference tests, but were exposed to 4% sucrose during consummatory training. Rats showed suppression of consummatory behavior after reward devaluation relative to unshifted controls. This effect was accompanied by a selective increase in preference for chlordiazepoxide and ethanol. Downshifted animals with access to water or unshifted controls with access to the anxiolytics failed to exhibit postsession changes in preference. Similar results were observed in terms of absolute consumption and consumption relative to body weight. This study shows for the first time that a prescription anxiolytic supports enhanced voluntary consumption during periods of emotional distress triggered by reward loss. Such anti-anxiety self-medication provides insights into the early stages of addictive behavior.

  5. Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A - Medical results

    PubMed Central

    Adams, James B; Baral, Matthew; Geis, Elizabeth; Mitchell, Jessica; Ingram, Julie; Hensley, Andrea; Zappia, Irene; Newmark, Sanford; Gehn, Eva; Rubin, Robert A; Mitchell, Ken; Bradstreet, Jeff; El-Dahr, Jane

    2009-01-01

    Background This study investigated the effect of oral dimercapto succinic acid (DMSA) therapy for children with autism spectrum disorders ages 3-8 years. Methods Phase 1 involved 65 children who received one round of DMSA (3 days). Participants who had high urinary excretion of toxic metals were selected to continue on to phase 2. In phase 2, 49 participants were randomly assigned in a double-blind design to receive an additional 6 rounds of either DMSA or placebo. Results DMSA greatly increased the excretion of lead, substantially increased excretion of tin and bismuth, and somewhat increased the excretion of thallium, mercury, antimony, and tungsten. There was some increase in urinary excretion of essential minerals, especially potassium and chromium. The Phase 1 single round of DMSA led to a dramatic normalization of RBC glutathione in almost all cases, and greatly improved abnormal platelet counts, suggesting a significant decrease in inflammation. Conclusion Overall, DMSA therapy seems to be reasonably safe, effective in removing several toxic metals (especially lead), dramatically effective in normalizing RBC glutathione, and effective in normalizing platelet counts. Only 1 round (3 days) was sufficient to improve glutathione and platelets. Additional rounds increased excretion of toxic metals. PMID:19852789

  6. Optimal frequency range for medical radar measurements of human heartbeats using body-contact radar.

    PubMed

    Brovoll, Sverre; Aardal, Øyvind; Paichard, Yoann; Berger, Tor; Lande, Tor Sverre; Hamran, Svein-Erik

    2013-01-01

    In this paper the optimal frequency range for heartbeat measurements using body-contact radar is experimentally evaluated. A Body-contact radar senses electromagnetic waves that have penetrated the human body, but the range of frequencies that can be used are limited by the electric properties of the human tissue. The optimal frequency range is an important property needed for the design of body-contact radar systems for heartbeat measurements. In this study heartbeats are measured using three different antennas at discrete frequencies from 0.1 - 10 GHz, and the strength of the received heartbeat signal is calculated. To characterize the antennas, when in contact with the body, two port S-parameters(†) are measured for the antennas using a pork rib as a phantom for the human body. The results shows that frequencies up to 2.5 GHz can be used for heartbeat measurements with body-contact radar.

  7. Medical image denoising via optimal implementation of non-local means on hybrid parallel architecture.

    PubMed

    Nguyen, Tuan-Anh; Nakib, Amir; Nguyen, Huy-Nam

    2016-06-01

    The Non-local means denoising filter has been established as gold standard for image denoising problem in general and particularly in medical imaging due to its efficiency. However, its computation time limited its applications in real world application, especially in medical imaging. In this paper, a distributed version on parallel hybrid architecture is proposed to solve the computation time problem and a new method to compute the filters' coefficients is also proposed, where we focused on the implementation and the enhancement of filters' parameters via taking the neighborhood of the current voxel more accurately into account. In terms of implementation, our key contribution consists in reducing the number of shared memory accesses. The different tests of the proposed method were performed on the brain-web database for different levels of noise. Performances and the sensitivity were quantified in terms of speedup, peak signal to noise ratio, execution time, the number of floating point operations. The obtained results demonstrate the efficiency of the proposed method. Moreover, the implementation is compared to that of other techniques, recently published in the literature. PMID:27084318

  8. Medical image denoising via optimal implementation of non-local means on hybrid parallel architecture.

    PubMed

    Nguyen, Tuan-Anh; Nakib, Amir; Nguyen, Huy-Nam

    2016-06-01

    The Non-local means denoising filter has been established as gold standard for image denoising problem in general and particularly in medical imaging due to its efficiency. However, its computation time limited its applications in real world application, especially in medical imaging. In this paper, a distributed version on parallel hybrid architecture is proposed to solve the computation time problem and a new method to compute the filters' coefficients is also proposed, where we focused on the implementation and the enhancement of filters' parameters via taking the neighborhood of the current voxel more accurately into account. In terms of implementation, our key contribution consists in reducing the number of shared memory accesses. The different tests of the proposed method were performed on the brain-web database for different levels of noise. Performances and the sensitivity were quantified in terms of speedup, peak signal to noise ratio, execution time, the number of floating point operations. The obtained results demonstrate the efficiency of the proposed method. Moreover, the implementation is compared to that of other techniques, recently published in the literature.

  9. Medication Related Osteonecrosis of the Jaw: 2015 Position Statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons

    PubMed Central

    Kim, Kyoung Min; Rhee, Yumie; Kwon, Yong-Dae; Kwon, Tae-Geon; Lee, Jeong Keun

    2015-01-01

    Bisphosphonates are the most widely prescribed drugs for the treatment of osteoporosis, and are also used in malignant bone metastases, multiple myeloma, and Paget's disease, and provide therapeutic efficacy on those diseases. However, it was reported that occurrence of osteonecrosis of the jaw (ONJ) could be related with bisphosphonate exposures, and there have been many cases regarding this issue. Therefore, a clearer definition and treatment guidelines were needed for this disease. The American Society for Bone and Mineral Research (ASBMR) and American Association of Oral and Maxillofacial Surgeons (AAOMS) reported statements on bisphosphonate-related ONJ (BRONJ), and a revised version was recently presented. In the revised edition, the diagnosis BRONJ was changed to medication-related ONJ (MRONJ), which reflects a consideration of the fact that ONJ also occurs for denosumab, a bone resorption inhibitor of the receptor activator of nuclear factor-kappa B ligand (RANKL) antibody family, and bevacizumab, an anti-angiogenesis inhibitor. In 2009, a statement on ONJ was also reported locally by a relevant organization, which has served as basis for clinical treatment in Korea. In addition to the new official stance of the AAOMS and ASBMR, with an increasing pool of ONJ clinical experience, a revised version of the 2009 local statement is needed. As such, the Korean Society for Bone and Mineral Research (KSBMR) and the Korean Association of Oral and Maxillofacial Surgeons (KAOMS) have collectively formed a committee for the preparation of an official statement on MRONJ, and have reviewed recent local and international data to propose guidelines customized for the local Korean situation. PMID:26713306

  10. Oral sex and oral health: An enigma in itself.

    PubMed

    Kumar, Tarun; Puri, Gagan; Aravinda, Konidena; Arora, Neha; Patil, Deepa; Gupta, Rajesh

    2015-01-01

    Oral sex is commonly practiced by sexually active couples of various age groups, including male-female and same-gender adolescents. The various type of oral sex practices are fellatio, cunnilingus, and analingus. Oral sex can transmit oral, respiratory, and genital infections from one site in body to the other. Oral health has a direct correlation on the transmission of infection; a cut in the mouth, bleeding gums, lip sores or broken skin increases chances of life-threatening infections. Although oral sex is considered a low risk activity, it is important to use protection such as physical barriers, health and medical issues, ethical issues, and oral hygiene and dental issues. The ulcerations or unhealthy periodontium in mouth accelerates the phenomenon of transmission of infections into the circulation. Thus, consequences of unhealthy or painful oral cavity are significant and oral health should be given paramount importance for the practice of oral sex. PMID:26692602

  11. Oral sex and oral health: An enigma in itself.

    PubMed

    Kumar, Tarun; Puri, Gagan; Aravinda, Konidena; Arora, Neha; Patil, Deepa; Gupta, Rajesh

    2015-01-01

    Oral sex is commonly practiced by sexually active couples of various age groups, including male-female and same-gender adolescents. The various type of oral sex practices are fellatio, cunnilingus, and analingus. Oral sex can transmit oral, respiratory, and genital infections from one site in body to the other. Oral health has a direct correlation on the transmission of infection; a cut in the mouth, bleeding gums, lip sores or broken skin increases chances of life-threatening infections. Although oral sex is considered a low risk activity, it is important to use protection such as physical barriers, health and medical issues, ethical issues, and oral hygiene and dental issues. The ulcerations or unhealthy periodontium in mouth accelerates the phenomenon of transmission of infections into the circulation. Thus, consequences of unhealthy or painful oral cavity are significant and oral health should be given paramount importance for the practice of oral sex.

  12. 'Ins' and 'outs' of triple therapy: Optimal antiplatelet therapy in patients on chronic oral anticoagulation who need coronary stenting.

    PubMed

    Dewilde, W; Verheugt, F W A; Breet, N; Koolen, J J; Ten Berg, J M

    2010-09-01

    Chronic oral anticoagulant treatment is obligatory in patients (class I) with mechanical heart valves and in patients with atrial fibrillation with CHADS2 score >1. When these patients undergo percutaneous coronary intervention with placement of a stent, there is also an indication for treatment with aspirin and clopidogrel. Unfortunately, triple therapy is known to increase the bleeding risk. For this group of patients, the bottom line is to find the ideal therapy in patients with indications for both chronic anticoagulation therapy and percutaneous intervention to prevent thromboembolic complications such as stent thrombosis without increasing the risk of bleeding. (Neth Heart J 2010;18:444-50.).

  13. Optimism

    PubMed Central

    Carver, Charles S.; Scheier, Michael F.; Segerstrom, Suzanne C.

    2010-01-01

    Optimism is an individual difference variable that reflects the extent to which people hold generalized favorable expectancies for their future. Higher levels of optimism have been related prospectively to better subjective well-being in times of adversity or difficulty (i.e., controlling for previous well-being). Consistent with such findings, optimism has been linked to higher levels of engagement coping and lower levels of avoidance, or disengagement, coping. There is evidence that optimism is associated with taking proactive steps to protect one's health, whereas pessimism is associated with health-damaging behaviors. Consistent with such findings, optimism is also related to indicators of better physical health. The energetic, task-focused approach that optimists take to goals also relates to benefits in the socioeconomic world. Some evidence suggests that optimism relates to more persistence in educational efforts and to higher later income. Optimists also appear to fare better than pessimists in relationships. Although there are instances in which optimism fails to convey an advantage, and instances in which it may convey a disadvantage, those instances are relatively rare. In sum, the behavioral patterns of optimists appear to provide models of living for others to learn from. PMID:20170998

  14. New strategies for medical data mining, part 3: automated workflow analysis and optimization.

    PubMed

    Reiner, Bruce

    2011-02-01

    The practice of evidence-based medicine calls for the creation of "best practice" guidelines, leading to improved clinical outcomes. One of the primary factors limiting evidence-based medicine in radiology today is the relative paucity of standardized databases. The creation of standardized medical imaging databases offer the potential to enhance radiologist workflow and diagnostic accuracy through objective data-driven analytics, which can be categorized in accordance with specific variables relating to the individual examination, patient, provider, and technology being used. In addition to this "global" database analysis, "individual" radiologist workflow can be analyzed through the integration of electronic auditing tools into the PACS. The combination of these individual and global analyses can ultimately identify best practice patterns, which can be adapted to the individual attributes of end users and ultimately used in the creation of automated evidence-based medicine workflow templates.

  15. Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson's disease: Consensus from an international survey and discussion program.

    PubMed

    Odin, P; Ray Chaudhuri, K; Slevin, J T; Volkmann, J; Dietrichs, E; Martinez-Martin, P; Krauss, J K; Henriksen, T; Katzenschlager, R; Antonini, A; Rascol, O; Poewe, W

    2015-10-01

    Navigate PD was an educational program established to supplement existing guidelines and provide recommendations on the management of Parkinson's disease (PD) refractory to oral/transdermal therapies. It involved 103 experts from 13 countries overseen by an International Steering Committee (ISC) of 13 movement disorder specialists. The ISC identified 71 clinical questions important for device-aided management of PD. Fifty-six experts responded to a web-based survey, rating 15 questions as 'critically important;' these were refined to 10 questions by the ISC to be addressed through available evidence and expert opinion. Draft guidance was presented at international/national meetings and revised based on feedback. Key take-home points are: • Patients requiring levodopa >5 times daily who have severe, troublesome 'off' periods (>1-2 h/day) despite optimal oral/transdermal levodopa or non-levodopa-based therapies should be referred for specialist assessment even if disease duration is <4 years. • Cognitive decline related to non-motor fluctuations is an indication for device-aided therapies. If cognitive impairment is mild, use deep brain stimulation (DBS) with caution. For patients who have cognitive impairment or dementia, intrajejunal levodopa infusion is considered as both therapeutic and palliative in some countries. Falls are linked to cognitive decline and are likely to become more frequent with device-aided therapies. • Insufficient control of motor complications (or drug-resistant tremor in the case of DBS) are indications for device-aided therapies. Levodopa-carbidopa intestinal gel infusions or subcutaneous apomorphine pump may be considered for patients aged >70 years who have mild or moderate cognitive impairment, severe depression or other contraindications to DBS. PMID:26233582

  16. 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.

  17. Optimized oral cholera vaccine distribution strategies to minimize disease incidence: A mixed integer programming model and analysis of a Bangladesh scenario.

    PubMed

    Smalley, Hannah K; Keskinocak, Pinar; Swann, Julie; Hinman, Alan

    2015-11-17

    In addition to improved sanitation, hygiene, and better access to safe water, oral cholera vaccines can help to control the spread of cholera in the short term. However, there is currently no systematic method for determining the best allocation of oral cholera vaccines to minimize disease incidence in a population where the disease is endemic and resources are limited. We present a mathematical model for optimally allocating vaccines in a region under varying levels of demographic and incidence data availability. The model addresses the questions of where, when, and how many doses of vaccines to send. Considering vaccine efficacies (which may vary based on age and the number of years since vaccination), we analyze distribution strategies which allocate vaccines over multiple years. Results indicate that, given appropriate surveillance data, targeting age groups and regions with the highest disease incidence should be the first priority, followed by other groups primarily in order of disease incidence, as this approach is the most life-saving and cost-effective. A lack of detailed incidence data results in distribution strategies which are not cost-effective and can lead to thousands more deaths from the disease. The mathematical model allows for what-if analysis for various vaccine distribution strategies by providing the ability to easily vary parameters such as numbers and sizes of regions and age groups, risk levels, vaccine price, vaccine efficacy, production capacity and budget.

  18. Computer-Assisted Optimization of Electrodeposited Hydroxyapatite Coating Parameters on Medical Alloys

    NASA Astrophysics Data System (ADS)

    Coşkun, M. İbrahim; Karahan, İsmail H.; Yücel, Yasin; Golden, Teresa D.

    2016-04-01

    CoCrMo bio-metallic alloys were coated with a hydroxyapatite (HA) film by electrodeposition using various electrochemical parameters. Response surface methodology and central composite design were used to optimize deposition parameters such as electrolyte pH, deposition potential, and deposition time. The effects of the coating parameters were evaluated within the limits of solution pH (3.66 to 5.34), deposition potential (-1.13 to -1.97 V), and deposition time (6.36 to 73.64 minutes). A 5-level-3-factor experimental plan was used to determine ideal deposition parameters. Optimum conditions for the deposition parameters of the HA coating with high in vitro corrosion performance were determined as electrolyte pH of 5.00, deposition potential of -1.8 V, and deposition time of 20 minutes.

  19. Nitrogen Separation and Liquefaction Apparatus for Medical Applications and Its Thermodynamic Optimization

    NASA Astrophysics Data System (ADS)

    Chorowski, M.; Piotrowska, A.; Polinski, J.

    2006-04-01

    Low temperature medicine is becoming a widely appreciated method in surgery, dermatology, gynecology and rheumatology. The cryomedical equipment is usually supplied with liquid nitrogen LN2 stored in a dewar and transferred to a tip, where it is evaporated providing a cooling power. LN2 in quantities sufficient for cryo-surgical and cryo-therapeutical applications can be first separated from air and then liquefied using a system combining polymer membrane gas separation technology and a Joule-Thomson closed-cycle refrigerator filled with a nitrogen-hydrocarbons gas mixture. Nitrogen is separated from the compressed air, then liquefied and throttled to atmospheric pressure. The paper analyzes the demanded cooling capacity of the system resulting from cryomedical treatment requirements. Thermal design and flow scheme of the apparatus are given. The system is thermodynamically optimized.

  20. Infant oral health and oral habits.

    PubMed

    Nowak, A J; Warren, J J

    2000-10-01

    Many oral diseases and conditions, including dental caries (cavities) and malocclusions, have their origins early in life. Prudent anticipatory guidance by the medical and dental professions can help prevent many of the more common oral health problems. This article provides information on the rationale for early dental examination and instructions for pediatric and family practitioners in scheduling and conducting an early oral intervention appointment. In addition, feeding practices, non-nutritive sucking, mouth breathing, and bruxing are discussed, including their effects on orofacial growth and development.

  1. 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.

  2. Optimization and Use of 3D sintered porous material in medical field for mixing fibrin glue.

    NASA Astrophysics Data System (ADS)

    Delmotte, Y.; Laroumanie, H.; Brossard, G.

    2012-04-01

    In medical field, Mixing of two or more chemical components (liquids and/or gases) is extremely important as improper mixing can affect the physico-chemical properties of the final product. At Baxter Healthcare Corporation, we are using a sintered porous material (PM) as a micro-mixer in medical device for mixing Fibrinogen and Thrombin in order to obtain a homogeneous polymerized Fibrin glue clot used in surgery. First trials were carried out with an interconnected PM from Porvair® (made of PE - porosity: 40% - permeability: 18Darcy). The injection rate is very low, usually about 10mL/min (Re number about 50) which keeps fluids in a laminar flow. Such a low flow rate does not favour mixing of fluids having gradient of viscosity if a mixer is not used. Promising results that were obtained lead the team to understand this ability to mix fluids which will be presented in the poster. Topology of porous media (PM) which associates a solid phase with interconnected (or not) porous structure is known and used in many commodity products. Researches on PM usually focus on flows inside this structure. By opposition to transport and filtration capacity, as well as mechanic and thermic properties, mixing is rarely associated with PM. However over the past few years, we shown that some type of PM have a real capacity to mix certain fluids. Poster will also describe the problematic of mixing complex biological fluids as fibrinogen and Thrombin. They indeed present a large viscosity difference (ratio about 120) limiting the diffusion and the interaction between the two solutions. As those products are expensive, we used Water (1cPo) and Glycerol 87% (120cPo) which are matching the viscosities of Thrombin and Fibrinogen. A parametric investigation of the "porous micro-mixer" as well as a scale up investigation was carried out to examine the influence of both diffusion and advection to successful mix fluids of different viscosity. Experiments were implemented with Planar Laser

  3. Teleconferencing: Cost optimization of satellite and ground systems for continuing progressional education and medical services

    NASA Technical Reports Server (NTRS)

    Dunn, D.; Lusignan, B.

    1972-01-01

    A set of analytical capabilities that are needed to assess the role satellite communications technology will play in public and other services was developed. It is user oriented in that it starts from descriptions of user demand and develops the ability to estimate the cost of satisfying that demand with the lowest cost communications system. To ensure that the analysis could cope with the complexities of the real users, two services were chosen as examples, continuing professional education and medical services. Telecommunications costs are effected greatly by demographic factors, involving distribution of users in urban areas and distances between towns in rural regions. For this reason the analytical tools were exercised on sample locations. San Jose, California and Denver, Colorado were used to represent an urban area and the Rocky Mountain states were used to represent a rural region. In assessing the range of satellite system costs, two example coverage areas were considered, one appropriate to cover the contiguous forty-eight states, a second appropriate to cover about one-third that area.

  4. [Attention-deficit hyperactivity disorder: determination of the optimal medical treatment duration].

    PubMed

    Zavadenko, N N; Suvorinova, N Iu

    2011-01-01

    Thirty-two patients with attention-deficit hyperactivity disorder (ADHD), 23 boys and 9 girls, aged 6-12 years, were examined in two months intervals during the long-term treatment (up to 6-8 months) with pantogam (homopantothenic acid) in daily dosages of 500-1000 mg. The treatment results were evaluated by the ADHD Rating Scale-DSM-IV and The Weiss Functional Impairment Rating Scale - Parent Report (WFIRS-P). While the core symptoms of ADHD were according ADHD-DSM-IV diminished after 2 months, the improvement of WFIRS-P parameters required the longer duration of medical treatment. Only after 4 months of treatment, the improvement was achieved in selfesteem and social activities, and after 6 months in learning and behavior at school as well as in the level of life skills along with the decrease of risky activities. Thus, getting over psychosocial adaptation problems needs the longer treatment duration than the decrease of ADHD core symptoms. PMID:22500309

  5. Boronic acid-containing aminopyridine- and aminopyrimidinecarboxamide CXCR1/2 antagonists: Optimization of aqueous solubility and oral bioavailability.

    PubMed

    Schuler, Aaron D; Engles, Courtney A; Maeda, Dean Y; Quinn, Mark T; Kirpotina, Liliya N; Wicomb, Winston N; Mason, S Nicholas; Auten, Richard L; Zebala, John A

    2015-09-15

    The chemokine receptors CXCR1 and CXCR2 are important pharmaceutical targets due to their key roles in inflammatory diseases and cancer progression. We have previously identified 2-[5-(4-fluoro-phenylcarbamoyl)-pyridin-2-ylsulfanylmethyl]-phenylboronic acid (SX-517) and 6-(2-boronic acid-5-trifluoromethoxy-benzylsulfanyl)-N-(4-fluoro-phenyl)-nicotinamide (SX-576) as potent non-competitive boronic acid-containing CXCR1/2 antagonists. Herein we report the synthesis and evaluation of aminopyridine and aminopyrimidine analogs of SX-517 and SX-576, identifying (2-{(benzyl)[(5-boronic acid-2-pyridyl)methyl]amino}-5-pyrimidinyl)(4-fluorophenylamino)formaldehyde as a potent chemokine antagonist with improved aqueous solubility and oral bioavailability.

  6. The optimal management of patients on oral anticoagulation undergoing coronary artery stenting. The 10th Anniversary Overview.

    PubMed

    Rubboli, A; Faxon, D P; Juhani Airaksinen, K E; Schlitt, A; Marín, F; Bhatt, D L; Lip, G Y H

    2014-12-01

    Even 10 years after the first appearance in the literature of articles reporting on the management of patients on oral anticoagulation (OAC) undergoing percutaneous coronary intervention with stent (PCI-S), this issue is still controversial. Nonetheless, some guidance for the everyday management of this patient subset, accounting for about 5-8 % of all patients referred for PCI-S, has been developed. In general, a period of triple therapy (TT) of OAC, with either vitamin K-antagonists (VKA) or non-vitamin K-antagonist oral anticoagulants (NOAC), aspirin, and clopidogrel is warranted, followed by the combination of OAC, and a single antiplatelet agent for up to 12 months, and then OAC alone. The duration of the initial period of TT is dependent on the individual risk of thromboembolism, and bleeding, as well as the clinical context in which PCI-S is performed (elective vs acute coronary syndrome), and the type of stent implanted (bare-metal vs drug-eluting). In this article, we aim to provide a comprehensive, at-a-glance, overview of the management strategies, which are currently suggested for the peri-procedural, medium-term, and long-term periods following PCI-S in OAC patients. While acknowledging that most of the evidence has been obtained from patients on OAC because of atrial fibrillation, and with warfarin being the most frequently used VKA, we refer in this overview to the whole population of OAC patients undergoing PCI-S. We refer to the whole population of patients on OAC undergoing PCI-S also when OAC is carried out with NOAC rather than VKA, pointing out, when appropriate, the particular management issues.

  7. Role of topical drugs in treatment of oral mucosal diseases. A literature review.

    PubMed

    Sheikh, Soheyl; Gupta, Deepak; Pallagatti, Shambulingappa; Singla, Isha; Gupta, Rajesh; Goel, Varun

    2013-11-01

    Few topical formulations have been designed specifically to treat oral mucosal diseases. Local drug delivery may provide a more targeted and efficient option than systemic delivery for diseases of the oral mucosa. The permeability to the topical drugs differs according to the thickness of the epithelium and the extent of keratinization. The loss of the permeability barrier in the oral mucosa, due to ulceration or erosion, leads to rapid diffusion of the drug into tissues as compared to the intact areas of the mucosa. Oral mucosal delivery has the potential to treat many different conditions and diseases, such as oral cancer, mucositis, lichen planus, herpes simplex, candidiasis, recurrent aphthous stomatitis, vesiculo-bullous diseases, neuropathic pain and salivary dysfunction. Each therapy requires distinct penetration and drug retention profiles in order to optimize treatment and minimize side effects. In this paper, topical medications are discussed, as these are advantageous for the treatment of oral mucosal lesions with fewer side effects.

  8. [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

  9. An optimal painless treatment for early hemorrhoids; our experience in Government Medical College and Hospital

    PubMed Central

    Singal, R; Gupta, S; Dalal, AK; Dalal, U; Attri, AK

    2013-01-01

    Objective - To evaluate the efficacy of Infrared Coagulation Therapy (IRC) for hemorrhoids. IRC is a painless, safe and successful procedure. Place and duration of study - Department of Surgery, Government Medical College and Hospital, Sector-32, Chandigarh, India, from August 2006 to October 2008. The choice of procedure depends on the patient's symptoms, the extent of the hemorrhoidal disease, and the experience of the surgeon along with the availability of the techniques/instruments. Materials and methods - This is a prospective study done from August 2006 to October 2008. Total number of 155 patients was included in the study. Infrared Coagulation Therapy (IRC) was performed through a special designed proctoscope. Patients excluded were with coagulopathy disorders, fissure in ano, and anal ulcers. Results - It is an outpatient Department (OPD), non-surgical, ambulatory, painless and bloodless procedure, without any hospital stay. Early recovery and minimal recurrence of hemorrhoids were noted without any morbidity or mortality. We have studied 155 patients, treated with IRC on OPD basis. Surgery was required in few patients in whom IRC failed or was contraindicated. Out of the total 155 patients, 127 came for follow up. After the 1st sitting of IRC therapy: out of 127; 43 patients got a total relief, mass shrinkage was of > 75% in 57 cases and < 50% in 14 cases. Twenty-eight cases did not come for follow-up. In the 2nd sitting, out of 84/127; 58 patients got a total relief, >75% relief in 15 cases and >50 % relief in 11 patients. In the 3rd sitting out of 26/84 cases: 13 cases got a total relief and 13 cases refused to take the third sitting; however, in 7 cases the hemorrhoidal mass shrank up to 50% after the two sittings. These 14 were operated as there was no relief from bleeding after giving two sittings of IRC. Our opinion is that, in the above 14 cases, the patient might have not followed the instructions properly for dietary habits. Conclusion - IRC is a

  10. Alendronate Sodium as Enteric Coated Solid Lipid Nanoparticles; Preparation, Optimization, and In Vivo Evaluation to Enhance Its Oral Bioavailability

    PubMed Central

    Hosny, Khaled Mohamed

    2016-01-01

    Treatment of osteoporosis with alendronate sodium has several challenges. The first challenge is the low bioavailability. The second main challenge is side effects, which include oesophageal ulceration. The aim of this research was to reformulate alendronate sodium as enteric coated solid lipid nanoparticles in order to enhance its bioavailability, and preventing the free alendronate sodium from coming into direct contact with the gastrointestinal mucosa, and thereby reducing the possibility of side effects. Enteric coated solid lipid nanoparticles were prepared according to the Box-Behnken design employing Design expert® software, and characterized for size, morphology, and entrapment efficiency. The optimized formula was coated with an Eudragit S100 and evaluated for drug release in acidic and basic media, stability studies and pharmacokinetic evaluations on rabbits. The results indicated that, using Derringer's desirability functional tool for optimization, the highest entrapment efficiency value of 74.3% and the smallest size value of 98 nm were predicted under optimum conditions with a desirability value of 0.917. The optimized nanoparticles released alendronate sodium only at an alkaline pH. The pharmacokinetic evaluation revealed that alendronate sodium bioavailability was enhanced by more than 7.4-fold in rabbits. In conclusion, enteric coated solid lipid nanoparticles is a promising formula for the delivery of alendronate sodium, eliminating its oesophageal side effects and enhancing its bioavailability. PMID:27148747

  11. Alginate coated chitosan microparticles mediated oral delivery of diphtheria toxoid. Part A. Systematic optimization, development and characterization.

    PubMed

    Shukla, Anshuman; Mishra, Vijay; Bhoop, Bhupinder Singh; Katare, Om Prakash

    2015-11-10

    The current study was embarked upon to develop "optimized" alginate coated chitosan microparticles (ACMs) loaded with Diphtheria toxoid (DTx) employing formulation by design approach. The developed system was characterized for particle size, zeta potential, surface morphology, acidic degradation protection studies, in process stability studies, storage stability studies and in-vivo uptake studies. Microparticles with minimum of average size of 5 μm (PDI, 0.184) were chosen after optimizing the composition and process conditions. The optimized chitosan microparticles were subjected to alginate coating for better protection of loaded antigen till it reached to uptake site i.e. M cells in the Peyer's patches (PPs) and transport of higher amount antigen to the PPs. The zeta-potential values for uncoated chitosan microparticles and ACMs were found to be +29 ± 3.3 mV and -32.6 ± 4.2 mV, respectively. This change of zeta potential, for uncoated to coated, can be explained by the fact that the coating of alginate on chitosan microparticles led to negative side of the zeta potential by virtue of its predominance on the surface. The developed ACMs were able to transport the antigen effectively to the M cell as revealed by confocal laser scanning microscopy. Further, DTx-loaded ACMs demonstrated significant immune responses at serum IgG as well as mucosal sIgA level. PMID:26319633

  12. Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012.

    PubMed

    Hess, Paul L; Mirro, Michael J; Diener, Hans-Christoph; Eikelboom, John W; Al-Khatib, Sana M; Hylek, Elaine M; Bosworth, Hayden B; Gersh, Bernard J; Singer, Daniel E; Flaker, Greg; Mega, Jessica L; Peterson, Eric D; Rumsfeld, John S; Steinberg, Benjamin A; Kakkar, Ajay K; Califf, Robert M; Granger, Christopher B

    2014-09-01

    Approximately half of patients with atrial fibrillation and with risk factors for stroke are not treated with oral anticoagulation (OAC), whether it be with vitamin K antagonists (VKAs) or novel OACs (NOACs); and of those treated, many discontinue treatment. Leaders from academia, government, industry, and professional societies convened in Washington, DC, on December 3-4, 2012, to identify barriers to optimal OAC use and adherence and to generate potential solutions. Participants identified a broad range of barriers, including knowledge gaps about stroke risk and the relative risks and benefits of anticoagulant therapies; lack of awareness regarding the potential use of NOAC agents for VKA-unsuitable patients; lack of recognition of expanded eligibility for OAC; lack of availability of reversal agents and the difficulty of anticoagulant effect monitoring for the NOACs; concerns with the bleeding risk of anticoagulant therapy, especially with the NOACs and particularly in the setting of dual antiplatelet therapy; suboptimal time in therapeutic range for VKA; and costs and insurance coverage. Proposed solutions were to define reasons for oral anticoagulant underuse classified in ways that can guide intervention and improve use, to increase awareness of stroke risk as well as the benefits and risks of OAC use via educational initiatives and feedback mechanisms, to better define the role of VKA in the current therapeutic era including eligibility and ineligibility for different anticoagulant therapies, to identify NOAC reversal agents and monitoring strategies and make knowledge regarding their use publicly available, to minimize the duration of dual antiplatelet therapy and concomitant OAC where possible, to improve time in therapeutic range for VKA, to leverage observational data sets to refine understanding of OAC use and outcomes in general practice, and to better align health system incentives. PMID:25173533

  13. Effect of two starting insulin regimens in patients with type II diabetes not controlled on a combination of oral antihyperglycemic medications.

    PubMed

    Milicevic, Z; Hancu, N; Car, N; Ivanyi, T; Schwarzenhofer, M; Jermendy, G

    2009-05-01

    In an open-label, 24-week, parallel-group study, 135 patients inadequately controlled with oral antihyperglycemic medications (OAMs) were treated with maximally tolerated doses of metformin and glibenclamide for at least 8 weeks and then randomized to bedtime neutral protamine Hagedorn (NPH) insulin plus maximally tolerated dose of glibenclamide BID (glib/NPH group) or insulin lispro mix 50 (50% lispro, 50% insulin lispro protamine suspension [ILPS]) pre-breakfast and lispro mix 25 (25% lispro, 75% ILPS) pre-dinner (LM50/LM25 group) (both OAMs discontinued). The LM50/LM25 group had significantly lower 2-hour postprandial BG (both meals combined) compared with glib/NPH after 12 (11.70+/-3.40 mmol/L vs. 13.15+/-2.44 mmol/L, p=0.010) and 24 weeks (11.13+/-3.31 mmol/L vs. 14.46+/-2.93 mmol/L, p =0.0001). Both regimens significantly decreased HbA1c. The reduction was greater with LM50/LM25 (-1.31+/-2% vs. -0.5+/-1.6%; P=0.01). At endpoint, the overall hypoglycemia rate increased with LM50/LM25 and decreased with glib/NPH compared with baseline (0.22+/-0.9 vs. -0.08+/-0.72 episodes/patient/30 days; p =0.037). Treatment with LM50/LM25 compared with glib/NPH in patients with inadequate control on combined OAMs yielded better postprandial and overall glycemic control with a higher rate of hypoglycemia.

  14. Protection of beagle dogs from mucosal challenge with canine oral papillomavirus by immunization with recombinant adenoviruses expressing codon-optimized early genes.

