Semi-Supervised Approach to Monitoring Clinical Depressive Symptoms in Social Media

PubMed Central

Yazdavar, Amir Hossein; Al-Olimat, Hussein S.; Ebrahimi, Monireh; Bajaj, Goonmeet; Banerjee, Tanvi; Thirunarayan, Krishnaprasad; Pathak, Jyotishman; Sheth, Amit

2017-01-01

With the rise of social media, millions of people are routinely expressing their moods, feelings, and daily struggles with mental health issues on social media platforms like Twitter. Unlike traditional observational cohort studies conducted through questionnaires and self-reported surveys, we explore the reliable detection of clinical depression from tweets obtained unobtrusively. Based on the analysis of tweets crawled from users with self-reported depressive symptoms in their Twitter profiles, we demonstrate the potential for detecting clinical depression symptoms which emulate the PHQ-9 questionnaire clinicians use today. Our study uses a semi-supervised statistical model to evaluate how the duration of these symptoms and their expression on Twitter (in terms of word usage patterns and topical preferences) align with the medical findings reported via the PHQ-9. Our proactive and automatic screening tool is able to identify clinical depressive symptoms with an accuracy of 68% and precision of 72%. PMID:29707701

Clinical diagnosis and typing of systemic amyloidosis in subcutaneous fat aspirates by mass spectrometry-based proteomics

PubMed Central

Vrana, Julie A.; Theis, Jason D.; Dasari, Surendra; Mereuta, Oana M.; Dispenzieri, Angela; Zeldenrust, Steven R.; Gertz, Morie A.; Kurtin, Paul J.; Grogg, Karen L.; Dogan, Ahmet

2014-01-01

Examination of abdominal subcutaneous fat aspirates is a practical, sensitive and specific method for the diagnosis of systemic amyloidosis. Here we describe the development and implementation of a clinical assay using mass spectrometry-based proteomics to type amyloidosis in subcutaneous fat aspirates. First, we validated the assay comparing amyloid-positive (n=43) and -negative (n=26) subcutaneous fat aspirates. The assay classified amyloidosis with 88% sensitivity and 96% specificity. We then implemented the assay as a clinical test, and analyzed 366 amyloid-positive subcutaneous fat aspirates in a 4-year period as part of routine clinical care. The assay had a sensitivity of 90%, and diverse amyloid types, including immunoglobulin light chain (74%), transthyretin (13%), serum amyloid A (%1), gelsolin (1%), and lysozyme (1%), were identified. Using bioinformatics, we identified a universal amyloid proteome signature, which has high sensitivity and specificity for amyloidosis similar to that of Congo red staining. We curated proteome databases which included variant proteins associated with systemic amyloidosis, and identified clonotypic immunoglobulin variable gene usage in immunoglobulin light chain amyloidosis, and the variant peptides in hereditary transthyretin amyloidosis. In conclusion, mass spectrometry-based proteomic analysis of subcutaneous fat aspirates offers a powerful tool for the diagnosis and typing of systemic amyloidosis. The assay reveals the underlying pathogenesis by identifying variable gene usage in immunoglobulin light chains and the variant peptides in hereditary amyloidosis. PMID:24747948

Design requirements for ubiquitous computing environments for healthcare professionals.

PubMed

Bång, Magnus; Larsson, Anders; Eriksson, Henrik

2004-01-01

Ubiquitous computing environments can support clinical administrative routines in new ways. The aim of such computing approaches is to enhance routine physical work, thus it is important to identify specific design requirements. We studied healthcare professionals in an emergency room and developed the computer-augmented environment NOSTOS to support teamwork in that setting. NOSTOS uses digital pens and paper-based media as the primary input interface for data capture and as a means of controlling the system. NOSTOS also includes a digital desk, walk-up displays, and sensor technology that allow the system to track documents and activities in the workplace. We propose a set of requirements and discuss the value of tangible user interfaces for healthcare personnel. Our results suggest that the key requirements are flexibility in terms of system usage and seamless integration between digital and physical components. We also discuss how ubiquitous computing approaches like NOSTOS can be beneficial in the medical workplace.

A comparison of families of children with autism spectrum disorders in family daily routines, service usage, and stress levels by regionality.

PubMed

McAuliffe, Tomomi; Vaz, Sharmila; Falkmer, Torbjörn; Cordier, Reinie

2017-11-01

To explore whether family routines, service usage, and stress levels in families of children with autism spectrum disorder differ as a function of regionality. Secondary analysis of data was undertaken from 535 surveys. Univariate and multivariate analyses were performed to investigate differences between families living in densely populated (DP) areas and less densely populated (LDP) areas. Families living in LDP areas were found to: (1) have reduced employment hours (a two-parent household: Exp (B) = 3.48, p < .001, a single-parent household: Exp (B) = 3.32, p = .011); (2) travel greater distance to access medical facilities (Exp (B) = 1.27, p = .006); and (3) report less severe stress levels (Exp (B) = 0.22, p = .014). There were no differences in family routines; however, flexible employment opportunities and travel distance to medical services need to be considered in families living in LDP areas.

Internet-delivered treatment for older adults with anxiety and depression: implementation of the Wellbeing Plus Course in routine clinical care and comparison with research trial outcomes

PubMed Central

Staples, Lauren G.; Fogliati, Vincent J.; Dear, Blake F.; Nielssen, Olav

2016-01-01

Background The Wellbeing Plus Course is an internet-delivered psychological intervention for older adults with anxiety or depression. Aims To compare the effectiveness of the Wellbeing Plus Course in a public health setting (clinic group) with its efficacy in a randomised controlled trial (research group). Method Participants (n=949) were Australian adults aged 60 and above. Primary outcome measures were the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7). Results Initial symptom severity was higher in the clinic group and course completion was lower. Both groups showed significant symptom reductions at post-treatment and were satisfied with the treatment. Results were maintained at 3-month follow-up. Within-group symptom changes were comparable between settings; there were no between-group differences on primary outcomes or satisfaction. Conclusions The Wellbeing Plus Course is as effective and acceptable in routine clinical care, as it is in controlled research trials. Declaration of interest N.T. and B.F.D developed the Wellbeing Plus Course but derived no financial benefit from it. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:27703794

The CMC/3DPNS computer program for prediction of three-dimensional, subsonic, turbulent aerodynamic juncture region flow. Volume 3: Programmers' manual

NASA Technical Reports Server (NTRS)

Orzechowski, J. A.

1982-01-01

The CMC fluid mechanics program system was developed to transmit the theoretical evolution of finite element numerical solution methodology, applied to nonlinear field problems into a versatile computer code for comprehensive flow field analysis. A detailed view of the code from the standpoint of a computer programmer's use is presented. A system macroflow chart and detailed flow charts of several routines necessary to interact with a theoretican/user to modify the operation of this program are presented. All subroutines and details of usage, primarily for input and output routines are described. Integer and real scalars and a cross reference list denoting subroutine usage for these scalars are outlined. Entry points in dynamic storage vector IZ; the lengths of each vector accompanying the scalar definitions are described. A listing of the routines peculiar to the standard test case and a listing of the input deck and printout for this case are included.

Evaluation of the Turkish translation of the Minimal Standard Terminology for Digestive Endoscopy by development of an endoscopic information system.

PubMed

Atalağ, Koray; Bilgen, Semih; Gür, Gürden; Boyacioğlu, Sedat

2007-09-01

There are very few evaluation studies for the Minimal Standard Terminology for Digestive Endoscopy. This study aims to evaluate the usage of the Turkish translation of Minimal Standard Terminology by developing an endoscopic information system. After elicitation of requirements, database modeling and software development were performed. Minimal Standard Terminology driven forms were designed for rapid data entry. The endoscopic report was rapidly created by applying basic Turkish syntax and grammar rules. Entering free text and also editing of final report were possible. After three years of live usage, data analysis was performed and results were evaluated. The system has been used for reporting of all endoscopic examinations. 15,638 valid records were analyzed, including 11,381 esophagogastroduodenoscopies, 2,616 colonoscopies, 1,079 rectoscopies and 562 endoscopic retrograde cholangiopancreatographies. In accordance with other previous validation studies, the overall usage of Minimal Standard Terminology terms was very high: 85% for examination characteristics, 94% for endoscopic findings and 94% for endoscopic diagnoses. Some new terms, attributes and allowed values were also added for better clinical coverage. Minimal Standard Terminology has been shown to cover a high proportion of routine endoscopy reports. Good user acceptance proves that both the terms and structure of Minimal Standard Terminology were consistent with usual clinical thinking. However, future work on Minimal Standard Terminology is mandatory for better coverage of endoscopic retrograde cholangiopancreatographies examinations. Technically new software development methodologies have to be sought for lowering cost of development and the maintenance phase. They should also address integration and interoperability of disparate information systems.

Effect of routine mental health screening in a low-resource pediatric primary care population.

PubMed

Berger-Jenkins, Evelyn; McCord, Mary; Gallagher, Trish; Olfson, Mark

2012-04-01

Despite evidence for its feasibility, the usage of mental health screening in primary care practices with overburdened providers and few referral options remains unclear. This study explores the effects of routine screening on mental health problem identification and management in a low-resource setting. Medical records of 5 to 12 year-old children presenting for well visits before and after screening was implemented were reviewed. Multivariate logistic regression was used to explore associations between study period and identification/management practices. Changes in the number of visits and wait times for a co-located referral service were assessed post hoc. Parents disclosed more mental health problems, and providers initiated more workups but referred fewer patients after screening was implemented. The proportion of new visits and wait times for the referral service did not change. Even in low-resource settings, screening may facilitate parental disclosure and increase clinical attention to mental health problems without overburdening referral services.

Knee arthroscopy routines and practice.

PubMed

Brattwall, M; Jacobson, E; Forssblad, M; Jakobsson, J

2010-12-01

Knee arthroscopy is one of most commonly performed day-case orthopaedic procedures, thus consuming huge medical resources. The aim of the present questionnaire survey was to study knee arthroscopy routines and practice. An electronic web-based survey including questions around pre-, per- and postoperative routines for elective knee arthroscopy was send to all orthopaedic units associated to the Swedish Arthroscopic Society (n = 60). Responses covering 37 centres out of 60 (response rate 62%) were returned. Preoperative radiograph routines varied considerable between centres; conventional radiograph varied between 5 and 100% and preoperative MRI between 5 and 80% of patients. General anaesthesia was the preferred intra-operative technique used in all centres (median 79% of patients), local anaesthesia with or without light sedation was used in all 28 out of the 37 centres responding (median 10% of cases) and spinal anaesthesia was used in 15 centres (median 5% of cases). Intra-articular local anaesthesia was provided in all but one of centres. Perioperative administration of oral NSAIDs was common (31 out 37), 6 centres (all teaching hospitals) did not routinely give pre- or postoperative NSAID. Analgesic prescription was provided on a regular base in 18 (49%) of centres; an NSAID being the most commonly prescribed. All but one centre provided written information and instruction at discharge. Referral to physiotherapy, prescribed sick leave and scheduled follow-up in the outpatient clinic diverged considerably. Routines and practice associated to elective knee arthroscopy differed; however, no clear differences in practice were seen between teaching centres, general or local hospitals apart from a lower usage of NSAID for perioperative analgesia. There is an obvious room for further standardisation in the routine handling of patients undergoing elective arthroscopy of the knee.

Phthalates impact human health: Epidemiological evidences and plausible mechanism of action.

PubMed

Benjamin, Sailas; Masai, Eiji; Kamimura, Naofumi; Takahashi, Kenji; Anderson, Robin C; Faisal, Panichikkal Abdul

2017-10-15

Disregarding the rising alarm on the hazardous nature of various phthalates and their metabolites, ruthless usage of phthalates as plasticizer in plastics and as additives in innumerable consumer products continues due low their cost, attractive properties, and lack of suitable alternatives. Globally, in silico computational, in vitro mechanistic, in vivo preclinical and limited clinical or epidemiological human studies showed that over a dozen phthalates and their metabolites ingested passively by man from the general environment, foods, drinks, breathing air, and routine household products cause various dysfunctions. Thus, this review addresses the health hazards posed by phthalates on children and adolescents, epigenetic modulation, reproductive toxicity in women and men; insulin resistance and type II diabetes; overweight and obesity, skeletal anomalies, allergy and asthma, cancer, etc., coupled with the description of major phthalates and their general uses, phthalate exposure routes, biomonitoring and risk assessment, special account on endocrine disruption; and finally, a plausible molecular cross-talk with a unique mechanism of action. This clinically focused comprehensive review on the hazards of phthalates would benefit the general population, academia, scientists, clinicians, environmentalists, and law or policy makers to decide upon whether usage of phthalates to be continued swiftly without sufficient deceleration or regulated by law or to be phased out from earth forever. Copyright © 2017. Published by Elsevier B.V.

Use Contexts and Usage Patterns of Interactive Case Simulation Tools by HIV Healthcare Providers in a Statewide Online Clinical Education Program.

PubMed

Wang, Dongwen

2017-01-01

We analyzed four interactive case simulation tools (ICSTs) from a statewide online clinical education program. Results have shown that ICSTs are increasingly used by HIV healthcare providers. Smart phone has become the primary usage platform for specific ICSTs. Usage patterns depend on particular ICST modules, usage stages, and use contexts. Future design of ICSTs should consider these usage patterns for more effective dissemination of clinical evidence to healthcare providers.

Complementary and alternative medicines use among pediatric patients with epilepsy in a multiethnic community.

PubMed

Chen, Chunliang; Chong, Ying Jie; Hie, Szu Liang; Sultana, Rehena; Lee, Sze Huay Dorothy; Chan, Wei Shih Derrick; Chan, Sui Yung; Cheong, Han Hui

2016-07-01

Prior studies highlighted that patients on chronic medications who used complementary and alternative medicines (CAMs) did not share this information with their healthcare providers. Furthermore, there might be potential adverse interactions between CAMs and antiepileptic drug (AED) therapy. However, there are no studies that investigate the effect of religion or race on CAM use in a multiethnic community. Therefore, we aimed to investigate CAM usage among pediatric patients with epilepsy (PPE) and identify predictors of CAM usage in our multiethnic setting. This was a cross-sectional study where caregivers of recruited at an outpatient epilepsy clinic between September 2013 and July 2014 completed a self-administered survey. Those who declined participation, lacked understanding of English or Mandarin, or missed the clinic appointments were excluded. Those caring for more than one patient participated only once. Of the 195 surveys collected, 178 were used for analysis. The PPE used an average of 1.50 AEDs (range: 0-4). Forty-nine (27.5%) caregivers reported giving CAMs to their PPE. Commonly used CAMs were multivitamins (44.4%), traditional herbs (42.2%), and acupuncture (17.4%). Multivitamins were mostly given by Christian/Catholic caregivers while Buddhist caregivers mostly gave traditional herbs or acupuncture. The majority of the CAM users were Chinese. Univariate analysis showed that caregivers with secondary school (high school) education were 3.52 times more likely to use CAMs compared to those with primary school (elementary school) education. While some caregivers gave CAMs to their PPE, they had various misconceptions and did not discuss the usage with their healthcare providers. We propose that the predictors identified in this study can help to identify potential CAM users. Healthcare providers should routinely probe about the usage of CAMs by PPE, and thereafter, the suitability of CAM use could be evaluated. The caregivers will benefit from open discussion with healthcare professionals on the safe use of AEDs with or without CAMs. Copyright © 2016 Elsevier Inc. All rights reserved.

Series: Pragmatic trials and real world evidence: Paper 8. Data collection and management.

PubMed

Meinecke, Anna-Katharina; Welsing, Paco; Kafatos, George; Burke, Des; Trelle, Sven; Kubin, Maria; Nachbaur, Gaelle; Egger, Matthias; Zuidgeest, Mira

2017-11-01

Pragmatic trials can improve our understanding of how treatments will perform in routine practice. In a series of eight papers, the GetReal Consortium has evaluated the challenges in designing and conducting pragmatic trials and their specific methodological, operational, regulatory, and ethical implications. The present final paper of the series discusses the operational and methodological challenges of data collection in pragmatic trials. A more pragmatic data collection needs to balance the delivery of highly accurate and complete data with minimizing the level of interference that data entry and verification induce with clinical practice. Furthermore, it should allow for the involvement of a representative sample of practices, physicians, and patients who prescribe/receive treatment in routine care. This paper discusses challenges that are related to the different methods of data collection and presents potential solutions where possible. No one-size-fits-all recommendation can be given for the collection of data in pragmatic trials, although in general the application of existing routinely used data-collection systems and processes seems to best suit the pragmatic approach. However, data access and privacy, the time points of data collection, the level of detail in the data, and the lack of a clear understanding of the data-collection process were identified as main challenges for the usage of routinely collected data in pragmatic trials. A first step should be to determine to what extent existing health care databases provide the necessary study data and can accommodate data collection and management. When more elaborate or detailed data collection or more structured follow-up is required, data collection in a pragmatic trial will have to be tailor-made, often using a hybrid approach using a dedicated electronic case report form (eCRF). In this case, the eCRF should be kept as simple as possible to reduce the burden for practitioners and minimize influence on routine clinical practice. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

[Computer usage among primary health care physicians in the Vukovar-Srijem County].

PubMed

Iveković, Hrvoje

2002-01-01

A survey was carried out, aiming at identification of the current usage of computers among primary health care physicians of the Vukovar-Srijem County. The results indicated poor knowledge and practice concerning the computer usage among examinees: 58% of the responders are not aware of the possibilities of computer usage in a GP office and 82% have not had an opportunity to see the software specialised for usage at GP offices. The results obtained from this survey indicate that none of the examinees use computer during daily routine work at the GP office. Only 26% of the examinees have got a computer, and use it at home, mostly for text processing. The Internet is used actively by 8% of examinees. Lack of education and equipment have been identified as main obstacles in the process of introducing computers to GP offices. Positive attitude towards computer usage has been identified, representing an important stimulus towards a more active role of the health centres management in solving this problem.

Wearable sensor-based objective assessment of motor symptoms in Parkinson's disease.

PubMed

Ossig, Christiana; Antonini, Angelo; Buhmann, Carsten; Classen, Joseph; Csoti, Ilona; Falkenburger, Björn; Schwarz, Michael; Winkler, Jürgen; Storch, Alexander

2016-01-01

Effective management and development of new treatment strategies of motor symptoms in Parkinson's disease (PD) largely depend on clinical rating instruments like the Unified PD rating scale (UPDRS) and the modified abnormal involuntary movement scale (mAIMS). Regarding inter-rater variability and continuous monitoring, clinical rating scales have various limitations. Patient-administered questionnaires such as the PD home diary to assess motor stages and fluctuations in late-stage PD are frequently used in clinical routine and as clinical trial endpoints, but diary/questionnaire are tiring, and recall bias impacts on data quality, particularly in patients with cognitive dysfunction or depression. Consequently, there is a strong need for continuous and objective monitoring of motor symptoms in PD for improving therapeutic regimen and for usage in clinical trials. Recent advances in battery technology, movement sensors such as gyroscopes, accelerometers and information technology boosted the field of objective measurement of movement in everyday life and medicine using wearable sensors allowing continuous (long-term) monitoring. This systematic review summarizes the current wearable sensor-based devices to objectively assess the various motor symptoms of PD.

New approaches to spatially analyse primary health care usage patterns in rural South Africa.

PubMed

Tanser, F; Hosegood, V; Benzler, J; Solarsh, G

2001-10-01

To develop indices to quantitatively assess and understand the spatial usage patterns of health facilities in the Hlabisa district of South Africa. We mapped and interviewed more than 23 000 homesteads (approximately 200 000 people) in Hlabisa district, South Africa and spatially analysed their modal primary health usage patterns using a geographical information system. We generated contour maps of health service use and quantified the relationship between clinic catchments and distance-defined catchments using inclusion and exclusion error. We propose the distance usage index (DUI) as an overall spatial measure of clinic usage. This index is the sum of the distances from clinic to all client homesteads divided by the sum of the distances from clinic to all homesteads within its distance-defined catchment. The index encompasses inclusion, exclusion, and strength of patient attraction for each clinic. Eighty-seven per cent of homesteads use the nearest clinic. Residents of homesteads travel an average Euclidean distance of 4.72 km to attend clinics. There is a significant logarithmic relationship between distance from clinic and their use by homesteads (r(2)=0.774, P < 0.0001). The DUI values range between 31 and 198% (mean=110%, SD=43.7) for 12 clinics and highlight clinic usage patterns across the district. The DUI is a powerful and informative composite measure of clinic usage. The results of the study have important implications for health care provision in developing countries.

A pilot study investigating the feasibility of symptom assessment manager (SAM), a Web-based real-time tool for monitoring challenging behaviors.

PubMed

Loi, Samantha M; Wanasinghage, Sangeeth; Goh, Anita; Lautenschlager, Nicola T; Darby, David G; Velakoulis, Dennis

2018-04-01

Improving and minimizing challenging behaviors seen in psychiatric conditions, including behavioral and psychological symptoms of dementia are important in the care of people with these conditions. Yet there is a lack of systematic evaluation of these as a part of routine clinical care. The Neuropsychiatric Inventory is a validated and reliable tool for rating the severity and disruptiveness of challenging behaviors. We report on the evaluation of a Web-based symptom assessment manager (SAM), designed to address the limitation of previous tools using some of the Neuropsychiatric Inventory functions, to monitor behaviors by staff caring for people with dementia and other psychiatric conditions in inpatient and residential care settings. The SAM was piloted in an 8-bed inpatient neuropsychiatry unit over 5 months. Eleven nurses and 4 clinicians were trained in usage of SAM. Primary outcomes were usage of SAM and perceived usability, utility, and acceptance of SAM. Secondary outcomes were the frequencies of documented behavior. Usage data were analyzed using chi-square and logistic regression analyses. The SAM was used for all admitted patients regardless of diagnosis, with a usage rate of 64% for nurses regularly employed in the unit. Staff provided positive feedback regarding the utility of SAM. The SAM appeared to offer individualized behavior assessment by providing a quick, structured, and standardized platform for assessing behavior in a real-world setting. Further research would involve trialing SAM with more staff in alternative settings such as in home or residential care settings. Copyright © 2017 John Wiley & Sons, Ltd.

Decision support systems for clinical radiological practice — towards the next generation

PubMed Central

Stivaros, S M; Gledson, A; Nenadic, G; Zeng, X-J; Keane, J; Jackson, A

2010-01-01

The huge amount of information that needs to be assimilated in order to keep pace with the continued advances in modern medical practice can form an insurmountable obstacle to the individual clinician. Within radiology, the recent development of quantitative imaging techniques, such as perfusion imaging, and the development of imaging-based biomarkers in modern therapeutic assessment has highlighted the need for computer systems to provide the radiological community with support for academic as well as clinical/translational applications. This article provides an overview of the underlying design and functionality of radiological decision support systems with examples tracing the development and evolution of such systems over the past 40 years. More importantly, we discuss the specific design, performance and usage characteristics that previous systems have highlighted as being necessary for clinical uptake and routine use. Additionally, we have identified particular failings in our current methodologies for data dissemination within the medical domain that must be overcome if the next generation of decision support systems is to be implemented successfully. PMID:20965900

MRI or not to MRI! Should brain MRI be a routine investigation in children with autistic spectrum disorders?

PubMed

Zeglam, Adel M; Al-Ogab, Marwa F; Al-Shaftery, Thouraya

2015-09-01

To evaluate the routine usage of Magnetic Resonance Imaging (MRI) of brain and estimate the prevalence of brain abnormalities in children presenting to the Neurodevelopment Clinic of Al-Khadra Hospital (NDC-KH), Tripoli, Libya with autistic spectrum disorders (ASD). The records of all children with ASD presented to NDC-KH over 4-year period (from January 2009 to December 2012) were reviewed. All MRIs were acquired with a 1.5-T Philips (3-D T1, T2, FLAIR coronal and axial sequences). MRIs were reported to be normal, abnormal or no significant abnormalities by a consultant neuroradiologist. One thousand and seventy-five children were included in the study. Seven hundred and eighty-two children (72.7 %) had an MRI brain of whom 555 (71 %) were boys. 26 children (24 males and 2 females) (3.3 %) demonstrated MRI abnormalities (8 leukodystrophic changes, 4 periventricular leukomalacia, 3 brain atrophy, 2 tuberous sclerosis, 2 vascular changes, 1 pineoblastoma, 1 cerebellar angioma, 1 cerebellar hypoplasia, 3 agenesis of corpus callosum, 1 neuro-epithelial cyst). An unexpectedly high rate of MRI abnormalities was found in the first large series of clinical MRI investigations in children with autism. These results could contribute to further research into the pathogenesis of autistic spectrum disorder.

Design of the e-Vita diabetes mellitus study: effects and use of an interactive online care platform in patients with type 2 diabetes (e-VitaDM-1/ZODIAC-40)

PubMed Central

2014-01-01

Background Due to ongoing rise in need for care for people with chronic diseases and lagging increase in number of care providers, alternative forms of care provision and self-management support are needed. Empowering patients through an online care platform could help to improve patients’ self-management and reduce the burden on the healthcare system. Methods Access to laboratory results and educational modules on diabetes will be offered through a platform for subjects with type 2 diabetes mellitus treated in primary care. Differences in socio-demographic and clinical characteristics between subjects expressing interest vs. disinterest to use the platform will be explored. Platform usage will be tracked and compared. Patient satisfaction and quality of life will be measured by validated questionnaires and economic analyses will be performed. Discussion This study is designed to assess the feasibility of use of an online platform in routine primary healthcare for subjects with type 2 diabetes mellitus in the Netherlands, and to study effects of use of the platform on treatment satisfaction, quality of life and clinical parameters. Although providing access to a online platform is not a novel intervention, usage and effects have not yet been studied in this patient population. Trial registration Trial registration: NCT01570140. PMID:24593656

A model for planning local contraceptive services.

PubMed

Wilson, S

1989-09-01

Data were collected on abortion referral rates, single young maternity rates and uptake of contraceptive services in order to identify specific areas of unmet need in the Nottingham Health District. Comparisons were made between boroughs and in the City of Nottingham between electoral wards. There was a direct relationship between abortion rate, single young maternity rate and social disadvantage. Analysis of contraceptive usage suggested a more ineffective service in the inner city, which has implications for the more efficient use of resources in the future. Targeting of consumer acceptable services to residents of the inner city and teenagers in general was recommended as a result of the study. For future planning a more useful routine data set was developed to record the activity at family planning clinics.

Technical aspects and limitations of fractional flow reserve measurement.

PubMed

Jerabek, Stepan; Kovarnik, Tomas

2018-02-27

The only indication for coronary revascularization is elimination of ischaemia. Invasive hemodynamic methods (fractional flow reserve - FFR and instantaneous wave-free ratio (iFR) are superior to coronary angiography in detection of lesions causing myocardial ischaemia. Current European guidelines for myocardial revascularization recommend using of FFR for detection of functional assessment of lesions severity in category IA and number of these procedures increases. However, routine usage of these methods requires knowledge of technical requirements and limitations. The aim of the study is to summarise good clinical practice for FFR and iFR measurements with explanation of possible technical challenges, that are necessary for increasing of measurement accuracy. Authors describe frequent technical mistakes and malpractice during invasive assessment of lesion severity in coronary arteries.

A parameter estimation subroutine package

NASA Technical Reports Server (NTRS)

Bierman, G. J.; Nead, M. W.

1978-01-01

Linear least squares estimation and regression analyses continue to play a major role in orbit determination and related areas. In this report we document a library of FORTRAN subroutines that have been developed to facilitate analyses of a variety of estimation problems. Our purpose is to present an easy to use, multi-purpose set of algorithms that are reasonably efficient and which use a minimal amount of computer storage. Subroutine inputs, outputs, usage and listings are given along with examples of how these routines can be used. The following outline indicates the scope of this report: Section (1) introduction with reference to background material; Section (2) examples and applications; Section (3) subroutine directory summary; Section (4) the subroutine directory user description with input, output, and usage explained; and Section (5) subroutine FORTRAN listings. The routines are compact and efficient and are far superior to the normal equation and Kalman filter data processing algorithms that are often used for least squares analyses.

Immobilization of gold nanoparticles on cell culture surfaces for safe and enhanced gold nanoparticle-mediated laser transfection.

PubMed

Kalies, Stefan; Heinemann, Dag; Schomaker, Markus; Gentemann, Lara; Meyer, Heiko; Ripken, Tammo

2014-01-01

In comparison to standard transfection methods, gold nanoparticle-mediated laser transfection has proven to be a versatile alternative. This is based on its minor influence on cell viability and its high efficiency, especially for the delivery of small molecules like small interfering RNA. However, in order to transfer it to routine usage, a safety aspect is of major concern: The avoidance of nanoparticle uptake by the cells is desired. The immobilization of the gold nanoparticles on cell culture surfaces can address this issue. In this study, we achieved this by silanization of the appropriate surfaces and the binding of gold nanoparticles to them. Comparable perforation efficiencies to the previous approaches of gold nanoparticle-mediated laser transfection with free gold nanoparticles are demonstrated. The uptake of the immobilized particles by the cells is unlikely. Consequently, these investigations offer the possibility of bringing gold nanoparticle-mediated laser transfection closer to routine usage.

A European inventory of common electronic health record data elements for clinical trial feasibility

PubMed Central

2014-01-01

Background Clinical studies are a necessity for new medications and therapies. Many studies, however, struggle to meet their recruitment numbers in time or have problems in meeting them at all. With increasing numbers of electronic health records (EHRs) in hospitals, huge databanks emerge that could be utilized to support research. The Innovative Medicine Initiative (IMI) funded project ‘Electronic Health Records for Clinical Research’ (EHR4CR) created a standardized and homogenous inventory of data elements to support research by utilizing EHRs. Our aim was to develop a Data Inventory that contains elements required for site feasibility analysis. Methods The Data Inventory was created in an iterative, consensus driven approach, by a group of up to 30 people consisting of pharmaceutical experts and informatics specialists. An initial list was subsequently expanded by data elements of simplified eligibility criteria from clinical trial protocols. Each element was manually reviewed by pharmaceutical experts and standard definitions were identified and added. To verify their availability, data exports of the source systems at eleven university hospitals throughout Europe were conducted and evaluated. Results The Data Inventory consists of 75 data elements that, on the one hand are frequently used in clinical studies, and on the other hand are available in European EHR systems. Rankings of data elements were created from the results of the data exports. In addition a sub-list was created with 21 data elements that were separated from the Data Inventory because of their low usage in routine documentation. Conclusion The data elements in the Data Inventory were identified with the knowledge of domain experts from pharmaceutical companies. Currently, not all information that is frequently used in site feasibility is documented in routine patient care. PMID:24410735

Selective upper airway stimulation for obstructive sleep apnea: a single center clinical experience.

PubMed

Heiser, Clemens; Knopf, Andreas; Bas, Murat; Gahleitner, Constanze; Hofauer, Benedikt

2017-03-01

Selective upper airway stimulation (UAS) is a novel therapy for patients with obstructive sleep apnea (OSA). The aim of this study was to analyze the application and outcome of UAS in patients with moderate to severe OSA in the clinical routine of a tertiary referral center. The design of this study is single-center, prospective clinical trial. Thirty-one patients who received a UAS device (Inspire Medical Systems) were included. Treatment outcome was evaluated at 2, 3, 6, and 12 months after surgery. Data collection included demographics, body mass index (BMI), apnea hypopnea index (AHI), oxygen saturation and desaturation index (ODI), Epworth Sleepiness Score (ESS), adverse events, and adherence to therapy. Sher criteria were used to evaluate treatment response. The mean age was 59.6 years with thirty patients being male. Mean BMI was 28.8 kg/m 2 . The mean pre-implantation AHI of 32.9/h could be reduced to 7.1/h after 12 months (p < 0.001). The mean pre-implantation ODI of 30.7/h could be reduced to 9.9/h after 12 months (p = 0.004). The mean pre-implantation ESS of 12.6 could be reduced to 5.9 after 12 months (p = 0.006). Serious adverse events did not occur. Therapy adherence was a usage of 6.6 h/night after 12 months. OSA severity and subjective daytime sleepiness were improved in patients with moderate to severe OSA after receiving UAS therapy. Patients maintained high adherence to therapy use after 12 months. It is encouraging that UAS has been shown to be successfully implemented in the routine clinical management of OSA outside of a clinical trial setting.

Reduction of Bridge Deck Cracking through Alternative Material Usage

DOT National Transportation Integrated Search

2017-12-01

ODOT routinely deploys a large number of continuous span structural slab bridges. Despite being designed to strictly satisfy all the relevant AASHTO and ODOT BDM requirements, many such bridge decks show transverse cracks, with widths greater than th...

Health information exchange usage in emergency departments and clinics: the who, what, and why.

PubMed

Johnson, Kevin B; Unertl, Kim M; Chen, Qingxia; Lorenzi, Nancy M; Nian, Hui; Bailey, James; Frisse, Mark

2011-01-01

Health information exchange (HIE) systems are being developed across the nation. Understanding approaches taken by existing successful exchanges can help new exchange efforts determine goals and plan implementations. The goal of this study was to explore characteristics of use and users of a successful regional HIE. We used a mixed-method analysis, consisting of cross-sectional audit log data, semi-structured interviews, and direct observation in a sample of emergency departments and ambulatory safety net clinics actively using HIE. For each site, we measured overall usage trends, user logon statistics, and data types accessed by users. We also assessed reasons for use and outcomes of use. Overall, users accessed HIE for 6.8% of all encounters, with higher rates of access for repeat visits, for patients with comorbidities, for patients known to have data in the exchange, and at sites providing HIE access to both nurses and physicians. Discharge summaries and test reports were the most frequently accessed data in the exchange. Providers consistently noted retrieving additional history, preventing repeat tests, comparing new results to retrieved results, and avoiding hospitalizations as a consequence of HIE access. HIE use in emergency departments and ambulatory clinics was focused on patients where missing information was believed to be present in the exchange and was related to factors including the roles of people with access, the setting, and other site-specific issues that impacted the overall breadth of routine system use. These data should form an important foundation as other sites embark upon HIE implementation.

Dose Tracker Application for Monitoring Crew Medication Usage, Symptoms, and Adverse Effects During Missions

NASA Technical Reports Server (NTRS)

Wotring, Virginia; Smith, LaRona

2015-01-01

Medication usage records can be used as a relatively nonintrusive means of monitoring health. This has been attempted previously through crew medical records, but these records are incomplete from the perspective of a research pharmacologist. During the shuttle era, NASA operations did not include routine questioning of crewmembers about their medication use until after missions were complete. The (long!) questionnaire was on paper. Asking crewmembers to recall medication use from weeks before questioning made getting complete and accurate information virtually impossible. This study will document medication usage of crewmembers before and during their missions. It will capture previously unrecorded data regarding medication use during spaceflight, including side effect qualities, frequencies and severities. The research-oriented data will be collected for research purposes, separate from medical records. Dose Tracker employs an iOS application (app) for fast & easy collection of medication usage data from crewmember participants during their missions.

Surgical wound management with adhesive polyurethane membrane: a preferred method for routine usage.

PubMed Central

Tinckler, L.

1983-01-01

The author gives an account of his experience of the use in some 1600 patients of adhesive polyurethane membrane, marketed as Op-site, both for skin closure and wound dressing, in combination, as a routine method of surgical wound management in a wide variety of surgical operations. The technique of utilising this method is described in detail, as also are the advantages for patients, nursing and medical staff. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:6870136

Current usage and future trends in gross digital photography in Canada.

PubMed

Horn, Christopher L; DeKoning, Lawrence; Klonowski, Paul; Naugler, Christopher

2014-01-14

The purpose of this study was to assess the current usage, utilization and future direction of digital photography of gross surgical specimens in pathology laboratories across Canada. An online survey consisting of 23 multiple choice and free-text questions regarding gross digital photography was sent out to via email to laboratory staff across Canada involved in gross dissection of surgical specimens. Sixty surveys were returned with representation from most of the provinces. Results showed that gross digital photography is utilized at most institutions (90.0%) and the primary users of the technology are Pathologists (88.0%), Pathologists' Assistants (54.0%) and Pathology residents (50.0%). Most respondents felt that there is a definite need for routine digital imaging of gross surgical specimens in their practice (80.0%). The top two applications for gross digital photography are for documentation of interesting/ complex cases (98.0%) and for teaching purposes (84.0%). The main limitations identified by the survey group are storage space (42.5%) and security issues (40.0%). Respondents indicated that future applications of gross digital photography mostly include teaching (96.6%), presentation at tumour boards/ clinical rounds (89.8%), medico-legal documentation (72.9%) and usage for consultation purposes (69.5%). The results of this survey indicate that pathology staff across Canada currently utilizes gross digital images for regular documentation and educational reasons. They also show that the technology will be needed for future applications in teaching, consultation and medico-legal purposes.

[Post-marketing re-evaluation about usage and dosage of Chinese medicine based on human population pharmacokinetics].

PubMed

Jiang, Junjie; Xie, Yanming

2011-10-01

The usage and dosage of Chinese patent medicine are determined by rigorous evaluation which include four clinical trail stages: I, II, III. But the usage and dosage of Chinese patent medicine are lacked re-evaluation after marketing. And this lead to unchanging or fixed of the usage and dosage of Chinese patent medicine instead of different quantity based on different situations in individual patients. The situation of Chinese patent medicine used in clinical application is far away from the idea of the "Treatment based on syndrome differentiation" in traditional Chinese medicine and personalized therapy. Human population pharmacokinetics provides data support to the personalized therapy in clinical application, and achieved the postmarking reevaluating of the usage and dosage of Chinese patent medicine. This paper briefly introduced the present situation, significance and the application of human population pharmacokinetics about re-evaluation of the usage and dosage of Chinese patent medicine after marketing.

HERALD (health economics using routine anonymised linked data).

PubMed

Husain, Muhammad J; Brophy, Sinead; Macey, Steven; Pinder, Leila M; Atkinson, Mark D; Cooksey, Roxanne; Phillips, Ceri J; Siebert, Stefan

2012-03-29

Health economic analysis traditionally relies on patient derived questionnaire data, routine datasets, and outcomes data from experimental randomised control trials and other clinical studies, which are generally used as stand-alone datasets. Herein, we outline the potential implications of linking these datasets to give one single joined up data-resource for health economic analysis. The linkage of individual level data from questionnaires with routinely-captured health care data allows the entire patient journey to be mapped both retrospectively and prospectively. We illustrate this with examples from an Ankylosing Spondylitis (AS) cohort by linking patient reported study dataset with the routinely collected general practitioner (GP) data, inpatient (IP) and outpatient (OP) datasets, and Accident and Emergency department data in Wales. The linked data system allows: (1) retrospective and prospective tracking of patient pathways through multiple healthcare facilities; (2) validation and clarification of patient-reported recall data, complementing the questionnaire/routine data information; (3) obtaining objective measure of the costs of chronic conditions for a longer time horizon, and during the pre-diagnosis period; (4) assessment of health service usage, referral histories, prescribed drugs and co-morbidities; and (5) profiling and stratification of patients relating to disease manifestation, lifestyles, co-morbidities, and associated costs. Using the GP data system we tracked about 183 AS patients retrospectively and prospectively from the date of questionnaire completion to gather the following information: (a) number of GP events; (b) presence of a GP 'drug' read codes; and (c) the presence of a GP 'diagnostic' read codes. We tracked 236 and 296 AS patients through the OP and IP data systems respectively to count the number of OP visits; and IP admissions and duration. The results are presented under several patient stratification schemes based on disease severity, functions, age, sex, and the onset of disease symptoms. The linked data system offers unique opportunities for enhanced longitudinal health economic analysis not possible through the use of traditional isolated datasets. Additionally, this data linkage provides important information to improve diagnostic and referral pathways, and thus helps maximise clinical efficiency and efficiency in the use of resources.

What Clinical Information Is Valuable to Doctors Using Mobile Electronic Medical Records and When?

PubMed

Kim, Junetae; Lee, Yura; Lim, Sanghee; Kim, Jeong Hoon; Lee, Byungtae; Lee, Jae-Ho

2017-10-18

There has been a lack of understanding on what types of specific clinical information are most valuable for doctors to access through mobile-based electronic medical records (m-EMRs) and when they access such information. Furthermore, it has not been clearly discussed why the value of such information is high. The goal of this study was to investigate the types of clinical information that are most valuable to doctors to access through an m-EMR and when such information is accessed. Since 2010, an m-EMR has been used in a tertiary hospital in Seoul, South Korea. The usage logs of the m-EMR by doctors were gathered from March to December 2015. Descriptive analyses were conducted to explore the overall usage patterns of the m-EMR. To assess the value of the clinical information provided, the usage patterns of both the m-EMR and a hospital information system (HIS) were compared on an hourly basis. The peak usage times of the m-EMR were defined as continuous intervals having normalized usage values that are greater than 0.5. The usage logs were processed as an indicator representing specific clinical information using factor analysis. Random intercept logistic regression was used to explore the type of clinical information that is frequently accessed during the peak usage times. A total of 524,929 usage logs from 653 doctors (229 professors, 161 fellows, and 263 residents; mean age: 37.55 years; males: 415 [63.6%]) were analyzed. The highest average number of m-EMR usage logs (897) was by medical residents, whereas the lowest (292) was by surgical residents. The usage amount for three menus, namely inpatient list (47,096), lab results (38,508), and investigation list (25,336), accounted for 60.1% of the peak time usage. The HIS was used most frequently during regular hours (9:00 AM to 5:00 PM). The peak usage time of the m-EMR was early in the morning (6:00 AM to 10:00 AM), and the use of the m-EMR from early evening (5:00 PM) to midnight was higher than during regular business hours. Four factors representing the types of clinical information were extracted through factor analysis. Factors related to patient investigation status and patient conditions were associated with the peak usage times of the m-EMR (P<.01). Access to information regarding patient investigation status and patient conditions is crucial for decision making during morning activities, including ward rounds. The m-EMRs allow doctors to maintain the continuity of their clinical information regardless of the time and location constraints. Thus, m-EMRs will best evolve in a manner that enhances the accessibility of clinical information helpful to the decision-making process under such constraints. ©Junetae Kim, Yura Lee, Sanghee Lim, Jeong Hoon Kim, Byungtae Lee, Jae-Ho Lee. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.10.2017.

What Clinical Information Is Valuable to Doctors Using Mobile Electronic Medical Records and When?

PubMed Central

Lim, Sanghee; Kim, Jeong Hoon; Lee, Byungtae

2017-01-01

Background There has been a lack of understanding on what types of specific clinical information are most valuable for doctors to access through mobile-based electronic medical records (m-EMRs) and when they access such information. Furthermore, it has not been clearly discussed why the value of such information is high. Objective The goal of this study was to investigate the types of clinical information that are most valuable to doctors to access through an m-EMR and when such information is accessed. Methods Since 2010, an m-EMR has been used in a tertiary hospital in Seoul, South Korea. The usage logs of the m-EMR by doctors were gathered from March to December 2015. Descriptive analyses were conducted to explore the overall usage patterns of the m-EMR. To assess the value of the clinical information provided, the usage patterns of both the m-EMR and a hospital information system (HIS) were compared on an hourly basis. The peak usage times of the m-EMR were defined as continuous intervals having normalized usage values that are greater than 0.5. The usage logs were processed as an indicator representing specific clinical information using factor analysis. Random intercept logistic regression was used to explore the type of clinical information that is frequently accessed during the peak usage times. Results A total of 524,929 usage logs from 653 doctors (229 professors, 161 fellows, and 263 residents; mean age: 37.55 years; males: 415 [63.6%]) were analyzed. The highest average number of m-EMR usage logs (897) was by medical residents, whereas the lowest (292) was by surgical residents. The usage amount for three menus, namely inpatient list (47,096), lab results (38,508), and investigation list (25,336), accounted for 60.1% of the peak time usage. The HIS was used most frequently during regular hours (9:00 AM to 5:00 PM). The peak usage time of the m-EMR was early in the morning (6:00 AM to 10:00 AM), and the use of the m-EMR from early evening (5:00 PM) to midnight was higher than during regular business hours. Four factors representing the types of clinical information were extracted through factor analysis. Factors related to patient investigation status and patient conditions were associated with the peak usage times of the m-EMR (P<.01). Conclusions Access to information regarding patient investigation status and patient conditions is crucial for decision making during morning activities, including ward rounds. The m-EMRs allow doctors to maintain the continuity of their clinical information regardless of the time and location constraints. Thus, m-EMRs will best evolve in a manner that enhances the accessibility of clinical information helpful to the decision-making process under such constraints. PMID:29046269

NHEXAS PHASE I MARYLAND STUDY--QUALITY SYSTEMS AND IMPLEMENTATION PLAN (HSPH QSIP)

EPA Science Inventory

This document describes the project design and quality systems used by the Maryland Study for NHEXAS Phase 1. It contains the following sections: Project Planning and Organization, Project Implementation Plan, Data Acquisition and Management, Records Usage and Management, Routin...

Effects of structured testing versus routine testing of blood glucose in diabetes self-management: A randomized controlled trial.

PubMed

Nishimura, Akiko; Harashima, Shin-Ichi; Fujita, Yoshihito; Tanaka, Daisuke; Wang, Yu; Liu, Yanyan; Inagaki, Nobuya

2017-01-01

To compare the effects of structured and routine testing regimens used in self-monitoring of blood glucose (SMBG) on glycemic control and diabetes self-management in insulin-naïve type 2 diabetes patients. Sixty-two outpatients with insulin-naïve type 2 diabetes were randomly allocated into two less-frequent SMBG usage groups: a structured testing group (STG) and a routine testing group (RTG). Subjects in STG measured 7-points on SMBG for 3 consecutive days once every two months without daily testing; subjects in RTG measured SMBG 3 times each week before breakfast on Monday and Friday and before dinner on Wednesday. The primary endpoint was HbA1c reduction. The secondary endpoints were change in body weight, blood pressure, treatment change, and self-management performance change. HbA1c levels were significantly decreased by 0.32% (3.50mmol/mol) in STG, partly because physicians changed medications more actively. In contrast, body weight and systolic/diastolic blood pressure were significantly reduced by 0.94kg and 6.8/4.7mmHg, respectively, in RTG, possibly related to the increased diet and exercise score in RTG. Structured testing without daily testing is beneficial for glycemic control; routine testing 3 times a week is more helpful for daily self-management. In low SMBG frequency usage, these two regimens can be utilized according to individual diabetic conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

Systematic review of use of β-blockers in sepsis.

PubMed

Chacko, Cyril Jacob; Gopal, Shameer

2015-01-01

We proposed a review of present literature and systematic analysis of present literature to summarize the evidence on the use of β-blockers on the outcome of a patient with severe sepsis and septic shock. Medline, EMBASE, Cochrane Library were searched from 1946 to December 2013. The bibliography of all relevant articles was hand searched. Full-text search of the grey literature was done through the medical institution database. The database search identified a total of 1241 possible studies. The citation list was hand searched by both the authors. A total of 9 studies were identified. Most studies found a benefit from β-blocker administration in sepsis. This included improved heart rate (HR) control, decreased mortality and improvement in acid-base parameters. Chronic β-blocker usage in sepsis was also associated with improved mortality. The administration of β-blockers during sepsis was associated with better control of HR. The methodological quality of all the included studies, however, was poor. There is insufficient evidence to justify the routine use of β-blockers in sepsis. A large adequately powered multi-centered randomized controlled clinical trial is required to address the question on the efficacy of β-blocker usage in sepsis. This trial should also consider a number of important questions including the choice of β-blocker used, optimal dosing, timing of intervention, duration of intervention and discontinuation of the drug. Until such time based on the available evidence, there is no place for the use of β-blockers in sepsis in current clinical practice.

Nucleic acid-based diagnostics for infectious diseases in public health affairs.

PubMed

Yu, Albert Cheung-Hoi; Vatcher, Greg; Yue, Xin; Dong, Yan; Li, Mao Hua; Tam, Patrick H K; Tsang, Parker Y L; Wong, April K Y; Hui, Michael H K; Yang, Bin; Tang, Hao; Lau, Lok-Ting

2012-06-01

Infectious diseases, mostly caused by bacteria and viruses but also a result of fungal and parasitic infection, have been one of the most important public health concerns throughout human history. The first step in combating these pathogens is to get a timely and accurate diagnosis at an affordable cost. Many kinds of diagnostics have been developed, such as pathogen culture, biochemical tests and serological tests, to help detect and fight against the causative agents of diseases. However, these diagnostic tests are generally unsatisfactory because they are not particularly sensitive and specific and are unable to deliver speedy results. Nucleic acid-based diagnostics, detecting pathogens through the identification of their genomic sequences, have shown promise to overcome the above limitations and become more widely adopted in clinical tests. Here we review some of the most popular nucleic acid-based diagnostics and focus on their adaptability and applicability to routine clinical usage. We also compare and contrast the characteristics of different types of nucleic acid-based diagnostics.

Breast Radiotherapy with Mixed Energy Photons; a Model for Optimal Beam Weighting.

PubMed

Birgani, Mohammadjavad Tahmasebi; Fatahiasl, Jafar; Hosseini, Seyed Mohammad; Bagheri, Ali; Behrooz, Mohammad Ali; Zabiehzadeh, Mansour; Meskani, Reza; Gomari, Maryam Talaei

2015-01-01

Utilization of high energy photons (>10 MV) with an optimal weight using a mixed energy technique is a practical way to generate a homogenous dose distribution while maintaining adequate target coverage in intact breast radiotherapy. This study represents a model for estimation of this optimal weight for day to day clinical usage. For this purpose, treatment planning computed tomography scans of thirty-three consecutive early stage breast cancer patients following breast conservation surgery were analyzed. After delineation of the breast clinical target volume (CTV) and placing opposed wedge paired isocenteric tangential portals, dosimeteric calculations were conducted and dose volume histograms (DVHs) were generated, first with pure 6 MV photons and then these calculations were repeated ten times with incorporating 18 MV photons (ten percent increase in weight per step) in each individual patient. For each calculation two indexes including maximum dose in the breast CTV (Dmax) and the volume of CTV which covered with 95% Isodose line (VCTV, 95%IDL) were measured according to the DVH data and then normalized values were plotted in a graph. The optimal weight of 18 MV photons was defined as the intersection point of Dmax and VCTV, 95%IDL graphs. For creating a model to predict this optimal weight multiple linear regression analysis was used based on some of the breast and tangential field parameters. The best fitting model for prediction of 18 MV photons optimal weight in breast radiotherapy using mixed energy technique, incorporated chest wall separation plus central lung distance (Adjusted R2=0.776). In conclusion, this study represents a model for the estimation of optimal beam weighting in breast radiotherapy using mixed photon energy technique for routine day to day clinical usage.

Factors relating to usage patterns of amalgam and resin composite for posterior restorations--a prospective analysis.

PubMed

Khalaf, Mai E; Alomari, Qasem D; Omar, Ridwaan

2014-07-01

This study prospectively analyzed the use of amalgam and resin composite posterior restorations placed by general dentists in relation to dentist, patient and cavity factors. One thousand posterior restorations placed by a representative sample of general dentists working in the Ministry of Health (MOH), Kuwait, during routine clinical practice were included. Information about the restorations was recorded using a survey questionnaire. Descriptive statistics and multivariate logistic regression analysis were used to determine the factors associated with the use of amalgam versus tooth coloured restoratives. Dentists chose amalgam for 30.8% of the 1000 restorations. Dentists with longer work experience (>15 years) were more likely to choose amalgam (OR=2.61, 95% CI=1.06, 6.40). Younger dentists (≤30 years) were less likely to choose amalgam (OR=0. 45, 95% CI=0.26, 0.77). Amalgam was more likely to be chosen for patients with poor oral hygiene (OR=1.58, 95% CI=1.08, 2.32) and a higher number (≥4) of restorations (OR=1.44, 95% CI=1.07, 1.94) with large cavity sizes (OR=6.33, 95% CI=3.88, 10.32). Tooth-coloured restorations were more likely to be chosen for cavities of smaller sizes. The use of resin composite materials as the dominant choice among dentists in Kuwait reflects the trend worldwide. Nevertheless, clinicians still find a use for amalgam in posterior load-bearing teeth and in the high-caries risk population. The findings give insight into factors influencing material usage under different clinical conditions and provides information about the perceived deficiencies or shortcomings of resin composite materials in a general dental practice setting. This information can be useful for identifying perceived barriers to the usage of newer restorative materials and finding ways to overcome them. Copyright © 2014 Elsevier Ltd. All rights reserved.

Informal Learning through Science Media Usage

ERIC Educational Resources Information Center

Maier, Michaela; Rothmund, Tobias; Retzbach, Andrea; Otto, Lukas; Besley, John C.

2014-01-01

This article reviews current research on informal science learning through news media. Based on a descriptive model of media-based science communication we distinguish between (a) the professional routines by which journalists select and depict scientific information in traditional media and (b) the psychological processes that account for how…

Benchmarking of hospital information systems: Monitoring of discharge letters and scheduling can reveal heterogeneities and time trends

PubMed Central

Dugas, Martin; Eckholt, Markus; Bunzemeier, Holger

2008-01-01

Background Monitoring of hospital information system (HIS) usage can provide insights into best practices within a hospital and help to assess time trends. In terms of effort and cost of benchmarking, figures derived automatically from the routine HIS system are preferable to manual methods like surveys, in particular for repeated analysis. Methods Due to relevance for quality management and efficient resource utilization we focused on time-to-completion of discharge letters (assessed by CT-plots) and usage of patient scheduling. We analyzed these parameters monthly during one year at a major university hospital in Germany. Results We found several distinct patterns of discharge letter documentation indicating a large heterogeneity of HIS usage between different specialties (completeness 51 – 99%, delays 0 – 90 days). Overall usage of scheduling increased during the observation period by 62%, but again showed a considerable variation between departments. Conclusion Regular monitoring of HIS key figures can contribute to a continuous HIS improvement process. PMID:18423046

EP and CD-ROM products - Current trends of production and market development -

NASA Astrophysics Data System (ADS)

Watanabe, Kazuhiko

The printed books and magazines/journals have been, and still even now are, dominant materials for public reading and reference usage. Microform publications have been also adopted for library collection build-up, but it is still within a very limited scale and coverage. As the first "new media" product, we should approve the fact that "CD-ROM" keeps amazingly large information storage capacity and also quite flexible application utility. So far, among the firstly released CD-ROMS, bibliographic databases, both for Japanese and English publications, look already quite widely purchased and now installed in many workstations of libraries. The users should evaluate its cost-effectiveness not only by its great data storage capacity but also by its frequent usage merit for library work rationalization. Multiple applied usage of CD-ROM will surely serve to such library routine works as searching, cataloguing, reading list preparation, inventory checking and new order placing, etc. 'CD-ROM' is the first EP product for quite wide usage.

Imaging mass spectrometry statistical analysis.

PubMed

Jones, Emrys A; Deininger, Sören-Oliver; Hogendoorn, Pancras C W; Deelder, André M; McDonnell, Liam A

2012-08-30

Imaging mass spectrometry is increasingly used to identify new candidate biomarkers. This clinical application of imaging mass spectrometry is highly multidisciplinary: expertise in mass spectrometry is necessary to acquire high quality data, histology is required to accurately label the origin of each pixel's mass spectrum, disease biology is necessary to understand the potential meaning of the imaging mass spectrometry results, and statistics to assess the confidence of any findings. Imaging mass spectrometry data analysis is further complicated because of the unique nature of the data (within the mass spectrometry field); several of the assumptions implicit in the analysis of LC-MS/profiling datasets are not applicable to imaging. The very large size of imaging datasets and the reporting of many data analysis routines, combined with inadequate training and accessible reviews, have exacerbated this problem. In this paper we provide an accessible review of the nature of imaging data and the different strategies by which the data may be analyzed. Particular attention is paid to the assumptions of the data analysis routines to ensure that the reader is apprised of their correct usage in imaging mass spectrometry research. Copyright © 2012 Elsevier B.V. All rights reserved.

Increased skills usage statistically mediates symptom reduction in self-guided internet-delivered cognitive-behavioural therapy for depression and anxiety: a randomised controlled trial.

PubMed

Terides, Matthew D; Dear, Blake F; Fogliati, Vincent J; Gandy, Milena; Karin, Eyal; Jones, Michael P; Titov, Nickolai

2018-01-01

Cognitive-behavioural therapy (CBT) is an effective treatment for clinical and subclinical symptoms of depression and general anxiety, and increases life satisfaction. Patients' usage of CBT skills is a core aspect of treatment but there is insufficient empirical evidence suggesting that skills usage behaviours are a mechanism of clinical change. This study investigated if an internet-delivered CBT (iCBT) intervention increased the frequency of CBT skills usage behaviours and if this statistically mediated reductions in symptoms and increased life satisfaction. A two-group randomised controlled trial was conducted comparing internet-delivered CBT (n = 65) with a waitlist control group (n = 75). Participants were individuals experiencing clinically significant symptoms of depression or general anxiety. Mixed-linear models analyses revealed that the treatment group reported a significantly higher frequency of skills usage, lower symptoms, and higher life satisfaction by the end of treatment compared with the control group. Results from bootstrapping mediation analyses revealed that the increased skills usage behaviours statistically mediated symptom reductions and increased life satisfaction. Although skills usage and symptom outcomes were assessed concurrently, these findings support the notion that iCBT increases the frequency of skills usage behaviours and suggest that this may be an important mechanism of change.

ePortfolios Meet Social Software

ERIC Educational Resources Information Center

Waters, John K.

2007-01-01

Although a seemingly good idea, electronic portfolios have to date failed to gain significant traction in higher education. Institutions with ePortfolio implementations routinely report high numbers of accounts on their campuses, but few believe that those numbers are a meaningful reflection of actual usage. Change is in the air for the…

Antimicrobial stewardship: English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR).

PubMed

Ashiru-Oredope, Diane; Hopkins, Susan

2013-11-01

The clinical, public health and economic implications of antimicrobial resistance present a major threat to future healthcare. Antimicrobial use is a major driver of resistance, and antimicrobial stewardship programmes are increasingly being advocated as a means of improving the quality of prescribing. However, to increase their impact and assess their success, a better understanding of antimicrobial usage, both in primary and secondary care, and linkage with antimicrobial resistance data are required. In England, national summaries of primary care dispensing data are issued annually by the Health and Social Care Information Centre. However, there is currently no routine public reporting of antimicrobial usage in hospitals. In response to the threat posed by antimicrobial resistance, as highlighted in the Report of the Chief Medical Officer and on the request of the Department of Health, Public Health England has developed a new national programme, the English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR). The programme will bring together the elements of antimicrobial utilization and resistance surveillance in both primary and secondary care settings, alongside the development of quality measures and methods to monitor unintended outcomes of antimicrobial stewardship and both public and professional behaviour interventions. This article reports on the background to the programme development, the current oversight group membership and the public reporting structure.

An introduction to implementation science for the non-specialist.

PubMed

Bauer, Mark S; Damschroder, Laura; Hagedorn, Hildi; Smith, Jeffrey; Kilbourne, Amy M

2015-09-16

The movement of evidence-based practices (EBPs) into routine clinical usage is not spontaneous, but requires focused efforts. The field of implementation science has developed to facilitate the spread of EBPs, including both psychosocial and medical interventions for mental and physical health concerns. The authors aim to introduce implementation science principles to non-specialist investigators, administrators, and policymakers seeking to become familiar with this emerging field. This introduction is based on published literature and the authors' experience as researchers in the field, as well as extensive service as implementation science grant reviewers. Implementation science is "the scientific study of methods to promote the systematic uptake of research findings and other EBPs into routine practice, and, hence, to improve the quality and effectiveness of health services." Implementation science is distinct from, but shares characteristics with, both quality improvement and dissemination methods. Implementation studies can be either assess naturalistic variability or measure change in response to planned intervention. Implementation studies typically employ mixed quantitative-qualitative designs, identifying factors that impact uptake across multiple levels, including patient, provider, clinic, facility, organization, and often the broader community and policy environment. Accordingly, implementation science requires a solid grounding in theory and the involvement of trans-disciplinary research teams. The business case for implementation science is clear: As healthcare systems work under increasingly dynamic and resource-constrained conditions, evidence-based strategies are essential in order to ensure that research investments maximize healthcare value and improve public health. Implementation science plays a critical role in supporting these efforts.

A novel enterovirus and parechovirus multiplex one-step real-time PCR-validation and clinical experience.

PubMed

Nielsen, Alex Christian Yde; Böttiger, Blenda; Midgley, Sofie Elisabeth; Nielsen, Lars Peter

2013-11-01

As the number of new enteroviruses and human parechoviruses seems ever growing, the necessity for updated diagnostics is relevant. We have updated an enterovirus assay and combined it with a previously published assay for human parechovirus resulting in a multiplex one-step RT-PCR assay. The multiplex assay was validated by analysing the sensitivity and specificity of the assay compared to the respective monoplex assays, and a good concordance was found. Furthermore, the enterovirus assay was able to detect 42 reference strains from all 4 species, and an additional 9 genotypes during panel testing and routine usage. During 15 months of routine use, from October 2008 to December 2009, we received and analysed 2187 samples (stool samples, cerebrospinal fluids, blood samples, respiratory samples and autopsy samples) were tested, from 1546 patients and detected enteroviruses and parechoviruses in 171 (8%) and 66 (3%) of the samples, respectively. 180 of the positive samples could be genotyped by PCR and sequencing and the most common genotypes found were human parechovirus type 3, echovirus 9, enterovirus 71, Coxsackievirus A16, and echovirus 25. During 2009 in Denmark, both enterovirus and human parechovirus type 3 had a similar seasonal pattern with a peak during the summer and autumn. Human parechovirus type 3 was almost invariably found in children less than 4 months of age. In conclusion, a multiplex assay was developed allowing simultaneous detection of 2 viruses, which can cause similar clinical symptoms. Copyright © 2013 Elsevier B.V. All rights reserved.

The Usefulness of the Electric Textbooks at Nursing Practicam by Analyzing the Usage Logs of the Terminal Tablet.

PubMed

Nakamura, Yumiko; Majima, Yukie; Fukayama, Kaori

2016-01-01

We conducted assessment tests for clinical training, analyzing the usage of the electronic textbooks and the tablet functions from the log information of the terminal tablets. Results revealed that usage of the terminal tablet and digital nursing dictionary (ver. 2), by which users can enjoy free access to electric textbooks during clinical training, was effective as learning support.

HIS-based Kaplan-Meier plots--a single source approach for documenting and reusing routine survival information.

PubMed

Breil, Bernhard; Semjonow, Axel; Müller-Tidow, Carsten; Fritz, Fleur; Dugas, Martin

2011-02-16

Survival or outcome information is important for clinical routine as well as for clinical research and should be collected completely, timely and precisely. This information is relevant for multiple usages including quality control, clinical trials, observational studies and epidemiological registries. However, the local hospital information system (HIS) does not support this documentation and therefore this data has to generated by paper based or spreadsheet methods which can result in redundantly documented data. Therefore we investigated, whether integrating the follow-up documentation of different departments in the HIS and reusing it for survival analysis can enable the physician to obtain survival curves in a timely manner and to avoid redundant documentation. We analysed the current follow-up process of oncological patients in two departments (urology, haematology) with respect to different documentation forms. We developed a concept for comprehensive survival documentation based on a generic data model and implemented a follow-up form within the HIS of the University Hospital Muenster which is suitable for a secondary use of these data. We designed a query to extract the relevant data from the HIS and implemented Kaplan-Meier plots based on these data. To re-use this data sufficient data quality is needed. We measured completeness of forms with respect to all tumour cases in the clinic and completeness of documented items per form as incomplete information can bias results of the survival analysis. Based on the form analysis we discovered differences and concordances between both departments. We identified 52 attributes from which 13 were common (e.g. procedures and diagnosis dates) and were used for the generic data model. The electronic follow-up form was integrated in the clinical workflow. Survival data was also retrospectively entered in order to perform survival and quality analyses on a comprehensive data set. Physicians are now able to generate timely Kaplan-Meier plots on current data. We analysed 1029 follow-up forms of 965 patients with survival information between 1992 and 2010. Completeness of forms was 60.2%, completeness of items ranges between 94.3% and 98.5%. Median overall survival time was 16.4 years; median event-free survival time was 7.7 years. It is feasible to integrate survival information into routine HIS documentation such that Kaplan-Meier plots can be generated directly and in a timely manner.

Guidelines for Standard Photography in Gross and Clinical Anatomy

ERIC Educational Resources Information Center

Barut, Cagatay; Ertilav, Hakan

2011-01-01

Photography has a widespread usage in medicine and anatomy. In this review, authors focused on the usage of photography in gross and clinical anatomy. Photography in gross and clinical anatomy is not only essential for accurate documentation of morphological findings but also important in sharing knowledge and experience. Photographs of cadavers…

Patterns of usage for a Web-based clinical information system.

PubMed

Chen, Elizabeth S; Cimino, James J

2004-01-01

Understanding how clinicians are using clinical information systems to assist with their everyday tasks is valuable to the system design and development process. Developers of such systems are interested in monitoring usage in order to make enhancements. System log files are rich resources for gaining knowledge about how the system is being used. We have analyzed the log files of our Web-based clinical information system (WebCIS) to obtain various usage statistics including which WebCIS features are frequently being used. We have also identified usage patterns, which convey how the user is traversing the system. We present our method and these results as well as describe how the results can be used to customize menus, shortcut lists, and patient reports in WebCIS and similar systems.

Cardiac asystole following cannabis (marijuana) usage--additional mechanism for sudden death?

PubMed

Menahem, Samuel

2013-12-10

A 21 year old university student previously operated during infancy for an unobstructed total anomalous pulmonary venous drainage with an excellent result, was noted on a routine follow up 24 h Holter monitor to have multiple pauses related to cardiac asystole, the longest lasting 5.8 s and temporally related to marijuana inhalation. A repeat Holter was normal following a two week cessation of marijuana usage and again when carried out 3 months later. The documented periods of asystole may be a precursor of sudden death seen in addicts even without evidence of ischaemic heart disease. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A parameter estimation subroutine package

NASA Technical Reports Server (NTRS)

Bierman, G. J.; Nead, M. W.

1978-01-01

Linear least squares estimation and regression analyses continue to play a major role in orbit determination and related areas. A library of FORTRAN subroutines were developed to facilitate analyses of a variety of estimation problems. An easy to use, multi-purpose set of algorithms that are reasonably efficient and which use a minimal amount of computer storage are presented. Subroutine inputs, outputs, usage and listings are given, along with examples of how these routines can be used. The routines are compact and efficient and are far superior to the normal equation and Kalman filter data processing algorithms that are often used for least squares analyses.

Factors motivating and affecting health information exchange usage

PubMed Central

Zhao, Hongwei; Jaspserson, 'Jon; Gamm, Larry D; Ohsfeldt, Robert L

2011-01-01

Objective Health information exchange (HIE) is the process of electronically sharing patient-level information between providers. However, where implemented, reports indicate HIE system usage is low. The aim of this study was to determine the factors associated with different types of HIE usage. Design Cross-sectional analysis of clinical data from emergency room encounters included in an operational HIE effort linked to system user logs using crossed random-intercept logistic regression. Measurements Independent variables included factors indicative of information needs. System usage was measured as none, basic usage, or a novel pattern of usage. Results The system was accessed for 2.3% of all encounters (6142 out of 271 305). Novel usage patterns were more likely for more complex patients. The odds of HIE usage were lower in the face of time constraints. In contrast to expectations, system usage was lower when the patient was unfamiliar to the facility. Limitations Because of differences between HIE efforts and the fact that not all types of HIE usage (ie, public health) could be included in the analysis, results are limited in terms of generalizablity. Conclusions This study of actual HIE system usage identifies patients and circumstances in which HIE is more likely to be used and factors that are likely to discourage usage. The paper explores the implications of the findings for system redesign, information integration across exchange partners, and for meaningful usage criteria emerging from provisions of the Health Information Technology for Economic & Clinical Health Act. PMID:21262919

The Analysis of New Generation Mobile Device Dependencies of Students in Faculty of Education

ERIC Educational Resources Information Center

Korucu, Agah Tugrul; Usta, Ertugrul

2016-01-01

The development of technology brought about some advantages as well as particular disadvantages. Smart phones which are new generation mobile devices are technological tools for meeting certain needs such as entertainment, social media, realization of daily routines and usage for educational purposes. The facts that new generation mobile devices…

A Model to Assess the Behavioral Impacts of Consultative Knowledge Based Systems.

ERIC Educational Resources Information Center

Mak, Brenda; Lyytinen, Kalle

1997-01-01

This research model studies the behavioral impacts of consultative knowledge based systems (KBS). A study of graduate students explored to what extent their decisions were affected by user participation in updating the knowledge base; ambiguity of decision setting; routinization of usage; and source credibility of the expertise embedded in the…

Adolescent use of electronic nicotine delivery systems.

PubMed

Vincent, Debra; Potts, Jeanne; Durbin, Jessica; Moore, Jill M; Eley, Susan

2018-03-12

Use of electronic nicotine delivery systems is flourishing among adolescents. The long-term effects have not been fully determined; however, literature suggests there is potential for significant harm. Providers must be aware of usage trends, device safety, and product knowledge. Adolescents should be evaluated through routine screening, and cessation counseling should be initiated.

Teacher Technology Acceptance and Usage for the Middle School Classroom

ERIC Educational Resources Information Center

Stone, Wilton, Jr.

2014-01-01

According to the U.S. Department of Education National Center for Education Statistics, students in the United States routinely perform poorly on international assessments. This study was focused specifically on the problem of the decrease in the number of middle school students meeting the requirements for one state's standardized tests for…

Before You Ban: Law Students' In-Class Laptop Usage and Academic Performance

ERIC Educational Resources Information Center

Morse, Kimberly Ann

2016-01-01

Legal educators are routinely banning students' laptops or wireless connectivity in law classes. Faculty assumes students are significantly off-task and in-class laptops are harmful to learning. Current research focuses almost exclusively on undergraduate students technology uses in- and out of the classroom. Only a handful of studies objectively…

Check-off logs for routine equipment maintenance.

PubMed

Brewster, M A; Carver, P H; Randolph, B

1995-12-01

The regulatory requirement for appropriate routine instrument maintenance documentation is approached by laboratories in numerous ways. Standard operating procedures (SOPs) may refer to maintenance listed in instrument manuals, may indicate "periodic" performance of an action, or may indicate specific tasks to be performed at certain frequencies. The Quality Assurance Unit (QAU) task of assuring the performance of these indicated maintenance tasks can be extremely laborious if these records are merged with other analysis records. Further, the lack of written maintenance schedules often leads to omission of infrequently performed tasks. We recommend creation of routine maintenance check-off logs for instruments with tasks grouped by frequency of expected performance. Usage of such logs should result in better laboratory compliance with SOPs and the compliance can be readily monitored by QAU or by regulatory agencies.

Addressing critical issues in the development of an Oncology Information System.

PubMed

Urda, D; Ribelles, N; Subirats, J L; Franco, L; Alba, E; Jerez, J M

2013-05-01

This paper presents the experience on the design and implementation of a user-centered Oncology Information System developed for the Medical Oncology Department at the "Hospital Universitario Virgen de la Victoria", in Málaga, Spain. The project focused on the aspects considered in the literature as critical factors for a successful deployment and usage of a health information system. System usability, adequate technology, integration of clinical routines, real-time statistical analysis of data, information confidentiality and standard protocol-based external interconnection were the key aspects considered. The developed system is based on a web application with a modular and layered architecture accounting for usability, ease of maintenance and further system development. Evaluation of system usability was carried at three and fifteen months after system deployment to analyze the advantages/disadvantages experienced by the end-users. A thorough prior analysis of clinical activities and workflows, the use of the adequate technology, and the availability of data analysis tools will almost guarantee success in the deployment of an Oncology Information System. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Topical treatment of melasma.

PubMed

Bandyopadhyay, Debabrata

2009-01-01

Melasma is a common hypermelanotic disorder affecting the face that is associated with considerable psychological impacts. The management of melasma is challenging and requires a long-term treatment plan. In addition to avoidance of aggravating factors like oral pills and ultraviolet exposure, topical therapy has remained the mainstay of treatment. Multiple options for topical treatment are available, of which hydroquinone (HQ) is the most commonly prescribed agent. Besides HQ, other topical agents for which varying degrees of evidence for clinical efficacy exist include azelaic acid, kojic acid, retinoids, topical steroids, glycolic acid, mequinol, and arbutin. Topical medications modify various stages of melanogenesis, the most common mode of action being inhibition of the enzyme, tyrosinase. Combination therapy is the preferred mode of treatment for the synergism and reduction of untoward effects. The most popular combination consists of HQ, a topical steroid, and retinoic acid. Prolonged HQ usage may lead to untoward effects like depigmentation and exogenous ochronosis. The search for safer alternatives has given rise to the development of many newer agents, several of them from natural sources. Well-designed controlled clinical trials are needed to clarify their role in the routine management of melasma.

Application and Evaluation of Interactive 3D PDF for Presenting and Sharing Planning Results for Liver Surgery in Clinical Routine

PubMed Central

Newe, Axel; Becker, Linda; Schenk, Andrea

2014-01-01

Background & Objectives The Portable Document Format (PDF) is the de-facto standard for the exchange of electronic documents. It is platform-independent, suitable for the exchange of medical data, and allows for the embedding of three-dimensional (3D) surface mesh models. In this article, we present the first clinical routine application of interactive 3D surface mesh models which have been integrated into PDF files for the presentation and the exchange of Computer Assisted Surgery Planning (CASP) results in liver surgery. We aimed to prove the feasibility of applying 3D PDF in medical reporting and investigated the user experience with this new technology. Methods We developed an interactive 3D PDF report document format and implemented a software tool to create these reports automatically. After more than 1000 liver CASP cases that have been reported in clinical routine using our 3D PDF report, an international user survey was carried out online to evaluate the user experience. Results Our solution enables the user to interactively explore the anatomical configuration and to have different analyses and various resection proposals displayed within a 3D PDF document covering only a single page that acts more like a software application than like a typical PDF file (“PDF App”). The new 3D PDF report offers many advantages over the previous solutions. According to the results of the online survey, the users have assessed the pragmatic quality (functionality, usability, perspicuity, efficiency) as well as the hedonic quality (attractiveness, novelty) very positively. Conclusion The usage of 3D PDF for reporting and sharing CASP results is feasible and well accepted by the target audience. Using interactive PDF with embedded 3D models is an enabler for presenting and exchanging complex medical information in an easy and platform-independent way. Medical staff as well as patients can benefit from the possibilities provided by 3D PDF. Our results open the door for a wider use of this new technology, since the basic idea can and should be applied for many medical disciplines and use cases. PMID:25551375

Application and evaluation of interactive 3D PDF for presenting and sharing planning results for liver surgery in clinical routine.

PubMed

Newe, Axel; Becker, Linda; Schenk, Andrea

2014-01-01

The Portable Document Format (PDF) is the de-facto standard for the exchange of electronic documents. It is platform-independent, suitable for the exchange of medical data, and allows for the embedding of three-dimensional (3D) surface mesh models. In this article, we present the first clinical routine application of interactive 3D surface mesh models which have been integrated into PDF files for the presentation and the exchange of Computer Assisted Surgery Planning (CASP) results in liver surgery. We aimed to prove the feasibility of applying 3D PDF in medical reporting and investigated the user experience with this new technology. We developed an interactive 3D PDF report document format and implemented a software tool to create these reports automatically. After more than 1000 liver CASP cases that have been reported in clinical routine using our 3D PDF report, an international user survey was carried out online to evaluate the user experience. Our solution enables the user to interactively explore the anatomical configuration and to have different analyses and various resection proposals displayed within a 3D PDF document covering only a single page that acts more like a software application than like a typical PDF file ("PDF App"). The new 3D PDF report offers many advantages over the previous solutions. According to the results of the online survey, the users have assessed the pragmatic quality (functionality, usability, perspicuity, efficiency) as well as the hedonic quality (attractiveness, novelty) very positively. The usage of 3D PDF for reporting and sharing CASP results is feasible and well accepted by the target audience. Using interactive PDF with embedded 3D models is an enabler for presenting and exchanging complex medical information in an easy and platform-independent way. Medical staff as well as patients can benefit from the possibilities provided by 3D PDF. Our results open the door for a wider use of this new technology, since the basic idea can and should be applied for many medical disciplines and use cases.

Complementary and alternative medicine usage by patients of a dental school clinic.

PubMed

Spector, Michael L; Fischer, Mark; Dawson, Deborah V; Holmes, David C; Kummet, Colleen; Nisly, Nicole L; Baker, Karen A K

2012-01-01

This pilot study investigated the prevalence and specific reasons for usage of complementary and alternative medicine (CAM) among patients of a dental school clinic. Four hundred and two patients completed a 30-page survey on CAM usage. A higher rate of CAM usage was found in this dental school clinic population than rates previously reported in a general population. More than three-quarters (76.1%) of the respondents reported using at least one CAM treatment in the past 12 months; 93.3% reported using at least one CAM treatment at some time in their lives. High rates of chiropractic use were found in this population. Tooth pain was the most frequently reported dental condition motivating CAM use. About 10% of dental school clinic patients use topical oral herbal and/or natural products to treat dental conditions, most frequently for preventive/oral health reasons or for tooth pain. © 2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

Cardio-oncology: the Nuclear Option.

PubMed

Alvarez, Jorge A; Russell, Raymond R

2017-04-01

Cardio-oncology focuses increased effort to decrease cancer treatment-related cardiotoxicity while continuing to improve outcomes. We sought to synthesize the latest in nuclear cardiology as it pertains to the assessment of left ventricular function in preventative guidelines and comparison to other modalities, novel molecular markers of pre-clinical cardiotoxicity, and its role in cardiac amyloid diagnosis. Planar ERNA (equilibrium radionuclide angiocardiography) provides a reliable and proven means of monitoring and preventing anthracycline cardiotoxicity, and SPECT ERNA using solid-state gamma cameras may provide reproducible assessments of left ventricular function with reduced radiation exposure. While certain chemotherapeutics have vascular side effects, the use of stress perfusion imaging has still not been adequately studied for routine use. Similarly, markers of apoptosis, inflammation, and sympathetic nerve dysfunction are promising, but are still not ready for uniform usage. SPECT tracers can assist in nonbiopsy diagnosis of cardiac amyloid. Nuclear cardiology is a significant contributor to the multimodality approach to cardio-oncology.

Ultrasonic imaging: safety considerations

PubMed Central

ter Haar, Gail

2011-01-01

Modern ultrasound imaging for diagnostic purposes has a wide range of applications. It is used in obstetrics to monitor the progress of pregnancy, in oncology to visualize tumours and their response to treatment, and, in cardiology, contrast-enhanced studies are used to investigate heart function and physiology. An increasing use of diagnostic ultrasound is to provide the first photograph for baby's album—in the form of a souvenir or keepsake scan that might be taken as part of a routine investigation, or during a visit to an independent high-street ‘boutique’. It is therefore important to ensure that any benefit accrued from these applications outweighs any accompanying risk, and to evaluate the existing ultrasound bio-effect and epidemiology literature with this in mind. This review considers the existing laboratory and epidemiological evidence about the safety of diagnostic ultrasound and puts it in the context of current clinical usage. PMID:22866238

De-Gendering in the Use of E-Learning

ERIC Educational Resources Information Center

Remmele, Bernd; Holthaus, Matthias

2013-01-01

The starting point of the paper is the co-construction of gender and technology, that is, the theory that the usage of and the attitude to certain kinds of technology are a way to "do" one's gender. A survey is presented that supports the assumption that with the routinization of e-learning in higher education e-learning loses its…

Advanced mathematical on-line analysis in nuclear experiments. Usage of parallel computing CUDA routines in standard root analysis

NASA Astrophysics Data System (ADS)

Grzeszczuk, A.; Kowalski, S.

2015-04-01

Compute Unified Device Architecture (CUDA) is a parallel computing platform developed by Nvidia for increase speed of graphics by usage of parallel mode for processes calculation. The success of this solution has opened technology General-Purpose Graphic Processor Units (GPGPUs) for applications not coupled with graphics. The GPGPUs system can be applying as effective tool for reducing huge number of data for pulse shape analysis measures, by on-line recalculation or by very quick system of compression. The simplified structure of CUDA system and model of programming based on example Nvidia GForce GTX580 card are presented by our poster contribution in stand-alone version and as ROOT application.

Psychosocial service needs of pediatric transport accident survivors: Using clinical data-mining to establish demographic and service usage characteristics.

PubMed

Manguy, Alys-Marie; Joubert, Lynette; Bansemer, Leah

2016-09-01

The objectives in this article are the exploration of demographic and service usage data gained through clinical data mining audit and suggesting recommendations for social work service delivery model and future research. The method is clinical data-mining audit of 100 sequentially sampled cases gathering quantitative demographic and service usage data. Descriptive analysis of file audit data raised interesting trends with potential to inform service delivery and usage; the key areas of the results included patient demographics, family involvement and impact, and child safety and risk issues. Transport accidents involving children often include other family members. Care planning must take into account psychosocial issues including patient and family emotional responses, availability of primary carers, and other practical needs that may impact on recovery and discharge planning. This study provides evidence to plan for further research and development of more integrated models of care.

Prosthetists' perceptions and use of outcome measures in clinical practice: Long-term effects of focused continuing education.

PubMed

Hafner, Brian J; Spaulding, Susan E; Salem, Rana; Morgan, Sara J; Gaunaurd, Ignacio; Gailey, Robert

2017-06-01

Continuing education is intended to facilitate clinicians' skills and knowledge in areas of practice, such as administration and interpretation of outcome measures. To evaluate the long-term effect of continuing education on prosthetists' confidence in administering outcome measures and their perceptions of outcomes measurement in clinical practice. Pretest-posttest survey methods. A total of 66 prosthetists were surveyed before, immediately after, and 2 years after outcomes measurement education and training. Prosthetists were grouped as routine or non-routine outcome measures users, based on experience reported prior to training. On average, prosthetists were just as confident administering measures 1-2 years after continuing education as they were immediately after continuing education. In all, 20% of prosthetists, initially classified as non-routine users, were subsequently classified as routine users at follow-up. Routine and non-routine users' opinions differed on whether outcome measures contributed to efficient patient evaluations (79.3% and 32.4%, respectively). Both routine and non-routine users reported challenges integrating outcome measures into normal clinical routines (20.7% and 45.9%, respectively). Continuing education had a long-term impact on prosthetists' confidence in administering outcome measures and may influence their clinical practices. However, remaining barriers to using standardized measures need to be addressed to keep practitioners current with evolving practice expectations. Clinical relevance Continuing education (CE) had a significant long-term impact on prosthetists' confidence in administering outcome measures and influenced their clinical practices. In all, approximately 20% of prosthetists, who previously were non-routine outcome measure users, became routine users after CE. There remains a need to develop strategies to integrate outcome measurement into routine clinical practice.

Teaching Perspectives and Usage of Journal Writing by Clinical Faculty

ERIC Educational Resources Information Center

Alschuler, Mari L.

2012-01-01

The purpose of this study was to investigate the associations between teaching perspectives (TPs), faculty usage and perceptions of reflective journaling (RJ), and demographic characteristics among clinical faculty in nursing, social work, and counseling. A combination of causal-comparative and correlational designs was utilized, with stratified…

Outcome after one year of upper airway stimulation for obstructive sleep apnea in a multicenter German post-market study.

PubMed

Steffen, Armin; Sommer, J Ulrich; Hofauer, Benedikt; Maurer, Joachim T; Hasselbacher, Katrin; Heiser, Clemens

2018-02-01

Upper airway stimulation (UAS) of the hypoglossal nerve has been implemented in the routine clinical practice for patients with moderate-to-severe obstructive sleep apnea (OSA) who could not adhere to continuous positive airway pressure. This study reports objective and patient-reported outcome after 12 months of implantation. Multicenter prospective single-arm study. Consecutive patients who received the UAS system (Inspire Medical Systems, Inc., Minneapolis, Minnesota, Maple Grove, MN, U.S.A.) were enrolled in three German centers. Key study exclusion criteria included body mass index > 35 kg/m 2 , apnea-hypopnea index (AHI) < 15 or > 65, or complete concentric collapse at the soft palate during sedated endoscopy. Data collection at 6- and 12-month visit include home sleep test and patient-reported outcome measures. Among the total of 60 participants, the median AHI reduced from 28.6 to 9.5 from baseline to 12 months. Patient-reported outcome measured in Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire both improved significantly from baseline to 12 months. The average usage time was 39.1 ± 14.9 hours per week among all participants based on recordings by the implanted device. One patient requested a removal of the device for cosmetic and other personal reasons and was completed without sequelae. This study supported that UAS is a safe and effective treatment option for patients with OSA in routine clinical practice. 4. Laryngoscope, 128:509-515, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Removal of paper-based health records from Norwegian hospitals: effects on clinical workflow.

PubMed

Lium, Jan Tore; Faxvaag, Arild

2006-01-01

Several Norwegian hospitals have, plan, or are in the process of removing the paper-based health record from clinical workflow. To assess the impact on usage and satisfaction of electronic health record (EHR) systems, we conducted a survey among physicians, nurses and medical secretaries at selected departments from six Norwegian hospitals. The main feature of the questionnaire is the description of a set of tasks commonly performed at hospitals, and respondents were asked to rate their usage and change of ease compared to previous routines for each tasks. There were 24 tasks for physicians, 19 for nurses and 23 for medical secretaries. In total, 64 physicians, 128 nurses and 57 medical secretaries responded, corresponding to a response rate of 68%, 58% and 84% respectively. Results showed a large degree of use among medical secretaries, while physicians and nurses displayed a more modest degree of use. Possibly suggesting that the EHR systems among clinicians still is considered more of an administrative system. Among the two latter groups, tasks regarding information retrieval were used more extensively than tasks regarding generating and storing information. Also, we observed large differences between hospitals and higher satisfaction with the part of the system handling regular electronic data than scanned document images. Even though the increase in use among clinicians after removing the paper based record were mainly in tasks where respondents had no choice other than use the electronic health record, the attitude towards EHR-systems were mainly positive. Thus, while removing the paper based record has yet to promote new ways of working, we see it as an important step towards the EHR system of tomorrow. Several Norwegian hospitals have shown that it is possible.

Tumor Marker Usage and Medical Care Costs Among Older Early-Stage Breast Cancer Survivors

PubMed Central

Ramsey, Scott D.; Henry, N. Lynn; Gralow, Julie R.; Mirick, Dana K.; Barlow, William; Etzioni, Ruth; Mummy, David; Thariani, Rahber; Veenstra, David L.

2015-01-01

Purpose Although American Society of Clinical Oncology guidelines discourage the use of tumor marker assessment for routine surveillance in nonmetastatic breast cancer, their use in practice is uncertain. Our objective was to determine use of tumor marker tests such as carcinoembryonic antigen and CA 15-3/CA 27.29 and associated Medicare costs in early-stage breast cancer survivors. Methods By using Surveillance, Epidemiology, and End Results-Medicare records for patients diagnosed with early-stage breast cancer between 2001 and 2007, tumor marker usage within 2 years after diagnosis was identified by billing codes. Logistic regression models were used to identify clinical and demographic factors associated with use of tumor markers. To determine impact on costs of care, we used multivariable regression, controlling for other factors known to influence total medical costs. Results We identified 39,650 eligible patients. Of these, 16,653 (42%) received at least one tumor marker assessment, averaging 5.7 tests over 2 years, with rates of use per person increasing over time. Factors significantly associated with use included age at diagnosis, diagnosis year, stage at diagnosis, race/ethnicity, geographic region, and urban/rural status. Rates of advanced imaging, but not biopsies, were significantly higher in the assessment group. Medical costs for patients who received at least one test were approximately 29% greater than costs for those who did not, adjusting for other factors. Conclusion Breast cancer tumor markers are frequently used among women with early-stage disease and are associated with an increase in both diagnostic procedures and total cost of care. A better understanding of factors driving the use of and the potential benefits and harms of surveillance-based tumor marker testing is needed. PMID:25332254

Outcomes of support rod usage in loop stoma formation.

PubMed

Whiteley, Ian; Russell, Michael; Nassar, Natasha; Gladman, Marc A

2016-06-01

Traditionally, support rods have been used when creating loop stomas in the hope of preventing retraction. However, their effectiveness has not been clearly established. This study aimed to investigate the rate of stoma rod usage and its impact on stoma retraction and complication rates. A prospective cohort of 515 consecutive patients who underwent loop ileostomy/colostomy formation at a tertiary referral colorectal unit in Sydney, Australia were studied. Mortality and unplanned return to theatre rates were calculated. The primary outcome measure of interest was stoma retraction, occurring within 30 days of surgery. Secondary outcome measures included early stoma complications. The 10-year temporal trends for rod usage, stoma retraction, and complications were examined. Mortality occurred in 23 patients (4.1 %) and unplanned return to theatre in 4 patients (0.8 %). Stoma retraction occurred in four patients (0.78 %), all without rods. However, the rate of retraction was similar, irrespective of whether rods were used (P = 0.12). There was a significant decline in the use of rods during the study period (P < 0.001) but this was not associated with an increase in stoma retraction rates. Early complications occurred in 94/432 patients (21.8 %) and were more likely to occur in patients with rods (64/223 versus 30/209 without rods, P < 0.001). Stoma retraction is a rare complication and its incidence is not significantly affected by the use of support rods. Further, complications are common post-operatively, and the rate appears higher when rods are used. The routine use of rods warrants judicious application. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: It remains unclear whether support rods prevent stoma retraction. This study, the largest to date, confirms that stoma retraction is a rare complication and is not significantly affected by the use of rods. Consequently, routine rod usage cannot be recommended, particularly as it is associated with increased stoma complications.

Durable usage of patient-reported outcome measures in clinical practice to monitor health-related quality of life in head and neck cancer patients.

PubMed

Duman-Lubberding, S; van Uden-Kraan, C F; Jansen, F; Witte, B I; Eerenstein, S E J; van Weert, S; de Bree, R; Leemans, C R; Verdonck-de Leeuw, I M

2017-12-01

To investigate the long-term follow-up (5 years) of implementing patient-reported outcome measures (PROMs) in clinical practice to monitor health-related quality of life (HRQOL) in head and neck cancer (HNC) patients. A mixed method design was used. The usage rate of OncoQuest (a touch screen computer system to monitor HRQOL) and the subsequent nurse consultation was calculated among HNC patients who visited the outpatient clinic for regular follow-up, as well as differences between ever users and never users (sociodemographic and clinical characteristics). The content of the nurse consultation was investigated. Reasons for not using (barriers) or using (facilitators) OncoQuest and the nurse consultation were explored from the perspective of HNC patients, and of head and neck surgeons. Usage rate of OncoQuest was 67% and of the nurse consultation 79%. Usage of OncoQuest was significantly related to tumor subsite and tumor stage. Topics most frequently (>40%) discussed during the nurse consultation were global quality of life (97%), head and neck cancer related symptoms (82%), other physical symptoms such as pain (61%), and psychological problems such as anxiety (44%). Several barriers and facilitators to implement PROMs in clinical practice were reported by both patients and head and neck surgeons. Usage of PROMs in clinical practice and a nurse consultation is durable, even 5 years after the introduction. This study contributes to better insight into long-term follow-up of implementation, thereby guiding future research and projects that aim to implement PROMs in clinical practice to monitor HRQOL among (head and neck) cancer patients.

Map projections: A working manual

USGS Publications Warehouse

Snyder, John P.

1987-01-01

With increased computerization, it is important to realize that rectangular coordinates for all these projections may be mathematically calculated with formulas which would have seemed too complicated in the past, but which now may be programmed routinely, especially if aided by numerical examples. A discussion of appearance, usage, and history is given together with both forward and inverse equations for each projection involved.

A User's Guide to CGNS. 1.0

NASA Technical Reports Server (NTRS)

Rumsey, Christopher L.; Poirier, Diane M. A.; Bush, Robert H.; Towne, Charles E.

2001-01-01

The CFD General Notation System (CGNS) was developed to be a self-descriptive, machine-independent standard for storing CFD aerodynamic data. This guide aids users in the implementation of CGNS. It is intended as a tutorial on the usage of the CGNS mid-level library routines for reading and writing grid and flow solution datasets for both structured and unstructured methodologies.

78 FR 57674 - Order Limiting Operations at Newark Liberty International Airport

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-19

... season. This waiver applies only to EWR slots for the following days and local times: (1) March 30... runway 4L/22R. Runway 4L/22R will be open during that period with reduced runway length. Night and... five or more consecutive days. However, the FAA does not routinely grant general waivers to the usage...

Metaphors for the Nature of Human-Computer Interaction in an Empowering Environment: Interaction Style Influences the Manner of Human Accomplishment.

ERIC Educational Resources Information Center

Weller, Herman G.; Hartson, H. Rex

1992-01-01

Describes human-computer interface needs for empowering environments in computer usage in which the machine handles the routine mechanics of problem solving while the user concentrates on its higher order meanings. A closed-loop model of interaction is described, interface as illusion is discussed, and metaphors for human-computer interaction are…

Advance Care Planning: Understanding Clinical Routines and Experiences of Interprofessional Team Members in Diverse Health Care Settings.

PubMed

Arnett, Kelly; Sudore, Rebecca L; Nowels, David; Feng, Cindy X; Levy, Cari R; Lum, Hillary D

2017-12-01

Interprofessional health care team members consider advance care planning (ACP) to be important, yet gaps remain in systematic clinical routines to support ACP. A clearer understanding of the interprofessional team members' perspectives on ACP clinical routines in diverse settings is needed. One hundred eighteen health care team members from community-based clinics, long-term care facilities, academic clinics, federally qualified health centers, and hospitals participated in a 35-question, cross-sectional online survey to assess clinical routines, workflow processes, and policies relating to ACP. Respondents were 53% physicians, 18% advanced practice nurses, 11% nurses, and 18% other interprofessional team members including administrators, chaplains, social workers, and others. Regarding clinical routines, respondents reported that several interprofessional team members play a role in facilitating ACP (ie, physician, social worker, nurse, others). Most (62%) settings did not have, or did not know of, policies related to ACP documentation. Only 14% of settings had a patient education program. Two-thirds of the respondents said that addressing ACP is a high priority and 85% felt that nonphysicians could have ACP conversations with appropriate training. The clinical resources needed to improve clinical routines included training for providers and staff, dedicated staff to facilitate ACP, and availability of patient/family educational materials. Although interprofessional health care team members consider ACP a priority and several team members may be involved, clinical settings lack systematic clinical routines to support ACP. Patient educational materials, interprofessional team training, and policies to support ACP clinical workflows that do not rely solely on physicians could improve ACP across diverse clinical settings.

Poor hospital infection control practice in hand hygiene, glove utilization, and usage of tourniquets.

PubMed

Sacar, Suzan; Turgut, Huseyin; Kaleli, Ilknur; Cevahir, Nural; Asan, Ali; Sacar, Mustafa; Tekin, Koray

2006-11-01

Hospital-acquired infection often occurs because of lapses in accepted standards of practice on the part of health care personnel. The aim of this study is to attract attention on poor hospital infection control practice in venepuncture and use of tourniquets and emphasize the importance of hand hygiene. Overall compliance with hygiene during usage of tourniquets and routine patient care before and after implementation of a hospital infection control measures was evaluated. According to the questionnaire, only 26.9% of respondents always washed their hands both before and after venepuncture. In the second step of the study, based on direct observation, hands were washed both before and after venepuncture on only 41 (45.1%) occasions. Failure to remove gloves after patient contact was observed on 23.1% occasions. Our survey reveals poor infection control practice in hand hygiene, glove utilization, and usage of tourniquets and the implementation of infection control measures produced a moderate improvement in compliance with them.

Wikipedia use: Risk for developing technology addiction.

PubMed

Sharma, Manoj Kumar

2016-01-01

The present case highlights the addictive potential of Wikipedia usage. The users approached a technology addiction clinic for the management of excessive use of technology. A clinical interview was used to elicit information about usages. It indicates the addictive use of Wikipedia and associated dysfunction in lifestyle. It has implication for promotion of healthy use of technology.

Roadmap to clinical use of gold nanoparticles for radiosensitization

PubMed Central

Schuemann, J.; Berbeco, R.; Chithrani, B. D.; Cho, S.; Kumar, R.; McMahon, S.; Sridhar, S.; Krishnan, S.

2015-01-01

The past decade has seen a dramatic increase in interest in the use of Gold Nanoparticles (GNPs) as radiation sensitizers for radiotherapy. This interest was initially driven by their strong absorption of ionizing radiation and the resulting ability to increase dose deposited within target volumes even at relatively low concentrations. These early observations are supported by extensive experimental validation, showing GNPs’ efficacy at sensitizing tumors in both in vitro and in vivo systems to a range of types of ionizing radiation, including kilovoltage and megavoltage X-rays as well as charged particles. Despite this experimental validation, there has been limited translation of GNP-mediated radiosensitization to a clinical setting. One of the key challenges in this area is the wide range of experimental systems that have been investigated, spanning a range of particle sizes, shapes and preparations. As a result, mechanisms of uptake and radiosensitization have remained difficult to clearly identify. This has proven a significant impediment to the identification of optimal GNP formulations which strike a balance among their radiosensitizing properties, their specificity to the tumors, their biocompatibility, and their imageability in vivo. This white paper reviews the current state of knowledge in each of the areas concerning the use of GNPs as radiosensitizers, and outlines the steps which will be required to advance GNP-enhanced radiation therapy from their current pre-clinical setting to clinical trials and eventual routine usage. PMID:26700713

Prevention and treatment of chemotherapy-induced neutropenia with the biosimilar filgrastim: a non-interventional observational study of clinical practice patterns.

PubMed

Tesch, Hans; Ulshöfer, Thomas; Vehling-Kaiser, Ursula; Ottillinger, Bertram; Bulenda, Dietmar; Turner, Matthew

2015-01-01

Biosimilars are similar but non-identical versions of existing biological drugs. The HEXAFIL study was an observational study that assessed the clinical usage, safety and efficacy of the biosimilar filgrastim in routine clinical practice in Germany. A total of 1,337 cancer patients received the biosimilar filgrastim for primary prophylaxis (PP), secondary prophylaxis (SP) or interventional treatment (TX) plus chemotherapy. Data including neutropenic complications and adverse events (AEs) were documented for up to 3 consecutive cycles. In cycle 1, 44.9% of the patients received the biosimilar filgrastim as PP, 31.0% as SP, and 23.6% as TX. Approximately 90% of the patients required no modifications to their chemotherapy regimen, with lower rates among the PP/SP versus the TX patients. Neutropenic complications occurred in 7.9%, 6.9%, and 3.9% of the patients (cycles 1, 2, and 3, respectively). Only 1.8% of the patients experienced febrile neutropenia during cycle 1. Earlier and longer filgrastim treatment reduced grade 3/4 leukopenia and neutropenic complications. The observed safety/tolerability profile was as expected; the most common AE (4.3%) was musculoskeletal back/bone pain. In this observational real-life study of clinical practice, the biosimilar filgrastim was effective and well tolerated, with results consistent with those reported in phase II and phase III trials. © 2015 S. Karger GmbH, Freiburg.

Map projections used by the U.S. Geological Survey

USGS Publications Warehouse

Snyder, John Parr

1982-01-01

With increased computerization, it is important to realize that rectangular coordinates for all these projections may be mathematically calculated with formulas which would have seemed too complicated in the past, but which now may be programed routinely, if clearly delineated with numerical examples. A discussion of appearance, usage, and history is given together with both forward and inverse equations for each projection involved.

A real-time digital computer program for the simulation of a single rotor helicopter

NASA Technical Reports Server (NTRS)

Houck, J. A.; Gibson, L. H.; Steinmetz, G. G.

1974-01-01

A computer program was developed for the study of a single-rotor helicopter on the Langley Research Center real-time digital simulation system. Descriptions of helicopter equations and data, program subroutines (including flow charts and listings), real-time simulation system routines, and program operation are included. Program usage is illustrated by standard check cases and a representative flight case.

Perceptions of Patient Engagement Applications During Pregnancy: A Qualitative Assessment of the Patient’s Perspective

PubMed Central

Goetz, Maren; Müller, Mitho; Matthies, Lina Maria; Hansen, Jenny; Doster, Anne; Szabo, Akos; Pauluschke-Fröhlich, Jan; Abele, Harald; Sohn, Christof

2017-01-01

Background With growing demand for medical information and health applications in pregnancy, the potential of electronic health (eHealth) and mobile health (mHealth) solutions in clinical care is increasingly unfolding. However, we still do not know how pregnant women engage with mobile apps, how such apps impact routine medical care, and whether benefit expectations are met. Whereas recent research has raised the subject of user distribution and analyzed the content of pregnancy applications, there is still a significant knowledge gap regarding what pregnant women like and dislike about pregnancy tools, along with how such interventions could be improved. Objective The aim of the study was to examine the perceptions and expectations of mobile and Web-based patient-engagement pregnancy applications. We assessed usability requirements, general acceptance of eHealth, and the impact of eHealth and mHealth pregnancy applications on the doctor-patient interaction and daily clinical routine. Methods A qualitative study was conducted at the maternity department of a major German university hospital. The sample included 30 women with low- to medium-risk pregnancies. Half of the patients were seen during outpatient care and half were hospitalized for several days. The extent and frequency of Web- and mobile phone app usage were assessed. Semistructured interviews were conducted and analyzed using systematic thematic analysis. Results Patients had a high demand for Web-based pregnancy applications. Study findings suggested a strong request for personalization, monitoring, and accessibility for frequent use as main themes derived from the interviews. Fostering patient empowerment in the doctor-patient relationship was also highly valued for a pregnancy app. Participants favored further integration of medical apps in their daily routine and pregnancy care. However, concerns were raised about content quality, trustworthiness of Web sources, and individual data security. Conclusions eHealth and mHealth applications are a highly frequented source of information. Expectations and usability requirements for those applications are also high, thus posing a challenge to interdisciplinary service providers. Patients’ attitude toward integrating apps in routine care settings was positive with a favorable influence on patient empowerment. Health care professionals should guide pregnant women toward a successful integration of these educational tools in pregnancy care. PMID:28550005

Using routinely recorded data in the UK to assess outcomes in a randomised controlled trial: The Trials of Access.

PubMed

Powell, G A; Bonnett, L J; Tudur-Smith, C; Hughes, D A; Williamson, P R; Marson, A G

2017-08-23

In the UK, routinely recorded data may benefit prospective studies including randomised controlled trials (RCTs). In an on-going study, we aim to assess the feasibility of access and agreement of routinely recorded clinical and non-clinical data compared to data collected during a RCT using standard prospective methods. This paper will summarise available UK routinely recorded data sources and discuss our experience with the feasibility of accessing routinely recorded data for participants of a RCT before finally proposing recommendations for improving the access and implementation of routinely recorded data in RCTs. Setting: the case study RCT is the Standard and New Antiepileptic Drugs II (SANAD II) trial, a pragmatic, UK, multicentre, phase IV RCT assessing the clinical and cost-effectiveness of antiepileptic drug treatments for newly diagnosed epilepsy. 98 participants have provided written consent to permit the request of routinely recorded data. Study procedures: routinely recorded clinical and non-clinical data were identified and data requested through formal applications from available data holders for the duration that participants have been recruited into SANAD II. The feasibility of accessing routinely recorded data during a RCT is assessed and recommendations for improving access proposed. Secondary-care clinical and socioeconomic data is recorded on a national basis and can be accessed, although there are limitations in the application process. Primary-care data are recorded by a number of organisations on a de-identified basis but access for specific individuals has not been feasible. Access to data recorded by non-clinical sources, including The Department for Work and Pensions and The Driving and Vehicle Licensing Agency, was not successful. Recommendations discussed include further research to assess the attributes of routinely recorded data, an assessment of public perceptions and the development of strategies to collaboratively improve access to routinely recorded data for research. International Standard Randomised Controlled Trials, ISRCTN30294119 . Registered on 3 July 2012. EudraCT No: 2012-001884-64. Registered on 9 May 2012.

Multinational institutional survey on patterns of intraoperative transesophageal echocardiography use in adult cardiac surgery.

PubMed

Dobbs, Heather A; Bennett-Guerrero, Elliott; White, William; Shernan, Stanton K; Nicoara, Alina; Del Rio, J Mauricio; Stafford-Smith, Mark; Swaminathan, Madhav

2014-02-01

To assess institutional patterns of perioperative transesophageal echocardiography (TEE) usage. The authors hypothesized that TEE is performed more frequently and comprehensively in academic centers, mainly by anesthesiologists, and barriers to performing TEE are due to inadequate resources. A survey was deployed to selected participants. Collated responses were assessed for demographic patterns in TEE practice, and 2-category comparisons were made with Chi-squared association tests. Web-based survey. Practitioners in cardiovascular anesthesia/surgery in 200 institutions. None. Surveys were completed by respondents representing 200 centers in 27 countries and 1,727 anesthesiologists with a mean annual institutional volume of 924 cases. Most centers were in the USA (53%) and were defined as academic (83%). Anesthesiologists performed (85%) and also read/reported TEEs (78%) in most centers. Three-dimensional TEE is performed routinely at 40% of centers. TEE is used routinely for valve surgery in 95% of institutions compared to 68% for coronary artery bypass graft surgery. Academic institutions assessed diastolic function more often than nonacademic centers (46% v 19%; p = 0.006). The most important reason cited for not using TEE in all cases was insufficient resource availability (47%). These results suggest that TEE is performed more comprehensively in academic centers, mainly by anesthesiologists, and that lack of resources is a significant barrier to routine TEE usage. TEE is used more often for valve surgery than for coronary artery bypass graft surgery, and many centers use 3D TEE. This survey describes international TEE practice patterns and identifies limitations to universal adoption of TEE in cardiac surgery. © 2013 Elsevier Inc. All rights reserved.

SPIRIT: Systematic Planning of Intelligent Reuse of Integrated Clinical Routine Data. A Conceptual Best-practice Framework and Procedure Model.

PubMed

Hackl, W O; Ammenwerth, E

2016-01-01

Secondary use of clinical routine data is receiving an increasing amount of attention in biomedicine and healthcare. However, building and analysing integrated clinical routine data repositories are nontrivial, challenging tasks. As in most evolving fields, recognized standards, well-proven methodological frameworks, or accurately described best-practice approaches for the systematic planning of solutions for secondary use of routine medical record data are missing. We propose a conceptual best-practice framework and procedure model for the systematic planning of intelligent reuse of integrated clinical routine data (SPIRIT). SPIRIT was developed based on a broad literature overview and further refined in two case studies with different kinds of clinical routine data, including process-oriented nursing data from a large hospital group and high-volume multimodal clinical data from a neurologic intensive care unit. SPIRIT aims at tailoring secondary use solutions to specific needs of single departments without losing sight of the institution as a whole. It provides a general conceptual best-practice framework consisting of three parts: First, a secondary use strategy for the whole organization is determined. Second, comprehensive analyses are conducted from two different viewpoints to define the requirements regarding a clinical routine data reuse solution at the system level from the data perspective (BOTTOM UP) and at the strategic level from the future users perspective (TOP DOWN). An obligatory clinical context analysis (IN BETWEEN) facilitates refinement, combination, and integration of the different requirements. The third part of SPIRIT is dedicated to implementation, which comprises design and realization of clinical data integration and management as well as data analysis solutions. The SPIRIT framework is intended to be used to systematically plan the intelligent reuse of clinical routine data for multiple purposes, which often was not intended when the primary clinical documentation systems were implemented. SPIRIT helps to overcome this gap. It can be applied in healthcare institutions of any size or specialization and allows a stepwise setup and evolution of holistic clinical routine data reuse solutions.

Patients' use of digital audio recordings in four different outpatient clinics.

PubMed

Wolderslund, Maiken; Kofoed, Poul-Erik; Holst, René; Ammentorp, Jette

2015-12-01

To investigate a new technology of digital audio recording (DAR) of health consultations to provide knowledge about patients' use and evaluation of this recording method. A cross-sectional feasibility analysis of the intervention using log data from the recording platform and data from a patient-administered questionnaire. Four different outpatient clinics at a Danish hospital: Paediatrics, Orthopaedics, Internal Medicine and Urology. Two thousand seven hundred and eighty-four outpatients having their consultation audio recorded by one of 49 participating health professionals. DAR of outpatient consultations provided to patients permitting replay of their consultation either alone or together with their relatives. Replay of the consultation within 90 days from the consultation. In the adult outpatient clinics, one in every three consultations was replayed; however, the rates were significantly lower in the paediatric clinic where one in five consultations was replayed. The usage of the audio recordings was positively associated with increasing patient age and first time visits to the clinic. Patient gender influenced replays in different ways; for instance, relatives to male patients replayed recordings more often than relatives to female patients did. Approval of future recordings was high among the patients who replayed the consultation. Patients found that recording health consultations was an important information aid, and the digital recording technology was found to be feasible in routine practice. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

The utility of decision support, clinical guidelines, and financial incentives as tools to achieve improved clinical performance.

PubMed

Goldfarb, S

1999-03-01

Whether one seeks to reduce inappropriate utilization of resources, improve diagnostic accuracy, increase utilization of effective therapies, or reduce the incidence of complications, the key to change is physician involvement in change. Unfortunately, a simple approach to the problem of inducing change in physician behavior is not available. There is a generally accepted view that expert, best-practice guidelines will improve clinical performance. However, there may be a bias to report positive results and a lack of careful analysis of guideline usage in routine practice in a "postmarketing" study akin to that seen in the pharmaceutical industry. Systems that allow the reliable assessment of quality of outcomes, efficiency of resource utilization, and accurate assessment of the risks associated with the care of given patient populations must be widely available before deciding whether an incentive-based system for providing the full range of medical care is feasible. Decision support focuses on providing information, ideally at the "point of service" and in the context of a particular clinical situation. Rules are self-imposed by physicians and are therefore much more likely to be adopted. As health care becomes corporatized, with increasing numbers of physicians employed by large organizations with the capacity to provide detailed information on the nature and quality of clinical care, it is possible that properly constructed guidelines, appropriate financial incentives, and robust forms of decision support will lead to a physician-led, process improvement approach to more rational and affordable health care.

A testing machine for dental air-turbine handpiece characteristics: free-running speed, stall torque, bearing resistance.

PubMed

Darvell, Brain W; Dyson, J E

2005-01-01

The measurement of performance characteristics of dental air turbine handpieces is of interest with respect to product comparisons, standards specifications and monitoring of bearing longevity in clinical service. Previously, however, bulky and expensive laboratory equipment was required. A portable test machine is described for determining three key characteristics of dental air-turbine handpieces: free-running speed, stall torque and bearing resistance. It relies on a special circuit design for performing a hardware integration of a force signal with respect to rotational position, independent of the rate at which the turbine is allowed to turn during both stall torque and bearing resistance measurements. Free-running speed without the introduction of any imbalance can be readily monitored. From the essential linear relationship between torque and speed, dynamic torque and, hence, power, can then be calculated. In order for these measurements to be performed routinely with the necessary precision of location on the test stage, a detailed procedure for ensuring proper gripping of the handpiece is described. The machine may be used to verify performance claims, standard compliance checks should this be established as appropriate, monitor deterioration with time and usage in the clinical environment and for laboratory investigation of design development.

RFA Guardian: Comprehensive Simulation of Radiofrequency Ablation Treatment of Liver Tumors.

PubMed

Voglreiter, Philip; Mariappan, Panchatcharam; Pollari, Mika; Flanagan, Ronan; Blanco Sequeiros, Roberto; Portugaller, Rupert Horst; Fütterer, Jurgen; Schmalstieg, Dieter; Kolesnik, Marina; Moche, Michael

2018-01-15

The RFA Guardian is a comprehensive application for high-performance patient-specific simulation of radiofrequency ablation of liver tumors. We address a wide range of usage scenarios. These include pre-interventional planning, sampling of the parameter space for uncertainty estimation, treatment evaluation and, in the worst case, failure analysis. The RFA Guardian is the first of its kind that exhibits sufficient performance for simulating treatment outcomes during the intervention. We achieve this by combining a large number of high-performance image processing, biomechanical simulation and visualization techniques into a generalized technical workflow. Further, we wrap the feature set into a single, integrated application, which exploits all available resources of standard consumer hardware, including massively parallel computing on graphics processing units. This allows us to predict or reproduce treatment outcomes on a single personal computer with high computational performance and high accuracy. The resulting low demand for infrastructure enables easy and cost-efficient integration into the clinical routine. We present a number of evaluation cases from the clinical practice where users performed the whole technical workflow from patient-specific modeling to final validation and highlight the opportunities arising from our fast, accurate prediction techniques.

TOPICAL TREATMENT OF MELASMA

PubMed Central

Bandyopadhyay, Debabrata

2009-01-01

Melasma is a common hypermelanotic disorder affecting the face that is associated with considerable psychological impacts. The management of melasma is challenging and requires a long-term treatment plan. In addition to avoidance of aggravating factors like oral pills and ultraviolet exposure, topical therapy has remained the mainstay of treatment. Multiple options for topical treatment are available, of which hydroquinone (HQ) is the most commonly prescribed agent. Besides HQ, other topical agents for which varying degrees of evidence for clinical efficacy exist include azelaic acid, kojic acid, retinoids, topical steroids, glycolic acid, mequinol, and arbutin. Topical medications modify various stages of melanogenesis, the most common mode of action being inhibition of the enzyme, tyrosinase. Combination therapy is the preferred mode of treatment for the synergism and reduction of untoward effects. The most popular combination consists of HQ, a topical steroid, and retinoic acid. Prolonged HQ usage may lead to untoward effects like depigmentation and exogenous ochronosis. The search for safer alternatives has given rise to the development of many newer agents, several of them from natural sources. Well-designed controlled clinical trials are needed to clarify their role in the routine management of melasma. PMID:20101327

Social influences on the duration of antibiotic treatment of clinical mastitis in dairy cows.

PubMed

Swinkels, J M; Hilkens, A; Zoche-Golob, V; Krömker, V; Buddiger, M; Jansen, J; Lam, T J G M

2015-04-01

Clinical mastitis of dairy cows is a visible inflammation of the udder, which is usually caused by bacteria and treated with antibiotics. Although pressure is increasing to reduce antibiotic usage in livestock in the European Union, feedback from the field suggests that clinical mastitis treatment is frequently repeated after the initial per-label treatment, thereby extending treatment duration. The aim of this study was to explore the social factors influencing farmers' decision-making on the duration of antibiotic treatment of clinical mastitis. In total, 38 dairy farmers in the Netherlands (n=17) and Germany (n=21) were interviewed in a qualitative semi-structured way. Extended treatment was defined as any treatment longer than that given in label directions. Of the 38 farmers, 30 reported routine and 7 occasional extended antibiotic treatment. The interviewed farmers were sensitive toward social norms of other farmers and recognition for good stockmanship. Extended treatment is perceived as part of the social norm of "being a good farmer." The participants' perception was that mastitis is not treated "thoroughly" if clinical symptoms were still visible at the time of cessation of treatment, because it may persist or recur. As a result, treatment was frequently extended by repeating the initial label treatment. Farmers, specifically the more "cow-oriented" farmers, expressed insecurity on how to treat mastitis effectively. This insecurity made them more sensitive to comply with other farmers' injunctive ("what ought to be") and descriptive ("what is done") norms and the perceived veterinarians' informational norm that extended treatment is better, resulting in an approved social norm. Social approval reduces the insecurity of being perceived as a poor farmer; thus, extended treatment is emotionally rewarded. This social reward apparently outweighs the higher costs of more waste milk and more antibiotic usage. Perceived positive reference groups with whom the farmer identifies and regularly communicates face to face, such as other farmers, the herd veterinarian, and other farm advisors, confirm the farmer's judgment on extending treatment and influences him or her toward socially accepted behavior. Society was the most negative reference group, barely influencing farmers' decision-making on treatment. The emotional gap between farmers and society is large and probably difficult to overcome. Legislation may reduce antibiotic usage, if doable and controllable. Evidence-based information on treatment efficacy or practical on-farm decision support indicating when to end treatment may be able to change social norms of "thorough" treatment, especially when communicated by a positive reference group such as veterinarians. Because prudent antibiotic use is hindered by perceived subjective norms on optimal duration of antibiotic treatment, more research is needed, particularly on the optimal duration of antibiotic treatment of specific pathogens as related to cure and recurrence of clinical mastitis. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Efficacy and effectiveness of tumour necrosis factor inhibitors in the treatment of rheumatoid arthritis in randomized controlled trials and routine clinical practice.

PubMed

Aaltonen, Kalle J; Ylikylä, Suvi; Tuulikki Joensuu, Jaana; Isomäki, Pia; Pirilä, Laura; Kauppi, Markku; Rannio, Tuomas; Eklund, Kari; Blom, Marja; Nordström, Dan

2017-05-01

Efficacy of TNF inhibitors in the treatment of RA assessed in randomized controlled trials (RCTs) may not be fully comparable to routine care owing to the stringent inclusion criteria. The objective of this study was to observe the effectiveness of TNF inhibitors in real-world patients and assess the patients' potential eligibility for the RCTs. RA patients starting a TNF-inhibitor treatment between 2004 and 2014 were identified from the National Register for Biologic Treatment in Finland, which is a longitudinal observational cohort study. Effectiveness was measured using the ACR and EULAR response criteria and by studying the proportion of patients reaching DAS28 remission. The patients' baseline characteristics were compared against the inclusion criteria of 27 RCTs. EULAR moderate and good treatment responses at 6 months were achieved by 69 and 40% of the users of the first TNF inhibitor, respectively. ACR20, ACR50 and ACR70 responses were reached by 48, 27 and 13%, respectively. DAS28 remission was reached by 47%. Only 7.6-44% of the patients would have been potentially eligible for the RCTs. The eligible patients had better treatment responses compared with the non-eligible patients. Different TNF inhibitors were mostly equipotent, but the usage of MTX co-therapy had a major influence on treatment response. Only a small proportion of patients would have been eligible for RCTs, and the efficacy of TNF inhibitors assessed in them cannot be generalized directly into Finnish routine health care. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials.

PubMed

Kotronoulas, Grigorios; Kearney, Nora; Maguire, Roma; Harrow, Alison; Di Domenico, David; Croy, Suzanne; MacGillivray, Stephen

2014-05-10

The systematic use of patient-reported outcome measures (PROMs) has been advocated as an effective way to standardize cancer practice. Yet, the question of whether PROMs can lead to actual improvements in the quality of patient care remains under debate. This review examined whether inclusion of PROM in routine clinical practice is associated with improvements in patient outcomes, processes of care, and health service outcomes during active anticancer treatment. A systematic review of five electronic databases (Medline, EMBASE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], PsycINFO, and Psychology and Behavioral Sciences Collection [PBSC]) was conducted from database inception to May 2012 to locate randomized and nonrandomized controlled trials of patients receiving active anticancer treatment or supportive care irrespective of type of cancer. Based on prespecified eligibility criteria, we included 26 articles that reported on 24 unique controlled trials. Wide variability in the design and use of interventions delivered, outcomes evaluated, and cancer- and modality-specific context was apparent. Health service outcomes were only scarcely included as end points. Overall, the number of statistically significant findings were limited and PROMs' intervention effect sizes were predominantly small-to-moderate. The routine use of PROMs increases the frequency of discussion of patient outcomes during consultations. In some studies, PROMs are associated with improved symptom control, increased supportive care measures, and patient satisfaction. Additional effort is required to ensure patient adherence, as well as additional support to clinicians who will respond to patient concerns and issues, with clear system guidelines in place to guide their responses. More research is required to support PROM cost-benefit in terms of patient safety, clinician burden, and health services usage.

Dysport (botulinum toxin type A) in routine therapeutic usage: a telephone needs assessment survey of European physicians to evaluate current awareness and adherence to product labeling changes.