    PubMed

    Johnston, Kimberly B; Monteiro, Juanita M; Schultz, Loren D; Chen, Ling; Wang, Fubao; Ausensi, Virginia A; Dell, Elayne C; Santos, Elmer B; Moore, Richard A; Palker, Thomas J; Stanley, Margaret A; Jansen, Kathrin U

    2005-06-01

    Replication-deficient adenoviral (rAd5) vaccines containing codon-optimized E1, E2, E4, and E7 genes of canine oral papillomavirus (COPV) were tested singly or in combination to determine which vaccines could protect against mucosal challenge with COPV. In three studies, groups of 4-6 beagle dogs were immunized subcutaneously (s.c.) with 10(11) rAd5 at 8-10 weeks and 4-6 weeks prior to challenge with infectious COPV particles at multiple oral mucosal sites. Control dogs were immunized with equivalent doses of rAd5 expressing human papillomavirus (HPV) type 16 L1 (rAd5-HPV-16 L1). In the first study, complete protection from COPV-induced papillomas was achieved by immunization with rAd5 vaccine combinations expressing either E1 + E2 or E1 + E2 + E4 + E7; whereas two of six dogs immunized with rAd5-E4 + rAd5-E7 and six of six rAd5-HPV16-L1-immunized control dogs developed oral papillomas. In two subsequent studies, rAd5-E1 and rAd5-E2 vaccines were tested singly or in combination to assess levels of protective immunity to COPV challenge. Subcutaneous immunization with either one or two doses of rAd5 expressing the COPV E1 and E2 genes could protect > 90% of challenged dogs from wart formation. In contrast, all eight dogs immunized with rAd5-HPV-16 L1 developed papillomas at multiple sites. Protection was accompanied by significant IFN-gamma responses to COPV E1 and E2 peptides. Partial protection was conferred by two immunizations with either rAd5-E1 (6 of 9 protected) or rAd5-E2 (8 of 9 protected). These data indicate that rAd5 expressing papillomavirus E1 and E2 proteins can induce strong protective responses even in outbred populations under practical immunization conditions. PMID:15892962

  15. Peri-procedural management of patients taking oral anticoagulants.

    PubMed

    Daniels, Paul R

    2015-07-14

    The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking. Existing data suggest that the use of bridging therapy may increase the risk of bleeding for some patients without reducing the risk of thrombosis. Clinical trials are currently under way to answer these questions. Because the half lives and time to anticoagulant activity of newer oral anticoagulants are shorter than for warfarin, bridging therapy is not thought to be necessary with these agents. Peri-procedural management of patients taking these agents is complicated by the lack of demonstrated reversal agents in emergency situations, although specific antidotes are being developed and tested. Existing guidelines for peri-procedural management of patients on oral anticoagulants highlight the importance of individualized patient decision making and suggest strategies to minimize complications. From a patient's perspective, given the uncertainties surrounding optimal management, explicit discussions regarding risks and benefits of treatment options and demonstration of effective communication among medical and surgical providers are essential.

  16. Medical marijuana.

    PubMed

    1999-04-30

    The Florida Supreme Court heard oral arguments in April regarding a glaucoma patient's request for a medical exception to the State prohibition on use of marijuana. [Name removed] was convicted on possession and cultivation charges, and a trial judge refused to allow a medical necessity defense. A State appeals court subsequently overturned [name removed]'s conviction. The case focuses on whether the legislature intended to prohibit such a defense when it declared in 1993 that the substance had no medicinal benefits.

  17. Medical Care in a Free Clinic: A Comprehensive Evaluation of Patient Experience, Incentives, and Barriers to Optimal Medical Care with Consideration of a Facility Fee

    PubMed Central

    Liu, Xinwei; Nash, Bee; Sullivan, Sara; Garris, Stephanie; Hardy, Marvin; Lee, Michael; Simms-Cendan, Judith; Pasarica, Magdalena

    2016-01-01

    Free and charitable clinics are important contributors to the health of the United States population. Recently, funding for these clinics has been declining, and it is, therefore, useful to identify what qualities patients value the most in clinics in an effort to allocate funding wisely. In order to identify targets and incentives for improvement of patients’ health, we performed a comprehensive analysis of patients’ experience at a free clinic by analyzing a patient survey (N=94). The survey also assessed patient opinions of a small facility fee, which could be used to offset the decrease in funds. Interestingly, our patients believed it is appropriate to be charged a facility fee (78%) because it increases involvement in their care (r = 0.69, p < 0.001) and self-respect (r = 0.66, p < 0.001). Incentives to medical care include continuity of care, faith-based care, having a patient medical provider partnership, and charging a facility fee. Barriers include affordable housing, transportation, medication, and accessible information. In order to improve medical care in the uninsured population, our study suggested that we need to: 1) offer continuity of medical care; 2) offer affordable preventive health screenings; 3) support affordable transportation, housing, and medications; and 4) consider including a facility fee. PMID:27014534

  18. Classification of Medical Datasets Using SVMs with Hybrid Evolutionary Algorithms Based on Endocrine-Based Particle Swarm Optimization and Artificial Bee Colony Algorithms.

    PubMed

    Lin, Kuan-Cheng; Hsieh, Yi-Hsiu

    2015-10-01

    The classification and analysis of data is an important issue in today's research. Selecting a suitable set of features makes it possible to classify an enormous quantity of data quickly and efficiently. Feature selection is generally viewed as a problem of feature subset selection, such as combination optimization problems. Evolutionary algorithms using random search methods have proven highly effective in obtaining solutions to problems of optimization in a diversity of applications. In this study, we developed a hybrid evolutionary algorithm based on endocrine-based particle swarm optimization (EPSO) and artificial bee colony (ABC) algorithms in conjunction with a support vector machine (SVM) for the selection of optimal feature subsets for the classification of datasets. The results of experiments using specific UCI medical datasets demonstrate that the accuracy of the proposed hybrid evolutionary algorithm is superior to that of basic PSO, EPSO and ABC algorithms, with regard to classification accuracy using subsets with a reduced number of features.

  19. Oral manifestations and dental management of a child with Zellweger syndrome.

    PubMed

    Lertsirivorakul, Jinda; Wongswadiwat, Malinee; Treesuwan, Panta

    2014-01-01

    Zellweger syndrome (ZS) is a rare autosomal recessive disorder, resulting from an impairment in peroxisome function. It is characterized by craniofacial dysmorphism and neurological abnormalities, and involves several systems, which may complicate dental and anesthesia management. The case of a 7-year-old girl diagnosed with ZS is described with emphasis on oral manifestations, oral rehabilitation under general anesthesia (GA), and home oral care. Apart from the unique features of ZS, she presented with clinodactyly, distinctive palatal vault, Class III malocclusion, missing teeth, microdontia, and delayed dental formation. Dental treatment under GA was conducted with concerns of risk of respiratory insufficiency. Oral home care by the parent and regular recall visits were essential to maintain good oral health. Children with ZS may survive into late childhood. They, however, present multiple health problems that are of special concern for not only the pediatric dentist but also the anesthesiologist. Collaboration with the medical team is essential for optimal care of these patients. PMID:24382371

  20. Oral manifestations and dental management of a child with Zellweger syndrome.

    PubMed

    Lertsirivorakul, Jinda; Wongswadiwat, Malinee; Treesuwan, Panta

    2014-01-01

    Zellweger syndrome (ZS) is a rare autosomal recessive disorder, resulting from an impairment in peroxisome function. It is characterized by craniofacial dysmorphism and neurological abnormalities, and involves several systems, which may complicate dental and anesthesia management. The case of a 7-year-old girl diagnosed with ZS is described with emphasis on oral manifestations, oral rehabilitation under general anesthesia (GA), and home oral care. Apart from the unique features of ZS, she presented with clinodactyly, distinctive palatal vault, Class III malocclusion, missing teeth, microdontia, and delayed dental formation. Dental treatment under GA was conducted with concerns of risk of respiratory insufficiency. Oral home care by the parent and regular recall visits were essential to maintain good oral health. Children with ZS may survive into late childhood. They, however, present multiple health problems that are of special concern for not only the pediatric dentist but also the anesthesiologist. Collaboration with the medical team is essential for optimal care of these patients.

  1. Tissue-engineered oral mucosa.

    PubMed

    Moharamzadeh, K; Colley, H; Murdoch, C; Hearnden, V; Chai, W L; Brook, I M; Thornhill, M H; Macneil, S

    2012-07-01

    Advances in tissue engineering have permitted the three-dimensional (3D) reconstruction of human oral mucosa for various in vivo and in vitro applications. Tissue-engineered oral mucosa have been further optimized in recent years for clinical applications as a suitable graft material for intra-oral and extra-oral repair and treatment of soft-tissue defects. Novel 3D in vitro models of oral diseases such as cancer, Candida, and bacterial invasion have been developed as alternatives to animal models for investigation of disease phenomena, their progression, and treatment, including evaluation of drug delivery systems. The introduction of 3D oral mucosal reconstructs has had a significant impact on the approaches to biocompatibility evaluation of dental materials and oral healthcare products as well as the study of implant-soft tissue interfaces. This review article discusses the recent advances in tissue engineering and applications of tissue-engineered human oral mucosa.

  2. Update on pediatric oral healthcare.

    PubMed

    Rizzolo, Denise; Bowser, Jonathan

    2016-08-01

    As part of the patient-centered medical home, clinicians are being asked to apply fluoride varnish and perform oral examinations in children. This article reviews the latest national recommendations for fluoride varnish use to prevent dental caries. PMID:27467301

  3. Cell-based medicinal chemistry optimization of high-throughput screening (HTS) hits for orally active antimalarials. Part 1: challenges in potency and absorption, distribution, metabolism, excretion/pharmacokinetics (ADME/PK).

    PubMed

    Chatterjee, Arnab K

    2013-10-24

    Malaria represents a significant health issue, and novel and effective drugs are needed to address parasite resistance that has emerged to the current drug arsenal. Antimalarial drug discovery has historically benefited from a whole-cell (phenotypic) screening approach to identify lead molecules. This approach has been utilized by several groups to optimize weakly active antimalarial pharmacophores, such as the quinolone scaffold, to yield potent and highly efficacious compounds that are now poised to enter clinical trials. More recently, GNF/Novartis, GSK, and others have employed the same approach in high-throughput screening (HTS) of large compound libraries to find novel scaffolds that have also been optimized to clinical candidates by GNF/Novartis. This perspective outlines some of the inherent challenges in cell-based medicinal chemistry optimization, including optimization of oral exposure and hERG activity.

  4. Pharmacokinetic modeling of penciclovir and BRL42359 in the plasma and tears of healthy cats to optimize dosage recommendations for oral administration of famciclovir.

    PubMed

    Sebbag, Lionel; Thomasy, Sara M; Woodward, Andrew P; Knych, Heather K; Maggs, David J

    2016-08-01

    OBJECTIVES To determine, following oral administration of famciclovir, pharmacokinetic (PK) parameters for 2 of its metabolites (penciclovir and BRL42359) in plasma and tears of healthy cats so that famciclovir dosage recommendations for the treatment of herpetic disease can be optimized. ANIMALS 7 male domestic shorthair cats. PROCEDURES In a crossover study, each of 3 doses of famciclovir (30, 40, or 90 mg/kg) was administered every 8 or 12 hours for 3 days. Six cats were randomly assigned to each dosage regimen. Plasma and tear samples were obtained at predetermined times after famciclovir administration. Pharmacokinetic parameters were determined for BRL42359 and penciclovir by compartmental and noncompartmental methods. Pharmacokinetic-pharmacodynamic (PK-PD) indices were determined for penciclovir and compared among all dosage regimens. RESULTS Compared with penciclovir concentrations, BRL42359 concentrations were 5- to 11-fold greater in plasma and 4- to 7-fold greater in tears. Pharmacokinetic parameters and PK-PD indices for the 90 mg/kg regimens were superior to those for the 30 and 40 mg/kg regimens, regardless of dosing frequency. Penciclovir concentrations in tears ranged from 18% to 25% of those in plasma. Administration of 30 or 40 mg/kg every 8 hours achieved penciclovir concentrations likely to be therapeutic in plasma but not in tears. Penciclovir concentrations likely to be therapeutic in tears were achieved only with the two 90 mg/kg regimens. CONCLUSIONS AND CLINICAL RELEVANCE In cats, famciclovir absorption is variable and its metabolism saturable. Conversion of BRL42359 to penciclovir is rate limiting. The recommended dosage of famciclovir is 90 mg/kg every 12 hours for cats infected with feline herpesvirus. PMID:27463546

  5. Addressing Barriers to Optimal Oral Anticoagulation Use and Persistence Among Patients with Atrial Fibrillation: Proceedings, Washington, DC, December 3–4, 2012

    PubMed Central

    Hess, Paul L.; Mirro, Michael J.; Diener, Hans-Christoph; Eikelboom, John W.; Al-Khatib, Sana M.; Hylek, Elaine M.; Bosworth, Hayden B.; Gersh, Bernard J.; Singer, Daniel E.; Flaker, Greg; Mega, Jessica L.; Peterson, Eric D.; Rumsfeld, John S.; Steinberg, Benjamin A.; Kakkar, Ajay K.; Califf, Robert M.; Granger, Christopher B.

    2014-01-01

    Approximately half of patients with atrial fibrillation (AF) and with risk factors for stroke are not treated with oral anticoagulation (OAC), whether it be with vitamin K antagonists (VKAs) or novel OACs (NOACs); and of those treated, many discontinue treatment. Leaders from academia, government, industry, and professional societies convened in Washington, DC, on December 3–4, 2012, to identify barriers to optimal OAC use and adherence and to generate potential solutions. Participants identified a broad range of barriers, including knowledge gaps about stroke risk and the relative risks and benefits of anticoagulant therapies; lack of awareness regarding the potential use of NOAC agents for VKA-unsuitable patients; lack of recognition of expanded eligibility for OAC; lack of availability of reversal agents and the difficulty of anticoagulant effect monitoring for the NOACs; concerns with the bleeding risk of anticoagulant therapy, especially with the NOACs and particularly in the setting of dual antiplatelet therapy; suboptimal time in therapeutic range for VKA; and costs and insurance coverage. Proposed solutions were to increase awareness of stroke risk as well as the benefits and risks of OAC use via educational initiatives and feedback mechanisms, to develop and disseminate shared decision-making tools, to better define the role of VKA in the current therapeutic era including eligibility and ineligibility for different anticoagulant therapies, to identify NOAC reversal agents and monitoring strategies and make knowledge regarding their use publicly available, to minimize the duration of dual antiplatelet therapy and concomitant OAC where possible, to improve time in therapeutic range for VKA, to leverage observational datasets to refine understanding of OAC use and outcomes in general practice, and to better align health system incentives. PMID:25173533

  6. Study on Optimization Method of Quantization Step and the Image Quality Evaluation for Medical Ultrasonic Echo Image Compression by Wavelet Transform

    NASA Astrophysics Data System (ADS)

    Khieovongphachanh, Vimontha; Hamamoto, Kazuhiko; Kondo, Shozo

    In this paper, we investigate optimized quantization method in JPEG2000 application for medical ultrasonic echo images. JPEG2000 has been issued as the new standard for image compression technique, which is based on Wavelet Transform (WT) and JPEG2000 incorporated into DICOM (Digital Imaging and Communications in Medicine). There are two quantization methods. One is the scalar derived quantization (SDQ), which is usually used in standard JPEG2000. The other is the scalar expounded quantization (SEQ), which can be optimized by user. Therefore, this paper is an optimization of quantization step, which is determined by Genetic Algorithm (GA). Then, the results are compared with SDQ and SEQ determined by arithmetic average method. The purpose of this paper is to improve image quality and compression ratio for medical ultrasonic echo images. The image quality is evaluated by objective assessment, PSNR (Peak Signal to Noise Ratio) and subjective assessment is evaluated by ultrasonographers from Tokai University Hospital and Tokai University Hachioji Hospital. The results show that SEQ determined by GA provides better image quality than SDQ and SEQ determined by arithmetic average method. Additionally, three optimization methods of quantization step apply to thin wire target image for analysis of point spread function.

  7. Enhancing Learning through Optimal Sequencing of Web-Based and Manikin Simulators to Teach Shock Physiology in the Medical Curriculum

    ERIC Educational Resources Information Center

    Cendan, Juan C.; Johnson, Teresa R.

    2011-01-01

    The Association of American Medical Colleges has encouraged educators to investigate proper linkage of simulation experiences with medical curricula. The authors aimed to determine if student knowledge and satisfaction differ between participation in web-based and manikin simulations for learning shock physiology and treatment and to determine if…

  8. [Oral ulcers].

    PubMed

    Bascones-Martínez, Antonio; Figuero-Ruiz, Elena; Esparza-Gómez, Germán Carlos

    2005-10-29

    Ulcers commonly occur in the oral cavity, their main symptom being pain. There are different ways to classify oral ulcers. The most widely accepted form divides them into acute ulcers--sudden onset and short lasting--and chronic ulcers--insidious onset and long lasting. Commonest acute oral ulcers include traumatic ulcer, recurrent aphthous stomatitis, viral and bacterial infections and necrotizing sialometaplasia. On the other hand, oral lichen planus, oral cancer, benign mucous membrane pemphigoid, pemphigus and drug-induced ulcers belong to the group of chronic oral ulcers. It is very important to make a proper differential diagnosis in order to establish the appropriate treatment for each pathology. PMID:16277953

  9. [Oral ulcers].

    PubMed

    Bascones-Martínez, Antonio; Figuero-Ruiz, Elena; Esparza-Gómez, Germán Carlos

    2005-10-29

    Ulcers commonly occur in the oral cavity, their main symptom being pain. There are different ways to classify oral ulcers. The most widely accepted form divides them into acute ulcers--sudden onset and short lasting--and chronic ulcers--insidious onset and long lasting. Commonest acute oral ulcers include traumatic ulcer, recurrent aphthous stomatitis, viral and bacterial infections and necrotizing sialometaplasia. On the other hand, oral lichen planus, oral cancer, benign mucous membrane pemphigoid, pemphigus and drug-induced ulcers belong to the group of chronic oral ulcers. It is very important to make a proper differential diagnosis in order to establish the appropriate treatment for each pathology.

  10. Oral cancer

    MedlinePlus

    Cancer - mouth; Mouth cancer; Head and neck cancer; Squamous cell cancer - mouth; Malignant neoplasm - oral ... Oral cancer most commonly involves the lips or the tongue. It may also occur on the: Cheek lining Floor ...

  11. Assessing Clinical Judgment Using Standardized Oral Examinations.

    ERIC Educational Resources Information Center

    Bashook, Philip

    This paper describes the use of oral examinations to assess the clinical judgment of aspiring physicians. Oral examinations have been used in U.S. medicine since 1917. Currently, 15 member boards of the American Board of Medical Specialties administer 17 different standardized oral examinations to approximately 10,000 physician candidates…

  12. Optimal Medical Equipment Maintenance Service Proposal Decision Support System combining Activity Based Costing (ABC) and the Analytic Hierarchy Process (AHP).

    PubMed

    da Rocha, Leticia; Sloane, Elliot; M Bassani, Jose

    2005-01-01

    This study describes a framework to support the choice of the maintenance service (in-house or third party contract) for each category of medical equipment based on: a) the real medical equipment maintenance management system currently used by the biomedical engineering group of the public health system of the Universidade Estadual de Campinas located in Brazil to control the medical equipment maintenance service, b) the Activity Based Costing (ABC) method, and c) the Analytic Hierarchy Process (AHP) method. Results show the cost and performance related to each type of maintenance service. Decision-makers can use these results to evaluate possible strategies for the categories of equipment.

  13. Optimal Medical Equipment Maintenance Service Proposal Decision Support System combining Activity Based Costing (ABC) and the Analytic Hierarchy Process (AHP).

    PubMed

    da Rocha, Leticia; Sloane, Elliot; M Bassani, Jose

    2005-01-01

    This study describes a framework to support the choice of the maintenance service (in-house or third party contract) for each category of medical equipment based on: a) the real medical equipment maintenance management system currently used by the biomedical engineering group of the public health system of the Universidade Estadual de Campinas located in Brazil to control the medical equipment maintenance service, b) the Activity Based Costing (ABC) method, and c) the Analytic Hierarchy Process (AHP) method. Results show the cost and performance related to each type of maintenance service. Decision-makers can use these results to evaluate possible strategies for the categories of equipment. PMID:17281912

  14. eMedOffice: A web-based collaborative serious game for teaching optimal design of a medical practice

    PubMed Central

    2012-01-01

    Background Preparing medical students for the takeover or the start-up of a medical practice is an important challenge in Germany today. Therefore, this paper presents a computer-aided serious game (eMedOffice) developed and currently in use at the RWTH Aachen University Medical School. The game is part of the attempt to teach medical students the organizational and conceptual basics of the medical practice of a general practitioner in a problem-based learning environment. This paper introduces methods and concepts used to develop the serious game and describes the results of an evaluation of the game's application in curricular courses at the Medical School. Results Results of the conducted evaluation gave evidence of a positive learning effect of the serious game. Educational supervisors observed strong collaboration among the players inspired by the competitive gaming aspects. In addition, an increase in willingness to learn and the exploration of new self-invented ideas were observed and valuable proposals for further prospective enhancements were elicited. A statistical analysis of the results of an evaluation provided a clear indication of the positive learning effect of the game. A usability questionnaire survey revealed a very good overall score of 4.07 (5=best, 1=worst). Conclusions We consider web-based, collaborative serious games to be a promising means of improving medical education. The insights gained by the implementation of eMedOffice will promote the future development of more effective serious games for integration into curricular courses of the RWTH Aachen University Medical School. PMID:23110606

  15. Optimization of Vertical Double-Diffused Metal-Oxide Semiconductor (VDMOS) Power Transistor Structure for Use in High Frequencies and Medical Devices.

    PubMed

    Farhadi, Rozita; Farhadi, Bita

    2014-01-01

    Power transistors, such as the vertical, double-diffused, metal-oxide semiconductor (VDMOS), are used extensively in the amplifier circuits of medical devices. The aim of this research was to construct a VDMOS power transistor with an optimized structure to enhance the operation of medical devices. First, boron was implanted in silicon by implanting unclamped inductive switching (UIS) and a Faraday shield. The Faraday shield was implanted in order to replace the gate-field parasitic capacitor on the entry part of the device. Also, implanting the UIS was used in order to decrease the effect of parasitic bipolar junction transistor (BJT) of the VDMOS power transistor. The research tool used in this study was Silvaco software. By decreasing the transistor entry resistance in the optimized VDMOS structure, power losses and noise at the entry of the transistor were decreased, and, by increasing the breakdown voltage, the lifetime of the VDMOS transistor lifetime was increased, which resulted in increasing drain flow and decreasing Ron. This consequently resulted in enhancing the operation of high-frequency medical devices that use transistors, such as Radio Frequency (RF) and electrocardiograph machines.

  16. Optimization of Vertical Double-Diffused Metal-Oxide Semiconductor (VDMOS) Power Transistor Structure for Use in High Frequencies and Medical Devices.

    PubMed

    Farhadi, Rozita; Farhadi, Bita

    2014-01-01

    Power transistors, such as the vertical, double-diffused, metal-oxide semiconductor (VDMOS), are used extensively in the amplifier circuits of medical devices. The aim of this research was to construct a VDMOS power transistor with an optimized structure to enhance the operation of medical devices. First, boron was implanted in silicon by implanting unclamped inductive switching (UIS) and a Faraday shield. The Faraday shield was implanted in order to replace the gate-field parasitic capacitor on the entry part of the device. Also, implanting the UIS was used in order to decrease the effect of parasitic bipolar junction transistor (BJT) of the VDMOS power transistor. The research tool used in this study was Silvaco software. By decreasing the transistor entry resistance in the optimized VDMOS structure, power losses and noise at the entry of the transistor were decreased, and, by increasing the breakdown voltage, the lifetime of the VDMOS transistor lifetime was increased, which resulted in increasing drain flow and decreasing Ron. This consequently resulted in enhancing the operation of high-frequency medical devices that use transistors, such as Radio Frequency (RF) and electrocardiograph machines. PMID:25763152

  17. Design and optimization of (3-aryl-1H-indazol-6-yl)spiro[cyclopropane-1,3'-indolin]-2'-ones as potent PLK4 inhibitors with oral antitumor efficacy.

    PubMed

    Li, Sze-Wan; Liu, Yong; Sampson, Peter B; Patel, Narendra Kumar; Forrest, Bryan T; Edwards, Louise; Laufer, Radoslaw; Feher, Miklos; Ban, Fuqiang; Awrey, Donald E; Hodgson, Richard; Beletskaya, Irina; Mao, Guodong; Mason, Jacqueline M; Wei, Xin; Luo, Xunyi; Kiarash, Reza; Green, Erin; Mak, Tak W; Pan, Guohua; Pauls, Henry W

    2016-10-01

    Previous efforts from our laboratory demonstrated that (E)-3-((3-(E)-vinylaryl)-1H-indazol-6-yl)methylene)-indolin-2-ones are potent PLK4 inhibitors with in vivo anticancer efficacy upon IP dosing. As part of a continued effort to develop selective and orally efficacious inhibitors, we examined variations on this theme wherein 'directly-linked' aromatics, pendant from the indazole core, replace the arylvinyl moiety. Herein, we describe the design and optimization of this series which was ultimately superseded by (3-aryl-1H-indazol-6-yl)spiro[cyclopropane-1,3'-indolin]-2'-ones. The latter compounds are potent and selective inhibitors of PLK4 with oral exposure in rodents and in vivo anticancer activity. Compound 13b, in particular, has a bioavailability of 22% and achieved a 96% tumor growth inhibition in an MDA-MB-468 xenograft study. PMID:27592744

  18. [Forensic medical diagnostics of chronic alcoholic intoxication based on histological changes in the soft tissues of oral cavity and salivary glands].

    PubMed

    Pigolkin, Iu I; Dolzhanskiĭ, O V; Mamsurova, T S; Chertovskikh, A A

    2011-01-01

    Histological studies of oral cavity mucosa and salivary glands in subjects with chronic alcoholic intoxication revealed changes at the surface of the tongue and in the glandular tissues. Specific features of chronic alcoholic intoxication include acinar and ductal hyperplasia, reduction of the adipose tissue mass in salivary gland stroma, predominance of T-lymphocytes in hard palate minor salivary glands and B-lymphocytes in the stroma of labial minor salivary gland, the absence of plasma cells in the stroma of hard palate minor salivary glands and labial mucosa. Leukoplakia, dysplasia, and hyperplasia of the basal epithelial layer of oral cavity mucosa are considered to be the signs of long-term (over 12 months) alcohol consumption. PMID:21866840

  19. Oral Chronic Graft-versus-Host Disease: Current Pathogenesis, Therapy, and Research

    PubMed Central

    Mays, JW; Fassil, H; Edwards, DA; Pavletic, SZ; Bassim, CW

    2012-01-01

    Optimal management of complex autoimmune diseases requires a multidisciplinary medical team including dentists to care for lesions of the oral cavity. In this review, we discuss the presentation, prevalence, diagnosis and treatment of oral manifestations in chronic Graft-versus-Host Disease (cGVHD) which is a major late complication in patients treated by allogeneic hematopoietic stem cell transplantation. We assess current general knowledge of systemic and oral cGVHD, and present general treatment recommendations based on literature review and our clinical experience. Additionally, we review areas where the understanding of oral cGVHD could be improved by further research, and address tools with which to accomplish the long-term goal of providing better health and quality-of-life to patients with cGVHD. PMID:23107104

  20. Oral and systemic photoprotection.

    PubMed

    Chen, Andrew C; Damian, Diona L; Halliday, Gary M

    2014-01-01

    Photoprotection can be provided not only by ultraviolet (UV) blockers but also by oral substances. Epidemiologically identified associations between foods and skin cancer and interventional experiments have discovered mechanisms of UV skin damage. These approaches have identified oral substances that are photoprotective in humans. UV inhibits adenosine triphosphate (ATP) production causing an energy crisis, which prevents optimal skin immunity and DNA repair. Enhancing ATP production with oral nicotinamide protects from UV immunosuppression, enhances DNA repair and reduces skin cancer in humans. Reactive oxygen species also contribute to photodamage. Nontoxic substances consumed in the diet, or available as oral supplements, can protect the skin by multiple potential mechanisms. These substances include polyphenols in fruit, vegetables, wine, tea and caffeine-containing foods. UV-induced prostaglandin E2 (PGE2 ) contributes to photodamage. Nonsteroidal anti-inflammatory drugs and food substances reduce production of this lipid mediator. Fish oils are photoprotective, at least partially by reducing PGE2 . Orally consumed substances, either in the diet or as supplements, can influence cutaneous responses to UV. A current research goal is to develop an oral supplement that could be used in conjunction with other sun protective strategies in order to provide improved protection from sunlight.

  1. Oral and systemic photoprotection.

    PubMed

    Chen, Andrew C; Damian, Diona L; Halliday, Gary M

    2014-01-01

    Photoprotection can be provided not only by ultraviolet (UV) blockers but also by oral substances. Epidemiologically identified associations between foods and skin cancer and interventional experiments have discovered mechanisms of UV skin damage. These approaches have identified oral substances that are photoprotective in humans. UV inhibits adenosine triphosphate (ATP) production causing an energy crisis, which prevents optimal skin immunity and DNA repair. Enhancing ATP production with oral nicotinamide protects from UV immunosuppression, enhances DNA repair and reduces skin cancer in humans. Reactive oxygen species also contribute to photodamage. Nontoxic substances consumed in the diet, or available as oral supplements, can protect the skin by multiple potential mechanisms. These substances include polyphenols in fruit, vegetables, wine, tea and caffeine-containing foods. UV-induced prostaglandin E2 (PGE2 ) contributes to photodamage. Nonsteroidal anti-inflammatory drugs and food substances reduce production of this lipid mediator. Fish oils are photoprotective, at least partially by reducing PGE2 . Orally consumed substances, either in the diet or as supplements, can influence cutaneous responses to UV. A current research goal is to develop an oral supplement that could be used in conjunction with other sun protective strategies in order to provide improved protection from sunlight. PMID:24313740

  2. An Exploratory, Open-Label, Randomized Trial Comparing Risperidone Long-Acting Injectable with Oral Antipsychotic Medication in the Treatment of Early Psychosis.

    PubMed

    Malla, Ashok; Chue, Pierre; Jordan, Gerald; Stip, Emmanuel; Koczerginski, David; Milliken, Heather; Joseph, Anil; Williams, Richard; Adams, Beverly; Manchanda, Rahul; Oyewumi, Kola; Roy, Marc-André

    2016-01-01

    Few studies have examined effectiveness and tolerability of risperidone long-acting injections (RLAI) in the early phase of a schizophrenia spectrum (SS) disorder using a randomized controlled trial (RCT) design. Eighty-five patients in early phase of an SS disorder were randomized to receive either oral second-generation antipsychotics (SGAs; n=41) or RLAI (n=44) over two years. Analyses were conducted on eligible participants (n=77) for the stabilization (maximum 18 weeks) and maintenance phases (up to Week 104) on primary outcome measures of time to stabilization and relapse, change in symptoms and safety, and comparisons made across the two groups. Both groups showed improvement on Positive and Negative Syndrome Scale (PANSS) scores and Clinical Global Impression-Severity (CGI-S) scores. There were no time X group interactions on any of the primary outcome measures. Post hoc examination revealed that the RLAI group showed greater change on CGI-S and PANSS negative symptom scores during the stabilization phase, while the oral group reached the same level of improvement during the maintenance phase. The current exploratory study suggests that-within an RCT design-RLAI and oral SGAs are equally effective and have similar safety profiles in patients in the early phase of SS disorders. Thus, RLAI offers no advantage to patients in early phase of SS disorders, but is likely to be effective and safe for those who may have problems with adherence and may either choose to take it or be prescribed under conditions of external control such as community treatment orders.

  3. Optimizing technology development and adoption in medical imaging using the principles of innovation diffusion, part II: practical applications.

    PubMed

    Reiner, Bruce I

    2012-02-01

    Successful adoption of new technology development can be accentuated by learning and applying the scientific principles of innovation diffusion. This is of particular importance to areas within the medical imaging practice which have lagged in innovation; perhaps, the most notable of which is reporting which has remained relatively stagnant for over a century. While the theoretical advantages of structured reporting have been well documented throughout the medical imaging community, adoption to date has been tepid and largely relegated to the academic and breast imaging communities. Widespread adoption will likely require an alternative approach to innovation, which addresses the heterogeneity and diversity of the practicing radiologist community along with the ever-changing expectations in service delivery. The challenges and strategies for reporting innovation and adoption are discussed, with the goal of adapting and customizing new technology to the preferences and needs of individual end-users.

  4. Oral health resources for cancer patients in Texas.

    PubMed

    Bitouni, Anneta; Urankar, Yashashri

    2012-05-01

    Over 1.4 million new cases of cancer are diagnosed each year, and many of these patients will, by necessity, be treated in private practice, including dental practice. Dental professionals play a key role in helping patients understand that good oral care can prevent or reduce oral complications. Treatment of oral cancers and other malignancies cause oral sequelae that can compromise patients' quality of life and dictate reduction or discontinuation of optimal therapeutic regimens, which in turn reduces the odds of long-term survival. This can be prevented or better managed if dental and medical health care providers work together. The purpose of this article is to identify the cancer centers associated with dental clinics and the dental practitioners in the state of Texas, including maxillofacial prosthodontists, with training and/or a special interest in providing oral care to cancer patients. To be included on the list, which will be available on the Dental Oncology Education Program (DOEP) Web site (doep.org), please contact Grady Basler at the DOEP office (grady@doep.org), or the Department of Public Health Sciences (214-828-8350).

  5. Oral Intake of a Liquid High-Molecular-Weight Hyaluronan Associated with Relief of Chronic Pain and Reduced Use of Pain Medication: Results of a Randomized, Placebo-Controlled Double-Blind Pilot Study

    PubMed Central

    Attridge, Victoria L.; Lenninger, Miki R.; Benson, Kathleen F.

    2015-01-01

    Abstract The goal for this study was to evaluate the effects of daily oral intake of a consumable liquid fermentate containing high-molecular-weight hyaluronan, as well as to perform a basic evaluation of safety and tolerability. A randomized, double-blind placebo-controlled study design was used to examine the effects of oral intake of hyaluronan on chronic pain conditions. Safety assessment included a complete blood count with differential, blood chemistry and electrocardiogram. The study duration was 4 weeks, where three tablespoons (45 mL) product or placebo was ingested during the first 2 weeks, and two tablespoons (30 mL) was consumed during the last 2 weeks. Seventy-eight people between the age of 19 and 71 years enrolled, and 72 people completed the study. Statistical analysis was performed using the two-tailed independent t-test for between-group significance and using the paired t-test for within-group significance. A reduction in pain scores was seen after 2 weeks of consumption of both placebo (P<.1) and active (P<.065) product; the reduction was more pronounced in the group consuming the active test product. Using “within-subject” analysis, a highly significant reduction in chronic pain scores was seen after 2 weeks of consumption of three tablespoons of active product (P<.001), whereas only a mild nonsignificant reduction in pain scores was seen in the placebo group. During the reduced intake for the last 2 weeks of study participation, pain scores showed a slight increase. During the last 2 weeks, a significant increase in the quality of sleep (P<.005) and level of physical energy (P<.05) was seen. The pain reduction during the initial 2 weeks was associated with significant reduction in the use of pain medication (P<.05). Consumption of an oral liquid formula containing high-molecular-weight hyaluronan was associated with relief of chronic pain. PMID:25415767

  6. Oral intake of a liquid high-molecular-weight hyaluronan associated with relief of chronic pain and reduced use of pain medication: results of a randomized, placebo-controlled double-blind pilot study.