PubMed

Hubble, Jean; Schwab, Joseph; Hubert, Catherine; Abbott, Chandra Coleman

2013-01-01

Botulinum neurotoxin type A is a well-established treatment for a number of conditions involving muscle hyperactivity. Dysport (Ipsen Ltd, Wrexham, United Kingdom) is a botulinum neurotoxin type A preparation that has been available for a number of therapeutic uses for over 20 years in the European Union (EU). This survey was part of the EU botulinum toxin risk management plan to identify potential educational needs of injectors by collecting data on their routine practice administration of Dysport and their awareness of potential adverse events (AEs) that are included in the current product labeling. Dysport-experienced injectors in 5 EU countries were surveyed via telephone about their experience of Dysport in patients with cervical dystonia, adult upper and lower limb spasticity, pediatric cerebral palsy, and blepharospasm/hemifacial spasm. The reconstitution dilution volume most often used was 2.5 mL per 500 U for all indications. The mean total dose ranged from 387 to 530 U for cervical dystonia, 508 to 773 U for upper limb spasticity, 600 to 832 U for lower limb spasticity, 375 to 700 U for pediatric cerebral palsy, and 54 to 213 U for blepharospasm/hemifacial spasm. The potential AEs most commonly mentioned by surveyed physicians were dysphagia for cervical dystonia, arm muscle weakness for upper limb spasticity, leg muscle weakness for lower limb spasticity, and pediatric cerebral palsy and ptosis for blepharospasm/hemifacial spasm. The results indicate that product-labeling recommendations are generally applied in clinical practice and that there is a good familiarity with potential AEs based on clinical condition. Nevertheless, the survey shows that experienced injectors do sometimes deviate from the manufacturers labeling recommendations, highlighting the importance of ongoing education.

[Circulatory Function Tests for Home & Community Use.

PubMed

Shimetani, Naoto

2016-05-01

Currently, the main circulatory function-testing tools for home use are blood pressure monitors and elec- trocardiography devices. Just like blood pressure monitors that are already widespread for home use, some devices with an electrocardiographic function have recently become available for purchase for personal use by the general public. On the other hand, clinic equipment on loan from doctors to patients in need can perform circulatory function tests like 24-hour ambulatory blood pressure monitoring (ABPM), Holter monitoring, and real-time electrocardiography. We introduce the actual clinical usage of ABPM and real-time electro- cardiography, and discuss the usefulness of these procedures. ABPM uses a blood pressure measurement device worn on the body for 24 hours a day to measure blood pressure at regular intervals. This makes it possible to check blood pressure changes throughout the day in a way in which conventional home-use blood pressure monitors cannot, like during sleep. This method al- lows the identification of masked hypertension like early-morning and nocturnal hypertension, stress hyper- tension including workplace hypertension, and white coat hypertension that only occurs in the doctor's office. Under routine care, there are few opportunities to perform electrocardiography at the time a patient is experiencing symptoms. Now, real-time electrocardiography has begun to be used in routine care, and pa- tients can record an electrocardiogram by themselves anytime, anywhere, and send the data by telephone or the Internet for analysis and diagnosis. Transmission-capable electrocardiography devices can play an im- portant role in the event of dangerous symptoms like arrhythmia, angina, or acute myocardial infarction. The spread of ABPM and event heart monitors is likely to make the early treatment and prevention of stroke and heart disease possible. We are expecting rapid development in this field in the future.

Evaluation of computer usage in healthcare among private practitioners of NCT Delhi.

PubMed

Ganeshkumar, P; Arun Kumar, Sharma; Rajoura, O P

2011-01-01

1. To evaluate the usage and the knowledge of computers and Information and Communication Technology in health care delivery by private practitioners. 2. To understand the determinants of computer usage by them. A cross sectional study was conducted among the private practitioners practising in three districts of NCT of Delhi between November 2007 and December 2008 by stratified random sampling method, where knowledge and usage of computers in health care and determinants of usage of computer was evaluated in them by a pre-coded semi open ended questionnaire. About 77% of the practitioners reported to have a computer and had the accessibility to internet. Computer availability and internet accessibility was highest among super speciality practitioners. Practitioners who attended a computer course were 13.8 times [OR: 13.8 (7.3 - 25.8)] more likely to have installed an EHR in the clinic. Technical related issues were the major perceived barrier in installing a computer in the clinic. Practice speciality, previous attendance of a computer course, age of started using a computer influenced the knowledge about computers. Speciality of the practice, presence of a computer professional and gender were the determinants of usage of computer.

Posterior pharyngeal candidiasis in the absence of clinically overt oral involvement: a cross-sectional study.

PubMed

Glavey, Siobhan V; Keane, Niamh; Power, Maria; O'Regan, Anthony W

2013-12-01

Although oropharyngeal candidiasis is associated with inhaled corticosteroid (ICS) usage, there is sparse data on the prevalence of posterior pharyngeal candidiasis in those without any detectable oral candidiasis on clinical examination. We systematically investigated the relationship between oral candidiasis on clinical examination and the presence of posterior pharyngeal candidiasis at bronchoscopy. We conducted a cross-sectional study on a convenience sample of 100 patients undergoing bronchoscopy at our institution. Patients were assessed for symptoms of and risk factors for candida infection and had an examination of their oropharynx for evidence of candidiasis before bronchoscopy. They subsequently had a detailed assessment for posterior candidiasis at bronchoscopy. We performed a posteriori subgroup analysis, which focused solely on those patients on ICS maintenance therapy. Median age was 54.7 (27-84) years, and 55 patients were male; 47 % of patients were on ICS, and 20 % of this cohort received recent oral corticosteroids. Twenty-eight percent of this convenience sample had posterior pharyngeal candidiasis; however, only 10.7 % (3/28) of these patients had clinically detectable oral candidiasis on clinical examination before bronchoscopy. Factors that were independently associated with the presence of pharyngeal candidiasis at bronchoscopy were OR (95 % CI) ICS usage 6.9 (2.5-19.2), particularly fluticasone usage 6.8 (2.62-17.9) and the presence of dysphonia 3.2 (1.3-8.0). In the subgroup analysis of ICS usage, posterior pharyngeal candidiasis was correlated with the presence of dysphonia but was not independently associated with fluticasone or budesonide dosage. This study demonstrates that posterior pharyngeal candidiasis in the absence of clinically overt oral candidiasis is frequent amongst ICS users. A history of ICS use, particularly fluticasone usage, as well as the presence of dysphonia are associated with posterior pharyngeal candidiasis at bronchoscopy, even in the absence of clinically overt oral involvement.

[Use of Reusable Textile Undergloves for Medical Procedures: A Feasibility Study].

PubMed

Hübner, N-O; Rubbert, K; Pohrt, U; Heidecke, C-D; Partecke, L I; Kramer, A

2016-02-01

Undergloves are a way to reduce moisture-related skin damage. The aim of this feasibility study was to gain experience with logistics, applicability, acceptability and cost of the routine use of reusable textile undergloves in a hospital setting. Undergloves were tested with 18 health-care workers on an intensive care unit over three months. Data on usage as well as logistics were recorded. At baseline, personal data and knowledge and use of cotton undergloves, existing skin problems and the nursing behaviour of the hands by the subjects were determined by means of an input questionnaire. After each wearing, data on usage were collected by a questionnaire. Participants were interviewed by means of a questionnaire with respect to their experience with the use of the undergloves. Acceptance and compliance with the use of undergloves was remarkably good. This was partly due to the properties of the gloves, and partly to the reduction of sweating and very positive effect on the skin of the hands. In the study period 2165 underglove uses were documented, resulting in an average daily consumption of four pairs per person per day. The average wearing time was 28.6 min. The undergloves were suitable for application as well as reprocessing. Reprocessment-related fatigue was relatively low and did not lead to the loss of the properties, only few gloves had to be sorted out. Even if one assumes a complete write-off of the gloves with end of the study, costs for reprocessing were about 0.46 € or 64 % less than the single use. The routine use of textile, reprocessable undergloves is feasible. Major challenges for broad usage are within logistics and acceptance by the user. Georg Thieme Verlag KG Stuttgart · New York.

Sing, muse: songs in Homer and in hospital.

PubMed

Marshall, Robert; Bleakley, Alan

2011-06-01

This paper progresses the original argument of Richard Ratzan that formal presentation of the medical case history follows a Homeric oral-formulaic tradition.The everyday work routines of doctors involve a ritual poetics, where the language of recounting the patient’s ‘history’ offers an explicitly aesthetic enactment or performance that can be appreciated and given meaning within the historical tradition of Homeric oral poetry and the modernist aesthetic of Minimalism. This ritual poetics shows a reliance on traditional word usages that crucially act as tools for memorisation and performance and can be linked to forms of clinical reasoning; both contain a tension between the oral and the written record, questioning the priority of the latter; and the performance of both helps to create the Janus-faced identity of the doctor as a ‘performance artist’ or ‘medical bard’ in identifying with medical culture and maintaining a positive difference from the patient as audience, offering a valid form of patient-centredness.

Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage.

PubMed

Chen, Ying; Bruning, Elizabeth; Rubino, Joseph; Eder, Scott E

2017-12-01

Women use various feminine hygiene products, often as part of their daily cleansing routine; however, there is a paucity of published medical literature related to the external vulva and how personal hygiene practices can affect it. This review article provides background information on the physiological changes that occur during women's lives and reviews the relevance of transient and resident microbiota as they relate to common vaginal and vulvar disorders. It also discusses the need for female intimate hygiene, common practices of feminine hygiene from a global perspective, and the potential benefits of using suitable external, topical feminine vulvar washes to minimize the risk of vulvovaginal disorders and to improve overall intimate health in women around the world. Supported by international guidelines, daily gentle cleansing of the vulva is an important aspect of feminine hygiene and overall intimate health. Women should be encouraged to choose a carefully formulated and clinically tested external wash that provides targeted antimicrobial and other health benefits without negatively impacting on the natural vulvovaginal microbiota.

A parameter estimation subroutine package

NASA Technical Reports Server (NTRS)

Bierman, G. J.; Nead, W. M.

1977-01-01

Linear least squares estimation and regression analyses continue to play a major role in orbit determination and related areas. FORTRAN subroutines have been developed to facilitate analyses of a variety of parameter estimation problems. Easy to use multipurpose sets of algorithms are reported that are reasonably efficient and which use a minimal amount of computer storage. Subroutine inputs, outputs, usage and listings are given, along with examples of how these routines can be used.

Feasibility of extended use of an electromagnetic lithotripter beyond the manufacturer's recommended maintenance schedule.

PubMed

Chen, Tony Y H; Ponsot, Yves; Brouillette, Martin; Tétrault, Jean-Píerre; Tu, Le Mai

2007-06-01

The study evaluates the effect of chronic usage, beyond the recommended maintenance schedule, on the efficacy of electromagnetic lithotripter. To our knowledge, there is no publication investigating the effect of chronic usage on the electromagnetic lithotripter, despite the maintenance schedule established by the manufacturers. Our goal is to verify if the acoustic parameters of the shock wave changed with usage, and if this change could be associated with change in clinical efficacy. This study lasted 18 months. Every 6 months the lithotripter's efficacy was evaluated in two ways: objectively and clinically. Objective efficacy was measured using a piezoelectric hydrophone and artificial stones to capture the acoustic parameters and the crater of fragmentation, respectively. Clinical efficacy data was collected by studying the rate of successful extracorporeal shock wave lithotripsy treatment in patients with urolithiasis. The changes in clinical efficacy, acoustic parameters, and craters of fragmentation were compared and analyzed with appropriate statistical methods. Five hundred twenty five patients participated in the study. The clinical efficacy remained stable throughout the three observation periods (55.7%, 66.2% and 55.5%; p = 0.11). The focal head of the lithotripter was used three times the recommended schedule. There was no obvious change in the acoustic parameters of the shock waves, and the focal zone remained stable. The clinical efficacy of the electromagnetic lithotripter appears to be stable despite usage beyond the recommended maintenance schedule. More studies are needed to validate the safety of this practice.

Do mental health professionals use diagnostic classifications the way we think they do? A global survey

PubMed Central

First, Michael B.; Rebello, Tahilia J.; Keeley, Jared W.; Bhargava, Rachna; Dai, Yunfei; Kulygina, Maya; Matsumoto, Chihiro; Robles, Rebeca; Stona, Anne‐Claire; Reed, Geoffrey M.

2018-01-01

We report on a global survey of diagnosing mental health professionals, primarily psychiatrists, conducted as a part of the development of the ICD‐11 mental and behavioural disorders classification. The survey assessed these professionals' use of various components of the ICD‐10 and the DSM, their attitudes concerning the utility of these systems, and usage of “residual” (i.e., “other” or “unspecified”) categories. In previous surveys, most mental health professionals reported they often use a formal classification system in everyday clinical work, but very little is known about precisely how they are using those systems. For example, it has been suggested that most clinicians employ only the diagnostic labels or codes from the ICD‐10 in order to meet administrative requirements. The present survey was conducted with clinicians who were members of the Global Clinical Practice Network (GCPN), established by the World Health Organization as a tool for global participation in ICD‐11 field studies. A total of 1,764 GCPN members from 92 countries completed the survey, with 1,335 answering the questions with reference to the ICD‐10 and 429 to the DSM (DSM‐IV, DSM‐IV‐TR or DSM‐5). The most frequent reported use of the classification systems was for administrative or billing purposes, with 68.1% reporting often or routinely using them for that purpose. A bit more than half (57.4%) of respondents reported often or routinely going through diagnostic guidelines or criteria systematically to determine whether they apply to individual patients. Although ICD‐10 users were more likely than DSM‐5 users to utilize the classification for administrative purposes, other differences were either slight or not significant. Both classifications were rated to be most useful for assigning a diagnosis, communicating with other health care professionals and teaching, and least useful for treatment selection and determining prognosis. ICD‐10 was rated more useful than DSM‐5 for administrative purposes. A majority of clinicians reported using “residual” categories at least sometimes, with around 12% of ICD‐10 users and 19% of DSM users employing them often or routinely, most commonly for clinical presentations that do not conform to a specific diagnostic category or when there is insufficient information to make a more specific diagnosis. These results provide the most comprehensive available information about the use of diagnostic classifications of mental disorders in ordinary clinical practice. PMID:29856559

Do mental health professionals use diagnostic classifications the way we think they do? A global survey.

PubMed

First, Michael B; Rebello, Tahilia J; Keeley, Jared W; Bhargava, Rachna; Dai, Yunfei; Kulygina, Maya; Matsumoto, Chihiro; Robles, Rebeca; Stona, Anne-Claire; Reed, Geoffrey M

2018-06-01

We report on a global survey of diagnosing mental health professionals, primarily psychiatrists, conducted as a part of the development of the ICD-11 mental and behavioural disorders classification. The survey assessed these professionals' use of various components of the ICD-10 and the DSM, their attitudes concerning the utility of these systems, and usage of "residual" (i.e., "other" or "unspecified") categories. In previous surveys, most mental health professionals reported they often use a formal classification system in everyday clinical work, but very little is known about precisely how they are using those systems. For example, it has been suggested that most clinicians employ only the diagnostic labels or codes from the ICD-10 in order to meet administrative requirements. The present survey was conducted with clinicians who were members of the Global Clinical Practice Network (GCPN), established by the World Health Organization as a tool for global participation in ICD-11 field studies. A total of 1,764 GCPN members from 92 countries completed the survey, with 1,335 answering the questions with reference to the ICD-10 and 429 to the DSM (DSM-IV, DSM-IV-TR or DSM-5). The most frequent reported use of the classification systems was for administrative or billing purposes, with 68.1% reporting often or routinely using them for that purpose. A bit more than half (57.4%) of respondents reported often or routinely going through diagnostic guidelines or criteria systematically to determine whether they apply to individual patients. Although ICD-10 users were more likely than DSM-5 users to utilize the classification for administrative purposes, other differences were either slight or not significant. Both classifications were rated to be most useful for assigning a diagnosis, communicating with other health care professionals and teaching, and least useful for treatment selection and determining prognosis. ICD-10 was rated more useful than DSM-5 for administrative purposes. A majority of clinicians reported using "residual" categories at least sometimes, with around 12% of ICD-10 users and 19% of DSM users employing them often or routinely, most commonly for clinical presentations that do not conform to a specific diagnostic category or when there is insufficient information to make a more specific diagnosis. These results provide the most comprehensive available information about the use of diagnostic classifications of mental disorders in ordinary clinical practice. © 2018 World Psychiatric Association.

Structuring clinical workflows for diabetes care: an overview of the OntoHealth approach.

PubMed

Schweitzer, M; Lasierra, N; Oberbichler, S; Toma, I; Fensel, A; Hoerbst, A

2014-01-01

Electronic health records (EHRs) play an important role in the treatment of chronic diseases such as diabetes mellitus. Although the interoperability and selected functionality of EHRs are already addressed by a number of standards and best practices, such as IHE or HL7, the majority of these systems are still monolithic from a user-functionality perspective. The purpose of the OntoHealth project is to foster a functionally flexible, standards-based use of EHRs to support clinical routine task execution by means of workflow patterns and to shift the present EHR usage to a more comprehensive integration concerning complete clinical workflows. The goal of this paper is, first, to introduce the basic architecture of the proposed OntoHealth project and, second, to present selected functional needs and a functional categorization regarding workflow-based interactions with EHRs in the domain of diabetes. A systematic literature review regarding attributes of workflows in the domain of diabetes was conducted. Eligible references were gathered and analyzed using a qualitative content analysis. Subsequently, a functional workflow categorization was derived from diabetes-specific raw data together with existing general workflow patterns. This paper presents the design of the architecture as well as a categorization model which makes it possible to describe the components or building blocks within clinical workflows. The results of our study lead us to identify basic building blocks, named as actions, decisions, and data elements, which allow the composition of clinical workflows within five identified contexts. The categorization model allows for a description of the components or building blocks of clinical workflows from a functional view.

Structuring Clinical Workflows for Diabetes Care

PubMed Central

Lasierra, N.; Oberbichler, S.; Toma, I.; Fensel, A.; Hoerbst, A.

2014-01-01

Summary Background Electronic health records (EHRs) play an important role in the treatment of chronic diseases such as diabetes mellitus. Although the interoperability and selected functionality of EHRs are already addressed by a number of standards and best practices, such as IHE or HL7, the majority of these systems are still monolithic from a user-functionality perspective. The purpose of the OntoHealth project is to foster a functionally flexible, standards-based use of EHRs to support clinical routine task execution by means of workflow patterns and to shift the present EHR usage to a more comprehensive integration concerning complete clinical workflows. Objectives The goal of this paper is, first, to introduce the basic architecture of the proposed OntoHealth project and, second, to present selected functional needs and a functional categorization regarding workflow-based interactions with EHRs in the domain of diabetes. Methods A systematic literature review regarding attributes of workflows in the domain of diabetes was conducted. Eligible references were gathered and analyzed using a qualitative content analysis. Subsequently, a functional workflow categorization was derived from diabetes-specific raw data together with existing general workflow patterns. Results This paper presents the design of the architecture as well as a categorization model which makes it possible to describe the components or building blocks within clinical workflows. The results of our study lead us to identify basic building blocks, named as actions, decisions, and data elements, which allow the composition of clinical workflows within five identified contexts. Conclusions The categorization model allows for a description of the components or building blocks of clinical workflows from a functional view. PMID:25024765

Pulsed radiofrequency for occipital neuralgia.

PubMed

Manolitsis, Nicholas; Elahi, Foad

2014-01-01

The clinical application of pulsed radiofrequency (PRF) by interventional pain physicians for a variety of chronic pain syndromes, including occipital neuralgia, is growing. As a minimally invasive percutaneous technique with none to minimal neurodestruction and a favorable side effect profile, use of PRF as an interventional neuromodulatory chronic pain treatment is appealing. Occipital neuralgia, also known as Arnold's neuralgia, is defined by the International Headache Society as a paroxysmal, shooting or stabbing pain in the greater, lesser, and/or third occipital nerve distributions. Pain intensity is often severe and debilitating, with an associated negative impact upon quality of life and function. Most cases of occipital neuralgia are idiopathic, with no clearly identifiable structural etiology. Treatment of occipital neuralgia poses inherent challenges as no criterion standard exists. Initially, conservative treatment options such as physical therapy and pharmacotherapy are routinely trialed. When occipital neuralgia is refractory to conservative measures, a number of interventional treatment options exist, including: local occipital nerve anesthetic and corticosteroid infiltration, botulinum toxin A injection, occipital nerve subcutaneous neurostimulation, and occipital nerve PRF. Of these, PRF has garnered significant interest as a potentially superior, safe, non-invasive treatment with long-term efficacy. The objective of this article is to provide a concise review of occipital neuralgia; and a concise, yet thorough, evidence-based review of the current literature concerning the use of PRF for occipital neuralgia. Review of published medical literature up through April 2013. The Center for Pain Medicine and Regional Anesthesia, the University of Iowa Hospitals and Clinics. A total of 3 clinical studies and one case report investigating the use of PRF for knee occipital neuralgia have been published worldwide. Statistically significant improvements in pain, quality of life, and adjuvant pain medication usage have been demonstrated. Lack of randomized control trials, small study sample sizes, an absence of diagnostic block imaging guidance, and the use of outcome measures that are inherently subjective, limiting objectivity and introducing an unquantifiable degree of bias. Clinical studies to date examining the efficacy of PRF as a treatment for occipital neuralgia have yielded promising results, demonstrating sustained improvement in pain, quality of life, and adjuvant pain medication usage. Despite these encouraging clinical studies, conclusive evidence in support of PRF as an interventional treatment option for occipital neuralgia awaits to be seen.

Dental unit water lines decontamination with the aid of nanotechnology.

PubMed

Paramashivaiah, Rashmi; Prabhuji, M L V; Narayanan, Roopalakshmi

2016-01-01

This article reviews the issue of dental unit waterline (DUWL) contamination which affects all the clinical and hospital settings. The contaminating microorganisms commonly isolated from these settings and the most pathogenic among them have serious consequences. Over the years several measures are inculcated for decontamination of water, their advantages and shortcomings have been addressed. Options using nanotechnology which are available in the market are described briefly. A manual and electronic search was conducted. Google and PubMed were searched for relevant material from studies up to 2013. Medical Subject Headings words looked for were "Nanotechnology," "Water purification," and "Biofilms." Reviewed findings were summarized by topic, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement for reporting. Seventy articles were shortlisted for articles pertaining to our topic of discussion. A systematic approach was followed by two independent reviewers and included eligibility criteria for study inclusion, data extraction, data synthesis, and drawing of conclusion. Dental waterline contamination is widespread in any type of dental setting having serious implications on clinicians and patients alike, especially elderly and immune-compromised. Hence, international bodies like center for disease and control and American Dental Association have come up with stringent measures for maintenance of water quality. A gamut of procedures has been tried to overcome this problem ranging from chlorinated products, water filters to the usage of distilled water. The use of nanoemulsions, nanofilters, nanomembranes, etc., and their applicability for routine usage is discussed. Biofilm formation in DUWLs is inevitable with the subsequent release of part of microbiota into the otherwise sterile dental settings. These consequences can be quite serious on clinicians and dental patients. Though conventional measures in water decontamination have been partly successful, the quest for more foolproof methods has led to the use of latest technology, i.e., nanotechnology. The most practical option has to be chosen based on the ease of their usage.

Rarity of late anastomotic leakage after low anterior resection of the rectum.

PubMed

Maeda, Hiromichi; Okamoto, Ken; Namikawa, Tsutomu; Akimori, Toyokazu; Kamioka, Norihito; Shiga, Mai; Dabanaka, Ken; Hanazaki, Kazuhiro; Kobayashi, Michiya

2015-06-01

Late anastomotic leakage is reported to account for half of all anastomotic leakages after low anterior resection of the rectum. An important clinical question is whether late and early anastomotic leakages are different entities. We retrospectively reviewed the medical records of patients who experienced anastomotic leakage after low anterior resection in two Japanese hospitals. The clinical characteristics were extracted and analyzed. During the study period, 179 patients underwent low anterior resection. A pelvic drainage tube was routinely utilized in all cases and was generally removed 4 to 6 days after the operation. Twenty-six patients had anastomotic leakage; the diagnosis was based on fecal contamination of the drainage in 24 cases. The median interval between operation and detection of anastomotic leakage was 3.5 days. Anastomotic leakage was diagnosed within 7 days of the operation in 25 cases and on postoperative day 20 (after hospital discharge) in one case. There was no instance of anastomotic leakage diagnosed more than 30 days after the operation. There was no relationship between clinical variables and days of leakage diagnosis. The rarity of late anastomotic leakage in our study, compared with previous studies, may relate to the relatively extended period of pelvic drainage tube usage in our institutes, which likely shortens the interval before leakage diagnosis. Our results suggest that late anastomotic leakage is a delayed symptom of subtle early anastomotic leakage rather than a separate entity.

A multifaceted intervention to narrow the evidence-based gap in the treatment of acute coronary syndromes: rationale and design of the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) cluster-randomized trial.

PubMed

Berwanger, Otávio; Guimarães, Hélio P; Laranjeira, Ligia N; Cavalcanti, Alexandre B; Kodama, Alessandra; Zazula, Ana Denise; Santucci, Eliana; Victor, Elivane; Flato, Uri A; Tenuta, Marcos; Carvalho, Vitor; Mira, Vera Lucia; Pieper, Karen S; Mota, Luiz Henrique; Peterson, Eric D; Lopes, Renato D

2012-03-01

Translating evidence into clinical practice in the management of acute coronary syndromes (ACS) is challenging. Few ACS quality improvement interventions have been rigorously evaluated to determine their impact on patient care and clinical outcomes. We designed a pragmatic, 2-arm, cluster-randomized trial involving 34 clusters (Brazilian public hospitals). Clusters were randomized to receive a multifaceted quality improvement intervention (experimental group) or routine practice (control group). The 6-month educational intervention included reminders, care algorithms, a case manager, and distribution of educational materials to health care providers. The primary end point was a composite of evidence-based post-ACS therapies within 24 hours of admission, with the secondary measure of major cardiovascular clinical events (death, nonfatal myocardial infarction, nonfatal cardiac arrest, and nonfatal stroke). Prescription of evidence-based therapies at hospital discharge were also evaluated as part of the secondary outcomes. All analyses were performed by the intention-to-treat principle and took the cluster design into account using individual-level regression modeling (generalized estimating equations). If proven effective, this multifaceted intervention would have wide use as a means of promoting optimal use of evidence-based interventions for the management of ACS. Copyright © 2012 Mosby, Inc. All rights reserved.

Roadmap to Clinical Use of Gold Nanoparticles for Radiation Sensitization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schuemann, Jan, E-mail: jschuemann@mgh.harvard.edu; Berbeco, Ross; Chithrani, Devika B.

2016-01-01

The past decade has seen a dramatic increase in interest in the use of gold nanoparticles (GNPs) as radiation sensitizers for radiation therapy. This interest was initially driven by their strong absorption of ionizing radiation and the resulting ability to increase dose deposited within target volumes even at relatively low concentrations. These early observations are supported by extensive experimental validation, showing GNPs' efficacy at sensitizing tumors in both in vitro and in vivo systems to a range of types of ionizing radiation, including kilovoltage and megavoltage X rays as well as charged particles. Despite this experimental validation, there has been limited translationmore » of GNP-mediated radiation sensitization to a clinical setting. One of the key challenges in this area is the wide range of experimental systems that have been investigated, spanning a range of particle sizes, shapes, and preparations. As a result, mechanisms of uptake and radiation sensitization have remained difficult to clearly identify. This has proven a significant impediment to the identification of optimal GNP formulations which strike a balance among their radiation sensitizing properties, their specificity to the tumors, their biocompatibility, and their imageability in vivo. This white paper reviews the current state of knowledge in each of the areas concerning the use of GNPs as radiosensitizers, and outlines the steps which will be required to advance GNP-enhanced radiation therapy from their current pre-clinical setting to clinical trials and eventual routine usage.« less

Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission.

PubMed

Pingali, Sai Ravi; Jewell, Sarah W; Havlat, Luiza; Bast, Martin A; Thompson, Jonathan R; Eastwood, Daniel C; Bartlett, Nancy L; Armitage, James O; Wagner-Johnston, Nina D; Vose, Julie M; Fenske, Timothy S

2014-07-15

The objective of this study was to compare the outcomes of patients with classical Hodgkin lymphoma (cHL) who achieved complete remission with frontline therapy and then underwent either clinical surveillance or routine surveillance imaging. In total, 241 patients who were newly diagnosed with cHL between January 2000 and December 2010 at 3 participating tertiary care centers and achieved complete remission after first-line therapy were retrospectively analyzed. Of these, there were 174 patients in the routine surveillance imaging group and 67 patients in the clinical surveillance group, based on the intended mode of surveillance. In the routine surveillance imaging group, the intended plan of surveillance included computed tomography and/or positron emission tomography scans; whereas, in the clinical surveillance group, the intended plan of surveillance was clinical examination and laboratory studies, and scans were obtained only to evaluate concerning signs or symptoms. Baseline patient characteristics, prognostic features, treatment records, and outcomes were collected. The primary objective was to compare overall survival for patients in both groups. For secondary objectives, we compared the success of second-line therapy and estimated the costs of imaging for each group. After 5 years of follow-up, the overall survival rate was 97% (95% confidence interval, 92%-99%) in the routine surveillance imaging group and 96% (95% confidence interval, 87%-99%) in the clinical surveillance group (P = .41). There were few relapses in each group, and all patients who relapsed in both groups achieved complete remission with second-line therapy. The charges associated with routine surveillance imaging were significantly higher than those for the clinical surveillance strategy, with no apparent clinical benefit. Clinical surveillance was not inferior to routine surveillance imaging in patients with cHL who achieved complete remission with frontline therapy. Routine surveillance imaging was associated with significantly increased estimated imaging charges. © 2014 American Cancer Society.

Impact of an Onsite Clinic on Utilization of Preventive Services.

PubMed

Ostovari, Mina; Yu, Denny; Yih, Yuehwern; Steele-Morris, Charlotte Joy

2017-07-01

To assess impact of an onsite clinic on healthcare utilization of preventive services for employees of a public university and their dependents. Descriptive statistics, logistic regression and classification tree techniques were used to assess health claim data to identify changes in patterns of healthcare utilization and factors impacting usage of onsite clinic. Utilization of preventive services significantly increased for women and men employees by 9% and 14% one year after implementation of the onsite clinic. Hourly-paid employees, employees without diabetes, employees with spouse opt out or no coverage were more likely to go to the onsite clinic. Adapted framework for assessing performance of onsite clinics based on usage of health informatics would help to identify health utilization patterns and interaction between onsite clinic and offsite health providers.

A comprehensive information technology system to support physician learning at the point of care.

PubMed

Cook, David A; Sorensen, Kristi J; Nishimura, Rick A; Ommen, Steve R; Lloyd, Farrell J

2015-01-01

MayoExpert is a multifaceted information system integrated with the electronic medical record (EMR) across Mayo Clinic's multisite health system. It was developed as a technology-based solution to manage information, standardize clinical practice, and promote and document learning in clinical contexts. Features include urgent test result notifications; models illustrating expert-approved care processes; concise, expert-approved answers to frequently asked questions (FAQs); a directory of topic-specific experts; and a portfolio for provider licensure and credentialing. The authors evaluate MayoExpert's reach, effectiveness, adoption, implementation, and maintenance. Evaluation data sources included usage statistics, user surveys, and pilot studies.As of October 2013, MayoExpert was available at 94 clinical sites in 12 states and contained 1,368 clinical topics, answers to 7,640 FAQs, and 92 care process models. In 2012, MayoExpert was accessed at least once by 2,578/3,643 (71%) staff physicians, 900/1,374 (66%) midlevel providers, and 1,728/2,291 (75%) residents and fellows. In a 2013 survey of MayoExpert users with 536 respondents, all features were highly rated (≥67% favorable). More providers reported using MayoExpert to answer questions before/after than during patient visits (68% versus 36%). During November 2012 to April 2013, MayoExpert sent 1,660 notifications of new-onset atrial fibrillation and 1,590 notifications of prolonged QT. MayoExpert has become part of routine clinical and educational operations, and its care process models now define Mayo Clinic best practices. MayoExpert's infrastructure and content will continue to expand with improved templates and content organization, new care process models, additional notifications, better EMR integration, and improved support for credentialing activities.

How characteristic routines of clinical departments influence students' self-regulated learning: A grounded theory study.

PubMed

Berkhout, J J; Slootweg, I A; Helmich, E; Teunissen, P W; van der Vleuten, C P M; Jaarsma, A D C

2017-11-01

In clerkships, students are expected to self-regulate their learning. How clinical departments and their routine approach on clerkships influences students' self-regulated learning (SRL) is unknown. This study explores how characteristic routines of clinical departments influence medical students' SRL. Six focus groups including 39 purposively sampled participants from one Dutch university were organized to study how characteristic routines of clinical departments influenced medical students' SRL from a constructivist paradigm, using grounded theory methodology. The focus groups were audio recorded, transcribed verbatim and were analyzed iteratively using constant comparison and open, axial and interpretive coding. Students described that clinical departments influenced their SRL through routines which affected the professional relationships they could engage in and affected their perception of a department's invested effort in them. Students' SRL in a clerkship can be supported by enabling them to engage others in their SRL and by having them feel that effort is invested in their learning. Our study gives a practical insight in how clinical departments influenced students' SRL. Clinical departments can affect students' motivation to engage in SRL, influence the variety of SRL strategies that students can use and how meaningful students perceive their SRL experiences to be.

Energy monitoring system based on human activity in the workplace

NASA Astrophysics Data System (ADS)

Mustafa, Nur Hanim; Husain, Mohd Nor; Aziz, Mohamad Zoinol Abidin Abdul; Othman, Mohd Azlishah; Malek, Fareq

2015-05-01

Human behaviors always related to day routine activities in a smart house directly give the significant factor to manage energy usage in human life. An Addition that, the factor will contribute to the best efficiency of the system. This paper will focus on the monitoring efficiency based on duration time in office hours around 8am until 5pm which depend on human behavior at working place. Besides that, the correlation coefficient method is used to show the relation between energy consumption and energy saving based on the total hours of time energy spent. In future, the percentages of energy monitoring system usage will be increase to manage energy saving based on human behaviors. This scenario will help to see the human activity in the workplace in order to get the energy saving and support world green environment.

Artificial limb representation in amputees

PubMed Central

van den Heiligenberg, Fiona M Z; Orlov, Tanya; Macdonald, Scott N; Duff, Eugene P; Henderson Slater, David; Beckmann, Christian F; Johansen-Berg, Heidi; Culham, Jody C; Makin, Tamar R

2018-01-01

Abstract The human brain contains multiple hand-selective areas, in both the sensorimotor and visual systems. Could our brain repurpose neural resources, originally developed for supporting hand function, to represent and control artificial limbs? We studied individuals with congenital or acquired hand-loss (hereafter one-handers) using functional MRI. We show that the more one-handers use an artificial limb (prosthesis) in their everyday life, the stronger visual hand-selective areas in the lateral occipitotemporal cortex respond to prosthesis images. This was found even when one-handers were presented with images of active prostheses that share the functionality of the hand but not necessarily its visual features (e.g. a ‘hook’ prosthesis). Further, we show that daily prosthesis usage determines large-scale inter-network communication across hand-selective areas. This was demonstrated by increased resting state functional connectivity between visual and sensorimotor hand-selective areas, proportional to the intensiveness of everyday prosthesis usage. Further analysis revealed a 3-fold coupling between prosthesis activity, visuomotor connectivity and usage, suggesting a possible role for the motor system in shaping use-dependent representation in visual hand-selective areas, and/or vice versa. Moreover, able-bodied control participants who routinely observe prosthesis usage (albeit less intensively than the prosthesis users) showed significantly weaker associations between degree of prosthesis observation and visual cortex activity or connectivity. Together, our findings suggest that altered daily motor behaviour facilitates prosthesis-related visual processing and shapes communication across hand-selective areas. This neurophysiological substrate for prosthesis embodiment may inspire rehabilitation approaches to improve usage of existing substitutionary devices and aid implementation of future assistive and augmentative technologies. PMID:29534154

Artificial limb representation in amputees.

PubMed

van den Heiligenberg, Fiona M Z; Orlov, Tanya; Macdonald, Scott N; Duff, Eugene P; Henderson Slater, David; Beckmann, Christian F; Johansen-Berg, Heidi; Culham, Jody C; Makin, Tamar R

2018-05-01

The human brain contains multiple hand-selective areas, in both the sensorimotor and visual systems. Could our brain repurpose neural resources, originally developed for supporting hand function, to represent and control artificial limbs? We studied individuals with congenital or acquired hand-loss (hereafter one-handers) using functional MRI. We show that the more one-handers use an artificial limb (prosthesis) in their everyday life, the stronger visual hand-selective areas in the lateral occipitotemporal cortex respond to prosthesis images. This was found even when one-handers were presented with images of active prostheses that share the functionality of the hand but not necessarily its visual features (e.g. a 'hook' prosthesis). Further, we show that daily prosthesis usage determines large-scale inter-network communication across hand-selective areas. This was demonstrated by increased resting state functional connectivity between visual and sensorimotor hand-selective areas, proportional to the intensiveness of everyday prosthesis usage. Further analysis revealed a 3-fold coupling between prosthesis activity, visuomotor connectivity and usage, suggesting a possible role for the motor system in shaping use-dependent representation in visual hand-selective areas, and/or vice versa. Moreover, able-bodied control participants who routinely observe prosthesis usage (albeit less intensively than the prosthesis users) showed significantly weaker associations between degree of prosthesis observation and visual cortex activity or connectivity. Together, our findings suggest that altered daily motor behaviour facilitates prosthesis-related visual processing and shapes communication across hand-selective areas. This neurophysiological substrate for prosthesis embodiment may inspire rehabilitation approaches to improve usage of existing substitutionary devices and aid implementation of future assistive and augmentative technologies.

Technical note: real-time web-based wireless visual guidance system for radiotherapy.

PubMed

Lee, Danny; Kim, Siyong; Palta, Jatinder R; Kim, Taeho

2017-06-01

Describe a Web-based wireless visual guidance system that mitigates issues associated with hard-wired audio-visual aided patient interactive motion management systems that are cumbersome to use in routine clinical practice. Web-based wireless visual display duplicates an existing visual display of a respiratory-motion management system for visual guidance. The visual display of the existing system is sent to legacy Web clients over a private wireless network, thereby allowing a wireless setting for real-time visual guidance. In this study, active breathing coordinator (ABC) trace was used as an input for visual display, which captured and transmitted to Web clients. Virtual reality goggles require two (left and right eye view) images for visual display. We investigated the performance of Web-based wireless visual guidance by quantifying (1) the network latency of visual displays between an ABC computer display and Web clients of a laptop, an iPad mini 2 and an iPhone 6, and (2) the frame rate of visual display on the Web clients in frames per second (fps). The network latency of visual display between the ABC computer and Web clients was about 100 ms and the frame rate was 14.0 fps (laptop), 9.2 fps (iPad mini 2) and 11.2 fps (iPhone 6). In addition, visual display for virtual reality goggles was successfully shown on the iPhone 6 with 100 ms and 11.2 fps. A high network security was maintained by utilizing the private network configuration. This study demonstrated that a Web-based wireless visual guidance can be a promising technique for clinical motion management systems, which require real-time visual display of their outputs. Based on the results of this study, our approach has the potential to reduce clutter associated with wired-systems, reduce space requirements, and extend the use of medical devices from static usage to interactive and dynamic usage in a radiotherapy treatment vault.

A diabetes scorecard does not improve HbA(1c), blood pressure, lipids, aspirin usage, exercise and diabetes knowledge over 9 months: a randomized controlled trial.

PubMed

Irwig, M S; Sood, P; Ni, D; Amass, T; Khurana, P S; Jayanthi, V V; Wang, L; Adler, S M

2012-09-01

To test (1) whether a diabetes scorecard can improve glycaemic control, blood pressure control, LDL cholesterol, aspirin usage and exercise; (2) if the scorecard will motivate and/or educate patients to improve their scores for subsequent visits; and (3) whether the scorecard will improve rates of clinical inertia. Five physicians enrolled 103 patients ≥ 40 years old with uncontrolled Type 2 diabetes [HbA(1c) ≥ 64 mmol/mol (8.0%)] to randomly receive either a diabetes scorecard or not during four clinical visits over a 9-month period. The population was predominantly urban with a disproportionately higher percentage of black people than the general population. Our scorecard assigned points to six clinical variables, with a perfect total score of 100 points corresponding to meeting all targets. The primary outcomes were total scores and HbA(1c) in the scorecard and control groups at 9 months. There were no significant differences between the control and scorecard groups at visits 1 and 4 in total score, HbA(1c) , blood pressure, LDL cholesterol, aspirin usage, exercise or knowledge about diabetic targets. By visit 4 both the control and scorecard groups had statistically significant improvements with their mean total score (9 and 7 points, respectively), HbA(1c) [-9 mmol/mol (-0.8%) and -15 mmol/mol (-1.4%), respectively] and aspirin usage (33% increase and 16% increase, respectively). Rates of clinical inertia were low throughout the study. A diabetes scorecard did not improve glycaemic control, blood pressure control, LDL cholesterol, aspirin usage, exercise or diabetic knowledge in an urban population with uncontrolled Type 2 diabetes. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

A survey of personal digital assistant use in a sample of New Zealand doctors.

PubMed

Menzies, Oliver H; Thwaites, John

2012-03-30

To gather information about handheld computing hardware and software usage by hospital based doctors in New Zealand (NZ). An online tool (SurveyMonkey) was used to conduct the survey from 27 June to 10 September 2010. Distribution of the survey was via an email to all NZ District Health Boards (DHBs). There were 850 responses. About half of respondents (52%) used a personal digital assistant (PDA), 90% using it at least once daily. Usage varied greatly between DHBs (27-100%), perhaps related to institutional support. Among PDA users, the most common applications were the non-clinical; Scheduler (95%), Contacts (97%), and Tasks (83%). Users felt PDAs helped considerably with organisation and time saving. For non-users there were a range of barriers to usage, cost being a large factor. Another major barrier identified by both users and non-users was lack of organisational integration and support. Half of survey respondents used a PDA. PDA usage of responders from different DHBs varied considerably. Perceived barriers to PDA use included cost and lack of institutional support. A collaborative approach between clinical leadership and Information Technology teams to address barriers may result in increased utility and usage of PDAs in the NZ health system.

Understanding the properties of common dietary supplements: clinical implications for healthcare practitioners.

PubMed

Zelig, Rena; Rigassio Radler, Diane

2012-12-01

Dietary supplement usage in the United States continues to increase. This article explores the background of dietary supplements and their regulations, discusses trends in usage patterns highlighting the properties of 10 popular dietary supplements, addresses safety concerns and drug-nutrient interactions, and discusses the role of the healthcare professional in assessing and recommending usage of dietary supplements. The authors reviewed the literature on dietary supplementation. Government websites were used to obtain background and regulatory information. Evidence-based databases were used to summarize popular dietary supplements in terms of their common uses, mechanisms of action, and clinical implications. The related literature was reviewed to discuss important factors for the healthcare professional to consider as well as the role of the healthcare professional in integrating dietary supplement use within patient care. Healthcare professionals need to be prepared to evaluate dietary supplement usage and make appropriate recommendations for an individualized plan of care. As the popularity of dietary supplements continues to grow, healthcare professionals will need to communicate with patients about their usage; educate themselves on their potential benefits, interactions, and contraindications; evaluate the literature; make recommendations; and document appropriately in a comprehensive and integrated plan of care.

Rubber dam use during root canal treatment: findings from The Dental Practice-Based Research Network

PubMed Central

Anabtawi, Mona F.; Gilbert, Gregg H.; Bauer, Michael R.; Reams, Gregg; Makhija, Sonia K.; Benjamin, Paul L.; Williams, O. Dale

2012-01-01

Background The Dental Practice-Based Research Network (DPBRN) provides a venue to investigate whether certain procedures are performed routinely. Study objectives were to: (1) quantify rubber dam use during root canal treatment (RCT) among general dentists; (2) test the hypothesis that certain dentist or practice characteristics are associated with its use. Methods DPBRN practitioner-investigators participated in a questionnaire that included items about rubber dam use and other forms of isolation during root RCT. DPBRN Enrollment Questionnaire data provided certain practitioner and practice characteristics. Results A total of 729 practitioners responded (74%); 524 were general dentists and indicated they do RCT and the percentage of RCT in which they use a rubber dam. Of these 524, 44% use rubber dam for all RCTs; 24% use it for 51%–99% of RCTs; 17% use it for 1%–50%; 15% never use it during RCT. Usage varied significantly by geographic region and practice type. Cotton rolls and other forms of isolation were also reported. Conclusions Similar to other reports in the literature, not all DPBRN general dentists use a rubber dam during RCT. Clinical implications Because the current clinical standard of care is to use a rubber dam during RCT, increasing its use may be important. PMID:23372134

Nomophobia: A Cross-sectional Study to Assess Mobile Phone Usage Among Dental Students.

PubMed

Prasad, Monika; Patthi, Basavaraj; Singla, Ashish; Gupta, Ritu; Saha, Sabyasachi; Kumar, Jishnu Krishna; Malhi, Ravneet; Pandita, Venisha

2017-02-01

Mobile phones were originally seen as a gadget for communication but currently, the internet enabled mobile phones have become an integral part of our daily life. Their benefits are incomparable but at the same time, they have some negative effects too. To assess the pattern of usage of mobile phones and its effects on the academic performance of students. A descriptive cross-sectional study was conducted amongst 554 students of D. J. College of Dental Sciences and Research through a self-administered questionnaire to collect the data regarding the usage and associated anxiety with mobile phone. About 39.5% students agreed that they score low marks in professional exams if they spend more time on phone. The number of students who frequently checked their cell phone during their classes or while doing clinical work were 24.7% . A total of 24.12% of the students were found to be nomophobic and at risk of being nomophobes were 40.97%. A statistically significant difference was found among preclinical, clinical, interns and postgraduates regarding the usage and effect of mobile phone on them. The pattern of usage of mobile phone among dental students showed alarming indication that students have been addicted to mobile phone which in turn affect their academic performance in a negative way. It would be useful to advise the students about the controlled as well as proper usage of mobile phone.

Patterns of usage and preferences of users for tuberculosis-related text messages and voice calls in Uganda.

PubMed

Ggita, J M; Ojok, C; Meyer, A J; Farr, K; Shete, P B; Ochom, E; Turimumahoro, P; Babirye, D; Mark, D; Dowdy, D; Ackerman, S; Armstrong-Hough, M; Nalugwa, T; Ayakaka, I; Moore, D; Haberer, J E; Cattamanchi, A; Katamba, A; Davis, J L

2018-05-01

Little information exists about mobile phone usage or preferences for tuberculosis (TB) related health communications in Uganda. We surveyed household contacts of TB patients in urban Kampala, Uganda, and clinic patients in rural central Uganda. Questions addressed mobile phone access, usage, and preferences for TB-related communications. We collected qualitative data about messaging preferences. We enrolled 145 contacts and 203 clinic attendees. Most contacts (58%) and clinic attendees (75%) owned a mobile phone, while 42% of contacts and 10% of clinic attendees shared one; 94% of contacts and clinic attendees knew how to receive a short messaging service (SMS) message, but only 59% of contacts aged 45 years (vs. 96% of contacts aged <45 years, P = 0.0001) did so. All contacts and 99% of clinic attendees were willing and capable of receiving personal-health communications by SMS. Among contacts, 55% preferred detailed messages disclosing test results, while 45% preferred simple messages requesting a clinic visit to disclose results. Most urban household TB contacts and rural clinic attendees reported having access to a mobile phone and willingness to receive TB-related personal-health communications by voice call or SMS. However, frequent phone sharing and variable messaging abilities and preferences suggest a need to tailor the design and monitoring of mHealth interventions to target recipients.

Clinical Outcome of Degenerative Mitral Regurgitation: Critical Importance of Echocardiographic Quantitative Assessment in Routine Practice.

PubMed

Antoine, Clemence; Benfari, Giovanni; Michelena, Hector I; Malouf, Joseph F; Nkomo, Vuyisile T; Thapa, Prabin; Enriquez-Sarano, Maurice

2018-05-31

Background -Echocardiographic quantitation of degenerative mitral regurgitation (DMR) is recommended whenever possible in clinical guidelines but is criticized and its scalability to routine clinical practice doubted. We hypothesized that echocardiographic DMR quantitation, performed in routine clinical practice by multiple practitioners predicts independently long-term survival, and thus is essential to DMR management. Methods -We included patients diagnosed with isolated mitral-valve-prolapse 2003-2011 and any degree of MR quantified by any physician/sonographer in routine clinical practice. Clinical/echocardiographic data acquired at diagnosis were retrieved electronically. Endpoint was mortality under medical treatment analyzed by Kaplan-Meir method and Proportional-Hazard models. Results -The cohort included 3914 patients (55% male) aged 62±17 years, with left ventricular ejection fraction (LVEF) 63±8% and routinely measured effective regurgitant orifice area (EROA) 19[0-40] mm 2 During follow-up (6.7±3.1 years) 696 patients died under medical management and 1263 underwent mitral surgery. In multivariate analysis, routinely measured EROA was associated with mortality (adjusted-hazard-ratio 1.19[1.13-1.24] p<0.0001 per-10mm 2 ) independently of LVEF and end-systolic diameter, symptoms and age/comorbidities. The association between routinely measured EROA and mortality persisted with competitive risk modeling (adjusted hazard-ratio 1.15[1.10-1.20] per 10mm 2 p<0.0001), or in patients without guideline-based Class I/II surgical triggers (adjusted hazard ratio 1.19[1.10-1.28] per 10mm 2 p<0.0001) and in all subgroups examined (all p<0.01). Spline curve analysis showed that, compared with general population mortality, excess mortality appears for moderate DMR (EROA ≥20mm 2 ) becomes notable ≥EROA 30mm 2 and steadily increases with higher EROA levels, > 40 mm 2 threshold. Conclusions -Echocardiographic DMR quantitation is scalable to routine practice and is independently associated with clinical outcome. Routinely measured EROA is strongly associated with long-term survival under medical treatment. Excess mortality vs. the general population appears in the "moderate" DMR range and steadily increases with higher EROA. Hence, individual EROA values should be integrated into therapeutic considerations, additionally to categorical DMR grading.

What should we measure? Conceptualizing usage in health information exchange

PubMed Central

Jasperson, Jon

2010-01-01

Under the provisions of the Health Information Technology for Economic & Clinical Health act providers need to demonstrate their ‘meaningful use’ of electronic health record systems' health information exchange (HIE) capability. HIE usage is not a simple construct, but the choice of its measurement must attend to the users, context, and objectives of the system being examined. This review examined how usage is reported in the existing literature and also what conceptualizations of usage might best reflect the nature and objectives of HIE. While existing literature on HIE usage included a diverse set of measures, most were theoretically weak, did not attend to the interplay of measure, level of analysis and architectural strategy, and did not reflect how HIE usage affected the actual process of care. Attention to these issues will provide greater insight into the effects of previously inaccessible information on medical decision-making and the process of care. PMID:20442148

Gathering Real World Evidence with Cluster Analysis for Clinical Decision Support.

PubMed

Xia, Eryu; Liu, Haifeng; Li, Jing; Mei, Jing; Li, Xuejun; Xu, Enliang; Li, Xiang; Hu, Gang; Xie, Guotong; Xu, Meilin

2017-01-01

Clinical decision support systems are information technology systems that assist clinical decision-making tasks, which have been shown to enhance clinical performance. Cluster analysis, which groups similar patients together, aims to separate patient cases into phenotypically heterogenous groups and defining therapeutically homogeneous patient subclasses. Useful as it is, the application of cluster analysis in clinical decision support systems is less reported. Here, we describe the usage of cluster analysis in clinical decision support systems, by first dividing patient cases into similar groups and then providing diagnosis or treatment suggestions based on the group profiles. This integration provides data for clinical decisions and compiles a wide range of clinical practices to inform the performance of individual clinicians. We also include an example usage of the system under the scenario of blood lipid management in type 2 diabetes. These efforts represent a step toward promoting patient-centered care and enabling precision medicine.

Pulmonary nodules: effect of adaptive statistical iterative reconstruction (ASIR) technique on performance of a computer-aided detection (CAD) system-comparison of performance between different-dose CT scans.

PubMed

Yanagawa, Masahiro; Honda, Osamu; Kikuyama, Ayano; Gyobu, Tomoko; Sumikawa, Hiromitsu; Koyama, Mitsuhiro; Tomiyama, Noriyuki

2012-10-01

To evaluate the effects of ASIR on CAD system of pulmonary nodules using clinical routine-dose CT and lower-dose CT. Thirty-five patients (body mass index, 22.17 ± 4.37 kg/m(2)) were scanned by multidetector-row CT with tube currents (clinical routine-dose CT, automatically adjusted mA; lower-dose CT, 10 mA) and X-ray voltage (120 kVp). Each 0.625-mm-thick image was reconstructed at 0%-, 50%-, and 100%-ASIR: 0%-ASIR is reconstructed using only the filtered back-projection algorithm (FBP), while 100%-ASIR is reconstructed using the maximum ASIR and 50%-ASIR implies a blending of 50% FBP and ASIR. CAD output was compared retrospectively with the results of the reference standard which was established using a consensus panel of three radiologists. Data were analyzed using Bonferroni/Dunn's method. Radiation dose was calculated by multiplying dose-length product by conversion coefficient of 0.021. The consensus panel found 265 non-calcified nodules ≤ 30 mm (ground-glass opacity [GGO], 103; part-solid, 34; and solid, 128). CAD sensitivity was significantly higher at 100%-ASIR [clinical routine-dose CT, 71% (overall), 49% (GGO); lower-dose CT, 52% (overall), 67% (solid)] than at 0%-ASIR [clinical routine-dose CT, 54% (overall), 25% (GGO); lower-dose CT, 36% (overall), 50% (solid)] (p<0.001). Mean number of false-positive findings per examination was significantly higher at 100%-ASIR (clinical routine-dose CT, 8.5; lower-dose CT, 6.2) than at 0%-ASIR (clinical routine-dose CT, 4.6; lower-dose CT, 3.5; p<0.001). Effective doses were 10.77 ± 3.41 mSv in clinical routine-dose CT and 2.67 ± 0.17 mSv in lower-dose CT. CAD sensitivity at 100%-ASIR on lower-dose CT is almost equal to that at 0%-ASIR on clinical routine-dose CT. ASIR can increase CAD sensitivity despite increased false-positive findings. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

[Instruments of management accounting in german hospitals - potentials for competitive advantage and status quo].

PubMed

Berens, W; Lachmann, M; Wömpener, A

2011-03-01

The aim of this study is to provide an analysis of the status quo for the usage of instruments of management accounting in German hospitals. 600 managing directors of German hospitals were asked to answer a questionnaire about the usage of management accounting instruments in their hospitals. We obtained 121 usable datasets, which are evaluated in this study. A significant increase in the usage of management accounting instruments can be observed over time. The respondents have an overall positive perception of the usage of these instruments. Cost accounting and information systems are among the most widely used instruments, while widely discussed concepts like the balanced scorecard or clinical pathways show surprisingly low usage rates. © Georg Thieme Verlag KG Stuttgart · New York.

Usage of purchased self-tests for HIV and sexually transmitted infections in Amsterdam, the Netherlands: results of population-based and serial cross-sectional studies among the general population and sexual risk groups

PubMed Central

Bil, Janneke P; Prins, Maria; Stolte, Ineke G; Dijkshoorn, Henriëtte; Heijman, Titia; Snijder, Marieke B; Davidovich, Udi; Zuure, Freke R

2017-01-01

Objectives There are limited data on the usage of commercially bought self-tests for HIV and other sexually transmitted infections (STIs). Therefore, we studied HIV/STI self-test usage and its determinants among the general population and sexual risk groups between 2007 and 2015 in Amsterdam, the Netherlands. Setting Data were collected in four different studies among the general population (S1–2) and sexual risk groups (S3–4). Participants S1–Amsterdam residents participating in representative population-based surveys (2008 and 2012; n=6044) drawn from the municipality register; S2–Participants of a population-based study stratified by ethnicity drawn from the municipality register of Amsterdam (2011–2015; n=17 603); S3–Men having sex with men (MSM) participating in an HIV observational cohort study (2008 and 2013; n=597) and S4–STI clinic clients participating in a cross-sectional survey (2007–2012; n=5655). Primary and secondary outcome measures Prevalence of HIV/STI self-test usage and its determinants. Results The prevalence of HIV/STI self-test usage in the preceding 6–12 months varied between 1% and 2% across studies. Chlamydia self-tests were most commonly used, except among MSM in S3. Chlamydia and syphilis self-test usage increased over time among the representative sample of Amsterdam residents (S1) and chlamydia self-test usage increased over time among STI clinic clients (S4). Self-test usage was associated with African Surinamese or Ghanaian ethnic origin (S2), being woman or MSM (S1 and 4) and having had a higher number of sexual partners (S1–2). Among those in the general population who tested for HIV/STI in the preceding 12 months, 5–9% used a self-test. Conclusions Despite low HIV/STI self-test usage, we observed increases over time in chlamydia and syphilis self-test usage. Furthermore, self-test usage was higher among high-risk individuals in the general population. It is important to continue monitoring self-test usage and informing the public about the unknown quality of available self-tests in the Netherlands and about the pros and cons of self-testing. PMID:28939577

Oral surgical handpiece use time parameters.

PubMed

Roberts, Howard W; Cohen, Mark E; Murchison, David F

2005-07-01

To evaluate the clinical usage time parameters of handpieces used in oral surgical procedures. One hundred randomly selected clinical oral surgery exodontia procedures were timed to record lengths of continuous segments of both handpiece use and non-usage. Providers with experience ranging from general dentists to board certified oral surgeons were timed during surgical exodontia treatment involving 1 to 4 teeth of various complexities. Usage times were compared with manufacturers' recommendations that on times should not exceed 20 seconds in any 50-second interval (20/50 rule). Handpiece run time increased with the number of teeth and surgical case complexity (both P < .001) but was unrelated to operator experience (P = .763), in a 3-predictor model (R2 = 0.20; P < .001). Ninety-four of the 100 cases experienced at least 1 second in violation of the 20/50 rule and 42% of all run seconds were in violation. Clinicians should be aware of recommended handpiece duty use cycles. Manufacturers' recommendations about handpiece use time cycles do not reflect actual clinical usage. Under the conditions of this study, actual surgical handpiece use time was not correlated with user experience. Less experienced providers did require longer to complete treatment, but increased treatment times were due to time spent that did not require surgical handpiece use.

Utilization of health care services in cancer patients with elevated fear of cancer recurrence.

PubMed

Champagne, Alexandra; Ivers, Hans; Savard, Josée

2018-05-02

Cancer patients commonly report experiencing fear of cancer recurrence (FCR), which may lead to several negative consequences. This study aimed at examining whether clinical levels of FCR are linked to a greater use of health care services. This is a secondary analysis of a longitudinal study of 962 cancer patients on the epidemiology of cancer-related insomnia. They completed the Fear of Cancer Recurrence Inventory-Short form (FCRI-SF) and reported information on their consultations (medical, psychosocial, and complementary and alternative medicine [CAM]) and medication usage (anxiolytics/hypnotics and antidepressants) at 6 time points over an 18-month period. Results indicated that clinical FCR at baseline was associated with greater consultation rates of medical and psychosocial professionals and a greater usage of anxiolytics/hypnotics and antidepressants. No significant association was found between the FCR level and use of CAM services. While consultation rates of medical and CAM professionals and usage of antidepressants generally increased over time, consultation rates of psychosocial professionals and usage of anxiolytics/hypnotics tended to decrease. Cancer patients with clinical levels of FCR are more likely to consult health care providers and to use psychotropic medications, which may translate into significant costs for society and the patients themselves. Copyright © 2018 John Wiley & Sons, Ltd.

[Importance of Post-Marketing Studies in Gathering of Clinical Evidences for Proper Usage of Anti-Cancer Drugs, and the StudyRequirements for Their Credibility].

PubMed

Inagaki, Osamu

2016-04-01

Pharmaceutical companies recognize the importance of post-marketing studies because they are crucial in the generation of clinical evidences for the usage of new medicines. To generate clinical evidences, quality of post-marketing studies should be well controlled from view point of "ethical conduction" and "reliability of results". In addition, control of conflict of interest (COI) between researchers and industries is also indispensable and is requested for the transparency of the studies. Japan Pharmaceutical Manufacturers Association(JPMA)stresses its commitment to the progressof transparency in post-marketing studies.

STS-1 environmental control and life support system. Consumables and thermal analysis

NASA Technical Reports Server (NTRS)

Steines, G.

1980-01-01

The Environmental Control and Life Support Systems (ECLSS)/thermal systems analysis for the Space Transportation System 1 Flight (STS-1) was performed using the shuttle environmental consumables usage requirements evaluation (SECURE) computer program. This program employs a nodal technique utilizing the Fortran Environmental Analysis Routines (FEAR). The output parameters evaluated were consumable quantities, fluid temperatures, heat transfer and rejection, and cabin atmospheric pressure. Analysis of these indicated that adequate margins exist for the nonpropulsive consumables and related thermal environment.

In vitro chlorhexidine release from alginate based microbeads for periodontal therapy

PubMed Central

Reske, Thomas; Böhmer, Femke; Hornung, Anne; Grabow, Niels; Lang, Hermann

2017-01-01

Periodontitis is one of the most common infectious diseases globally that, if untreated, leads to destruction of the tooth supporting tissues and finally results in tooth loss. Evidence shows that standard procedures as mechanical root cleaning could be supported by further treatment options such as locally applied substances. Due to gingival crevicular fluid flow, substances are commonly washed out off the periodontal pockets. The evaluation of administration techniques and the development of local drug releasing devices is thus an important aspect in periodontal research. This study describes the development and examination of a new alginate based, biodegradable and easily applicable drug delivery system for chlorhexidine (CHX). Different micro beads were produced and loaded with CHX and the release profiles were investigated by high performance liquid chromatography (HPLC). The in vitro-demonstrated release of CHX from alginate based beads shows comparable releasing characteristics as clinically approved systems. Yet many characteristics of this new delivery system show to be favourable for periodontal therapy. Easy application by injection, low production costs and multifunctional adaptions to patient related specifics may improve the usage in routine care. PMID:28973028

Deformation and fracture of Mtwo rotary nickel-titanium instruments after clinical use.

PubMed

Inan, Ugur; Gonulol, Nihan

2009-10-01

In recent years, a number of rotary nickel titanium (NiTi) systems have been developed to provide better, faster, and easier cleaning and shaping of the root canal system. Although the NiTi instruments are more flexible than the stainless steel files, the main problem with the rotary NiTi instruments is the failure of the instruments. The aim of this study was to evaluate the deformation and fracture rate of Mtwo rotary nickel-titanium instruments (VDW, Munich, Germany) discarded after routine clinical use. A total of 593 Mtwo rotary NiTi instruments were collected after clinical use from the clinic of endodontics over 12 months. The length of the files was measured using a digital caliper to determine any fracture, and then all the files were evaluated under a stereomicroscope for defects such as unwinding, curving, or bending and fracture. The fracture faces of separated files were also evaluated under a scanning electron microscope. The data were analyzed using a chi-square and z test. A percentage of all files (25.80%) showed defects, and the major defect was fracture (16.02%). The most frequently fractured file was #10.04 (30.39%). Deformations without fracture were mostly observed on #15.05 files (25.47%). A higher rate of deformation was observed for #10.04 and #15.05 files. Therefore, these files should be considered as single-use instruments. Because cyclic fatigue was the cause of 71.58% of the instrument fractures, it is also important not to exceed the maximum number of usage recommended by the manufacturer and discard the instruments on a regular basis.

Nomophobia: A Cross-sectional Study to Assess Mobile Phone Usage Among Dental Students

PubMed Central

Patthi, Basavaraj; Singla, Ashish; Gupta, Ritu; Saha, Sabyasachi; Kumar, Jishnu Krishna; Malhi, Ravneet; Pandita, Venisha

2017-01-01

Introduction Mobile phones were originally seen as a gadget for communication but currently, the internet enabled mobile phones have become an integral part of our daily life. Their benefits are incomparable but at the same time, they have some negative effects too. Aim To assess the pattern of usage of mobile phones and its effects on the academic performance of students. Materials and Methods A descriptive cross-sectional study was conducted amongst 554 students of D. J. College of Dental Sciences and Research through a self-administered questionnaire to collect the data regarding the usage and associated anxiety with mobile phone. Results About 39.5% students agreed that they score low marks in professional exams if they spend more time on phone. The number of students who frequently checked their cell phone during their classes or while doing clinical work were 24.7% . A total of 24.12% of the students were found to be nomophobic and at risk of being nomophobes were 40.97%. A statistically significant difference was found among preclinical, clinical, interns and postgraduates regarding the usage and effect of mobile phone on them. Conclusion The pattern of usage of mobile phone among dental students showed alarming indication that students have been addicted to mobile phone which in turn affect their academic performance in a negative way. It would be useful to advise the students about the controlled as well as proper usage of mobile phone. PMID:28384977

Ultrasound transducer function: annual testing is not sufficient.

PubMed

Mårtensson, Mattias; Olsson, Mats; Brodin, Lars-Åke

2010-10-01

The objective was to follow-up the study 'High incidence of defective ultrasound transducers in use in routine clinical practice' and evaluate if annual testing is good enough to reduce the incidence of defective ultrasound transducers in routine clinical practice to an acceptable level. A total of 299 transducers were tested in 13 clinics at five hospitals in the Stockholm area. Approximately 7000-15,000 ultrasound examinations are carried out at these clinics every year. The transducers tested in the study had been tested and classified as fully operational 1 year before and since then been in normal use in the routine clinical practice. The transducers were tested with the Sonora FirstCall Test System. There were 81 (27.1%) defective transducers found; giving a 95% confidence interval ranging from 22.1 to 32.1%. The most common transducer errors were 'delamination' of the ultrasound lens and 'break in the cable' which together constituted 82.7% of all transducer errors found. The highest error rate was found at the radiological clinics with a mean error rate of 36.0%. There was a significant difference in error rate between two observed ways the clinics handled the transducers. There was no significant difference in the error rates of the transducer brands or the transducers models. Annual testing is not sufficient to reduce the incidence of defective ultrasound transducers in routine clinical practice to an acceptable level and it is strongly advisable to create a user routine that minimizes the handling of the transducers.

Mild versus moderate stages of Alzheimer's disease: three-year outcomes in a routine clinical setting of cholinesterase inhibitor therapy.

PubMed

Wattmo, Carina; Minthon, Lennart; Wallin, Åsa K

2016-02-17

There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer's disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of cholinesterase inhibitor (ChEI) therapy. This 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20-26) and 287 had moderate AD (MMSE score, 10-19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models. The change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD. More sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.

Current V3 genotyping algorithms are inadequate for predicting X4 co-receptor usage in clinical isolates.

PubMed

Low, Andrew J; Dong, Winnie; Chan, Dennison; Sing, Tobias; Swanstrom, Ronald; Jensen, Mark; Pillai, Satish; Good, Benjamin; Harrigan, P Richard

2007-09-12

Integrating CCR5 antagonists into clinical practice would benefit from accurate assays of co-receptor usage (CCR5 versus CXCR4) with fast turnaround and low cost. Published HIV V3-loop based predictors of co-receptor usage were compared with actual phenotypic tropism results in a large cohort of antiretroviral naive individuals to determine accuracy on clinical samples and identify areas for improvement. Aligned HIV envelope V3 loop sequences (n = 977), derived by bulk sequencing were analyzed by six methods: the 11/25 rule; a neural network (NN), two support vector machines, and two subtype-B position specific scoring matrices (PSSM). Co-receptor phenotype results (Trofile Co-receptor Phenotype Assay; Monogram Biosciences) were stratified by CXCR4 relative light unit (RLU) readout and CD4 cell count. Co-receptor phenotype was available for 920 clinical samples with V3 genotypes having fewer than seven amino acid mixtures (n = 769 R5; n = 151 X4-capable). Sensitivity and specificity for predicting X4 capacity were evaluated for the 11/25 rule (30% sensitivity/93% specificity), NN (44%/88%), PSSM(sinsi) (34%/96%), PSSM(x4r5) (24%/97%), SVMgenomiac (22%/90%) and SVMgeno2pheno (50%/89%). Quantitative increases in sensitivity could be obtained by optimizing the cut-off for methods with continuous output (PSSM methods), and/or integrating clinical data (CD4%). Sensitivity was directly proportional to strength of X4 signal in the phenotype assay (P < 0.05). Current default implementations of co-receptor prediction algorithms are inadequate for predicting HIV X4 co-receptor usage in clinical samples, particularly those X4 phenotypes with low CXCR4 RLU signals. Significant improvements can be made to genotypic predictors, including training on clinical samples, using additional data to improve predictions and optimizing cutoffs and increasing genotype sensitivity.

Validation of a novel biomarker panel for the detection of ovarian cancer

PubMed Central

Leung, Felix; Bernardini, Marcus Q.; Brown, Marshall D.; Zheng, Yingye; Molina, Rafael; Bast, Robert C.; Davis, Gerard; Serra, Stefano; Diamandis, Eleftherios P.; Kulasingam, Vathany

2016-01-01

Background Ovarian cancer (OvCa) is the most lethal gynecological malignancy. Our integrated -omics approach to OvCa biomarker discovery has identified kallikrein 6 (KLK6) and folate-receptor 1 (FOLR1) as promising candidates but these markers require further validation. Methods KLK6, FOLR1 CA125 and HE4 were investigated in three independent serum cohorts with a total of 20 healthy controls, 150 benign controls and 216 OvCa patients. The serum biomarker levels were determined by ELISA or automated immunoassay. Results All biomarkers demonstrated elevations in the sera of OvCa patients compared to controls (p<0.01). Overall, CA125 and HE4 displayed the strongest ability (AUC 0.80 and 0.82, respectively) to identify OvCa patients and the addition of HE4 to CA125 improved the sensitivity from 36% to 67% at a set specificity of 95%. As well, the combination of HE4 and FOLR1 was a strong predictor of OvCa diagnosis, displaying comparable sensitivity (65%) to the best performing CA125-based models (67%) at a set specificity of 95%. Conclusions The markers identified through our integrated –omics approach performed similarly to the clinically-approved markers CA125 and HE4. Furthermore, HE4 represents a powerful diagnostic marker for OvCa and should be used more routinely in a clinical setting. Impact The implications of our study are two-fold: (1) we have demonstrated the strengths of HE4 alone and in combination with CA125, lending credence to increasing its usage in the clinic; and (2) we have demonstrated the clinical utility of our integrated –omics approach to identifying novel serum markers with comparable performance to clinical markers. PMID:27448593

The sexual health of female sex workers compared with other women in England: analysis of cross-sectional data from genitourinary medicine clinics

PubMed Central

Mc Grath-Lone, Louise; Marsh, Kimberly; Hughes, Gwenda; Ward, Helen

2014-01-01

Background While female sex workers (FSWs) are assumed to be at increased risk of sexually transmitted infections (STIs), there are limited comparative data with other population groups available. Using routine STI surveillance data, we investigated differences in sexual health between FSWs and other female attendees at genitourinary medicine (GUM) clinics in England. Methods Demographic characteristics, STI prevalence and service usage among FSWs and other attendees in 2011 were compared using logistic regression. Results In 2011, 2704 FSWs made 8411 recorded visits to 131/208 GUM clinics, (primarily large, FSW-specialist centres in London). FSWs used a variety of services, however, 10% did not have an STI/HIV test at presentation. By comparison with other female attendees, FSWs travelled further for their care and had increased risk of certain STIs (eg, gonorrhoea ORadj: 2.76, 95% CI 2.16 to 3.54, p<0.001). Migrant FSWs had better sexual health outcomes than UK-born FSWs (eg, period prevalence of chlamydia among those tested: 8.5% vs 13.5%, p<0.001) but were more likely to experience non-STI outcomes (eg, pelvic inflammatory disease ORadj: 2.92, 95% CI 1.57 to 5.41, p<0.001). Conclusions FSWs in England have access to high-quality care through the GUM clinic network, but there is evidence of geographical inequality in access to these services. A minority do not appear to access STI/HIV testing through clinics, and some STIs are more prevalent among FSWs than other female attendees. Targeted interventions aimed at improving uptake of testing in FSWs should be developed, and need to be culturally sensitive to the needs of this predominantly migrant population. PMID:24493858

The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users

PubMed Central

Nazi, Kim M; Hibbard, Judith H; Houston, Thomas K

2017-01-01

Background As electronic health records and computerized workflows expand, there are unprecedented opportunities to digitally connect with patients using secure portals. To realize the value of patient portals, initial reach across populations will need to be demonstrated, as well as sustained usage over time. Objective The study aim was to identify patient factors associated with short-term and long-term portal usage after patients registered to access all portal functions. Methods We prospectively followed a cohort of patients at a large Department of Veterans Affairs (VA) health care facility who recently completed identity proofing to use the VA patient portal. Information collected at baseline encompassed patient factors potentially associated with portal usage, including: demographics, Internet access and use, health literacy, patient activation, and self-reported health conditions. The primary outcome was the frequency of portal log-ins during 6-month and 18-month time intervals after study enrollment. Results A total of 270 study participants were followed prospectively. Almost all participants (260/268, 97.0%) reported going online, typically at home (248/268, 92.5%). At 6 months, 84.1% (227/270) of participants had visited the portal, with some variation in usage across demographic and health-related subgroups. There were no significant differences in portal log-ins by age, gender, education, marital status, race/ethnicity, distance to a VA facility, or patient activation measure. Significantly higher portal usage was seen among participants using high-speed broadband at home, greater self-reported ability using the Internet, and routinely going online. By 18 months, 91% participants had logged in to the portal, and no significant associations were found between usage and demographics, health status, or patient activation. When examining portal activity between 6 and 18 months, patients who were infrequent or high portal users remained in those categories, respectively. Conclusions Short-term and long-term portal usage was associated with having broadband at home, high self-rated ability when using the Internet, and overall online behavior. Digital inclusion, or ready access to the Internet and digital skills, appears to be a social determinant in patient exposure to portal services. PMID:29042345

Use and Perceived Benefits of Handheld Computer-based Clinical References

PubMed Central

Rothschild, Jeffrey M.; Fang, Edward; Liu, Vincent; Litvak, Irina; Yoon, Cathy; Bates, David W.

2006-01-01

Objective Clinicians are increasingly using handheld computers (HC) during patient care. We sought to assess the role of HC-based clinical reference software in medical practice by conducting a survey and assessing actual usage behavior. Design During a 2-week period in February 2005, 3600 users of a HC-based clinical reference application were asked by e-mail to complete a survey and permit analysis of their usage patterns. The software includes a pharmacopeia, an infectious disease reference, a medical diagnostic and therapeutic reference and transmits medical alerts and other notifications during HC synchronizations. Software usage data were captured during HC synchronization for the 4 weeks prior to survey completion. Measurements Survey responses and software usage data. Results The survey response rate was 42% (n = 1501). Physicians reported using the clinical reference software for a mean of 4 years and 39% reported using the software during more than half of patient encounters. Physicians who synchronized their HC during the data collection period (n = 1249; 83%) used the pharmacopeia for unique drug lookups a mean of 6.3 times per day (SD 12.4). The majority of users (61%) believed that in the prior 4 weeks, use of the clinical reference prevented adverse drug events or medication errors 3 or more times. Physicians also believed that alerts and other notifications improved patient care if they were public health warnings (e.g. about influenza), new immunization guidelines or drug alert warnings (e.g. rofecoxib withdrawal). Conclusion Current adopters of HC-based medical references use these tools frequently, and found them to improve patient care and be valuable in learning of recent alerts and warnings. PMID:16929041

Treatment practices and quantification of antimicrobial drug usage in conventional and organic dairy farms in Wisconsin.

PubMed

Pol, M; Ruegg, P L

2007-01-01

The objective of this study was to develop a method to quantify antimicrobial drug usage and treatment practices on conventional and organic dairy farms that had been recruited to represent a broad spectrum of potential exposure to antimicrobial drugs. Data on disease prevalence and treatment practices of organic (n = 20) and conventional (n = 20) farms were obtained during a farm visit using a survey instrument. A standardized estimate of antimicrobial drug usage was developed using a defined daily dose (DDD) of selected compounds. Density of antimicrobial drug usage was expressed as the number of DDD per adult cow per year. Differences in prevalence and management of selected diseases between conventional and organic farms were identified. The overall estimated prevalence of selected diseases was greater for conventional farms compared with organic farms. Organic farmers reported use of a variety of nonantimicrobial compounds for treatment and prevention of disease. Conventional farmers reported that penicillin was the compound most commonly used for dry cow therapy and cephapirin was most commonly used for treatment of clinical mastitis. On conventional farms, the estimated overall exposure to antimicrobial drugs was 5.43 DDD per cow per year composed of 3.58 and 1.85 DDD of intramammary and parenteral antimicrobial drugs, respectively. Of total intramammary antimicrobial drug usage, treatment of clinical mastitis contributed 2.02 DDD compared with 1.56 DDD attributed to the use of dry cow therapy. Of total parenteral treatments, the distribution of exposure was 0.52 (dry cow therapy), 1.43 (clinical mastitis treatment), 0.39 (treatment of foot disease), 0.14 (treatment of respiratory disease), and 0.32 (treatment of metritis) DDD. For treatments of foot infections (0.33 DDD), respiratory infections (0.07 DDD), and metritis (0.19 DDD), the mean density of ceftiofur usage was significantly greater compared with other compounds.

[The existence vomeronasal organ in adult humans].

PubMed

Rapiejko, Piotr; Zielnik-Jurkiewicz, Beata; Wojdas, Andrzej; Ratajczak, Jan; Jurkiewicz, Dariusz

2007-01-01

The influence of chemical substances (feromones) on human emotional and physical condition has fascinated psychologists, sexuologists and laryngologists since centurie. Literature conveys inconsistent information on vomeronasal organ (VNO) occurrence in humans. This organ is often called Jacobson's, and 2 symmetrical openings leading into it, located on both sides of septum, are called Ruyasch's ducts. The aim of the study was to analyze vomeronasal organ occurrence in humans in relation to age and sex. The study was conducted in a group of 634 patients, aged 18-80 years. All patients underwent routine ENT examination including rhinoscopy, nasal cavity examination with usage of 2.5x magnification lens (surgical glasses) and surgical microscope with 10x magnification. All persons had nasal cavities examined endoscopically. Every time presence of vomeronasal organ openings, along with localization, size and symmetry of these was noted. Subjects, who presented Jacobson's organ, were asked to fill a questionnaire concerning influence of smells on erotic sensations. Vomeronasal organ was fund in 312 persons, that is 49.21%. In 83.65% of cases vomeronasal organ opening size was smaller than 0.2 mm, what restricted its visibility to usage of magnifying lens, microscope, or endoscope. In 16.34% of cases only vomeronasal organ ducts openings were well visible in routine rhinoscopy without magnification. Vomeronasal organ was found more often in men than women. VNO was significantly more rare in patients with nasal septal deviation. In these cases, vomeronasal organ was usually found unilaterally, in all the cases on the concave side of deviated nasal septum.

[Use of PubMed to improve evidence-based medicine in routine urological practice].

PubMed

Rink, M; Kluth, L A; Shariat, S F; Chun, F K; Fisch, M; Dahm, P

2013-03-01

Applying evidence-based medicine in daily clinical practice is the basis of patient-centered medicine and knowledge of accurate literature acquisition skills is necessary for informed clinical decision-making. PubMed is an easy accessible, free bibliographic database comprising over 21 million citations from the medical field, life-science journals and online books. The article summarizes the effective use of PubMed in routine urological clinical practice based on a common case scenario. This article explains the simple use of PubMed to obtain the best search results with the highest evidence. Accurate knowledge about the use of PubMed in routine clinical practice can improve evidence-based medicine and also patient treatment.

Atlas2 Cloud: a framework for personal genome analysis in the cloud

PubMed Central

2012-01-01

Background Until recently, sequencing has primarily been carried out in large genome centers which have invested heavily in developing the computational infrastructure that enables genomic sequence analysis. The recent advancements in next generation sequencing (NGS) have led to a wide dissemination of sequencing technologies and data, to highly diverse research groups. It is expected that clinical sequencing will become part of diagnostic routines shortly. However, limited accessibility to computational infrastructure and high quality bioinformatic tools, and the demand for personnel skilled in data analysis and interpretation remains a serious bottleneck. To this end, the cloud computing and Software-as-a-Service (SaaS) technologies can help address these issues. Results We successfully enabled the Atlas2 Cloud pipeline for personal genome analysis on two different cloud service platforms: a community cloud via the Genboree Workbench, and a commercial cloud via the Amazon Web Services using Software-as-a-Service model. We report a case study of personal genome analysis using our Atlas2 Genboree pipeline. We also outline a detailed cost structure for running Atlas2 Amazon on whole exome capture data, providing cost projections in terms of storage, compute and I/O when running Atlas2 Amazon on a large data set. Conclusions We find that providing a web interface and an optimized pipeline clearly facilitates usage of cloud computing for personal genome analysis, but for it to be routinely used for large scale projects there needs to be a paradigm shift in the way we develop tools, in standard operating procedures, and in funding mechanisms. PMID:23134663

Atlas2 Cloud: a framework for personal genome analysis in the cloud.

PubMed

Evani, Uday S; Challis, Danny; Yu, Jin; Jackson, Andrew R; Paithankar, Sameer; Bainbridge, Matthew N; Jakkamsetti, Adinarayana; Pham, Peter; Coarfa, Cristian; Milosavljevic, Aleksandar; Yu, Fuli

2012-01-01

Until recently, sequencing has primarily been carried out in large genome centers which have invested heavily in developing the computational infrastructure that enables genomic sequence analysis. The recent advancements in next generation sequencing (NGS) have led to a wide dissemination of sequencing technologies and data, to highly diverse research groups. It is expected that clinical sequencing will become part of diagnostic routines shortly. However, limited accessibility to computational infrastructure and high quality bioinformatic tools, and the demand for personnel skilled in data analysis and interpretation remains a serious bottleneck. To this end, the cloud computing and Software-as-a-Service (SaaS) technologies can help address these issues. We successfully enabled the Atlas2 Cloud pipeline for personal genome analysis on two different cloud service platforms: a community cloud via the Genboree Workbench, and a commercial cloud via the Amazon Web Services using Software-as-a-Service model. We report a case study of personal genome analysis using our Atlas2 Genboree pipeline. We also outline a detailed cost structure for running Atlas2 Amazon on whole exome capture data, providing cost projections in terms of storage, compute and I/O when running Atlas2 Amazon on a large data set. We find that providing a web interface and an optimized pipeline clearly facilitates usage of cloud computing for personal genome analysis, but for it to be routinely used for large scale projects there needs to be a paradigm shift in the way we develop tools, in standard operating procedures, and in funding mechanisms.

Sequencing-based breast cancer diagnostics as an alternative to routine biomarkers.

PubMed

Rantalainen, Mattias; Klevebring, Daniel; Lindberg, Johan; Ivansson, Emma; Rosin, Gustaf; Kis, Lorand; Celebioglu, Fuat; Fredriksson, Irma; Czene, Kamila; Frisell, Jan; Hartman, Johan; Bergh, Jonas; Grönberg, Henrik

2016-11-30

Sequencing-based breast cancer diagnostics have the potential to replace routine biomarkers and provide molecular characterization that enable personalized precision medicine. Here we investigate the concordance between sequencing-based and routine diagnostic biomarkers and to what extent tumor sequencing contributes clinically actionable information. We applied DNA- and RNA-sequencing to characterize tumors from 307 breast cancer patients with replication in up to 739 patients. We developed models to predict status of routine biomarkers (ER, HER2,Ki-67, histological grade) from sequencing data. Non-routine biomarkers, including mutations in BRCA1, BRCA2 and ERBB2(HER2), and additional clinically actionable somatic alterations were also investigated. Concordance with routine diagnostic biomarkers was high for ER status (AUC = 0.95;AUC(replication) = 0.97) and HER2 status (AUC = 0.97;AUC(replication) = 0.92). The transcriptomic grade model enabled classification of histological grade 1 and histological grade 3 tumors with high accuracy (AUC = 0.98;AUC(replication) = 0.94). Clinically actionable mutations in BRCA1, BRCA2 and ERBB2(HER2) were detected in 5.5% of patients, while 53% had genomic alterations matching ongoing or concluded breast cancer studies. Sequencing-based molecular profiling can be applied as an alternative to histopathology to determine ER and HER2 status, in addition to providing improved tumor grading and clinically actionable mutations and molecular subtypes. Our results suggest that sequencing-based breast cancer diagnostics in a near future can replace routine biomarkers.

Usage of purchased self-tests for HIV and sexually transmitted infections in Amsterdam, the Netherlands: results of population-based and serial cross-sectional studies among the general population and sexual risk groups.

PubMed

Bil, Janneke P; Prins, Maria; Stolte, Ineke G; Dijkshoorn, Henriëtte; Heijman, Titia; Snijder, Marieke B; Davidovich, Udi; Zuure, Freke R

2017-09-21

There are limited data on the usage of commercially bought self-tests for HIV and other sexually transmitted infections (STIs). Therefore, we studied HIV/STI self-test usage and its determinants among the general population and sexual risk groups between 2007 and 2015 in Amsterdam, the Netherlands. Data were collected in four different studies among the general population (S1 - 2) and sexual risk groups (S3 - 4). S1 - Amsterdam residents participating in representative population-based surveys (2008 and 2012; n=6044) drawn from the municipality register; S2 - Participants of a population-based study stratified by ethnicity drawn from the municipality register of Amsterdam (2011-2015; n=17 603); S3 - Men having sex with men (MSM) participating in an HIV observational cohort study (2008 and 2013; n=597) and S4 - STI clinic clients participating in a cross-sectional survey (2007-2012; n=5655). Prevalence of HIV/STI self-test usage and its determinants. The prevalence of HIV/STI self-test usage in the preceding 6-12 months varied between 1% and 2% across studies. Chlamydia self-tests were most commonly used, except among MSM in S3. Chlamydia and syphilis self-test usage increased over time among the representative sample of Amsterdam residents (S1) and chlamydia self-test usage increased over time among STI clinic clients (S4). Self-test usage was associated with African Surinamese or Ghanaian ethnic origin (S2), being woman or MSM (S1 and 4) and having had a higher number of sexual partners (S1-2). Among those in the general population who tested for HIV/STI in the preceding 12 months, 5-9% used a self-test. Despite low HIV/STI self-test usage, we observed increases over time in chlamydia and syphilis self-test usage. Furthermore, self-test usage was higher among high-risk individuals in the general population. It is important to continue monitoring self-test usage and informing the public about the unknown quality of available self-tests in the Netherlands and about the pros and cons of self-testing. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The quality of clinical maternal and neonatal healthcare - a strategy for identifying 'routine care signal functions'.

PubMed

Brenner, Stephan; De Allegri, Manuela; Gabrysch, Sabine; Chinkhumba, Jobiba; Sarker, Malabika; Muula, Adamson S

2015-01-01

A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the 'EmOC signal functions', a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi. Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants' adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks. The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining MNH program evaluations in LMICs.

The Quality of Clinical Maternal and Neonatal Healthcare – A Strategy for Identifying ‘Routine Care Signal Functions’

PubMed Central

Brenner, Stephan; De Allegri, Manuela; Gabrysch, Sabine; Chinkhumba, Jobiba; Sarker, Malabika; Muula, Adamson S.

2015-01-01

Background A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the ‘EmOC signal functions’, a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. Methods We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi. Results Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants’ adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks. Conclusion The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining MNH program evaluations in LMICs. PMID:25875252

Gender, technology and jobs.

PubMed

Brynin, Malcolm

2006-09-01

Men have traditionally gained more than women from access to technologies at work which bring prestige, job security, more satisfying work and higher pay. Typically female jobs have centred on technologies, if they have at all, which tend towards routine and possibly deskilled work. Typing is a prime example. It is possible that this is changing through computerization, which is extensive but also equally distributed by gender. Does the wage premium, which use of a computer has been found to confer on users, benefit women sufficiently to suggest some sort of equalization through technology, or possibly even a female advantage? This is tested using data from four European countries. There is no across-the-board benefit from the use of computers. For both men and women it depends on the nature of their occupation. Some, more routine usages of computers are associated with a negative outcome. However, this occupational balance itself varies by gender.

A decade of HIV-1 drug resistance in the United States: trends and characteristics in a large protease/reverse transcriptase and co-receptor tropism database from 2003 to 2012.

PubMed

Paquet, Agnes C; Solberg, Owen D; Napolitano, Laura A; Volpe, Joseph M; Walworth, Charles; Whitcomb, Jeannette M; Petropoulos, Christos J; Haddad, Mojgan

2014-01-01

Drug resistance testing and co-receptor tropism determination are key components of the management of antiretroviral therapy for HIV-1-infected individuals. The purpose of this study was to examine trends of HIV-1 resistance and viral evolution in the past decade by surveying a large commercial patient testing database. Temporal trends of drug resistance, viral fitness and co-receptor usage among samples submitted for routine phenotypic and genotypic resistance testing to protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), as well as for tropism determination were investigated. Within 62,397 resistant viruses reported from 2003 to 2012, we observed a decreasing trend in the prevalence of three-class resistance (from 25% to 9%) driven by decreased resistance to PIs (43% to 21%) and NRTIs (79% to 57%), while observing a slight increase in NNRTI resistance (68% to 75%). The prevalence of CXCR4-mediated entry among tropism testing samples (n=52,945) declined over time from 47% in 2007 to 40% in 2012. A higher proportion of CXCR4-tropic viruses was observed within samples with three-class resistance (50%) compared with the group with no resistance (36%). Decreased prevalence of three-class resistance and increased prevalence of one-class resistance was observed within samples reported between 2003 and 2012. The fraction of CXCR4-tropic viruses has decreased over time; however, CXCR4 usage was more prevalent among multi-class-resistant samples, which may be due to the more advanced disease stage of treatment-experienced patients. These trends have important implications for clinical practice and future drug discovery and development.

Assessing usage patterns of electronic clinical documentation templates.

PubMed

Vawdrey, David K

2008-11-06

Many vendors of electronic medical records support structured and free-text entry of clinical documents using configurable templates. At a healthcare institution comprising two large academic medical centers, a documentation management data mart and a custom, Web-accessible business intelligence application were developed to track the availability and usage of electronic documentation templates. For each medical center, template availability and usage trends were measured from November 2007 through February 2008. By February 2008, approximately 65,000 electronic notes were authored per week on the two campuses. One site had 934 available templates, with 313 being used to author at least one note. The other site had 765 templates, of which 480 were used. The most commonly used template at both campuses was a free text note called "Miscellaneous Nursing Note," which accounted for 33.3% of total documents generated at one campus and 15.2% at the other.

Organizational Uses of Health Information Exchange to Change Cost and Utilization Outcomes: A Typology from a Multi-Site Qualitative Analysis.

PubMed

Vest, Joshua R; Abramson, Erika

2015-01-01

Health information exchange (HIE) systems facilitate access to patient information for a variety of health care organizations, end users, and clinical and organizational goals. While a complex intervention, organizations' usage of HIE is often conceptualized and measured narrowly. We sought to provide greater specificity to the concept of HIE as an intervention by formulating a typology of organizational HIE usage. We interviewed representatives of a regional health information organization and health care organizations actively using HIE information to change patient utilization and costs. The resultant typology includes three dimensions: user role, usage initiation, and patient set. This approach to categorizing how health care organizations are actually applying HIE information to clinical and business tasks provides greater clarity about HIE as an intervention and helps elucidate the conceptual linkage between HIE an organizational and patient outcomes.

Drug usage by outpatients in Croatia during an 8-year period: Influence of changes in pricing policy.

PubMed

Vitezic, Dinko; Madjarevic, Tomislav; Gantumur, Monja; Buble, Tonci; Vitezic, Miomira; Kovacevic, Miljenko; Mrsic-Pelcic, Jasenka; Sestan, Branko

2012-07-01

The aim of our study was to investigate the changes in drug usage and financial expenditure according to legal changes in Croatia during the period 2001 - 2008, especially considering pricing policy. The data on outpatient drug usage during the studied period was obtained from the Croatian National Health Insurance (CNHI). CNHI maintains a database on drugs prescribed by primary health care physicians and dispensed by pharmacies. The data was calculated and presented in defined daily doses (DDD) per inhabitant per year for antibiotics and in DDD/1,000 inhabitants/day for other drugs. The data is also presented in Euro/DDD and the financial expenditures are presented in Euros. During the investigated period drug usage increased 81.33%, while financial expenditure increased 77.23%. While total DDD/1,000 increased ~ 10% every year, financial expenditure increased 10 - 20% annually until 2006, but since then there have been no significant changes. Pricing policy changes could influence drug financial expenditure considerably in the short-term, but it is also important to apply a combination of measures for drug expenditure control. Numerous interventions from authorities from different countries all over the world, prove that there is still no so called "gold standard" which could restrain growing usage and expenditure of drugs. Clinical pharmacologists and clinical pharmacists should be included in these processes.

The use of online information resources by nurses.

PubMed

Wozar, Jody A; Worona, Paul C

2003-04-01

Based on the results of an informal needs assessment, the Usage of Online Information Resources by Nurses Project was designed to provide clinical nurses with accurate medical information at the point of care by introducing them to existing online library resources through instructional classes. Actual usage of the resources was then monitored for a set period of time. A two-hour hands-on class was developed for interested nurses. Participants were instructed in the content and use of several different online resources. A special Web page was designed for this project serving as an access point to the resources. Using a password system and WebTrends trade mark software, individual participant's usage of the resources was monitored for a thirty-day period following the class. At the end of the thirty days, usage results were tabulated, and participants were sent general evaluation forms. Eight participants accessed the project page thirty-nine times in a thirty-day period. The most accessed resource was Primary Care Online (PCO), accessed thirty-three times. PCO was followed by MD Consult (17), Ovid (8), NLM resources (5), and electronic journals (1). The individual with the highest usage accessed the project page thirteen times. Practicing clinical nurses will use online medical information resources if they are first introduced to them and taught how to access and use them. Health sciences librarians can play an important role in providing instruction to this often overlooked population.

The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low.

PubMed

Graat, Marleen E; Choi, Goda; Wolthuis, Esther K; Korevaar, Johanna C; Spronk, Peter E; Stoker, Jaap; Vroom, Margreeth B; Schultz, Marcus J

2006-02-01

The clinical value of daily routine chest radiographs (CXRs) in critically ill patients is unknown. We conducted this study to evaluate how frequently unexpected predefined major abnormalities are identified with daily routine CXRs, and how often these findings lead to a change in care for intensive care unit (ICU) patients. This was a prospective observational study conducted in a 28-bed, mixed medical-surgical ICU of a university hospital. Over a 5-month period, 2,457 daily routine CXRs were done in 754 consecutive ICU patients. The majority of these CXRs did not reveal any new predefined major finding. In only 5.8% of daily routine CXRs (14.3% of patients) was one or more new and unexpected abnormality encountered, including large atelectases (24 times in 20 patients), large infiltrates (23 in 22), severe pulmonary congestion (29 in 25), severe pleural effusion (13 in 13), pneumothorax/pneumomediastinum (14 in 13), and malposition of the orotracheal tube (32 in 26). Fewer than half of the CXRs with a new and unexpected finding were ultimately clinically relevant; in only 2.2% of all daily routine CXRs (6.4% of patients) did these radiologic abnormalities result in a change to therapy. Subgroup analysis revealed no differences between medical and surgical patients with regard to the incidence of new and unexpected findings on daily routine CXRs and the effect of new and unexpected CXR findings on daily care. In the ICU, daily routine CXRs seldom reveal unexpected, clinically relevant abnormalities, and they rarely prompt action. We propose that this diagnostic examination be abandoned in ICU patients.

Therapists' and patients' stress responses during graduated versus flooding in vivo exposure in the treatment of specific phobia: A preliminary observational study.

PubMed

Schumacher, Sarah; Miller, Robert; Fehm, Lydia; Kirschbaum, Clemens; Fydrich, Thomas; Ströhle, Andreas

2015-12-15

Exposure therapy is considered an effective treatment strategy for phobic anxiety, however, it is rarely applied in clinical practice. The under-usage might be due to various factors of which heightened stress levels not only in patients but also in therapists are presumed to be of particular relevance. The present study aimed to investigate whether different forms of exposure might lead to varying physiological and psychological stress responses in therapists and phobic patients. 25 patients with specific phobia underwent individual cognitive behavioural therapy, performed by 25 psychotherapist trainees, applying exposure sessions in graduated form or the flooding technique. Patients and therapists provided subjective evaluations of stress and five saliva samples for analysis of salivary cortisol and alpha-amylase either during two graduated exposure sessions or during one flooding session, while a regular therapy session served as control condition. Therapists displayed heightened salivary alpha-amylase release during exposure of the flooding, but not the graduated, type. Patients showed elevated salivary cortisol during flooding exposure numerically, however, not on a statistically significant level. Therapists reported more pronounced subjective stress during flooding compared to graduated exposure. Elevated stress levels should be addressed in clinical training in order to improve application of exposure in routine practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A Daily Diary Analysis of Condom Breakage and Slippage During Vaginal Sex or Anal Sex Among Adolescent Women.

PubMed

Hensel, Devon J; Selby, Sarah; Tanner, Amanda E; Fortenberry, J Dennis

2016-09-01

Adolescent women are disproportionately impacted by the adverse outcomes associated with sexual activity, including sexually transmitted infections (STI). Condoms as a means of prevention relies on use that is free of usage failure, including breakage and/or slippage. This study examined the daily prevalence of and predictors of condom breakage and/or slippage during vaginal sex and during anal sex among adolescent women. Adolescent women (N = 387; 14 to 17 years) were recruited from primary care clinics for a longitudinal cohort study of STIs and sexual behavior. Data were daily partner-specific sexual diaries. Random intercept mixed-effects logistic regression was used to estimate the fixed effect of each predictor on condom breakage/slippage during vaginal or during anal sex (Stata, 13.0), adjusting model coefficients for the correlation between repeated within-participant diary entries. Condom slippage and/or breakage varied across sexual behaviors and was associated with individual-specific (eg, age and sexual interest) and partner-specific factors (eg, negativity). Recent behavioral factors (eg, experiencing slippage and/or breakage in the past week) were the strongest predictors of current condom slippage and/or breakage during vaginal or anal sex. Factors associated with young women's condom breakage/slippage during vaginal or during anal sex should be integrated as part of STI prevention efforts and should be assessed as part of ongoing routine clinical care.

128 SHADES OF RED: Objective Remote Assessment of Radiation Dermatitis by Augmented Digital Skin Imaging.

PubMed

Partl, Richard; Jonko, Beata; Schnidar, Stefan; Schöllhammer, Michael; Bauer, Max; Singh, Sanchit; Simeckova, Julia; Wiesner, Kathrin; Neubauer, Andreas; Schnidar, Harald

2017-01-01

The purpose of our investigation was to develop a novel and state of the art digital skin imaging method capable for remote monitoring and objective assessment of Radiation Induced Dermatitis (RID). Therefore, radiation therapy related side effects were assessed by medical experts according to Common Terminology Criteria for Adverse Events (CTCAE) grade of severity in 20 female breast cancer patients in a clinical trial over the treatment time frame of 25-28 radiation cycles, 50.0-50.4 Gy each. Furthermore the intensity of developed skin erythema was documented by using conventional spectrophotometry plus digital skin imaging. Thereby we could derive the Standardized Erythema Value (SEV), a novel objective parameter, which in contrast to single parametric L* and a* delivers a long dynamic measurement range for analyzing RID from bright to very dark skin tones. Methodical superiority of the SEV could be proven over spectrophotometer measurements in terms of a higher sensitivity and by enabling signal intensity mapping in analyzed skin images. Our thereupon-derived patent enables novel objective dermatologic eHealth applications in a broad range of medical and industrial use by opening likewise the window for augmented dermatology. The first of its kind system is now already further developed in form of the medical device product Scarletred^®Vision. It is available on the market for primary usage in clinical trials and in medical routine.

Smartphone dependence classification using tensor factorization.

PubMed

Choi, Jingyun; Rho, Mi Jung; Kim, Yejin; Yook, In Hye; Yu, Hwanjo; Kim, Dai-Jin; Choi, In Young

2017-01-01

Excessive smartphone use causes personal and social problems. To address this issue, we sought to derive usage patterns that were directly correlated with smartphone dependence based on usage data. This study attempted to classify smartphone dependence using a data-driven prediction algorithm. We developed a mobile application to collect smartphone usage data. A total of 41,683 logs of 48 smartphone users were collected from March 8, 2015, to January 8, 2016. The participants were classified into the control group (SUC) or the addiction group (SUD) using the Korean Smartphone Addiction Proneness Scale for Adults (S-Scale) and a face-to-face offline interview by a psychiatrist and a clinical psychologist (SUC = 23 and SUD = 25). We derived usage patterns using tensor factorization and found the following six optimal usage patterns: 1) social networking services (SNS) during daytime, 2) web surfing, 3) SNS at night, 4) mobile shopping, 5) entertainment, and 6) gaming at night. The membership vectors of the six patterns obtained a significantly better prediction performance than the raw data. For all patterns, the usage times of the SUD were much longer than those of the SUC. From our findings, we concluded that usage patterns and membership vectors were effective tools to assess and predict smartphone dependence and could provide an intervention guideline to predict and treat smartphone dependence based on usage data.

Computer programs: Information retrieval and data analysis, a compilation

NASA Technical Reports Server (NTRS)

1972-01-01

The items presented in this compilation are divided into two sections. Section one treats of computer usage devoted to the retrieval of information that affords the user rapid entry into voluminous collections of data on a selective basis. Section two is a more generalized collection of computer options for the user who needs to take such data and reduce it to an analytical study within a specific discipline. These programs, routines, and subroutines should prove useful to users who do not have access to more sophisticated and expensive computer software.

An innovative use of instant messaging technology to support a library's single-service point.

PubMed

Horne, Andrea S; Ragon, Bart; Wilson, Daniel T

2012-01-01

A library service model that provides reference and instructional services by summoning reference librarians from a single service point is described. The system utilizes Libraryh3lp, an open-source, multioperator instant messaging system. The selection and refinement of this solution and technical challenges encountered are explored, as is the design of public services around this technology, usage of the system, and best practices. This service model, while a major cultural and procedural change at first, is now a routine aspect of customer service for this library.

The Alba ray tracing code: ART

NASA Astrophysics Data System (ADS)

Nicolas, Josep; Barla, Alessandro; Juanhuix, Jordi

2013-09-01

The Alba ray tracing code (ART) is a suite of Matlab functions and tools for the ray tracing simulation of x-ray beamlines. The code is structured in different layers, which allow its usage as part of optimization routines as well as an easy control from a graphical user interface. Additional tools for slope error handling and for grating efficiency calculations are also included. Generic characteristics of ART include the accumulation of rays to improve statistics without memory limitations, and still providing normalized values of flux and resolution in physically meaningful units.

OSCAR4: a flexible architecture for chemical text-mining.

PubMed

Jessop, David M; Adams, Sam E; Willighagen, Egon L; Hawizy, Lezan; Murray-Rust, Peter

2011-10-14

The Open-Source Chemistry Analysis Routines (OSCAR) software, a toolkit for the recognition of named entities and data in chemistry publications, has been developed since 2002. Recent work has resulted in the separation of the core OSCAR functionality and its release as the OSCAR4 library. This library features a modular API (based on reduction of surface coupling) that permits client programmers to easily incorporate it into external applications. OSCAR4 offers a domain-independent architecture upon which chemistry specific text-mining tools can be built, and its development and usage are discussed.

Clinical Supervision of Mental Health Professionals Serving Youth: Format and Microskills.

PubMed

Bailin, Abby; Bearman, Sarah Kate; Sale, Rafaella

2018-03-21

Clinical supervision is an element of quality assurance in routine mental health care settings serving children; however, there is limited scientific evaluation of its components. This study examines the format and microskills of routine supervision. Supervisors (n = 13) and supervisees (n = 20) reported on 100 supervision sessions, and trained coders completed observational coding on a subset of recorded sessions (n = 57). Results indicate that microskills shown to enhance supervisee competency in effectiveness trials and experiments were largely absent from routine supervision, highlighting potential missed opportunities to impart knowledge to therapists. Findings suggest areas for quality improvement within routine care settings.

Cardiac troponins--Translational biomarkers in cardiology: Theory and practice of cardiac troponin high-sensitivity assays.

PubMed

Adamcova, Michaela; Popelova-Lencova, Olga; Jirkovsky, Eduard; Simko, Fedor; Gersl, Vladimir; Sterba, Martin

2016-01-01

Tn is a unique translational biomarker in cardiology whose potential has not been diminished in the new era of high sensitive assays. cTns can be valuable markers in cardiac diseases as well as in infectious diseases and respiratory diseases. Furthermore, the role of cTns is growing in the routine evaluation of cardioxicity and in determining the efficacy/safety ratio of novel cardioprotective strategies in clinical settings. cTns can detect myocardial injury not only in a wide spectrum of laboratory animals in experimental studies in vivo, but also in isolated heart models or cardiomyocytes in vitro. The crucial issue regarding the cross-species usage of cardiac troponin investigation remains the choice of cardiac troponin testing. This review summarizes the recent proteomic data on aminoacid sequences of cTnT and cTnI in various species, as well as selected analytical characteristics of human cardiac troponin high-sensitivity assays. Due to the highly phylogenetically conserved structure of troponins, the same bioindicator can be investigated using the same method in both clinical and experimental cardiology, thus contributing to a better understanding of the pathogenesis of cardiac diseases as well as to increased effectiveness of troponin use in clinical practice. Measuring cardiac troponins using commercially available human high-sensitivity cardiac troponin tests with convenient antibodies selected on the basis of adequate proteomic knowledge can solve many issues which would otherwise be difficult to address in clinical settings for various ethical and practical reasons. Our survey could help elaborate the practical guidelines for optimizing the choice of cTns assay in cardiology. © 2016 International Union of Biochemistry and Molecular Biology.

Long-Term Experience with First-Generation Implantable Neurostimulation Device in Central Sleep Apnea Treatment.

PubMed

Fox, Henrik; Bitter, Thomas; Horstkotte, Dieter; Oldenburg, Olaf; Gutleben, Klaus-Jürgen

2017-05-01

Sleep-disordered breathing (SDB) and Cheyne-Stokes respiration (CSR) are associated with shorter survival in patients with heart failure. A novel treatment method for this patient group is unilateral phrenic nerve stimulation by the remedē® system (Respicardia Inc., Minnetonka, MN, USA), a transvenously implantable neurostimulation device, which has recently been studied in a large randomized, controlled trial. Previous literature has shown efficacy and safety of the treatment with this first-generation device, but hardly any data are available on long-term clinical parameters, the remedē® device's battery lifetime, device exchangeability, lead position stability, surgical accessibility, and manageability. We performed remedē® device replacements in consecutive patients for battery depletion, and documented clinical parameters, longevity, operation procedure, complications, and difficulties. All patients were on neurostimulation treatment by phrenic nerve neurostimulation when device replacement became necessary. Apnea-hypopnea index (from 45 ± 4/h to 9 ± 4/h), oxygen-desaturation index (from 35 ± 7/h to 7 ± 6/h), and time spent with oxygen saturation of <90% (T < 90% from 5 ± 7% to 0 ± 0%) were improved and improvements remained constant throughout the 4-year follow-up. Mean battery life was 4.2 ± 0.2 years and mean replacement procedure time was 25 ± 5.1 minutes. Apart from conventional X-ray documentation of stable lead positions in a long-term setting, no radiation or contrast dye usage was needed and no major complications occurred. In addition, clinical exercise capacity and sleepiness symptoms improved. Novel remedē® device shows sustained therapy efficacy and safety in terms of stable lead positions over 4 years. Long-term phrenic nerve neurostimulation therapy for central SDB/CSR appears feasible in a clinical routine setting. © 2017 Wiley Periodicals, Inc.

Usage patterns and 1-year outcomes with the TAXUS Liberté stent: results of the TAXUS OLYMPIA registry.

PubMed

Ahmed, Waqar H; Mendiz, Oscar A; Thomas, Martyn R

2011-06-01

The TAXUS OLYMPIA registry is a prospective, global, post-approval program designed to collect clinical outcome data through 1 year from patients receiving the TAXUS Liberté paclitaxel-eluting stent in routine interventional cardiology practice. The thin-strut TAXUS Liberté stent has been studied in ongoing clinical trials with specific inclusion/exclusion criteria. Between September 2005 and April 2007, a total of 21,954 patients from 365 sites in 57 countries eligible to receive a TAXUS Liberté stent were enrolled in the TAXUS OLYMPIA registry. Baseline characteristics and procedure patterns were collected and clinical follow-up is available for 1 year. The primary endpoint was the composite cardiac event (cardiac death, MI, and reintervention of the target vessel) rate related to the TAXUS Liberté stent at 1 year. All cardiac events were monitored and all endpoints were independently adjudicated. Complex patients and lesions were prevalent, including: 27% medically-treated diabetes, 58% ACC/AHA type B2/C lesions, 32% multiple stenting, 13% long lesions (>28 mm), and 10% small vessels (<2.5 mm). At 1 year, the composite cardiac event rate was 4.4%, including 1.4% cardiac death, 1.0% MI, and 3.2% TVR. Stent thrombosis (ST, angiographically confirmed) occurred in 0.8% of patients, with 0.4% ST occurring >30 days postprocedure. The composite cardiac event rate related to the TAXUS Liberté stent was 3.8% at 1 year. Low 1-year cardiac event rates were reported with TAXUS Liberté in a broad spectrum of patients, thereby confirming the technical and clinical performance of this stent in a "real-world" setting. Copyright © 2010 Wiley-Liss, Inc.

pmx Webserver: A User Friendly Interface for Alchemistry.

PubMed

Gapsys, Vytautas; de Groot, Bert L

2017-02-27

With the increase of available computational power and improvements in simulation algorithms, alchemical molecular dynamics based free energy calculations have developed into routine usage. To further facilitate the usability of alchemical methods for amino acid mutations, we have developed a web based infrastructure for obtaining hybrid protein structures and topologies. The presented webserver allows amino acid mutation selection in five contemporary molecular mechanics force fields. In addition, a complete mutation scan with a user defined amino acid is supported. The output generated by the webserver is directly compatible with the Gromacs molecular dynamics engine and can be used with any of the alchemical free energy calculation setup. Furthermore, we present a database of input files and precalculated free energy differences for tripeptides approximating a disordered state of a protein, of particular use for protein stability studies. Finally, the usage of the webserver and its output is exemplified by performing an alanine scan and investigating thermodynamic stability of the Trp cage mini protein. The webserver is accessible at http://pmx.mpibpc.mpg.de.

A study to assess the usage of MCR footwear in West Bengal, India.

PubMed

Lal, Vivek; Sarkar, Debajit; Das, Sukumar; Mahato, Mukunda; Srinivas, Govindrajulu

2015-09-01

The routine use of appropriate footwear is an important intervention to prevent disability in leprosy. We conducted a study to assess utilisation of MCR footwear and observe the condition of footwear. Fifty-six persons affected by leprosy who had been provided MCR footwear in the preceding 3 years were paid home visit and administered a semi-structured interview schedule. Although a total of 30 participants reported using special footwear currently, only 10 reported usage during participation in social events. On observation, 16 pairs were found to be in an unusable condition owing to foot deformity and another 14 pairs in poor condition. In order to ensure greater utilisation of special footwear, the National Programme may seek local solutions through engagement of cobblers and shoemakers with appropriate training in customisation. Persons affected by leprosy should be empowered to appreciate the benefits of special footwear and to take care of themselves, including taking responsibility for using their footwear.

Randomised controlled trial of routine individual feedback to improve rationality and reduce numbers of test requests.

PubMed

Winkens, R A; Pop, P; Bugter-Maessen, A M; Grol, R P; Kester, A D; Beusmans, G H; Knottnerus, J A

1995-02-25

Feedback can be described as a way to provide information on doctors' performance to enable changes in future behaviour. Feedback is used with the aim of changing test-ordering behaviour. It can lead to reductions in test usage and cost savings. It is not sufficiently clear, however, whether feedback leads to more appropriate test use. Since 1985, the Diagnostic Coordinating Center Maastricht has been giving feedback on diagnostic tests as a routine health care activity to all family doctors in its region. Both quantity and quality of requests are discussed. In a randomised, controlled trial over 2.5 years, discussion of tests not included previously was added to the existing routine feedback. One group of family doctors (n = 39) received feedback on test-group A (electrocardiography, endoscopy, cervical smears, and allergy tests), the other (n = 40) on test-group B (radiographic and ultrasonographic tests). Thus, each group of doctors acted as a control group for the other. Changes in volume and rationality of requests were analysed. The number of requests decreased during the trial (p = 0.036). Request numbers decreased particularly for test-group A (p = 0.04). The proportion of requests that were non-rational decreased more in the intervention than in the control groups (p = 0.009). Rationality improved predominantly for test-group B (p = 0.043). Thus, routine feedback can change the quantity and quality of requests.

Characterization of Medication Use in a Multicenter Sample of Pediatric Inpatients with Autism Spectrum Disorder.

PubMed

Wink, Logan K; Pedapati, Ernest V; Adams, Ryan; Erickson, Craig A; Pedersen, Kahsi A; Morrow, Eric M; Kaplan, Desmond; Siegel, Matthew

2017-05-17

Nearly 11% of youth with Autism Spectrum Disorder (ASD) undergo psychiatric hospitalization, and 65% are treated with psychotropic medication. Here we characterize psychotropic medication usage in subjects enrolled in the Autism Inpatient Collection. Participant psychotropic medication usage rates topped 90% at admission and discharge, though there was a decline at 2-month follow-up. Antipsychotics, ADHD medications, and sleep aids were the most commonly reported classes of medications. The impact of age, gender, and non-verbal IQ on medication usage rates was minimal, though age and IQ may play a role in prescribing practices. Future work is indicated to explore medication usage trends, the impact of clinical factors on medication use rates, and the safety of psychotropic medications in youth with ASD.

Assessing the ownership, usage and knowledge of Insecticide Treated Nets (ITNs) in Malaria Prevention in the Hohoe Municipality, Ghana

PubMed Central

Nyavor, Kunche Delali; Kweku, Margaret; Agbemafle, Isaac; Takramah, Wisdom; Norman, Ishmael; Tarkang, Elvis; Binka, Fred

2017-01-01

Introduction Malaria remains one of the top five killer diseases in sub-Saharan Africa (SSA) and its burden is skewed towards pregnant women and children under five. Insecticide Treated Bed-Net (ITN) usage is considered one of the most cost-effective, preventive interventions against malaria. This study sought to assess ownership, usage, effectiveness, knowledge, access and availability of ITNs among mothers with children under five in the Hohoe municipality. Methods In August 2010 a cross-sectional survey was carried out in 30 communities, selected using the WHO 30 cluster sampling technique. In the selected communities, mothers/caregivers with children under five years were selected using the snowball method. Data were collected through questionnaires and direct observation of ITN. Descriptive statistics was used to analyse the data collected. Results A total of 450 mothers/caregivers were interviewed and their mean age was 30 ± 7 years. ITN ownership was 81.3%, and usage was 66.4%. The majority (97.8%) of the mothers/caregivers said ITNs were effective for malaria prevention. Awareness about ITNs was high (98.7%) and the majority (52.9%) had heard about ITNs from Reproductive and Child Health (RCH) Clinic and antenatal care ANC clinic (33.6%). Over 60% of the ITNs were acquired through free distribution at RCH clinics, clinic and home distribution during mass immunization sessions. The majority of the mothers/caregivers (78.6%) knew the signs and symptoms of malaria, what causes malaria (82.2%) and who is most at risk (90%). Conclusion Behaviour change communication strategies on ITN use may need to be further targeted to ensure full use of available ITNs. PMID:29255537

Assessing the ownership, usage and knowledge of Insecticide Treated Nets (ITNs) in Malaria Prevention in the Hohoe Municipality, Ghana.

PubMed

Nyavor, Kunche Delali; Kweku, Margaret; Agbemafle, Isaac; Takramah, Wisdom; Norman, Ishmael; Tarkang, Elvis; Binka, Fred

2017-01-01

Malaria remains one of the top five killer diseases in sub-Saharan Africa (SSA) and its burden is skewed towards pregnant women and children under five. Insecticide Treated Bed-Net (ITN) usage is considered one of the most cost-effective, preventive interventions against malaria. This study sought to assess ownership, usage, effectiveness, knowledge, access and availability of ITNs among mothers with children under five in the Hohoe municipality. In August 2010 a cross-sectional survey was carried out in 30 communities, selected using the WHO 30 cluster sampling technique. In the selected communities, mothers/caregivers with children under five years were selected using the snowball method. Data were collected through questionnaires and direct observation of ITN. Descriptive statistics was used to analyse the data collected. A total of 450 mothers/caregivers were interviewed and their mean age was 30 ± 7 years. ITN ownership was 81.3%, and usage was 66.4%. The majority (97.8%) of the mothers/caregivers said ITNs were effective for malaria prevention. Awareness about ITNs was high (98.7%) and the majority (52.9%) had heard about ITNs from Reproductive and Child Health (RCH) Clinic and antenatal care ANC clinic (33.6%). Over 60% of the ITNs were acquired through free distribution at RCH clinics, clinic and home distribution during mass immunization sessions. The majority of the mothers/caregivers (78.6%) knew the signs and symptoms of malaria, what causes malaria (82.2%) and who is most at risk (90%). Behaviour change communication strategies on ITN use may need to be further targeted to ensure full use of available ITNs.

Effect of different scenarios for selective dry-cow therapy on udder health, antimicrobial usage, and economics.

PubMed

Scherpenzeel, C G M; den Uijl, I E M; van Schaik, G; Riekerink, R G M Olde; Hogeveen, H; Lam, T J G M

2016-05-01

The goal of dry-cow therapy (DCT) is to reduce the prevalence of intramammary infections (IMI) by eliminating existing IMI at drying off and preventing new IMI from occurring during the dry period. Due to public health concerns, however, preventive use of antimicrobials has become questionable. In this study, we evaluated the effects of 8 scenarios for selecting animals for DCT, taking into account variation in parity and cow-level somatic cell count (SCC) at drying off. The aim of this study was to evaluate udder health, antimicrobial usage, and economics at the herd level when using different scenarios for selecting cows for DCT. To enable calculation and comparison of the effects of different scenarios to select cows for DCT in an "average" herd, we created an example herd, with a virtual herd size of 100 dairy cows to be calving during a year. Udder health, antimicrobial usage, and economics were evaluated during the dry period and the first 100 d in lactation, the period during which the greatest effect of DCT is expected. This leads to an estimated 13,551 cow-days at risk during a year in a 100-cow dairy herd. In addition to a blanket DCT (BDCT) scenario, we developed 7 scenarios to select cows for DCT based on SCC. The scenarios covered a range of possible approaches to select low-SCC cows for DCT, all based on cow-level SCC thresholds on the last milk recording before drying off. The incidence rate of clinical mastitis in the example herd varied from 11.6 to 14.5 cases of clinical mastitis per 10,000 cow-days at risk in the different scenarios, and the prevalence of subclinical mastitis varied from 38.8% in scenario 1 (BDCT) to 48.3% in scenario 8. Total antimicrobial usage for DCT and clinical mastitis treatment varied over the scenarios from 1.27 (scenario 8) to 3.15 animal daily dosages (BDCT), leading to a maximum reduction in antimicrobial usage of 60% for scenario 8 compared with BDCT. The total costs for each of the scenarios showed little variation, varying from €4,893 for scenario 5 to €5,383 for scenario 8. The effect of selective DCT compared with BDCT on udder health, antimicrobial usage, and economics is influenced by the SCC criteria used to select cows for DCT. Scenario 2 resulted in the lowest increases in clinical and subclinical mastitis compared with BDCT. The greatest reduction in antimicrobial usage was achieved under scenario 8. From an economic perspective, lowest costs were achieved with scenario 5. Drying off dairy cows with antimicrobials has an effect on udder health, antimicrobial usage, and economics. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Evidence and resources to implement Pharmacogenetic Knowledge for Precision Medicine

PubMed Central

Caudle, Kelly E.; Gammal, Roseann S.; Whirl-Carrillo, Michelle; Hoffman, James M.; Relling, Mary V.; Klein, Teri E.