    PubMed

    Jensen, Gitte S; Attridge, Victoria L; Lenninger, Miki R; Benson, Kathleen F

    2015-01-01

    The goal for this study was to evaluate the effects of daily oral intake of a consumable liquid fermentate containing high-molecular-weight hyaluronan, as well as to perform a basic evaluation of safety and tolerability. A randomized, double-blind placebo-controlled study design was used to examine the effects of oral intake of hyaluronan on chronic pain conditions. Safety assessment included a complete blood count with differential, blood chemistry and electrocardiogram. The study duration was 4 weeks, where three tablespoons (45 mL) product or placebo was ingested during the first 2 weeks, and two tablespoons (30 mL) was consumed during the last 2 weeks. Seventy-eight people between the age of 19 and 71 years enrolled, and 72 people completed the study. Statistical analysis was performed using the two-tailed independent t-test for between-group significance and using the paired t-test for within-group significance. A reduction in pain scores was seen after 2 weeks of consumption of both placebo (P<.1) and active (P<.065) product; the reduction was more pronounced in the group consuming the active test product. Using "within-subject" analysis, a highly significant reduction in chronic pain scores was seen after 2 weeks of consumption of three tablespoons of active product (P<.001), whereas only a mild nonsignificant reduction in pain scores was seen in the placebo group. During the reduced intake for the last 2 weeks of study participation, pain scores showed a slight increase. During the last 2 weeks, a significant increase in the quality of sleep (P<.005) and level of physical energy (P<.05) was seen. The pain reduction during the initial 2 weeks was associated with significant reduction in the use of pain medication (P<.05). Consumption of an oral liquid formula containing high-molecular-weight hyaluronan was associated with relief of chronic pain.

  7. Oral cysticercosis.

    PubMed

    Chunduri, Nagendra S; Goteki, Venkateswarulu; Gelli, Vamsi; Madasu, Krishnaveni

    2013-03-01

    Cysticercosis is a common disease in developing countries, but oral lesions caused by this parasitic infestation are rare. We report here a rare case of oral cysticercosis in a 17 year old male who sought treatment for an asymptomatic nodule of the lower lip that had previously been diagnosed as a mucocele. PMID:23691623

  8. Monte Carlo Simulation in the Optimization of a Free-Air Ionization Chamber for Dosimetric Control in Medical Digital Radiography

    NASA Astrophysics Data System (ADS)

    Leyva, A.; Piñera, I.; Montaño, L. M.; Abreu, Y.; Cruz, C. M.

    2008-08-01

    During the earliest tests of a free-air ionization chamber a poor response to the X-rays emitted by several sources was observed. Then, the Monte Carlo simulation of X-rays transport in matter was employed in order to evaluate chamber behavior as X-rays detector. The photons energy deposition dependence with depth and its integral value in all active volume were calculated. The obtained results reveal that the designed device geometry is feasible to be optimized.

  9. Prediction of optimized composition for enhanced mechanical and electrochemical response of Zr-C-N-Ag coatings for medical devices

    NASA Astrophysics Data System (ADS)

    Calderon V., S.; Oliveira, J. C.; Evaristo, M.; Cavaleiro, A.; Carvalho, S.

    2014-11-01

    The necessity of improving the performance of existing biocompatible materials promotes the investigation of new approaches to solve biocompatibility problems caused by low chemical stability and poor mechanical performance of implanted materials. Envisioning those problems and considering the current reported complications of implanted stainless steel 316L devices, this work aimed to produce new Zr-C-N-Ag coatings and to predict an optimal composition to provide the required electrochemical stability and mechanical performance to the stainless steel 316L. The coatings were deposited by dual unbalance magnetron sputtering and characterized in terms of chemical, structural, mechanical and electrochemical properties to optimize their functional properties by means of a second-order response surface methodology. The optimization process revealed that the best mechanical and electrochemical performance was reached when stoichiometric ZrC0.5N0.5 phase is the main constituent of the materials, with low amounts of silver (<8 at.%) and residual oxygen, mainly explained by the electrochemical stability and mechanical performance of the Zr-C-N solid solution. The current density applied to the silver target was identified as the main parameter affecting the final properties of the films due to its direct relation to the incorporation of metallic silver in the system. However, the reactive gases, as well as the high amount of residual oxygen, were also found to be significant in the process.

  10. A Method for the Design and Development of Medical or Health Care Information Websites to Optimize Search Engine Results Page Rankings on Google

    PubMed Central

    Cummins, Niamh Maria; Hannigan, Ailish; Shannon, Bill; Dunne, Colum; Cullen, Walter

    2013-01-01

    Background The Internet is a widely used source of information for patients searching for medical/health care information. While many studies have assessed existing medical/health care information on the Internet, relatively few have examined methods for design and delivery of such websites, particularly those aimed at the general public. Objective This study describes a method of evaluating material for new medical/health care websites, or for assessing those already in existence, which is correlated with higher rankings on Google's Search Engine Results Pages (SERPs). Methods A website quality assessment (WQA) tool was developed using criteria related to the quality of the information to be contained in the website in addition to an assessment of the readability of the text. This was retrospectively applied to assess existing websites that provide information about generic medicines. The reproducibility of the WQA tool and its predictive validity were assessed in this study. Results The WQA tool demonstrated very high reproducibility (intraclass correlation coefficient=0.95) between 2 independent users. A moderate to strong correlation was found between WQA scores and rankings on Google SERPs. Analogous correlations were seen between rankings and readability of websites as determined by Flesch Reading Ease and Flesch-Kincaid Grade Level scores. Conclusions The use of the WQA tool developed in this study is recommended as part of the design phase of a medical or health care information provision website, along with assessment of readability of the material to be used. This may ensure that the website performs better on Google searches. The tool can also be used retrospectively to make improvements to existing websites, thus, potentially enabling better Google search result positions without incurring the costs associated with Search Engine Optimization (SEO) professionals or paid promotion. PMID:23981848

  11. The Oral Microbiota.

    PubMed

    Arweiler, Nicole B; Netuschil, Lutz

    2016-01-01

    The oral microbiota represents an important part of the human microbiota, and includes several hundred to several thousand diverse species. It is a normal part of the oral cavity and has an important function to protect against colonization of extrinsic bacteria which could affect systemic health. On the other hand, the most common oral diseases caries, gingivitis and periodontitis are based on microorganisms. While (medical) research focused on the planktonic phase of bacteria over the last 100 years, it is nowadays generally known, that oral microorganisms are organised as biofilms. On any non-shedding surfaces of the oral cavity dental plaque starts to form, which meets all criteria for a microbial biofilm and is subject to the so-called succession. When the sensitive ecosystem turns out of balance - either by overload or weak immune system - it becomes a challenge for local or systemic health. Therefore, the most common strategy and the golden standard for the prevention of caries, gingivitis and periodontitis is the mechanical removal of this biofilms from teeth, restorations or dental prosthesis by regular toothbrushing. PMID:27161350

  12. The Oral Microbiota.

    PubMed

    Arweiler, Nicole B; Netuschil, Lutz

    2016-01-01

    The oral microbiota represents an important part of the human microbiota, and includes several hundred to several thousand diverse species. It is a normal part of the oral cavity and has an important function to protect against colonization of extrinsic bacteria which could affect systemic health. On the other hand, the most common oral diseases caries, gingivitis and periodontitis are based on microorganisms. While (medical) research focused on the planktonic phase of bacteria over the last 100 years, it is nowadays generally known, that oral microorganisms are organised as biofilms. On any non-shedding surfaces of the oral cavity dental plaque starts to form, which meets all criteria for a microbial biofilm and is subject to the so-called succession. When the sensitive ecosystem turns out of balance - either by overload or weak immune system - it becomes a challenge for local or systemic health. Therefore, the most common strategy and the golden standard for the prevention of caries, gingivitis and periodontitis is the mechanical removal of this biofilms from teeth, restorations or dental prosthesis by regular toothbrushing.

  13. Optimization of a phased-array transducer for multiple harmonic imaging in medical applications: frequency and topology.

    PubMed

    Matte, Guillaume M; Van Neer, Paul L M J; Danilouchkine, Mike G; Huijssen, Jacob; Verweij, Martin D; de Jong, Nico

    2011-03-01

    Second-harmonic imaging is currently one of the standards in commercial echographic systems for diagnosis, because of its high spatial resolution and low sensitivity to clutter and near-field artifacts. The use of nonlinear phenomena mirrors is a great set of solutions to improve echographic image resolution. To further enhance the resolution and image quality, the combination of the 3rd to 5th harmonics--dubbed the superharmonics--could be used. However, this requires a bandwidth exceeding that of conventional transducers. A promising solution features a phased-array design with interleaved low- and high-frequency elements for transmission and reception, respectively. Because the amplitude of the backscattered higher harmonics at the transducer surface is relatively low, it is highly desirable to increase the sensitivity in reception. Therefore, we investigated the optimization of the number of elements in the receiving aperture as well as their arrangement (topology). A variety of configurations was considered, including one transmit element for each receive element (1/2) up to one transmit for 7 receive elements (1/8). The topologies are assessed based on the ratio of the harmonic peak pressures in the main and grating lobes. Further, the higher harmonic level is maximized by optimization of the center frequency of the transmitted pulse. The achievable SNR for a specific application is a compromise between the frequency-dependent attenuation and nonlinearity at a required penetration depth. To calculate the SNR of the complete imaging chain, we use an approach analogous to the sonar equation used in underwater acoustics. The generated harmonic pressure fields caused by nonlinear wave propagation were modeled with the iterative nonlinear contrast source (INCS) method, the KZK, or the Burger's equation. The optimal topology for superharmonic imaging was an interleaved design with 1 transmit element per 6 receive elements. It improves the SNR by ~5 dB compared with

  14. [Medical guidelines for diabetes mellitus in Saxony. An instrument for interdisciplinary quality management for optimizing patient care].

    PubMed

    Schulze, J; Kunath, H; Rothe, U; Müller, G

    1998-09-01

    Patients with diabetes still have a life expectancy of 5-10 years less and a markedly reduced quality of life than non-diabetic persons. Concepts, models, and contracts aiming at an efficient co-operative care for chronically ill patients have been developed in the new German states to overcome shortage of care. The dual care of motivated diabetic patients by family physicians and experts for metabolic diseases has proven to be efficient both in pilot studies as well as in country-wide investigations. A representative commission for diabetes has developed guidelines for such a structure of dual care. Design and content of these regional developed guidelines about an cooperative evidence based care for diabetic patients fulfills the criteria suggested by international bodies of experts and the medical society for quality assurance. The Saxonian guidelines for diabetes have been successfully implemented step by step in medical offices and hospitals. We are sure that the further implementation of the shared care system diabetes will further improve quality of care. PMID:9842697

  15. A long-term study of regression of precancerous lesions under oral progestin medication: observations on the prevalence of carcinoma in situ and dysplasia in private versus planned parenthood groups.

    PubMed

    Ayre, J E; Reyner, F C; Leguerrier, J M; Schwartz, R

    1971-01-01

    This study is concerned with the relationship of the oral progestins to cancer of the cervix and endometrium and to establish the effect of long-term use of the pill on lesions of carcinoma in situ or dysplasia. A screening study was made of 1696 women attending the Nassau County Planned Parenthood Clinic. Patients with negative cytology were advised to have a routine check in 6 to 12 months. Those with positive cytology who were also found to have advanced or progressive lesions were referred for surgical treatment. Patients showing cells of moderate dysplasia or carcinoma in situ were referred to the Cancer Prevention Clinic where they could elect immediate surgical treatment or experimental treatment with an oral contraceptive. Almost all, 68 in number, chose to defer surgery. They visited the clinic at 4 to 6 week intervals when an examination, a Paanicolaou smear and fluorescent microscopic DNA of nuclear patterna were done. While under study no premalignant lesion progressed to a stage of infiltration. Clinically none showed lesions suggestive of early cancer. Of this group 45 showed no alteration in growth, of cells while 21 had signs of regression, some to a normal morphology. Progression occurred in 2 patients. Of these 1 followed a 4 month interval without oral progestin medication. The greater prevalence of positive findings in patients attending Planned Parenthood Clinics as compared with those being treated by private practitioners is attributed to the types of patients being tested. The clinics see mostly patients of lower socioeconomic status, those who have been more sexually active and those who have begun sexual activities at an early age with more sexual partners. These findings are consistent with the theory of viral transmission of cancer of the cervix by sexual intercourse. After over 8 years of study the authors conclude that the pill does not initiate or accelerate precancerous growth but that the oral progestins at high dose levels show

  16. Prevalence and predictors of sub-optimal medication adherence among patients with severe mental illnesses in a tertiary psychiatric facility in Maiduguri, North-eastern Nigeria

    PubMed Central

    Ibrahim, Abdu Wakawa; Yahya, Shuaibu; Pindar, Sadique Kwajafa; Wakil, Musa Abba; Garkuwa, Adamu; Sale, Shehu

    2015-01-01

    Introduction Sub-optimal adherence constitutes a significant impediment to the management of severe mental illnesses (SMIs) as it negatively impacts on the course of the illness and the treatment outcome. In this study, the levels of adherence, prevalence and the predictors of sub-optimal adherence were assessed in a sub-Saharan African setting. Methods Three hundred and seventy (370) respondents with diagnoses of schizophrenia, bipolar disorder or severe depression were randomly enrolled and interviewed at the out-patient department of the Federal Neuropsychiatric Hospital, Maiduguri in northeastern Nigeria. An anonymous sociodemographic questionnaire and a clinical proforma designed by the authors, Oslo social support scale and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used for data collection. Results The prevalence of sub-optimal adherence was 55.7%. The independent predictors of sub-optimal adherence were; seeking for traditional/ spiritual treatment (Odds Ratio (O.R.) = 6.523, 95% C.I. = 3.773 - 11.279, P = < 0.001), male gender (O.R. = 3.307, 95% C.I. = 1.907 - 5.737, P = < 0.001), low levels of insight (O.R. = 1.753, 95 C.I. = 1.220 - 2.519, P = 0.002), and low social support levels (O.R. = 1.528, 95% C.I. = 1.097 - 2.129, P = 0.012). Conclusion Based on the outcome of the study, we recommend the development of psycho-educational programmes on adherence and the active involvement of the relations and significant others in the management of patients with SMIs in sub-Saharan Africa. PMID:26405475

  17. Poly (ε-caprolactone) nanocapsules for oral delivery of raloxifene: process optimization by hybrid design approach, in vitro and in vivo evaluation.

    PubMed

    Aditya, N; Ravi, Punna Rao; Avula, Uday Sai Ranjan; Vats, Rahul

    2014-01-01

    Raloxifene HCl (RLX), a selective oestrogen receptor modulator, has low oral bioavailability (<2%) in humans due to its poor aqueous solubility and extensive first-pass metabolism in gut. In this study, we optimised the method of preparation for poly (ε-caprolactone) (PCL) based nanocapsules of RLX by double emulsion method (w/o/w). A hybrid design approach, Plackett-Burman design followed by rotatable central composite design, was used to arrive at the optimised formulation. The optimised formulation was subjected to in vitro and in vivo evaluation. RLX loaded nanocapsules were spherical in shape with particle size less than 200 nm and high encapsulation efficiency (>80%). RLX-loaded nanocapsules showed 2.1-fold increase in oral bioavailability compared to free RLX. IV pharmacokinetic studies indicated that RLX loaded into nanocapsule had significantly low clearance in comparison with free RLX. Designed nanocapsules showed promise as delivery systems to enhance oral bioavailability and in reducing clearance of raloxifene. PMID:24697167

  18. Oral Insulin Reloaded

    PubMed Central

    Heinemann, Lutz; Plum-Mörschel, Leona

    2014-01-01

    Optimal coverage of insulin needs is the paramount aim of insulin replacement therapy in patients with diabetes mellitus. To apply insulin without breaking the skin barrier by a needle and/or to allow a more physiological provision of insulin are the main reasons triggering the continuous search for alternative routes of insulin administration. Despite numerous attempts over the past 9 decades to develop an insulin pill, no insulin for oral dosing is commercially available. By way of a structured approach, we aim to provide a systematic update on the most recent developments toward an orally available insulin formulation with a clear focus on data from clinical-experimental and clinical studies. Thirteen companies that claim to be working on oral insulin formulations were identified. However, only 6 of these companies published new clinical trial results within the past 5 years. Interestingly, these clinical data reports make up a mere 4% of the considerably high total number of publications on the development of oral insulin formulations within this time period. While this picture clearly reflects the rising research interest in orally bioavailable insulin formulations, it also highlights the fact that the lion’s share of research efforts is still allocated to the preclinical stages. PMID:24876606

  19. Ampicillin Oral

    MedlinePlus

    ... capsule, liquid, and pediatric drops to take by mouth. It is usually taken every 6 hours (four ... blood thinners') such as warfarin (Coumadin), atenolol (Tenormin), oral contraceptives, probenecid (Benemid), rifampin, sulfasalazine, and vitamins.tell ...

  20. Oral pathology.

    PubMed

    Niemiec, Brook A

    2008-05-01

    Oral disease is exceedingly common in small animal patients. In addition, there is a very wide variety of pathologies that are encountered within the oral cavity. These conditions often cause significant pain and/or localized and systemic infection; however, the majority of these conditions have little to no obvious clinical signs. Therefore, diagnosis is not typically made until late in the disease course. Knowledge of these diseases will better equip the practitioner to effectively treat them. This article covers the more common forms of oral pathology in the dog and cat, excluding periodontal disease, which is covered in its own chapter. The various pathologies are presented in graphic form, and the etiology, clinical signs, recommended diagnostic tests, and treatment options are discussed. Pathologies that are covered include: persistent deciduous teeth, fractured teeth, intrinsically stained teeth, feline tooth resorption, caries, oral neoplasia, eosinophilic granuloma complex, lymphoplasmacytic gingivostomatitis, enamel hypoplasia, and "missing" teeth.

  1. Oral Cancer

    MedlinePlus

    ... swallowing A lump in your neck An earache Oral cancer treatments may include surgery, radiation therapy or chemotherapy. Some patients have a combination of treatments. NIH: National Cancer Institute

  2. Oral Health

    MedlinePlus

    ... its box has the American Dental Association's (ADA) seal of acceptance, it is good for your oral ... dispensed solutions have the American Dental Association (ADA) seal. Other over-the-counter whitening products include whitening ...

  3. Oral Cancer

    MedlinePlus

    ... use. Some oral cancers are linked to human papilloma virus (HPV) infections of the mouth and throat. ... The number of oropharyngeal cancers linked to human papilloma virus (HPV) has risen dramatically over the past ...

  4. Oral feeding readiness assessment in premature infants.

    PubMed

    Gennattasio, Annmarie; Perri, Elizabeth A; Baranek, Donna; Rohan, Annie

    2015-01-01

    Oral feeding readiness is a complex concept. More evidence is needed on how to approach beginning oral feedings in premature hospitalized infants. This article provides a review of literature related to oral feeding readiness in the premature infant and strategies for promoting safe and efficient progression to full oral intake. Oral feeding readiness assessment tools, clinical pathways, and feeding advancement protocols have been developed to assist with oral feeding initiation and progression. Recognition and support of oral feeding readiness may decrease length of hospital stay and have a positive impact on reducing healthcare costs. Supporting effective cue-based oral feeding through use of rigorous assessment or evidence-based care guidelines can also optimize the hospital experience for infants and caregivers, which, in turn, can promote attachment and parent satisfaction.

  5. Dexamethasone Oral

    MedlinePlus

    ... of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this drug. Dexamethasone makes your stomach and intestines more susceptible to the irritating effects of alcohol, aspirin, and certain arthritis medications: this ...

  6. Methylprednisolone Oral

    MedlinePlus

    ... of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this drug. Methylprednisolone makes your stomach and intestines more susceptible to the irritating effects of alcohol, aspirin, and certain arthritis medications. This ...

  7. Diabetes mellitus and oral health.

    PubMed

    Kudiyirickal, Marina George; Pappachan, Joseph M

    2015-05-01

    The oral health is influenced by systemic health, and one of the most common chronic diseases encountered in dental practice is diabetes mellitus. Diabetes can worsen oral infections and vice versa. In the literature, periodontitis and diabetes in the young to middle-aged adults have been the most widely researched area. Understanding the patho-physiology, clinical manifestations and management of different types of orofacial diseases in diabetic patients are important to the diabetologist and the dentist for the optimal care of patients with these diseases. This review explores the inter-link between diabetes and oral health. PMID:25487035

  8. Multiparameter Lead Optimization to Give an Oral Checkpoint Kinase 1 (CHK1) Inhibitor Clinical Candidate: (R)-5-((4-((Morpholin-2-ylmethyl)amino)-5-(trifluoromethyl)pyridin-2-yl)amino)pyrazine-2-carbonitrile (CCT245737).

    PubMed

    Osborne, James D; Matthews, Thomas P; McHardy, Tatiana; Proisy, Nicolas; Cheung, Kwai-Ming J; Lainchbury, Michael; Brown, Nathan; Walton, Michael I; Eve, Paul D; Boxall, Katherine J; Hayes, Angela; Henley, Alan T; Valenti, Melanie R; De Haven Brandon, Alexis K; Box, Gary; Jamin, Yann; Robinson, Simon P; Westwood, Isaac M; van Montfort, Rob L M; Leonard, Philip M; Lamers, Marieke B A C; Reader, John C; Aherne, G Wynne; Raynaud, Florence I; Eccles, Suzanne A; Garrett, Michelle D; Collins, Ian

    2016-06-01

    Multiparameter optimization of a series of 5-((4-aminopyridin-2-yl)amino)pyrazine-2-carbonitriles resulted in the identification of a potent and selective oral CHK1 preclinical development candidate with in vivo efficacy as a potentiator of deoxyribonucleic acid (DNA) damaging chemotherapy and as a single agent. Cellular mechanism of action assays were used to give an integrated assessment of compound selectivity during optimization resulting in a highly CHK1 selective adenosine triphosphate (ATP) competitive inhibitor. A single substituent vector directed away from the CHK1 kinase active site was unexpectedly found to drive the selective cellular efficacy of the compounds. Both CHK1 potency and off-target human ether-a-go-go-related gene (hERG) ion channel inhibition were dependent on lipophilicity and basicity in this series. Optimization of CHK1 cellular potency and in vivo pharmacokinetic-pharmacodynamic (PK-PD) properties gave a compound with low predicted doses and exposures in humans which mitigated the residual weak in vitro hERG inhibition. PMID:27167172

  9. Utilisation of oral health services, oral health needs and oral health status in a peri-urban informal settlement.

    PubMed

    Westaway, M S; Viljoen, E; Rudolph, M J

    1999-04-01

    Interviews were conducted with 294 black residents (155 females and 138 males) of a peri-urban informal settlement in Gauteng to ascertain utilisation of oral health services, oral health needs and oral health status. Only 37 per cent of the sample had consulted a dentist or medical practitioner, usually for extractions. Teenagers and employed persons were significantly less likely to utilise dentists than the older age groups and unemployed persons. Forty per cent were currently experiencing oral health problems such as a sore mouth, tooth decay and bleeding/painful gums. Two hundred and twelve (73 per cent) interviewees wanted dental treatment or advice. Residents who rated their oral health status as fair or poor appeared to have the greatest need for oral health services. The use of interviews appears to be a cost-effective method of determining oral morbidity. PMID:10518916

  10. Oral lichen planus.

    PubMed

    Olson, Meredith A; Rogers, Roy S; Bruce, Alison J

    2016-01-01

    Lichen planus is an inflammatory mucocutaneous disease that can affect the skin, hair, nails, and mucosal surfaces. Mucosal sites of involvement include oral, genital, ocular, otic, esophageal, and, less commonly, bladder, nasal, laryngeal, and anal surfaces. Oral lichen planus is a mucosal variant of lichen planus, which tends to affect women more often than men, with a typically more chronic course and potential for significant morbidity. Treatment can be challenging, and there is potentially a low risk of malignant transformation; however, therapeutic benefits can be obtained with various topical and systemic medications. Clinical monitoring is recommended to ensure symptomatic control. Increasing awareness and recognition of this entity have continued to fuel advances in therapy and in our understanding of the disease. PMID:27343965

  11. Use of oral hypoglycemic and insulin agents in pregnant patients.

    PubMed

    Feldman, Deborah M; Fang, Yu Ming Victor

    2013-06-01

    Although insulin remains the standard medication for the treatment of all types of patients with diabetes during pregnancy, oral hypoglycemics may be considered as alternative medications in the treatment of some types of diabetes in pregnancy. PMID:23702114

  12. Preparation of an oral acetaminophen film that is expected to improve medication administration: Effect of polyvinylpyrrolidone on physical properties of the film.

    PubMed

    Ito, Ikumi; Ito, Akihiko; Unezaki, Sakae

    2016-01-01

    This study investigated the effect of polyvinylpyrrolidone (PVP) on a film containing carboxymethyl cellulose sodium (CMC) as a matrix to improve surface roughness caused by drug recrystallization. Acetaminophen (AA) was used as the model drug. Recrystallization is a problem encountered during the preparation of films that contain high drug doses, making them difficult to take. A film that does not disintegrate for clinical applications requires a smooth surface, moderate strength and elasticity, and a low level of adhesiveness to facilitate taking of the medication. Addition of PVP to the film formulation made the surface significantly smoother, and it was independent of the compounding method. Smooth films were obtained when the CMC concentration was kept constant and the amount of PVP was increased, but it also increased the adhesiveness and strength, and decreased the elasticity of the films. When high polymer concentration was kept constant and the ratio of CMC and PVP was varied, the films with smaller amounts of PVP tended to have a smoother surface and less adhesiveness. However, when the amount of PVP was reduced, the film strength increased and elasticity decreased. The amount of PVP had a negligible effect on drug dissolution behavior, making it useful for preparation of the AA film. However, it is necessary to determine the compounding method and the PVP load considering the adhesiveness, strength, and elasticity of the films. PMID:27301710

  13. Oral Anticoagulant Therapy

    PubMed Central

    Gallus, Alexander S.; Wittkowsky, Ann; Crowther, Mark; Hylek, Elaine M.; Palareti, Gualtiero

    2012-01-01

    Background: The objective of this article is to summarize the published literature concerning the pharmacokinetics and pharmacodynamics of oral anticoagulant drugs that are currently available for clinical use and other aspects related to their management. Methods: We carried out a standard review of published articles focusing on the laboratory and clinical characteristics of the vitamin K antagonists; the direct thrombin inhibitor, dabigatran etexilate; and the direct factor Xa inhibitor, rivaroxaban Results: The antithrombotic effect of each oral anticoagulant drug, the interactions, and the monitoring of anticoagulation intensity are described in detail and discussed without providing specific recommendations. Moreover, we describe and discuss the clinical applications and optimal dosages of oral anticoagulant therapies, practical issues related to their initiation and monitoring, adverse events such as bleeding and other potential side effects, and available strategies for reversal. Conclusions: There is a large amount of evidence on laboratory and clinical characteristics of vitamin K antagonists. A growing body of evidence is becoming available on the first new oral anticoagulant drugs available for clinical use, dabigatran and rivaroxaban. PMID:22315269

  14. Illumination devices for uniform delivery of light to the oral cavity for photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Canavesi, Cristina; Cassarly, William J.; Foster, Thomas H.; Rolland, Jannick P.

    2011-10-01

    To date, the lack of light delivery mechanisms to the oral cavity remains a barrier to the treatment of oral cancer with photodynamic therapy (PDT). The greatest impediment to medical practitioners is the current need to shield the normal tissues of the oral cavity, a costly and time-consuming procedure. In this research, we present the design of illumination devices to deliver light to the oral cavity for PDT, which will facilitate administration of PDT in the clinic. The goal for such an illumination device, as indicated by our clinical collaborators at Roswell Park Cancer Institute in Buffalo, NY, is to limit exposure of healthy tissue and produce an average irradiance of 100 mW/cm2 over the treatment field, with spatial non-uniformities below 10%. Furthermore, the size of the device must be compact to allow use in the oral cavity. Our research led to the design and fabrication of two devices producing spatial non-uniformities below 6% over a treatment area of 0.25 cm2 by design. One device consisted of an appropriately-sized reflector, inspired by solar concentrators, illuminated by a cylindrical diffusing fiber optimally located within the reflector; another was a solid lightpipe with a combination of optimized tapered and straight components.

  15. Oral agents in multiple sclerosis.

    PubMed

    Lorefice, L; Fenu, G; Frau, J; Coghe, G C; Marrosu, M G; Cocco, E

    2015-01-01

    Multiple sclerosis (MS) is a complex autoimmune disease of the central nervous system. Disease-modifying drugs licensed for MS treatment have been developed to reduce relapse rates and halt disease progression. The majority of current MS drugs involve regular, parenteral administration, affecting long-term adherence and thus reducing treatment efficacy. Over the last two decades great progress has been made towards developing new MS therapies with different modes of action and biologic effects. In particular, oral drugs have generated much interest because of their convenience and positive impact on medication adherence. Fingolimod was the first launched oral treatment for relapsing-remitting MS; recently, Teriflunomide and Dimethyl fumarate have also been approved as oral disease-modifying agents. In this review, we summarize and discuss the history, pharmacodynamics, efficacy, and safety of oral agents that have been approved or are under development for the selective treatment of MS. PMID:25924620

  16. Long-Term Preservation of Left Ventricular Systolic Function in Patients With Refractory Angina Pectoris and Inducible Myocardial Ischemia on Optimal Medical Therapy.

    PubMed

    Slavich, Massimo; Maranta, Francesco; Fumero, Andrea; Godino, Cosmo; Giannini, Francesco; Oppizzi, Michele; Colombo, Antonio; Fragasso, Gabriele; Margonato, Alberto

    2016-05-15

    Refractory angina pectoris (RAP) represents a clinical condition characterized by frequent episodes of chest pain despite therapy optimization. According to myocardial stunning and myocardial hibernation definitions, RAP should represent the ideal condition for systolic dysfunction development. We aim to investigate the evolution of left ventricular (LV) function in patients with RAP. A retrospective study which encompasses 144 patients with RAP referred to our institution from 1999 to December 2014 was performed. Of them, 88 met the inclusion criteria, and LV function was assessed by echocardiography. All of them had persistent angina episodes on top of optimal medical therapy and evidence of significant inducible myocardial ischemia and no further revascularization options. Nitrates consumption rate, time of angina duration, and the number of angina attacks were evaluated. In the whole population, ejection fraction (EF) was 44% ± 2. EF was significantly lower in patients with previous myocardial infarction (41% ± 1.5 vs 51% ± 1.8, p <0.0001). The duration time and the number of angina attacks did not correlate with EF in the whole population and in patients without previous myocardial infarction. In patients with previous myocardial infarction, the number of anginal attacks did not correlate with EF, but EF appeared higher in patients with angina duration >5 years (<5 years EF 37% ± 1 [n = 26]; >5 years 44% ± 2 [n = 44]; p 0.02). Long-term LV function in patients with RAP is generally preserved. A previous history of myocardial infarction is the only determinant in the development of systolic dysfunction. In conclusion, frequent angina attacks and a long-term history of angina are not apparently associated to worse LV function.

  17. Long-Term Preservation of Left Ventricular Systolic Function in Patients With Refractory Angina Pectoris and Inducible Myocardial Ischemia on Optimal Medical Therapy.

    PubMed

    Slavich, Massimo; Maranta, Francesco; Fumero, Andrea; Godino, Cosmo; Giannini, Francesco; Oppizzi, Michele; Colombo, Antonio; Fragasso, Gabriele; Margonato, Alberto

    2016-05-15

    Refractory angina pectoris (RAP) represents a clinical condition characterized by frequent episodes of chest pain despite therapy optimization. According to myocardial stunning and myocardial hibernation definitions, RAP should represent the ideal condition for systolic dysfunction development. We aim to investigate the evolution of left ventricular (LV) function in patients with RAP. A retrospective study which encompasses 144 patients with RAP referred to our institution from 1999 to December 2014 was performed. Of them, 88 met the inclusion criteria, and LV function was assessed by echocardiography. All of them had persistent angina episodes on top of optimal medical therapy and evidence of significant inducible myocardial ischemia and no further revascularization options. Nitrates consumption rate, time of angina duration, and the number of angina attacks were evaluated. In the whole population, ejection fraction (EF) was 44% ± 2. EF was significantly lower in patients with previous myocardial infarction (41% ± 1.5 vs 51% ± 1.8, p <0.0001). The duration time and the number of angina attacks did not correlate with EF in the whole population and in patients without previous myocardial infarction. In patients with previous myocardial infarction, the number of anginal attacks did not correlate with EF, but EF appeared higher in patients with angina duration >5 years (<5 years EF 37% ± 1 [n = 26]; >5 years 44% ± 2 [n = 44]; p 0.02). Long-term LV function in patients with RAP is generally preserved. A previous history of myocardial infarction is the only determinant in the development of systolic dysfunction. In conclusion, frequent angina attacks and a long-term history of angina are not apparently associated to worse LV function. PMID:27055755

  18. The Integrated Medical Model

    NASA Technical Reports Server (NTRS)

    Butler, Douglas J.; Kerstman, Eric

    2010-01-01

    This slide presentation reviews the goals and approach for the Integrated Medical Model (IMM). The IMM is a software decision support tool that forecasts medical events during spaceflight and optimizes medical systems during simulations. It includes information on the software capabilities, program stakeholders, use history, and the software logic.

  19. Oral Cancer

    MedlinePlus

    ... What are the effects of oral cancer on speech and swallowing? The effects of cancer on speech and swallowing depend on the location and size ... movement. This could result in unclear production of speech sounds made with the lips such as /p/, / ...

  20. Oral Warts

    MedlinePlus

    ... Title: Oral Warts Description: Warts are small, white, gray, or pinkish rough bumps that look like cauliflower. They can appear inside the lips and on other parts of the mouth. Credit: NIDCR publication: Mouth Problems + HIV Download: Low-Resolution Image High- ...

  1. 21 CFR 872.6510 - Oral irrigation unit.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Oral irrigation unit. 872.6510 Section 872.6510...) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6510 Oral irrigation unit. (a) Identification. An oral irrigation unit is an AC-powered device intended to provide a pressurized stream of water...

  2. 21 CFR 872.6030 - Oral cavity abrasive polishing agent.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Oral cavity abrasive polishing agent. 872.6030... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6030 Oral cavity abrasive polishing agent. (a) Identification. An oral cavity abrasive polishing agent is a device in paste or powder...

  3. 21 CFR 872.6030 - Oral cavity abrasive polishing agent.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Oral cavity abrasive polishing agent. 872.6030... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6030 Oral cavity abrasive polishing agent. (a) Identification. An oral cavity abrasive polishing agent is a device in paste or powder...

  4. 21 CFR 872.6510 - Oral irrigation unit.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6510 Oral irrigation unit. (a) Identification. An oral irrigation unit is an AC-powered device intended to provide a pressurized stream of water to... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Oral irrigation unit. 872.6510 Section...

  5. 21 CFR 872.6510 - Oral irrigation unit.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6510 Oral irrigation unit. (a) Identification. An oral irrigation unit is an AC-powered device intended to provide a pressurized stream of water to... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Oral irrigation unit. 872.6510 Section...

  6. 21 CFR 872.6510 - Oral irrigation unit.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6510 Oral irrigation unit. (a) Identification. An oral irrigation unit is an AC-powered device intended to provide a pressurized stream of water to... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Oral irrigation unit. 872.6510 Section...

  7. 21 CFR 872.6510 - Oral irrigation unit.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6510 Oral irrigation unit. (a) Identification. An oral irrigation unit is an AC-powered device intended to provide a pressurized stream of water to... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Oral irrigation unit. 872.6510 Section...