2016-01-01

Purpose Implementation of pharmacogenetics into clinical practice has been relatively slow despite substantial scientific progress over the last decade. One barrier that inhibits uptake of pharmacogenetics into routine clinical practice is the lack of knowledge of how to translate a genetic test into a clinical action based on current evidence. The purpose of this paper is to describe the current state of pharmacogenetic evidence and evidence-based resources that facilitate the uptake of pharmacogenetics into clinical practice. Summary Controversy exists over the required evidence threshold needed for routine clinical implementation of pharmacogenetics. Large randomized controlled trials are not clinically feasible or necessary for many pharmacogenetic applications. Online resources exist like the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Pharmacogenomics Knowledgebase (PharmGKB) that provide freely available, evidence-based resources that facilitate the translation of genetic laboratory test results into actionable prescribing recommendations for specific drugs. Conclusion Resources provided by organizations such as CPIC and PharmGKB that use standardized approaches to evaluate the literature and provide clinical guidance are essential for the implementation of pharmacogenetics into routine clinical practice. PMID:27864205

US-Cut: interactive algorithm for rapid detection and segmentation of liver tumors in ultrasound acquisitions

NASA Astrophysics Data System (ADS)

Egger, Jan; Voglreiter, Philip; Dokter, Mark; Hofmann, Michael; Chen, Xiaojun; Zoller, Wolfram G.; Schmalstieg, Dieter; Hann, Alexander

2016-04-01

Ultrasound (US) is the most commonly used liver imaging modality worldwide. It plays an important role in follow-up of cancer patients with liver metastases. We present an interactive segmentation approach for liver tumors in US acquisitions. Due to the low image quality and the low contrast between the tumors and the surrounding tissue in US images, the segmentation is very challenging. Thus, the clinical practice still relies on manual measurement and outlining of the tumors in the US images. We target this problem by applying an interactive segmentation algorithm to the US data, allowing the user to get real-time feedback of the segmentation results. The algorithm has been developed and tested hand-in-hand by physicians and computer scientists to make sure a future practical usage in a clinical setting is feasible. To cover typical acquisitions from the clinical routine, the approach has been evaluated with dozens of datasets where the tumors are hyperechoic (brighter), hypoechoic (darker) or isoechoic (similar) in comparison to the surrounding liver tissue. Due to the interactive real-time behavior of the approach, it was possible even in difficult cases to find satisfying segmentations of the tumors within seconds and without parameter settings, and the average tumor deviation was only 1.4mm compared with manual measurements. However, the long term goal is to ease the volumetric acquisition of liver tumors in order to evaluate for treatment response. Additional aim is the registration of intraoperative US images via the interactive segmentations to the patient's pre-interventional CT acquisitions.

Short structured general mental health in service training programme in Kenya improves patient health and social outcomes but not detection of mental health problems - a pragmatic cluster randomised controlled trial

PubMed Central

2013-01-01

Trial design A pragmatic cluster randomised controlled trial. Methods Participants: Clusters were primary health care clinics on the Ministry of Health list. Clients were eligible if they were aged 18 and over. Interventions: Two members of staff from each intervention clinic received the training programme. Clients in both intervention and control clinics subsequently received normal routine care from their health workers. Objective: To examine the impact of a mental health inservice training on routine detection of mental disorder in the clinics and on client outcomes. Outcomes: The primary outcome was the rate of accurate routine clinic detection of mental disorder and the secondary outcome was client recovery over a twelve week follow up period. Randomisation: clinics were randomised to intervention and control groups using a table of random numbers. Blinding: researchers and clients were blind to group assignment. Results Numbers randomised: 49 and 50 clinics were assigned to intervention and control groups respectively. 12 GHQ positive clients per clinic were identified for follow up. Numbers analysed: 468 and 478 clients were followed up for three months in intervention and control groups respectively. Outcome: At twelve weeks after training of the intervention group, the rate of accurate routine clinic detection of mental disorder was greater than 0 in 5% versus 0% of the intervention and control groups respectively, in both the intention to treat analysis (p = 0.50) and the per protocol analysis (p =0.50). Standardised effect sizes for client improvement were 0.34 (95% CI = (0.01,0.68)) for the General Health Questionnaire, 0.39 ((95% CI = (0.22, 0.61)) for the EQ and 0.49 (95% CI = (0.11,0.87)) for WHODAS (using ITT analysis); and 0.43 (95% CI = (0.09,0.76)) for the GHQ, 0.44 (95% CI = (0.22,0.65)) for the EQ and 0.58 (95% CI = (0.18,0.97)) for WHODAS (using per protocol analysis). Harms: None identified. Conclusion The training programme did not result in significantly improved recorded diagnostic rates of mental disorders in the routine clinic consultation register, but did have significant effects on patient outcomes in routine clinical practice. Trial registration International Standard Randomised Controlled Trial Number Register ISRCTN53515024. PMID:24188964

Smartphone dependence classification using tensor factorization

PubMed Central

Kim, Yejin; Yook, In Hye; Yu, Hwanjo; Kim, Dai-Jin

2017-01-01

Excessive smartphone use causes personal and social problems. To address this issue, we sought to derive usage patterns that were directly correlated with smartphone dependence based on usage data. This study attempted to classify smartphone dependence using a data-driven prediction algorithm. We developed a mobile application to collect smartphone usage data. A total of 41,683 logs of 48 smartphone users were collected from March 8, 2015, to January 8, 2016. The participants were classified into the control group (SUC) or the addiction group (SUD) using the Korean Smartphone Addiction Proneness Scale for Adults (S-Scale) and a face-to-face offline interview by a psychiatrist and a clinical psychologist (SUC = 23 and SUD = 25). We derived usage patterns using tensor factorization and found the following six optimal usage patterns: 1) social networking services (SNS) during daytime, 2) web surfing, 3) SNS at night, 4) mobile shopping, 5) entertainment, and 6) gaming at night. The membership vectors of the six patterns obtained a significantly better prediction performance than the raw data. For all patterns, the usage times of the SUD were much longer than those of the SUC. From our findings, we concluded that usage patterns and membership vectors were effective tools to assess and predict smartphone dependence and could provide an intervention guideline to predict and treat smartphone dependence based on usage data. PMID:28636614

Clinical practice of analysis of anti-drug antibodies against interferon beta and natalizumab in multiple sclerosis patients in Europe: A descriptive study of test results

PubMed Central

Auer, Michael; Ryner, Malin; Hässler, Signe; Bachelet, Delphine; Mbogning, Cyprien; Warnke, Clemens; Buck, Dorothea; Hyldgaard Jensen, Poul Erik; Sievers, Claudia; Ingenhoven, Kathleen; Fissolo, Nicolas; Lindberg, Raija; Grummel, Verena; Donnellan, Naoimh; Comabella, Manuel; Montalban, Xavier; Kieseier, Bernd; Soelberg Sørensen, Per; Hartung, Hans-Peter; Derfuss, Tobias; Lawton, Andy; Sikkema, Dan; Pallardy, Marc; Hemmer, Bernhard; Deisenhammer, Florian; Broët, Philippe; Dönnes, Pierre; Davidson, Julie; Fogdell-Hahn, Anna

2017-01-01

Antibodies against biopharmaceuticals (anti-drug antibodies, ADA) have been a well-integrated part of the clinical care of multiple sclerosis (MS) in several European countries. ADA data generated in Europe during the more than 10 years of ADA monitoring in MS patients treated with interferon beta (IFNβ) and natalizumab have been pooled and characterized through collaboration within a European consortium. The aim of this study was to report on the clinical practice of ADA testing in Europe, considering the number of ADA tests performed and type of ADA assays used, and to determine the frequency of ADA testing against the different drug preparations in different countries. A common database platform (tranSMART) for querying, analyzing and storing retrospective data of MS cohorts was set up to harmonize the data and compare results of ADA tests between different countries. Retrospective data from six countries (Sweden, Austria, Spain, Switzerland, Germany and Denmark) on 20,695 patients and on 42,555 samples were loaded into tranSMART including data points of age, gender, treatment, samples, and ADA results. The previously observed immunogenic difference among the four IFNβ preparations was confirmed in this large dataset. Decreased usage of the more immunogenic preparations IFNβ-1a subcutaneous (s.c.) and IFNβ-1b s.c. in favor of the least immunogenic preparation IFNβ-1a intramuscular (i.m.) was observed. The median time from treatment start to first ADA test correlated with time to first positive test. Shorter times were observed for IFNβ-1b-Extavia s.c. (0.99 and 0.94 years) and natalizumab (0.25 and 0.23 years), which were introduced on the market when ADA testing was already available, as compared to IFNβ-1a i.m. (1.41 and 2.27 years), IFNβ-1b-Betaferon s.c. (2.51 and 1.96 years) and IFNβ-1a s.c. (2.11 and 2.09 years) which were available years before routine testing began. A higher rate of anti-IFNβ ADA was observed in test samples taken from older patients. Testing for ADA varies between different European countries and is highly dependent on the policy within each country. For drugs where routine monitoring of ADA is not in place, there is a risk that some patients remain on treatment for several years despite ADA positivity. For drugs where a strategy of ADA testing is introduced with the release of the drug, there is a reduced risk of having ADA positive patients and thus of less efficient treatment. This indicates that potential savings in health cost might be achieved by routine analysis of ADA. PMID:28170401

Clinical practice of analysis of anti-drug antibodies against interferon beta and natalizumab in multiple sclerosis patients in Europe: A descriptive study of test results.

PubMed

Link, Jenny; Ramanujam, Ryan; Auer, Michael; Ryner, Malin; Hässler, Signe; Bachelet, Delphine; Mbogning, Cyprien; Warnke, Clemens; Buck, Dorothea; Hyldgaard Jensen, Poul Erik; Sievers, Claudia; Ingenhoven, Kathleen; Fissolo, Nicolas; Lindberg, Raija; Grummel, Verena; Donnellan, Naoimh; Comabella, Manuel; Montalban, Xavier; Kieseier, Bernd; Soelberg Sørensen, Per; Hartung, Hans-Peter; Derfuss, Tobias; Lawton, Andy; Sikkema, Dan; Pallardy, Marc; Hemmer, Bernhard; Deisenhammer, Florian; Broët, Philippe; Dönnes, Pierre; Davidson, Julie; Fogdell-Hahn, Anna

2017-01-01

Antibodies against biopharmaceuticals (anti-drug antibodies, ADA) have been a well-integrated part of the clinical care of multiple sclerosis (MS) in several European countries. ADA data generated in Europe during the more than 10 years of ADA monitoring in MS patients treated with interferon beta (IFNβ) and natalizumab have been pooled and characterized through collaboration within a European consortium. The aim of this study was to report on the clinical practice of ADA testing in Europe, considering the number of ADA tests performed and type of ADA assays used, and to determine the frequency of ADA testing against the different drug preparations in different countries. A common database platform (tranSMART) for querying, analyzing and storing retrospective data of MS cohorts was set up to harmonize the data and compare results of ADA tests between different countries. Retrospective data from six countries (Sweden, Austria, Spain, Switzerland, Germany and Denmark) on 20,695 patients and on 42,555 samples were loaded into tranSMART including data points of age, gender, treatment, samples, and ADA results. The previously observed immunogenic difference among the four IFNβ preparations was confirmed in this large dataset. Decreased usage of the more immunogenic preparations IFNβ-1a subcutaneous (s.c.) and IFNβ-1b s.c. in favor of the least immunogenic preparation IFNβ-1a intramuscular (i.m.) was observed. The median time from treatment start to first ADA test correlated with time to first positive test. Shorter times were observed for IFNβ-1b-Extavia s.c. (0.99 and 0.94 years) and natalizumab (0.25 and 0.23 years), which were introduced on the market when ADA testing was already available, as compared to IFNβ-1a i.m. (1.41 and 2.27 years), IFNβ-1b-Betaferon s.c. (2.51 and 1.96 years) and IFNβ-1a s.c. (2.11 and 2.09 years) which were available years before routine testing began. A higher rate of anti-IFNβ ADA was observed in test samples taken from older patients. Testing for ADA varies between different European countries and is highly dependent on the policy within each country. For drugs where routine monitoring of ADA is not in place, there is a risk that some patients remain on treatment for several years despite ADA positivity. For drugs where a strategy of ADA testing is introduced with the release of the drug, there is a reduced risk of having ADA positive patients and thus of less efficient treatment. This indicates that potential savings in health cost might be achieved by routine analysis of ADA.

Gender differences in depressive symptom profiles and patterns of psychotropic drug usage in Asian patients with depression: Findings from the Research on Asian Psychotropic Prescription Patterns for Antidepressants study.

PubMed

Park, Seon-Cheol; Lee, Min-Soo; Shinfuku, Naotaka; Sartorius, Norman; Park, Yong Chon

2015-09-01

The purpose of this study was to investigate whether there were gender-specific depressive symptom profiles or gender-specific patterns of psychotropic agent usage in Asian patients with depression. Clinical data from the Research on Asian Psychotropic Prescription Patterns for Antidepressant study (1171 depressed patients) were used to determine gender differences by analysis of covariates for continuous variables and by logistic regression analysis for discrete variables. In addition, a binary logistic regression model was fitted to identify independent clinical correlates of the gender-specific pattern on psychotropic drug usage. Men were more likely than women to have loss of interest (adjusted odds ratio = 1.379, p = 0.009), fatigue (adjusted odds ratio = 1.298, p = 0.033) and concurrent substance abuse (adjusted odds ratio = 3.793, p = 0.008), but gender differences in other symptom profiles and clinical features were not significant. Men were also more likely than women to be prescribed adjunctive therapy with a second-generation antipsychotic (adjusted odds ratio = 1.320, p = 0.044). However, men were less likely than women to have suicidal thoughts/acts (adjusted odds ratio = 0.724, p = 0.028). Binary logistic regression models revealed that lower age (odds ratio = 0.986, p = 0.027) and current hospitalization (odds ratio = 3.348, p < 0.0001) were independent clinical correlates of use of second-generation antipsychotics as adjunctive therapy for treating depressed Asian men. Unique gender-specific symptom profiles and gender-specific patterns of psychotropic drug usage can be identified in Asian patients with depression. Hence, ethnic and cultural influences on the gender preponderance of depression should be considered in the clinical psychiatry of Asian patients. © The Royal Australian and New Zealand College of Psychiatrists 2015.

A Survey of Attitudes towards the Clinical Application of Systemic Inflammation Based Prognostic Scores in Cancer.

PubMed

Watt, David G; Roxburgh, Campbell S; White, Mark; Chan, Juen Zhik; Horgan, Paul G; McMillan, Donald C

2015-01-01

The systemic inflammatory response (SIR) plays a key role in determining nutritional status and survival of patients with cancer. A number of objective scoring systems have been shown to have prognostic value; however, their application in routine clinical practice is not clear. The aim of the present survey was to examine the range of opinions internationally on the routine use of these scoring systems. An online survey was distributed to a target group consisting of individuals worldwide who have reported an interest in systemic inflammation in patients with cancer. Of those invited by the survey (n = 238), 65% routinely measured the SIR, mainly for research and prognostication purposes and clinically for allocation of adjuvant therapy or palliative chemotherapy. 40% reported that they currently used the Glasgow Prognostic Score/modified Glasgow Prognostic Score (GPS/mGPS) and 81% reported that a measure of systemic inflammation should be incorporated into clinical guidelines, such as the definition of cachexia. The majority of respondents routinely measured the SIR in patients with cancer, mainly using the GPS/mGPS for research and prognostication purposes. The majority reported that a measure of the SIR should be adopted into clinical guidelines.

Non-invasive prenatal testing (NIPT): Europe's first multicenter post-market clinical follow-up study validating the quality in clinical routine.

PubMed

Flöck, Anne; Tu, Ngoc-Chi; Rüland, Anna; Holzgreve, Wolfgang; Gembruch, Ulrich; Geipel, Annegret

2017-11-01

Non-invasive prenatal tests (NIPT) for the determination of fetal aneuploidies from maternal blood are firmly established in clinical routine. For the first time, the accuracy of an NIPT for the determination of trisomies 21, 18 and 13 in singleton pregnancies was assessed by means of a prospective German-wide multicenter post-market clinical follow-up study, to reliably evaluate the quality in clinical routine. The study covered the indications for testing, the test results, the rate of invasive diagnostics and the pregnancy outcome. 2232 cases were tested for trisomy 21. Of these, 1946 cases were additionally examined for trisomy 18 and 13. Sensitivity and specificity for trisomy 21 (43/43) and for trisomy 13 (2/2) were 100%, for trisomy 18 the sensitivity was 80% (4/5) with a specificity of 99.8%. Three false-positive results for trisomy 18 were observed (FPR 0.15%). The no-call rate was 0.5%. In this subgroup, 27.3% (3/11) aneuploidies were diagnosed. The rate of invasive procedures was 2.6%. NIPT provides a very high quality for the fetal trisomies 21, 13 and 18 in clinical routine. The results support the recommendation that NIPT should be offered after genetic counseling and only in conjunction with a qualified ultrasound examination.

The quality mammographic image. A review of its components.

PubMed

Rickard, M T

1989-11-01

Seven major factors resulting in a quality or high contrast and high resolution mammographic image have been discussed. The following is a summary of their key features: 1) Dedicated mammographic equipment. --Molybdenum target material --Molybdenum filter, beryllium window --Low kVp usage, in range of 24 to 30 --Routine contact mammography performed at 25 kVp --Slightly lower kVp for coned compression --Slightly higher kVp for microfocus magnification 2) Film density --Phototimer with adjustable position --Calibration of phototimer to optimal optical density of approx. 1.4 over full kVp range 3) Breast Compression --General and focal (coned compression). --Essential to achieve proper contrast, resolution and breast immobility. --Foot controls preferable. 4) Focal Spot. --Size recommendation for contact work 0.3 mm. --Minimum power output of 100 mA at 25 kVp desirable to avoid movement blurring in contact grid work. --Size recommendation for magnification work 0.1 mm. 5) Grid. --Usage recommended as routine in all but magnification work. 6) Film-screen Combination. --High contrast--high speed film. --High resolution screen. --Specifically designed cassette for close film-screen contact and low radiation absorption. --Use of faster screens for magnification techniques. 7) Dedicated processing. --Increased developing time--40 to 45 seconds. --Increased developer temperature--35 to 38 degrees. --Adjusted replenishment rate and dryer temperature. All seven factors contributing to image contrast and resolution affect radiation dosage to the breast. The risk of increased dosage associated with the use of various techniques needs to be balanced against the risks of incorrect diagnosis associated with their non-use.(ABSTRACT TRUNCATED AT 250 WORDS)

The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users.

PubMed

Woods, Susan S; Forsberg, Christopher W; Schwartz, Erin C; Nazi, Kim M; Hibbard, Judith H; Houston, Thomas K; Gerrity, Martha

2017-10-17

As electronic health records and computerized workflows expand, there are unprecedented opportunities to digitally connect with patients using secure portals. To realize the value of patient portals, initial reach across populations will need to be demonstrated, as well as sustained usage over time. The study aim was to identify patient factors associated with short-term and long-term portal usage after patients registered to access all portal functions. We prospectively followed a cohort of patients at a large Department of Veterans Affairs (VA) health care facility who recently completed identity proofing to use the VA patient portal. Information collected at baseline encompassed patient factors potentially associated with portal usage, including: demographics, Internet access and use, health literacy, patient activation, and self-reported health conditions. The primary outcome was the frequency of portal log-ins during 6-month and 18-month time intervals after study enrollment. A total of 270 study participants were followed prospectively. Almost all participants (260/268, 97.0%) reported going online, typically at home (248/268, 92.5%). At 6 months, 84.1% (227/270) of participants had visited the portal, with some variation in usage across demographic and health-related subgroups. There were no significant differences in portal log-ins by age, gender, education, marital status, race/ethnicity, distance to a VA facility, or patient activation measure. Significantly higher portal usage was seen among participants using high-speed broadband at home, greater self-reported ability using the Internet, and routinely going online. By 18 months, 91% participants had logged in to the portal, and no significant associations were found between usage and demographics, health status, or patient activation. When examining portal activity between 6 and 18 months, patients who were infrequent or high portal users remained in those categories, respectively. Short-term and long-term portal usage was associated with having broadband at home, high self-rated ability when using the Internet, and overall online behavior. Digital inclusion, or ready access to the Internet and digital skills, appears to be a social determinant in patient exposure to portal services. ©Susan S Woods, Christopher W Forsberg, Erin C Schwartz, Kim M Nazi, Judith H Hibbard, Thomas K Houston, Martha Gerrity. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.10.2017.

Computers and clinical arrhythmias.

PubMed

Knoebel, S B; Lovelace, D E

1983-02-01

Cardiac arrhythmias are ubiquitous in normal and abnormal hearts. These disorders may be life-threatening or benign, symptomatic or unrecognized. Arrhythmias may be the precursor of sudden death, a cause or effect of cardiac failure, a clinical reflection of acute or chronic disorders, or a manifestation of extracardiac conditions. Progress is being made toward unraveling the diagnostic and therapeutic problems involved in arrhythmogenesis. Many of the advances would not be possible, however, without the availability of computer technology. To preserve the proper balance and purposeful progression of computer usage, engineers and physicians have been exhorted not to work independently in this field. Both should learn some of the other's trade. The two disciplines need to come together to solve important problems with computers in cardiology. The intent of this article was to acquaint the practicing cardiologist with some of the extant and envisioned computer applications and some of the problems with both. We conclude that computer-based database management systems are necessary for sorting out the clinical factors of relevance for arrhythmogenesis, but computer database management systems are beset with problems that will require sophisticated solutions. The technology for detecting arrhythmias on routine electrocardiograms is quite good but human over-reading is still required, and the rationale for computer application in this setting is questionable. Systems for qualitative, continuous monitoring and review of extended time ECG recordings are adequate with proper noise rejection algorithms and editing capabilities. The systems are limited presently for clinical application to the recognition of ectopic rhythms and significant pauses. Attention should now be turned to the clinical goals for detection and quantification of arrhythmias. We should be asking the following questions: How quantitative do systems need to be? Are computers required for the detection of all arrhythmias? In all settings? Should we be focusing alternatively on those arrhythmias that are frequent and with clinical significance? The ultimate test of any technology is, after all, its use in advancing knowledge and patient care.

Diabetes services in the UK: third national survey confirms continuing deficiencies.

PubMed

Jefferson, I G; Swift, P G F; Skinner, T C; Hood, G K

2003-01-01

To determine the current level of diabetes services and to compare the results with previous national surveys. A questionnaire was mailed to all paediatricians in the UK identified as providing care for children with diabetes aged under 16 years. Information was sought on staffing, personnel, clinic size, facilities, and patterns of care. Responses were compared with results of two previous national surveys. Replies were received from 244 consultant paediatricians caring for an estimated 17 192 children. A further 2234 children were identified as being cared for by other consultants who did not contribute to the survey. Of 244 consultants, 78% expressed a special interest in diabetes and 91% saw children in a designated diabetic clinic. In 93% of the clinics there was a specialist nurse (44% were not trained to care for children; 47% had nurse:patient ratio >1:100), 65% a paediatric dietitian, and in 25% some form of specialist psychology or counselling available. Glycated haemoglobin was measured routinely at clinics in 88%, retinopathy screening was performed in 87%, and microalbuminuria measured in 66%. Only 34% consultants used a computer database. There were significant differences between the services provided by paediatricians expressing a special interest in diabetes compared with "non-specialists", the latter describing less frequent clinic attendance of dietitians or psychologists, less usage of glycated haemoglobin measurements, and less screening for vascular complications. Non-specialist clinics met significantly fewer of the recommendations of good practice described by Diabetes UK. The survey shows improvements in services provided for children with diabetes, but serious deficiencies remain. There is a shortage of diabetes specialist nurses trained to care for children and paediatric dietitians, and a major shortfall in the provision of psychology/counselling services. The services described confirm the need for more consultant paediatricians to receive specialist training and to develop expertise and experience in childhood diabetes.

Chapter IX. Bedtime Routines in Toddlerhood: Prevalence, Consistency, and Associations with Nighttime Sleep

PubMed Central

Staples, Angela D.; Bates, John E.; Petersen, Isaac T.

2016-01-01

The ability to transition from wakefulness to sleep is one of the most important tasks in the development of sleep during early childhood. Although establishing regular bedtime routines for children with sleep problems can be clinically effective in reducing the number of signaled night awakenings and increasing amounts of sleep, it is unclear whether a regular bedtime routine would be associated with either the frequency of signaled night awakenings or nightly sleep minutes in a non-clinical sample of children. This study examined the role of a regular bedtime routine on the development of sleep regulation and consolidation in a community sample of young children. Adherence to a bedtime routine was concurrently associated with a greater amount of nightly sleep at 36 and 42 months. In addition, adherence to a bedtime routine predicted an increase in nightly sleep minutes over a six-month period. Finally, this study demonstrated that adherence to a bedtime routine was particularly supportive of developmental gains for children of mothers who used consistent parenting practices during the day. PMID:25704740

Comparison of smartphone application-based vital sign monitors without external hardware versus those used in clinical practice: a prospective trial.

PubMed

Alexander, John C; Minhajuddin, Abu; Joshi, Girish P

2017-08-01

Use of healthcare-related smartphone applications is common. However, there is concern that inaccurate information from these applications may lead patients to make erroneous healthcare decisions. The objective of this study is to study smartphone applications purporting to measure vital sign data using only onboard technology compared with monitors used routinely in clinical practice. This is a prospective trial comparing correlation between a clinically utilized vital sign monitor (Propaq CS, WelchAllyn, Skaneateles Falls, NY, USA) and four smartphone application-based monitors Instant Blood Pressure, Instant Blood Pressure Pro, Pulse Oximeter, and Pulse Oximeter Pro. We performed measurements of heart rate (HR), systolic blood pressures (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO 2 ) using standard monitor and four smartphone applications. Analysis of variance was used to compare measurements from the applications to the routine monitor. The study was completed on 100 healthy volunteers. Comparison of routine monitor with the smartphone applications shows significant differences in terms of HR, SpO 2 and DBP. The SBP values from the applications were not significantly different from those from the routine monitor, but had wide limits of agreement signifying a large degree of variation in the compared values. The degree of correlation between monitors routinely used in clinical practice and the smartphone-based applications studied is insufficient to recommend clinical utilization. This lack of correlation suggests that the applications evaluated do not provide clinically meaningful data. The inaccurate data provided by these applications can potentially contribute to patient harm.

Use of structured musculoskeletal examination routines in undergraduate medical education and postgraduate clinical practice - a UK survey.

PubMed

Baker, Kenneth F; Jandial, Sharmila; Thompson, Ben; Walker, David; Taylor, Ken; Foster, Helen E

2016-10-21

Structured examination routines have been developed as educational resources for musculoskeletal clinical skills teaching, including Gait-Arms-Legs-Spine (GALS), Regional Examination of the Musculoskeletal System (REMS) and paediatric GALS (pGALS). In this study, we aimed to assess the awareness and use of these examination routines in undergraduate medical teaching in UK medical schools and UK postgraduate clinical practice. Electronic questionnaires were distributed to adult and paediatric musculoskeletal teaching leads at UK medical schools and current UK doctors in training. Responses were received from 67 tutors representing teaching at 22/33 [67 %] of all UK medical schools, and 70 trainee doctors across a range of postgraduate training specialities. There was widespread adoption, at responding medical schools, of the adult examination routines within musculoskeletal teaching (GALS: 14/16 [88 %]; REMS: 12/16 [75 %]) and assessment (GALS: 13/16 [81 %]; REMS: 12/16 [75 %]). More trainees were aware of GALS (64/70 [91 %]) than REMS (14/67 [21 %]). Of the 39 trainees who used GALS in their clinical practice, 35/39 [90 %] reported that it had improved their confidence in musculoskeletal examination. Of the 17/22 responding medical schools that included paediatric musculoskeletal examination within their curricula, 15/17 [88 %] used the pGALS approach and this was included within student assessment at 4 medical schools. We demonstrate the widespread adoption of these examination routines in undergraduate education and significant uptake in postgraduate clinical practice. Further study is required to understand their impact upon clinical performance.

Identifying complications of interventional procedures from UK routine healthcare databases: a systematic search for methods using clinical codes.

PubMed

Keltie, Kim; Cole, Helen; Arber, Mick; Patrick, Hannah; Powell, John; Campbell, Bruce; Sims, Andrew

2014-11-28

Several authors have developed and applied methods to routine data sets to identify the nature and rate of complications following interventional procedures. But, to date, there has been no systematic search for such methods. The objective of this article was to find, classify and appraise published methods, based on analysis of clinical codes, which used routine healthcare databases in a United Kingdom setting to identify complications resulting from interventional procedures. A literature search strategy was developed to identify published studies that referred, in the title or abstract, to the name or acronym of a known routine healthcare database and to complications from procedures or devices. The following data sources were searched in February and March 2013: Cochrane Methods Register, Conference Proceedings Citation Index - Science, Econlit, EMBASE, Health Management Information Consortium, Health Technology Assessment database, MathSciNet, MEDLINE, MEDLINE in-process, OAIster, OpenGrey, Science Citation Index Expanded and ScienceDirect. Of the eligible papers, those which reported methods using clinical coding were classified and summarised in tabular form using the following headings: routine healthcare database; medical speciality; method for identifying complications; length of follow-up; method of recording comorbidity. The benefits and limitations of each approach were assessed. From 3688 papers identified from the literature search, 44 reported the use of clinical codes to identify complications, from which four distinct methods were identified: 1) searching the index admission for specified clinical codes, 2) searching a sequence of admissions for specified clinical codes, 3) searching for specified clinical codes for complications from procedures and devices within the International Classification of Diseases 10th revision (ICD-10) coding scheme which is the methodology recommended by NHS Classification Service, and 4) conducting manual clinical review of diagnostic and procedure codes. The four distinct methods identifying complication from codified data offer great potential in generating new evidence on the quality and safety of new procedures using routine data. However the most robust method, using the methodology recommended by the NHS Classification Service, was the least frequently used, highlighting that much valuable observational data is being ignored.

Improving computer usage for students with physical disabilities through a collaborative approach: a pilot study.

PubMed

Borgestig, Maria; Falkmer, Torbjörn; Hemmingsson, Helena

2013-11-01

The aim of this study was to evaluate the effect of an assistive technology (AT) intervention to improve the use of available computers as assistive technology in educational tasks for students with physical disabilities during an ongoing school year. Fifteen students (aged 12-18) with physical disabilities, included in mainstream classrooms in Sweden, and their teachers took part in the intervention. Pre-, post-, and follow-up data were collected with Goal Attainment Scaling (GAS), a computer usage diary, and with the Psychosocial Impact of Assistive Devices Scale (PIADS). Teachers' opinions of goal setting were collected at follow-up. The intervention improved the goal-related computer usage in educational tasks and teachers reported they would use goal setting again when appropriate. At baseline, students reported a positive impact from computer usage with no differences over time regarding the PIADS subscales independence, adaptability, or self-esteem. The AT intervention showed a positive effect on computer usage as AT in mainstream schools. Some additional support to teachers is recommended as not all students improved in all goal-related computer usage. A clinical implication is that students' computer usage can be improved and collaboratively established computer-based strategies can be carried out by teachers in mainstream schools.

Suspension culture of pluripotent stem cells: effect of shear on stem cell fate.

PubMed

Keller, Kevin C; Rodrigues, Beatriz; zur Nieden, Nicole I

2014-01-01

Despite significant promise, the routine usage of suspension cell culture to manufacture stem cell-derived differentiated cells has progressed slowly. Suspension culture is an innovative way of either expanding or differentiating cells and sometimes both are combined into a single bioprocess. Its advantages over static 2D culturing include a homogeneous and controllable culture environment and producing a large quantity of cells in a fraction of time. This feature makes suspension cell culture ideal for use in stem cell research and eventually ideal in the large-scale production of differentiated cells for regenerative medicine. Because of their tremendous differentiation capacities and unlimited growth properties, pluripotent stem cells (PSCs) in particular are considered potential sources for future cell-replacement therapies. Currently, expansion of PSCs is accomplished in 2D, which only permits a limited amount of cell growth per culture flask before cells need to be passaged. However, before stem cells can be applied clinically, several aspects of their expansion, such as directed growth, but also differentiation, need to be better controlled. This review will summarize recent advantages in suspension culture of PSCs, while at the same time highlighting current challenges.

A Device for Fetal Monitoring by Means of Control Over Cardiovascular Parameters Based on Acoustic Data

NASA Astrophysics Data System (ADS)

Khokhlova, L. A.; Seleznev, A. I.; Zhdanov, D. S.; Zemlyakov, I. Yu; Kiseleva, E. Yu

2016-01-01

The problem of monitoring fetal health is topical at the moment taking into account a reduction in the level of fertile-age women's health and changes in the concept of perinatal medicine with reconsideration of live birth criteria. Fetal heart rate monitoring is a valuable means of assessing fetal health during pregnancy. The routine clinical measurements are usually carried out by the means of ultrasound cardiotocography. Although the cardiotocography monitoring provides valuable information on the fetal health status, the high quality ultrasound devices are expensive, they are not available for home care use. The recommended number of measurement is also limited. The passive and fully non-invasive acoustic recording provides an alternative low-cost measurement method. The article describes a device for fetal and maternal health monitoring by analyzing the frequency and periodicity of heart beats by means of acoustic signal received on the maternal abdomen. Based on the usage of this device a phonocardiographic fetal telemedicine system, which will allow to reduce the antenatal fetal mortality rate significantly due to continuous monitoring over the state of fetus regardless of mother's location, can be built.

Mould routine identification in the clinical laboratory by matrix-assisted laser desorption ionization time-of-flight mass spectrometry.

PubMed

Cassagne, Carole; Ranque, Stéphane; Normand, Anne-Cécile; Fourquet, Patrick; Thiebault, Sandrine; Planard, Chantal; Hendrickx, Marijke; Piarroux, Renaud

2011-01-01

MALDI-TOF MS recently emerged as a valuable identification tool for bacteria and yeasts and revolutionized the daily clinical laboratory routine. But it has not been established for routine mould identification. This study aimed to validate a standardized procedure for MALDI-TOF MS-based mould identification in clinical laboratory. First, pre-extraction and extraction procedures were optimized. With this standardized procedure, a 143 mould strains reference spectra library was built. Then, the mould isolates cultured from sequential clinical samples were prospectively subjected to this MALDI-TOF MS based-identification assay. MALDI-TOF MS-based identification was considered correct if it was concordant with the phenotypic identification; otherwise, the gold standard was DNA sequence comparison-based identification. The optimized procedure comprised a culture on sabouraud-gentamicin-chloramphenicol agar followed by a chemical extraction of the fungal colonies with formic acid and acetonitril. The identification was done using a reference database built with references from at least four culture replicates. For five months, 197 clinical isolates were analyzed; 20 were excluded because they were not identified at the species level. MALDI-TOF MS-based approach correctly identified 87% (154/177) of the isolates analyzed in a routine clinical laboratory activity. It failed in 12% (21/177), whose species were not represented in the reference library. MALDI-TOF MS-based identification was correct in 154 out of the remaining 156 isolates. One Beauveria bassiana was not identified and one Rhizopus oryzae was misidentified as Mucor circinelloides. This work's seminal finding is that a standardized procedure can also be used for MALDI-TOF MS-based identification of a wide array of clinically relevant mould species. It thus makes it possible to identify moulds in the routine clinical laboratory setting and opens new avenues for the development of an integrated MALDI-TOF MS-based solution for the identification of any clinically relevant microorganism.

The Levels of Speech Usage rating scale: comparison of client self-ratings with speech pathologist ratings.

PubMed

Gray, Christina; Baylor, Carolyn; Eadie, Tanya; Kendall, Diane; Yorkston, Kathryn

2012-01-01

The term 'speech usage' refers to what people want or need to do with their speech to fulfil the communication demands in their life roles. Speech-language pathologists (SLPs) need to know about clients' speech usage to plan appropriate interventions to meet their life participation goals. The Levels of Speech Usage is a categorical scale intended for client self-report of speech usage, but SLPs may want the option to use it as a proxy-report tool. The relationship between self-report and clinician ratings should be examined before the instrument is used in a proxy format. The primary purpose of this study was to compare client self-ratings with SLP ratings on the Levels of Speech Usage scale. The secondary purpose was to determine if the SLP ratings differed depending on whether or not the SLPs knew about the clients' medical condition. Self-ratings of adults with communication disorders on the Levels of Speech Usage scale were available from prior research. Vignettes about these individuals were created from existing data. Two sets of vignettes were created. One set contained information about demographic information, living situation, occupational status and hobbies or social activities. The second set was identical to the first with the addition of information about the clients' medical conditions and communication disorders. Various communication disorders were represented including dysarthria, voice disorders, laryngectomy, and mild cognitive and language disorders. Sixty SLPs were randomly divided into two groups with each group rating one set of vignettes. The task was completed online. While this does not replicate typical in-person clinical interactions, it was a feasible method for this study. For data analysis, the client self-ratings were considered fixed points and the percentage of SLP ratings in agreement with the self-ratings was calculated. The percentage of SLP ratings in exact agreement with client self-ratings was 44.9%. Agreement was lowest for the less-demanding speech usage categories and highest for the most demanding usage category. There was no significant difference between the two groups of SLPs based on knowledge of medical condition. SLPs often need to document the speech usage levels of clients. This study suggests the potential for SLPs to misjudge how clients see their own speech demands. Further research is needed to determine if similar results would be found in actual clinical interactions. Until then, SLPs should seek the input of their clients when using this instrument. © 2012 Royal College of Speech and Language Therapists.

Can you hear me now?

PubMed Central

Shacham, Enbal; Stamm, Kate E.; Overton, Edgar T.

2013-01-01

Recent studies support technology-based behavioral interventions for individuals with HIV. This study focused on the use of cell phone and internet technologies among a cohort of 515 HIV-infected individuals. Socio-demographic and clinic data were collected among individuals presenting at an urban Midwestern university HIV clinic in 2007. Regular internet usage occurred more often with males, Caucasians, those who were employed, had higher salaries, and were more educated. Higher levels of education and salary >$10,000 predicted regular usage when controlling for race, employment, and gender. Cell phone ownership was associated with being Caucasian, employed, more educated, and salary > $10,000. Employment was the only predictor of owning a cell phone when controlling for income, race, and education. Individuals who were <40 years of age, employed, and more educated were more likely to know how to text message. Employment and post-high school education predicted knowledge of text messaging, when controlling for age. Disparities among internet, cell phone, and text messaging usage exist among HIV-infected individuals. PMID:20024756

[Curative effect of ozone hydrotherapy for pemphigus].

PubMed

Jiang, Fuqiong; Deng, Danqi; Li, Xiaolan; Wang, Wenfang; Xie, Hong; Wu, Yongzhuo; Luan, Chunyan; Yang, Binbin

2018-02-28

To determine clinical curative effects of ozone therapy for pemphigus vulgaris.
 Methods: Ozone hydrotherapy was used as an aid treatment for 32 patients with pemphigus vulgaris. The hydropathic compression of potassium permanganate solution for 34 patients with pemphigus vulgaris served as a control. The main treatment for both groups were glucocorticoids and immune inhibitors. The lesions of patients, bacterial infection, usage of antibiotics, patient's satisfaction, and clinical curative effect were evaluated in the 2 groups.
 Results: There was no significant difference in the curative effect and the average length of staying at hospital between the 2 groups (P>0.05). But rate for the usage of antibiotics was significantly reduced in the group of ozone hydrotherapy (P=0.039). The patients were more satisfied in using ozone hydrotherapy than the potassium permanganate solution after 7-day therapy (P>0.05).
 Conclusion: Ozone hydrotherapy is a safe and effective aid method for pemphigus vulgaris. It can reduce the usage of antibiotics.

Assessing 3D tunnel position in ACL reconstruction using a novel single image 3D-2D registration

NASA Astrophysics Data System (ADS)

Kang, X.; Yau, W. P.; Otake, Y.; Cheung, P. Y. S.; Hu, Y.; Taylor, R. H.

2012-02-01

The routinely used procedure for evaluating tunnel positions following anterior cruciate ligament (ACL) reconstructions based on standard X-ray images is known to pose difficulties in terms of obtaining accurate measures, especially in providing three-dimensional tunnel positions. This is largely due to the variability in individual knee joint pose relative to X-ray plates. Accurate results were reported using postoperative CT. However, its extensive usage in clinical routine is hampered by its major requirement of having CT scans of individual patients, which is not available for most ACL reconstructions. These difficulties are addressed through the proposed method, which aligns a knee model to X-ray images using our novel single-image 3D-2D registration method and then estimates the 3D tunnel position. In the proposed method, the alignment is achieved by using a novel contour-based 3D-2D registration method wherein image contours are treated as a set of oriented points. However, instead of using some form of orientation weighting function and multiplying it with a distance function, we formulate the 3D-2D registration as a probability density estimation using a mixture of von Mises-Fisher-Gaussian (vMFG) distributions and solve it through an expectation maximization (EM) algorithm. Compared with the ground-truth established from postoperative CT, our registration method in an experiment using a plastic phantom showed accurate results with errors of (-0.43°+/-1.19°, 0.45°+/-2.17°, 0.23°+/-1.05°) and (0.03+/-0.55, -0.03+/-0.54, -2.73+/-1.64) mm. As for the entry point of the ACL tunnel, one of the key measurements, it was obtained with high accuracy of 0.53+/-0.30 mm distance errors.

Machine learning: a useful radiological adjunct in determination of a newly diagnosed glioma's grade and IDH status.

PubMed

De Looze, Céline; Beausang, Alan; Cryan, Jane; Loftus, Teresa; Buckley, Patrick G; Farrell, Michael; Looby, Seamus; Reilly, Richard; Brett, Francesca; Kearney, Hugh

2018-05-16

Machine learning methods have been introduced as a computer aided diagnostic tool, with applications to glioma characterisation on MRI. Such an algorithmic approach may provide a useful adjunct for a rapid and accurate diagnosis of a glioma. The aim of this study is to devise a machine learning algorithm that may be used by radiologists in routine practice to aid diagnosis of both: WHO grade and IDH mutation status in de novo gliomas. To evaluate the status quo, we interrogated the accuracy of neuroradiology reports in relation to WHO grade: grade II 96.49% (95% confidence intervals [CI] 0.88, 0.99); III 36.51% (95% CI 0.24, 0.50); IV 72.9% (95% CI 0.67, 0.78). We derived five MRI parameters from the same diagnostic brain scans, in under two minutes per case, and then supplied these data to a random forest algorithm. Machine learning resulted in a high level of accuracy in prediction of tumour grade: grade II/III; area under the receiver operating characteristic curve (AUC) = 98%, sensitivity = 0.82, specificity = 0.94; grade II/IV; AUC = 100%, sensitivity = 1.0, specificity = 1.0; grade III/IV; AUC = 97%, sensitivity = 0.83, specificity = 0.97. Furthermore, machine learning also facilitated the discrimination of IDH status: AUC of 88%, sensitivity = 0.81, specificity = 0.77. These data demonstrate the ability of machine learning to accurately classify diffuse gliomas by both WHO grade and IDH status from routine MRI alone-without significant image processing, which may facilitate usage as a diagnostic adjunct in clinical practice.

Chronic Opioid Usage in Surgical Patients in a Large Academic Center

PubMed Central

Jiang, Xueying; Orton, Margaret; Feng, Rui; Hossain, Erik; Malhotra, Neil R.; Zager, Eric L.; Liu, Renyu

2017-01-01

Objective The objective of this study is to investigate the prevalence and disparity of chronic opioid usage in surgical patients and the potential risk factors associated with chronic opioid usage. Background Chronic opioid usage is common in surgical patients; however, the characteristics of opioid usage in surgical patients is unclear. In this study, we hypothesize that the prevalence of chronic opioid usage in surgical patients is high, and that significant disparities may exist among different surgical populations. Methods Data of opioid usage in outpatients among different surgical services were extracted from the electronic medical record database. Patient demographics, clinical characteristics of sex, age, race, body mass index (BMI), specialty visited, duration of opioid use, and opioid type were collected. Chronic opioid users were defined as patients who had been recorded as taking opioids for at least 90 days determined by the first and last visit dates under opioid usage during the investigation. Results There were 79,123 patients included in this study. The average prevalence is 9.2%, ranging from 4.4% to 23.8% among various specialties. The prevalence in orthopedics (23.8%), neurosurgery (18.7%), and gastrointestinal surgery (14.4%) ranked in the top three subspecialties. Major factors influencing chronic opioid use include age, Ethnicitiy, Subspecialtiy, and multiple specialty visits. Approximately 75% of chronic users took opioids that belong to the category II Drug Enforcement Administration classification. Conclusions Overall prevalence of chronic opioid usage in surgical patients is high with widespread disparity among different sex, age, ethnicity, BMI, and subspecialty groups. Information obtained from this study provides clues to reduce chronic opioid usage in surgical patients. PMID:27163960

Nonoperative management of blunt renal trauma: Is routine early follow-up imaging necessary?

PubMed Central

Malcolm, John B; Derweesh, Ithaar H; Mehrazin, Reza; DiBlasio, Christopher J; Vance, David D; Joshi, Salil; Wake, Robert W; Gold, Robert

2008-01-01

Background There is no consensus on the role of routine follow-up imaging during nonoperative management of blunt renal trauma. We reviewed our experience with nonoperative management of blunt renal injuries in order to evaluate the utility of routine early follow-up imaging. Methods We reviewed all cases of blunt renal injury admitted for nonoperative management at our institution between 1/2002 and 1/2006. Data were compiled from chart review, and clinical outcomes were correlated with CT imaging results. Results 207 patients were identified (210 renal units). American Association for the Surgery of Trauma (AAST) grades I, II, III, IV, and V were assigned to 35 (16%), 66 (31%), 81 (39%), 26 (13%), and 2 (1%) renal units, respectively. 177 (84%) renal units underwent routine follow-up imaging 24–48 hours after admission. In three cases of grade IV renal injury, a ureteral stent was placed after serial imaging demonstrated persistent extravasation. In no other cases did follow-up imaging independently alter clinical management. There were no urologic complications among cases for which follow-up imaging was not obtained. Conclusion Routine follow-up imaging is unnecessary for blunt renal injuries of grades I-III. Grade IV renovascular injuries can be followed clinically without routine early follow-up imaging, but urine extravasation necessitates serial imaging to guide management decisions. The volume of grade V renal injuries in this study is not sufficient to support or contest the need for routine follow-up imaging. PMID:18768088

The gap between available knowledge and its use in clinical psychiatry.

PubMed

Munk-Jørgensen, P; Blanner Kristiansen, C; Uwawke, R; Larsen, J I; Okkels, N; Christiansen, B; Hjorth, P

2015-12-01

The time span between knowledge becoming available and its integration into daily clinical routine is lengthy. This phenomenon is explored in this study. We used the outcomes of our activities for investigating and strengthening the research-based activities to improve physical health in the routines of clinical psychiatric wards as examples for our analyses. The time span between new knowledge becoming available and its implementation into general clinical treatment is very long. However, a shortening of this time span is seen through active leadership backup and clinical research experience among psychiatrists and staff in the wards. In particular, the involvement of medical students interested in clinical research activities seems to have a positive impact. Academia needs to be re-implemented into clinical psychiatry. Staff with research experience is needed in all professions to increase evidence-based practice. Leaders must take responsibility for implementing new knowledge into the routines of the department and must support staff in these activities on a daily basis. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Benchmarking routine psychological services: a discussion of challenges and methods.

PubMed

Delgadillo, Jaime; McMillan, Dean; Leach, Chris; Lucock, Mike; Gilbody, Simon; Wood, Nick

2014-01-01

Policy developments in recent years have led to important changes in the level of access to evidence-based psychological treatments. Several methods have been used to investigate the effectiveness of these treatments in routine care, with different approaches to outcome definition and data analysis. To present a review of challenges and methods for the evaluation of evidence-based treatments delivered in routine mental healthcare. This is followed by a case example of a benchmarking method applied in primary care. High, average and poor performance benchmarks were calculated through a meta-analysis of published data from services working under the Improving Access to Psychological Therapies (IAPT) Programme in England. Pre-post treatment effect sizes (ES) and confidence intervals were estimated to illustrate a benchmarking method enabling services to evaluate routine clinical outcomes. High, average and poor performance ES for routine IAPT services were estimated to be 0.91, 0.73 and 0.46 for depression (using PHQ-9) and 1.02, 0.78 and 0.52 for anxiety (using GAD-7). Data from one specific IAPT service exemplify how to evaluate and contextualize routine clinical performance against these benchmarks. The main contribution of this report is to summarize key recommendations for the selection of an adequate set of psychometric measures, the operational definition of outcomes, and the statistical evaluation of clinical performance. A benchmarking method is also presented, which may enable a robust evaluation of clinical performance against national benchmarks. Some limitations concerned significant heterogeneity among data sources, and wide variations in ES and data completeness.

Vital Signs Screening for Alcohol Misuse in a Rural Primary Care Clinic: A Feasibility Study

ERIC Educational Resources Information Center

Seale, J. Paul; Guyinn, Monique R.; Matthews, Michael; Okosun, Ike; Dent, M. Marie

2008-01-01

Context: Alcohol misuse is more common in rural areas, and rural problem drinkers are less likely to seek alcohol treatment services. Rural clinics face unique challenges to implementing routine alcohol screening and intervention. Purpose: To assess the feasibility of using the single alcohol screening question (SASQ) during routine nursing vital…

Modifying the Clinical Outcomes in Routine Evaluation Measure for Use with People Who Have a Learning Disability

ERIC Educational Resources Information Center

Marshall, Keith; Willoughby-Booth, Simon

2007-01-01

There are few reliable self-report measures suitable for people with a learning disability in reporting psychological distress. This study examines the modification of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), exploring its reliability, using two different presentation styles. One style included a sequencing task then…

On being green: can flow chemistry help?

PubMed

Ley, Steven V

2012-08-01

The principles of Green Chemistry are important but challenging drivers for most modern synthesis programs. To meet these challenges new flow chemistry tools are proving to be very effective by providing improved heat/mass transfer opportunities, lower solvent usage, less waste generation, hazardous compound containment, and the possibility of a 24/7 working regime. This machine-assisted approach can be used to effect repetitive or routine scale-up steps or when combined with reagent and scavenger cartridges, to achieve multi-step synthesis of complex natural products and pharmaceutical agents. Copyright © 2012 The Japan Chemical Journal Forum and Wiley Periodicals, Inc.

OSCAR4: a flexible architecture for chemical text-mining

PubMed Central

2011-01-01

The Open-Source Chemistry Analysis Routines (OSCAR) software, a toolkit for the recognition of named entities and data in chemistry publications, has been developed since 2002. Recent work has resulted in the separation of the core OSCAR functionality and its release as the OSCAR4 library. This library features a modular API (based on reduction of surface coupling) that permits client programmers to easily incorporate it into external applications. OSCAR4 offers a domain-independent architecture upon which chemistry specific text-mining tools can be built, and its development and usage are discussed. PMID:21999457

Prevailing practices in the use of antibiotics by dairy farmers in Eastern Haryana region of India

PubMed Central

Kumar, Vikash; Gupta, Jancy

2018-01-01

Aim: The aim of the study was to assess the antibiotic use in dairy animals and to trace its usage pattern among the small, medium, and large dairy farmers in Eastern Haryana region of India. Materials and Methods: Karnal and Kurukshetra districts from Eastern region of Haryana state were purposively selected, and four villages from each district were selected randomly. From each village, 21 farmers were selected using stratified random sampling by categorizing into small, medium, and large farmers constituting a total of 168 farmers as respondents. An antibiotic usage index (AUI) was developed to assess usage of antibiotics by dairy farmers. Results: Frequency of veterinary consultancy was high among large dairy farmers, and they mostly preferred veterinarians over para-veterinarians for treatment of dairy animals. Small farmers demanded low-cost antibiotics from veterinarians whereas large farmers rarely went for it. Antibiotics were used maximum for therapeutic purposes by all categories of farmers. Completion of treatment schedules and follow-up were strictly practiced by the majority of large farmers. AUI revealed that large farmers were more consistent on decision-making about prudent use of antibiotics. Routine use of antibiotics after parturition to prevent disease and sale of milk without adhering to withdrawal period was responsible for aggravating the antibiotic resistance. The extent of antibiotic use by small farmers depended on the severity of disease. The large farmers opted for the prophylactic use of antibiotics at the herd level. Conclusion: Antibiotic usage practices were judicious among large dairy farmers, moderately prudent by medium dairy farmers and faulty by small farmers. The frequency of veterinary consultancy promoted better veterinary-client relationship among large farmers. PMID:29657416

The impact of telemedicine in the postoperative care of the neurosurgery patient in an outpatient clinic: a unique perspective of this valuable resource in the developing world--an experience of more than 3000 teleconsultations.

PubMed

Dadlani, Ravi; Mani, Subramaniyan; A U, Jai Ganesh; Mohan, Dilip; Rajgopalan, Niranjana; Thakar, Sumit; Aryan, Saritha; Hegde, Alangar S

2014-01-01

Telemedicine has always been used as a teleconsultation tool in neurological emergencies (e.g., triage in head injuries, stroke, and cerebrovascular accidents). At Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India, we have been operating two teleconsultation sessions per week for the postoperative patient population, addressing routine follow-up and semiemergent conditions in this cohort of patients. At our center more than 80% of the neurosurgical procedures are conducted in patients traveling more than 1500 km. Telemedicine as a routine tool in clinical medicine has significant financial and psychosocial benefits versus routine outpatient clinics. There are very few reports of telemedicine use in routine outpatient teleconsultations in the available neurosurgical literature; those that are present do not differentiate or analyze the use in routine versus emergency neurosurgery. We discuss the role of this underused resource in the developing countries and retrospectively analyze the clinical data in more than 1500 patients and 3000 teleconsultations during a period of 6 years. We address the financial implications, psychosocial factors, and several other factors that could make this relatively modest technology an indispensible tool in current neurosurgical practice, especially in a developing country like India. Copyright © 2014 Elsevier Inc. All rights reserved.

Practical Considerations for Clinical PET/MR Imaging.

PubMed

Galgano, Samuel; Viets, Zachary; Fowler, Kathryn; Gore, Lael; Thomas, John V; McNamara, Michelle; McConathy, Jonathan

2018-01-01

Clinical PET/MR imaging is currently performed at a number of centers around the world as part of routine standard of care. This article focuses on issues and considerations for a clinical PET/MR imaging program, focusing on routine standard-of-care studies. Although local factors influence how clinical PET/MR imaging is implemented, the approaches and considerations described here intend to apply to most clinical programs. PET/MR imaging provides many more options than PET/computed tomography with diagnostic advantages for certain clinical applications but with added complexity. A recurring theme is matching the PET/MR imaging protocol to the clinical application to balance diagnostic accuracy with efficiency. Copyright © 2017 Elsevier Inc. All rights reserved.

Practical Considerations for Clinical PET/MR Imaging.

PubMed

Galgano, Samuel; Viets, Zachary; Fowler, Kathryn; Gore, Lael; Thomas, John V; McNamara, Michelle; McConathy, Jonathan

2017-05-01

Clinical PET/MR imaging is currently performed at a number of centers around the world as part of routine standard of care. This article focuses on issues and considerations for a clinical PET/MR imaging program, focusing on routine standard-of-care studies. Although local factors influence how clinical PET/MR imaging is implemented, the approaches and considerations described here intend to apply to most clinical programs. PET/MR imaging provides many more options than PET/computed tomography with diagnostic advantages for certain clinical applications but with added complexity. A recurring theme is matching the PET/MR imaging protocol to the clinical application to balance diagnostic accuracy with efficiency. Copyright © 2016 Elsevier Inc. All rights reserved.

Widespread use of internet, applications, and social media in the professional life of urology residents.

PubMed

Salem, Johannes; Borgmann, Hendrik; Baunacke, Martin; Boehm, Katharina; Hanske, Julian; Macneily, Andrew; Meyer, Christian; Nestler, Tim; Schmid, Marianne; Huber, Johannes

2017-09-01

Digital media have revolutionized communication and information dissemination in healthcare. We aimed to quantify and evaluate professional digital media use among urology residents. We designed a 17-item survey to assess usage and perceived usefulness of digital media, as well as communication type and device type and distributed it via email to 143 Canadian and 721 German urology residents. In total, 58 (41% response rate) residents from Canada and 170 (24% response rate) from Germany reported professional usage rates of 100% on the internet, 89% on apps, and 46% on social media (SoMe). For professional use, residents spent a median of 30 minutes per day on the internet, 10 minutes on apps, and 15 minutes on SoMe. 100% rated the internet, 89% apps, and 31% SoMe as useful for clinical practice. Most (94%) used digital media for communication with colleagues and 23% for communication with patients. Digital media use was allocated to desktop computers (55%) and mobile devices (45%). Canadian residents had higher usage rates of apps (96% vs. 86%; p=0.042) and SoMe (65% vs. 39%; p=0.002) and longer daily usage times for the internet, apps, and SoMe than German residents (p<0.001 each). Digital media are an integral part of the daily professional practice of urology residents, reflected by high usage rates and perceived usefulness of the internet and apps, and the growing importance of SoMe. Urologists should strive to progressively exhaust the vast potential of digital media for academic and clinical practice.

Exploring the relationship between parental worry about their children's health and usage of an internet intervention for pediatric encopresis.

PubMed

Magee, Joshua C; Ritterband, Lee M; Thorndike, Frances P; Cox, Daniel J; Borowitz, Stephen M

2009-06-01

To investigate whether parental worry about their children's health predicts usage of a pediatric Internet intervention for encopresis. Thirty-nine families with a child diagnosed with encopresis completed a national clinical trial of an Internet-based intervention for encopresis (www.ucanpooptoo.com). Parents rated worry about their children's health, encopresis severity, current parent treatment for depression, and parent comfort with the Internet. Usage indicators were collected while participants utilized the intervention. Regression analyses showed that parents who reported higher baseline levels of worry about their children's health showed greater subsequent intervention use (beta =.52, p =.002), even after accounting for other plausible predictors. Exploratory analyses indicated that this effect may be stronger for families with younger children. Characteristics of individuals using Internet-based treatment programs, such as parental worry about their children's health, can influence intervention usage, and should be considered by developers of Internet interventions.

The human false-negative rate of rescreening Pap tests. Measured in a two-arm prospective clinical trial.

PubMed

Renshaw, A A; Lezon, K M; Wilbur, D C

2001-04-25

Routine quality control rescreening often is used to calculate the false-negative rate (FNR) of gynecologic cytology. Theoretic analysis suggests that this is not appropriate, due to the high FNR of rescreening and the inability to actually measure it. The authors sought to determine the FNR of manual rescreening in a large, prospective, two-arm clinical trial using an analytic instrument in the evaluation. The results of the Autopap System Clinical Trial, encompassing 25,124 analyzed slides, were reviewed. The false-negative and false-positive rates at various thresholds were determined for routine primary screening, routine rescreening, Autopap primary screening, and Autopap rescreening by using a simple, standard methodology. The FNR of routine manual rescreening at the level of atypical squamous cells of undetermined significance (ASCUS) was 73%, more than 3 times the FNR of primary screening; 11 cases were detected. The FNR of Autopap rescreening was 34%; 80 cases were detected. Routine manual rescreening decreased the laboratory FNR by less than 1%; Autopap rescreening reduced the overall laboratory FNR by 5.7%. At the same time, the false-positive rate for Autopap screening was significantly less than that of routine manual screening at the ASCUS level (4.7% vs. 5.6%; P < 0.0001). Rescreening with the Autopap system remained more sensitive than manual rescreening at the low grade squamous intraepithelial lesions threshold (FNR of 58.8% vs. 100%, respectively), although the number of cases rescreened was low. Routine manual rescreening cannot be used to calculate the FNR of primary screening. Routine rescreening is an extremely ineffective method to detect error and thereby decrease a laboratory's FNR. The Autopap system is a much more effective way of detecting errors within a laboratory and reduces the laboratory's FNR by greater than 25%.

A Daily Diary Analysis of Condom Breakage and Slippage during Vaginal Sex or Anal Sex among Adolescent Women

PubMed Central

Hensel, Devon J.; Selby, Sarah; Tanner, Amanda E.; Fortenberry, J. Dennis

2016-01-01

Background Adolescent women Adolescent women are disproportionately impacted by the adverse outcomes associated with sexual activity, including sexually transmitted infections (STI). Condoms as a means of prevention relies upon use that is free of usage failure, including breakage and/or slippage. This study examined the daily prevalence of and predictors of condom breakage and/or slippage during vaginal sex and during anal sex among adolescent women. Methods Adolescent women (N=387; 14 to 17 years) were recruited from primary care clinics for a longitudinal cohort study of STIs and sexual behavior. Data were daily partner-specific sexual diaries. Random intercept mixed effects logistic regression was used to estimate the fixed effect of each predictor on condom breakage/slippage during vaginal or during anal sex (Stata, 13.0), adjusting model coefficients for the correlation between repeated within-participant diary entries. Results Condom slippage and/or breakage varied across sexual behaviors and was associated with individual-specific (e.g., age and sexual interest) and partner-specific factors (e.g., negativity). Recent behavioral factors (e.g., experiencing slippage and/or breakage in the past week) were the strongest predictors of current condom slippage and/or breakage during vaginal or anal sex Conclusion Factors associated with young women’s condom breakage/slippage during vaginal or during anal sex should be integrated as part of STI prevention efforts, and should be assessed as part of ongoing routine clinical care. PMID:27513377

Outcomes of Upper Airway Stimulation for Obstructive Sleep Apnea in a Multicenter German Postmarket Study.

PubMed

Heiser, Clemens; Maurer, Joachim T; Hofauer, Benedikt; Sommer, J Ulrich; Seitz, Annemarie; Steffen, Armin

2017-02-01

Objective Selective stimulation of the hypoglossal nerve is a new surgical therapy for obstructive sleep apnea, with proven efficacy in well-designed clinical trials. The aim of the study is to obtain additional safety and efficacy data on the use of selective upper airway stimulation during daily clinical routine. Study Design Prospective single-arm study. Setting Three tertiary hospitals in Germany (Munich, Mannheim, Lübeck). Subjects and Methods A multicenter prospective single-arm study under a common implant and follow-up protocol took place in 3 German centers (Mannheim, Munich, Lübeck). Every patient who received an implant of selective upper airway stimulation was included in this trial (apnea-hypopnea index ≥15/h and ≤65/h and body mass index <35 kg/m 2 ). Before and 6 months after surgery, a 2-night home sleep test was performed. Data regarding the safety and efficacy were collected. Results From July 2014 through October 2015, 60 patients were included. Every subject reported improvement in sleep and daytime symptoms. The average usage time of the system was 42.9 ± 11.9 h/wk. The median apnea-hypopnea index was significantly reduced at 6 months from 28.6/h to 8.3/h. No patient required surgical revision of the implanted system. Conclusion Selective upper airway stimulation is a safe and effective therapy for patients with obstructive sleep apnea and represents a powerful option for its surgical treatment.

Clinical whole-genome sequencing from routine formalin-fixed, paraffin-embedded specimens: pilot study for the 100,000 Genomes Project.

PubMed

Robbe, Pauline; Popitsch, Niko; Knight, Samantha J L; Antoniou, Pavlos; Becq, Jennifer; He, Miao; Kanapin, Alexander; Samsonova, Anastasia; Vavoulis, Dimitrios V; Ross, Mark T; Kingsbury, Zoya; Cabes, Maite; Ramos, Sara D C; Page, Suzanne; Dreau, Helene; Ridout, Kate; Jones, Louise J; Tuff-Lacey, Alice; Henderson, Shirley; Mason, Joanne; Buffa, Francesca M; Verrill, Clare; Maldonado-Perez, David; Roxanis, Ioannis; Collantes, Elena; Browning, Lisa; Dhar, Sunanda; Damato, Stephen; Davies, Susan; Caulfield, Mark; Bentley, David R; Taylor, Jenny C; Turnbull, Clare; Schuh, Anna

2018-02-01

PurposeFresh-frozen (FF) tissue is the optimal source of DNA for whole-genome sequencing (WGS) of cancer patients. However, it is not always available, limiting the widespread application of WGS in clinical practice. We explored the viability of using formalin-fixed, paraffin-embedded (FFPE) tissues, available routinely for cancer patients, as a source of DNA for clinical WGS.MethodsWe conducted a prospective study using DNAs from matched FF, FFPE, and peripheral blood germ-line specimens collected from 52 cancer patients (156 samples) following routine diagnostic protocols. We compared somatic variants detected in FFPE and matching FF samples.ResultsWe found the single-nucleotide variant agreement reached 71% across the genome and somatic copy-number alterations (CNAs) detection from FFPE samples was suboptimal (0.44 median correlation with FF) due to nonuniform coverage. CNA detection was improved significantly with lower reverse crosslinking temperature in FFPE DNA extraction (80 °C or 65 °C depending on the methods). Our final data showed somatic variant detection from FFPE for clinical decision making is possible. We detected 98% of clinically actionable variants (including 30/31 CNAs).ConclusionWe present the first prospective WGS study of cancer patients using FFPE specimens collected in a routine clinical environment proving WGS can be applied in the clinic.GENETICS in MEDICINE advance online publication, 1 February 2018; doi:10.1038/gim.2017.241.

Magic and Misdirection: The Influence of Social Cues on the Allocation of Visual Attention While Watching a Cups-and-Balls Routine

PubMed Central

Hergovich, Andreas; Oberfichtner, Bernhard

2016-01-01

In recent years, a body of research that regards the scientific study of magic performances as a promising method of investigating psychological phenomena in an ecologically valid setting has emerged. Seemingly contradictory findings concerning the ability of social cues to strengthen a magic trick’s effectiveness have been published. In this experiment, an effort was made to disentangle the unique influence of different social and physical triggers of attentional misdirection on observers’ overt and covert attention. The ability of 120 participants to detect the mechanism of a cups-and-balls trick was assessed, and their visual fixations were recorded using an eye-tracker while they were watching the routine. All the investigated techniques of misdirection, including sole usage of social cues, were shown to increase the probability of missing the trick mechanism. Depending on the technique of misdirection used, very different gaze patterns were observed. A combination of social and physical techniques of misdirection influenced participants’ overt attention most effectively. PMID:27303327

Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices.

PubMed

Wallace, Aaron S; Willis, Fred; Nwaze, Eric; Dieng, Boubacar; Sipilanyambe, Naawa; Daniels, Danni; Abanida, Emmanuel; Gasasira, Alex; Mahmud, Mustapha; Ryman, Tove K

2017-12-04

The introduction of new vaccines highlights concerns about high vaccine wastage, knowledge of wastage policies and quality of stock management. However, an emphasis on minimizing wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate wastage rates and vaccine vial usage patterns. Nearly half of facilities had incomplete vaccine stock data for calculating wastage rates. Among facilities with sufficient data, mean monthly facility-level wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system's contradicting policies may force health workers to prioritize reduced wastage rates over vaccine administration, particularly for multi-dose vials. Published by Elsevier Ltd.

Sharing electronic structure and crystallographic data with ETSF_IO

NASA Astrophysics Data System (ADS)

Caliste, D.; Pouillon, Y.; Verstraete, M. J.; Olevano, V.; Gonze, X.

2008-11-01

We present a library of routines whose main goal is to read and write exchangeable files (NetCDF file format) storing electronic structure and crystallographic information. It is based on the specification agreed inside the European Theoretical Spectroscopy Facility (ETSF). Accordingly, this library is nicknamed ETSF_IO. The purpose of this article is to give both an overview of the ETSF_IO library and a closer look at its usage. ETSF_IO is designed to be robust and easy to use, close to Fortran read and write routines. To facilitate its adoption, a complete documentation of the input and output arguments of the routines is available in the package, as well as six tutorials explaining in detail various possible uses of the library routines. Catalogue identifier: AEBG_v1_0 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/AEBG_v1_0.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: Gnu Lesser General Public License No. of lines in distributed program, including test data, etc.: 63 156 No. of bytes in distributed program, including test data, etc.: 363 390 Distribution format: tar.gz Programming language: Fortran 95 Computer: All systems with a Fortran95 compiler Operating system: All systems with a Fortran95 compiler Classification: 7.3, 8 External routines: NetCDF, http://www.unidata.ucar.edu/software/netcdf Nature of problem: Store and exchange electronic structure data and crystallographic data independently of the computational platform, language and generating software Solution method: Implement a library based both on NetCDF file format and an open specification (http://etsf.eu/index.php?page=standardization)

[Freiburg keratoconus registry : Example of application of smart data for clinical research and inititial results].

PubMed

Lang, S J; Böhringer, D; Reinhard, T

2016-06-01

Keratoconus is a progressive corneal disease with thinning and scarring of the cornea. Diagnostic and treatment options are usually evaluated in large prospective or retrospective trials. Big data and smart data provide the possibility to analyze routine data for clinical research. In this article we report the generation of a monocentric keratoconus registry by means of computerized data analysis of routine data. This demonstrates the potential of clinical research by means of routine data. A "clinical data warehouse" was created from all available routine electronic data. At the time of first presentation, each eye was classified into one out of four categories: suspected, early disease, late disease and status postkeratoplasty. Through integration of multiple data sources the clinical course for each patient was documented in the registry. A total of 3681 eyes from 1841 patients were included. The median follow-up time was 0.54 years. Patient age was higher in the groups with more severe stages of keratoconus, the proportion of female patients was higher in the group of suspected keratoconus and patient age and male to female ratios showed statistically significant differences between the groups (p < 0.001). We were able to create a "clinical data warehouse" by linking multiple data sources and normalizing the data. With this tool we established a novel, monocentric keratoconus registry. Only the grading of disease severity and the exclusion of false positive results were carried out manually. In our opinion establishing a structured clinical data warehouse has a huge potential for clinical and retrospective studies and proves the value of the Smart Data concept.

Treatment of painful bone metastases in prostate and breast cancer patients with the therapeutic radiopharmaceutical rhenium-188-HEDP. Clinical benefit in a real-world study.

PubMed

Lange, Rogier; Overbeek, Floor; de Klerk, John M H; Pasker-de Jong, Pieternel C M; van den Berk, Alexandra M; Ter Heine, Rob; Rodenburg, Cees J; Kooistra, Anko; Hendrikse, N Harry; Bloemendal, Haiko J

2016-09-26

Rhenium-188-HEDP ((188)Re-HEDP) is an effective radiopharmaceutical for the palliative treatment of osteoblastic bone metastases. However, only limited data on its routine use are available and its effect on quality of life (QoL) has not been studied. Therefore, we evaluated the clinical benefit of (188)Re-HEDP in routine clinical care. Prostate or breast cancer patients with painful bone metastases receiving (188)Re-HEDP as a routine clinical procedure were eligible for evaluation. Clinical benefit was assessed in terms of efficacy and toxicity. Pain palliation and QoL were monitored using the visual analogue scale (VAS), corrected for opioid intake, and the EORTC QLQ-C30 Global health status/QoL-scale. Thrombocyte and leukocyte nadirs were used to assess haematological toxicity. 45 and 47 patients were evaluable for pain palliation and QoL, respectively. After a single injection of (188)Re-HEDP, the overall pain response rate was 69% and mean VAS-scores decreased relevantly and significantly (p < 0.05). Repeated treatment resulted in similar pain response. The overall QoL response rate was 68% and mean Global health status/QoL-scores increased relevantly and significantly. Haematological side effects were mild and transient. The clinically relevant response on pain and quality of life and the limited adverse events prove clinical benefit of treatment with (188)Re-HEDP and support its use in routine clinical care. Its effectiveness appears comparable to that of external beam radiotherapy.

Colon cleansing protocol in children: research conditions vs. clinical practice.

PubMed

Elitsur, Yoram; Balfaqih, Yaslam; Preston, Deborah

2018-04-01

 Colon preparation rates are the limiting factor for a successful diagnostic colonoscopy in children. Different colon cleansing protocols have been published for use in children. Unfortunately, the applicability of those published research protocols has not been formally evaluated in routine clinical practice. We investigated the success rate of our previously published colon cleansing protocol as utilized in our clinical practice.  This was a retrospective study. In the clinical practice, the colon cleansing protocol included PEG-3350 at a dose of 2 g/kg/day plus Dulcolax (Bisacodyl, Boehringer Ingelheim, TX USA) 5 mg/day for 2 days. Adequate colon preparation was graded between 1 - 5, as previously described, and grade ≥ 4.0 was considered an adequate preparation. Patients were instructed to complete a questionnaire that included PEG-3350 dose, number of stools per day, consistency of each stool, and side effects (vomiting, abdominal pain). Clinical and endoscopic results were compared between the protocol under research conditions and routine practice.  The success rate of the colon preparation in our clinical practice was similar to the results observed under our research protocol (75 % vs. 73.6 %). Moreover, the total number of stools, stool consistency, and the intubation rate of the terminal ileum were also similar. We concluded, that in our experience, the colon cleansing protocol used under research conditions was effective and appropriate for use in routine clinical practice.  We recommend testing each new protocol under the routine conditions of clinical practice to confirm its applicability for general practitioners.

The sexual health of female sex workers compared with other women in England: analysis of cross-sectional data from genitourinary medicine clinics.

PubMed

Mc Grath-Lone, Louise; Marsh, Kimberly; Hughes, Gwenda; Ward, Helen

2014-06-01

While female sex workers (FSWs) are assumed to be at increased risk of sexually transmitted infections (STIs), there are limited comparative data with other population groups available. Using routine STI surveillance data, we investigated differences in sexual health between FSWs and other female attendees at genitourinary medicine (GUM) clinics in England. Demographic characteristics, STI prevalence and service usage among FSWs and other attendees in 2011 were compared using logistic regression. In 2011, 2704 FSWs made 8411 recorded visits to 131/208 GUM clinics, (primarily large, FSW-specialist centres in London). FSWs used a variety of services, however, 10% did not have an STI/HIV test at presentation. By comparison with other female attendees, FSWs travelled further for their care and had increased risk of certain STIs (e.g., gonorrhoea ORadj: 2.76, 95% CI 2.16 to 3.54, p<0.001). Migrant FSWs had better sexual health outcomes than UK-born FSWs (e.g., period prevalence of chlamydia among those tested: 8.5% vs 13.5%, p<0.001) but were more likely to experience non-STI outcomes (eg, pelvic inflammatory disease ORadj: 2.92, 95% CI 1.57 to 5.41, p<0.001). FSWs in England have access to high-quality care through the GUM clinic network, but there is evidence of geographical inequality in access to these services. A minority do not appear to access STI/HIV testing through clinics, and some STIs are more prevalent among FSWs than other female attendees. Targeted interventions aimed at improving uptake of testing in FSWs should be developed, and need to be culturally sensitive to the needs of this predominantly migrant population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Is heart rate variability better than routine vital signs for prehospital identification of major hemorrhage?

PubMed

Edla, Shwetha; Reisner, Andrew T; Liu, Jianbo; Convertino, Victor A; Carter, Robert; Reifman, Jaques

2015-02-01

During initial assessment of trauma patients, metrics of heart rate variability (HRV) have been associated with high-risk clinical conditions. Yet, despite numerous studies, the potential of HRV to improve clinical outcomes remains unclear. Our objective was to evaluate whether HRV metrics provide additional diagnostic information, beyond routine vital signs, for making a specific clinical assessment: identification of hemorrhaging patients who receive packed red blood cell (PRBC) transfusion. Adult prehospital trauma patients were analyzed retrospectively, excluding those who lacked a complete set of reliable vital signs and a clean electrocardiogram for computation of HRV metrics. We also excluded patients who did not survive to admission. The primary outcome was hemorrhagic injury plus different PRBC transfusion volumes. We performed multivariate regression analysis using HRV metrics and routine vital signs to test the hypothesis that HRV metrics could improve the diagnosis of hemorrhagic injury plus PRBC transfusion vs routine vital signs alone. As univariate predictors, HRV metrics in a data set of 402 subjects had comparable areas under receiver operating characteristic curves compared with routine vital signs. In multivariate regression models containing routine vital signs, HRV parameters were significant (P<.05) but yielded areas under receiver operating characteristic curves with minimal, nonsignificant improvements (+0.00 to +0.05). A novel diagnostic test should improve diagnostic thinking and allow for better decision making in a significant fraction of cases. Our findings do not support that HRV metrics add value over routine vital signs in terms of prehospital identification of hemorrhaging patients who receive PRBC transfusion. Published by Elsevier Inc.

Prediction of HIV-1 coreceptor usage (tropism) by sequence analysis using a genotypic approach.

PubMed

Sierra, Saleta; Kaiser, Rolf; Lübke, Nadine; Thielen, Alexander; Schuelter, Eugen; Heger, Eva; Däumer, Martin; Reuter, Stefan; Esser, Stefan; Fätkenheuer, Gerd; Pfister, Herbert; Oette, Mark; Lengauer, Thomas

2011-12-01

Maraviroc (MVC) is the first licensed antiretroviral drug from the class of coreceptor antagonists. It binds to the host coreceptor CCR5, which is used by the majority of HIV strains in order to infect the human immune cells (Fig. 1). Other HIV isolates use a different coreceptor, the CXCR4. Which receptor is used, is determined in the virus by the Env protein (Fig. 2). Depending on the coreceptor used, the viruses are classified as R5 or X4, respectively. MVC binds to the CCR5 receptor inhibiting the entry of R5 viruses into the target cell. During the course of disease, X4 viruses may emerge and outgrow the R5 viruses. Determination of coreceptor usage (also called tropism) is therefore mandatory prior to administration of MVC, as demanded by EMA and FDA. The studies for MVC efficiency MOTIVATE, MERIT and 1029 have been performed with the Trofile assay from Monogram, San Francisco, U.S.A. This is a high quality assay based on sophisticated recombinant tests. The acceptance for this test for daily routine is rather low outside of the U.S.A., since the European physicians rather tend to work with decentralized expert laboratories, which also provide concomitant resistance testing. These laboratories have undergone several quality assurance evaluations, the last one being presented in 2011. For several years now, we have performed tropism determinations based on sequence analysis from the HIV env-V3 gene region (V3). This region carries enough information to perform a reliable prediction. The genotypic determination of coreceptor usage presents advantages such as: shorter turnover time (equivalent to resistance testing), lower costs, possibility to adapt the results to the patients' needs and possibility of analysing clinical samples with very low or even undetectable viral load (VL), particularly since the number of samples analysed with VL < 1000 copies/μl roughly increased in the last years (Fig. 3). The main steps for tropism testing (Fig. 4) demonstrated in this video: Collection of a blood sample Isolation of the HIV RNA from the plasma and/or HIV proviral DNA from blood mononuclear cells Amplification of the env region Amplification of the V3 region Sequence reaction of the V3 amplicon Purification of the sequencing samples Sequencing the purified samples Sequence editing Sequencing data interpretation and tropism prediction.

Underutilisation of routinely collected data in the HIV programme in Zambia: a review of quantitatively analysed peer-reviewed articles.

PubMed

Munthali, Tendai; Musonda, Patrick; Mee, Paul; Gumede, Sehlulekile; Schaap, Ab; Mwinga, Alwyn; Phiri, Caroline; Kapata, Nathan; Michelo, Charles; Todd, Jim

2017-06-13

The extent to which routinely collected HIV data from Zambia has been used in peer-reviewed published articles remains unexplored. This paper is an analysis of peer-reviewed articles that utilised routinely collected HIV data from Zambia within six programme areas from 2004 to 2014. Articles on HIV, published in English, listed in the Directory of open access journals, African Journals Online, Google scholar, and PubMed were reviewed. Only articles from peer-reviewed journals, that utilised routinely collected data and included quantitative data analysis methods were included. Multi-country studies involving Zambia and another country, where the specific results for Zambia were not reported, as well as clinical trials and intervention studies that did not take place under routine care conditions were excluded, although community trials which referred patients to the routine clinics were included. Independent extraction was conducted using a predesigned data collection form. Pooled analysis was not possible due to diversity in topics reviewed. A total of 69 articles were extracted for review. Of these, 7 were excluded. From the 62 articles reviewed, 39 focused on HIV treatment and retention in care, 15 addressed prevention of mother-to-child transmission, 4 assessed social behavioural change, and 4 reported on voluntary counselling and testing. In our search, no articles were found on condom programming or voluntary male medical circumcision. The most common outcome measures reported were CD4+ count, clinical failure or mortality. The population analysed was children in 13 articles, women in 16 articles, and both adult men and women in 33 articles. During the 10 year period of review, only 62 articles were published analysing routinely collected HIV data in Zambia. Serious consideration needs to be made to maximise the utility of routinely collected data, and to benefit from the funds and efforts to collect these data. This could be achieved with government support of operational research and publication of findings based on routinely collected Zambian HIV data.

Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.

PubMed

Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

2015-01-01

The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

Clinical Outcomes and Cost Effectiveness of Accelerated Diagnostic Protocol in a Chest Pain Center Compared with Routine Care of Patients with Chest Pain

PubMed Central

Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

2015-01-01

Aims The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Methods and Results Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14–0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. Conclusion An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources. PMID:25622029

Practical issues in implementing whole-genome-sequencing in routine diagnostic microbiology.

PubMed

Rossen, J W A; Friedrich, A W; Moran-Gilad, J

2018-04-01

Next generation sequencing (NGS) is increasingly being used in clinical microbiology. Like every new technology adopted in microbiology, the integration of NGS into clinical and routine workflows must be carefully managed. To review the practical aspects of implementing bacterial whole genome sequencing (WGS) in routine diagnostic laboratories. Review of the literature and expert opinion. In this review, we discuss when and how to integrate whole genome sequencing (WGS) in the routine workflow of the clinical laboratory. In addition, as the microbiology laboratories have to adhere to various national and international regulations and criteria for their accreditation, we deliberate on quality control issues for using WGS in microbiology, including the importance of proficiency testing. Furthermore, the current and future place of this technology in the diagnostic hierarchy of microbiology is described as well as the necessity of maintaining backwards compatibility with already established methods. Finally, we speculate on the question of whether WGS can entirely replace routine microbiology in the future and the tension between the fact that most sequencers are designed to process multiple samples in parallel whereas for optimal diagnosis a one-by-one processing of the samples is preferred. Special reference is made to the cost and turnaround time of WGS in diagnostic laboratories. Further development is required to improve the workflow for WGS, in particular to shorten the turnaround time, reduce costs, and streamline downstream data analyses. Only when these processes reach maturity will reliance on WGS for routine patient management and infection control management become feasible, enabling the transformation of clinical microbiology into a genome-based and personalized diagnostic field. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Very poor agreement between routine outpatient clinic office and ambulatory blood pressure: time to improve an old hospital outpatient clinic routine?

PubMed

Reinhard, Mark; Poulsen, Per L; Christensen, Kent L

2016-12-01

We investigated the agreement between elevated outpatient clinic office blood pressure (OC-OBP) as measured in the daily routine in our University Hospital Cardiology Outpatient Clinic and subsequent awake ambulatory blood pressure (AABP). In all patients referred for ambulatory blood pressure monitoring from our Cardiology Outpatient Clinic, we identified OC-OBP and changes in medication in the period from 1 January 2014 to 15 September 2015. The AABP was used as a reference measurement for the OC-OBP. A total of 183 patients were included in the study. Their mean age was 62.1±14.0 years and 49% were women. The mean systolic OC-OBP was 166.8±17.9 mmHg and the difference between the mean systolic OC-OBP and AABP was 28.0±19.5 mmHg (P<0.001) with 95% limits of agreement from -10.2 to +66.3 mmHg. The difference in mean systolic OC-OBP and AABP was 18.6±14.7 mmHg in patients less than 45 years (n=21), 24.8±18.2 mmHg in patients 45-74 years (n=121) and 42.3±18.5 mmHg in patients more than or equal to 75 years (n=41). In 32 (17%) of the patients, the antihypertensive treatment was intensified before the AABP, but in nine (28%) of these patients, the antihypertensive treatment was reduced again after the AABP because of low blood pressure. Routine OC-OBP in a busy cardiology clinic agrees poorly with AABP and may lead to unnecessary treatment and pharmacologically induced symptomatic hypotension, particularly in elderly patients. The results of this study urgently call for alternative solutions to routine OC-OBP in hospital outpatient clinics.

The essential role of reconfiguration capabilities in the implementation of HIV-related health information exchanges.

PubMed

Steward, Wayne T; Koester, Kimberly A; Collins, Shane P; Maiorana, Andre; Myers, Janet J

2012-10-01

To understand the dynamic capabilities that enabled the six demonstration projects of the Information Technology Networks of Care Initiative to implement health information exchanges (HIEs) tailored to their local HIV epidemics and regional care systems. We conducted 111 semi-structured interviews with project staff and information technology (IT) specialists associated with the demonstration projects, staff from community-based organizations and public health agencies collaborating in the design and implementation of the HIEs, and providers who used each HIE. The dynamic capability framework guided analyses. In the context of a HIE, the framework's components include information systems (the actual technological exchange systems and capacity to update them), absorptive capacity (the ability to implement an operating HIE), reconfiguration capacity (the ability to adapt workflows and clinical practices in response to a HIE), and organizational size and human resources (characteristics likely to affect a clinic's ability to respond). Across the projects, we found evidence for the importance of three dynamic capabilities: information systems, reconfiguration capacity, and organizational size and human resources. However, of these three, reconfiguration capacity was the most salient. Implementation outcomes at all six of the projects were shaped substantially by the degree of attention dedicated to reworking procedures and practices so that HIE usage became routine. Electronic information exchange offers the promise of improved coordination of care. However, implementation of HIEs goes beyond programing and hardware installation challenges, and requires close attention to the needs of the HIEs end-users. Providers need to discern value from a HIE because their active participation is essential to ensuring that clinic and agency practices and procedures are reconfigured to incorporate new systems into daily work processes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Gaming Device Usage Patterns Predict Internet Gaming Disorder: Comparison across Different Gaming Device Usage Patterns.

PubMed

Paik, Soo-Hyun; Cho, Hyun; Chun, Ji-Won; Jeong, Jo-Eun; Kim, Dai-Jin

2017-12-05

Gaming behaviors have been significantly influenced by smartphones. This study was designed to explore gaming behaviors and clinical characteristics across different gaming device usage patterns and the role of the patterns on Internet gaming disorder (IGD). Responders of an online survey regarding smartphone and online game usage were classified by different gaming device usage patterns: (1) individuals who played only computer games; (2) individuals who played computer games more than smartphone games; (3) individuals who played computer and smartphone games evenly; (4) individuals who played smartphone games more than computer games; (5) individuals who played only smartphone games. Data on demographics, gaming-related behaviors, and scales for Internet and smartphone addiction, depression, anxiety disorder, and substance use were collected. Combined users, especially those who played computer and smartphone games evenly, had higher prevalence of IGD, depression, anxiety disorder, and substance use disorder. These subjects were more prone to develop IGD than reference group (computer only gamers) (B = 0.457, odds ratio = 1.579). Smartphone only gamers had the lowest prevalence of IGD, spent the least time and money on gaming, and showed lowest scores of Internet and smartphone addiction. Our findings suggest that gaming device usage patterns may be associated with the occurrence, course, and prognosis of IGD.

Gaming Device Usage Patterns Predict Internet Gaming Disorder: Comparison across Different Gaming Device Usage Patterns

PubMed Central

Cho, Hyun; Chun, Ji-Won; Jeong, Jo-Eun; Kim, Dai-Jin

2017-01-01

Gaming behaviors have been significantly influenced by smartphones. This study was designed to explore gaming behaviors and clinical characteristics across different gaming device usage patterns and the role of the patterns on Internet gaming disorder (IGD). Responders of an online survey regarding smartphone and online game usage were classified by different gaming device usage patterns: (1) individuals who played only computer games; (2) individuals who played computer games more than smartphone games; (3) individuals who played computer and smartphone games evenly; (4) individuals who played smartphone games more than computer games; (5) individuals who played only smartphone games. Data on demographics, gaming-related behaviors, and scales for Internet and smartphone addiction, depression, anxiety disorder, and substance use were collected. Combined users, especially those who played computer and smartphone games evenly, had higher prevalence of IGD, depression, anxiety disorder, and substance use disorder. These subjects were more prone to develop IGD than reference group (computer only gamers) (B = 0.457, odds ratio = 1.579). Smartphone only gamers had the lowest prevalence of IGD, spent the least time and money on gaming, and showed lowest scores of Internet and smartphone addiction. Our findings suggest that gaming device usage patterns may be associated with the occurrence, course, and prognosis of IGD. PMID:29206183

Active trachoma and community use of sanitation, Ethiopia.

PubMed

Oswald, William E; Stewart, Aisha Ep; Kramer, Michael R; Endeshaw, Tekola; Zerihun, Mulat; Melak, Berhanu; Sata, Eshetu; Gessese, Demelash; Teferi, Tesfaye; Tadesse, Zerihun; Guadie, Birhan; King, Jonathan D; Emerson, Paul M; Callahan, Elizabeth K; Flanders, Dana; Moe, Christine L; Clasen, Thomas F

2017-04-01

To investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1-9 years and community sanitation usage. Between 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys. Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma. Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access. In surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28-30) and mean community sanitation usage was 47% (95% CI: 45-48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected. Summarizing across strata, community sanitation usage values of 60 to < 80% and ≥ 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57-1.03 and OR: 0.67; 95% CI: 0.48-0.95, respectively). In Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level.

Development and Validation of the Pediatric Diabetes Routines Questionnaire for Adolescents.

PubMed

Pierce, Jessica S; Jordan, Sara S; Arnau, Randolph C

2018-04-06

This study describes the development and psychometric evaluation of an adolescent self-report version of the Pediatric Diabetes Routines Questionnaire (PDRQ:A), a measure of diabetes-specific routines for youth with type 1 diabetes, and further validation of the parent-version (PDRQ:P) in an adolescent sample. Participants included 120 parent-adolescent dyads (ages 12-17) and an additional 24 parents who completed measures of diabetes-specific adolescent routines, general adolescent routines, diabetes self-care, and family support of youth diabetes care. The PDRQ:P/A demonstrated good internal consistency, test-retest reliability, and parent-child agreement, and adequate validity coefficients. Confirmatory factor analysis supported a one-factor model. Promising results were obtained. The PDRQ:P/A is a clinically feasible parent- and self-report measure that can provide valuable information regarding how frequently adolescents engage in their diabetes management tasks in a consistent manner. Addition of an adolescent report format will enhance the utility of the measure for clinical and research use.

Can you hear me now? Limited use of technology among an urban HIV-infected cohort.

PubMed

Shacham, E; Stamm, K; Overton, E T

2009-08-01

Recent studies support technology-based behavioral interventions for individuals with HIV. This study focused on the use of cell phone and internet technologies among a cohort of 515 HIV-infected individuals. Socio-demographic and clinic data were collected among individuals presenting at an urban Midwestern university HIV clinic in 2007. Regular internet usage occurred more often with males, Caucasians, those who were employed, had higher income, and were more educated. Higher levels of education and income >$10,000 predicted regular usage when controlling for race, employment, and gender. Cell phone ownership was associated with being Caucasian, employed, more educated, and salary >$10,000. Employment was the only predictor of owning a cell phone when controlling for income, race, and education. Individuals who were <40 years of age, employed, and more educated were more likely to know how to text message. Employment and post-high school education predicted knowledge of text messaging, when controlling for age. Disparities among internet, cell phone, and text messaging usage exist among HIV-infected individuals.

[Usage of Calendula officinalis in the prevention and treatment of radiodermatitis: a randomized double-blind controlled clinical trial].

PubMed

Schneider, Franciane; Danski, Mitzy Tannia Reichembach; Vayego, Stela Adami

2015-04-01

To evaluate the efficacy of Calendula officinalis in relation to Essential Fatty Acids for the prevention and treatment of radiodermatitis. This is a randomized double-blind controlled clinical trial with 51 patients with head and neck cancer in radiotherapy treatment divided into two groups: control (27) and experimental (24). There is statistically significant evidence (p-value = 0.0120) that the proportion of radiodermatitis grade 2 in Essential Fatty Acids group is higher than Calendula group. Through the Kaplan-Meier survival curve we observed that Essential Fatty Acids group has always remained below the Calendula group survival curve, due to the lower risk of developing radiodermatitis grade 1, which makes the usage of Calendula more effective, with statistical significance (p-value = 0.00402). Calendula showed better therapeutic response than the Essential Fatty Acids in the prevention and treatment of radiodermatitis. Brazilian Registry of Clinical Trials: RBR-237v4b.

Brief sexual histories and routine HIV/STD testing by medical providers.

PubMed

Lanier, Yzette; Castellanos, Ted; Barrow, Roxanne Y; Jordan, Wilbert C; Caine, Virginia; Sutton, Madeline Y

2014-03-01

Clinicians who routinely take patient sexual histories have the opportunity to assess patient risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and make appropriate recommendations for routine HIV/STD screenings. However, less than 40% of providers conduct sexual histories with patients, and many do not receive formal sexual history training in school. After partnering with a national professional organization of physicians, we trained 26 (US and US territory-based) practicing physicians (58% female; median age=48 years) regarding sexual history taking using both in-person and webinar methods. Trainings occurred during either a 6-h onsite or 2-h webinar session. We evaluated their post-training experiences integrating sexual histories during routine medical visits. We assessed use of sexual histories and routine HIV/STD screenings. All participating physicians reported improved sexual history taking and increases in documented sexual histories and routine HIV/STD screenings. Four themes emerged from the qualitative evaluations: (1) the need for more sexual history training; (2) the importance of providing a gender-neutral sexual history tool; (3) the existence of barriers to routine sexual histories/testing; and (4) unintended benefits for providers who were conducting routine sexual histories. These findings were used to develop a brief, gender-neutral sexual history tool for clinical use. This pilot evaluation demonstrates that providers were willing to utilize a sexual history tool in clinical practice in support of HIV/STD prevention efforts.

Taking a new biomarker into routine use – A perspective from the routine clinical biochemistry laboratory

PubMed Central

Sturgeon, Catharine; Hill, Robert; Hortin, Glen L; Thompson, Douglas

2010-01-01

There is increasing pressure to provide cost-effective healthcare based on “best practice.” Consequently, new biomarkers are only likely to be introduced into routine clinical biochemistry departments if they are supported by a strong evidence base and if the results will improve patient management and outcome. This requires convincing evidence of the benefits of introducing the new test, ideally reflected in fewer hospital admissions, fewer additional investigations and/or fewer clinic visits. Carefully designed audit and cost-benefit studies in relevant patient groups must demonstrate that introducing the biomarker delivers an improved and more effective clinical pathway. From the laboratory perspective, pre-analytical requirements must be thoroughly investigated at an early stage. Good stability of the biomarker in relevant physiological matrices is essential to avoid the need for special processing. Absence of specific timing requirements for sampling and knowledge of the effect of medications that might be used to treat the patients in whom the biomarker will be measured is also highly desirable. Analytically, automation is essential in modern high-throughput clinical laboratories. Assays must therefore be robust, fulfilling standard requirements for linearity on dilution, precision and reproducibility, both within- and between-run. Provision of measurements by a limited number of specialized reference laboratories may be most appropriate, especially when a new biomarker is first introduced into routine practice. PMID:21137030

Contamination of the Clinical Microbiology Laboratory with Vancomycin-Resistant Enterococci and Multidrug- Resistant Enterobacteriaceae: Implications for Hospital and Laboratory Workers

PubMed Central

Collins, Susan M.; Hacek, Donna M.; Degen, Lisa A.; Wright, Marc O.; Noskin, Gary A.; Peterson, Lance R.

2001-01-01

We surveyed environmental surfaces in our clinical microbiology laboratory to determine the prevalence of vancomycin-resistant enterococci (VRE) and multidrug-resistant Enterobacteriaceae (MDRE) during a routine working day. From a total of 193 surfaces, VRE were present on 20 (10%) and MDRE were present on 4 (2%) of the surfaces tested. In a subsequent survey after routine cleaning, all of the 24 prior positive surfaces were found to be negative. Thus, those in the laboratory should recognize that many surfaces may be contaminated by resistant organisms during routine processing of patient specimens. PMID:11574615

Can PET-CT imaging and radiokinetic analyses provide useful clinical information on atypical femoral shaft fracture in osteoporotic patients?

PubMed

Chesnut, C Haile; Chesnut, Charles H

2012-03-01

Atypical femoral shaft fractures are associated with the extended usage of nitrogen-containing bisphosphonates as therapy for osteoporosis. For such fractures, the positron emission tomography (PET) procedure, coupled with computerized tomography (CT), provides a potential imaging modality for defining aspects of the pathogenesis, site specificity, and possible prodromal abnormalities prior to fracture. PET-CT may assess the radiokinetic variables K1 (a putative marker for skeletal blood flow) and Ki (a putative marker for skeletal bone formation), and when combined with PET imaging modalities and CT skeletal site localization, may define the site of such radiokinetic findings. Further studies into the clinical usage of PET-CT in patients with atypical femoral shaft fractures are warranted.

A review of medical terminology standards and structured reporting.

PubMed

Awaysheh, Abdullah; Wilcke, Jeffrey; Elvinger, François; Rees, Loren; Fan, Weiguo; Zimmerman, Kurt

2018-01-01

Much effort has been invested in standardizing medical terminology for representation of medical knowledge, storage in electronic medical records, retrieval, reuse for evidence-based decision making, and for efficient messaging between users. We only focus on those efforts related to the representation of clinical medical knowledge required for capturing diagnoses and findings from a wide range of general to specialty clinical perspectives (e.g., internists to pathologists). Standardized medical terminology and the usage of structured reporting have been shown to improve the usage of medical information in secondary activities, such as research, public health, and case studies. The impact of standardization and structured reporting is not limited to secondary activities; standardization has been shown to have a direct impact on patient healthcare.

Initial Experience of the American Society of Regional Anesthesia and Pain Medicine Coags Regional Smartphone Application: A Novel Report of Global Distribution and Clinical Usage of an Electronic Decision Support Tool to Enhance Guideline Use.

PubMed

Gupta, Rajnish K; McEvoy, Matthew D

2016-01-01

Decision support tools have been demonstrated to improve adherence to medical guidelines; however, smartphone applications (apps) have not been studied in this regard. In a collaboration between Vanderbilt University and the American Society of Regional Anesthesia and Pain Medicine (ASRA), the ASRA Coags Regional app was created to be a decision support tool for the 2010 published guideline on regional anesthesia for patients receiving anticoagulation. This is a review of the distribution and usage of this app. The app was created to be a user-friendly version of the guideline. Download statistics were collected from April 2014 to October 2015, and app usage data were collected from October 2014 to October 2015. Usage data were analyzed for number of devices, number of search sessions, medications searched, and types of procedures. There were 8381 downloads, with 83% from North America. Of users who allowed data tracking, 4504 unique devices were identified with 30,003 separate search events. The most searched-for medications were rivaroxaban (n = 4427; 11%), clopidogrel (n = 4042; 10%), and enoxaparin, prophylactic twice daily dosing (n = 3249; 8%). Neuraxial procedures (n = 22,477; 78%) were the most commonly searched-for procedures and over half (n = 22,773; 52%) the users were interested in how long to hold a medication before performing a procedure. This is the first publication of download and usage data concerning medical smartphone apps. It provides a template for future app uptake and use in clinical practice. The app platform provides a new mechanism of rapidly disseminating guidelines and facilitating distribution of frequent updates.

Impact of Routine Surveillance Imaging on Outcomes of Patients With Diffuse Large B-Cell Lymphoma After Autologous Hematopoietic Cell Transplantation.

PubMed

Epperla, Narendranath; Shah, Namrata; Hamadani, Mehdi; Richardson, Kristin; Kapke, Jonathan T; Patel, Asmita; Teegavarapu, Sravanthi P; Carrum, George; Hari, Parameswaran N; Pingali, Sai R; Karmali, Reem; Fenske, Timothy S

2016-12-01

For patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), autologous hematopoietic cell transplantation (auto-HCT) is commonly used. After auto-HCT, DLBCL patients are often monitored with surveillance imaging. However, there is little evidence to support this practice. We performed a multicenter retrospective study of DLBCL patients who underwent auto-HCT (n = 160), who experienced complete remission after transplantation, and who then underwent surveillance imaging. Of these, only 45 patients experienced relapse after day +100 after auto-HCT, with relapse detected by routine imaging in 32 (71%) and relapse detected clinically in 13 (29%). Baseline patient characteristics were similar between the 2 groups. Comparing the radiographic and clinically detected relapse groups, the median time from diagnosis to auto-HCT (389 days vs. 621 days, P = .06) and the median follow-up after auto-HCT (2464 days vs. 1593 days P = .60) were similar. The median time to relapse after auto-HCT was 191 days in radiographically detected relapses compared to 492 days in clinically detected relapses (P = .35), and median postrelapse survival was 359 days in such patients compared to 123 days in patients with clinically detected relapse (P = .36). However, the median posttransplantation overall survival was not significantly different for patients with relapse detected by routine imaging versus relapse detected clinically (643 vs. 586 days, P = .68). A majority (71%) of DLBCL relapses after auto-HCT are detected by routine surveillance imaging. Overall, there appears to be limited utility for routine imaging after auto-HCT except in select cases where earlier detection and salvage therapy with allogeneic HCT is a potential option. Copyright © 2016 Elsevier Inc. All rights reserved.

[Clinical observation on external humeral epicondylitis treated with back-rotation traction].

PubMed

Fu, Rui-yang; Wang, Ya-ling; Gu, Zhong-zhong; Wang, Bao-hu; Zhu, Qi; Li, Ye; Wang, En-ping

2009-02-01

To evaluate the clinical effect of manipulation on external humeral epicondylitis, and to explore the functional mechanism and ideal treatment. Eighty-six patients who had been treated with acupuncture, obturation and needle-knife were divided into routine group and treatment group randomly. In routine group, there were 42 cases (male 13, female 29, means 40.8 years); and in treatment group there were 44 cases (male 16, female 28, means 41.2 years). There's no further treatment for the routine group after the therapy above, while the treatment group was added with back-rotation traction manipulation. Taking Verhaar therapy effect appraisal system of tennis-ball elbow to evaluate elbow function. After 7 days of therapy, the results were excellent in 13 cases, good in 16, fair in 4, poor in 9 in the routine group; and excellent in 38, good in 4 and fair in 2 in treatment group; and the effect in the treatment group were better than that of the routine group (P < 0.010). Half a year later, in the routine group 38 cases recurrenced and in the treatment group 10 cases recurrenced. Making manipulation after routine acupuncture, local obturation and needle-knife has active meaning to remove trauma inflammation, prevent re-conglutination, promote recovery and prevent recurrence.

Management of asthma in Australian general practice: care is still not in line with clinical practice guidelines.

PubMed

Barton, Christopher; Proudfoot, Judith; Amoroso, Cheryl; Ramsay, Emmae; Holton, Christine; Bubner, Tanya; Harris, Mark; Beilby, Justin

2009-06-01

We investigated the quality of primary care asthma management in a sample of Australian general practices. 247 general practitioners (GPs) from 97 practices completed a structured interview about management of asthma, diabetes and hypertension/heart disease. A further structured interview with the senior practice principal and practice manager was used to collect information about practice capacity for chronic disease management. Just under half of GPs (47%) had access to an asthma register and the majority (76%) had access to spirometry in their practice. In terms of routine management of asthma, 12% of GPs reported using spirometry routinely, 13% routinely reviewed written asthma action plans, 27% routinely provided education about trigger factors, 30% routinely reviewed inhaler technique, 24% routinely assessed asthma severity, and 29% routinely assessed physical activity. Practice characteristics such as practice size (p=1.0) and locality (rural/metropolitan) (p=0.7) did not predict quality of asthma management nor did indicators of practice capacity including Business maturity, IT/IM maturity, Multidisciplinary teamwork, and Clinical linkages. Gaps remain in the provision of evidence-based care for patients with asthma in general practice. Markers of practice capacity measured here were not associated with guideline-based respiratory care within practices.

Design and Validation of a Radio-Frequency Identification-Based Device for Routinely Assessing Gait Speed in a Geriatrics Clinic.

PubMed

Barry, Lisa C; Hatchman, Laura; Fan, Zhaoyan; Guralnik, Jack M; Gao, Robert X; Kuchel, George A

2018-05-01

To evaluate the feasibility, acceptability, and validity of a radio-frequency identification (RFID)-based system to measure gait speed in a clinical setting as a first step to using unobtrusive gait speed assessment in routine clinical care. Feasibility study comparing gait speed assessed using an RFID-based system with gait speed assessed using handheld stopwatch, the criterion standard. Outpatient geriatrics clinic at a Connecticut-based academic medical center. Clinic attendees who could walk independently with or without an assistive device (N=50) and healthcare providers (N=9). Gait speed was measured in twice using 2 methods each time before participants entered an examination room. Participants walked at their usual pace while gait speed was recorded simultaneously using the RFID-based system and a handheld stopwatch operated by a trained study investigator. After 2 trials, participants completed a brief survey regarding their experience. At the end of the study period, clinic healthcare providers completed a separate survey. Test-retest reliability of the RFID-based system was high (intraclass correlation coefficient = 0.953). The mean difference ± standard deviation in gait speed between the RFID-based system and the stopwatch was -0.003±0.035 m/s (p=.53) and did not differ significantly according to age, sex, or use of an assistive walking aid. Acceptability of the device was high, and 8 of 9 providers indicated that measuring gait speed using the RFID-based system should be a part of routine clinical care. RFID technology may offer a practical means of overcoming barriers to routine measurement of gait speed in real-world outpatient clinical settings. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Addressing phenoconversion: the Achilles' heel of personalized medicine

PubMed Central

Shah, Rashmi R; Smith, Robert L

2015-01-01

Phenoconversion is a phenomenon that converts genotypic extensive metabolizers (EMs) into phenotypic poor metabolizers (PMs) of drugs, thereby modifying their clinical response to that of genotypic PMs. Phenoconversion, usually resulting from nongenetic extrinsic factors, has a significant impact on the analysis and interpretation of genotype-focused clinical outcome association studies and personalizing therapy in routine clinical practice. The high phenotypic variability or genotype–phenotype mismatch, frequently observed due to phenoconversion within the genotypic EM population, means that the real number of phenotypic PM subjects may be greater than predicted from their genotype alone, because many genotypic EMs would be phenotypically PMs. If the phenoconverted population with genotype–phenotype mismatch, most extensively studied for CYP2D6, is as large as the evidence suggests, there is a real risk that genotype-focused association studies, typically correlating only the genotype with clinical outcomes, may miss clinically strong pharmacogenetic associations, thus compromising any potential for advancing the prospects of personalized medicine. This review focuses primarily on co-medication-induced phenoconversion and discusses potential approaches to rectify some of the current shortcomings. It advocates routine phenotyping of subjects in genotype-focused association studies and proposes a new nomenclature to categorize study populations. Even with strong and reliable data associating patients' genotypes with clinical outcome(s), there are problems clinically in applying this knowledge into routine pharmacotherapy because of potential genotype–phenotype mismatch. Drug-induced phenoconversion during routine clinical practice remains a major public health issue. Therefore, the principal challenges facing personalized medicine, which need to be addressed, include identification of the following factors: (i) drugs that are susceptible to phenoconversion; (ii) co-medications that can cause phenoconversion; and (iii) dosage amendments that need to be applied during and following phenoconversion. PMID:24913012

Usage and Dose Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis of the Intervention Arm of a Randomized Controlled Trial

PubMed Central

Lappalainen, Raimo; Välkkynen, Pasi; Sairanen, Essi; Lappalainen, Päivi; Karhunen, Leila; Peuhkuri, Katri; Korpela, Riitta; Kolehmainen, Marjukka; Ermes, Miikka

2016-01-01

Background Mobile phone apps offer a promising medium to deliver psychological interventions. A mobile app based on Acceptance and Commitment Therapy (ACT) was developed and studied in a randomized controlled trial (RCT). Objective To study usage metrics of a mobile ACT intervention and dose-response relationship between usage and improvement in psychological flexibility. Methods An RCT was conducted to investigate the effectiveness of different lifestyle interventions for overweight people with psychological stress. This paper presents a secondary analysis of the group that received an 8-week mobile ACT intervention. Most of the analyzed 74 participants were female (n=64, 86%). Their median age was 49.6 (interquartile range, IQR 45.4-55.3) years and their mean level of psychological flexibility, measured with the Acceptance and Action Questionnaire II, was 20.4 (95% confidence interval 18.3-22.5). Several usage metrics describing the intensity of use, usage of content, and ways of use were calculated. Linear regression analyses were performed to study the dose-response relationship between usage and the change in psychological flexibility and to identify the usage metrics with strongest association with improvement. Binary logistic regression analyses were further used to assess the role of usage metrics between those who showed improvement in psychological flexibility and those who did not. In addition, associations between usage and baseline participant characteristics were studied. Results The median number of usage sessions was 21 (IQR 11.8-35), the number of usage days was 15 (IQR 9.0-24), and the number of usage weeks was 7.0 (IQR 4.0-8.0). The participants used the mobile app for a median duration of 4.7 (IQR 3.2-7.2) hours and performed a median of 63 (IQR 46-98) exercises. There was a dose-response relationship between usage and the change in psychological flexibility. The strongest associations with psychological flexibility (results adjusted with gender, age, and baseline psychological variables) were found for lower usage of Self as context related exercises (B=0.22, P=.001) and higher intensity of use, described by the number of usage sessions (B=−0.10, P=.01), usage days (B=−0.17, P=.008), and usage weeks (B=−0.73, P=.02), the number of exercises performed (B=−0.02, P=.03), and the total duration of use (B=−0.30, P=.04). Also, higher usage of Acceptance related exercises (B=−0.18, P=.04) was associated with improvement. Active usage was associated with female gender, older age, and not owning a smart mobile phone before the study. Conclusions The results indicated that active usage of a mobile ACT intervention was associated with improved psychological flexibility. Usage metrics describing intensity of use as well as two metrics related to the usage of content were found to be most strongly associated with improvement. Trial Registration ClinicalTrials.gov NCT01738256; https://clinicaltrials.gov/ct2/show/NCT01738256 (Archived by WebCite at http://www.webcitation.org/6iTePjPLL) PMID:27468653

ClinicAl Evaluation of Dental Restorative Materials

DTIC Science & Technology

1989-01-01

use of an Atuarial Life Table Survival Analysis procedure. The median survival time for anterior composites was 13.5 years, as compared to 12.1 years...dental materials. For the first time in clinical biomaterials research, we used a statistical approach of Survival Analysis which utilized the... analysis has been established to assure uniformity in usage. This scale is now in use by clinical investigators throughout the country. Its use at the

Defining a region of optimization based on engine usage data

DOEpatents

Jiang, Li; Lee, Donghoon; Yilmaz, Hakan; Stefanopoulou, Anna

2015-08-04

Methods and systems for engine control optimization are provided. One or more operating conditions of a vehicle engine are detected. A value for each of a plurality of engine control parameters is determined based on the detected one or more operating conditions of the vehicle engine. A range of the most commonly detected operating conditions of the vehicle engine is identified and a region of optimization is defined based on the range of the most commonly detected operating conditions of the vehicle engine. The engine control optimization routine is initiated when the one or more operating conditions of the vehicle engine are within the defined region of optimization.

SOFIP: A Short Orbital Flux Integration Program

NASA Technical Reports Server (NTRS)

Stassinopoulos, E. G.; Hebert, J. J.; Butler, E. L.; Barth, J. L.

1979-01-01

A computer code was developed to evaluate the space radiation environment encountered by geocentric satellites. The Short Orbital Flux Integration Program (SOFIP) is a compact routine of modular compositions, designed mostly with structured programming techniques in order to provide core and time economy and ease of use. The program in its simplest form produces for a given input trajectory a composite integral orbital spectrum of either protons or electrons. Additional features are available separately or in combination with the inclusion of the corresponding (optional) modules. The code is described in detail, and the function and usage of the various modules are explained. A program listing and sample outputs are attached.

[Clinical research of analgesic for labor with acupoint injection and electroacupuncture].

PubMed

Liu, Xiaohui; Wu, Lingling; Yi, Wei

2015-11-01

To explore a safe and effective scheme of analgesic for labor. Eighty-four primiparas without contraindication of vaginal delivery were divided into an observation group and a control group, 42 cases in each one. In the observation group, the acupoint injection was given at Zusanli (ST 36) combined with electroacupuncture (EA) at Hegu (LI 4) and Sanyinjiao (SP 6) till the cervical opening at the end of first stage labor. In the control group, the routine respiratory instruction was applied. In 5 min, 10 min and 60 min of acupuncture (the same time points in the control group) as well as at the end of the first and second stage labor, the analgesic effect was assessed for the primiparas of the two groups. The labor stages, adverse reactions, postpartum hemorrhage, postpartum urine retention, newborn asphyxia rate and usage rate of oxytocin were compared between the two groups. In the observation group, in 5 min, 10 min and 60 min of acupuncture as well as at the end of the first and second stages, the visual analogue scale (VAS) was lower apparently as compared with the control group at the corresponding time points (all P < 0.05). The differences in the time limit in the active period, the second and third stages were not significant between the two groups (all P > 0.05). The incidence of adverse reactions and the usage rate of oxytocin were lower than those in the control group [2.4% (1/42) vs 31.0% (13/42); 2.4% (1/42) vs 23.8% (10/42), both P < 0.05]. The differences in postpartum hemorrhage, postpartum urine retention and newborn asphyxia rate were not significant between the two groups (all P > 0.05). The combination of acupoint injection and EA is the effective analgesic scheme for labor. This scheme effectively alleviates labor pain and has no maternal and child complications.

High-Throughput Microbore UPLC-MS Metabolic Phenotyping of Urine for Large-Scale Epidemiology Studies.

PubMed

Gray, Nicola; Lewis, Matthew R; Plumb, Robert S; Wilson, Ian D; Nicholson, Jeremy K

2015-06-05

A new generation of metabolic phenotyping centers are being created to meet the increasing demands of personalized healthcare, and this has resulted in a major requirement for economical, high-throughput metabonomic analysis by liquid chromatography-mass spectrometry (LC-MS). Meeting these new demands represents an emerging bioanalytical problem that must be solved if metabolic phenotyping is to be successfully applied to large clinical and epidemiological sample sets. Ultraperformance (UP)LC-MS-based metabolic phenotyping, based on 2.1 mm i.d. LC columns, enables comprehensive metabolic phenotyping but, when employed for the analysis of thousands of samples, results in high solvent usage. The use of UPLC-MS employing 1 mm i.d. columns for metabolic phenotyping rather than the conventional 2.1 mm i.d. methodology shows that the resulting optimized microbore method provided equivalent or superior performance in terms of peak capacity, sensitivity, and robustness. On average, we also observed, when using the microbore scale separation, an increase in response of 2-3 fold over that obtained with the standard 2.1 mm scale method. When applied to the analysis of human urine, the 1 mm scale method showed no decline in performance over the course of 1000 analyses, illustrating that microbore UPLC-MS represents a viable alternative to conventional 2.1 mm i.d. formats for routine large-scale metabolic profiling studies while also resulting in a 75% reduction in solvent usage. The modest increase in sensitivity provided by this methodology also offers the potential to either reduce sample consumption or increase the number of metabolite features detected with confidence due to the increased signal-to-noise ratios obtained. Implementation of this miniaturized UPLC-MS method of metabolic phenotyping results in clear analytical, economic, and environmental benefits for large-scale metabolic profiling studies with similar or improved analytical performance compared to conventional UPLC-MS.

Effects of probiotic supplementation over 5 months on routine haematology and clinical chemistry measures in healthy active adults.

PubMed

Cox, A J; West, N P; Horn, P L; Lehtinen, M J; Koerbin, G; Pyne, D B; Lahtinen, S J; Fricker, P A; Cripps, A W

2014-11-01

Use of probiotic-containing foods and probiotic supplements is increasing; however, few studies document safety and tolerability in conjunction with defined clinical end points. This paper reports the effects of 150 days of supplementation with either a single- (Bifidobacterium animalis subsp. lactis Bl-04) or a double-strain (Lactobacillus acidophilus NCFM and Bifidobacterium animalis subsp. lactis Bi-07) probiotic on routine haematology and clinical chemistry measures in healthy active adults. Pre- to post-intervention changes in laboratory measures were determined and compared between supplement and placebo groups. Overall there were few differences in routine haematology and clinical chemistry measures between supplement and placebo groups post-intervention. Exceptions included plasma calcium (P=0.03) and urea (P=0.015); however, observed changes were small and within assay-specific laboratory reference ranges. These data provide evidence supporting the use of these probiotic supplements over a period of 5 months in healthy active adults without obvious safety or tolerability issues.

Clinical Data Systems to Support Public Health Practice: A National Survey of Software and Storage Systems Among Local Health Departments.

PubMed

McCullough, J Mac; Goodin, Kate

2016-01-01

Numerous software and data storage systems are employed by local health departments (LHDs) to manage clinical and nonclinical data needs. Leveraging electronic systems may yield improvements in public health practice. However, information is lacking regarding current usage patterns among LHDs. To analyze clinical and nonclinical data storage and software types by LHDs. Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County and City Health Officials. A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). Outcome measures included LHD's primary clinical service data system, nonclinical data system(s) used, and plans to adopt electronic clinical data system (if not already in use). Predictors of interest included jurisdiction size and governance type, and other informatics capacities within the LHD. Bivariate analyses were performed using χ and t tests. Up to 38.4% of LHDs reported using an electronic health record (EHR). Usage was common especially among LHDs that provide primary care and/or dental services. LHDs serving smaller populations and those with state-level governance were both less likely to use an EHR. Paper records were a common data storage approach for both clinical data (28.9%) and nonclinical data (59.4%). Among LHDs without an EHR, 84.7% reported implementation plans. Our findings suggest that LHDs are increasingly using EHRs as a clinical data storage solution and that more LHDs are likely to adopt EHRs in the foreseeable future. Yet use of paper records remains common. Correlates of electronic system usage emerged across a range of factors. Program- or system-specific needs may be barriers or facilitators to EHR adoption. Policy makers can tailor resources to address barriers specific to LHD size, governance, service portfolio, existing informatics capabilities, and other pertinent characteristics.

Dose Adjustment for Normal Eating (DAFNE) in routine clinical practice: who benefits?

PubMed

Keen, A J A; Duncan, E; McKillop-Smith, A; Evans, N D; Gold, A E

2012-05-01

To explore the effectiveness of Dose Adjustment for Normal Eating in routine clinical practice in the UK. Participants were 124 adults with Type 1 diabetes who had completed a Dose Adjustment for Normal Eating course. Data were collected before the course and again 1 year later on a variety of biological, psychological and social measures. There were a range of significant benefits consistent with Dose Adjustment for Normal Eating aims, including: better control among those with baseline HbA(1c) ≥ 81 mmol/mol (9.6%) (z = -2.8, P = 0.004); reduced number of participants reporting severe hypoglycaemia (χ² = 4.27, P = 0.039); total eradication of diabetic ketoacidosis (χ² = 4.17, P = 0.041) and lower diabetes-related distress (z = -4.5, P < 0.001). The most deprived of the clinic population were significantly under-represented (χ² = 17.8, P = 0.001) and the levels of clinical depression were unusually low. These results indicate that Dose Adjustment for Normal Eating delivered in routine clinical practice is associated with a range of benefits and that certain clinical and psychosocial characteristics are associated with better outcomes. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Exploring the Relationship between Parental Worry about their Children's Health and Usage of an Internet Intervention for Pediatric Encopresis

PubMed Central

Magee, Joshua C.; Thorndike, Frances P.; Cox, Daniel J.; Borowitz, Stephen M.