  8. Oral care.

    PubMed

    Hitz Lindenmüller, Irène; Lambrecht, J Thomas

    2011-01-01

    Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing/recovering from chemo-/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases. The use of a toothbrush is the most important measure for oral hygiene. Toothbrushes with soft bristles operated carefully by hand or via an electric device help to remove plaque and to avoid mucosal trauma. A handlebar with a grip cover can be helpful for manually disabled patients or for those with reduced motor skills. In case of oral hygiene at the bedside or of patients during/after chemo-/radiotherapy a gauze pad can be helpful for gently cleaning the teeth, gums and tongue. The use of fluoride toothpaste is imperative for the daily oral hygiene. Detergents such as sodium lauryl sulphate improve the cleaning action but may also dehydrate and irritate the mucous membrane. The use of products containing detergents and flavouring agents (peppermint, menthol, cinnamon) should therefore be avoided by bedridden patients or those with dry mouth and sensitive mucosa. Aids for suitable interdental cleaning, such as dental floss, interdental brushes or dental sticks, are often complicated to operate. Their correct use should be instructed by healthcare professionals. To support dental care, additional fluoridation with a fluoride gel or rinse can be useful. Products further containing antiseptics such as chlorhexidine or triclosan reduce the quantity of bacteria in the mouth. For patients undergoing or having undergone radio-/chemotherapy, a mouthwash that concomitantly moisturizes the oral mucosa is advisable. PMID:21325845

  9. Oral care.

    PubMed

    Hitz Lindenmüller, Irène; Lambrecht, J Thomas

    2011-01-01

    Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing/recovering from chemo-/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases. The use of a toothbrush is the most important measure for oral hygiene. Toothbrushes with soft bristles operated carefully by hand or via an electric device help to remove plaque and to avoid mucosal trauma. A handlebar with a grip cover can be helpful for manually disabled patients or for those with reduced motor skills. In case of oral hygiene at the bedside or of patients during/after chemo-/radiotherapy a gauze pad can be helpful for gently cleaning the teeth, gums and tongue. The use of fluoride toothpaste is imperative for the daily oral hygiene. Detergents such as sodium lauryl sulphate improve the cleaning action but may also dehydrate and irritate the mucous membrane. The use of products containing detergents and flavouring agents (peppermint, menthol, cinnamon) should therefore be avoided by bedridden patients or those with dry mouth and sensitive mucosa. Aids for suitable interdental cleaning, such as dental floss, interdental brushes or dental sticks, are often complicated to operate. Their correct use should be instructed by healthcare professionals. To support dental care, additional fluoridation with a fluoride gel or rinse can be useful. Products further containing antiseptics such as chlorhexidine or triclosan reduce the quantity of bacteria in the mouth. For patients undergoing or having undergone radio-/chemotherapy, a mouthwash that concomitantly moisturizes the oral mucosa is advisable.

  10. Oral Cancer Screening

    MedlinePlus

    ... Prevention Oral Cavity and Oropharyngeal Cancer Screening Research Oral Cavity and Oropharyngeal Cancer Screening (PDQ®)–Patient Version What ... These are called diagnostic tests . General Information About Oral Cavity and Oropharyngeal Cancer Key Points Oral cavity and ...

  11. Structure-based optimization leads to the discovery of NSC765844, a highly potent, less toxic and orally efficacious dual PI3K/mTOR inhibitor.

    PubMed

    Han, Jinsong; Chen, Ying; Yang, Chao; Liu, Ting; Wang, Mingping; Xu, Haojie; Zhang, Ling; Zheng, Canhui; Song, Yunlong; Zhu, Ju

    2016-10-21

    The phosphoinositide 3-kinase (PI3K) family is one of the most frequently activated enzymes in a wide range of human cancers; thus, inhibition of PI3K represents a promising strategy for cancer therapy. Herein, a series of benzylamine substituted arylsulfonamides were designed and synthesized as dual PI3K/mTOR inhibitors using a strategy integrating focused library design and virtual screening, resulting in the discovery of 13b (NSC765844). The compound 13b exhibits highly potent enzyme inhibition with IC50s of 1.3, 1.8, 1.5, 3.8 and 3.8 nM for PI3Kα, β, γ, δ, and mTOR, respectively. 13b was further evaluated in NCI by an in vitro cytotoxic screening program. Broad-spectrum antitumor activities with mean GI50 value of 18.6 nM against approximately 60 human tumor cell lines were found. 13b displayed favorable physicochemical properties and superior pharmacokinetic profiles for animal studies. It significantly inhibited tumor growth when administered orally in an A549 non-small-cell lung carcinoma xenograft and BEL7404 human hepatocellular carcinoma xenograft models. On the basis of its excellent in vivo efficacy and superior pharmacokinetic profiles, 13b has been selected for further preclinical investigation as a promising anticancer drug candidate. PMID:27448924

  12. Oral health survey and oral health questionnaire for high school students in Tibet, China

    PubMed Central

    2014-01-01

    Objectives The aim of this study is to identify the oral health status as well as oral health practices and access for care of graduating senior high school Tibetan students in Shannan prefecture of Tibet. Methods Based on standards of the 3rd Chinese National Oral Epidemiological Survey and WHO Oral Health Surveys, 1907 graduating students from three senior high schools were examined for caries, periodontitis, dental fluorosis, and oral hygiene status. The questionnaire to the students addressed oral health practices and present access to oral medical services. Results Dental caries prevalence (39.96%) and mean DMFT (0.97) were high in Tibetan students. In community periodontal indexes, the detection rate of gingivitis and dental calculus were 59.50% and 62.64%, respectively. Oral hygiene index-simplified was 0.69, with 0.36 and 0.33 in debris index-simplified and calculus index-simplified, respectively. Community dental fluorosis index was 0.29, with 8.13% in prevalence rate. The questionnaire showed students had poor oral health practices and unawareness for their needs for oral health services. It was also noted that the local area provides inadequate oral medical services. Conclusions Tibetan students had higher prevalence of dental diseases and lower awareness of oral health needs. The main reasons were geographical environment, dietary habit, students’ attitude to oral health, and lack of oral health promotion and education. Oral health education and local dentists training should be strengthened to get effective prevention of dental diseases. PMID:24884668

  13. Oral Adverse Reactions Caused by Over-the-Counter Oral Agents

    PubMed Central

    Andabak Rogulj, Ana; Vidovic Juras, Danica; Gabric, Dragana; Vrdoljak, Danko Velimir

    2015-01-01

    Over-the-counter products rarely cause unwanted reactions in the oral cavity. Oral reactions to these agents are not specific and might present with various clinical oral findings. Detailed medical history is a key to the proper diagnosis of these lesions and fortunately other diagnostic procedures are rarely needed. Lesions are usually managed with elimination of the offending agent and with topical steroids. In more severe cases systemic steroids should be applied. PMID:25883811

  14. Pharmacokinetics of IDX184, a liver-targeted oral prodrug of 2'-methylguanosine-5'-monophosphate, in the monkey and formulation optimization for human exposure.

    PubMed

    Pan-Zhou, Xin-Ru; Mayes, Benjamin A; Rashidzadeh, Hassan; Gasparac, Rahela; Smith, Steven; Bhadresa, Sanjeev; Gupta, Kusum; Cohen, Marita Larsson; Bu, Charlie; Good, Steven S; Moussa, Adel; Rush, Roger

    2016-10-01

    IDX184 is a phosphoramidate prodrug of 2'-methylguanosine-5'-monophosphate, developed to treat patients infected with hepatitis C virus. A mass balance study of radiolabeled IDX184 and pharmacokinetic studies of IDX184 in portal vein-cannulated monkeys revealed relatively low IDX184 absorption but higher exposure of IDX184 in the portal vein than in the systemic circulation, indicating >90 % of the absorbed dose was subject to hepatic extraction. Systemic exposures to the main metabolite, 2'-methylguanosine (2'-MeG), were used as a surrogate for liver levels of the pharmacologically active entity 2'-MeG triphosphate, and accordingly, systemic levels of 2'-MeG in the monkey were used to optimize formulations for further clinical development of IDX184. Capsule formulations of IDX184 delivered acceptable levels of 2'-MeG in humans; however, the encapsulation process introduced low levels of the genotoxic impurity ethylene sulfide (ES), which necessitated formulation optimization. Animal pharmacokinetic data guided the development of a tablet with trace levels of ES and pharmacokinetic performance equal to that of the clinical capsule in the monkey. Under fed conditions in humans, the new tablet formulation showed similar exposure to the capsule used in prior clinical trials. PMID:25898809

  15. Pharmacokinetics of IDX184, a liver-targeted oral prodrug of 2'-methylguanosine-5'-monophosphate, in the monkey and formulation optimization for human exposure.

    PubMed

    Pan-Zhou, Xin-Ru; Mayes, Benjamin A; Rashidzadeh, Hassan; Gasparac, Rahela; Smith, Steven; Bhadresa, Sanjeev; Gupta, Kusum; Cohen, Marita Larsson; Bu, Charlie; Good, Steven S; Moussa, Adel; Rush, Roger

    2016-10-01

    IDX184 is a phosphoramidate prodrug of 2'-methylguanosine-5'-monophosphate, developed to treat patients infected with hepatitis C virus. A mass balance study of radiolabeled IDX184 and pharmacokinetic studies of IDX184 in portal vein-cannulated monkeys revealed relatively low IDX184 absorption but higher exposure of IDX184 in the portal vein than in the systemic circulation, indicating >90 % of the absorbed dose was subject to hepatic extraction. Systemic exposures to the main metabolite, 2'-methylguanosine (2'-MeG), were used as a surrogate for liver levels of the pharmacologically active entity 2'-MeG triphosphate, and accordingly, systemic levels of 2'-MeG in the monkey were used to optimize formulations for further clinical development of IDX184. Capsule formulations of IDX184 delivered acceptable levels of 2'-MeG in humans; however, the encapsulation process introduced low levels of the genotoxic impurity ethylene sulfide (ES), which necessitated formulation optimization. Animal pharmacokinetic data guided the development of a tablet with trace levels of ES and pharmacokinetic performance equal to that of the clinical capsule in the monkey. Under fed conditions in humans, the new tablet formulation showed similar exposure to the capsule used in prior clinical trials.

  16. Baclofen Oral

    MedlinePlus

    ... nerves and decreases the number and severity of muscle spasms caused by multiple sclerosis or spinal cord diseases. It also relieves pain and improves muscle movement.This medication is sometimes prescribed for other ...

  17. Quinidine Oral

    MedlinePlus

    ... medications for seizures, sleep, or an infection; and vitamins.tell your doctor if you have an infection or have or have ever had myasthenia gravis; heart, kidney, or liver disease; or muscle weakness.tell your doctor if you ...

  18. Desmopressin Oral

    MedlinePlus

    ... of surgery. Desmopressin is also used to control bed-wetting. Desmopressin is in a class of medications ... a day. When desmopressin is used to treat bed-wetting, it is usually taken once a day ...

  19. Oral cancer staging established by magnetic resonance imaging.

    PubMed

    Paiva, Rogério Ribeiro de; Figueiredo, Paulo Tadeu de Souza; Leite, André Ferreira; Silva, Maria Alves Garcia; Guerra, Eliete Neves Silva

    2011-01-01

    The aim of this study was to compare clinical staging and magnetic resonance imaging (MRI) staging for oral cancer, and to assess inter-observer agreement between oral and medical radiologists. A total of 10 patients diagnosed with oral cancer were assessed before treatment. A head and neck surgeon performed clinical TNM staging. Two medical radiologists and two oral radiologists performed a new staging assessment by interpreting MRI scans, without prior knowledge of the clinical staging. They evaluated the extent of the primary tumor (T), metastasis to regional lymph nodes (N) and grouping by stages. The data were analyzed using the Kappa Index. There was significant agreement (p < 0.05) between the clinical and MRI staging assessments made by one oral radiologist for N stage, and between those made by one medical radiologist for the T and N stages and for the grouping by stages. In the MRI assessment, there was significant agreement among all four observers for both T stage and grouping by stages. For the N stage, there was no significant agreement between one oral radiologist and one medical radiologist or between both medical radiologists. There was significant agreement among the remaining radiologists. There was no agreement between the clinical and MRI staging. These results indicate the importance of using MRI for the diagnosis of oral cancer. Training initiatives and calibration of medical and oral radiologists should be promoted to provide an improved multidisciplinary approach to oral cancer.

  20. Options for treating postherpetic neuralgia in the medically complicated patient

    PubMed Central

    Bruckenthal, Patricia; Barkin, Robert L

    2013-01-01

    Patients with postherpetic neuralgia (PHN) are often of advanced age or immunocompromised and likely to have ≥1 comorbid medical condition for which they receive ≥1 medication (polypharmacy). Comorbidities affecting renal or hepatic function can alter pharmacokinetics, thereby impacting the efficacy or tolerability of PHN analgesic therapies. Cardiovascular, cerebrovascular, or psychiatric comorbidities may increase patient vulnerability to potential adverse events associated with some PHN analgesic therapies. Because PHN is a localized condition, localized therapy with a topical analgesic (lidocaine patch 5% and capsaicin 8% patch or cream) may provide adequate efficacy while mitigating the risk of systemic adverse events compared with oral analgesics (eg, tricyclic antidepressants, anticonvulsants, opioids). However, combined therapy with a topical and an oral analgesic or with >1 oral analgesic may be needed for optimal pain management in some patients. This review summarizes how comorbidities and concomitant medications should be taken into account when selecting among available pharmacotherapies for PHN and provides recommendations for the selection of therapies that will provide analgesia while minimizing the risk of adverse events. PMID:23990726

  1. Cost‐Effectiveness of Supervised Exercise, Stenting, and Optimal Medical Care for Claudication: Results From the Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) Trial

    PubMed Central

    Reynolds, Matthew R.; Apruzzese, Patricia; Galper, Benjamin Z.; Murphy, Timothy P.; Hirsch, Alan T.; Cutlip, Donald E.; Mohler, Emile R.; Regensteiner, Judith G.; Cohen, David J.

    2014-01-01

    Background Both supervised exercise (SE) and stenting (ST) improve functional status, symptoms, and quality of life compared with optimal medical care (OMC) in patients with claudication. The relative cost‐effectiveness of these strategies is not well defined. Methods and Results The Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) study randomized patients with claudication due to aortoiliac stenosis to a 6‐month SE program, to ST, or to OMC. Participants who completed 6‐month follow‐up (n=98) were included in a health economic analysis through 18 months. Costs were assessed using resource‐based methods and hospital billing data. Quality‐adjusted life‐years were estimated using the EQ‐5D. Markov modeling based on the in‐trial results was used to explore the impact of assumptions about the longer term durability of observed differences in quality of life. Through 18 months, mean healthcare costs were $5178, $9804, and $14 590 per patient for OMC, SE, and ST, respectively. Measured quality‐adjusted life‐years through 18 months were 1.04, 1.16, and 1.20. In our base case analysis, which assumed that observed differences in quality of life would dissipate after 5 years, the incremental cost‐effectiveness ratios were $24 070 per quality‐adjusted life‐year gained for SE versus OMC, $41 376 for ST versus OMC, and $122 600 for ST versus SE. If the treatment effect of ST was assumed to be more durable than that of SE, the incremental cost‐effectiveness ratio for ST versus SE became more favorable. Conclusions Both SE and ST are economically attractive by US standards relative to OMC for the treatment of claudication in patients with aortoiliac disease. ST is more expensive than SE, with uncertain incremental benefit. Clinical Trial Registration URL: www.clinicaltrials.gov, Unique identifier: NCT00132743. PMID:25389284

  2. Risk of Stroke in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention versus Optimal Medical Therapy: Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Taglieri, Nevio; Bacchi Reggiani, Maria Letizia; Ghetti, Gabriele; Saia, Francesco; Dall’Ara, Gianni; Gallo, Pamela; Moretti, Carolina; Palmerini, Tullio; Marrozzini, Cinzia; Marzocchi, Antonio; Rapezzi, Claudio

    2016-01-01

    Background Stroke is a rare but serious adverse event associated with percutaneous coronary intervention (PCI). However, the relative risk of stroke between stable patients undergoing a direct PCI strategy and those undergoing an initial optimal medical therapy (OMT) strategy has not been established yet. This study sought to investigate if, in patients with stable coronary artery disease (SCAD), an initial strategy PCI is associated with a higher risk of stroke than a strategy based on OMT alone. Methods We performed a meta-analysis of 6 contemporary randomized control trials in which 5673 patients with SCAD were randomized to initial PCI or OMT. Only trials with stent utilization more than 50% were included. Study endpoint was the rate of stroke during follow up. Results Mean age of patients ranged from 60 to 65 years and stent utilization ranged from 72% to 100%. Rate of stroke was 2.0% at a weighted mean follow up of 55.3 months. On pooled analysis, the risk of stroke was similar between patients undergoing a PCI plus OMT and those receiving only OMT (2.2% vs. 1.8%, OR on fixed effect = 1.24 95%CI: 0.85–1.79). There was no heterogeneity among the studies (I2 = 0.0%, P = 0.15). On sensitivity analysis after removing each individual study the pooled effect estimate remains unchanged. Conclusions In patients with SCAD an initial strategy based on a direct PCI is not associated with an increased risk of stroke during long-term follow up compared to an initial strategy based on OMT alone. PMID:27391212

  3. Reassessment of risk factors for oral cancer.

    PubMed

    Gangane, Nitin; Chawla, Shweta; Anshu; Subodh, Anshu; Gupta, Subodh Sharan; Sharma, Satish M

    2007-01-01

    A total of 140 cases of histologically confirmed oral cancer were evaluated for their demographic details, dietary habits and addiction to tobacco and alcohol using a pre-designed structured questionnaire at the Mahatma Gandhi Institute of Medical Sciences, Sevagram in Central India. These cases were matched with three sets of age and sex matched controls. Oral cancer was predominant in the age group of 50-59 years. Individuals on a non-vegetarian diet appeared to be at greater risk of developing oral cancer. Cases were habituated to consuming hot beverages more frequently and milk less frequently than controls. Consumption of ghutka, a granular form of chewable tobacco and areca nut, was significantly associated with oral cancer cases. Cases had been using oral tobacco for longer duration than controls, and were habituated to sleeping with tobacco quid in their mouth. Most cases were also addicted to smoking tobacco and alcohol consumption. Bidi (a crude cigarette) smoking was most commonly associated with oral cancer. On stratified analysis, a combination of regular smoking and oral tobacco use, as well as a combination of regular alcohol intake and oral tobacco use were significantly associated with oral cancer cases. Synergistic effects of all three or even two of the risk factors - oral tobacco use, smoking and alcohol consumption- was more commonly seen in cases when compared to controls.

  4. ADVERSE DRUG REACTIONS IN THE ORAL CAVITY.

    PubMed

    Boras, Vanja Vučićević; Andabak-Rogulj, Ana; Brailo, Vlaho; Šimunković, Sonja Kraljević; Gabrić, Dragana; Vrdoljak, Danko Velimir

    2015-06-01

    Every medication may lead to adverse effects, even when used in standard doses and mode of application. In the oral cavity, adverse effects may affect every part of oral mucosa and are the result of medications taken either locally or systemically. Oral adverse reactions to drugs are not typical and therefore sometimes not easy to recognize. On diagnosing adverse side effects in the oral cavity, experienced clinician will usually diagnose the condition on the basis of detailed medical history and clinical finding. However, the only objective evidence for the offending drug is 're-challenge', i.e. exposure to the drug after its discontinuation. It carries a huge risk of anaphylactic reaction; therefore it has to be performed in a controlled hospital setting. Therapy is based on immediate exclusion of the offending drug and, if lesions are present in the oral cavity, topical or systemic corticosteroid therapy is prescribed. This article gives a review of patients with oral adverse drug reactions referred to the Department of Oral Medicine in Zagreb.

  5. Abortion - medical

    MedlinePlus

    ... womb (uterus). There are different types of medical abortions: Therapeutic medical abortion is done because the woman has ... Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion

  6. Optimal timing of initiation of oral P2Y12-receptor antagonist therapy in patients with non-ST elevation acute coronary syndromes. Lessons learnt from the ACCOAST-trial.

    PubMed

    Zeymer, Uwe; Montalescot, Gilles; Ardissino, Diego; Bolognese, Leonardo; Clemmensen, Peter; Collet, Jean-Philippe; Lopez-Sendon, Jose; Widimsky, Petr

    2016-06-01

    The optimal time-point of the initiation of P2Y12 antagonist therapy in patients with non-ST elevation acute coronary syndromes (NTSE-ACS) is still a matter of debate. European guidelines recommend P2Y12 as soon as possible after first medical contact. However, the only trial which compared the two strategies did not demonstrate any benefit of pre-treatment with prasugrel before angiography compared to starting therapy after angiography and just prior to percutaneous coronary intervention (PCI). This paper summarizes the results of pharmacodynamic and previous studies, and gives recommendations for the initiation of P2Y12 antagonist therapy in NSTE-ACS in different clinical situations. PMID:25921481

  7. [Oral therapy of interstitial cystitis].

    PubMed

    Sievert, K D; Edenfeld, K D; Oberpenning, F; Piechota, H J

    2000-11-01

    Up to now there is no specific treatment targeting the ultimate cause of interstitial cystitis (IC), since its pathogenesis and etiology are still unknown. Most studies focussing on oral medication have not been randomized, double-blinded or placebo-controlled. Numerous case reports and intent-to-treat trials are lacking a systematic approach and do not meet evidence-based medicine criteria. Consequently there is as yet no standard oral therapy available for the treatment of IC. However, only a few oral substances have shown a potential to improve symptoms such as frequency and pain. The best results were obtained from monotherapeutic use of pentosanpolysulfate, amitriptylin and hydroxycin. The true benefit of these substances alone should be compared to analgesics and anticholinergics in the course of controlled clinical trials.

  8. Design and statistical analysis of oral medicine studies: common pitfalls.

    PubMed

    Baccaglini, L; Shuster, J J; Cheng, J; Theriaque, D W; Schoenbach, V J; Tomar, S L; Poole, C

    2010-04-01

    A growing number of articles are emerging in the medical and statistics literature that describe epidemiologic and statistical flaws of research studies. Many examples of these deficiencies are encountered in the oral, craniofacial, and dental literature. However, only a handful of methodologic articles have been published in the oral literature warning investigators of potential errors that may arise early in the study and that can irreparably bias the final results. In this study, we briefly review some of the most common pitfalls that our team of epidemiologists and statisticians has identified during the review of submitted or published manuscripts and research grant applications. We use practical examples from the oral medicine and dental literature to illustrate potential shortcomings in the design and analysis of research studies, and how these deficiencies may affect the results and their interpretation. A good study design is essential, because errors in the analysis can be corrected if the design was sound, but flaws in study design can lead to data that are not salvageable. We recommend consultation with an epidemiologist or a statistician during the planning phase of a research study to optimize study efficiency, minimize potential sources of bias, and document the analytic plan.

  9. Minoxidil Oral

    MedlinePlus

    ... heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control ... least 30 minutes most days, not smoking, and using alcohol in moderation.

  10. Torsemide Oral

    MedlinePlus

    ... heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control ... least 30 minutes most days, not smoking, and using alcohol in moderation.

  11. Labetalol Oral

    MedlinePlus

    ... heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control ... least 30 minutes most days, not smoking, and using alcohol in moderation.

  12. Timolol Oral

    MedlinePlus

    ... heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control ... least 30 minutes most days, not smoking, and using alcohol in moderation.

  13. [Medicines and oral healthcare 1. What oral healthcare providers need to know about medicines].

    PubMed

    Vissink, A; de Baat, C

    2016-09-01

    Many patients who visit a dentist, oral hygienist or other oral healthcare provider use medicines. As a result of the ageing of the Dutch population, the number of patients using medicines will further increase, including the number of patients who are using more than one medicine. In addition to medicines, many patients, including healthy individuals, use self-care medications. Both medicines and self-care medications can interfere with dental treatment and/or may serve as an explanation for changes that dentists, oral hygienists or other oral healthcare providers observe in and around the mouth. With a series of articles about medicines and oral healthcare, attention will be given to this issue, an issue that will be increasingly important in the future. In addition, suggestions will be made in these articles for medicines for disorders in the head and neck region, keeping in mind that these suggestions should not be seen as dogmatic. PMID:27643494

  14. Chapter Oral Health Advocates: A Nationwide Model for Pediatrician Peer Education and Advocacy about Oral Health

    PubMed Central

    Lewis, Charlotte W.; Barone, Lauren; Quinonez, Rocio B.; Boulter, Suzanne; Mouradian, Wendy E.

    2013-01-01

    Objective. (1) To describe an innovative program training US pediatricians to be Chapter Oral Health Advocates (COHAs). (2) To provide insight into COHAs' experiences disseminating oral health knowledge to fellow pediatricians. Patients and Methods. Interviews with 40 COHAs who responded to an email request, from a total of 64 (62% response). Transcripts were analyzed for common themes about COHA activities, facilitators, and barriers. Results. COHAs reported positive experiences at the AAP oral health training program. A subset of academic COHAs focused on legislative activity and another on resident education about oral health. Residents had an easier time adopting oral health activities while practicing pediatricians cited time constraints. COHAs provided insights into policy, barriers, and facilitators for incorporating oral health into practice. Conclusions. This report identifies factors influencing pediatricians' adoption of oral health care into practice. COHAs reported successes in training peers on integrating oral health into pediatric practice, identified opportunities and challenges to oral health implementation in primary care, and reported issues about the state of children's oral health in their communities. With ongoing support, the COHA program has a potential to improve access to preventive oral health services in the Medical Home and to increase referrals to a Dental Home. PMID:24228032

  15. Pain Scores Are Not Predictive of Pain Medication Utilization

    PubMed Central

    Galloway, Suzanne; Chimhanda, Maryann; Sloan, Jayme; Anderson, Charles; Sinacore, James; Brubaker, Linda

    2011-01-01

    Objective. To compare Visual Analogue Scale (VAS) scores with overall postoperative pain medication requirements including cumulative dose and patterns of medication utilization and to determine whether VAS scores predict pain medication utilization. Methods. VAS scores and pain medication data were collected from participants in a randomized trial of the utility of phenazopyridine for improved pain control following gynecologic surgery. Results. The mean age of the 219 participants was 54 (range19 to 94). We did not detect any association between VAS and pain medication utilization for patient-controlled anesthesia (PCA) or RN administered (intravenous or oral) medications. We also did not detect any association between the number of VAS scores recorded and mean pain scores. Conclusion. Postoperative VAS scores do not predict pain medication use in catheterized women inpatients following gynecologic surgery. Increased pain severity, as reflected by higher VAS scores, is not associated with an increase in pain assessment. Our findings suggest that VAS scores are of limited utility for optimal pain control. Alternative or complimentary methods may improve pain management. PMID:22110938

  16. [Oral pain].

    PubMed

    Benslama, Lotfi

    2002-02-15

    Pain, a major symptom of stomatological disease, usually leads to a specialist consultation. Most commonly it is caused by dental caries and differs in nature and in intensity according to the stage of disease: dentinitis, pulpitis, desmodontitis and dental abscess. Added to this is peridental pain and the pre- and post-operative pains related to these diseases. Almost all oral-maxillary pathology is painful, be it boney such as in osteomyelitis and fractures, mucosal in gingivo-stomatitis and aphthous ulcers, or tumourous. However, besides the "multidisciplinary" facial pains such as facial neuralgia and vascular pain, two pain syndromes are specific to stomatology: pain of the tempero-mandibular joint associated with problems of the bite and glossodynia, a very common somatic expression of psychological problems.

  17. [Oral contraception].

    PubMed

    Guillat, J C

    1980-04-20

    OC (oral contraception) includes the combined and sequential methods, postcoital and progestin only contraception, mini pills, and macro pills. The mechanism of action of OC modifies the hypothalamo-hypophysary secretion, the uterine mucosa, and the cervical mucus. Effectiveness of OC is nearly 100%; prescription of OC requires a complete clinical and biological evaluation of the patient. Contraindications to OC are any form of cancer, hypertension, vascular or thrombotic antecedents, obesity, tabagism, diabetes. OC users must be checked at least every 6 months, and treatment can last, if there are no evident signs of side effects, until about age 40. The most commonly known side effects of OC are menstruation disorders, cardio- and cerebrovascular effects, hepatic and metabolic effects; there is no evidence that OC can cause carcinogenic effects, but it can increase teratogenic risk. The association of OC with such drugs as Rifampicine, anticonvulsants and/or tranquillizers, can nullify contraceptive effectiveness. PMID:6900393

  18. Medical abortion in Australia: a short history.

    PubMed

    Baird, Barbara

    2015-11-01

    Surgical abortion has been provided liberally in Australia since the early 1970s, mainly in privately owned specialist clinics. The introduction of medical abortion, however, was deliberately obstructed and consequently significantly delayed when compared to similar countries. Mifepristone was approved for commercial import only in 2012 and listed as a government subsidised medicine in 2013. Despite optimism from those who seek to improve women's access to abortion, the increased availability of medical abortion has not yet addressed the disadvantage experienced by poor and non-metropolitan women. After telling the story of medical abortion in Australia, this paper considers the context through which it has become available since 2013. It argues that the integration of medical abortion into primary health care, which would locate abortion provision in new settings and expand women's access, has been constrained by the stigma attached to abortion, overly cautious institutionalised frameworks, and the lack of public health responsibility for abortion services. The paper draws on documentary sources and oral history interviews conducted in 2013 and 2015. PMID:26719008

  19. Recurrent oral ulcers--an overview.

    PubMed

    Gaffar, A

    2001-01-01

    Recurrent oral ulcers (ROUs) are the most common oral mucosal disease. The etiology of ROUs is complex. The factors include mechanical trauma, genetics, stress, smoking, and viral and bacterial infections. Treatment modalities depend on the differential diagnosis of ROUs and could consist of antimicrobial agents, anti-inflammatory agents, immunomodulators, or over-the-counter medications. New therapy available in the form of a coating polymer, Colgate ORABASE Soothe.N.Seal, is clinically proven to provide rapid relief and healing of ROUs.

  20. Comparison of insulin lispro protamine suspension versus insulin glargine once daily added to oral antihyperglycaemic medications and exenatide in type 2 diabetes: a prospective randomized open-label trial

    PubMed Central

    Arakaki, R F; Blevins, T C; Wise, J K; Liljenquist, D R; Jiang, H H; Jacobson, J G; Martin, S A; Jackson, J A

    2014-01-01

    Aims To compare efficacy and safety of two, once-daily basal insulin formulations [insulin lispro protamine suspension (ILPS) vs. insulin glargine (glargine)] added to oral antihyperglycaemic medications (OAMs) and exenatide BID in suboptimally controlled type 2 diabetes (T2D) patients. Methods This 24-week, open-label, multicentre trial randomized patients to bedtime ILPS (n = 171) or glargine (n = 168). Non-inferiority of ILPS versus glargine was assessed by comparing the upper limit of 95% confidence intervals (CIs) for change in haemoglobin A1c (HbA1c) from baseline to week 24 (adjusted for baseline HbA1c) with non-inferiority margin 0.4%. Results Non-inferiority of ILPS versus glargine was demonstrated: least-squares mean between-treatment difference (ILPS minus glargine) (95% CI) was 0.22% (0.06, 0.38). Mean HbA1c reduction was less for ILPS- versus glargine-treated patients (−1.16 ± 0.84 vs. −1.40 ± 0.97%, p = 0.008). Endpoint HbA1c < 7.0% was achieved by 53.7% (ILPS) and 61.7% (glargine) (p = NS). Overall hypoglycaemia rates (p = NS) and severe hypoglycaemia incidence (p = NS) were similar. Nocturnal hypoglycaemia rate was higher in patients treated with ILPS versus glargine (p = 0.004). Weight gain was similar between groups (ILPS: 0.27 ± 3.38 kg; glargine: 0.66 ± 3.93 kg, p = NS). Endpoint total insulin doses were lower in patients treated with ILPS versus glargine (0.30 ± 0.17 vs. 0.37 ± 0.17 IU/kg/day, p < 0.001). Conclusions ILPS was non-inferior to glargine for HbA1c change over 24 weeks, but was associated with less HbA1c reduction and more nocturnal hypoglycaemia. Treat-to-target basal insulin therapy improves glycaemic control and is associated with minimal weight gain when added to OAMs and exenatide BID for suboptimally controlled T2D. PMID:24298995

  1. Innovative Primary Care Training: The Cambridge Health Alliance Oral Physician Program

    PubMed Central

    Seymour, Brittany Anne; Swann, Brian; Jayaratne, Yasas S. N.; Outlaw, Jason; Kalenderian, Elsbeth

    2012-01-01

    We evaluated the Oral Physician Program, a dental residency sponsored by Harvard Medical School, Harvard School of Dental Medicine, and the Cambridge Health Alliance that offers an innovative model for training dentists to provide limited primary care. The didactic and clinical experiences increased residents' medical knowledge and interviewing skills, and faculty assessments supported their role as oral physicians. Oral physicians could increase patients'—especially patients from underserved groups—access to integrated oral and primary care services. PMID:22994253

  2. [Oral jewelry: a review].

    PubMed

    Jeger, Franziska; Lussi, Adrian; Zimmerli, Brigitte

    2009-01-01

    Oral jewelry is popular. One of the most widely spread types are so-called tooth diamonds made of composite materials which are applied to the teeth with an adhesive. Note that parents are required to sign a release form for under-aged patients in Switzerland. Tooth cap grills and gold teeth are considered status symbols within the Hip-Hop fashion scene. However, tooth ornaments favour the accumulation of plaque and can diminish the ability to articulate. With respect to jewelry in oral soft tissue especially tongue and lip piercings are of significance to dentists. Besides the systemic complications, which are mostly caused by a lack of hygiene or the failure of noting medical contraindications by the piercer, local complications occur frequently. After surgery, pain, swelling, infections as well as hemorrhages or hematomas can be observed. Long-term effects can be problematic: gingival recession can be discernes mainly in the case of lip piercings the loss of hard tooth substance in the case of tongue piercings. Because of that, conservation therapies can become indespensable. Patients wearing dental jewelry have to be aware of risks of tooth damage, and they regularly have to undergo dental check-ups. Information campaigns--for dentists as well as patients--are necessary.

  3. Ototoxic Medications (Medication Effects)

    MedlinePlus

    ... Toggle navigation Careers Certification Publications Events Advocacy Continuing Education Practice Management Research Home / Information for the Public / Hearing and Balance Ototoxic Medications ( ...

  4. Biomechanics of oral mucosa

    PubMed Central

    Chen, Junning; Ahmad, Rohana; Li, Wei; Swain, Michael; Li, Qing

    2015-01-01

    The prevalence of prosthodontic treatment has been well recognized, and the need is continuously increasing with the ageing population. While the oral mucosa plays a critical role in the treatment outcome, the associated biomechanics is not yet fully understood. Using the literature available, this paper provides a critical review on four aspects of mucosal biomechanics, including static, dynamic, volumetric and interactive responses, which are interpreted by its elasticity, viscosity/permeability, apparent Poisson's ratio and friction coefficient, respectively. Both empirical studies and numerical models are analysed and compared to gain anatomical and physiological insights. Furthermore, the clinical applications of such biomechanical knowledge on the mucosa are explored to address some critical concerns, including stimuli for tissue remodelling (interstitial hydrostatic pressure), pressure–pain thresholds, tissue displaceability and residual bone resorption. Through this review, the state of the art in mucosal biomechanics and their clinical implications are discussed for future research interests, including clinical applications, computational modelling, design optimization and prosthetic fabrication. PMID:26224566

  5. Medical Evaluation Before Operation

    PubMed Central

    Elliot, Diane L.; Linz, Douglas H.; Kane, Joseph A.