2009-01-01

Objective To investigate whether parental worry about their children's health predicts usage of a pediatric Internet intervention for encopresis. Methods Thirty-nine families with a child diagnosed with encopresis completed a national clinical trial of an Internet-based intervention for encopresis (www.ucanpooptoo.com). Parents rated worry about their children's health, encopresis severity, current parent treatment for depression, and parent comfort with the Internet. Usage indicators were collected while participants utilized the intervention. Results Regression analyses showed that parents who reported higher baseline levels of worry about their children's health showed greater subsequent intervention use (β =.52, p =.002), even after accounting for other plausible predictors. Exploratory analyses indicated that this effect may be stronger for families with younger children. Conclusions Characteristics of individuals using Internet-based treatment programs, such as parental worry about their children's health, can influence intervention usage, and should be considered by developers of Internet interventions. PMID:18772228

Enabling active and healthy ageing decision support systems with the smart collection of TV usage patterns

PubMed Central

Billis, Antonis S.; Batziakas, Asterios; Bratsas, Charalampos; Tsatali, Marianna S.; Karagianni, Maria

2016-01-01

Smart monitoring of seniors behavioural patterns and more specifically activities of daily living have attracted immense research interest in recent years. Development of smart decision support systems to support the promotion of health smart homes has also emerged taking advantage of the plethora of smart, inexpensive and unobtrusive monitoring sensors, devices and software tools. To this end, a smart monitoring system has been used in order to extract meaningful information about television (TV) usage patterns and subsequently associate them with clinical findings of experts. The smart TV operating state remote monitoring system was installed in four elderly women homes and gathered data for more than 11 months. Results suggest that TV daily usage (time the TV is turned on) can predict mental health change. Conclusively, the authors suggest that collection of smart device usage patterns could strengthen the inference capabilities of existing health DSSs applied in uncontrolled settings such as real senior homes. PMID:27284457

Enabling active and healthy ageing decision support systems with the smart collection of TV usage patterns.

PubMed

Billis, Antonis S; Batziakas, Asterios; Bratsas, Charalampos; Tsatali, Marianna S; Karagianni, Maria; Bamidis, Panagiotis D

2016-03-01

Smart monitoring of seniors behavioural patterns and more specifically activities of daily living have attracted immense research interest in recent years. Development of smart decision support systems to support the promotion of health smart homes has also emerged taking advantage of the plethora of smart, inexpensive and unobtrusive monitoring sensors, devices and software tools. To this end, a smart monitoring system has been used in order to extract meaningful information about television (TV) usage patterns and subsequently associate them with clinical findings of experts. The smart TV operating state remote monitoring system was installed in four elderly women homes and gathered data for more than 11 months. Results suggest that TV daily usage (time the TV is turned on) can predict mental health change. Conclusively, the authors suggest that collection of smart device usage patterns could strengthen the inference capabilities of existing health DSSs applied in uncontrolled settings such as real senior homes.

Comparison of codon usage bias across Leishmania and Trypanosomatids to understand mRNA secondary structure, relative protein abundance and pathway functions.

PubMed

Subramanian, Abhishek; Sarkar, Ram Rup

2015-10-01

Understanding the variations in gene organization and its effect on the phenotype across different Leishmania species, and to study differential clinical manifestations of parasite within the host, we performed large scale analysis of codon usage patterns between Leishmania and other known Trypanosomatid species. We present the causes and consequences of codon usage bias in Leishmania genomes with respect to mutational pressure, translational selection and amino acid composition bias. We establish GC bias at wobble position that governs codon usage bias across Leishmania species, rather than amino acid composition bias. We found that, within Leishmania, homogenous codon context coding for less frequent amino acid pairs and codons avoiding formation of folding structures in mRNA are essentially chosen. We predicted putative differences in global expression between genes belonging to specific pathways across Leishmania. This explains the role of evolution in shaping the otherwise conserved genome to demonstrate species-specific function-level differences for efficient survival. Copyright © 2015 Elsevier Inc. All rights reserved.

Patterns of Hierarchical Structure in the Medical Lexicon

PubMed Central

Michael, Patricia A.; Cole, William G.; Stewart, James; Blois, Marsden S.

1987-01-01

Concepts in basic and clinical medical science cover a wide range of levels of description, from the subatomic level to the level of the patient as a whole. Medical language may have usage regularities consistent with this hierarchical nature of medical knowledge. Preliminary studies of word occurrence in abstracts drawn from three medical journals representing three broadly defined levels of description (chemical system, physiologic system, and patient as a whole) demonstrated a nonuniform word usage, with many words unique to one or another journal. In this present study, word occurrence was examined in an expanded pool of medical text consisting of sixteen textbooks representing ten different levels of description: atom/ion, micromolecule, macromolecule, organelle, cell, tissue, organ, physiologic system, major body part (or multiple physiologic systems) and patient as a whole. Word usage was found to be nonuniform, with many words unique to specific levels. The presence of such usage regularities may provide a basis for facilitating the automatic classification and retrieval of medical text.

Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use

PubMed Central

Johnson, Kevin B; Lorenzi, Nancy M

2011-01-01

Objective The goal of this study was to develop an in-depth understanding of how a health information exchange (HIE) fits into clinical workflow at multiple clinical sites. Materials and Methods The ethnographic qualitative study was conducted over a 9-month period in six emergency departments (ED) and eight ambulatory clinics in Memphis, Tennessee, USA. Data were collected using direct observation, informal interviews during observation, and formal semi-structured interviews. The authors observed for over 180 h, during which providers used the exchange 130 times. Results HIE-related workflow was modeled for each ED site and ambulatory clinic group and substantial site-to-site workflow differences were identified. Common patterns in HIE-related workflow were also identified across all sites, leading to the development of two role-based workflow models: nurse based and physician based. The workflow elements framework was applied to the two role-based patterns. An in-depth description was developed of how providers integrated HIE into existing clinical workflow, including prompts for HIE use. Discussion Workflow differed substantially among sites, but two general role-based HIE usage models were identified. Although providers used HIE to improve continuity of patient care, patient–provider trust played a significant role. Types of information retrieved related to roles, with nurses seeking to retrieve recent hospitalization data and more open-ended usage by nurse practitioners and physicians. User and role-specific customization to accommodate differences in workflow and information needs may increase the adoption and use of HIE. Conclusion Understanding end users' perspectives towards HIE technology is crucial to the long-term success of HIE. By applying qualitative methods, an in-depth understanding of HIE usage was developed. PMID:22003156

Prevalence of Estimated GFR Reporting Among US Clinical Laboratories

PubMed Central

Accetta, Nancy A.; Gladstone, Elisa H.; DiSogra, Charles; Wright, Elizabeth C.; Briggs, Michael; Narva, Andrew S.

2008-01-01

Background Routine laboratory reporting of estimated glomerular filtration rate (eGFR) may help clinicians detect kidney disease. The current national prevalence of eGFR reporting among clinical laboratories is unknown, thus the extent of the situation of laboratories not routinely reporting eGFR with serum creatinine (SCr) results is not quantified. Design Observational analysis. Setting National Kidney Disease Education Program survey of clinical laboratory conducted in 2006-7 by mail, Web, and telephone follow up. Participants A national random sample, 6,350 clinical laboratories, drawn from the Federal Clinical Laboratory Improvement Amendments database and stratified by six major laboratory types/groupings. Predictors Laboratory reports SCr results. Outcomes Reporting eGFR values along with SCr results. Measurements Percent of laboratories reporting eGFR along with reporting SCr, reporting protocol, eGFR formula used, and style of reporting cutoff values. Results Among laboratories reporting SCr, 38.4% report eGFR (physician offices, 25.8%; hospitals, 43.6%; independents, 38.9%; community clinics, 47.2%; health fair/insurance/public health, 45.5%; others, 43.2%). Physician office laboratories have a reporting prevalence lower than other laboratory types (p < 0.001). Among laboratories reporting eGFR, 66.7% do so routinely with all adult SCr determinations; 71.6% use the 4-variable Modification of Diet in Renal Disease Study equation; and 45.3% use the “>60 mL/min/1.73 m2” reporting convention. Independent laboratories are least likely to routinely report eGFR, (50.6%, p < .05) and most likely to report only when specifically requested (45.4%, p < 0.05). High-volume laboratories across all strata are more likely to report eGFR (p < 0.001). Limitations Self-reporting by laboratories, Federal database did not have names of laboratory directors/managers (intended respondents), assumed accuracy of Federal database for sample purposes. Conclusions Routine eGFR reporting with SCr is not yet universal and laboratories vary in their reporting practices. PMID:18676076

[Health services research the example of atopic dermatitis].

PubMed

Schmitt, J

2011-03-01

Within the past years, health services research projects have analyzed critically the management of atopic eczema (AE) in routine care, quantified the utility of controlling severe AE, and introduced an international standardization of core outcome measures for AE. With a prevalence of 16%, AE is the most frequent chronic condition at all among children and adolescents seeking medical care. Despite lower prevalence in adults, about 60% of patients with AE in routine care are adults. There is a clinically relevant comorbidity of AE and psychiatric conditions. Independent of patient's age and physician's medical discipline topical corticosteroids dominate outpatient treatment of AE. However, there is considerable heterogeneity in the management of AE between treating physicians. Despite a lack of clinical trials, systemic corticosteroids are most frequently prescribed for severe AE. In contrast, cyclosporine only plays a minor role in routine care of severe AE although its efficacy is well-documented in trials. This observation stimulated a head-to-head trial that indicated superiority of cyclosporine over prednisolone for severe adult AE. The control of severe AE has high priority from the perspective of the general population and from the patients' perspective. Competence of the treating physician, disease severity and patient's competence to adjust treatment to disease activity are the main determinants of patient satisfaction. Aiming for a better comparability of clinical trials and better translation of trial evidence into clinical practice, we conducted a Delphi exercise including clinical experts from 11 countries, editors of international dermatological journals, regulatory agencies, and patient representatives. The preliminary core set of outcome domains for eczema trials as defined by the panel included symptoms, physician-assessed clinical signs, and a measurement for long-term control of flares. Symptoms such as itching should be regularly assessed in clinical practice. The presented studies indicate that health services research not only describes and critically analyzes the effectiveness of routine clinical care, but is also translational research in that it may stimulate clinical trials and generate new, clinically relevant hypotheses for experimental studies.

Recognizing cognitive and psychiatric changes in the post-highly active antiretroviral therapy era.

PubMed

Carvalhal, Adriana; Baril, Jean-Guy; Crouzat, Frederic; De Wet, Joss; Junod, Patrice; Kovacs, Colin; Sheehan, Nancy

2012-01-01

Amid numerous complications that plague the health and quality of life of people living with HIV, neurocognitive and psychiatric illnesses pose unique challenges. While there remains uncertainty with respect to the pathophysiology surrounding these disorders, their adverse implications are increasingly recognized. Left undetected, they have the potential to significantly impact patient well being, adherence to antiretroviral treatment and overall health outcomes. As such, early identification of HIV-associated neurocognitive disorders (HAND) and psychiatric illnesses will be paramount in the proactive management of affected patients. The present review focuses on strategies to ensure optimal screening and detection of HAND, depression and substance abuse in routine practice. For each topic, currently available screening methods are discussed. These include identification of risk factors, recognition of relevant symptomatology and an update on validated screening tools that can be efficiently implemented in the clinical setting. Specifically addressed in the present review are the International HIV Dementia Scale, a novel screening equation and algorithm for HAND, as well as brief, validated, verbal questionnaires for detection of depression and substance abuse. Adequate understanding and usage of these screening mechanisms can ensure effective use of resources by distinguishing patients who require referral for more extensive diagnostic procedures from those who likely do not.

Recognizing cognitive and psychiatric changes in the post-highly active antiretroviral therapy era

PubMed Central

Carvalhal, Adriana; Baril, Jean-Guy; Crouzat, Frederic; De Wet, Joss; Junod, Patrice; Kovacs, Colin; Sheehan, Nancy

2012-01-01

Amid numerous complications that plague the health and quality of life of people living with HIV, neurocognitive and psychiatric illnesses pose unique challenges. While there remains uncertainty with respect to the pathophysiology surrounding these disorders, their adverse implications are increasingly recognized. Left undetected, they have the potential to significantly impact patient well being, adherence to antiretroviral treatment and overall health outcomes. As such, early identification of HIV-associated neurocognitive disorders (HAND) and psychiatric illnesses will be paramount in the proactive management of affected patients. The present review focuses on strategies to ensure optimal screening and detection of HAND, depression and substance abuse in routine practice. For each topic, currently available screening methods are discussed. These include identification of risk factors, recognition of relevant symptomatology and an update on validated screening tools that can be efficiently implemented in the clinical setting. Specifically addressed in the present review are the International HIV Dementia Scale, a novel screening equation and algorithm for HAND, as well as brief, validated, verbal questionnaires for detection of depression and substance abuse. Adequate understanding and usage of these screening mechanisms can ensure effective use of resources by distinguishing patients who require referral for more extensive diagnostic procedures from those who likely do not. PMID:24294277

Quantification of fetal and total circulatory DNA in maternal plasma samples before and after size fractionation by agarose gel electrophoresis.

PubMed

Hromadnikova, I; Zejskova, L; Doucha, J; Codl, D

2006-11-01

Fetal extracellular DNA is mainly derived from apoptotic bodies of trophoblast. Recent studies have shown size differences between fetal and maternal extracellular DNA. We have examined the quantification of fetal (SRY gene) and total (GLO gene) extracellular DNA in maternal plasma in different fractions (100-300, 300-500, 500-700, 700-900, and >900 bp) after size fractionation by agarose gel electrophoresis. DNA was extracted from maternal plasma samples from 11 pregnant women carrying male foetuses at the 16th week of gestation. Fetal circulatory DNA was mainly detected in the 100-300 bp fraction with the median concentration being 14.4 GE/ml. A lower median amount of 4.9 GE/ml was also found in the 300-500 bp fraction. Circulatory DNA extracted from the 100-300 bp fraction contained 4.2 times enriched fetal DNA when compared with unseparated DNA sample. Fetal DNA within the 300-500 bp fraction was 2.5 times enriched. Circulatory fetal DNA is predominantly present in a fraction with molecular size <500 bp, which can be used for the detection of paternally inherited alleles. However, the usage of size-separated DNA is not suitable for routine clinical applications because of risk of contamination.

Adoption of routine telemedicine in Norway: the current picture

PubMed Central

Zanaboni, Paolo; Knarvik, Undine; Wootton, Richard

2014-01-01

Background Telemedicine appears to be ready for wider adoption. Although existing research evidence is useful, the adoption of routine telemedicine in healthcare systems has been slow. Objective We conducted a study to explore the current use of routine telemedicine in Norway, at national, regional, and local levels, to provide objective and up-to-date information and to estimate the potential for wider adoption of telemedicine. Design A top-down approach was used to collect official data on the national use of telemedicine from the Norwegian Patient Register. A bottom-up approach was used to collect complementary information on the routine use of telemedicine through a survey conducted at the five largest publicly funded hospitals. Results Results show that routine telemedicine has been adopted in all health regions in Norway and in 68% of hospitals. Despite being widely adopted, the current level of use of telemedicine is low compared to the number of face-to-face visits. Examples of routine telemedicine can be found in several clinical specialties. Most services connect different hospitals in secondary care, and they are mostly delivered as teleconsultations via videoconference. Conclusions Routine telemedicine in Norway has been widely adopted, probably for geographical reasons, as in other settings. However, the level of use of telemedicine in Norway is rather low, and it has significant potential for further development as an alternative to face-to-face outpatient visits. This study is a first attempt to map routine telemedicine at regional, institutional, and clinical levels, and it provides useful information to understand the adoption of telemedicine in routine healthcare and to measure change in future updates. PMID:24433942

Incidence and severity of self-reported chemotherapy side effects in routine care: A prospective cohort study

PubMed Central

Haas, Marion; Viney, Rosalie; Pearson, Sallie-Anne; Haywood, Philip; Brown, Chris; Ward, Robyn

2017-01-01

Aim Chemotherapy side effects are often reported in clinical trials; however, there is little evidence about their incidence in routine clinical care. The objective of this study was to describe the frequency and severity of patient-reported chemotherapy side effects in routine care across treatment centres in Australia. Methods We conducted a prospective cohort study of individuals with breast, lung or colorectal cancer undergoing chemotherapy. Side effects were identified by patient self-report. The frequency, prevalence and incidence rates of side effects were calculated by cancer type and grade, and cumulative incidence curves for each side effect computed. Frequencies of side effects were compared between demographic subgroups using chi-squared statistics. Results Side effect data were available for 449 eligible individuals, who had a median follow-up of 5.64 months. 86% of participants reported at least one side effect during the study period and 27% reported a grade IV side effect, most commonly fatigue or dyspnoea. Fatigue was the most common side effect overall (85%), followed by diarrhoea (74%) and constipation (74%). Prevalence and incidence rates were similar across side effects and cancer types. Age was the only demographic factor associated with the incidence of side effects, with older people less likely to report side effects. Conclusion This research has produced the first Australian estimates of self-reported incidence of chemotherapy side effects in routine clinical care. Chemotherapy side effects in routine care are common, continue throughout chemotherapy and can be serious. This work confirms the importance of observational data in providing clinical practice-relevant information to decision-makers. PMID:29016607

Incidence and severity of self-reported chemotherapy side effects in routine care: A prospective cohort study.

PubMed

Pearce, Alison; Haas, Marion; Viney, Rosalie; Pearson, Sallie-Anne; Haywood, Philip; Brown, Chris; Ward, Robyn

2017-01-01

Chemotherapy side effects are often reported in clinical trials; however, there is little evidence about their incidence in routine clinical care. The objective of this study was to describe the frequency and severity of patient-reported chemotherapy side effects in routine care across treatment centres in Australia. We conducted a prospective cohort study of individuals with breast, lung or colorectal cancer undergoing chemotherapy. Side effects were identified by patient self-report. The frequency, prevalence and incidence rates of side effects were calculated by cancer type and grade, and cumulative incidence curves for each side effect computed. Frequencies of side effects were compared between demographic subgroups using chi-squared statistics. Side effect data were available for 449 eligible individuals, who had a median follow-up of 5.64 months. 86% of participants reported at least one side effect during the study period and 27% reported a grade IV side effect, most commonly fatigue or dyspnoea. Fatigue was the most common side effect overall (85%), followed by diarrhoea (74%) and constipation (74%). Prevalence and incidence rates were similar across side effects and cancer types. Age was the only demographic factor associated with the incidence of side effects, with older people less likely to report side effects. This research has produced the first Australian estimates of self-reported incidence of chemotherapy side effects in routine clinical care. Chemotherapy side effects in routine care are common, continue throughout chemotherapy and can be serious. This work confirms the importance of observational data in providing clinical practice-relevant information to decision-makers.

Effect of On-Demand vs Routine Nebulization of Acetylcysteine With Salbutamol on Ventilator-Free Days in Intensive Care Unit Patients Receiving Invasive Ventilation: A Randomized Clinical Trial.

PubMed

van Meenen, David M P; van der Hoeven, Sophia M; Binnekade, Jan M; de Borgie, Corianne A J M; Merkus, Maruschka P; Bosch, Frank H; Endeman, Henrik; Haringman, Jasper J; van der Meer, Nardo J M; Moeniralam, Hazra S; Slabbekoorn, Mathilde; Muller, Marcella C A; Stilma, Willemke; van Silfhout, Bart; Neto, Ary Serpa; Ter Haar, Hans F M; Van Vliet, Jan; Wijnhoven, Jan Willem; Horn, Janneke; Juffermans, Nicole P; Pelosi, Paolo; Gama de Abreu, Marcelo; Schultz, Marcus J; Paulus, Frederique

2018-03-13

It remains uncertain whether nebulization of mucolytics with bronchodilators should be applied for clinical indication or preventively in intensive care unit (ICU) patients receiving invasive ventilation. To determine if a strategy that uses nebulization for clinical indication (on-demand) is noninferior to one that uses preventive (routine) nebulization. Randomized clinical trial enrolling adult patients expected to need invasive ventilation for more than 24 hours at 7 ICUs in the Netherlands. On-demand nebulization of acetylcysteine or salbutamol (based on strict clinical indications, n = 471) or routine nebulization of acetylcysteine with salbutamol (every 6 hours until end of invasive ventilation, n = 473). The primary outcome was the number of ventilator-free days at day 28, with a noninferiority margin for a difference between groups of -0.5 days. Secondary outcomes included length of stay, mortality rates, occurrence of pulmonary complications, and adverse events. Nine hundred twenty-two patients (34% women; median age, 66 (interquartile range [IQR], 54-75 years) were enrolled and completed follow-up. At 28 days, patients in the on-demand group had a median 21 (IQR, 0-26) ventilator-free days, and patients in the routine group had a median 20 (IQR, 0-26) ventilator-free days (1-sided 95% CI, -0.00003 to ∞). There was no significant difference in length of stay or mortality, or in the proportion of patients developing pulmonary complications, between the 2 groups. Adverse events (13.8% vs 29.3%; difference, -15.5% [95% CI, -20.7% to -10.3%]; P < .001) were more frequent with routine nebulization and mainly related to tachyarrhythmia (12.5% vs 25.9%; difference, -13.4% [95% CI, -18.4% to -8.4%]; P < .001) and agitation (0.2% vs 4.3%; difference, -4.1% [95% CI, -5.9% to -2.2%]; P < .001). Among ICU patients receiving invasive ventilation who were expected to not be extubated within 24 hours, on-demand compared with routine nebulization of acetylcysteine with salbutamol did not result in an inferior number of ventilator-free days. On-demand nebulization may be a reasonable alternative to routine nebulization. clinicaltrials.gov Identifier: NCT02159196.

Measuring clinical outcomes of animal-assisted therapy: impact on resident medication usage.

PubMed

Lust, Elaine; Ryan-Haddad, Ann; Coover, Kelli; Snell, Jeff

2007-07-01

To measure changes in medication usage of as-needed, psychoactive medications and other select as-needed medication usage as a result of a therapy dog residing in the rehabilitation facility. Additional measures are participants' thoughts and feelings on quality-of-life factors. One group, pretest, post-test. Residential rehabilitation facility. Convenience sample, N = 58 residents living at the facility. A certified, trained therapy dog. Changes in as-needed medication usage for the following categories: analgesics, psychoactive medications, and laxatives, as well as changes in vital sign measurements of blood pressure, pulse, respiration rate, and body weight. Additionally, changes in the residents' perception of quality-of-life factors. One of the three monitored drug classes, analgesia, revealed a decrease in medication usage (mean = 2.6, standard deviation [SD] +/- 6.90, P = 0.017), and one of four monitored vital signs, pulse, showed a decrease (mean = 5.8, SD +/-7.39, P = 0.000) in study participants exposed to the therapy dog. Positive changes were reported in study participants' quality of life. The benefits to human welfare as a result of the presence of a therapy dog have the potential to decrease medication usage for certain conditions in long-term care patients as well as decrease costs. Pharmacist involvement in animal-assisted therapy has the potential to make unique and measurable improvements to best patient care.

Brief Sexual Histories and Routine HIV/STD Testing by Medical Providers

PubMed Central

Lanier, Yzette; Castellanos, Ted; Barrow, Roxanne Y.; Jordan, Wilbert C.; Caine, Virginia

2014-01-01

Abstract Clinicians who routinely take patient sexual histories have the opportunity to assess patient risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and make appropriate recommendations for routine HIV/STD screenings. However, less than 40% of providers conduct sexual histories with patients, and many do not receive formal sexual history training in school. After partnering with a national professional organization of physicians, we trained 26 (US and US territory-based) practicing physicians (58% female; median age=48 years) regarding sexual history taking using both in-person and webinar methods. Trainings occurred during either a 6-h onsite or 2-h webinar session. We evaluated their post-training experiences integrating sexual histories during routine medical visits. We assessed use of sexual histories and routine HIV/STD screenings. All participating physicians reported improved sexual history taking and increases in documented sexual histories and routine HIV/STD screenings. Four themes emerged from the qualitative evaluations: (1) the need for more sexual history training; (2) the importance of providing a gender-neutral sexual history tool; (3) the existence of barriers to routine sexual histories/testing; and (4) unintended benefits for providers who were conducting routine sexual histories. These findings were used to develop a brief, gender-neutral sexual history tool for clinical use. This pilot evaluation demonstrates that providers were willing to utilize a sexual history tool in clinical practice in support of HIV/STD prevention efforts. PMID:24564387

Systematic review of discharge coding accuracy

PubMed Central

Burns, E.M.; Rigby, E.; Mamidanna, R.; Bottle, A.; Aylin, P.; Ziprin, P.; Faiz, O.D.

2012-01-01

Introduction Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain. Methods Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries. Results Thirty-two studies were included. Twenty-five studies compared routinely collected data with case or operation notes. Seven studies compared routinely collected data with clinical registries. The overall median accuracy (routinely collected data sets versus case notes) was 83.2% (IQR: 67.3–92.1%). The median diagnostic accuracy was 80.3% (IQR: 63.3–94.1%) with a median procedure accuracy of 84.2% (IQR: 68.7–88.7%). There was considerable variation in accuracy rates between studies (50.5–97.8%). Since the 2002 introduction of Payment by Results, accuracy has improved in some respects, for example primary diagnoses accuracy has improved from 73.8% (IQR: 59.3–92.1%) to 96.0% (IQR: 89.3–96.3), P= 0.020. Conclusion Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making. PMID:21795302

Making sense of the shadows: priorities for creating a learning healthcare system based on routinely collected data

PubMed Central

Deeny, Sarah R; Steventon, Adam

2015-01-01

Socrates described a group of people chained up inside a cave, who mistook shadows of objects on a wall for reality. This allegory comes to mind when considering ‘routinely collected data’—the massive data sets, generated as part of the routine operation of the modern healthcare service. There is keen interest in routine data and the seemingly comprehensive view of healthcare they offer, and we outline a number of examples in which they were used successfully, including the Birmingham OwnHealth study, in which routine data were used with matched control groups to assess the effect of telephone health coaching on hospital utilisation. Routine data differ from data collected primarily for the purposes of research, and this means that analysts cannot assume that they provide the full or accurate clinical picture, let alone a full description of the health of the population. We show that major methodological challenges in using routine data arise from the difficulty of understanding the gap between patient and their ‘data shadow’. Strategies to overcome this challenge include more extensive data linkage, developing analytical methods and collecting more data on a routine basis, including from the patient while away from the clinic. In addition, creating a learning health system will require greater alignment between the analysis and the decisions that will be taken; between analysts and people interested in quality improvement; and between the analysis undertaken and public attitudes regarding appropriate use of data. PMID:26065466

Electrodiagnostic applications of somatosensory evoked high-frequency EEG oscillations: Technical considerations.

PubMed

Simpson, A J; Cunningham, M O; Baker, M R

2018-03-01

High frequency oscillations (HFOs) embedded within the somatosensory evoked potential (SEP) are not routinely recorded/measured as part of standard clinical SEPs. However, HFOs could provide important additional diagnostic/prognostic information in various patient groups in whom SEPs are tested routinely. One area is the management of patients with hypoxic ischaemic encephalopathy (HIE) in the intensive care unit (ICU). However, the sensitivity of standard clinical SEP recording techniques for detecting HFOs is unknown. SEPs were recorded using routine clinical methods in 17 healthy subjects (median nerve stimulation; 0.5 ms pulse width; 5 Hz; maximum 4000 stimuli) in an unshielded laboratory. Bipolar EEG recordings were acquired (gain 50 k; bandpass 3Hz-2 kHz; sampling rate 5 kHz; non-inverting electrode 2 cm anterior to C3/C4; inverting electrode 2 cm posterior to C3/C4). Data analysis was performed in MATLAB. SEP-HFOs were detected in 65% of controls using standard clinical recording techniques. In 3 controls without significant HFOs, experiments were repeated using a linear electrode array with higher spatial sampling frequency. SEP-HFOs were observed in all 3 subjects. Currently standard clinical methods of recording SEPs are not sufficiently sensitive to permit the inclusion of SEP-HFOs in routine clinical diagnostic/prognostic assessments. Whilst an increase in the number/density of EEG electrodes should improve the sensitivity for detecting SEP-HFOs, this requires confirmation. By improving and standardising clinical SEP recording protocols to permit the acquisition/analysis of SEP-HFOs, it should be possible to gain important insights into the pathophysiology of neurological disorders and refine the management of conditions such as HIE. Copyright © 2018. Published by Elsevier Inc.

Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi.

PubMed

Ahmed, Saeed; Schwarz, Monica; Flick, Robert J; Rees, Chris A; Harawa, Mwelura; Simon, Katie; Robison, Jeff A; Kazembe, Peter N; Kim, Maria H

2016-04-01

To assess implementation of provider-initiated testing and counselling (PITC) for HIV in Malawi. A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected programme data. Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics and 49.4% (6871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of HIV counsellors (32/71) while providers from inpatient units cited the inability to test on weekends. Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests that routine PITC is feasible. These results underscore the need to develop clear, standardised PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Routine operation of an Elliott 903 computer in a clinical chemistry laboratory

PubMed Central

Whitby, L. G.; Simpson, D.

1973-01-01

Experience gained in the last four years concerning the capabilities and limitations of an 8K Elliott 903 (18-bit word) computer with magnetic tape backing store in the routine operation of a clinical chemistry laboratory is described. Designed as a total system, routine operation has latterly had to be confined to data acquisition and process control functions, due primarily to limitations imposed by the choice of hardware early in the project. In this final report of a partially successful experiment the opportunity is taken to review mistakes made, especially at the start of the project, to warn potential computer users of pitfalls to be avoided. PMID:4580240

Routine clinical heart examinations using SQUID magnetocardiography at University of Tsukuba Hospital

NASA Astrophysics Data System (ADS)

Inaba, T.; Nakazawa, Y.; Yoshida, K.; Kato, Y.; Hattori, A.; Kimura, T.; Hoshi, T.; Ishizu, T.; Seo, Y.; Sato, A.; Sekiguchi, Y.; Nogami, A.; Watanabe, S.; Horigome, H.; Kawakami, Y.; Aonuma, K.

2017-11-01

A 64-channel Nb-based DC-SQUID magnetocardiography (MCG) system was installed at the University of Tsukuba Hospital (UTH) in March 2007 after obtaining Japanese pharmaceutical approval and insurance reimbursement approval. In the period between 2008 and 2016, the total number of patients was 10 085. The heart diseases diagnosed in fetuses as well as adults are mainly atrial arrhythmia, abnormal repolarization, ventricular arrhythmia, and fetal arrhythmia. In most cases of insufficient diagnostic accuracy with electrocardiography, SQUID MCG precisely revealed these heart diseases as an abnormal electrical current distribution. Based on success in routine examinations, SQUID MCG is now an indispensable clinical instrument with diagnostic software tuned up during routine use at UTH.

Highlights of PBTI Coimbra Conference on PRT of Plasma & Current Opinions on Pathogen Reduction Treatment of Blood Components.

PubMed

de Sousa, Gracinda; Seghatchian, Jerard

2015-04-01

Two experts from Octapharma and from Cerus addressed, in very concise ways, the concerns about non-viral inactivated FFP and how they managed to obtain highest standard of safety margin for pathogen reduction treatment [PRT] of plasma. The session was moderated by Portuguese Institute of Blood and Transplantation (PIBT) consultant advisor [Jerard Seghatchian] with long standing familiarity and international recognition in PR technologies for plasma, platelets and WB/red cells. The focus of conference was mainly on the criteria of acceptability of PRT-FFP; added values of having diversity in choice without fears of liability, as both of PRT technologies provide an excellent safeguard margins, for more than a decade of usage. In most European countries, it is believed that patients' safety come first followed by the safe usage initiatives, in particular using locally available products. Portugal is finally going forward with the implementation PRT plasma using its own FFP for their clinical use. The round table Q&A session focused on the impacts of the additional processing, which is still continuously improving, on the residual/emerging pathogen infectivity; eliminating the clinical impacts of donors viable leukocytes; the degree of altered product potency in particular cold activation of FVII; and loss of endothelial permeability factors during fluid storage of plasma. Both speakers highlighted their product safety and clinical efficacy using both routine in vitro, including the modern proteomic tests to establish the relevant changes in various parameters and in the overall clinical outcomes. The advancements in pharmacovigilance and hemovigilance, regulatory aspects and cost effectiveness were also highlighted. A local speaker [from the PIBT] described the state of the art of local processing issues and overall required standards used both during validation and the intercept process scale up, which is going ahead smoothly to providing the highest safety standards PRT-intercept plasma locally, in production now. Overall this was an excellent conference, open to transfusion medicine specialists and other health care professionals, for feedback and quality awareness, of providing diversity in choice, to local clinicians, who demand the best for the ultimate patient requirements. This is achieved in a period where both cost effectiveness and affordability matter, so is the clinical outcome, which ultimately counts. There was an atmosphere of non-competitive collaboration and sharing knowledge and working togetherness, even between two manufacturer representatives, which made the conference most joyful event. This was the opportunity to the scientific update and sharing "the once upon a time" impossible task of going for PRT-plasmas in Portugal, making it a reality in their local setting, in real time using Portuguese plasmas. This is in fact the timely news in the period of austerity, to provide a pre launching session for reporting the state of the arts of Portugal achievements to staff, academician, laboratory experts and clinician alike. Copyright © 2015 Elsevier Ltd. All rights reserved.

Moving anesthesiology educational resources to the point of care: experience with a pediatric anesthesia mobile app.

PubMed

Monroe, Katherine S; Evans, Michael A; Mukkamala, Shivani G; Williamson, Julie L; Jabaley, Craig S; Mariano, Edward R; O'Reilly-Shah, Vikas N

2018-05-09

Educators in all disciplines recognize the need to update tools for the modern learner. Mobile applications (apps) may be useful, but real-time data is needed to demonstrate the patterns of utilization and engagement amongst learners. We examined the use of an anesthesia app by two groups of learners (residents and anesthesiologist assistant students [AAs]) during a pediatric anesthesiology rotation. The app calculates age and weight-based information for clinical decision support and contains didactic materials for self-directed learning. The app transmitted detailed usage information to our research team. Over a 12-month period, 39 participants consented; 30 completed primary study procedures (18 residents, 12 AAs). AAs used the app more frequently than residents (P = 0.025) but spent less time in the app (P < 0.001). The median duration of app usage was 2.3 minutes. During the course of the rotation, usage of the app decreased over time. 'Succinylcholine' was the most accessed drug, while 'orientation' was the most accessed teaching module. Ten (33%) believed that the use of apps was perceived to be distracting by operating room staff and surgeons. Real-time in-app analytics helped elucidate the actual usage of this educational resource and will guide future decisions regarding development and educational content. Further research is required to determine learners' preferred choice of device, user experience, and content in the full range of clinical and nonclinical purposes.

Mass Spectrometry in Clinical Laboratory: Applications in Therapeutic Drug Monitoring and Toxicology.

PubMed

Garg, Uttam; Zhang, Yan Victoria

2016-01-01

Mass spectrometry (MS) has been used in research and specialized clinical laboratories for decades as a very powerful technology to identify and quantify compounds. In recent years, application of MS in routine clinical laboratories has increased significantly. This is mainly due to the ability of MS to provide very specific identification, high sensitivity, and simultaneous analysis of multiple analytes (>100). The coupling of tandem mass spectrometry with gas chromatography (GC) or liquid chromatography (LC) has enabled the rapid expansion of this technology. While applications of MS are used in many clinical areas, therapeutic drug monitoring, drugs of abuse, and clinical toxicology are still the primary focuses of the field. It is not uncommon to see mass spectrometry being used in routine clinical practices for those applications.

Automated Broad-Range Molecular Detection of Bacteria in Clinical Samples

PubMed Central

Hoogewerf, Martine; Vandenbroucke-Grauls, Christina M. J. E.; Savelkoul, Paul H. M.

2016-01-01

Molecular detection methods, such as quantitative PCR (qPCR), have found their way into clinical microbiology laboratories for the detection of an array of pathogens. Most routinely used methods, however, are directed at specific species. Thus, anything that is not explicitly searched for will be missed. This greatly limits the flexibility and universal application of these techniques. We investigated the application of a rapid universal bacterial molecular identification method, IS-pro, to routine patient samples received in a clinical microbiology laboratory. IS-pro is a eubacterial technique based on the detection and categorization of 16S-23S rRNA gene interspace regions with lengths that are specific for each microbial species. As this is an open technique, clinicians do not need to decide in advance what to look for. We compared routine culture to IS-pro using 66 samples sent in for routine bacterial diagnostic testing. The samples were obtained from patients with infections in normally sterile sites (without a resident microbiota). The results were identical in 20 (30%) samples, IS-pro detected more bacterial species than culture in 31 (47%) samples, and five of the 10 culture-negative samples were positive with IS-pro. The case histories of the five patients from whom these culture-negative/IS-pro-positive samples were obtained suggest that the IS-pro findings are highly clinically relevant. Our findings indicate that an open molecular approach, such as IS-pro, may have a high added value for clinical practice. PMID:26763956

Prospective evaluation of the VITEK MS for the routine identification of bacteria and yeast in the clinical microbiology laboratory: assessment of accuracy of identification and turnaround time.

PubMed

Charnot-Katsikas, Angella; Tesic, Vera; Boonlayangoor, Sue; Bethel, Cindy; Frank, Karen M

2014-02-01

This study assessed the accuracy of bacterial and yeast identification using the VITEK MS, and the time to reporting of isolates before and after its implementation in routine clinical practice. Three hundred and sixty-two isolates of bacteria and yeast, consisting of a variety of clinical isolates and American Type Culture Collection strains, were tested. Results were compared with reference identifications from the VITEK 2 system and with 16S rRNA sequence analysis. The VITEK MS provided an acceptable identification to species level for 283 (78 %) isolates. Considering organisms for which genus-level identification is acceptable for routine clinical care, 315 isolates (87 %) had an acceptable identification. Six isolates (2 %) were identified incorrectly, five of which were Shigella species. Finally, the time for reporting the identifications was decreased significantly after implementation of the VITEK MS for a total mean reduction in time of 10.52 h (P<0.0001). Overall, accuracy of the VITEK MS was comparable or superior to that from the VITEK 2. The findings were also comparable to other studies examining the accuracy of the VITEK MS, although differences exist, depending on the diversity of species represented as well as on the versions of the databases used. The VITEK MS can be incorporated effectively into routine use in a clinical microbiology laboratory and future expansion of the database should provide improved accuracy for the identification of micro-organisms.

Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study.

PubMed

Nuss, Michelle A; Hill, Janette R; Cervero, Ronald M; Gaines, Julie K; Middendorf, Bruce F

2014-01-01

Despite widespread use of mobile technology in medical education, medical students' use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime. This year-long (July 2012-June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis. Students predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates(®), PDF Expert(®), VisualDx(®), and Micromedex(®). The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime. This mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical student's daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions.

Identification of chronic rhinosinusitis phenotypes using cluster analysis.

PubMed

Soler, Zachary M; Hyer, J Madison; Ramakrishnan, Viswanathan; Smith, Timothy L; Mace, Jess; Rudmik, Luke; Schlosser, Rodney J

2015-05-01

Current clinical classifications of chronic rhinosinusitis (CRS) have been largely defined based upon preconceived notions of factors thought to be important, such as polyp or eosinophil status. Unfortunately, these classification systems have little correlation with symptom severity or treatment outcomes. Unsupervised clustering can be used to identify phenotypic subgroups of CRS patients, describe clinical differences in these clusters and define simple algorithms for classification. A multi-institutional, prospective study of 382 patients with CRS who had failed initial medical therapy completed the Sino-Nasal Outcome Test (SNOT-22), Rhinosinusitis Disability Index (RSDI), Medical Outcomes Study Short Form-12 (SF-12), Pittsburgh Sleep Quality Index (PSQI), and Patient Health Questionnaire (PHQ-2). Objective measures of CRS severity included Brief Smell Identification Test (B-SIT), CT, and endoscopy scoring. All variables were reduced and unsupervised hierarchical clustering was performed. After clusters were defined, variations in medication usage were analyzed. Discriminant analysis was performed to develop a simplified, clinically useful algorithm for clustering. Clustering was largely determined by age, severity of patient reported outcome measures, depression, and fibromyalgia. CT and endoscopy varied somewhat among clusters. Traditional clinical measures, including polyp/atopic status, prior surgery, B-SIT and asthma, did not vary among clusters. A simplified algorithm based upon productivity loss, SNOT-22 score, and age predicted clustering with 89% accuracy. Medication usage among clusters did vary significantly. A simplified algorithm based upon hierarchical clustering is able to classify CRS patients and predict medication usage. Further studies are warranted to determine if such clustering predicts treatment outcomes. © 2015 ARS-AAOA, LLC.

The sexual health of male sex workers in England: analysis of cross-sectional data from genitourinary medicine clinics.

PubMed

Mc Grath-Lone, Louise; Marsh, Kimberly; Hughes, Gwenda; Ward, Helen

2014-02-01

Male sex workers (MSW) are thought to be at increased risk of sexually transmitted infections (STI), however, limited comparative data with other groups are available. Disparities among MSWs by migrant status may also exist. Using newly available, cross-sectional surveillance data, the characteristics of MSWs and other male genitourinary medicine (GUM) clinic attendees can be investigated. Demographic characteristics, STI prevalence and service usage among MSWs and other male attendees between 1 January and 31 December 2011 were compared using logistic regression. In 2011, 627 780 men attended GUM clinics; 488 (0.08%) were identified as MSWs. MSWs used a variety of services, however, one in seven had no HIV test at presentation. Adjusting for demographic factors and self-reported sexual orientation, MSWs had increased risk of some STIs and reinfection compared to other male attendees (eg, ORadj of gonorrhoea infection: 2.21, 95% CI 1.61 to 3.01, p<0.001, 14.1% vs 4.8% reinfected in 2011, p=0.005). Service usage did not vary between migrant and UK-born MSWs, but migrant MSWs were twice as likely to be diagnosed with chlamydia. Some STIs are more prevalent and some reinfections more common among MSWs than other male attendees. A minority of MSWs do not appear to access STI/HIV testing through GUM clinics, and targeted interventions to improve uptake of testing in MSWs should be developed. Service usage and sexual health of MSWs does not appear to vary greatly by migrant status, though the increased risk of chlamydia infection among migrant MSWs should be investigated further.

HIV coreceptor phenotyping in the clinical setting.

PubMed

Low, Andrew J; Swenson, Luke C; Harrigan, P Richard

2008-01-01

The introduction of CCR5 antagonists increases the options available for constructing antiretroviral regimens. However, this option is coupled with the caveat that patients should be tested for HIV coreceptor tropism prior to initiating CCR5 antagonist-based therapy. Failure to screen for CXCR4 usage increases the risk of using an ineffective drug, thus reducing the likelihood of viral suppression and increasing their risk for developing antiretroviral resistance. This review discusses current and future methods of determining HIV tropism, with a focus on their utility in the clinical setting for screening purposes. Some of these methods include recombinant phenotypic tests, such as the Monogram Trofile assay, as well as genotype-based predictors, heteroduplex tracking assays, and flow cytometry based methods. Currently, the best evidence supports the use of phenotypic methods, although other methods of screening for HIV coreceptor usage prior to the administration of CCR5 antagonists may reduce costs and increase turnaround time over phenotypic methods. The presence of low levels of X4 virus is a challenge to all assay methods, resulting in reduced sensitivity in clinical, patient-derived samples when compared to clonally derived samples. Gaining a better understanding of the output of these assays and correlating them with clinical progression and therapy response will provide some indication on how both genotype-based, and phenotypic assays for determining HIV coreceptor usage can be improved. In addition, leveraging new technologies capable of detecting low-level minority species may provide the most significant advances in ensuring that individuals with low levels of dual/mixed tropic virus are not inadvertently prescribed CCR5 antagonists.

Tuberculosis screening in patients with HIV: An audit against UK national guidelines to assess current practice and the effectiveness of an electronic tuberculosis-screening prompt.

PubMed

Fox-Lewis, A; Brima, N; Muniina, P; Grant, A D; Edwards, S G; Miller, R F; Pett, S L

2016-09-01

A retrospective clinical audit was performed to assess if the British HIV Association 2011 guidelines on routine screening for tuberculosis in HIV are being implemented in a large UK urban clinic, and if a tuberculosis-screening prompt on the electronic patient record for new attendees was effective. Of 4658 patients attending during the inclusion period, 385 were newly diagnosed first-time attendees and routine tuberculosis screening was recommended in 165. Of these, only 6.1% of patients had a completed tuberculosis screening prompt, and 12.1% underwent routine tuberculosis screening. This audit represents the first published UK data on routine screening rates for tuberculosis in HIV and demonstrates low rates of tuberculosis screening despite an electronic screening prompt designed to simplify adherence to the national guideline. Reasons why tuberculosis screening rates were low, and the prompt ineffective, are unclear. A national audit is ongoing, and we await the results to see if our data reflect a lack of routine tuberculosis screening in HIV-infected patients at a national level. © The Author(s) 2016.

New laser technologies in the clinic of neurosurgery

NASA Astrophysics Data System (ADS)

Stupak, V. V.; Fomichev, N. G.; Tsvetovsky, S. B.; Dmitriev, A. B.; Kobosev, V. V.; Bagaev, S. N.; Mayorov, A. P.; Struts, S. G.

2005-08-01

In report summarized more then 10 experience of authors in Novosibirsk Traumatology and orthopedics research institute Neurosurgery clinic on usage of laser technologies in treatment of central nervous system tumors. On the basis of ND-YAG laser application original technologies have been developed and used in surgical treatment of patients with various neurosurgical pathology and protected by 8 Patents of the Russian Federation. 427 patients were operated on with the use of YAG:Nd3+ laser. Out of them 152 patients had extracerebral tumors of various volume and localization, 135 patients - spinal cord tumors, 74 patients - a pathology of cerebrospinal transition (Amold-Chiari syndrome of 1-2 types), and 66 patients - intramedullary tumors of deep localization. Results showed good results of laser technologies usage for central nervous system tumors removal.

The hospital transfusion committee: a step towards improved quality assurance.

PubMed

Calder, L; Woodfield, G

1991-10-09

Quality assurance has an important contribution to make in the judicious use of scarce resources. Auckland Hospital has established a transfusion committee because there was an escalating usage of blood and blood products which are expensive prescription medicines. A pilot audit of red cell transfusions indicated that 29% of red cell transfusions may have been unnecessary. A wide range of initiatives at Auckland Hospital has reduced blood product usage. Inappropriate use of blood carries an opportunity cost and may subject patients to unnecessary risk of reactions, including potential disease transmission. Strategies which need to be employed by transfusion committees include the introduction of clinical audit, physician education, restrictions on availability, and clinical budgeting. It is recommended that transfusion committees be set up in all major hospitals.

Biomedical data mining in clinical routine: expanding the impact of hospital information systems.

PubMed

Müller, Marcel; Markó, Kornel; Daumke, Philipp; Paetzold, Jan; Roesner, Arnold; Klar, Rüdiger

2007-01-01

In this paper we want to describe how the promising technology of biomedical data mining can improve the use of hospital information systems: a large set of unstructured, narrative clinical data from a dermatological university hospital like discharge letters or other dermatological reports were processed through a morpho-semantic text retrieval engine ("MorphoSaurus") and integrated with other clinical data using a web-based interface and brought into daily clinical routine. The user evaluation showed a very high user acceptance - this system seems to meet the clinicians' requirements for a vertical data mining in the electronic patient records. What emerges is the need for integration of biomedical data mining into hospital information systems for clinical, scientific, educational and economic reasons.

Protocol investigating the clinical utility of an objective measure of activity and attention (QbTest) on diagnostic and treatment decision-making in children and young people with ADHD-'Assessing QbTest Utility in ADHD' (AQUA): a randomised controlled trial.

PubMed

Hall, Charlotte L; Walker, Gemma M; Valentine, Althea Z; Guo, Boliang; Kaylor-Hughes, Catherine; James, Marilyn; Daley, David; Sayal, Kapil; Hollis, Chris

2014-12-01

The National Institute for Health and Care Excellence (NICE) guidelines for attention deficit/hyperactivity disorder (ADHD) state that young people need to have access to the best evidence-based care to improve outcome. The current 'gold standard' ADHD diagnostic assessment combines clinical observation with subjective parent, teacher and self-reports. In routine practice, reports from multiple informants may be unavailable or contradictory, leading to diagnostic uncertainty and delay. The addition of objective tests of attention and activity may help reduce diagnostic uncertainty and delays in initiating treatment leading to improved outcomes. This trial investigates whether providing clinicians with an objective report of levels of attention, impulsivity and activity can lead to an earlier, and more accurate, clinical diagnosis and improved patient outcome. This multisite randomised controlled trial will recruit young people (aged 6-17 years old) who have been referred for an ADHD diagnostic assessment at Child and Adolescent Mental Health Services (CAMHS) and Community Paediatric clinics across England. Routine clinical assessment will be augmented by the QbTest, incorporating a continuous performance test (CPT) and infrared motion tracking of activity. The participant will be randomised into one of two study arms: QbOpen (clinician has immediate access to a QbTest report): QbBlind (report is withheld until the study end). Primary outcomes are time to diagnosis and diagnostic accuracy. Secondary outcomes include clinician's diagnostic confidence and routine clinical outcome measures. Cost-effective analysis will be conducted, alongside a qualitative assessment of the feasibility and acceptability of incorporating QbTest in routine practice. The findings from the study will inform commissioners, clinicians and managers about the feasibility, acceptability, clinical utility and cost-effectiveness of incorporating QbTest into routine diagnostic assessment of young people with ADHD. The results will be submitted for publication in peer-reviewed journals. The study has received ethical approval. NCT02209116. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Protocol investigating the clinical utility of an objective measure of activity and attention (QbTest) on diagnostic and treatment decision-making in children and young people with ADHD—‘Assessing QbTest Utility in ADHD’ (AQUA): a randomised controlled trial

PubMed Central

Hall, Charlotte L; Walker, Gemma M; Valentine, Althea Z; Guo, Boliang; Kaylor-Hughes, Catherine; James, Marilyn; Daley, David; Sayal, Kapil; Hollis, Chris

2014-01-01

Introduction The National Institute for Health and Care Excellence (NICE) guidelines for attention deficit/hyperactivity disorder (ADHD) state that young people need to have access to the best evidence-based care to improve outcome. The current ‘gold standard’ ADHD diagnostic assessment combines clinical observation with subjective parent, teacher and self-reports. In routine practice, reports from multiple informants may be unavailable or contradictory, leading to diagnostic uncertainty and delay. The addition of objective tests of attention and activity may help reduce diagnostic uncertainty and delays in initiating treatment leading to improved outcomes. This trial investigates whether providing clinicians with an objective report of levels of attention, impulsivity and activity can lead to an earlier, and more accurate, clinical diagnosis and improved patient outcome. Methods and analysis This multisite randomised controlled trial will recruit young people (aged 6–17 years old) who have been referred for an ADHD diagnostic assessment at Child and Adolescent Mental Health Services (CAMHS) and Community Paediatric clinics across England. Routine clinical assessment will be augmented by the QbTest, incorporating a continuous performance test (CPT) and infrared motion tracking of activity. The participant will be randomised into one of two study arms: QbOpen (clinician has immediate access to a QbTest report): QbBlind (report is withheld until the study end). Primary outcomes are time to diagnosis and diagnostic accuracy. Secondary outcomes include clinician's diagnostic confidence and routine clinical outcome measures. Cost-effective analysis will be conducted, alongside a qualitative assessment of the feasibility and acceptability of incorporating QbTest in routine practice. Ethics and dissemination The findings from the study will inform commissioners, clinicians and managers about the feasibility, acceptability, clinical utility and cost-effectiveness of incorporating QbTest into routine diagnostic assessment of young people with ADHD. The results will be submitted for publication in peer-reviewed journals. The study has received ethical approval. Trial registration number NCT02209116. PMID:25448628

Questionnaire survey to assess the pattern and characteristics of cell-phone usage among Indian oncologists.

PubMed

Munshi, Anusheel; Dutta, Debanarayan; Tike, Pramod; Agarwal, Jai Prakash

2016-01-01

Obtain baseline data of cell-phone usage in the medical (MO), surgical (SO) and radiation (RO) oncology community practicing in India. Indigenously prepared cell-phone usage related questionnaire was used in the present study after approval by the Institutional Ethics/Scientific Committees. The questionnaire had 41 items and was made to assess the cell-phone usage parameters, utility in clinical practice, awareness, and to compare parameters between oncology specialties. Between November 2009 and January 2010, the questionnaire was sent as an E-mail attachment to 200 oncologists in India. In all, 123 responses were received (61% responders); 84 (68.3%) were RO. The median age of responders was 35 years. Overall, 80% felt handicapped without cell-phone. The Mean cell-phone score, an index to assess overall usefulness over a score of 1-10, was 6.46 (median 7, standard deviation 1.709). There was no significant difference between RO, MO and SO in duration of usage (P = 0.235), number of cell-phones (P = 0.496), call duration per day (P = 0.490) and dependence on cell-phone (P = 0.574). Age of starting cell-phone usage was earlier in RO (P = 0.086). Professional usage was significantly more by MO and SO compared to RO (P < 0.001); however, the former were less aware of any potential cell-phone hazards compared to RO (P < 0.007). The results of the first such questionnaire based study have been presented. Most oncologists consider cell-phones a useful tool in patient care. More RO are aware of potential cell-phone hazards compared to non-RO's.

Internet and smartphone application usage in eating disorders: A descriptive study in Singapore.

PubMed

Tan, Tina; Kuek, Angeline; Goh, Shih Ee; Lee, Ee Lian; Kwok, Victor

2016-02-01

Eating disorders are associated with significant morbidity and mortality. The Internet is a popular medium for individuals with eating disorders to discuss and reinforce their affliction. However, the available literature on Internet usage and eating disorders is scarce, especially in the area of social media and smartphone application ("app") usage. This study looked at the Internet and smartphone app usage patterns of participants who presented with an eating disorder in Singapore, and whether it corresponded to severity of illness. Individuals who presented to the Eating Disorders clinic at the Singapore General Hospital completed a self-reported questionnaire on Internet and app usage. They also completed the EDE-Q, EAT-26 and CIA 3.0. 55 participants completed the study. 41.8% had anorexia nervosa, 34.5% had bulimia nervosa, and 9.1% were ED-NOS. 41.8% felt that apps helped to perpetuate their illness while 32.7% felt that the apps were helpful for recovery. Overall, any smartphone application usage was associated with younger age and greater eating disorder psychopathology and psychosocial impairment. While 30.9% had encountered eating disorder-related content on Facebook, only 12.7% visited Facebook groups related to eating disorders. For YouTube, "Cooking and Food" and "Beauty and Fashion" videos were among the top 3 types of videos that participants watched. In conclusion, Internet and smartphone app usage is significant, and they are associated with greater severity of illness. It is necessary to include interventions in this aspect as part of treatment of eating disorders. Copyright © 2015 Elsevier B.V. All rights reserved.

Herbal medications and plastic surgery: a hidden danger.

PubMed

Mohan, Arvind; Lahiri, Anindya

2014-04-01

Herbal medicine is a multibillion-pound industry, and surveys suggest that ~10% of the UK population uses herbal supplements concurrently with prescription medications. Patients and health care practitioners are often unaware of the adverse side effects of herbal medicines. In addition, because many of these herbal supplements are available over the counter, many patients do not disclose these when listing medications to health care providers. A 39-year-old nurse underwent an abdominoplasty with rectus sheath plication after weight loss surgery. Postoperatively, she experienced persistent drain output, and after discharge, a seroma developed requiring repeated drainage in the clinic. After scar revision 10 months later, the woman bled postoperatively, requiring suturing. Again, a seroma developed, requiring repeated drainage. It was discovered that the patient had been taking a herbal menopause supplement containing ingredients known to have anticoagulant effects. Complementary medicine is rarely taught in UK medical schools and generally not practiced in UK hospitals. Many supplements are known to have anticoagulant, cardiovascular, and sedative effects. Worryingly, questions about herbal medicines are not routinely asked in clinics, and patients do not often volunteer such information. With the number and awareness of complementary medications increasing, their usage among the population is likely to increase. The authors recommend specific questioning about the use of complementary medications and consideration of ceasing such medications before surgery. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Polyvinylidene fluoride film based nasal sensor to monitor human respiration pattern: an initial clinical study.

PubMed

Roopa Manjunatha, G; Rajanna, K; Mahapatra, D Roy; Nayak, M M; Krishnaswamy, Uma Maheswari; Srinivasa, R

2013-12-01

Design and development of a piezoelectric polyvinylidene fluoride (PVDF) thin film based nasal sensor to monitor human respiration pattern (RP) from each nostril simultaneously is presented in this paper. Thin film based PVDF nasal sensor is designed in a cantilever beam configuration. Two cantilevers are mounted on a spectacle frame in such a way that the air flow from each nostril impinges on this sensor causing bending of the cantilever beams. Voltage signal produced due to air flow induced dynamic piezoelectric effect produce a respective RP. A group of 23 healthy awake human subjects are studied. The RP in terms of respiratory rate (RR) and Respiratory air-flow changes/alterations obtained from the developed PVDF nasal sensor are compared with RP obtained from respiratory inductance plethysmograph (RIP) device. The mean RR of the developed nasal sensor (19.65 ± 4.1) and the RIP (19.57 ± 4.1) are found to be almost same (difference not significant, p > 0.05) with the correlation coefficient 0.96, p < 0.0001. It was observed that any change/alterations in the pattern of RIP is followed by same amount of change/alterations in the pattern of PVDF nasal sensor with k = 0.815 indicating strong agreement between the PVDF nasal sensor and RIP respiratory air-flow pattern. The developed sensor is simple in design, non-invasive, patient friendly and hence shows promising routine clinical usage. The preliminary result shows that this new method can have various applications in respiratory monitoring and diagnosis.

Meta-narrative analysis of sports injury reporting practices based on the Injury Definitions Concept Framework (IDCF): A review of consensus statements and epidemiological studies in athletics (track and field).

PubMed

Timpka, Toomas; Jacobsson, Jenny; Ekberg, Joakim; Finch, Caroline F; Bichenbach, Jerome; Edouard, Pascal; Bargoria, Victor; Branco, Pedro; Alonso, Juan Manuel

2015-11-01

Consistency in routines for reporting injury has been a focus of development efforts in sports epidemiology for a long time. To gain an improved understanding of current reporting practices, we applied the Injury Definitions Concept Framework (IDCF) in a review of injury reporting in a subset of the field. Meta-narrative review. An analysis of injury definitions reported in consensus statements for different sports and studies of injury epidemiology in athletics (track and field) published in PubMed between 1980 and 2013 was performed. Separate narratives for each of the three reporting contexts in the IDCF were constructed from the data. Six consensus statements and 14 studies reporting on athletics injury epidemiology fulfilled the selection criteria. The narratives on sports performance, clinical examination, and athlete self-report contexts were evenly represented in the eligible studies. The sports performance and athlete self-report narratives covered both professional and community athletes as well as training and competition settings. In the clinical examination narrative, data collection by health service professionals was linked to studies of professional athletes at international championships. From an application of the IDCF in a review of injury reporting in sports epidemiology we observed a parallel usage of reporting contexts in this field of research. The co-existence of reporting methodologies does not necessarily reflect a problematic situation, but only provided that firm precautions are taken when comparing studies performed in the different contexts. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Prevalence of complementary and alternative therapy use by cancer patients undergoing radiation therapy.