    1982-01-01

    Surgical outcome can be optimized by anticipation and prevention of medical complications. General considerations that apply to all patients include evaluation for coagulation disorders, prior anesthetic complications and drug history. Evaluation for organ-specific risk factors allows identification of patients at high surgical risk, minimization of risk and anticipation of postoperative complications. Review of the recent literature and a practical guide to therapy is presented for the major medical considerations before surgical procedures: cardiac disease, hypertension, pulmonary disease, endocrine considerations and hepatic disease. Attention to these areas and communication among internists, anesthesiologists and surgeons should provide optimal treatment of surgical patients with medical disease. PMID:7179956

  6. Oral rehabilitation and management of mentally retarded.

    PubMed

    Solanki, Jitender; Khetan, Jitendra; Gupta, Sarika; Tomar, Deepak; Singh, Meenakshi

    2015-01-01

    High level of periodontal problems of dental caries are frequently observed in mentally handicapped children. This group of patients presents various problems when they face dental treatments. Identification of such population and providing them affordable oral health care is the new concept. A systematic method for identification and screening of persons with mental retardation has been developed and is being followed. Cost and fear are the most commonly cited barriers to dental care. Physical or mental may lead to deterioration in self-care, and oral care state have a low priority. Risk factors are inter-related and are often barriers to oral health. With advancements in today's world sufficient information and support is available for each and every individual to lead a healthy life which include the access to the oral health care. Factors such as fear, anxiety and dental phobia plays a vital role in acceptance of dental care and also the delaying of dental care. Lack of knowledge of oral and dental disease, awareness or oral need, oral side-effects of medication and organization of dental services are highlighted in the literature. All health personnel should receive training to support the concept of primary oral health care. Training about dealing with such mentally handicapped people should be addressed urgently among the health professionals. PMID:25738098

  7. Oral Rehabilitation and Management of Mentally Retarded

    PubMed Central

    Khetan, Jitendra; Gupta, Sarika; Tomar, Deepak; Singh, Meenakshi

    2015-01-01

    High level of periodontal problems of dental caries are frequently observed in mentally handicapped children. This group of patients presents various problems when they face dental treatments. Identification of such population and providing them affordable oral health care is the new concept. A systematic method for identification and screening of persons with mental retardation has been developed and is being followed. Cost and fear are the most commonly cited barriers to dental care. Physical or mental may lead to deterioration in self-care, and oral care state have a low priority. Risk factors are inter-related and are often barriers to oral health. With advancements in today’s world sufficient information and support is available for each and every individual to lead a healthy life which include the access to the oral health care. Factors such as fear, anxiety and dental phobia plays a vital role in acceptance of dental care and also the delaying of dental care. Lack of knowledge of oral and dental disease, awareness or oral need, oral side-effects of medication and organization of dental services are highlighted in the literature. All health personnel should receive training to support the concept of primary oral health care. Training about dealing with such mentally handicapped people should be addressed urgently among the health professionals. PMID:25738098

  8. Anticancer oral therapy: emerging related issues.

    PubMed

    Banna, Giuseppe Luigi; Collovà, Elena; Gebbia, Vittorio; Lipari, Helga; Giuffrida, Pietro; Cavallaro, Sebastiano; Condorelli, Rosaria; Buscarino, Calogero; Tralongo, Paolo; Ferraù, Francesco

    2010-12-01

    The use of oral anticancer drugs has shown a steady increase. Most patients prefer anticancer oral therapy to intravenous treatment primarily for the convenience of a home-based therapy, although they require that the efficacy of oral therapy must be equivalent and toxicity not superior than those expected with the intravenous treatment. A better patient compliance, drug tolerability, convenience and possible better efficacy for oral therapy as compared to intravenous emerge as the major reasons to use oral anticancer agents among oncologists. Inter- and intra-individual pharmacokinetic variations in the bioavailability of oral anticancer drugs may be more relevant than for intravenous agents. Compliance is particularly important for oral therapy because it determines the dose-intensity of the treatment and ultimately treatment efficacy and toxicity. Patient stands as the most important determinant of compliance. Possible measures for an active and safe administration of oral therapy include a careful preliminary medical evaluation and selection of patients based on possible barriers to an adequate compliance, pharmacologic issues, patient-focused education, an improvement of the accessibility to healthcare service, as well as the development of home-care nursing symptom-focused interventions. Current evidences show similar quality of life profile between oral and intravenous treatments, although anticancer oral therapy seems to be more convenient in terms of administration and reduced time lost for work or other activities. Regarding cost-effectiveness, current evidences are in favor of oral therapy, mainly due to reduced need of visits and/or day in hospital for the administration of the drug and/or the management of adverse events. PMID:20570443

  9. Hershey Medical Center Technical Workshop Report: optimizing the design and interpretation of epidemiologic studies for assessing neurodevelopmental effects from in utero chemical exposure.

    PubMed

    Amler, Robert W; Barone, Stanley; Belger, Aysenil; Berlin, Cheston M; Cox, Christopher; Frank, Harry; Goodman, Michael; Harry, Jean; Hooper, Stephen R; Ladda, Roger; LaKind, Judy S; Lipkin, Paul H; Lipsitt, Lewis P; Lorber, Matthew N; Myers, Gary; Mason, Ann M; Needham, Larry L; Sonawane, Babasaheb; Wachs, Theodore D; Yager, Janice W

    2006-09-01

    Neurodevelopmental disabilities affect 3-8% of the 4 million babies born each year in the U.S. alone, with known etiology for less than 25% of those disabilities. Numerous investigations have sought to determine the role of environmental exposures in the etiology of a variety of human neurodevelopmental disorders (e.g., learning disabilities, attention deficit-hyperactivity disorder, intellectual disabilities) that are manifested in childhood, adolescence, and young adulthood. A comprehensive critical examination and discussion of the various methodologies commonly used in investigations is needed. The Hershey Medical Center Technical Workshop: Optimizing the design and interpretation of epidemiologic studies for assessing neurodevelopmental effects from in utero chemical exposure provided such a forum for examining these methodologies. The objective of the Workshop was to develop scientific consensus on the key principles and considerations for optimizing the design and interpretation of epidemiologic studies of in utero exposure to environmental chemicals and subsequent neurodevelopmental effects. (The Panel recognized that the nervous system develops post-natally and that critical periods of exposure can span several developmental life stages.) Discussions from the Workshop Panel generated 17 summary points representing key tenets of work in this field. These points stressed the importance of: a well-defined, biologically plausible hypothesis as the foundation of in utero studies for assessing neurodevelopmental outcomes; understanding of the exposure to the environmental chemical(s) of interest, underlying mechanisms of toxicity, and anticipated outcomes; the use of a prospective, longitudinal cohort design that, when possible, runs for periods of 2-5 years, and possibly even longer, in an effort to assess functions at key developmental epochs; measuring potentially confounding variables at regular, fixed time intervals; including measures of specific cognitive

  10. Oral Health in Pregnancy.

    PubMed

    Hartnett, Erin; Haber, Judith; Krainovich-Miller, Barbara; Bella, Abigail; Vasilyeva, Anna; Lange Kessler, Julia

    2016-01-01

    Oral health is crucial to overall health. Because of normal physiologic changes, pregnancy is a time of particular vulnerability in terms of oral health. Pregnant women and their providers need more knowledge about the many changes that occur in the oral cavity during pregnancy. In this article we describe the importance of the recognition, prevention, and treatment of oral health problems in pregnant women. We offer educational strategies that integrate interprofessional oral health competencies. PMID:27281467

  11. Progress in understanding oral health and HIV/AIDS.

    PubMed

    Patton, Ll

    2014-04-01

    Over the last 30 years, there have been significant advances in our scientific knowledge of HIV disease, including prevention, detection, medical management, and attempts at cure. Investigations and observations of the oral cavity in individuals with HIV disease have contributed substantially to scientific discovery and innovation. Challenges remain for managing existing and emerging oral diseases associated with HIV and understanding the contribution of latent oral mucosal reservoirs to HIV eradication.

  12. Medical Transcriptionists

    MedlinePlus

    ... equipment or software that is connected to their computer. However, technological advances have changed the way medical ... this section Medical transcriptionists must be comfortable using computers. Medical transcriptionists typically need postsecondary education. Prospective medical ...

  13. 21 CFR 872.6030 - Oral cavity abrasive polishing agent.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6030 Oral cavity abrasive polishing... that contains an abrasive material, such as silica pumice, intended to remove debris from the...

  14. 21 CFR 872.6030 - Oral cavity abrasive polishing agent.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6030 Oral cavity abrasive polishing... that contains an abrasive material, such as silica pumice, intended to remove debris from the...

  15. 21 CFR 872.6030 - Oral cavity abrasive polishing agent.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6030 Oral cavity abrasive polishing... that contains an abrasive material, such as silica pumice, intended to remove debris from the...

  16. Allergy Medications During Pregnancy.

    PubMed

    Gonzalez-Estrada, Alexei; Geraci, Stephen A

    2016-09-01

    Allergic diseases are common in women of childbearing age. Both asthma and atopic conditions may worsen, improve or remain the same during pregnancy. Primary care physicians commonly encounter women receiving multiple medications for pre-existing atopic conditions, who then become pregnant and require medication changes to avoid potential fetal injury or congenital malformations. Each medication should be evaluated; intranasal and inhaled steroids are relatively safe to continue during pregnancy (budesonide is the drug of choice), second-generation antihistamines of choice are cetirizine and loratadine, leukotriene receptor antagonists are safe, sparing use of oral decongestants during the first trimester and omalizumab may be used for both uncontrolled asthma and for antihistamine-resistant urticaria. Medications to avoid during pregnancy include intranasal antihistamines, first-generation antihistamines, mycophenolate mofetil, methotrexate, cyclosporine, azathioprine and zilueton. Common allergic diseases may develop de novo during pregnancy, such as anaphylaxis. PMID:27650241

  17. Therapeutic Uses of Oral History Techniques in Medicine.

    ERIC Educational Resources Information Center

    Harris, Raymond; Harris, Sara

    1981-01-01

    Use of the oral history technique in clinical medicine supplies significant additional data that illuminate the psychological, social, and spiritual background of healthy or ailing aging patients. Describes some practical applications of oral history techniques in clinical medical practice and discusses their usefulness for gerontological…

  18. Maturation of oral feeding skills in preterm infants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Safe and successful oral feeding requires proper maturation of sucking, swallowing and respiration. We hypothesized that oral feeding difficulties result from different temporal development of the musculatures implicated in these functions. Sixteen medically stable preterm infants (26 to 29 weeks ge...

  19. Oral Syphilis: A Reemerging Infection Prompting Clinicians' Alertness

    PubMed Central

    Dybeck Udd, Sebastian; Lund, Bodil

    2016-01-01

    Syphilis is a rare but increasing disease. Due to changing sexual habits, presentation of oral manifestations may rise. Since syphilis may mimic other oral manifestations, diagnoses can be difficult. Clinicians need to be aware that ambiguous oral manifestations may in fact be caused by oral syphilis. Here, we present a case of extended diagnostic delay highlighting the importance of consulting an expert in infectious diseases in case of obscure oral lesions not responding to standard treatment. Despite seven visits to six different medical doctors, a patient who presented with oral syphilis was continuously misdiagnosed. After 6 months of increasing complaints and deteriorating severity of disease, the patient was referred to an oral and maxillofacial surgeon where the correct diagnosis was determined and proper treatment initiated. PMID:27293914

  20. Oral Syphilis: A Reemerging Infection Prompting Clinicians' Alertness.

    PubMed

    Dybeck Udd, Sebastian; Lund, Bodil

    2016-01-01

    Syphilis is a rare but increasing disease. Due to changing sexual habits, presentation of oral manifestations may rise. Since syphilis may mimic other oral manifestations, diagnoses can be difficult. Clinicians need to be aware that ambiguous oral manifestations may in fact be caused by oral syphilis. Here, we present a case of extended diagnostic delay highlighting the importance of consulting an expert in infectious diseases in case of obscure oral lesions not responding to standard treatment. Despite seven visits to six different medical doctors, a patient who presented with oral syphilis was continuously misdiagnosed. After 6 months of increasing complaints and deteriorating severity of disease, the patient was referred to an oral and maxillofacial surgeon where the correct diagnosis was determined and proper treatment initiated. PMID:27293914

  1. [Oral viral infections].

    PubMed

    Parent, Dominique

    2016-02-01

    Exclude herpes infection in the presence of acute oral ulcers of unknown origin, particularly in patients in poor general condition. Remember that asymptomatic HSV-1 shedding in saliva may result in an oral-genital transmission. Perform an anogenital examination and a screening for other sexually transmitted diseases when oral warts are diagnosed. Search for immunosuppression and monitor the patient (screening for a potential associated carcinoma) when there is rapid growth of oral warts. Consider all the clinical signs (systemic, skin, other mucosa, immunity...) when a patient has an enanthem or oral ulcerations. Ask for a HIV test when an oral Kaposi's sarcoma, a hairy leukoplakia or major aphthae are diagnosed. PMID:26854091

  2. Comprehensive review on oral disintegrating films.

    PubMed

    Nagaraju, T; Gowthami, R; Rajashekar, M; Sandeep, S; Mallesham, M; Sathish, D; Kumar, Y Shravan

    2013-02-01

    Fast-dissolving drug-delivery systems were first developed in the late 1970s as an alternative to tablets, capsules, and syrups for pediatric and geriatric patients who experience difficulties swallowing traditional oral solid dosage forms. In response to this need, a variety of orally disintegrating tablet (ODT) formats were commercialized, which disintegrate within 1 min when placed in the mouth without drinking water or chewing. Oral drug delivery technology has improved from conventional dosage forms to modified release dosage forms to ODT to the recent oral disintegrating films (ODF). Oral disintegrating film or strip that employs a water dissolving polymer which allows the dosage form to quickly hydrate by saliva, adhere to mucosa, and disintegrate within a few seconds, dissolve and releases medication for oromucosal absorption when placed on the tongue or oral cavity. Oral strip technology provides an alternate route for drugs with first pass metabolism. This review give details of materials used in ODF, manufacturing aspects, technologies, evaluation tests and marketed products. PMID:22920576

  3. Optimizing technology development and adoption in medical imaging using the principles of innovation diffusion, part I: theoretical, historical, and contemporary considerations.

    PubMed

    Reiner, Bruce I

    2011-10-01

    The pioneering work performed in the social sciences on diffusion of innovation can be applied to medical imaging and shed valuable insights as to how innovation is analyzed and adopted within the population of end-users. Successful innovation must take into account unique stakeholder differences, changes in communication and social interactions, and shifting priorities in market economics. The dramatic changes currently underway in current medical imaging practice provides unique innovation opportunities to those individuals and companies which can utilize this knowledge and effect change in objective and reproducible means. Successful innovation should rely upon data-driven objective analysis, which can scientifically validate the inherent strengths and weaknesses of the innovation, when compared with the idea or technology it supercedes.

  4. Not for industry only: medical students and office-based academic detailing the PIVOT (Pregnant women Influenza Vaccine Optimization Team) initiative.

    PubMed

    Blitz, Daina A; Mallen, Jonathan R; Kwiatkowski, Thomas G; Rabin, Jill M; Dlugacz, Yosef D; Silverman, Robert A

    2015-01-01

    Academic detailing is a method of educational outreach that utilizes individualized encounters with physicians to broach specific medical issues in an evidence-based and quality-driven manner. Medical students utilized the matter of influenza vaccination during pregnancy as a lens through which to explore the methods of academic detailing in a community setting. Structured and customized dialogues between North Shore-LIJ affiliated obstetricians and Hofstra North Shore-LIJ medical students were conducted regarding the disparity between the proportion of providers that recommend the vaccine and the percentage of pregnant women being vaccinated annually. Ultimately the project aimed to increase vaccine-carrying rates throughout office based practices in the community, while establishing a viable method for up-to-date information exchange between practicing physicians and academic medicine. While the extent of affected change is currently being quantified, the project proved successful insofar as academic detailing allowed the students to gain access to physicians, and engage in compelling and educational conversations. Both the physicians and students felt these interactions were valuable and well worth continuing. The goal for the future is to expand these practices to other pressing public health issues while continuing to refine the technique.

  5. Oral Cancer Foundation

    MedlinePlus

    ... Famous People Famous historical Arts & Entertainment Sports figures ... The Oral Cancer Foundation The Oral Cancer Foundation is a national public service, non-profit entity designed to reduce suffering ...

  6. Assessment of clinical psychiatric skills in final-year medical students: the use of videotape.

    PubMed

    Fenton, G W; O'Gorman, E C

    1984-09-01

    Sixty final-year medical students had their clinical performance in psychiatry assessed by the following three methods: a multiple choice questionnaire based on a series of short videotaped interviews with psychiatric patients; the examination of a traditional long 'case' with presentation of the history, mental state findings and formulation about diagnosis and management to a panel of three examiners; and a conventional oral examination about the principles and practice of psychiatry with a different trio of examiners. The total mark on the videotape session correlated significantly with the combined clinical and oral marks. There was also a significant positive correlation between the total video marks and the individual clinical marks, but none between the marks obtained during the video and oral components of the examination. However, the significant positive correlations between the video marks and those of the clinical examination were modest and only accounted for not more than 14% of the variance. Inspection of the distribution of correct answers to the videotape questions shows that students do best in identifying mental state symptoms and signs and in choosing the correct diagnosis. They do less well in the areas of aetiology and treatment. Indeed, optimal performance in the latter distinguishes those who do well in the clinical/oral examination from those whose performance is mediocre. The significance of these findings to the teaching and assessment of psychiatric skills in medical students is discussed. PMID:6472143

  7. Oral capsaicin provides temporary relief for oral mucositis pain secondary to chemotherapy/radiation therapy.

    PubMed

    Berger, A; Henderson, M; Nadoolman, W; Duffy, V; Cooper, D; Saberski, L; Bartoshuk, L

    1995-04-01

    Pain from oral mucositis afflicts from 40% to 70% of patients receiving chemotherapy or radiation therapy. Current methods of clinical pain management (for example, topical anesthetics, systemic analgesics) have limited success. In a pilot study, we examined the ability of oral capsaicin to provide temporary relief of oral mucositis pain. Capsaicin, the active ingredient in chili peppers, desensitizes some neurons and has provided moderate pain relief when applied to the skin surface. Oral capsaicin in a candy (taffy) vehicle produced substantial pain reduction in 11 patients with oral mucositis pain from cancer therapy. However, this pain relief was not complete for most patients and was only temporary. Additional research is needed to fully utilize the properties of capsaicin desensitization and thus optimize analgesia. PMID:7629418

  8. 21 CFR 872.6650 - Massaging pick or tip for oral hygiene.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Massaging pick or tip for oral hygiene. 872.6650... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6650 Massaging pick or tip for oral hygiene. (a) Identification. A massaging pick or tip for oral hygiene is a rigid, pointed device...

  9. 21 CFR 872.6650 - Massaging pick or tip for oral hygiene.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Massaging pick or tip for oral hygiene. 872.6650... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6650 Massaging pick or tip for oral hygiene. (a) Identification. A massaging pick or tip for oral hygiene is a rigid, pointed device...

  10. 21 CFR 872.6650 - Massaging pick or tip for oral hygiene.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Massaging pick or tip for oral hygiene. 872.6650... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6650 Massaging pick or tip for oral hygiene. (a) Identification. A massaging pick or tip for oral hygiene is a rigid, pointed device...

  11. 21 CFR 872.6650 - Massaging pick or tip for oral hygiene.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Massaging pick or tip for oral hygiene. 872.6650... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6650 Massaging pick or tip for oral hygiene. (a) Identification. A massaging pick or tip for oral hygiene is a rigid, pointed device...

  12. 21 CFR 872.6650 - Massaging pick or tip for oral hygiene.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Massaging pick or tip for oral hygiene. 872.6650... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6650 Massaging pick or tip for oral hygiene. (a) Identification. A massaging pick or tip for oral hygiene is a rigid, pointed device...

  13. 21 CFR 872.5580 - Oral rinse to reduce the adhesion of dental plaque.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Oral rinse to reduce the adhesion of dental plaque... SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Therapeutic Devices § 872.5580 Oral rinse to reduce the adhesion of dental plaque. (a) Identification. The device is assigned the generic name oral rinse to...

  14. 21 CFR 872.5580 - Oral rinse to reduce the adhesion of dental plaque.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Oral rinse to reduce the adhesion of dental plaque... SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Therapeutic Devices § 872.5580 Oral rinse to reduce the adhesion of dental plaque. (a) Identification. The device is assigned the generic name oral rinse to...

  15. 21 CFR 872.5580 - Oral rinse to reduce the adhesion of dental plaque.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Oral rinse to reduce the adhesion of dental plaque... SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Therapeutic Devices § 872.5580 Oral rinse to reduce the adhesion of dental plaque. (a) Identification. The device is assigned the generic name oral rinse to...

  16. 21 CFR 872.5580 - Oral rinse to reduce the adhesion of dental plaque.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Oral rinse to reduce the adhesion of dental plaque... SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Therapeutic Devices § 872.5580 Oral rinse to reduce the adhesion of dental plaque. (a) Identification. The device is assigned the generic name oral rinse to...

  17. 21 CFR 872.5580 - Oral rinse to reduce the adhesion of dental plaque.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Oral rinse to reduce the adhesion of dental plaque... SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Therapeutic Devices § 872.5580 Oral rinse to reduce the adhesion of dental plaque. (a) Identification. The device is assigned the generic name oral rinse to...

  18. Oral-systemic health during pregnancy: exploring prenatal and oral health providers' information, motivation and behavioral skills.

    PubMed

    Vamos, Cheryl A; Walsh, Margaret L; Thompson, Erika; Daley, Ellen M; Detman, Linda; DeBate, Rita

    2015-06-01

    Pregnancy is identified as a sensitive period of increased risk for poor oral health among mothers and offspring. Subsequently, both medical and dental associations have re-endorsed consolidated, inter-professional guidelines promoting oral health during pregnancy. The objective was to explore prenatal and oral health providers' information, motivation and practice behaviors related to oral health during pregnancy. Twenty-two in-depth interviews were conducted with prenatal and oral health providers based on the Information-Motivation-Behavioral Skills Model. Data were analyzed using the constant comparative method in NVivo 10. Providers held variable knowledge with regards to identified oral-systemic connections and implications. Most providers were unaware of the guidelines; however, some oral health providers reported avoiding specific treatment behaviors during this period. Motivation to address oral-systemic health during pregnancy included: prevention; healthy pregnancy/birth outcomes; patient's complaint/question as cue to action; comprehensive, patient-centered, and family-centered care; ethical duty; and professional governing body. Oral health providers reported assessing, educating, and communicating with patients about oral health issues; whereas prenatal providers rarely addressed oral health but reported signing approval forms to receive such care. A few oral health providers highlighted lifecourse implications and the need for family-centered care when addressing poor oral health among pregnant patients. Findings suggest gaps in oral health prevention information and behaviors among prenatal and oral health providers. Future efforts should examine effective dissemination and implementation strategies that translate evidence-based guidelines into clinical practice, with the ultimate goal of improve oral-systemic health among women and their offspring across the lifecourse.

  19. Oral Steroids for Dermatitis.

    PubMed

    Fisher, Andrew D; Clarke, Jesse; Williams, Timothy K

    2015-01-01

    Contact/allergic dermatitis is frequently treated inappropriately with lower-than-recommended doses or inadequate duration of treatment with oral and intramuscular glucocorticoids. This article highlights a case of dermatitis in a Ranger Assessment and Selection Program student who was improperly treated over 2 weeks with oral steroids after being bit by Cimex lectularius, commonly known as bed bugs. The article also highlights the pitfalls of improper oral steroid dosing and provides reasoning for longer-duration oral steroid treatment.

  20. HAD Oral History Project

    NASA Astrophysics Data System (ADS)

    Holbrook, Jarita

    2014-01-01

    The Historical Astronomy Division is the recipient of an American Institute of Physics Neils Bohr Library Grant for Oral History. HAD has assembled a team of volunteers to conduct oral history interviews since May 2013. Each oral history interview varies in length between two and six hours. This presentation is an introduction to the HAD Oral History Project and the activities of the team during the first six months of the grant.

  1. Oral Steroids for Dermatitis.

    PubMed

    Fisher, Andrew D; Clarke, Jesse; Williams, Timothy K

    2015-01-01

    Contact/allergic dermatitis is frequently treated inappropriately with lower-than-recommended doses or inadequate duration of treatment with oral and intramuscular glucocorticoids. This article highlights a case of dermatitis in a Ranger Assessment and Selection Program student who was improperly treated over 2 weeks with oral steroids after being bit by Cimex lectularius, commonly known as bed bugs. The article also highlights the pitfalls of improper oral steroid dosing and provides reasoning for longer-duration oral steroid treatment. PMID:26125159

  2. Developing Oral Communication Skills.

    ERIC Educational Resources Information Center

    Washington Office of the State Superintendent of Public Instruction, Olympia.

    Intended for use by both elementary and secondary school teachers, the two papers in this report stress the importance of developing students' oral and written communication skills. The first paper, "Relationship of Oral Communication to Reading," by Phil Backlund and John Johnson, argues that ability in oral communication is a prerequisite to the…

  3. Bibliography on Oral History.

    ERIC Educational Resources Information Center

    Waserman, Manfred J., Comp.

    This annotated bibliography covers articles and books dealing with oral history published between 1950 and 1970. In addition to works treating oral history as a methodology for historical discovery, the guide includes a separate annotated list of twenty selected books that use oral history material in the development of their themes and…

  4. [Pharmacoeconomic aspects of oral cytostatic agents].

    PubMed

    Poquet Jornet, J E; Carrera-Hueso, F J; Gasent Blesa, J M; Peris Godoy, M

    2011-05-01

    When validating oral chemotherapy, pharmacists should confirm the suitability and correctness of the prescription, applying the same safety standards as those used for parenteral cytostatic drugs. There are an increasing number of cancers for which orally administered drugs are available, which increases patient satisfaction as these drugs can be taken at home without the need to visit a hospital. As oral cytostatic treatments increase, so does the importance of ensuring optimal treatment compliance. The new oral cytostatic agents are less toxic, reduce indirect costs and imply less loss of time for patients and their families. However, the cost of these agents should be below a threshold acceptable for society. As an aid to decision making, pharmacoeconomic tools should be used.

  5. Oral Contraceptives and Cancer Risk

    MedlinePlus

    ... oral contraceptives are available in the United States today? How could oral contraceptives influence cancer risk? How ... oral contraceptives are available in the United States today? Two types of oral contraceptives (birth control pills) ...

  6. Head, Neck, and Oral Cancer

    MedlinePlus

    ... Neck and Oral Pathology Head, Neck and Oral Pathology Close to 42,000 Americans will be diagnosed ... Neck and Oral Pathology Head, Neck and Oral Pathology Close to 42,000 Americans will be diagnosed ...

  7. Theoretical and Monte Carlo optimization of a stacked three-layer flat-panel x-ray imager for applications in multi-spectral diagnostic medical imaging

    NASA Astrophysics Data System (ADS)

    Lopez Maurino, Sebastian; Badano, Aldo; Cunningham, Ian A.; Karim, Karim S.

    2016-03-01

    We propose a new design of a stacked three-layer flat-panel x-ray detector for dual-energy (DE) imaging. Each layer consists of its own scintillator of individual thickness and an underlying thin-film-transistor-based flat-panel. Three images are obtained simultaneously in the detector during the same x-ray exposure, thereby eliminating any motion artifacts. The detector operation is two-fold: a conventional radiography image can be obtained by combining all three layers' images, while a DE subtraction image can be obtained from the front and back layers' images, where the middle layer acts as a mid-filter that helps achieve spectral separation. We proceed to optimize the detector parameters for two sample imaging tasks that could particularly benefit from this new detector by obtaining the best possible signal to noise ratio per root entrance exposure using well-established theoretical models adapted to fit our new design. These results are compared to a conventional DE temporal subtraction detector and a single-shot DE subtraction detector with a copper mid-filter, both of which underwent the same theoretical optimization. The findings are then validated using advanced Monte Carlo simulations for all optimized detector setups. Given the performance expected from initial results and the recent decrease in price for digital x-ray detectors, the simplicity of the three-layer stacked imager approach appears promising to usher in a new generation of multi-spectral digital x-ray diagnostics.

  8. Medical marijuana

    MedlinePlus

    ... people who have not had relief from other treatments. Unlike medical marijuana, the active ingredient in these drugs can be ... American Academy of Neurology. Medical Marijuana in Certain Medical Disorders. ... . Accessed August 24, 2015. ...

  9. Essentials of oral cancer

    PubMed Central

    Rivera, César

    2015-01-01

    Oral cancer is one of the 10 most common cancers in the world, with a delayed clinical detection, poor prognosis, without specific biomarkers for the disease and expensive therapeutic alternatives. This review aims to present the fundamental aspects of this cancer, focused on squamous cell carcinoma of the oral cavity (OSCC), moving from its definition and epidemiological aspects, addressing the oral carcinogenesis, oral potentially malignant disorders, epithelial precursor lesions and experimental methods for its study, therapies and future challenges. Oral cancer is a preventable disease, risk factors and natural history is already being known, where biomedical sciences and dentistry in particular are likely to improve their poor clinical indicators. PMID:26617944

  10. Essentials of oral cancer.

    PubMed

    Rivera, César

    2015-01-01

    Oral cancer is one of the 10 most common cancers in the world, with a delayed clinical detection, poor prognosis, without specific biomarkers for the disease and expensive therapeutic alternatives. This review aims to present the fundamental aspects of this cancer, focused on squamous cell carcinoma of the oral cavity (OSCC), moving from its definition and epidemiological aspects, addressing the oral carcinogenesis, oral potentially malignant disorders, epithelial precursor lesions and experimental methods for its study, therapies and future challenges. Oral cancer is a preventable disease, risk factors and natural history is already being known, where biomedical sciences and dentistry in particular are likely to improve their poor clinical indicators. PMID:26617944

  11. Management of type 2 diabetes mellitus in self-motivated patients: optimized diet, exercise, and medication for weight loss and cardiometabolic fitness.

    PubMed

    Nadeau, Daniel A

    2014-11-01

    Type 2 diabetes mellitus (T2DM) is a growing public health problem with significant lifetime health care costs. The majority of Americans do not achieve minimal targets for exercise, and individuals with T2DM typically engage in less exercise than the general adult population. However, those patients with T2DM who are sufficiently self-motivated to manage their condition have the potential to reverse diabetes and prevent its complications through behavioral and pharmacologic interventions. Marked improvements are possible through increased awareness and selection of healthy eating options, a willingness to incorporate vigorous exercise into their lifestyle, and the use of newer medications that essentially eliminate the risk of hypoglycemia while facilitating weight loss and the achievement of ideal glucose targets. For self-motivated patients, daily aerobic activity of 45 to 60 minutes per day may be a suitable target. For those who have cardiovascular clearance, high-intensity interval training accomplishes high levels of cardiometabolic fitness with shorter training periods by alternating moderate and intense exertion. Suitable medications that have a low risk of hypoglycemia during exercise include metformin, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium-glucose linked transporter-2 inhibitors. Specific daily caloric goals and incorporation of a mainly plant-based diet should be considered as a primary target for diabetes management. Self-management is important to achieving diabetes treatment goals, and mobile applications can be useful tools to support lifestyle changes in patients with T2DM.

  12. Ageing, dementia and oral health.

    PubMed

    Foltyn, P

    2015-03-01

    Neurocognitive decline and delirium, frailty, incontinence, falls, hearing and vision impairment, medication compliance and pharmacokinetics, skin breakdown, impaired sleep and rest are regarded as geriatric giants by gerontologists, geriatricians and nursing home staff. As these are all interrelated in the elderly, failure to act on one can impact on the others. However, the implications of poor oral health have for too long been ignored and deserve equal status. Mouth pain can be devastating for the elderly, compound psychosocial problems, frustrate carers and nursing home staff and disrupt family dynamics. As appearance, function and comfort suffer, so may a person's self-esteem and confidence. The contributing factors for poor oral health such as rapid dental decay, acute and chronic periodontal infections and compromised systemic health on a background of a dry mouth, coupled with xerostomia-inducing medications, reduced fine motor function, declining cognition and motivation will not only lead to an increase in both morbidity and mortality but also impact on quality of life. PMID:25762045

  13. Recurrent oral ulcers--an overview.

    PubMed

    Gaffar, A

    2001-01-01

    Recurrent oral ulcers (ROUs) are the most common oral mucosal disease. The etiology of ROUs is complex. The factors include mechanical trauma, genetics, stress, smoking, and viral and bacterial infections. Treatment modalities depend on the differential diagnosis of ROUs and could consist of antimicrobial agents, anti-inflammatory agents, immunomodulators, or over-the-counter medications. New therapy available in the form of a coating polymer, Colgate ORABASE Soothe.N.Seal, is clinically proven to provide rapid relief and healing of ROUs. PMID:11915640

  14. Association of individual and systemic barriers to optimal medical care in people living with HIV/AIDS in Miami-Dade County.

    PubMed

    Wawrzyniak, Andrew J; Rodríguez, Allan E; Falcon, Anthony E; Chakrabarti, Anindita; Parra, Alexa; Park, Jane; Mercogliano, Kathleen; Villamizar, Kira; Kolber, Michael A; Feaster, Daniel J; Metsch, Lisa R

    2015-05-01

    Barriers to retention in HIV care are detrimental to patients' progress along the HIV continuum of care. Previous literature has focused on individual, client-level barriers, and interventions to address them. In contrast, less work has examined the role of system-level barriers on HIV care outcomes. This study seeks to understand how individual and systemic barriers individually are associated with clinic appointment attendance and virologic suppression in HIV-infected patients attending the largest HIV clinic in Miami-Dade, FL. In addition, we examined the synergistic effects of these barriers as potential syndemic factors on these health outcomes. Barriers to clinic attendance were determined in a face-to-face study interview with 444 HIV-infected outpatients (187 regular attenders, 191 irregular attenders, and 66 nonattenders) identified from electronic medical records. Compared with the other attendance groups, nonattenders had higher viral loads, were less likely to be virologically suppressed, had lower CD4 counts, had higher depressive symptoms, life chaos, lower quality of life, and higher rates of food insecurity, and recent drug use. Additionally, nonattenders compared with regular attenders had lower physician relationship ratings, had lower medical information clarity and more often reported transportation as a barrier to clinic attendance. When viewed as a syndemic, compared with patients not reporting any barriers, patients with 3 or more individual-level barriers were more likely to have a detectable viral load (odds ratio = 3.60, 95% CI: 1.71 to 7.61). Our findings suggest that patients presenting to the clinic with multiple barriers should be prioritized for assistance and future interventions to improve retention in care. Interventions should address multiple individual and system-level barriers simultaneously with particular attention to addressing depressive symptoms, organizational skills, relationship with the physician, and HIV

  15. The Association of Individual and Systemic Barriers to Optimal Medical Care in People Living with HIV/AIDS (PLWHA) in Miami-Dade County

    PubMed Central

    Wawrzyniak, Andrew J.; Rodríguez, Allan E.; Falcon, Anthony E.; Chakrabarti, Anindita; Parra, Alexa; Park, Jane; Mercogliano, Kathleen; Villamizar, Kira; Kolber, Michael A.; Feaster, Daniel J.; Metsch, Lisa R.

    2015-01-01

    Barriers to retention in HIV care are detrimental to patients’ progress along the HIV continuum of care. Previous literature has focused on individual, client-level barriers and interventions to address them. In contrast, less work has examined the role of system-level barriers on HIV care outcomes. The present study seeks to understand how individual and systemic barriers individually are associated with clinic appointment attendance and virologic suppression in HIV-infected patients attending the largest HIV clinic in Miami-Dade, Florida. In addition, we examined the synergistic effects of these barriers as potential syndemic factors on these health outcomes. Barriers to clinic attendance were determined in a face-to-face study interview with 444 HIV-infected outpatients (187 regular attenders, 191 irregular attenders, 66 non-attenders) identified from electronic medical records. Compared to the other attendance groups, non-attenders had higher viral loads, were less likely to be virologically suppressed, had lower CD4 counts, had higher depressive symptoms, life chaos, lower quality of life, and higher rates of food insecurity and recent drug use. Additionally, non-attenders compared to regular attenders had lower physician relationship ratings, had lower medical information clarity, and more often reported transportation as a barrier to clinic attendance. When viewed as a syndemic, compared to patients not reporting any barriers, patients with three or more individual-level barriers were more likely to have a detectable viral load (OR = 3.60, 95%CI [1.71, 7.61]). Our findings suggest that patients presenting to the clinic with multiple barriers should be prioritized for assistance and future interventions to improve retention in care. Interventions should address multiple individual and system level barriers simultaneously with particular attention to addressing depressive symptoms, organizational skills, relationship with the physician, and HIV

  16. Group A Streptococcus endometritis following medical abortion.

    PubMed

    Gendron, Nicolas; Joubrel, Caroline; Nedellec, Sophie; Campagna, Jennifer; Agostini, Aubert; Doucet-Populaire, Florence; Casetta, Anne; Raymond, Josette; Poyart, Claire; Kernéis, Solen

    2014-07-01

    Medical abortion is not recognized as a high-risk factor for invasive pelvic infection. Here, we report two cases of group A Streptococcus (GAS; Streptococcus pyogenes) endometritis following medical abortions with a protocol of oral mifepristone and misoprostol. PMID:24829245

  17. Group A Streptococcus Endometritis following Medical Abortion

    PubMed Central

    Gendron, Nicolas; Joubrel, Caroline; Nedellec, Sophie; Campagna, Jennifer; Agostini, Aubert; Doucet-Populaire, Florence; Casetta, Anne; Raymond, Josette; Kernéis, Solen

    2014-01-01

    Medical abortion is not recognized as a high-risk factor for invasive pelvic infection. Here, we report two cases of group A Streptococcus (GAS; Streptococcus pyogenes) endometritis following medical abortions with a protocol of oral mifepristone and misoprostol. PMID:24829245

  18. Medical Management of Patients Undergoing Dentoalveolar Surgery.

    PubMed

    Abramowicz, Shelly; Roser, Steven M

    2015-08-01

    The oral and maxillofacial surgeon (OMS) should have an understanding of common medical comorbidities. This understanding allows for risk stratification and thus prevention of potential problems. Remaining knowledgeable regarding diseases, diagnosis, treatment strategies, and pharmacology ultimately improves patient care. This article provides an update on some of the most common medical diseases for the patient undergoing dentoalveolar surgery.

  19. Quick reference guide to the new oral anticoagulants.

    PubMed

    Hurst, Katherine; Lee, Regent; Handa, Ashok

    2016-06-01

    After the commissioning of new oral anticoagulants for the treatment and prevention of thrombosis, these medications are now widely used within clinical settings. Increasing numbers of patients present to the health services on anticoagulant medications, and it is therefore imperative for surgeons to be aware of the new therapeutic treatments available and how patients will benefit from such interventions. This review highlights the most pertinent learning points for surgeons regarding the indications, pharmacokinetics, and perioperative management of these new oral medications, as a quick reference guide. PMID:27113315

  20. [Selected aspects of oral contraception side effects].

    PubMed

    Wolski, Hubert

    2014-12-01

    The first hormonal pill was approved in the 60s of the twentieth century Since that time, oral contraception has been used worldwide by dozens of women due to its high availability as well as relative ease and safety of taking. The main side effects of oral contraception include elevated risk for venous thromboembolism (VTE). Estrogens increase the probability of VTE development, depending on the dose in medication, and third-generation progestins increase the risk of VTE development more than older-generation progestins. Also, the coexistence of hereditary thrombophilia increases the risk of VTE development in women using oral contraceptives. Other side effects include changes in the carbohydrate and lipid economy Progestins in oral contraceptives decrease HDL cholesterol levels but increase LDL cholesterol and total cholesterol levels. Additionally estrogens are a recognized mitogenic factor for the epithelium of the mammary gland, acting proliferative on the glandular tissue and in the same way influence on the increased risk of breast cancer development. Patients sometimes complain about some subjective side symptoms such as headache, mood changes, nausea, back pain, breast pain and swelling, as well as decreased libido. Some patients discontinue oral contraception due to fear of side effects or temporary ailments before con- sulting their doctor what may result in unintended pregnancy The aim of the following paper was to present most frequent side effects of oral contraception, ways of their moni- toring and diagnosis. PMID:25669065

  1. Oral carriage of Helicobacter pylori: a review.

    PubMed

    Madinier, I M; Fosse, T M; Monteil, R A

    1997-01-01

    Helicobacter pylori is a microaerophilic, motile bacterium, especially adapted to life in the human stomach. The presence of H. pylori in the stomach is strongly associated with chronic gastritis and ulcer disease and is a risk factor for gastric cancers. The microorganism may be transmitted orally and has been detected in dental plaque, saliva, and feces, but the hypothesis that oral microflora may be a permanent reservoir of H. pylori is still controversial. A review of the literature suggests that the recovery of H. pylori in the mouth is probably intermittent, associated with gastroesophageal reflux but not with specific oral disease. Nonetheless, the PCR identification of oral H. pylori may become helpful, particularly in cases of gastritis or ulcer relapse after antimicrobial therapy. Eradication of oral H. pylori by local medication or periodontal procedures would rely on the precise identification of its ecological niche. Within family groups, prophylactic methods should be practiced to avoid oral carriage of H. pylori. The risk of iatrogenic transmission during dental care, however, is already circumscribed by standard professional hygiene procedures.

  2. Overcoming Historical Separation between Oral and General Health Care: Interprofessional Collaboration for Promoting Health Equity.

    PubMed

    Simon, Lisa

    2016-01-01

    Since the founding of dental schools as institutions distinct from medical schools, dentistry-its practice, service delivery, and insurance coverage, for example-and dental care have been kept separate from medical care in the United States. This separation is most detrimental to undeserved groups at highest risk for poor oral health. As awareness grows of the important links between oral and general health, physicians and dentists are collaborating to develop innovative service delivery and payment models that can reintegrate oral health care into medical care. Interprofessional education of medical and dental students can help produce clinicians who work together to the benefit of their patients. PMID:27669140

  3. The Optimizing Patient Transfers, Impacting Medical Quality, andImproving Symptoms:Transforming Institutional Care approach: preliminary data from the implementation of a Centers for Medicare and Medicaid Services nursing facility demonstration project.

    PubMed

    Unroe, Kathleen T; Nazir, Arif; Holtz, Laura R; Maurer, Helen; Miller, Ellen; Hickman, Susan E; La Mantia, Michael A; Bennett, Merih; Arling, Greg; Sachs, Greg A

    2015-01-01

    The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project aims to reduce avoidable hospitalizations of long-stay residents enrolled in 19 central Indiana nursing facilities. This clinical demonstration project, funded by the Centers for Medicare and Medicaid Services Innovations Center, places a registered nurse in each nursing facility to implement an evidence-based quality improvement program with clinical support from nurse practitioners. A description of the model is presented, and early implementation experiences during the first year of the project are reported. Important elements include better medical care through implementation of Interventions to Reduce Acute Care Transfers tools and chronic care management, enhanced transitional care, and better palliative care with a focus on systematic advance care planning. There were 4,035 long-stay residents in 19 facilities enrolled in OPTIMISTIC between February 2013 and January 2014. Root-cause analyses were performed for all 910 acute transfers of these long stay residents. Of these transfers, the project RN evaluated 29% as avoidable (57% were not avoidable and 15% were missing), and opportunities for quality improvement were identified in 54% of transfers. Lessons learned in early implementation included defining new clinical roles, integrating into nursing facility culture, managing competing facility priorities, communicating with multiple stakeholders, and developing a system for collecting and managing data. The success of the overall initiative will be measured primarily according to reduction in avoidable hospitalizations of long-stay nursing facility residents. PMID:25537789

  4. Oral lesions in infection with human immunodeficiency virus.

    PubMed Central

    Coogan, Maeve M.; Greenspan, John; Challacombe, Stephen J.

    2005-01-01

    This paper discusses the importance of oral lesions as indicators of infection with human immunodeficiency virus (HIV) and as predictors of progression of HIV disease to acquired immunodeficiency syndrome (AIDS). Oral manifestations are among the earliest and most important indicators of infection with HIV. Seven cardinal lesions, oral candidiasis, hairy leukoplakia, Kaposi sarcoma, linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis and non-Hodgkin lymphoma, which are strongly associated with HIV infection, have been identified and internationally calibrated, and are seen in both developed and developing countries. They may provide a strong indication of HIV infection and be present in the majority of HIV-infected people. Antiretroviral therapy may affect the prevalence of HIV-related lesions. The presence of oral lesions can have a significant impact on health-related quality of life. Oral health is strongly associated with physical and mental health and there are significant increases in oral health needs in people with HIV infection, especially in children, and in adults particularly in relation to periodontal diseases. International collaboration is needed to ensure that oral aspects of HIV disease are taken into account in medical programmes and to integrate oral health care with the general care of the patient. It is important that all health care workers receive education and training on the relevance of oral health needs and the use of oral lesions as surrogate markers in HIV infection. PMID:16211162

  5. Oral health of substance-dependent individuals: Impact of specific substances

    PubMed Central

    D’Amore, Meredith M.; Cheng, Debbie M.; Kressin, Nancy R.; Jones, Judith; Samet, Jeffrey H.; Winter, Michael; Kim, Theresa W.; Saitz, Richard

    2012-01-01

    Little is known about how different types of substances affect oral health. Our objective was to examine the respective effects of alcohol, stimulants, opioids, and marijuana on oral health in substance-dependent persons. Using self-reported data from 563 substance-dependent individuals, we found that most reported unsatisfactory oral health, with their most recent dental visit more than 1 year ago. In multivariable logistic regressions, none of the substance types were significantly associated with oral health status. However, opioid use was significantly related to a worse overall oral health rating compared to 1 year ago. These findings highlight the poor oral health of individuals with substance dependence and the need to address declining oral health among opioid users. General health and specialty addiction care providers should be aware of oral health problems among these patients. In addition, engagement into addiction and medical care may be facilitated by addressing oral health concerns. PMID:21474269

  6. Use of Lipid-Lowering Medications and the Likelihood of Achieving Optimal LDL-Cholesterol Goals in Coronary Artery Disease Patients.

    PubMed

    Karalis, Dean G; Victor, Brett; Ahedor, Lilian; Liu, Longjian

    2012-01-01

    Background. In clinical practice, most coronary artery disease patients are not achieving their recommend LDL-cholesterol goal of <70 mg/dL. Methods. We conducted a retrospective analysis of outpatient electronic health records and the most recent lipid profile, lipid-lowering medications and doses were collected. Results. We identified 9950 coronary artery disease patients. Only 37% on a statin alone achieved an LDL-cholesterol of <70 mg/dL, and most were on moderate-to-high-potency statins. The intensity of statin therapy did not improve LDL-cholesterol goal attainment. Among patients on combination therapy, 41% on statin plus ezetimibe and 46% on statin plus niacin achieved an LDL-cholesterol of <70 mg/dL (P = 0.01 and <0.0001 versus statin alone). If patients were switched to a high-potency statin LDL-cholesterol goal attainment of <70 mg/dL would increase to 46% and would increase up to 72% with combination therapy. Conclusions. Most coronary artery disease patients in clinical practice do not attain an LDL-cholesterol of <70 mg/dL, even among patients on high potency statins. The combination of statin plus either ezetimibe or niacin is the most effective regimen to achieve an LDL-cholesterol of <70 mg/dL, however, these drug combinations are used infrequently in clinical practice.

  7. Evaluation of a Theory-Driven E-Learning Intervention for Future Oral Healthcare Providers on Secondary Prevention of Disordered Eating Behaviors

    ERIC Educational Resources Information Center

    DeBate, Rita D.; Severson, Herbert H.; Cragun, Deborah L.; Gau, Jeff M.; Merrell, Laura K.; Bleck, Jennifer R.; Christiansen, Steve; Koerber, Anne; Tomar, Scott L.; Brown, Kelli R. McCormack; Tedesco, Lisa A.; Hendricson, William

    2013-01-01

    Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning…

  8. Lead optimization of a pyrazolo[1,5-a]pyrimidin-7(4H)-one scaffold to identify potent, selective and orally bioavailable KDM5 inhibitors suitable for in vivo biological studies.

    PubMed

    Liang, Jun; Zhang, Birong; Labadie, Sharada; Ortwine, Daniel F; Vinogradova, Maia; Kiefer, James R; Gehling, Victor S; Harmange, Jean-Christophe; Cummings, Richard; Lai, Tommy; Liao, Jiangpeng; Zheng, Xiaoping; Liu, Yichin; Gustafson, Amy; Van der Porten, Erica; Mao, Weifeng; Liederer, Bianca M; Deshmukh, Gauri; Classon, Marie; Trojer, Patrick; Dragovich, Peter S; Murray, Lesley

    2016-08-15

    Starting with a lead [1,5-a]pyrimidin-7(4H)-one-containing molecule (1), we generated potent, selective and orally bioavailable KDM5 inhibitors. Using structure- and property-based approaches, we designed 48 with improved cell potency (PC9 H3K4Me3 EC50=0.34μM). Furthermore, 48 maintained suitable physiochemical properties and displayed an excellent pharmacokinetic (PK) profile in mice. When dosed orally in mice at 50mg/kg twice a day (BID), 48 showed an unbound maximal plasma concentration (Cmax) >15-fold over its cell EC50, thereby providing a robust chemical probe for studying KDM5 biological functions in vivo. PMID:27406798

  9. Towards understanding oral health.

    PubMed

    Zaura, Egija; ten Cate, Jacob M

    2015-01-01

    During the last century, dental research has focused on unraveling the mechanisms behind various oral pathologies, while oral health was typically described as the mere absence of oral diseases. The term 'oral microbial homeostasis' is used to describe the capacity of the oral ecosystem to maintain microbial community stability in health. However, the oral ecosystem itself is not stable: throughout life an individual undergoes multiple physiological changes while progressing through infancy, childhood, adolescence, adulthood and old age. Recent discussions on the definition of general health have led to the proposal that health is the ability of the individual to adapt to physiological changes, a condition known as allostasis. In this paper the allostasis principle is applied to the oral ecosystem. The multidimensionality of the host factors contributing to allostasis in the oral cavity is illustrated with an example on changes occurring in puberty. The complex phenomenon of oral health and the processes that prevent the ecosystem from collapsing during allostatic changes in the entire body are far from being understood. As yet individual components (e.g. hard tissues, microbiome, saliva, host response) have been investigated, while only by consolidating these and assessing their multidimensional interactions should we be able to obtain a comprehensive understanding of the ecosystem, which in turn could serve to develop rational schemes to maintain health. Adapting such a 'system approach' comes with major practical challenges for the entire research field and will require vast resources and large-scale multidisciplinary collaborations. PMID:25871419

  10. Oral microbiota and cancer

    PubMed Central

    Meurman, Jukka H.

    2010-01-01

    Inflammation caused by infections may be the most important preventable cause of cancer in general. However, in the oral cavity the role of microbiota in carcinogenesis is not known. Microbial populations on mouth mucosa differ between healthy and malignant sites and certain oral bacterial species have been linked with malignancies but the evidence is still weak in this respect. Nevertheless, oral microorganisms inevitably up-regulate cytokines and other inflammatory mediators that affect the complex metabolic pathways and may thus be involved in carcinogenesis. Poor oral health associates statistically with prevalence of many types of cancer, such as pancreatic and gastrointestinal cancer. Furthermore, several oral micro-organisms are capable of converting alcohol to carcinogenic acetaldehyde which also may partly explain the known association between heavy drinking, smoking, poor oral health and the prevalence of oral and upper gastrointestinal cancer. A different problem is the cancer treatment-caused alterations in oral microbiota which may lead to the emergence of potential pathogens and subsequent other systemic health problems to the patients. Hence clinical guidelines and recommendations have been presented to control oral microbiota in patients with malignant disease, but also in this area the scientific evidence is weak. More controlled studies are needed for further conclusion. PMID:21523227

  11. Optimization and validation of a liquid chromatography-tandem mass spectrometry method for the simultaneous quantification of nicotine, cotinine, trans-3′-hydroxycotinine and norcotinine in human oral fluid

    PubMed Central

    Shakleya, Diaa M.

    2011-01-01

    An analytical procedure was developed and validated for the simultaneous identification and quantification of nicotine, cotinine, trans-3′-hydroxycotinine, and norcotinine in 0.5 mL of human oral fluid collected with the Quantisal™ oral fluid collection device. Solid phase extraction and liquid chromatography-tandem mass spectrometry with multiple reaction monitoring were utilized. Endogenous and exogenous interferences were extensively evaluated. Limits of quantification were empirically identified by decreasing analyte concentrations. Linearity was from 1 to 2,000 ng/mL for nicotine and norcotinine, 0.5 to 2,000 ng/mL for trans-3′-hydroxycotinine, and 0.2 to 2,000 ng/mL for cotinine. Correlation coefficients for calibration curves were >0.99 and analytes quantified within ±13% of target at all calibrator concentrations. Suitable analytical recovery (>91%) was achieved with extraction efficiencies >56% and matrix effects <29%. This assay will be applied to the quantification of nicotine and metabolites in oral fluid in a clinical study determining the most appropriate nicotine biomarker concentrations differentiating active, passive, and environmental nicotine exposure. PMID:19838828

  12. Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol.

    PubMed

    Cohen, Alexander Thomas; Spiro, Theodore Erich; Büller, Harry Roger; Haskell, Lloyd; Hu, Dayi; Hull, Russell; Mebazaa, Alexandre; Merli, Geno; Schellong, Sebastian; Spyropoulos, Alex; Tapson, Victor

    2011-05-01

    Patients with acute medical illnesses are at increased risk of venous thromboembolism (VTE), a significant cause of morbidity and mortality. Thromboprophylaxis is recommended in these patients but questions remain regarding the optimal duration of therapy. The aim of this study is to determine whether oral rivaroxaban is non-inferior to standard-duration (approximately 10 days) subcutaneous (s.c.) enoxaparin for the prevention of VTE in acutely ill medical patients, and whether extended-duration (approximately 5 weeks) rivaroxaban is superior to standard-duration enoxaparin. Patients aged 40 years or older and hospitalized for various acute medical illnesses with risk factors for VTE randomly receive either s.c. enoxaparin 40 mg once daily (od) for 10 ± 4 days or oral rivaroxaban 10 mg od for 35 ± 4 days. The primary efficacy outcomes are the composite of asymptomatic proximal deep vein thrombosis (DVT), symptomatic DVT, symptomatic non-fatal pulmonary embolism (PE), and VTE-related death up to day 10 + 4 and up to day 35 + 4. The primary safety outcome is the composite of treatment-emergent major bleeding and clinically relevant non-major bleeding. As of July 2010, 8,101 patients from 52 countries have been randomized. These patients have a broad range of medical conditions: approximately one-third were diagnosed with acute heart failure, just under one-third were diagnosed with acute infectious disease, and just under one-quarter were diagnosed with acute respiratory insufficiency. MAGELLAN will determine the efficacy, safety, and pharmacological profile of oral rivaroxaban for the prevention of VTE in a diverse population of medically ill patients and the potential of extended-duration therapy to reduce incidence of VTE.

  13. [Chinese experts consensus on the use of oral propranolol for treatment of infantile hemangiomas].

    PubMed

    Zheng, Jia-Wei; Wang, Xu-Kai; Qin, Zhong-Ping; Fan, Xin-Dong; Li, Kai; Yang, Yao-Wu; Huo, Ran; Liu, Shao-Hua; Zhao, Ji-Hong; Wang, Xiao-Yong; Zhou, De-Kai

    2016-06-01

    Infantile hemangioma (IH) is one of the most common benign vascular tumors in children. A variety of treatment methods have been documented for the management of IH over the past years, including pharmacotherapy via oral administration or injection of corticosteroids, vincristine, alpha interferon and bleomycin; laser therapy, radionuclide therapy, cryotherapy and excisional surgery. The therapeutic efficacy of each treatment modality is variable, while adverse effects or complications are common and sometimes serious. Since the serendipitous discovery of propranolol, a nonselective beta-adrenergic receptor blocker, being very efficacious in treating IH in 2008, oral propranolol has earned a role as a first-line medical therapy for complicated IH. However, the appropriate drug dosage, dosing regimen, time for initiation, optimal duration, monitoring for side effects remains controversial. To standardize the use of propranolol in treating IH, avoid overtreatment or under-treatment, as well as minimize complications, a Chinese experts consensus on the use of oral propranolol for treatment of IH has been approved and written by a multidisciplinary experts group based on an up-to-date literature review and repeated discussion. PMID:27609372

  14. Design and Statistical Analyses of Oral Medicine Studies:Common Pitfalls

    PubMed Central

    Baccaglini, Lorena; Shuster, Jonathan J.; Cheng, Jing; Theriaque, Douglas W.; Schoenbach, Victor J.; Tomar, Scott L.; Poole, Charles

    2010-01-01

    A growing number of articles are emerging in the medical and statistics literature that describe epidemiological and statistical flaws of research studies. Many examples of these deficiencies are encountered in the oral, craniofacial and dental literature. However, only a handful of methodological articles have been published in the oral literature warning investigators of potential errors that may arise early in the study and that can irreparably bias the final results. In this paper we briefly review some of the most common pitfalls that our team of epidemiologists and statisticians has identified during the review of submitted or published manuscripts and research grant applications. We use practical examples from the oral medicine and dental literature to illustrate potential shortcomings in the design and analyses of research studies, and how these deficiencies may affect the results and their interpretation. A good study design is essential, because errors in the analyses can be corrected if the design was sound, but flaws in study design can lead to data that are not salvageable. We recommend consultation with an epidemiologist or a statistician during the planning phase of a research study to optimize study efficiency, minimize potential sources of bias, and document the analytic plan. PMID:19874532

  15. Cognitive Improvement of Attention and Inhibition in the Late Afternoon in Children With Attention-Deficit Hyperactivity Disorder (ADHD) Treated With Osmotic-Release Oral System Methylphenidate.

    PubMed

    Slama, Hichem; Fery, Patrick; Verheulpen, Denis; Vanzeveren, Nathalie; Van Bogaert, Patrick

    2015-07-01

    Long-acting medications have been developed and approved for use in the treatment of attention-deficit hyperactivity disorder (ADHD). These compounds are intended to optimize and maintain symptoms control throughout the day. We tested prolonged effects of osmotic-release oral system methylphenidate on both attention and inhibition, in the late afternoon. A double-blind, randomized, placebo-controlled study was conducted in 36 boys (7-12 years) with ADHD and 40 typically developing children. The ADHD children received an individualized dose of placebo or osmotic-release oral system methylphenidate. They were tested about 8 hours after taking with 2 continuous performance tests (continuous performance test-X [CPT-X] and continuous performance test-AX [CPT-AX]) and a counting Stroop. A positive effect of osmotic-release oral system methylphenidate was present in CPT-AX with faster and less variable reaction times under osmotic-release oral system methylphenidate than under placebo, and no difference with typically developing children. In the counting Stroop, we found a decreased interference with osmotic-release oral system methylphenidate but no difference between children with ADHD under placebo and typically developing children.

  16. Innovative Oral Treatments of Uterine Leiomyoma

    PubMed Central

    Sabry, Mohamed; Al-Hendy, Ayman

    2012-01-01

    Uterine fibroids (leiomyoma), the benign tumors of the uterine wall, are very common cause of morbidity in reproductive age women usually in the form of excessive vaginal bleeding, chronic pelvic pain, miscarriage and infertility. These tumors are the leading indication for hysterectomy in the United States. Uterine fibroids are about 4 times higher in blacks compared to whites and constitute a major health disparity challenge. The estimated cost of uterine fibroids is up to $34.4 billion annually. Additionally, women who suffer from this disease and desire to maintain their future fertility have very limited treatment choices. Currently, there is no effective long-term medicinal treatment for uterine fibroids. While surgery has traditionally been the gold standard for the treatment of uterine fibroids, there is growing interest towards orally administered medications for the management of leiomyoma-related symptoms. In this paper, we will discuss these promising innovative oral medical treatments in detail. PMID:22518167

  17. Competencies for the new postdoctoral Oral Medicine graduate in the United States.

    PubMed

    Whitney, Eli M; Stoopler, Eric; Brennan, Michael T; DeRossi, Scott S; Treister, Nathaniel S

    2015-09-01

    Oral Medicine is primarily a nonsurgical dental discipline that includes management of (1) oral mucosal and salivary gland diseases; (2) temporomandibular disorders and orofacial pain; (3) oral complications of systemic disease; and (4) dental management of medically complex patients within its scope of practice. In the United States, the American Academy of Oral Medicine (AAOM) is the professional organization that primarily supports Oral Medicine education, research, and patient care. This document informs the knowledge, skills, and behaviors of beginning Oral Medicine graduates in the United States in three domains: Diagnosis and primarily nonsurgical management of oral mucosal and salivary gland disorders. Diagnosis and primarily nonsurgical management of temporomandibular, orofacial pain, and neurosensory disorders. Management of the medically complex patient. Each domain is subsequently expanded with major competencies and supporting competencies.

  18. Competencies for the new postdoctoral Oral Medicine graduate in the United States.

    PubMed

    Whitney, Eli M; Stoopler, Eric; Brennan, Michael T; DeRossi, Scott S; Treister, Nathaniel S

    2015-09-01

    Oral Medicine is primarily a nonsurgical dental discipline that includes management of (1) oral mucosal and salivary gland diseases; (2) temporomandibular disorders and orofacial pain; (3) oral complications of systemic disease; and (4) dental management of medically complex patients within its scope of practice. In the United States, the American Academy of Oral Medicine (AAOM) is the professional organization that primarily supports Oral Medicine education, research, and patient care. This document informs the knowledge, skills, and behaviors of beginning Oral Medicine graduates in the United States in three domains: Diagnosis and primarily nonsurgical management of oral mucosal and salivary gland disorders. Diagnosis and primarily nonsurgical management of temporomandibular, orofacial pain, and neurosensory disorders. Management of the medically complex patient. Each domain is subsequently expanded with major competencies and supporting competencies. PMID:26138609

  19. Regenerative nanotechnology in oral and maxillofacial surgery.

    PubMed

    Shakib, Kaveh; Tan, Aaron; Soskic, Vukic; Seifalian, Alexander M

    2014-12-01

    Regenerative nanotechnology is at the forefront of medical research, and translational medicine is a challenge to both scientists and clinicians. Although there has been an exponential rise in the volume of research generated about it for both medical and surgical uses, key questions remain about its actual benefits. Nevertheless, some people think that therapeutics based on its principles may form the core of applied research for the future. Here we give an account of its current use in oral and maxillofacial surgery, and implications and challenges for the future.

  20. Oral plasmablastic lymphoma: a case report.

    PubMed

    Hewson, I

    2011-09-01

    Oral plasmablastic lymphoma is a rare malignancy that is associated with patients with HIV or other immunosuppression. This article describes a case of a patient with severe haemophilia A (<1% factor VIII) who had medically acquired HIV and hepatitis C, a CD4+ count of 192 cells/μL and a viral load of 33 200 copies/mL. The patient presented with a two-month history of a firm swelling around a lower molar. The tooth was removed and the surrounding tissue biopsied. The importance of obtaining an early definitive diagnosis and seeking adequate medical treatment is discussed.

  1. Oral environment and cancer.

    PubMed

    Kudo, Yasusei; Tada, Hidesuke; Fujiwara, Natsumi; Tada, Yoshiko; Tsunematsu, Takaaki; Miyake, Yoichiro; Ishimaru, Naozumi

    2016-01-01

    Cancer is now the leading cause of death in Japan. A rapid increase in cancer mortality is expected as Japan is facing a super-aged society. Many causes of cancer are known to be closely linked to life style factors, such as smoking, drinking, and diet. The oral environment is known to be involved in the pathogenesis and development of various diseases such as bronchitis, pneumonia, diabetes, heart disease, and dementia. Because the oral cavity acts as the bodily entrance for air and food, it is constantly exposed to foreign substances, including bacteria and viruses. A large number of bacteria are endemic to the oral cavity, and indigenous oral flora act to prevent the settlement of foreign bacteria. The oral environment is influenced by local factors, including dental plaque, tartar, teeth alignment, occlusion, an incompatible prosthesis, and bad lifestyle habits, and systemic factors, including smoking, consumption of alcohol, irregular lifestyle and eating habits, obesity, stress, hormones, and heredity. It has recently been revealed that the oral environment is associated with cancer. In particular, commensal bacteria in the oral cavity are involved in the development of cancer. Moreover, Candida, human papilloma virus and Epstein-Barr virus as well as commensal bacteria have been reported to be associated with the pathogenesis of cancer. In this review, we introduce recent findings of the correlation between the oral environment and cancer. PMID:27482300

  2. Oral Transliterating. PEPNet Tipsheet

    ERIC Educational Resources Information Center

    Troiano, Claire A.

    2010-01-01

    An oral transliterator provides communication access to a person who is deaf or hard of hearing and who uses speechreading and speaking as a means of communicating. The oral transliterator, positioned in front of the speechreader, inaudibly repeats the spoken message, making it as speechreadable as possible. This is called Expressive Oral…

  3. Oral Transliterating. NETAC Tipsheet

    ERIC Educational Resources Information Center

    Troiano, Claire A.

    2005-01-01

    An oral transliterator provides communication access to a person who is deaf or hard of hearing and who uses speechreading and speaking as a means of communicating. The oral transliterator, positioned in front of the deaf person, inaudibly repeats the spoken message for the deaf person, making it as speechreadable as possible. This is called…

  4. Medical neglect.

    PubMed

    Boos, Stephen C; Fortin, Kristine

    2014-11-01

    Medical neglect occurs when children are harmed or placed at significant risk of harm by gaps in their medical care. This is most likely to occur and to be recognized when families lack resources, commonly due to poverty, and when medical demands are high, such as with complex, severe, and chronic illness. A systematic evaluation of the probabilities for harm from gaps in care versus benefits from improved care will define medical neglect. A broad consideration of child, family, community, and medical system contributions to identified gaps will guide management. Special circumstances, such as lapsed immunizations, unremitting obesity, and medically motivated alterations in care, are often challenging for medical providers. Guidance for these specific situations is available from the American Academy of Pediatrics, and from the medical literature.

  5. Medication Errors

    MedlinePlus

    ... to reduce the risk of medication errors to industry and others at FDA. Additionally, DMEPA prospectively reviews ... List of Abbreviations Regulations and Guidances Guidance for Industry: Safety Considerations for Product Design to Minimize Medication ...

  6. Oral complications of cancer therapies. Management of mucositis during therapy

    SciTech Connect

    Miaskowski, C. )

    1990-01-01

    This paper reviews the purposes of an oral care protocol, the major components of an oral care regimen, and oral care protocols and studies done to date. Many questions remain in the area of optimal oral care for the patient experiencing mucositis as a sequela of cancer treatment. Research is needed on types and use of mouth rinses, effective, harmless, and pleasant lip lubricants, appropriate analgesic and anti-inflammatory combinations, and the effectiveness of a variety of devices for oral cleansing, to name a few areas. As outpatient oncology services grow, oral care protocols must be developed to meet the needs of ambulatory patient populations. Oral care regimens must be safe, easy to use, and economical as well as effective to ensure patient and staff compliance. Research on the management of mucositis must be conducted in both inpatient and outpatient settings. Finally, in order to obtain sufficient sample sizes and optimize data collection, these studies will need to be conducted by multidisciplinary teams (including dentists, oncologists, radiation therapists, and nurses) across multiple sites. Not until large-scale clinical trials are done on the treatment of mucositis will we be able to optimize the therapeutic regimen for the patient. 43 references.

  7. Curricular Guidelines for Oral Biology.

    ERIC Educational Resources Information Center

    Journal of Dental Education, 1984

    1984-01-01

    The American Association of Dental Schools' guidelines for oral biology curriculum cover its scope, primary educational goals, prerequisites, sequencing, faculty, course content in each subarea (oral tissues and systems and oral diagnostic methodology), and specific behavioral objectives. (MSE)

  8. Thrush (Oral Candidiasis) in Children

    MedlinePlus

    ... A A A In oral candidiasis, normal mouth yeast overgrows, causing white, slightly elevated lesions. Overview Thrush ( ... candidiasis), also known as oral moniliasis, is a yeast infection of the mouth or throat (the oral ...

  9. Serological diagnosis of HIV infection using oral fluid samples.

    PubMed Central

    Tamashiro, H.; Constantine, N. T.

    1994-01-01

    The serological identification of antibodies to human immunodeficiency virus (HIV) in blood is the most widely used method to diagnose HIV infection. Recently, however, the use of oral fluid samples for the detection of antibodies to HIV has been suggested as an alternative. This review describes some basic information about oral fluids, the application of these samples for HIV testing, and summarizes results from many of the studies performed using HIV tests with oral fluids. The fluids obtained from the oral cavity include saliva and crevicular fluid, and can be collected directly (by dribbling) or by using commercially available devices. The immunoglobulin content of oral fluids is similar to that of blood, but their levels are less. However, the use of an HIV IgG antibody capture assay (GAC ELISA) designed specifically for testing oral fluids, and certain routine HIV blood tests that have been optimized for use with oral fluids, has produced encouraging results. A number of studies, including several in developing countries, report that the sensitivities and specificities of these optimized tests lie in the range 95-100% and 98-100%, respectively. Also, the performance of the GAC ELISA was consistent and in general, excellent. The article identifies several issues that need to be addressed before a recommendation on the routine use of oral fluid samples for HIV antibody detection can be made. PMID:8131250

  10. Medical Appointments

    MedlinePlus

    ... trouble concentrating, stomach problems or emotional issues like anxiety. New or increasing side effects or reactions to your medications. Again, for how long? How serious are they? Medication compliance: How well you’ve been taking your medications. Have you missed doses? If so, ...

  11. MEDICAL "DEPRIVATION."

    ERIC Educational Resources Information Center

    SUCHMAN, EDWARD A.

    THE SOCIAL AND MEDICAL PROBLEM TODAY HAS SHIFTED FROM PROVIDING FOR THE EMERGENCY MEDICAL NEEDS OF THE INDIGENT SICK TO RAISING THE LEVEL OF LOWER CLASS PARTICIPATION IN THE BENEFITS OF MODERN MEDICINE. GREATER ATTENTION IS BEING FOCUSED ON MEDICAL DEPRIVATION SUFFERED BY LARGE SEGMENTS OF THE POPULATION WHO DO NOT SHARE EQUALLY IN MEDICAL…

  12. Molecular based treatment of oral cancer.

    PubMed

    Sudbø, Jon; Bryne, Magne; Mao, Li; Lotan, Reuben; Reith, Albrecht; Kildal, Wanja; Davidson, Ben; Søland, Tine M; Lippman, Scott M

    2003-12-01

    Given the increase in the age distribution of the population, an increase in cancer incidence rates are to be expected. Oral cancer is a disfiguring disease that continues to increase in incidence, particularly in the young, and to an extent that cannot be fully explained by increased exposure to known risk factors. Despite extensive research on treatment modalities towards oral cancer, the 5-year survival rate of this disease has not been improved over the last 4-5 decades. These facts strongly favour chemoprevention-systemic medication to revert, stop, or delay the carcinogenic process-as an approach to treating oral cancer. A chemopreventive approach to oral cancer most likely should encompass a combination of drugs targeting metabolic pathways relevant to oral carcinogenesis. Candidate drugs are retinoids and selective inhibitors of cyclooxygenase-2, epidermal growth factor receptor (EGFR), and peroxisome proliferator activated receptors (PPARs). Chemopreventive trials so far have used surrogate intermediate biomarkers as measurement of treatment effect. However, the efficiency of any drug for chemopreventive use should be assessed through a prospective randomized trial and evaluated by the only definitive end point for prevention of cancer, the incidence rates of new carcinomas. PMID:13679198

  13. Estimation of the impact of warfarin's time-in-therapeutic range on stroke and major bleeding rates and its influence on the medical cost avoidance associated with novel oral anticoagulant use-learnings from ARISTOTLE, ROCKET-AF, and RE-LY trials.

    PubMed

    Amin, Alpesh; Deitelzweig, Steve; Jing, Yonghua; Makenbaeva, Dinara; Wiederkehr, Daniel; Lin, Jay; Graham, John

    2014-01-01

    Warfarin's time-in-therapeutic range (TTR) is highly variable among patients with nonvalvular atrial fibrillation (NVAF). The objective of this study was to estimate the impact of variations in wafarin's TTR on rates of stroke/systemic embolism (SSE) and major bleedings among NVAF patients in the ARISTOTLE, ROCKET-AF, and RE-LY trials. Additionally, differences in medical costs for clinical endpoints when novel oral anticoagulants (NOACs) were used instead of warfarin at different TTR values were estimated. Quartile ranges of TTR values and corresponding event rates (%/patient - year = %/py) of SSE and major bleedings among NVAF patients treated with warfarin were estimated from published literature and FDA documents. The associations of SSE and major bleeding rates with TTR values were evaluated by regression analysis and then the calculated regression coefficients were used in analysis of medical cost differences associated with use of each NOAC versus warfarin (2010 costs; US payer perspective) at different TTRs. Each 10 % increase in warfarin's TTR correlated with a -0.32%/py decrease in SSE rate (R(2) = 0.61; p < 0.001). Although, the rate of major bleedings decreased as TTR increased, it was not significant (-0.035%/py, p = 0.63). As warfarin's TTR increased from 30 to 90% the estimated medical cost decreased from -$902 to -$83 for apixaban, from -$506 to +$314 for rivaroxaban, and from -$596 to +$223 for dabigatran. Among NVAF patients there is a significant negative correlation between warfarin's TTR and SSE rate, but not major bleedings. The variations in warfarin's TTR impacted the economic comparison of use of individual NOACs versus warfarin.

  14. Literatura Oral Hispanica (Hispanic Oral Literature).

    ERIC Educational Resources Information Center

    McAlpine, Dave

    As part of a class in Hispanic Oral Literature, students collected pieces of folklore from various Hispanic residents in the region known as "Siouxland" in Iowa. Consisting of some of the folklore recorded from the residents, this paper includes 18 "cuentos y leyendas" (tales and legends), 48 "refranes" (proverbs), 17 "chistes" (jokes), 1…

  15. Building better oral health: a dental home for all Texans.

    PubMed

    2008-01-01

    Poor oral health affects more than just the mouth. It can seriously compromise a person's general health, quality of life and life expectancy. Oral diseases can and do lead to systemic problems--damaging other parts of the body and resulting in the need for expensive emergency department visits, hospital stays and medications. The consequences of poor oral health, however, go far beyond damaging medical effects. Oral disease can also wreak economic havoc--keeping children out of school and adults home from work--not to mention lower productivity of workers in pain. Untreated oral diseases can also drive up health care costs in general. The good news is that with proper oral health care, both at home and in professional settings, many of the negative consequences associated with poor oral health can be prevented. The State of Texas has a unique and unprecedented opportunity to significantly increase access to oral health care for all Texans. Complying with the Frew agreement is a key priority. However, there are additional ways that Texas policymakers can improve the oral health of the state. In an effort to begin a constructive dialogue about improving the oral health of all Texans, the Texas Dental Association (TDA) with grant funding from the American Dental Association (ADA) commissioned an independent third-party report on the issue of access to oral health care in Texas modeled after the 2000 groundbreaking surgeon general's report, Oral Health in America. The TDA assembled a team of five nationally recognized dentists from both academia and private practice to oversee the project. The dentists (hereafter called the editorial review board or ERB) were asked to identify the state's most pressing issues, needs and challenges associated with improving the oral health of all Texans, with a special focus on the state's most vulnerable. The ERB looked carefully at the economic, medical and social consequences of untreated oral disease in Texas. It reviewed the

  16. Building better oral health: a dental home for all Texans.

    PubMed

    2008-01-01

    Poor oral health affects more than just the mouth. It can seriously compromise a person's general health, quality of life and life expectancy. Oral diseases can and do lead to systemic problems--damaging other parts of the body and resulting in the need for expensive emergency department visits, hospital stays and medications. The consequences of poor oral health, however, go far beyond damaging medical effects. Oral disease can also wreak economic havoc--keeping children out of school and adults home from work--not to mention lower productivity of workers in pain. Untreated oral diseases can also drive up health care costs in general. The good news is that with proper oral health care, both at home and in professional settings, many of the negative consequences associated with poor oral health can be prevented. The State of Texas has a unique and unprecedented opportunity to significantly increase access to oral health care for all Texans. Complying with the Frew agreement is a key priority. However, there are additional ways that Texas policymakers can improve the oral health of the state. In an effort to begin a constructive dialogue about improving the oral health of all Texans, the Texas Dental Association (TDA) with grant funding from the American Dental Association (ADA) commissioned an independent third-party report on the issue of access to oral health care in Texas modeled after the 2000 groundbreaking surgeon general's report, Oral Health in America. The TDA assembled a team of five nationally recognized dentists from both academia and private practice to oversee the project. The dentists (hereafter called the editorial review board or ERB) were asked to identify the state's most pressing issues, needs and challenges associated with improving the oral health of all Texans, with a special focus on the state's most vulnerable. The ERB looked carefully at the economic, medical and social consequences of untreated oral disease in Texas. It reviewed the

  17. Medication safety.

    PubMed

    Keohane, Carol A; Bates, David W

    2008-03-01

    Patient safety is a state of mind, not a technology. The technologies used in the medical setting represent tools that must be properly designed, used well, and assessed on an on-going basis. Moreover, in all settings, building a culture of safety is pivotal for improving safety, and many nontechnologic approaches, such as medication reconciliation and teaching patients about their medications, are also essential. This article addresses the topic of medication safety and examines specific strategies being used to decrease the incidence of medication errors across various clinical settings.

  18. Oral health in Libya: addressing the future challenges.

    PubMed

    Peeran, Syed Wali; Altaher, Omar Basheer; Peeran, Syed Ali; Alsaid, Fatma Mojtaba; Mugrabi, Marei Hamed; Ahmed, Aisha Mojtaba; Grain, Abdulgader

    2014-01-01

    Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human resources with the present status of dental education are reviewed comprehensively. A bibliographic study of oral health research and publications has been carried out. The results point toward a common indicator that oral health-related research is low. Strategies have to be developed to educate the medical and dental professionals, to update the current curriculum and enable the system to be competent in all aspects of oral health care management.

  19. Oral health in Libya: addressing the future challenges

    PubMed Central

    Peeran, Syed Wali; Altaher, Omar Basheer; Peeran, Syed Ali; Alsaid, Fatma Mojtaba; Mugrabi, Marei Hamed; Ahmed, Aisha Mojtaba; Grain, Abdulgader

    2014-01-01

    Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human resources with the present status of dental education are reviewed comprehensively. A bibliographic study of oral health research and publications has been carried out. The results point toward a common indicator that oral health–related research is low. Strategies have to be developed to educate the medical and dental professionals, to update the current curriculum and enable the system to be competent in all aspects of oral health care management. PMID:24666627

  20. Dermographism in the Oral Cavity

    PubMed Central

    Binmadi, Nada; Almazrooa, Soulafa

    2016-01-01

    Patient: Male, 20 Final Diagnosis: Dermographism Symptoms: Unusual skin reaction to trauma Medication: — Clinical Procedure: — Specialty: Dentistry Objective: Unusual clinical course Background: Dermographism is a type of physical urticaria that can be induced by writing on the skin. It occurs in 2–5% of the population and is considered to be a normal physiological phenomenon. However, in a small subset of patients, it can be symptomatic and may affect the quality of life. The etiology of this disease remains unclear. Case Report: Herein, we present a case of dermographism in a 20-year-old male and discuss the involvement of the oral mucosa in this condition. Conclusions: Although this condition is well known to occur in the skin, we believe this condition is rarely discussed among dentists. All healthcare providers, especially dentists, should know its potential to cause complications during dental procedures. PMID:27324161

  1. Examining the association between oral health and oral HPV infection.

    PubMed

    Bui, Thanh Cong; Markham, Christine M; Ross, Michael Wallis; Mullen, Patricia Dolan

    2013-09-01

    Oral human papillomavirus (HPV) infection is the cause of 40% to 80% of oropharyngeal cancers; yet, no published study has examined the role of oral health in oral HPV infection, either independently or in conjunction with other risk factors. This study examined the relation between oral health and oral HPV infection and the interactive effects of oral health, smoking, and oral sex on oral HPV infection. Our analyses comprised 3,439 participants ages 30 to 69 years for whom data on oral HPV and oral health were available from the nationally representative 2009-2010 National Health and Nutrition Examination Survey. Results showed that higher unadjusted prevalence of oral HPV infection was associated with four measures of oral health, including self-rated oral health as poor-to-fair [prevalence ratio (PR) = 1.56; 95% confidence interval (CI), 1.25-1.95], indicated the possibility of gum disease (PR = 1.51; 95% CI, 1.13-2.01), reported use of mouthwash to treat dental problems in the past week (PR = 1.28; 95% CI, 1.07-1.52), and higher number of teeth lost (Ptrend = 0.035). In multivariable logistic regression models, oral HPV infection had a statistically significant association with self-rated overall oral health (OR = 1.55; 95% CI, 1.15-2.09), independent of smoking and oral sex. In conclusion, poor oral health was an independent risk factor of oral HPV infection, irrespective of smoking and oral sex practices. Public health interventions may aim to promote oral hygiene and oral health as an additional measure to prevent HPV-related oral cancers.

  2. Oral insulin--a perspective.

    PubMed

    Raj, N K Kavitha; Sharma, Chandra P

    2003-01-01

    Diabetes mellitus is generally controlled quite well with the administration of oral medications or by the use of insulin injections. The current practice is the use of one or more doses, intermediate or long acting insulin per day. Oral insulin is a promising yet experimental method providing tight glycemic control for patients with diabetes. A biologically adhesive delivery systems offer important advantage over conventional drug delivery systems. The engineered polymer microspheres made of erodable polymer display strong adhesive interactions with gastrointestinal mucus and cellular lining can traverse both the mucosal epithelium and the follicle associated epithelium covering the lymphoid tissue of Peyer's patches. Alginate, a natural polymer recovered from seaweed is being developed as a nanoparticle for the delivery of insulin without being destroyed in the stomach. Alginate is in fact finding application in biotechnology industry as thickening agent, a gelling agent and a colloid stabilizer. Alginate has in addition, several other properties that have enabled it to be used as a matrix for entrapment and for the delivery of a variety of proteins such as insulin and cells. These properties include: a relatively inert aqueous environment within the matrix; a mild room temperature encapsulation process free of organic solvents; a high gel porosity which allows for high diffusion rates of macromolecules; the ability to control this porosity with simple coating procedures and dissolution and biodegradation of the system under normal physiological conditions.

  3. Advanced medical video services through context-aware medical networks.

    PubMed

    Doukas, Charalampos N; Maglogiannis, Ilias; Pliakas, Thomas

    2007-01-01

    The aim of this paper is to present a framework for advanced medical video delivery services, through network and patient-state awareness. Under this scope a context-aware medical networking platform is described. The developed platform enables proper medical video data coding and transmission according to both a) network availability and/or quality and b) patient status, optimizing thus network performance and telediagnosis. An evaluation platform has been developed based on scalable H.264 coding of medical videos. Corresponding results of video transmission over a WiMax network have proved the effectiveness and efficiency of the platform providing proper video content delivery. PMID:18002643

  4. Advanced medical video services through context-aware medical networks.

    PubMed

    Doukas, Charalampos N; Maglogiannis, Ilias; Pliakas, Thomas

    2007-01-01

    The aim of this paper is to present a framework for advanced medical video delivery services, through network and patient-state awareness. Under this scope a context-aware medical networking platform is described. The developed platform enables proper medical video data coding and transmission according to both a) network availability and/or quality and b) patient status, optimizing thus network performance and telediagnosis. An evaluation platform has been developed based on scalable H.264 coding of medical videos. Corresponding results of video transmission over a WiMax network have proved the effectiveness and efficiency of the platform providing proper video content delivery.

  5. Interdisciplinary Strategies for Treating Oral Aversions in Children.

    PubMed

    Edwards, Sarah; Davis, Ann McGrath; Ernst, Linda; Sitzmann, Brenda; Bruce, Amanda; Keeler, David; Almadhoun, Osama; Mousa, Hayat; Hyman, Paul

    2015-11-01

    Oral aversion is a frequent diagnosis in the pediatric population. For a minority of children, feeding challenges rise to the level of requiring clinical evaluation and intervention. Determining the best evaluation and treatment plan can be challenging, but there is a consensus that treatment for children with a severe oral aversion involves an interdisciplinary approach. Within the team model, multiple strategies have demonstrated effectiveness, including sensorimotor skill building, behavioral modification, hunger provocation, and sensory integration therapy. This tutorial reviews the diagnostic and treatment process for a child with oral aversion, including identification of an underlying etiology, the medical and behavioral evaluation, and formulation of a treatment plan.

  6. Fungal infections of the oral cavity.

    PubMed

    Zegarelli, D J

    1993-12-01

    Although several strains of Candida can infect the oral mucosa, the most commonly encountered oral fungal infection is Candida albicans, which may be highly infective because of its greater level of pathogenicity and adherence properties. C. albicans is an oral commensal in as many as 40% to 65% of healthy adult mouths. The papillated dorsal surface of the tongue and palatal mucosa beneath a maxillary denture are favored reservoir sites. Oral candidal infection almost always involves a compromised host. The compromise may be local or systemic. Local factors include decreased salivation and the weaning of dentures. Systemic factors include diabetes mellitus, pernicious anemia, and AIDS. Some have even implicated advanced age and the female gender as being mild predisposing factors. Furthermore, the C. albicans infection itself can depress a host's immune system. A patient with oral candidiasis can present with one or more of the following clinical forms: pseudomembranous, erythematous, hyperplastic, and denture erythematous. Many investigators accept median rhomboid glossitis as a form of chronic oral candidiasis. In some patients with angular cheilitis, genesis of the lesions is secondary to monilial infestation. Because C. albicans is a normal inhabitant in many mouths, diagnostic confirmation of infection often rests with successful response (i.e., resolution of lesions) to antifungal medications. This form of diagnostic confirmation can be further enhanced by culturing the offending microbe, preparing a fungal smear, or even incisional biopsy. The microscopic demonstration of fungal hyphae is highly diagnostic of the candidal infection, whether the hyphae are demonstrated on a PAS smear or on a biopsy within surface stratified squamous epithelium. Numerous medications exist for the treatment of oral candidiasis. They include the antibiotic nystatin as well as clotrimazole, ketoconazole, and fluconazole. Nystatin is safe and is used as a topical agent in rinse or

  7. "Noninvasive" oral treatment of asthma in the emergency room.

    PubMed

    Aelony, Y

    1985-06-01

    One hundred forty consecutive patients with acute asthmatic episodes presenting to the emergency room were studied prospectively to assess the efficacy of oral therapy. After the emergency room staff was oriented to the pharmacologic action of hydroalcoholic elixir of theophylline, oral terbutaline, and a metered-dose hand-held nebulizer (metaproterenol), use of oral therapy as initial therapy rose from 12 percent to 76 percent (p = 0.005). More than half of these patients were discharged without receiving any of the traditional more invasive therapies of subcutaneous epinephrine, intravenous hydrating fluids with aminophylline, and machine-delivered sympathomimetic aerosols. Oral therapy did not substantially alter the total time spent in the emergency room. Only 4 percent treated with oral therapy required further treatment in the emergency room within 48 hours; 2 percent vomited after treatment. Oral therapy is safe and effective for most asthmatic patients presenting to the emergency room, as they generally are undermedicated with regard to theophyllines and sympathomimetic drugs. Use of oral therapy in the emergency room is a potent tool for educating asthmatic patients in the use of medication available for home use. The patients who require emergency room treatment despite being well-medicated at home (a small minority) need a higher level of care including intermittent positive-pressure breathing, corticosteroids, and often hospitalization.

  8. Do current sports nutrition guidelines conflict with good oral health?

    PubMed

    Broad, Elizabeth M; Rye, Leslie A

    2015-01-01

    For optimal athletic performance, an athlete requires good oral health to reduce the risk of oral pain, inflammation, and infection and thereby minimize the use of analgesics and antimicrobial agents. Increased intake, frequency, and dental contact time of carbohydrate-rich foods, sports nutrition products, and acidic carbohydrate-containing sports and energy drinks may contribute to risks of dental erosion, caries, and inflammatory periodontal conditions in the athlete, especially when he or she also exhibits dehydration and poor oral hygiene habits. Examining the athlete before he or she begins participating in a sport allows the dental care provider to determine the patient's existing oral health, hygiene, and susceptibility to risk factors for erosion, caries, and inflammatory periodontal disease. This oral profile, in conjunction with the individual athlete's dietary needs, can be used to establish a treatment and preventive program, including oral health education. Good oral hygiene practices and application of topical fluoride, especially via fluoridated toothpastes and topical fluoride varnishes, must be available to the athlete. Rinsing with water or a neutral beverage after exposure to carbohydrates or acidic sports nutrition products may reduce carbohydrate contact time and bring oral pH levels back to neutral more quickly, reducing the risk of caries and erosion. Finally, the dentist should encourage the athlete to consult with an experienced sports dietitian to ensure that principles of sports nutrition are being appropriately applied for the type, frequency, and duration of exercise in consideration of the individual's oral health needs.

  9. Do current sports nutrition guidelines conflict with good oral health?

    PubMed

    Broad, Elizabeth M; Rye, Leslie A

    2015-01-01

    For optimal athletic performance, an athlete requires good oral health to reduce the risk of oral pain, inflammation, and infection and thereby minimize the use of analgesics and antimicrobial agents. Increased intake, frequency, and dental contact time of carbohydrate-rich foods, sports nutrition products, and acidic carbohydrate-containing sports and energy drinks may contribute to risks of dental erosion, caries, and inflammatory periodontal conditions in the athlete, especially when he or she also exhibits dehydration and poor oral hygiene habits. Examining the athlete before he or she begins participating in a sport allows the dental care provider to determine the patient's existing oral health, hygiene, and susceptibility to risk factors for erosion, caries, and inflammatory periodontal disease. This oral profile, in conjunction with the individual athlete's dietary needs, can be used to establish a treatment and preventive program, including oral health education. Good oral hygiene practices and application of topical fluoride, especially via fluoridated toothpastes and topical fluoride varnishes, must be available to the athlete. Rinsing with water or a neutral beverage after exposure to carbohydrates or acidic sports nutrition products may reduce carbohydrate contact time and bring oral pH levels back to neutral more quickly, reducing the risk of caries and erosion. Finally, the dentist should encourage the athlete to consult with an experienced sports dietitian to ensure that principles of sports nutrition are being appropriately applied for the type, frequency, and duration of exercise in consideration of the individual's oral health needs. PMID:26545270

  10. Etiology of oral habits.

    PubMed

    Bayardo, R E; Mejia, J J; Orozco, S; Montoya, K

    1996-01-01

    The pedodontic admission histories of 1600 Mexican children were analyzed, to determine general epidemiologic factors or oral habits, as well as their relationship with identifiable biopsychosociologic factors. Fifty-six percent of the children gave evidence of an oral habit, with significant predisposition among female patients, single children, subjects in poor physical health (particularly from allergies), as well as children with histories of chronic health problems. Oral habits should be considered a major health hazard because of their high incidence. Successful treatment requires a multidisciplinary approach to the basic cause of the problem.

  11. Oral Lesions in Neonates

    PubMed Central

    Rao, Roopa S; Majumdar, Barnali; Jafer, Mohammed; Maralingannavar, Mahesh; Sukumaran, Anil

    2016-01-01

    ABSTRACT Oral lesions in neonates represent a wide range of diseases often creating apprehension and anxiety among parents. Early examination and prompt diagnosis can aid in prudent management and serve as baseline against the future course of the disease. The present review aims to enlist and describe the diagnostic features of commonly encountered oral lesions in neonates. How to cite this article: Patil S, Rao RS, Majumdar B, Jafer M, Maralingannavar M, Sukumaran A. Oral Lesions in Neonates. Int J Clin Pediatr Dent 2016;9(2):131-138. PMID:27365934

  12. The Oral Pathology Related Articles Published in Iranian Journal of Pathology from 2006 to 2015

    PubMed Central

    Shamim, Thorakkal

    2016-01-01

    Background: There is a paucity of information about the oral pathology related articles published in a pathology journal. This study aimed to audit the oral pathology related articles published in Iranian Journal of Pathology (Iran J Pathol) from 2006 to 2015. Methods: Bibliometric analysis of issues of Iran J Pathol from 2006 to 2015 was performed using web-based search. The articles published were analyzed for type of article and individual topic of oral pathology. The articles published were also checked for authorship trends. Results: Out of the total 49 published articles related to oral pathology, case reports (21) and original articles (18) contributed the major share. The highest number of oral pathology related articles was published in 2011, 2014 and 2015 with 8 articles each and the least published year was 2012 with 1 article. Among the oral pathology related articles published, spindle cell neoplasms (7) followed by salivary gland tumors (5), jaw tumors (4), oral granulomatous conditions (4), lymphomas (4), oral cancer (3) and odontogenic cysts (3) form the major attraction of the contributors. The largest numbers of published articles related to oral pathology were received from Tehran University of Medical Sciences; Tehran (7) followed by Mashhad University of Medical Sciences, Mashhad (6) and Shahid Beheshti University of Medical Sciences, Tehran (5). Conclusion: This paper may be considered as a baseline study for the bibliometric information regarding oral pathology related articles published in a pathology journal. PMID:27799973

  13. A phase II trial of oral gimatecan for recurrent glioblastoma.

    PubMed

    Hu, Jethro; Wen, Patrick Y; Abrey, Lauren E; Fadul, Camilo E; Drappatz, Jan; Salem, Nadia; Supko, Jeffrey G; Hochberg, Fred

    2013-02-01

    Gimatecan is a lipophilic oral camptothecin analogue with preclinical activity in glioma models. We conducted a multicenter phase II trial to evaluate the efficacy of gimatecan in adults with recurrent glioblastoma. Eligibility criteria included ≤1 prior treatment for recurrent disease, age ≥18, Eastern Cooperative Oncology Group performance status 0-1, and normal organ function. Patients taking enzyme-inducing anti-seizure medications were excluded. Gimatecan 1.22 mg/m(2) was given orally once daily for 5 consecutive days during each 28-day cycle. The primary endpoint was progression-free survival at 6 months. A Simon 2-stage optimal design was used in which 19 patients were evaluated in the 1st stage, with an additional 36 patients accrued if >4 patients in stage 1 achieved PFS at 6 months. 29 patients were enrolled in the study, with median age of 58 years (range, 25-77 years); 58.6 % female. All patients received prior surgery, radiation therapy, and at least one chemotherapy regimen. The daily dose was reduced to 1.0 mg/m(2) after four of the first 10 patients experienced grade 4 hematologic toxicity. Treatment-related grade 3/4 toxicities included thrombocytopenia (17.2 %), leukopenia (17.2 %) and neutropenia (10.3 %). None of the 19 patients treated at 1.0 mg/m(2)/day experienced grade 4 hematologic toxicity. One patient had a partial radiographic response by modified Macdonald criteria. Only 3 patients (12 %) were progression-free at 6 months. Median time to progression was 12.0 weeks (7.0, 17.0).Treatment with gimatecan 1.0 mg/m(2)/day for 5 days, repeated every 28-days showed minimal efficacy.

  14. Oral care and pulmonary infection - the importance of plaque scoring

    PubMed Central

    2013-01-01

    Improving the quality of oral hygiene is recognised as an important counter measure for reducing the incidence of ventilator-associated pneumonia amongst critically ill patients. Toothbrushing physically disrupts the dental plaque that acts as a reservoir for pulmonary infection and therefore has the potential to reduce the incidence of ventilator-associated pneumonia. Gu and colleagues performed a systematic review and meta-analysis of oral hygiene with and without a toothbrush and found no difference in the incidence of pneumonia in mechanically ventilated patients. The diagnosis of ventilator-associated pneumonia is prone to bias and future studies of oral care interventions should focus on measures of oral cleanliness such as plaque and gingival scores. Once the optimal strategy for oral hygiene is defined in the critically ill, larger studies focussing on ventilator-associated pneumonia or mortality can be conducted. PMID:23302185

  15. Medication Management of Jaw Lesions for Dental Patients.

    PubMed

    Ogle, Orrett E; Santosh, Arvind Babu Rajendra

    2016-04-01

    Most pathologic lesions of the jaws or of oral mucosa are treated successfully by surgical interventions. For treatment of the central giant cell lesion, aneurysmal bone cysts, histiocytosis of the mandible, hemangioma, odontogenic keratocyst, Paget disease, oral submucous fibrosis, and oral lichen planus, medical management consisting of intralesional injections, sclerosing agents, and systemic bisphosphonates is as successful as surgical procedures with fewer complications. Pharmacology of agents used and protocols are presented. PMID:27040297

  16. Medical criminalistics.

    PubMed

    Pollak, S

    2007-01-17

    Medical criminalistics is an essential part of legal/forensic medicine. It includes the clinical examination of surviving victims and suspects, the inspection of the scene in suspicious deaths with subsequent performance of medico-legal autopsies, the assessment of (biological) traces and the reconstruction of criminal events under medical aspects. Just as the circumstances of life and the manifestations of crime are changing with time, there is a permanent alteration regarding the issues of medical criminalistics. Legal/forensic medicine is a university subject in most countries and therefore, research work is one of the main tasks also in medical criminalistics. In contrast to clinical medicine and basic research, some common study designs are not suitable for the special needs of medical criminalistics, whereas other types are more appropriate like epidemiological evaluations, cross-sectional studies and (retrospective) observation studies. Moreover, experimental model tests and case reports also rate high in medical criminalistics. PMID:16822631

  17. Medical criminalistics.

    PubMed

    Pollak, S

    2007-01-17

    Medical criminalistics is an essential part of legal/forensic medicine. It includes the clinical examination of surviving victims and suspects, the inspection of the scene in suspicious deaths with subsequent performance of medico-legal autopsies, the assessment of (biological) traces and the reconstruction of criminal events under medical aspects. Just as the circumstances of life and the manifestations of crime are changing with time, there is a permanent alteration regarding the issues of medical criminalistics. Legal/forensic medicine is a university subject in most countries and therefore, research work is one of the main tasks also in medical criminalistics. In contrast to clinical medicine and basic research, some common study designs are not suitable for the special needs of medical criminalistics, whereas other types are more appropriate like epidemiological evaluations, cross-sectional studies and (retrospective) observation studies. Moreover, experimental model tests and case reports also rate high in medical criminalistics.

  18. Oral Cancer Exam

    MedlinePlus

    ... Diabetes Heart Disease HIV/AIDS See All Order Publications English and Spanish brochures available free of charge. ... early—when it can be treated more successfully. Publications​ For Health Professionals Detecting Oral Cancer: A Guide ...

  19. Oral Cancer Foundation

    MedlinePlus

    ... Oral Cancer Foundation is a national public service, non-profit entity designed to reduce suffering and save lives ... National Academy of Sciences (NAS) is a private, non-profit society of distinguished scholars. Established by an Act ...

  20. Olodaterol Oral Inhalation

    MedlinePlus

    ... of breath, coughing, and chest tightness caused by chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways, which includes chronic bronchitis and emphysema). Olodaterol oral inhalation is in ...

  1. Oral hypoglycemics overdose

    MedlinePlus

    ... calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. Poisonous Ingredient There are many types of oral hypoglycemics. The poisonous ingredient depends on ...

  2. Budesonide Oral Inhalation

    MedlinePlus

    ... 6 years of age and older. Budesonide suspension (liquid) for oral inhalation (Pulmicort Respules) is used in ... of inhalations even if it still contains some liquid and continues to release a spray when it ...

  3. Oral cleft prevention program (OCPP)

    PubMed Central

    2012-01-01

    Background Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted. Methods/design This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings. Discussion The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for

  4. Oral Antineoplastic Agents: Assessing the Delay in Care

    PubMed Central

    Anders, Brandi; Shillingburg, Alexandra; Newton, Michael

    2015-01-01

    The study was undertaken to determine the length of time between when a prescription for an oral antineoplastic agent is written by the provider and when the medication is received by the patient and to identify risk factors that significantly increase time to medication receipt. First-time fill prescriptions for oral antineoplastic agents were identified. The date the prescription was written and received by the patient was determined. A retrospective review was completed to gather additional information, including prescribed medication, indication, insurance coverage, patient assistance program use, dispensing pharmacy, and prior authorization requirements. The data was analyzed through multivariate statistical analysis and used to identify risk factors that may significantly increase the time to medication receipt. A total of 58 patients were included in the study. A median of 8 days elapsed between when the medication was prescribed and when it was received by the patient. Medication prescribed, absence of a Risk Evaluation Mitigation Strategies (REMS) program, and insurance type are factors that increased time to medication receipt. An understanding of the median time involved, as well as factors affecting the time to delivery of prescriptions, will help healthcare providers better plan and prepare for the use of oral antineoplastic agents. PMID:26605087

  5. Oral pigmentation: A review

    PubMed Central

    Sreeja, C.; Ramakrishnan, K.; Vijayalakshmi, D.; Devi, M.; Aesha, I.; Vijayabanu, B.

    2015-01-01

    Pigmentations are commonly found in the mouth. They represent in various clinical patterns that can range from just physiologic changes to oral manifestations of systemic diseases and malignancies. Color changes in the oral mucosa can be attributed to the deposition of either endogenous or exogenous pigments as a result of various mucosal diseases. The various pigmentations can be in the form of blue/purple vascular lesions, brown melanotic lesions, brown heme-associated lesions, gray/black pigmentations. PMID:26538887

  6. Oral vs. salivary diagnostics

    NASA Astrophysics Data System (ADS)

    Marques, Joana; Corby, Patricia M.; Barber, Cheryl A.; Abrams, William R.; Malamud, Daniel

    2015-05-01

    The field of "salivary diagnostics" includes studies utilizing samples obtained from a variety of sources within the oral cavity. These samples include; whole unstimulated saliva, stimulated whole saliva, duct saliva collected directly from the parotid, submandibular/sublingual glands or minor salivary glands, swabs of the buccal mucosa, tongue or tonsils, and gingival crevicular fluid. Many publications state "we collected saliva from subjects" without fully describing the process or source of the oral fluid. Factors that need to be documented in any study include the time of day of the collection, the method used to stimulate and collect the fluid, and how much fluid is being collected and for how long. The handling of the oral fluid during and post-collection is also critical and may include addition of protease or nuclease inhibitors, centrifugation, and cold or frozen storage prior to assay. In an effort to create a standard protocol for determining a biomarker's origin we carried out a pilot study collecting oral fluid from 5 different sites in the mouth and monitoring the concentrations of pro- and anti-inflammatory cytokines detected using MesoScaleDiscovery (MSD) electrochemiluminesence assays. Our data suggested that 3 of the cytokines are primarily derived from the submandibular gland, while 7 of the cytokines come from a source other than the major salivary glands such as the minor salivary glands or cells in the oral mucosae. Here we review the literature on monitoring biomarkers in oral samples and stress the need for determining the blood/saliva ratio when a quantitative determination is needed and suggest that the term oral diagnostic be used if the source of an analyte in the oral cavity is unknown.

  7. Oral pigmentation: A review.

    PubMed

    Sreeja, C; Ramakrishnan, K; Vijayalakshmi, D; Devi, M; Aesha, I; Vijayabanu, B

    2015-08-01

    Pigmentations are commonly found in the mouth. They represent in various clinical patterns that can range from just physiologic changes to oral manifestations of systemic diseases and malignancies. Color changes in the oral mucosa can be attributed to the deposition of either endogenous or exogenous pigments as a result of various mucosal diseases. The various pigmentations can be in the form of blue/purple vascular lesions, brown melanotic lesions, brown heme-associated lesions, gray/black pigmentations. PMID:26538887

  8. Medical confidence.

    PubMed

    Havard, J

    1985-03-01

    If medical confidentiality is not observed patients may well be reluctant to disclose information to their doctors or even to seek medical advice. Therefore, argues the author, it is of the utmost importance that doctors strive to protect medical confidentiality, particularly now when it is under threat not only in this country but also overseas. The profession must cease to regard ethical issues to do with confidentiality, and indeed to do with all areas of medical practice, as abstract phenomena requiring no justification. If it does not then it will come under increasing and justified criticism from the community it serves.

  9. Personality and oral health

    PubMed Central

    Thomson, W. Murray; Caspi, Avshalom; Poulton, Richie; Moffitt, Terrie E.; Broadbent, Jonathan M.

    2013-01-01

    We investigated age-26 personality characteristics and age-32 oral health in a prospective study of a complete birth cohort born in Dunedin, New Zealand. Personality was measured using the Multidimensional Personality Questionnaire (MPQ). Oral health was measured using the short-form Oral Health Impact Profile (OHIP-14), a global measure, and dental examinations. Personality profiles were constructed for 916 individuals (50.8% men) using standardized MPQ scores, and multivariate analyses examined their association with oral health. Those reporting 1+ OHIP-14 impacts had higher Negative Emotionality scores (and lower Constraint and Positive Emotionality MPQ superfactor scores) than those who did not. After controlling for gender, clinical status, and the other two MPQ superfactors, those scoring higher on Negative Emotionality had a greater risk of reporting 1+ OHIP-14 impacts, as well as 3+ OHIP-14 impacts and worse-than-average oral health. They also had a greater risk of having lost at least one tooth from caries and of having 3+ decayed surfaces. Personality characteristics appear to shape self-reports of oral health. Personality is also a risk factor for clinical disease status, at least with respect to dental caries and its sequelae. Because the attitudes and values tapped into by personality tests can be altered by brief cognitive interventions, those might be useful in preventive dentistry. PMID:21896053

  10. [Dementia and oral health].

    PubMed

    Wierink, C D; de Baat, C

    2009-02-01

    The first part of this article is a translation of an editorial which appeared in the journal Gerodontology. The author warns that a great increase is expected in the number of dementia patients in the United Kingdom and he argues that care for these patients be given a high place on the national agenda. Dementia was also a major issue at the meeting of the International Association for Dental Research in March 2007. Several international studies presented there indicated that elderly people with dementia constitute a group at risk with respect to oral health. In the evaluation of the editorial, the situation in The Netherlands is described. There is also serious concern in The Netherlands about the statistics with respect to dementia. Due to the growing number of frail elderly people having a natural dentition, the need for professional oral care will increase. General practitioners have the important task of providing adequate oral health care for elderly people suffering from dementia who are still living at home. Guidelines for Oral Care, having to do with the improvement of oral care in institutions, appeared recently. With the guidelines, a good basis for developing adequate oral health care of frail elderly people is available. However, the implementation of these guidelines will require some attention. PMID:19280891

  11. Personality and oral health.

    PubMed

    Thomson, W Murray; Caspi, Avshalom; Poulton, Richie; Moffitt, Terrie E; Broadbent, Jonathan M

    2011-10-01

    We investigated age-26 personality characteristics and age-32 oral health in a prospective study of a complete birth cohort born in Dunedin, New Zealand. Personality was measured using the Multidimensional Personality Questionnaire (MPQ). Oral health was measured using the short-form Oral Health Impact Profile (OHIP-14), a global measure, and dental examinations. Personality profiles were constructed for 916 individuals (50.8% men) using standardized MPQ scores, and multivariate analyses examined their association with oral health. Those reporting 1+ OHIP-14 impacts had higher Negative Emotionality scores (and lower Constraint and Positive Emotionality MPQ superfactor scores) than those who did not. After controlling for gender, clinical status, and the other two MPQ superfactors, those scoring higher on Negative Emotionality had a greater risk of reporting 1+ OHIP-14 impacts, as well as 3+ OHIP-14 impacts and worse-than-average oral health. They also had a greater risk of having lost at least one tooth from caries and of having 3+ decayed surfaces. Personality characteristics appear to shape self-reports of oral health. Personality is also a risk factor for clinical disease status, at least with respect to dental caries and its sequelae. Because the attitudes and values tapped into by personality tests can be altered by brief cognitive interventions, those might be useful in preventive dentistry.

  12. Melatonin and Oral Cavity

    PubMed Central

    Cengiz, Murat İnanç; Cengiz, Seda; Wang, Hom-Lay

    2012-01-01

    While initially the oral cavity was considered to be mainly a source of various bacteria, their toxins and antigens, recent studies showed that it may also be a location of oxidative stress and periodontal inflammation. Accordingly, this paper focuses on the involvement of melatonin in oxidative stress diseases of oral cavity as well as on potential therapeutic implications of melatonin in dental disorders. Melatonin has immunomodulatory and antioxidant activities, stimulates the proliferation of collagen and osseous tissue, and acts as a protector against cellular degeneration associated with aging and toxin exposure. Arising out of its antioxidant actions, melatonin protects against inflammatory processes and cellular damage caused by the toxic derivates of oxygen. As a result of these actions, melatonin may be useful as a coadjuvant in the treatment of certain conditions of the oral cavity. However, the most important effect of melatonin seems to result from its potent antioxidant, immunomodulatory, protective, and anticancer properties. Thus, melatonin could be used therapeutically for instance, locally, in the oral cavity damage of mechanical, bacterial, fungal, or viral origin, in postsurgical wounds caused by tooth extractions and other oral surgeries. Additionally, it can help bone formation in various autoimmunological disorders such as Sjorgen syndrome, in periodontal diseases, in toxic effects of dental materials, in dental implants, and in oral cancers. PMID:22792106

  13. A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction

    PubMed Central

    Dugosh, Karen; Abraham, Amanda; Seymour, Brittany; McLoyd, Keli; Chalk, Mady; Festinger, David

    2016-01-01

    Opioid use and overdose rates have risen to epidemic levels in the United States during the past decade. Fortunately, there are effective medications (ie, methadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction. Each of these medications is approved for use in conjunction with psychosocial treatment; however, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. In this systematic review, we outline and discuss the findings of 3 prominent prior reviews and 27 recent publications of empirical studies on this topic. The most widely studied psychosocial interventions examined in conjunction with medications for opioid addiction were contingency management and cognitive behavioral therapy, with the majority focusing on methadone treatment. The results generally support the efficacy of providing psychosocial interventions in combination with medications to treat opioid addictions, although the incremental utility varied across studies, outcomes, medications, and interventions. The review highlights significant gaps in the literature and provides areas for future research. Given the enormity of the current opioid problem in the United States, it is critical to gain a better understanding of the most effective ways to deliver psychosocial treatments in conjunction with these medications to improve the health and well-being of individuals suffering from opioid addiction. PMID:26808307

  14. The Integrated Medical Model

    NASA Technical Reports Server (NTRS)

    Kerstman, Eric; Minard, Charles; Saile, Lynn; Freiere deCarvalho, Mary; Myers, Jerry; Walton, Marlei; Butler, Douglas; Iyengar, Sriram; Johnson-Throop, Kathy; Baumann, David

    2010-01-01

    The goals of the Integrated Medical Model (IMM) are to develop an integrated, quantified, evidence-based decision support tool useful to crew health and mission planners and to help align science, technology, and operational activities intended to optimize crew health, safety, and mission success. Presentation slides address scope and approach, beneficiaries of IMM capabilities, history, risk components, conceptual models, development steps, and the evidence base. Space adaptation syndrome is used to demonstrate the model's capabilities.

  15. Oral care needs, barriers and challenges among elderly in India

    PubMed Central

    Bharti, Ramesh; Chandra, Anil; Tikku, Aseem Prakash; Arya, Deeksha; Gupta, Richa

    2015-01-01

    Objective: This paper presents an approach to the assessment of oral health needs of elderly and barriers to receive oral care in the life course. Background: The dental needs of the elderly are changing and growing day by day. The management of older patients requires not only an understanding of the medical and dental aspects of ageing but also provide them good oral health service. In the life course of elderly there are many hurdles to receive proper oral care. The use of an assessment of oral health need will be essential in the development of care pathways to the elderly. Methods: The proportion of older people is growing faster than that of any other age group. There is no sound database regarding the oral disease burden and treatment needs of the elderly in India. Physical and biological barriers with age can also affect oral health care either directly or indirectly. Conclusion: Oral care guidelines designed to assist elderly should consider not only prevention and treatment modalities but also the means of implementing such therapies in varying settings and utilizing the whole dental team. PMID:26929481

  16. Virtual Alternative to the Oral Examination for Emergency Medicine Residents

    PubMed Central

    McGrath, Jillian; Kman, Nicholas; Danforth, Douglas; Bahner, David P.; Khandelwal, Sorabh; Martin, Daniel R.; Nagel, Rollin; Verbeck, Nicole; Way, David P.; Nelson, Richard

    2015-01-01

    Introduction The oral examination is a traditional method for assessing the developing physician’s medical knowledge, clinical reasoning and interpersonal skills. The typical oral examination is a face-to-face encounter in which examiners quiz examinees on how they would confront a patient case. The advantage of the oral exam is that the examiner can adapt questions to the examinee’s response. The disadvantage is the potential for examiner bias and intimidation. Computer-based virtual simulation technology has been widely used in the gaming industry. We wondered whether virtual simulation could serve as a practical format for delivery of an oral examination. For this project, we compared the attitudes and performance of emergency medicine (EM) residents who took our traditional oral exam to those who took the exam using virtual simulation. Methods EM residents (n=35) were randomized to a traditional oral examination format (n=17) or a simulated virtual examination format (n=18) conducted within an immersive learning environment, Second Life (SL). Proctors scored residents using the American Board of Emergency Medicine oral examination assessment instruments, which included execution of critical actions and ratings on eight competency categories (1–8 scale). Study participants were also surveyed about their oral examination experience. Results We observed no differences between virtual and traditional groups on critical action scores or scores on eight competency categories. However, we noted moderate effect sizes favoring the Second Life group on the clinical competence score. Examinees from both groups thought that their assessment was realistic, fair, objective, and efficient. Examinees from the virtual group reported a preference for the virtual format and felt that the format was less intimidating. Conclusion The virtual simulated oral examination was shown to be a feasible alternative to the traditional oral examination format for assessing EM residents

  17. [Medical errors in obstetrics].

    PubMed

    Marek, Z

    1984-08-01

    Errors in medicine may fall into 3 main categories: 1) medical errors made only by physicians, 2) technical errors made by physicians and other health care specialists, and 3) organizational errors associated with mismanagement of medical facilities. This classification of medical errors, as well as the definition and treatment of them, fully applies to obstetrics. However, the difference between obstetrics and other fields of medicine stems from the fact that an obstetrician usually deals with healthy women. Conversely, professional risk in obstetrics is very high, as errors and malpractice can lead to very serious complications. Observations show that the most frequent obstetrical errors occur in induced abortions, diagnosis of pregnancy, selection of optimal delivery techniques, treatment of hemorrhages, and other complications. Therefore, the obstetrician should be prepared to use intensive care procedures similar to those used for resuscitation.

  18. Exploration Medical System Demonstration

    NASA Technical Reports Server (NTRS)

    Rubin, D. A.; Watkins, S. D.

    2014-01-01

    BACKGROUND: Exploration class missions will present significant new challenges and hazards to the health of the astronauts. Regardless of the intended destination, beyond low Earth orbit a greater degree of crew autonomy will be required to diagnose medical conditions, develop treatment plans, and implement procedures due to limited communications with ground-based personnel. SCOPE: The Exploration Medical System Demonstration (EMSD) project will act as a test bed on the International Space Station (ISS) to demonstrate to crew and ground personnel that an end-to-end medical system can assist clinician and non-clinician crew members in optimizing medical care delivery and data management during an exploration mission. Challenges facing exploration mission medical care include limited resources, inability to evacuate to Earth during many mission phases, and potential rendering of medical care by non-clinicians. This system demonstrates the integration of medical devices and informatics tools for managing evidence and decision making and can be designed to assist crewmembers in nominal, non-emergent situations and in emergent situations when they may be suffering from performance decrements due to environmental, physiological or other factors. PROJECT OBJECTIVES: The objectives of the EMSD project are to: a. Reduce or eliminate the time required of an on-orbit crew and ground personnel to access, transfer, and manipulate medical data. b. Demonstrate that the on-orbit crew has the ability to access medical data/information via an intuitive and crew-friendly solution to aid in the treatment of a medical condition. c. Develop a common data management framework that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all activities pertaining to crew health and life sciences. d. Ensure crew access to medical data during periods of restricted ground communication. e. Develop a common data management framework that

  19. Cardiac Medications

    MedlinePlus

    ... Diovan) What the Medication Does Rather than lowering levels of angiotensin II (as ACE inhibitors do) angiotensin II receptor blockers prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising. Reason for Medication Used to treat or improve ...

  20. Medical photography.

    PubMed

    Brown, S E

    Medical photography and illustration still provides an essential service for the clinician and researcher, despite an ever-increasing remit. This article describes the role of the medical illustration department and may help the hospital practitioner to use this service to the full.

  1. Medication reviews

    PubMed Central

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

    2012-01-01

    Recent years have seen a formalization of medication review by pharmacists in all settings of care. This article describes the different types of medication review provided in primary care in the UK National Health Service (NHS), summarizes the evidence of effectiveness and considers how such reviews might develop in the future. Medication review is, at heart, a diagnostic intervention which aims to identify problems for action by the prescriber, the clinican conducting the review, the patient or all three but can also be regarded as an educational intervention to support patient knowledge and adherence. There is good evidence that medication review improves process outcomes of prescribing including reduced polypharmacy, use of more appropriate medicines formulation and more appropriate choice of medicine. When ‘harder’ outcome measures have been included, such as hospitalizations or mortality in elderly patients, available evidence indicates that whilst interventions could improve knowledge and adherence they did not reduce mortality or hospital admissions with one study showing an increase in hospital admissions. Robust health economic studies of medication reviews remain rare. However a review of cost-effectiveness analyses of medication reviews found no studies in which the cost of the intervention was greater than the benefit. The value of medication reviews is now generally accepted despite lack of robust research evidence consistently demonstrating cost or clinical effectiveness compared with traditional care. Medication reviews can be more effectively deployed in the future by targeting, multi-professional involvement and paying greater attention to medicines which could be safely stopped. PMID:22607195

  2. Oral administration of grass pollen to hay fever patients. An efficacy study in oral hyposensitization.

    PubMed

    Taudorf, E; Laursen, L C; Djurup, R; Kappelgaard, E; Pedersen, C T; Søborg, M; Wilkinson, P; Weeke, B

    1985-07-01

    Oral hyposensitization is still widely used in the treatment of allergic diseases, but controlled studies proving a beneficial effect are lacking. Fifty-eight hay fever patients were admitted to a double-blind placebo efficacy study in oral hyposensitization. An enterosoluble tablet containing timothy whole pollen or placebo was taken daily. Preseasonally, the actively treated patients received 4,315,000 PNU (880,260 AUR) and totally for 6 months 8,915,000 PNU (1,818,660 AUR). Such high doses have never been tried in similar studies. A new principle has been used - "the pollen count interval method" - in the evaluation of symptom and medication score. The study failed to prove any beneficial effect of oral hyposensitization measured by symptom score, medication score, nasal provocation test or skin prick test. There was no change in timothy specific IgE and IgG which could be caused by the treatment. The possibility that oral hyposensitization might be an effective treatment of hay fever in the future is discussed, but it is concluded that the present regimens cannot be recommended.

  3. The epidemiology of oral and oropharyngeal cancer

    PubMed Central

    Wahi, P. N.

    1968-01-01

    Records of the Sarojini Naidu Medical College Hospital, Agra, India, suggested that there was a much higher endemicity of oral and oropharyngeal cancer in Mainpuri district, a rural area about 75 miles (120 km) from Agra City, than there was in Agra district itself. It was decided in 1963 to set up a complete cancer registry in Mainpuri district, based on the Sarojini Naidu Medical College and in association with the WHO International Reference Centre for the Histopathological Nomenclature and Classification of Oropharyngeal Tumours, which would, among other duties, undertake a study of the epidemiology by means of an intensive field-programme in the area. The epidemiological survey was carried out between March 1964 and September 1966. All factors considered to have any relevance to the disease were surveyed and particularly strong correlations were discovered between the prevalence of oral cancer and the use of local tobaccos (adulterated to a greater or lesser extent with various other materials), especially for chewing but also for smoking. There was also some correlation between prevalence of oral cancer and the use of certain alcoholic drinks. A number of other factors, most probably influencing or modifying the use of tobacco and alcohol, were found to be significant also. PMID:5302449

  4. Significance of Ferritin in Recurrent Oral Ulceration

    PubMed Central

    K., Sumathi; B., Shanthi; Palaneeswari M., Subha; Devi A.J., Manjula

    2014-01-01

    Background: Ferritin is the storage form of iron. Hence, the sensitive test which can be used for diagnosing iron deficiency anaemia is estimation of ferritin in serum. One of the causative factors of oral ulceration is nutritional deficiency, which includes iron also. Aim: To study the meaningful association between recurrent oral ulcer and ferritin. Materials and Methods: Fifty oral ulcer cases which were diagnosed clinically in the ENT Department of Sree Balaji Medical College and Hospital and Twenty Five controls were included in this study. Serum ferritin was estimated by doing a particle enhanced turbidimetric immunoassay for both cases and controls. Results: 66% of cases had decreased ferritin values and 34% had normal values, which was significant. Conclusion: From this study, it can be concluded that it is mandatory to screen oral ulcer patients for iron deficiency anaemia by estimating serum ferritin and it is also advisable for the patients to have iron supplementation on regular basis, along with diet rich in iron in addition to vitamins. PMID:24783067

  5. Effect of oral cephalexin in the treatment of BCG lymphadenitis.

    PubMed

    Ayazi, Parviz; Mahyar, Abolfazl; Taremiha, Alireza; Ghorani, Najmeh; Esmailzadehha, Neda

    2014-06-01

    Lymphadenitis and abscess formation are the most common side effects of vaccination with Bacille Calmette Guerin (BCG). The lower the child's age at the time of vaccination, the higher the incidence of BCG lymphadenitis tends to be. Although various therapeutic approaches are in use for the treatment of BCG lymphadenitis, there is no consensus on which of them is optimal. This study aimed to determine whether oral cephalexin treatment hastens recovery from BCG lymphadenitis. The study involved 40 children (24 boys and 16 girls) with BCG lymphadenitis who were referred to Qazvin Children's Hospital, Qazvin University of Medical Sciences between December 2008 and the end of September 2009. The patients were randomly assigned to two groups of 20 patients each (12 boys and 8 girls in each group): group A patients did not receive any treatment and served as controls, and group B patients were treated with 50 mg/kg/day cephalexin syrup, administered in four doses, for 10 days. In all patients, clinical examination was normal, except for lymphadenitis. In all patients, BCG vaccination had been performed at birth, and polymerase chain reaction tests were positive for tuberculous bacilli. The recovery period and requirement of fine needle aspiration did not significantly differ between the two groups (P 0.05). This study showed that treatment with cephalexin does not hasten recovery from BCG lymphadenitis.

  6. Oral health: something to smile about!

    PubMed

    Munro, Cindy L

    2014-07-01

    Oral health is integrally linked to overall well-being. This article describes a research program focused on the contribution of poor oral health to systemic illness. Initial investigations examined factors related to streptococcal virulence that were important in dental caries and endocarditis and led to development of immunization strategies in animal models to reduce risk of endocarditis. Clinical investigations related to critically ill adults began with descriptive and observational studies that established the importance of dental plaque in development of ventilator-associated pneumonia (VAP) and examined existing nursing practices in oral care. Subsequent intervention studies sponsored by the National Institutes of Health (NIH) to test oral care protocols in critically ill adults have built on that foundation. The group's first NIH-funded randomized clinical trial tested the effects of toothbrushing and use of chlorhexidine in reducing risk of VAP in critically ill adults and showed that VAP was reduced by topical application of chlorhexidine initiated after intubation, although toothbrushing did not reduce VAP. The study had a rapid and dramatic effect on clinical practice. Results of the study were published in September 2009 in the American Journal of Critical Care, and in May 2010, the Institute for Health-care Improvement updated the recommendations for the care of patients receiving mechanical ventilation (the ventilator bundle) to include daily oral care with chlorhexidine, referencing the results of that study as evidence for the change. Chlorhexidine is now the standard of care for adults receiving mechanical ventilation. Because the effects of chlorhexidine after intubation were so beneficial, a second recently completed NIH-funded randomized clinical trial investigated the impact of chlorhexidine applied before intubation compared with after intubation. Currently a large randomized clinical trial is being launched to determine the optimal

  7. A US Policy Perspective on Oral Preexposure Prophylaxis for HIV

    PubMed Central

    Parker, Karen Byrnes; Rotheram-Borus, Mary Jane

    2011-01-01

    Orally administered preexposure prophylaxis is an innovative and controversial HIV prevention strategy involving the regular use of antiretroviral medications by uninfected individuals. Antiretroviral medications protect against potential HIV infection by reducing susceptibility to the virus. Recent clinical trial results indicate that preexposure prophylaxis can be safe and efficacious for men who have sexual intercourse with men, yet there remain policy considerations surrounding costs, opportunity costs, and ethical issues that must be addressed before broad implementation in the United States. PMID:21493945

  8. Blogging Medical Students: A Qualitative Analysis

    PubMed Central

    Pinilla, Severin; Weckbach, Ludwig T.; Alig, Stefan K.; Bauer, Helen; Noerenberg, Daniel; Singer, Katharina; Tiedt, Steffen

    2013-01-01

    Purpose: Blogging is an increasingly popular method of sharing and reflecting on experiences of medical students in the World Wide Web with a potentially global learning community. The authors are not aware of studies that specifically examined blogs by medical students and thus for the first time investigated the type of experiences and impressions that emerged from these blogs with relevance for medical students and medical educators. Method: This was a qualitative study. Initially 75 blogs were identified. 33 blogs with a total of 1228 English and 337 German blog entries met the inclusion criteria and were analyzed. We started with line-by-line coding and switched to focused coding using constant comparative analysis to create a categorical framework for blogs. Results: Medical students use blogs to write and reflect about a large variety of issues related to medical school. Major emerging themes included the preparation for written and oral high-stakes exams, experiences during clinical rotations, dealing with distressing situations during medical school, and social life of students beyond medical school. Conclusions: Our findings suggest that blogs are a potentially useful tool for medical students to reflect on their experiences during medical school as well as for medical educators to better understand how students perceive their time in medical school. The educational benefit of blogging might even be increased if trained medical educators would help to facilitate meaningful and targeted discussions emerging from blog entries and comment on students’ learning challenges with the chance to reach a large community of learners. PMID:23467720

  9. Communication among Oral Bacteria

    PubMed Central

    Kolenbrander, Paul E.; Andersen, Roxanna N.; Blehert, David S.; Egland, Paul G.; Foster, Jamie S.; Palmer, Robert J.

    2002-01-01

    Human oral bacteria interact with their environment by attaching to surfaces and establishing mixed-species communities. As each bacterial cell attaches, it forms a new surface to which other cells can adhere. Adherence and community development are spatiotemporal; such order requires communication. The discovery of soluble signals, such as autoinducer-2, that may be exchanged within multispecies communities to convey information between organisms has emerged as a new research direction. Direct-contact signals, such as adhesins and receptors, that elicit changes in gene expression after cell-cell contact and biofilm growth are also an active research area. Considering that the majority of oral bacteria are organized in dense three-dimensional biofilms on teeth, confocal microscopy and fluorescently labeled probes provide valuable approaches for investigating the architecture of these organized communities in situ. Oral biofilms are readily accessible to microbiologists and are excellent model systems for studies of microbial communication. One attractive model system is a saliva-coated flowcell with oral bacterial biofilms growing on saliva as the sole nutrient source; an intergeneric mutualism is discussed. Several oral bacterial species are amenable to genetic manipulation for molecular characterization of communication both among bacteria and between bacteria and the host. A successful search for genes critical for mixed-species community organization will be accomplished only when it is conducted with mixed-species communities. PMID:12209001

  10. Orally administered grass pollen.

    PubMed

    Taudorf, E; Weeke, B

    1983-11-01

    In 1900 it was claimed that oral administration of ragweed could be used for the hyposensitization of hay fever patients. Several uncontrolled trials have been published, all showing an effect of oral hyposensitization. Only one study was controlled and showed no effect of oral hyposensitization. It was decided to undertake controlled clinical trials to determine the safety and effectiveness of orally administered enteric-coated grass pollen tablets in patients with hay fever. The actual grass pollen dose in the first trial was 30 times the dose that is normally recommended for preseasonal oral pollen hyposensitization using pollen aqueous solution or pollen powder. The safety study will be described here. Twelve young adults with a history of grass pollen hay fever positive skin prick test and positive nasal provocation test with extracts of timothy grass pollen were randomly allocated to one of the treatment groups with four patients in each group taking enteric-coated Conjuvac Timothy tablets or enteric-coated Whole Timothy pollen tablets or enteric-coated placebo tablets. The study was double blind. Preseasonally, the patients received 342,500 PNU and in total they received 4,500,000 PNU during 6 months. The patients receiving active treatment did not have any side effects. No significant changes were shown in the skin and nasal reactivity to grass pollen during the study. Neither were there any changes in timothy-specific IgE, IgG, total IgE nor histamine liberation from basophils.

  11. Oral Health Care Needs in the Dependant Elderly in India

    PubMed Central

    Panchbhai, Arati S

    2012-01-01

    There is a sudden blast of the “65 plus” population in the last decade, and India is no exception to that. A continuing progress in the medical field has raised the longevity of life. This changing face of population offers the oral professionals to observe unique challenges to treat the rapidly growing segment of the elderly and the dependant overage population— the Homebound residents and the Nursing homebound residents. The old age of the residents is compounded with chronic medical problems they are suffering from and the medications they are taking. This cohort is characteristically different from other elderly due to their dependency to carry even the routine activities such as tooth cleaning which results in increased risk towards the oral ailments. As very few surveys are done regarding the oral health status among this section, the prevalence of oral and dental problems in them is under a cloud. “Dental care at home or at destinations of residents” is yet a novel concept in India, hence not only there is a need to reach to the residents but also to treat them in the holistic manner. The purpose of this paper is to review the existing oral health conditions in the elderly in India. PMID:22837606

  12. Changes in the Oral Moisture and the Amount of Microorganisms in Saliva and Tongue Coating after Oral Ingestion Resumption: A Pilot Study

    PubMed Central

    Kishimoto, Natsuki; Stegaroiu, Roxana; Shibata, Satoko; Ito, Kayoko; Inoue, Makoto; Ohuchi, Akitsugu

    2016-01-01

    Background and Objective: Tube feeding has been significantly associated with a higher rate of aspiration pneumonia that is mainly related to oral microorganisms and a reduced salivary flow. Thus, the difference in the mode of nutritional intake is expected to affect the oral environment, but this has not yet been fully clarified. The purpose of this study was to investigate, in tube-fed patients, changes in the oral moisture and the counts of microorganisms in saliva and tongue coating, which occur after oral ingestion resumption. Methods: Study participants were 7 tube-fed inpatients of the Niigata University Medical and Dental Hospital (72.7±8.5 years old) who received dysphagia rehabilitation at the Unit of Dysphagia Rehabilitation until oral ingestion resumption. Their oral health, swallowing, and nutrition status, oral mucosal moisture, amount of unstimulated saliva and the counts of microorganisms (total microorganisms, streptococci, Candida) in saliva and tongue coating were investigated and compared before and after the recommencement of oral intake. Results: Tongue coating, choking, oral mucosal moisture and amount of unstimulated saliva were improved significantly after resumption of oral ingestion. The other investigated parameters did not significantly change, except for the streptococci in tongue coating, which significantly increased 1 week after oral ingestion recommencement, but decreased thereafter. Conclusion: After oral intake resumption, oral mucosal moisture and amount of unstimulated saliva were improved. However, because of a transitory increase in the counts of streptococci with oral ingestion recommencement, it is important to appropriately manage oral hygiene in these patients, according to the changes in their intraoral microbiota. PMID:27099636

  13. Direct Oral Anticoagulants: Monitoring Anticoagulant Effect.

    PubMed

    Konkle, Barbara A

    2016-10-01

    In some clinical settings laboratory measurement of direct oral anticoagulants effect is helpful in guiding medical care, such as life-threatening bleeding, need for emergency surgery, renal impairment, severe hepatic failure, extremes of body weight, or in patients with bleeding or thrombosis on therapy. This article reviews approaches to laboratory testing to assess the anticoagulant effect of these drugs. Because of the wide variation in levels measured in patients on therapy and minimal clinical data from dose adjustment, dose adjustment based on levels is not currently advised. In addition, these drugs interfere with many clot-based laboratory tests and caution is advised in interpreting these tests in patients on direct oral anticoagulants. PMID:27637303

  14. [Oral problems in divers].

    PubMed

    Scheper, W A; Lobbezoo, F; Eijkman, M A J

    2005-05-01

    Divers can have several oral problems. Firstly, problems caused by pressure changes. These are barodontalgia and odontocrexis. Barodontalgia is toothache by barotrauma. Odontocrexis is restorations coming lose or breaking or tooth fractures by expansion of air beneath restorations. Other problems can occur by cements used to fix casted restorations, by inflammations in the orofacial region, and by not yet fully healed oral wounds. Secondly, there are problems related to the diver's mouthpiece. To keep the mouthpiece in place, the mandible has to be forced in a forward position. Holding this position often and for long periods of time, may develop or aggravate temporomandibular dysfunction. Insufficient fit of the mouthpiece may induce oral mucosal lesions. Therefore, it is recommended to produce individual diver mouthpieces. It is also recommended to produce individual diver mouthpieces for complete dentures wearing divers and for divers with fixed orthodontic appliances.

  15. Miconazole in oral candidiasis.

    PubMed Central

    Brincker, H

    1977-01-01

    Twenty-four patients were treated with oral miconazole (250 mg) for a total of 35 episodes of oral candidiasis. Sixteen had various forms of leukaemia and all were massively predisposed to fungal infection because of granulocytopenia and treatment with prednisolone and antibiotics. Clinical cure was observed in all 35 of the treated episodes, with a mean treatment time of five days, cure being observed in two to three days. When patients violating the protocol were excluded, the mycological cure rate was 97%. In 21 episodes there was a recurrence less than one month after miconazole treatment, probably because of reinfection. No side-effects ascribable to miconazole were observed, even in the severely debilitated patients, and the orally administered drug appeared to be superior to other commercially available antimycotic preparations. Images p29-a PMID:122644

  16. Exploration Medical System Demonstration Project

    NASA Technical Reports Server (NTRS)

    Chin, D. A.; McGrath, T. L.; Reyna, B.; Watkins, S. D.

    2011-01-01

    A near-Earth Asteroid (NEA) mission will present significant new challenges including hazards to crew health created by exploring a beyond low earth orbit destination, traversing the terrain of asteroid surfaces, and the effects of variable gravity environments. Limited communications with ground-based personnel for diagnosis and consultation of medical events require increased crew autonomy when diagnosing conditions, creating treatment plans, and executing procedures. Scope: The Exploration Medical System Demonstration (EMSD) project will be a test bed on the International Space Station (ISS) to show an end-to-end medical system assisting the Crew Medical Officers (CMO) in optimizing medical care delivery and medical data management during a mission. NEA medical care challenges include resource and resupply constraints limiting the extent to which medical conditions can be treated, inability to evacuate to Earth during many mission phases, and rendering of medical care by a non-clinician. The system demonstrates the integration of medical technologies and medical informatics tools for managing evidence and decision making. Project Objectives: The objectives of the EMSD project are to: a) Reduce and possibly eliminate the time required for a crewmember and ground personnel to manage medical data from one application to another. b) Demonstrate crewmember's ability to access medical data/information via a software solution to assist/aid in the treatment of a medical condition. c) Develop a common data management architecture that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all crew health and life sciences activities. d) Develop a common data management architecture that allows for scalability, extensibility, and interoperability of data sources and data users. e) Lower total cost of ownership for development and sustainment of peripheral hardware and software that use EMSD for data management f) Provide

  17. The human oral microbiome.

    PubMed

    Dewhirst, Floyd E; Chen, Tuste; Izard, Jacques; Paster, Bruce J; Tanner, Anne C R; Yu, Wen-Han; Lakshmanan, Abirami; Wade, William G

    2010-10-01

    The human oral cavity contains a number of different habitats, including the teeth, gingival sulcus, tongue, cheeks, hard and soft palates, and tonsils, which are colonized by bacteria. The oral microbiome is comprised of over 600 prevalent taxa at the species level, with distinct subsets predominating at different habitats. The oral microbiome has been extensively characterized by cultivation and culture-independent molecular methods such as 16S rRNA cloning. Unfortunately, the vast majority of unnamed oral taxa are referenced by clone numbers or 16S rRNA GenBank accession numbers, often without taxonomic anchors. The first aim of this research was to collect 16S rRNA gene sequences into a curated phylogeny-based database, the Human Oral Microbiome Database (HOMD), and make it web accessible (www.homd.org). The HOMD includes 619 taxa in 13 phyla, as follows: Actinobacteria, Bacteroidetes, Chlamydiae, Chloroflexi, Euryarchaeota, Firmicutes, Fusobacteria, Proteobacteria, Spirochaetes, SR1, Synergistetes, Tenericutes, and TM7. The second aim was to analyze 36,043 16S rRNA gene clones isolated from studies of the oral microbiota to determine the relative abundance of taxa and identify novel candidate taxa. The analysis identified 1,179 taxa, of which 24% were named, 8% were cultivated but unnamed, and 68% were uncultivated phylotypes. Upon validation, 434 novel, nonsingleton taxa will be added to the HOMD. The number of taxa needed to account for 90%, 95%, or 99% of the clones examined is 259, 413, and 875, respectively. The HOMD is the first curated description of a human-associated microbiome and provides tools for use in understanding the role of the microbiome in health and disease.

  18. Oral therapy for Peyronie’s disease, does it work?

    PubMed Central

    Barrett-Harlow, Brittani

    2016-01-01

    Peyronie’s disease (PD) is a localized, wound-healing, connective tissue disorder of the penis characterized by scarring of the tunica albuginea. This fibrous inelastic scar leads to penile pain, penile deformity and erectile dysfunction (ED), and a difficulty performing coitus. Over the past several decades, a myriad of oral agents for the treatment of PD have been studied and suggested. While the gold standard of care remains surgical therapy, many physicians continue to prescribe oral and intralesional injections for treatment during the acute phase of the disease. This article seeks to summarize the different oral therapy agents for PD and the research associated with each medication. While the American Urological Association has not recommended most of the mentioned medications for the treatment of PD, two newer therapies have shown success and have the potential of becoming baseline treatments for the acute phase of PD. PMID:27298776

  19. Transition from Tube to Oral Feeding in the School Setting

    ERIC Educational Resources Information Center

    McKirdy, Laura S.; Sheppard, Justine J.; Osborne, Mary L.; Payne, Pamela

    2008-01-01

    Purpose: A school-based treatment program for tube-fed children with medically complex conditions and food refusal was implemented to facilitate the children's transition to oral feeding and advance their eating skills. Method: The program combined educational and therapeutic goals. It was implemented in a regional public school for children with…

  20. The Oral Cancer Epidemic.

    PubMed

    Bregman, Jonathan A

    2016-01-01

    The incidence of oral cancer is increasing every year. The issues that this epidemic brings are as wide ranging as changes in patient/community education, dental practice systems/ protocols, risk management and investigating new technologies for enhanced detection. The dentist, along with the entire dental team, must continually make every effort to save lives through early detection along with educating patients and our communities about the risk factors for oral cancer. With everyone's efforts, we can stop the growth of this terrible epidemic. PMID:27220177