PubMed

Edwards, Grace V; Aherne, Noel J; Horsley, Patrick J; Benjamin, Linus C; McLachlan, Craig S; McKay, Michael J; Shakespeare, Thomas P

2014-12-01

The use of complementary and alternative therapies (CAT) in oncology patients is increasing in incidence, with calls to routinely screen for their use. We introduced a screening tool as part of clinical care to identify CAT use. We evaluated all patients who attended the radiation oncology outpatient clinic between December 2011 and July 2012, who had filled out the CAT screening tool, and evaluated types of CAT use, reasons for use and predictors of CAT usage. A total of 639 patients completed the CAT screening tool, which was 75% of eligible patients. There were 464 (72.6%) men and 175 (27.4%) women, with a mean age of 69.9 years (range 27-94 years). Prostate cancer was the predominant diagnosis (53.1%), followed by breast cancer (17.5%) and skin cancer (14.7%). Of these, 530 patients (82.9%) had used at least one therapy. Of the 530 patients using CAT, the most quoted reasons for use were to improve quality of life (42.6%), to boost the immune system and general health (33.6%), to increase energy levels (32.6%) and to live longer (28.9%). Of the 530 users, only 112 patients (21.1%) took CAT to help cure their cancer. Women were significantly more likely to use CAT, as were patients with breast cancer. The use of CAT in patients with cancer is prevalent and more frequent in our population than in other published studies. Few patients use CAT to improve their cancer cure, but rather use CAT for other reasons. © 2014 Wiley Publishing Asia Pty Ltd.

Comparison of 3D reconstruction of mandible for pre-operative planning using commercial and open-source software

NASA Astrophysics Data System (ADS)

Abdullah, Johari Yap; Omar, Marzuki; Pritam, Helmi Mohd Hadi; Husein, Adam; Rajion, Zainul Ahmad

2016-12-01

3D printing of mandible is important for pre-operative planning, diagnostic purposes, as well as for education and training. Currently, the processing of CT data is routinely performed with commercial software which increases the cost of operation and patient management for a small clinical setting. Usage of open-source software as an alternative to commercial software for 3D reconstruction of the mandible from CT data is scarce. The aim of this study is to compare two methods of 3D reconstruction of the mandible using commercial Materialise Mimics software and open-source Medical Imaging Interaction Toolkit (MITK) software. Head CT images with a slice thickness of 1 mm and a matrix of 512x512 pixels each were retrieved from the server located at the Radiology Department of Hospital Universiti Sains Malaysia. The CT data were analysed and the 3D models of mandible were reconstructed using both commercial Materialise Mimics and open-source MITK software. Both virtual 3D models were saved in STL format and exported to 3matic and MeshLab software for morphometric and image analyses. Both models were compared using Wilcoxon Signed Rank Test and Hausdorff Distance. No significant differences were obtained between the 3D models of the mandible produced using Mimics and MITK software. The 3D model of the mandible produced using MITK open-source software is comparable to the commercial MIMICS software. Therefore, open-source software could be used in clinical setting for pre-operative planning to minimise the operational cost.

Characterization of the microbunch time structure of proton pencil beams at a clinical treatment facility.

PubMed

Petzoldt, J; Roemer, K E; Enghardt, W; Fiedler, F; Golnik, C; Hueso-González, F; Helmbrecht, S; Kormoll, T; Rohling, H; Smeets, J; Werner, T; Pausch, G

2016-03-21

Proton therapy is an advantageous treatment modality compared to conventional radiotherapy. In contrast to photons, charged particles have a finite range and can thus spare organs at risk. Additionally, the increased ionization density in the so-called Bragg peak close to the particle range can be utilized for maximum dose deposition in the tumour volume. Unfortunately, the accuracy of the therapy can be affected by range uncertainties, which have to be covered by additional safety margins around the treatment volume. A real-time range and dose verification is therefore highly desired and would be key to exploit the major advantages of proton therapy. Prompt gamma rays, produced in nuclear reactions between projectile and target nuclei, can be used to measure the proton's range. The prompt gamma-ray timing (PGT) method aims at obtaining this information by determining the gamma-ray emission time along the proton path using a conventional time-of-flight detector setup. First tests at a clinical accelerator have shown the feasibility to observe range shifts of about 5 mm at clinically relevant doses. However, PGT spectra are smeared out by the bunch time spread. Additionally, accelerator related proton bunch drifts against the radio frequency have been detected, preventing a potential range verification. At OncoRay, first experiments using a proton bunch monitor (PBM) at a clinical pencil beam have been conducted. Elastic proton scattering at a hydrogen-containing foil could be utilized to create a coincident proton-proton signal in two identical PBMs. The selection of coincident events helped to suppress uncorrelated background. The PBM setup was used as time reference for a PGT detector to correct for potential bunch drifts. Furthermore, the corrected PGT data were used to image an inhomogeneous phantom. In a further systematic measurement campaign, the bunch time spread and the proton transmission rate were measured for several beam energies between 69 and 225 MeV as well as for variable momentum limiting slit openings. We conclude that the usage of a PBM increases the robustness of the PGT method in clinical conditions and that the obtained data will help to create reliable range verification procedures in clinical routine.

Integrating an internet-mediated walking program into family medicine clinical practice: a pilot feasibility study.

PubMed

Goodrich, David E; Buis, Lorraine R; Janney, Adrienne W; Ditty, Megan D; Krause, Christine W; Zheng, Kai; Sen, Ananda; Strecher, Victor J; Hess, Michael L; Piette, John D; Richardson, Caroline R

2011-06-24

Regular participation in physical activity can prevent many chronic health conditions. Computerized self-management programs are effective clinical tools to support patient participation in physical activity. This pilot study sought to develop and evaluate an online interface for primary care providers to refer patients to an Internet-mediated walking program called Stepping Up to Health (SUH) and to monitor participant progress in the program. In Phase I of the study, we recruited six pairs of physicians and medical assistants from two family practice clinics to assist with the design of a clinical interface. During Phase II, providers used the developed interface to refer patients to a six-week pilot intervention. Provider perspectives were assessed regarding the feasibility of integrating the program into routine care. Assessment tools included quantitative and qualitative data gathered from semi-structured interviews, surveys, and online usage logs. In Phase I, 13 providers used SUH and participated in two interviews. Providers emphasized the need for alerts flagging patients who were not doing well and the ability to review participant progress. Additionally, providers asked for summary views of data across all enrolled clinic patients as well as advertising materials for intervention recruitment. In response to this input, an interface was developed containing three pages: 1) a recruitment page, 2) a summary page, and 3) a detailed patient page. In Phase II, providers used the interface to refer 139 patients to SUH and 37 (27%) enrolled in the intervention. Providers rarely used the interface to monitor enrolled patients. Barriers to regular use of the intervention included lack of integration with the medical record system, competing priorities, patient disinterest, and physician unease with exercise referrals. Intention-to-treat analyses showed that patients increased walking by an average of 1493 steps/day from pre- to post-intervention (t = (36) = 4.13, p < 0.01). Providers successfully referred patients using the SUH provider interface, but were less willing to monitor patient compliance in the program. Patients who completed the program significantly increased their step counts. Future research is needed to test the effectiveness of integrating SUH with clinical information systems over a longer evaluation period.

Metagenomics: The Next Culture-Independent Game Changer

PubMed Central

Forbes, Jessica D.; Knox, Natalie C.; Ronholm, Jennifer; Pagotto, Franco; Reimer, Aleisha

2017-01-01

A trend towards the abandonment of obtaining pure culture isolates in frontline laboratories is at a crossroads with the ability of public health agencies to perform their basic mandate of foodborne disease surveillance and response. The implementation of culture-independent diagnostic tests (CIDTs) including nucleic acid and antigen-based assays for acute gastroenteritis is leaving public health agencies without laboratory evidence to link clinical cases to each other and to food or environmental substances. This limits the efficacy of public health epidemiology and surveillance as well as outbreak detection and investigation. Foodborne outbreaks have the potential to remain undetected or have insufficient evidence to support source attribution and may inadvertently increase the incidence of foodborne diseases. Next-generation sequencing of pure culture isolates in clinical microbiology laboratories has the potential to revolutionize the fields of food safety and public health. Metagenomics and other ‘omics’ disciplines could provide the solution to a cultureless future in clinical microbiology, food safety and public health. Data mining of information obtained from metagenomics assays can be particularly useful for the identification of clinical causative agents or foodborne contamination, detection of AMR and/or virulence factors, in addition to providing high-resolution subtyping data. Thus, metagenomics assays may provide a universal test for clinical diagnostics, foodborne pathogen detection, subtyping and investigation. This information has the potential to reform the field of enteric disease diagnostics and surveillance and also infectious diseases as a whole. The aim of this review will be to present the current state of CIDTs in diagnostic and public health laboratories as they relate to foodborne illness and food safety. Moreover, we will also discuss the diagnostic and subtyping utility and concomitant bias limitations of metagenomics and comparable detection techniques in clinical microbiology, food and public health laboratories. Early advances in the discipline of metagenomics, however, have indicated noteworthy challenges. Through forthcoming improvements in sequencing technology and analytical pipelines among others, we anticipate that within the next decade, detection and characterization of pathogens via metagenomics-based workflows will be implemented in routine usage in diagnostic and public health laboratories. PMID:28725217

Large Data at Small Universities: Astronomical processing using a computer classroom

NASA Astrophysics Data System (ADS)

Fuller, Nathaniel James; Clarkson, William I.; Fluharty, Bill; Belanger, Zach; Dage, Kristen

2016-06-01

The use of large computing clusters for astronomy research is becoming more commonplace as datasets expand, but access to these required resources is sometimes difficult for research groups working at smaller Universities. As an alternative to purchasing processing time on an off-site computing cluster, or purchasing dedicated hardware, we show how one can easily build a crude on-site cluster by utilizing idle cycles on instructional computers in computer-lab classrooms. Since these computers are maintained as part of the educational mission of the University, the resource impact on the investigator is generally low.By using open source Python routines, it is possible to have a large number of desktop computers working together via a local network to sort through large data sets. By running traditional analysis routines in an “embarrassingly parallel” manner, gains in speed are accomplished without requiring the investigator to learn how to write routines using highly specialized methodology. We demonstrate this concept here applied to 1. photometry of large-format images and 2. Statistical significance-tests for X-ray lightcurve analysis. In these scenarios, we see a speed-up factor which scales almost linearly with the number of cores in the cluster. Additionally, we show that the usage of the cluster does not severely limit performance for a local user, and indeed the processing can be performed while the computers are in use for classroom purposes.

Medical Student Use of Objectives in Basic Science and Clinical Instruction.

ERIC Educational Resources Information Center

And Others; Mast, Terrill A.

1980-01-01

A study that investigated the long-term use of instructional objectives by medical students taking basic science and clinical courses is reported. Focus is on the extent and manner in which the objectives were used and factors that influenced their use. Students reported heavier usage earlier in the curriculum. (Author/JMD)

Projective Techniques: An International Perspective.

ERIC Educational Resources Information Center

Piotrowski, Chris; And Others

The findings of the following four recent surveys on clinical test use in the United States, the Netherlands, Japan, and Hong Kong are reviewed: (1) "Clinical Psychological Test Usage in Japan: A Comparative Study with a Survey in the U.S.A." (T. Ogawa and C. Piotrowski, 1992); (2) "Patterns of Psychological Test Use in Hong…

The Patient Concerns Inventory integrated as part of routine head and neck cancer follow-up consultations: frequency, case-mix, and items initiated by the patient.

PubMed

Rogers, S N; Thomson, F; Lowe, D

2018-03-01

Introduction The National Institute for Health and Care Excellence guidance Improving Supportive and Palliative Care for Adults with Cancer (2004) and the Cancer Reform Strategy (2007) support the premise that assessment and discussion of patients' needs for physical, social, psychological, and spiritual wellbeing should be undertaken during oncology follow-up. We report the use of the Patient Concerns Inventory in a routine head and neck cancer clinic setting over a seven-year period, summarising the number of available clinics, the number of patients completing the inventory within a clinic, the range of clinical characteristics and the concerns they wanted to discuss. Methods The data were analysed from oncology follow-up clinics between 1 August 2007 and 10 December 2014. Audit approval was given by the Clinical Audit Department, University Hospital Aintree. Results There were 386 patients with 1198 inventories completed at 220 clinics, median 6 (range 4-7) per clinic. The most common concerns raised by patients across all the clinic consultations were dry mouth (34%), fear of recurrence (33%), sore mouth (26%), dental health (25%), chewing (22%) and fatigue/tiredness (21%). Conclusions The incorporation of the Patient Concerns Inventory as part of routine oncology clinics allows for a more patient initiated and focused consultation available to the majority of patients throughout their follow-up. The inventory allows for greater opportunity to provide holistic targeted multiprofessional intervention and support.

A comprehensive clinical research database based on CDISC ODM and i2b2.

PubMed

Meineke, Frank A; Stäubert, Sebastian; Löbe, Matthias; Winter, Alfred

2014-01-01

We present a working approach for a clinical research database as part of an archival information system. The CDISC ODM standard is target for clinical study and research relevant routine data, thus decoupling the data ingest process from the access layer. The presented research database is comprehensive as it covers annotating, mapping and curation of poorly annotated source data. Besides a conventional relational database the medical data warehouse i2b2 serves as main frontend for end-users. The system we developed is suitable to support patient recruitment, cohort identification and quality assurance in daily routine.

Adverse events, toxicity and post-mortem data on duloxetine: case reports and literature survey.

PubMed

Vey, Eric L; Kovelman, Inna

2010-05-01

Duloxetine, a dual acting norepinephrine serotonin reuptake inhibitor, is a relatively new pharmacologic agent utilized in the treatment of depression, as well as diabetic neuropathic pain, fibromyalgia, and female stress urinary incontinence. This expanding scope of usage will inevitably lead to its eventual appearance during routine post-mortem toxicologic assays. Currently there is a paucity of post-mortem toxicologic data concerning duloxetine. The current report provides six additional case reports of post-mortem duloxetine levels, along with a review of duloxetine's pharmacokinetics, and the toxicologic manifestations which have been reported in the literature. The post-mortem levels reported, including the highest level recorded to date, are integrated with previously published reports to generate a foundation for a nascent guide to the interpretation of post-mortem duloxetine levels that could be encountered during routine post-mortem toxicologic analyses, and establish a basis upon which the establishment of toxic and lethal thresholds for this compound can be further elucidated with greater clarity. Copyright (c) 2010 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

The Self-Perception and Usage of Medical Apps amongst Medical Students in the United States: A Cross-Sectional Survey.

PubMed

Quant, Cara; Altieri, Lisa; Torres, Juan; Craft, Noah

2016-01-01

Background. Mobile medical software applications (apps) are used for clinical decision-making at the point of care. Objectives. To determine (1) the usage, reliability, and popularity of mobile medical apps and (2) medical students' perceptions of app usage effect on the quality of patient-provider interaction in healthcare settings. Methods. An anonymous web-based survey was distributed to medical students. Frequency of use, type of app used, and perceptions of reliability were assessed via univariate analysis. Results. Seven hundred thirty-one medical students responded, equating to a response rate of 29%. The majority (90%) of participants thought that medical apps enhance clinical knowledge, and 61% said that medical apps are as reliable as textbooks. While students thought that medical apps save time, improve the care of their patients, and improve diagnostic accuracy, 53% of participants believed that mobile device use in front of colleagues and patients makes one appear less competent. Conclusion. While medical students believe in the utility and reliability of medical apps, they were hesitant to use them out of fear of appearing less engaged. Higher levels of training correlated with a greater degree of comfort when using medical apps in front of patients.

Frequency of Addictive Habits and its Association with Oral Diseases Among a Cross Section of Indian Police Personnel Connotation.

PubMed

Singh, Aishwarya; Bhambal, Ajay; Saxena, Sudhanshu; Tiwari, Vidhatri; Tiwari, Utkarsh

2016-05-01

To assess the frequency of adverse addictive habits, specially alcohol and tobacco usage, among police personnel of Bhopal City, Central India and its association with the frequency of oral mucosal lesions and periodontal diseases. Across-sectional analytical study. Bhopal City, Capital of Madhya Pradesh State, Central India, from February to April 2013. All the police personnel posted at various police stations were interviewed and clinically examined. Police personnel who did not cooperate or were not willing, were excluded from the study. Chi-square test was used to analyze categorical variables. Atotal of 781 subjects were interviewed for the various forms of adverse habits, followed by clinical assessment of oral mucosal lesions and periodontal status using WHO 1997 criteria. The mean age of study subjects was 40.58 ±9.84 years. Usage of tobacco was found among 55% and only 1.3% of subjects consumed alcohol. The prevalence of oral mucosal lesions and periodontal diseases was significantly higher among tobacco users. There was high usage of tobacco among police personnel in Bhopal City, India with a detrimental effect on oral health.

Mobile technologies in medical education: AMEE Guide No. 105.

PubMed

Masters, Ken; Ellaway, Rachel H; Topps, David; Archibald, Douglas; Hogue, Rebecca J

2016-06-01

Mobile technologies (including handheld and wearable devices) have the potential to enhance learning activities from basic medical undergraduate education through residency and beyond. In order to use these technologies successfully, medical educators need to be aware of the underpinning socio-theoretical concepts that influence their usage, the pre-clinical and clinical educational environment in which the educational activities occur, and the practical possibilities and limitations of their usage. This Guide builds upon the previous AMEE Guide to e-Learning in medical education by providing medical teachers with conceptual frameworks and practical examples of using mobile technologies in medical education. The goal is to help medical teachers to use these concepts and technologies at all levels of medical education to improve the education of medical and healthcare personnel, and ultimately contribute to improved patient healthcare. This Guide begins by reviewing some of the technological changes that have occurred in recent years, and then examines the theoretical basis (both social and educational) for understanding mobile technology usage. From there, the Guide progresses through a hierarchy of institutional, teacher and learner needs, identifying issues, problems and solutions for the effective use of mobile technology in medical education. This Guide ends with a brief look to the future.

The art and science of using routine outcome measurement in mental health benchmarking.

PubMed

McKay, Roderick; Coombs, Tim; Duerden, David

2014-02-01

To report and critique the application of routine outcome measurement data when benchmarking Australian mental health services. The experience of the authors as participants and facilitators of benchmarking activities is augmented by a review of the literature regarding mental health benchmarking in Australia. Although the published literature is limited, in practice, routine outcome measures, in particular the Health of the National Outcomes Scales (HoNOS) family of measures, are used in a variety of benchmarking activities. Use in exploring similarities and differences in consumers between services and the outcomes of care are illustrated. This requires the rigour of science in data management and interpretation, supplemented by the art that comes from clinical experience, a desire to reflect on clinical practice and the flexibility to use incomplete data to explore clinical practice. Routine outcome measurement data can be used in a variety of ways to support mental health benchmarking. With the increasing sophistication of information development in mental health, the opportunity to become involved in benchmarking will continue to increase. The techniques used during benchmarking and the insights gathered may prove useful to support reflection on practice by psychiatrists and other senior mental health clinicians.

Mobile Phone Sensor Correlates of Depressive Symptom Severity in Daily-Life Behavior: An Exploratory Study.

PubMed

Saeb, Sohrab; Zhang, Mi; Karr, Christopher J; Schueller, Stephen M; Corden, Marya E; Kording, Konrad P; Mohr, David C

2015-07-15

Depression is a common, burdensome, often recurring mental health disorder that frequently goes undetected and untreated. Mobile phones are ubiquitous and have an increasingly large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms. The objective of this study was to explore the detection of daily-life behavioral markers using mobile phone global positioning systems (GPS) and usage sensors, and their use in identifying depressive symptom severity. A total of 40 adult participants were recruited from the general community to carry a mobile phone with a sensor data acquisition app (Purple Robot) for 2 weeks. Of these participants, 28 had sufficient sensor data received to conduct analysis. At the beginning of the 2-week period, participants completed a self-reported depression survey (PHQ-9). Behavioral features were developed and extracted from GPS location and phone usage data. A number of features from GPS data were related to depressive symptom severity, including circadian movement (regularity in 24-hour rhythm; r=-.63, P=.005), normalized entropy (mobility between favorite locations; r=-.58, P=.012), and location variance (GPS mobility independent of location; r=-.58, P=.012). Phone usage features, usage duration, and usage frequency were also correlated (r=.54, P=.011, and r=.52, P=.015, respectively). Using the normalized entropy feature and a classifier that distinguished participants with depressive symptoms (PHQ-9 score ≥5) from those without (PHQ-9 score <5), we achieved an accuracy of 86.5%. Furthermore, a regression model that used the same feature to estimate the participants' PHQ-9 scores obtained an average error of 23.5%. Features extracted from mobile phone sensor data, including GPS and phone usage, provided behavioral markers that were strongly related to depressive symptom severity. While these findings must be replicated in a larger study among participants with confirmed clinical symptoms, they suggest that phone sensors offer numerous clinical opportunities, including continuous monitoring of at-risk populations with little patient burden and interventions that can provide just-in-time outreach.

Mobile Phone Sensor Correlates of Depressive Symptom Severity in Daily-Life Behavior: An Exploratory Study

PubMed Central

Saeb, Sohrab; Zhang, Mi; Karr, Christopher J; Schueller, Stephen M; Corden, Marya E; Kording, Konrad P

2015-01-01

Background Depression is a common, burdensome, often recurring mental health disorder that frequently goes undetected and untreated. Mobile phones are ubiquitous and have an increasingly large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms. Objective The objective of this study was to explore the detection of daily-life behavioral markers using mobile phone global positioning systems (GPS) and usage sensors, and their use in identifying depressive symptom severity. Methods A total of 40 adult participants were recruited from the general community to carry a mobile phone with a sensor data acquisition app (Purple Robot) for 2 weeks. Of these participants, 28 had sufficient sensor data received to conduct analysis. At the beginning of the 2-week period, participants completed a self-reported depression survey (PHQ-9). Behavioral features were developed and extracted from GPS location and phone usage data. Results A number of features from GPS data were related to depressive symptom severity, including circadian movement (regularity in 24-hour rhythm; r=-.63, P=.005), normalized entropy (mobility between favorite locations; r=-.58, P=.012), and location variance (GPS mobility independent of location; r=-.58, P=.012). Phone usage features, usage duration, and usage frequency were also correlated (r=.54, P=.011, and r=.52, P=.015, respectively). Using the normalized entropy feature and a classifier that distinguished participants with depressive symptoms (PHQ-9 score ≥5) from those without (PHQ-9 score <5), we achieved an accuracy of 86.5%. Furthermore, a regression model that used the same feature to estimate the participants’ PHQ-9 scores obtained an average error of 23.5%. Conclusions Features extracted from mobile phone sensor data, including GPS and phone usage, provided behavioral markers that were strongly related to depressive symptom severity. While these findings must be replicated in a larger study among participants with confirmed clinical symptoms, they suggest that phone sensors offer numerous clinical opportunities, including continuous monitoring of at-risk populations with little patient burden and interventions that can provide just-in-time outreach. PMID:26180009

Mobile Tablet Use among Academic Physicians and Trainees

PubMed Central

Sclafani, Joseph; Tirrell, Timothy F.

2014-01-01

The rapid adoption rate and integration of mobile technology (tablet computing devices and smartphones) by physicians is reshaping the current clinical landscape. These devices have sparked an evolution in a variety of arenas, including educational media dissemination, remote patient data access and point of care applications. Quantifying usage patterns of clinical applications of mobile technology is of interest to understand how these technologies are shaping current clinical care. A digital survey examining mobile tablet and associated application usage was administered via email to all ACGME training programs. Data regarding respondent specialty, level of training, and habits of tablet usage were collected and analyzed. 40 % of respondents used a tablet, of which the iPad was the most popular. Nearly half of the tablet owners reported using the tablet in clinical settings; the most commonly used application types were point of care and electronic medical record access. Increased level of training was associated with decreased support for mobile computing improving physician capabilities and patient interactions. There was strong and consistent desire for institutional support of mobile computing and integration of mobile computing technology into medical education. While many physicians are currently purchasing mobile devices, often without institutional support, successful integration of these devices into the clinical setting is still developing. Potential reasons behind the low adoption rate may include interference of technology in doctor-patient interactions or the lack of appropriate applications available for download. However, the results convincingly demonstrate that physicians recognize a potential utility in mobile computing, indicated by their desire for institutional support and integration of mobile technology into medical education. It is likely that the use of tablet computers in clinical practice will expand in the future. Thus, we believe medical institutions, providers, educators, and developers should collaborate in ways that enhance the efficacy, reliability, and safety of integrating these devices into daily medical practice. PMID:23321961

Most routine laboratory testing of pediatric psychiatric patients in the emergency department is not medically necessary.

PubMed

Donofrio, J Joelle; Horeczko, Timothy; Kaji, Amy; Santillanes, Genevieve; Claudius, Ilene

2015-05-01

We examined the patient characteristics and hospital charges associated with routine medical clearance laboratory screening tests in 1,082 children younger than age eighteen who were brought to the emergency department (ED) for involuntary mental health holds--that is, each patient was brought to the ED to be evaluated for being a danger to him- or herself or to others, for being gravely disabled (unable to meet his or her basic needs due to a mental disorder), or both--from July 2009 to December 2010. Testing was performed on 871 of the children; all patients also received a clinical examination. The median charge for blood and urine testing together was $1,235, and the most frequent ordering pattern was the full comprehensive panel of tests. Of the patients with a nonconcerning clinical examination, 94.3 percent also had clinically nonsignificant test results. When we extrapolated cost savings to the national level, omitting routine screening laboratory tests in the population of pediatric patients presenting to the ED on an involuntary psychiatric hold with nonconcerning clinical exams could represent up to $90 million in savings annually, without reducing the ability to screen for emergency medical conditions. Provider-initiated diagnostic testing instead of routine screening would lead to significantly lower charges to the ED and the patient. Project HOPE—The People-to-People Health Foundation, Inc.

Philosophical Provocation: The Lifeblood of Clinical Ethics.

PubMed

McCullough, Laurence B

2017-02-01

The daily work of the clinical ethics teacher and clinical ethics consultant falls into the routine of classifying clinical cases by ethical type and proposing ethically justified alternatives for the professionally responsible management of a specific type of case. Settling too far into this routine creates the risk of philosophical inertia, which is not good either for the clinical ethicist or for the field of clinical ethics. The antidote to this philosophical inertia and resultant blinkered vision of clinical ethics is sustained, willing exposure to philosophical provocation. The papers in this clinical ethics issue of the Journal of Medicine and Philosophy provide just such philosophical provocation related to core topics in clinical ethics: the distinction between clinical practice and clinical research; telemedicine, or medicine at a distance; illness narratives; the concept of the placebo effect; and sex reassignment. © The Author 2017. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Chinese Herbal Medicine for Postpartum Depression: A Systematic Review of Randomized Controlled Trials

PubMed Central

Li, Yongle; Chen, Zijie; Yu, Ning; Yao, Keyu; Che, Yiwen; Xi, Yupeng

2016-01-01

Background. Postpartum depression (PPD) does great harm to women following childbirth. The aim of this study was to conduct a systematic review of the literature to assess the efficacy and safety of CHM for the treatment of PPD. Methods. Published or ongoing registered trials were searched for from the inception of the various databases to December 31, 2015. Data extraction and methodology assessment were conducted independently by two researchers. RevMan 5.3 software was used to analyze the data. Results. Forty-seven registered clinical trials (RCTs) were identified and reviewed. The results showed CHM alone or in combination with routine treatments could reduce HAMD score, EPDS score, incidence of adverse events, TESS, and SERS. CHM combined with routine treatment was more effective in increasing serum estradiol levels and reducing progesterone levels than routine treatment alone. Meanwhile, pooled data revealed that MRLQS combined with routine treatments or MRLQS plus MSHS combined with routine treatments were more effective than other therapeutic methods in TCM. MRLQS plus MSHS alone was found to be an effective alternative when compared to routine treatments. Conclusions. This review suggested that CHM was safe and effective in the treatment of PPD. However, this could not be proven conclusively. To ensure evidence-based clinical practice, more rigorously designed trials are warranted. PMID:27774110

The Evaluation of the Health Information Exchange with the Number of Usage and the Introduction of Outpatient to the Hospitals at Nagasaki Japan.

PubMed

Matsumoto, Takehiro; Honda, Masayuki

2017-01-01

Health Information Exchange (HIE) has been gradually spreading in Japan. But the effect and evaluation of these systems have not been proven. The aim of this study is to examine the effect of the Japanese HIE through the evaluation of the clinical activities in Nagasaki University Hospital. The electric medical records of 5335 patients were shared in the Ajisai-net, which was Japanese HIE in Nagasaki, from 2009 to 2015. And the number of shared patients increased every year, and the annual average number was 762.1. On the other hand, the number of the patients who was introduced from clinics to our hospital and whose medical records were shared in the Ajisai-net increased every year. In conclusion, the usage of Japanese HIE is useful for the clinical consultation and medical care, and these systems have the good effect on the hospital management in Japan.

Building Data-Driven Pathways From Routinely Collected Hospital Data: A Case Study on Prostate Cancer

PubMed Central

Clark, Jeremy; Cooper, Colin S; Mills, Robert; Rayward-Smith, Victor J; de la Iglesia, Beatriz

2015-01-01

Background Routinely collected data in hospitals is complex, typically heterogeneous, and scattered across multiple Hospital Information Systems (HIS). This big data, created as a byproduct of health care activities, has the potential to provide a better understanding of diseases, unearth hidden patterns, and improve services and cost. The extent and uses of such data rely on its quality, which is not consistently checked, nor fully understood. Nevertheless, using routine data for the construction of data-driven clinical pathways, describing processes and trends, is a key topic receiving increasing attention in the literature. Traditional algorithms do not cope well with unstructured processes or data, and do not produce clinically meaningful visualizations. Supporting systems that provide additional information, context, and quality assurance inspection are needed. Objective The objective of the study is to explore how routine hospital data can be used to develop data-driven pathways that describe the journeys that patients take through care, and their potential uses in biomedical research; it proposes a framework for the construction, quality assessment, and visualization of patient pathways for clinical studies and decision support using a case study on prostate cancer. Methods Data pertaining to prostate cancer patients were extracted from a large UK hospital from eight different HIS, validated, and complemented with information from the local cancer registry. Data-driven pathways were built for each of the 1904 patients and an expert knowledge base, containing rules on the prostate cancer biomarker, was used to assess the completeness and utility of the pathways for a specific clinical study. Software components were built to provide meaningful visualizations for the constructed pathways. Results The proposed framework and pathway formalism enable the summarization, visualization, and querying of complex patient-centric clinical information, as well as the computation of quality indicators and dimensions. A novel graphical representation of the pathways allows the synthesis of such information. Conclusions Clinical pathways built from routinely collected hospital data can unearth information about patients and diseases that may otherwise be unavailable or overlooked in hospitals. Data-driven clinical pathways allow for heterogeneous data (ie, semistructured and unstructured data) to be collated over a unified data model and for data quality dimensions to be assessed. This work has enabled further research on prostate cancer and its biomarkers, and on the development and application of methods to mine, compare, analyze, and visualize pathways constructed from routine data. This is an important development for the reuse of big data in hospitals. PMID:26162314

Telemedicine in a pediatric headache clinic: A prospective survey.

PubMed

Qubty, William; Patniyot, Irene; Gelfand, Amy

2018-05-08

The aim of this prospective study was to survey our patients about their experience with our clinic's telemedicine program to better understand telemedicine's utility for families, and to improve patient satisfaction and ultimately patient care. This was a prospective survey study of patients and their families who had a routine telemedicine follow-up visit with the University of California San Francisco Pediatric Headache Program. The survey was administered to patients and a parent(s) following their telemedicine visit. Fifty-one of 69 surveys (74%) were completed. All (51/51) patients and families thought that (1) telemedicine was more convenient compared to a clinic visit, (2) telemedicine caused less disruption of their daily routine, and (3) they would choose to do telemedicine again. The mean round-trip travel time from home to clinic was 6.8 hours (SD ± 8.6 hours). All participants thought telemedicine was more cost-effective than a clinic visit. Parents estimated that participating in a telemedicine visit instead of a clinic appointment saved them on average $486. This prospective, pediatric headache telemedicine study shows that telemedicine is convenient, perceived to be cost-effective, and patient-centered. Providing the option of telemedicine for routine pediatric headache follow-up visits results in high patient and family satisfaction. © 2018 American Academy of Neurology.

Clinical and physiological assessments for elucidating falls risk in Parkinson's disease.

PubMed

Latt, Mark D; Lord, Stephen R; Morris, John G L; Fung, Victor S C

2009-07-15

The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 +/- 95% CI 1.6 years) underwent clinical assessments and quantitative tests of sway, gait, strength, reaction time, and lower limb sensation. Participants were then followed up for 12 months to determine fall incidence. In the follow-up year, 51 participants (45%) fell one or more times whereas 62 participants (55%) did not fall. Multivariate analyses of routine clinical measures revealed that a fall in the past year, abnormal axial posture, cognitive impairment, and freezing of gait were independent risk factors for falls and predicted 38/51 fallers (75%) and 45/62 non-fallers (73%). A multivariate model combining clinical and physiological measures that elucidate the pathophysiology of falls identified abnormal posture, freezing of gait, frontal impairment, poor leaning balance, and leg weakness as independent risk factors. This model correctly classified 39/51 fallers (77%) and 51/62 non-fallers (82%). Patients with PD at risk of falls can be identified accurately with routine clinical assessments and quantitative physiological tests. Many of the risk factors identified are amenable to targeted intervention. 2009 Movement Disorder Society.

Clinical applications of MS-based protein quantification.

PubMed

Sabbagh, Bassel; Mindt, Sonani; Neumaier, Michael; Findeisen, Peter

2016-04-01

Mass spectrometry-based assays are increasingly important in clinical laboratory medicine and nowadays are already commonly used in several areas of routine diagnostics. These include therapeutic drug monitoring, toxicology, endocrinology, pediatrics, and microbiology. Accordingly, some of the most common analyses are therapeutic drug monitoring of immunosuppressants, vitamin D, steroids, newborn screening, and bacterial identification. However, MS-based quantification of peptides and proteins for routine diagnostic use is rather rare up to now despite excellent analytical specificity and good sensitivity. Here, we want to give an overview over current fit-for-purpose assays for MS-based protein quantification. Advantages as well as challenges of this approach will be discussed with focus on feasibility for routine diagnostic use. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

[Classification of results of studying blood plasma with laser correlation spectroscopy based on semiotics of preclinical and clinical states].

PubMed

Ternovoĭ, K S; Kryzhanovskiĭ, G N; Musiĭchuk, Iu I; Noskin, L A; Klopov, N V; Noskin, V A; Starodub, N F

1998-01-01

The usage of laser correlation spectroscopy for verification of preclinical and clinical states is substantiated. Developed "semiotic" classifier for solving the problems of preclinical and clinical states is presented. The substantiation of biological algorithms as well as the mathematical support and software for the proposed classifier for the data of laser correlation spectroscopy of blood plasma are presented.

Urgent access to a specialty care melanoma clinic is associated with a higher rate of melanoma detection.

PubMed

Lipworth, Adam D; Park, Jong Min; Trefrey, Brie L; Rubin, Krista M; Geller, Alan C; Sober, Arthur J; Tsao, Hensin

2011-06-01

As melanoma rates increase, and the supply of dermatologists remains suboptimal to meet demand for services, detection of early melanoma has become an increasingly difficult challenge. Some authors advocate for shifting dermatologic resources from routine appointments to urgent visits for those with lesions concerning for melanoma. We sought to investigate the potential of an urgent access track (UAT) embedded within a pigmented lesion clinic to improve early melanoma detection. We conducted a retrospective review of patient records from a tertiary care hospital's pigmented lesion clinic and the associated UAT. Results of procedures for all 4495 patient visits to the routine track and all 316 visits to the UAT during the 21-month study period were included, as were detailed chart reviews of all UAT patient visits. UAT visits were more than 4 times as likely (4.1% vs 1.0%) to yield a diagnosis of melanoma as routine track visits (odds ratio 4.24; 95% confidence interval 2.28-7.88; P < .0001), and almost 25 times as likely (2.2% vs 0.1%) to yield a diagnosis of metastatic melanoma (odds ratio 25.4; 95% confidence interval 7.4-87.4; P < .0001). This was a preliminary analysis with only limited data extracted from the routine track pigmented lesion clinic patient visits. This initial analysis of UAT strategy suggests that UATs have potential to detect patients with earlier melanomas; further research is needed to specifically delineate how resources should be best allocated between routine surveillance and urgent care to maximize melanoma early detection and survival. Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Stakeholders' views on the routine use of n-of-1 trials to improve clinical care and to make resource allocation decisions for drug use.

PubMed

Nikles, Jane; Mitchell, Geoffrey K; Clavarino, Alexandra; Yelland, Michael J; Del Mar, Christopher B

2010-03-01

N-of-1 trials are empirical formal tests using a within-patient randomised, double-blind, cross-over comparison of drug and placebo (or another drug), which we adapted to study individual patients' responses as a clinical tool to guide clinical management. We administered semi-structured interviews to gauge stakeholder perspectives on the possibility of using routine n-of-1 trials for this purpose. Stakeholders included government and non-government health care sector, and patient, clinician and consumer, organisations. Stakeholders supported more widespread implementation of n-of-1 trials, in a targeted fashion, with some caveats. Barriers to their widespread implementation included constraints on doctors' time, doctors' acceptance, drug company acceptance, patient willingness, and cost. Strategies for overcoming barriers included conditional Pharmaceutical Benefits Scheme listing if cost-effective. There was little consensus on which model of n-of-1 trial implementation would be most effective. We discuss different approaches to addressing the several concerns raised to enable widespread introduction of n-of-1 trials into routine clinical practice as a decision tool.

Utility of routine versus selective upper gastrointestinal series to detect anastomotic leaks after laparoscopic gastric bypass.

PubMed

Schiesser, Marc; Guber, Josef; Wildi, Stefan; Guber, Ivo; Weber, Markus; Muller, Markus K

2011-08-01

In up to 4% of laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures, anastomotic leaks occur. Early detection of gastrointestinal leakage is important for successful treatment. Consequently, many centers advocate routine postoperative upper gastrointestinal (UGI) series. The aim of this study was to determine the utility of this practice after LRYGB. Eight hundred four consecutive patients undergoing LRYGB from June 2000 to April 2010 were analyzed prospectively. The first 382 patients received routine UGI series between the third and fifth postoperative days (group A). Thereafter, the test was only performed when clinical findings (tachycardia, fever, and drainage content) were suspicious for a leak of the gastrointestinal anastomosis (group B; n = 422). Overall, nine of 804 (1.1%) patients suffered from leaks at the gastroenterostomy. In group A, four of 382 (1%) patients had a leak, but only two were detected by the routine UGI series. This corresponds to a sensitivity of 50%. In group B, the sensitivity was higher with 80%. Specificities were comparable with 97% and 91%, respectively. Routine UGI series cost only 1.6% of the overall costs of a non-complicated gastric bypass procedure. With this leak rate and sensitivity, US $86,800 would have to be spent on 200 routine UGI series to find one leak which is not justified. This study shows that routine UGI series have a low sensitivity for the detection of anastomotic leaks after LRYGB. In most cases, the diagnosis is initiated by clinical findings. Therefore, routine upper gastrointestinal series are of limited value for the diagnosis of a leak.

Central implementation strategies outperform local ones in improving HIV testing in Veterans Healthcare Administration facilities.

PubMed

Goetz, Matthew Bidwell; Hoang, Tuyen; Knapp, Herschel; Burgess, Jane; Fletcher, Michael D; Gifford, Allen L; Asch, Steven M

2013-10-01

Pilot data suggest that a multifaceted approach may increase HIV testing rates, but the scalability of this approach and the level of support needed for successful implementation remain unknown. To evaluate the effectiveness of a scaled-up multi-component intervention in increasing the rate of risk-based and routine HIV diagnostic testing in primary care clinics and the impact of differing levels of program support. Three arm, quasi-experimental implementation research study. Veterans Health Administration (VHA) facilities. Persons receiving primary care between June 2009 and September 2011 INTERVENTION: A multimodal program, including a real-time electronic clinical reminder to facilitate HIV testing, provider feedback reports and provider education, was implemented in Central and Local Arm Sites; sites in the Central Arm also received ongoing programmatic support. Control Arm sites had no intervention Frequency of performing HIV testing during the 6 months before and after implementation of a risk-based clinical reminder (phase I) or routine clinical reminder (phase II). The adjusted rate of risk-based testing increased by 0.4 %, 5.6 % and 10.1 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). During phase II, the adjusted rate of routine testing increased by 1.1 %, 6.3 % and 9.2 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). At study end, 70-80 % of patients had been offered an HIV test. Use of clinical reminders, provider feedback, education and social marketing significantly increased the frequency at which HIV testing is offered and performed in VHA facilities. These findings support a multimodal approach toward achieving the goal of having every American know their HIV status as a matter of routine clinical practice.

Previously unknown species of Aspergillus.

PubMed

Gautier, M; Normand, A-C; Ranque, S

2016-08-01

The use of multi-locus DNA sequence analysis has led to the description of previously unknown 'cryptic' Aspergillus species, whereas classical morphology-based identification of Aspergillus remains limited to the section or species-complex level. The current literature highlights two main features concerning these 'cryptic' Aspergillus species. First, the prevalence of such species in clinical samples is relatively high compared with emergent filamentous fungal taxa such as Mucorales, Scedosporium or Fusarium. Second, it is clearly important to identify these species in the clinical laboratory because of the high frequency of antifungal drug-resistant isolates of such Aspergillus species. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) has recently been shown to enable the identification of filamentous fungi with an accuracy similar to that of DNA sequence-based methods. As MALDI-TOF MS is well suited to the routine clinical laboratory workflow, it facilitates the identification of these 'cryptic' Aspergillus species at the routine mycology bench. The rapid establishment of enhanced filamentous fungi identification facilities will lead to a better understanding of the epidemiology and clinical importance of these emerging Aspergillus species. Based on routine MALDI-TOF MS-based identification results, we provide original insights into the key interpretation issues of a positive Aspergillus culture from a clinical sample. Which ubiquitous species that are frequently isolated from air samples are rarely involved in human invasive disease? Can both the species and the type of biological sample indicate Aspergillus carriage, colonization or infection in a patient? Highly accurate routine filamentous fungi identification is central to enhance the understanding of these previously unknown Aspergillus species, with a vital impact on further improved patient care. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

A review of the patterns of docetaxel use for hormone-resistant prostate cancer at the Princess Margaret Hospital.

PubMed

Chin, S N; Wang, L; Moore, M; Sridhar, S S

2010-04-01

Based on the TAX 327 phase III trial, docetaxel-based chemotherapy is the standard first-line treatment for hormone-resistant prostate cancer (HRPC); however, there is some heterogeneity in the use of this agent in routine clinical practice. The aim of the present study was to examine the patterns of docetaxel use in routine clinical practice at our institution and to compare them with docetaxel use in the TAX 327 clinical trial. We conducted a retrospective chart review of HRPC patients treated with first-line docetaxel between 2005 and 2007 at the Princess Margaret Hospital. In the first-line setting, 88 patients with HRPC received docetaxel. The main reasons for initiating docetaxel were rising prostate-specific antigen (PSA, 98%) and progressive symptoms (77%). The PSA response rate was 67%; median time to response was 1.5 months, and duration of response was 6.8 months. Median survival was 15.9 months (95% confidence interval: 12.4 to 20.5 months). Patients received a median of 7 cycles of treatment, and the main toxicities were fatigue (35%) and neuropathy (24%). Post docetaxel, 36 patients received second-line treatment with a 22% response rate. In routine clinical practice, HRPC patients received docetaxel mainly because of symptomatic disease progression. Overall response rates and toxicities were comparable to those in the TAX 327 trial. However, our patients received a median of only 7 cycles of treatment versus the 9.5 administered on trial, and survival was slightly shorter in our single-institution study. A larger prospective multicentre analysis, including performance status and quality-of-life parameters, may be warranted to determine if docetaxel performs as well in routine clinical practice as it does in the clinical trial setting.

What is the yield of routine chest radiography following tube thoracostomy for trauma?

PubMed

Kong, Victor Y; Oosthuizen, George V; Clarke, Damian L

2015-01-01

Routine chest radiography (CXR) following tube thoracostomy (TT) is a standard practice in most trauma centres worldwide. Evidence supporting this routine practice is lacking and the actual yield is unknown. We performed a retrospective review of 1042 patients over a 4-year period who had a routine post-insertion CXR performed in accordance with current ATLS® recommendations. A total 1042 TTs were performed on 1004 patients. Ninety-one per cent of patients (913/1004) were males, and the median age for all patients was 24 years. Seventy-five per cent of all injuries (756/1004) were from penetrating trauma, and the remaining 25% (248/1004) were from blunt. The initial pathologies requiring TT were: haemopneumothorax: 34% (339/1042), haemothroax: 31% (314/1042), simple pneumothorax: 25% (256/1042), tension pneumothorax: 8% (77/1042) and open pneumothorax: 5% (54/1042). One hundred and three patients had TTs performed on clinical grounds alone without a pre-insertion CXR [Group A]. One hundred and ninety-one patients had a pre-insertion CXR but had persistent clinical concerns following insertion [Group B]. Seven hundred and ten patients had pre-insertion CXR but no clinical concerns following insertion [Group C]. Overall, 15% (152/1004) [9 from Group A, 111 from Group B and 32 from Group C] of all patients had their clinical management influenced as a direct result of the post-insertion CXR. Despite the widely accepted practice of routine CXR following tube thoracostomy, the yield is relatively low. In many cases, good clinical examination post tube insertion will provide warnings as to whether problems are likely to result. However, in the more rural setting, and in resource challenged environments, there is a relatively high yield from the CXR, which alters management. Further prospective studies are needed to establish or refute the role of the existing ATLS® guidelines in these specific environments. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Biodegradable synthetic implant materials : clinical applications and immunological aspects].

PubMed

Witte, F; Calliess, T; Windhagen, H

2008-02-01

In the last decade biodegradable synthetic implant materials have been established for various clinical applications. Ceramic materials such as calcium phosphate, bioglass and polymers are now routinely used as degradable implants in the clinical practice. Additionally these materials are now also used as coating materials or as microspheres for controlled drug release and belong to a series of examples for applications as scaffolds for tissue engineering. Because immense local concentrations of degradation products are produced during biodegradation, this review deals with the question whether allergic immune reactions, which have been reported for classical metallic and organic implant materials, also play a role in the clinical routine for synthetic biodegradable materials. Furthermore, possible explanatory theories will be developed to clarify the lack of clinical reports on allergy or sensitization to biodegradable synthetic materials.

Effectiveness and cost of atypical versus typical antipsychotic treatment for schizophrenia in routine care.

PubMed

Stargardt, Tom; Weinbrenner, Susanne; Busse, Reinhard; Juckel, Georg; Gericke, Christian A

2008-06-01

In two recent randomised clinical trials, a meta-analysis and in an effectiveness study analysing routine data from the U.S. Veterans Administration the superiority of the newer atypical drugs over typical antipsychotic drugs, concerning both their efficacy and their side-effect profile, has been questioned. To analyse the effectiveness and cost of atypical versus typical antipsychotic treatment for schizophrenia in routine care. Cohort study using routine care data from a statutory sickness fund with 5.4 million insured in Germany. To be included, patients had to be discharged with a diagnosis of schizophrenia in 2003 and fulfil membership criteria. Main outcome measures were rehospitalisation rates, mean hospital bed days, mean length of stay, cost of inpatient and pharmaceutical care to the sickness fund during follow-up and medication used to treat side-effects. 3121 patients were included into the study. There were no statistically significant differences in the effectiveness of atypical and typical antipsychotics on rehospitalisation during follow-up (rehospitalisation rate ratio 1.07, 95% confidence interval 0.86 to 1.33). However, there were consistent observations of atypical antipsychotics being more effective for severe cases of schizophrenia (14.6% of study population; >61 prior bed days per year in 2000-2002) in the follow-up period, whereas for the other severity strata typical antipsychotics seemed more effective in reducing various rehospitalisation outcomes. Patients treated with atypical antipsychotics received significantly less prescriptions for anticholinergics or tiaprid (relative risk 0.26, 95% confidence interval 0.18 to 0.38). The effectiveness of atypical antipsychotics for schizophrenia on rehospitalisation measures appeared similar to that of typical antipsychotics. With the exception of severe cases, the higher costs for atypical antipsychotics were not offset by savings from reduced inpatient care. Major limitations include the lack of statistical power for subgroup analyses, the lack of clinical severity scale data and of life-course medical history data which both increase the risk of residual confounding by disease severity. This study provides evidence that the effectiveness of atypical and typical antipsychotics measured in terms of hospital readmissions appears to be similar in routine care. From a clinical perspective, this study provides evidence that the effectiveness of atypical and typical antipsychotics measured in terms of hospital readmissions appears to be similar in routine care. Routine data studies can yield valuable information for policy decision-makers on the costs and the effectiveness of pharmaceuticals in routine care, complementing efficacy data from randomised clinical trials currently used for licensing and reimbursement decisions. The non-significant differences in the effectiveness of atypical compared to typical antipsychotics according to severity of disease should be investigated in a prospective observational study or in a randomised clinical trial.

Effect of Routine Surveillance Imaging on the Outcomes of Patients With Classical Hodgkin Lymphoma After Autologous Hematopoietic Cell Transplantation.

PubMed

Kapke, Jonathan T; Epperla, Narendranath; Shah, Namrata; Richardson, Kristin; Carrum, George; Hari, Parameswaran N; Pingali, Sai R; Hamadani, Mehdi; Karmali, Reem; Fenske, Timothy S

2017-07-01

Patients with relapsed and refractory classical Hodgkin lymphoma (cHL) are often treated with autologous hematopoietic cell transplantation (auto-HCT). After auto-HCT, most transplant centers implement routine surveillance imaging to monitor for disease relapse; however, there is limited evidence to support this practice. In this multicenter, retrospective study, we identified cHL patients (n = 128) who received auto-HCT, achieved complete remission (CR) after transplantation, and then were followed with routine surveillance imaging. Of these, 29 (23%) relapsed after day 100 after auto-HCT. Relapse was detected clinically in 14 patients and with routine surveillance imaging in 15 patients. When clinically detected relapse was compared with to radiographically detected relapse respectively, the median overall survival (2084 days [range, 225-4161] vs. 2737 days [range, 172-2750]; P = .51), the median time to relapse (247 days [range, 141-3974] vs. 814 days [range, 96-1682]; P = .30) and the median postrelapse survival (674 days [range, 13-1883] vs. 1146 days [range, 4-2548]; P = .52) were not statistically different. In patients who never relapsed after auto-HCT, a median of 4 (range, 1-25) surveillance imaging studies were performed over a median follow-up period of 3.5 years. A minority of patients with cHL who achieve CR after auto-HCT will ultimately relapse. Surveillance imaging detected approximately half of relapses; however, outcomes were similar for those whose relapse was detected using routine surveillance imaging versus detected clinically in between surveillance imaging studies. There appears to be limited utility for routine surveillance imaging in cHL patients who achieve CR after auto-HCT. Copyright © 2017 Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nalu is a Sierra ToolKit (STK) based application module, and it has provided a set of "lessons learned" for the STK transition effort through its early adoption of STK. It makes use of the open-sourced Trilinos/ Tpetra library. Through the investment of LORD and ASCR projects, the Nalu code module has been extended beyond prototype status. Physics capability includes low Mach, variable density turbulent flow. The ongoing objective for Nalu is to facilitate partnerships with external organizations in order to extend code capability and knowledge; however, it is not intended to support routine CFD analysis. The targeted usage of thismore » module is for non-NW applications that support work-for-others in the multiphysics energy sector.« less

The pEst version 2.1 user's manual

NASA Technical Reports Server (NTRS)

Murray, James E.; Maine, Richard E.

1987-01-01

This report is a user's manual for version 2.1 of pEst, a FORTRAN 77 computer program for interactive parameter estimation in nonlinear dynamic systems. The pEst program allows the user complete generality in definig the nonlinear equations of motion used in the analysis. The equations of motion are specified by a set of FORTRAN subroutines; a set of routines for a general aircraft model is supplied with the program and is described in the report. The report also briefly discusses the scope of the parameter estimation problem the program addresses. The report gives detailed explanations of the purpose and usage of all available program commands and a description of the computational algorithms used in the program.

Stress assessment in small ruminants kept on city farms in southern Germany.

PubMed

Schilling, Anna-Katarina; Reese, Sven; Palme, Rupert; Erhard, Michael; Wöhr, Anna-Caroline

2015-01-01

Sheep and goats are frequently used in nonhuman animal-assisted activities on city farms. There are few data available on this type of usage of small ruminants. Health evaluations, behavioral observations (feeding, resting, comfort, explorative and social behaviors), behavioral tests (human approach tests and touch test), and measurements of fecal cortisol metabolites and heart rate were performed to assess stress levels in 25 sheep and 32 goats on 7 city farms and 2 activity playgrounds in Germany. No evidence was found that the animals suffered from major distress. Health evaluations, behavioral observations, and behavioral tests proved to be the methods of stress assessment most suitable for routine on-farm checks in these settings.

Mathematical defense method of networked servers with controlled remote backups

NASA Astrophysics Data System (ADS)

Kim, Song-Kyoo

2006-05-01

The networked server defense model is focused on reliability and availability in security respects. The (remote) backup servers are hooked up by VPN (Virtual Private Network) with high-speed optical network and replace broken main severs immediately. The networked server can be represent as "machines" and then the system deals with main unreliable, spare, and auxiliary spare machine. During vacation periods, when the system performs a mandatory routine maintenance, auxiliary machines are being used for back-ups; the information on the system is naturally delayed. Analog of the N-policy to restrict the usage of auxiliary machines to some reasonable quantity. The results are demonstrated in the network architecture by using the stochastic optimization techniques.

A clinical economics workstation for risk-adjusted health care cost management.

PubMed Central

Eisenstein, E. L.; Hales, J. W.

1995-01-01

This paper describes a healthcare cost accounting system which is under development at Duke University Medical Center. Our approach differs from current practice in that this system will dynamically adjust its resource usage estimates to compensate for variations in patient risk levels. This adjustment is made possible by introducing a new cost accounting concept, Risk-Adjusted Quantity (RQ). RQ divides case-level resource usage variances into their risk-based component (resource consumption differences attributable to differences in patient risk levels) and their non-risk-based component (resource consumption differences which cannot be attributed to differences in patient risk levels). Because patient risk level is a factor in estimating resource usage, this system is able to simultaneously address the financial and quality dimensions of case cost management. In effect, cost-effectiveness analysis is incorporated into health care cost management. PMID:8563361

A mixed methods approach to adapting health-related quality of life measures for use in routine oncology clinical practice.

PubMed

Harley, Clare; Takeuchi, Elena; Taylor, Sally; Keding, Ada; Absolom, Kate; Brown, Julia; Velikova, Galina

2012-04-01

The current study reviewed and adapted existing health-related quality of life (HRQoL) instruments for use in routine clinical practice delivering outpatient chemotherapy for colorectal, breast and gynaecological cancers. 564 (288 gynaecological, 208 breast and 68 colorectal) outpatient consultations of 141 patients were audio-recorded and analysed to identify discussed issues. Issues were ranked from most to least commonly discussed within each disease group. Existing HRQoL instruments were evaluated against these lists and best fitting items entered into cancer-specific item banks. Item banks were evaluated during semi-structured interviews by twenty-one oncologists (13 consultants and 8 specialist registrars), four clinical nurse specialists and thirty patients, from breast, gynaecological and colorectal cancer practices. Pilot questionnaires were completed by 448 (145 breast, 148 gynaecological and 155 colorectal) patients attending outpatient clinics. Item selection and scale reliability was explored using descriptive data and psychometric methods alongside qualitative patient and clinician ratings. Each questionnaire includes five physical and three psychosocial function scales each with good internal consistency reliability (α > 0.70) plus disease-specific individual-symptom items identified as useful in clinical practice. Three cancer-specific health-related quality of life measures were developed for use in routine clinical practice. Initial analyses suggest good clinical utility and acceptable psychometric properties for the new instruments.

Urinary Tract Infection in Children: Management in the Era of Antibiotic Resistance-A Pediatric Urologist's View.

PubMed

Kutasy, Balazs; Coyle, David; Fossum, Magdalena

2017-04-01

Antibiotic resistance to uropathogens has grown significantly worldwide. Today, pediatric urologist experience a situation that needs appropriate action because urinary tract infections are one of the most common bacterial infections in children. In this overview we aimed at presenting the clinical aspects of antibiotic usage in pediatric urology. Our intention was to take part of the important debate regarding future management of bacterial resistance against antibiotics. We searched PubMed for the terms: [UTI in children], [Recurrent UTI in children], and [Antibiotic resistance in UTI]. When using these terms, we found a numerous amount (3875) of published clinical articles related to the topic. By means of an overview, we chose not to focus on a specific condition but to an overall understanding of the problems related to pediatric urology in general. We found that usage of antibiotics has had an unquestionable benefit to reduce the morbidity and mortality related to urinary tract infections in childhood. However, recent studies suggest that early exposure to antibiotics in childhood might have negative systemic effects related to neurocognitive function, body metabolism, and fat distribution. In addition to increased resistance to common antimicrobial agents, it has resulted in increased costs and inadequate effect in severe infections. This calls for changes in the clinical management of urinary pathogens in pediatric urology. As the prevalence of antibiotic resistance grows, pediatric urologists have a key role in managing its consequences and its prevention. In this overview we looked at the consequences of antibiotic usage treating urinary tract infections in childhood. We found that the prevalence of antibiotic resistance has grown. We concluded that decision-makers must know about the short- and long-term effects of antibiotic usage in children. When we understand the development of antibiotic resistance better, we can build up prevention strategies. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Experience of domestic violence routine screening in Family Planning NSW clinics.

PubMed

Hunter, Tara; Botfield, Jessica R; Estoesta, Jane; Markham, Pippa; Robertson, Sarah; McGeechan, Kevin

2017-04-01

This study reviewed implementation of the Domestic Violence Routine Screening (DVRS) program at Family Planning NSW and outcomes of screening to determine the feasibility of routine screening in a family planning setting and the suitability of this program in the context of women's reproductive and sexual health. A retrospective review of medical records was undertaken of eligible women attending Family Planning NSW clinics between 1 January and 31 December 2015. Modified Poisson regression was used to estimate prevalence ratios and assess association between binary outcomes and client characteristics. Of 13440 eligible women, 5491 were screened (41%). Number of visits, clinic attended, age, employment status and disability were associated with completion of screening. In all, 220 women (4.0%) disclosed domestic violence. Factors associated with disclosure were clinic attended, age group, region of birth, employment status, education and disability. Women who disclosed domestic violence were more likely to have discussed issues related to sexually transmissible infections in their consultation. All women who disclosed were assessed for any safety concerns and offered a range of suitable referral options. Although routine screening may not be appropriate in all health settings, given associations between domestic violence and sexual and reproductive health, a DVRS program is considered appropriate in sexual and reproductive health clinics and appears to be feasible in a service such as Family Planning NSW. Consistent implementation of the program should continue at Family Planning NSW and be expanded to other family planning services in Australia to support identification and early intervention for women affected by domestic violence.

Aging & Community Health: A University-Community Partnership Project

ERIC Educational Resources Information Center

Robinson-Dooley, Vanessa; Dumont, Kelly; Riapos, Jennifer A.

2018-01-01

The purpose of this paper is to discuss how university-community partnerships can be utilized to provide affordable and accessible health care for the elderly at community health clinics. A review of community health clinics, usage data from 2013 to 2014 by a sample of aging individuals will be described along with faculty perspectives about the…

VARK Learning Preferences and Mobile Anatomy Software Application Use in Pre-Clinical Chiropractic Students

ERIC Educational Resources Information Center

Meyer, Amanda J.; Stomski, Norman J.; Innes, Stanley I.; Armson, Anthony J.

2016-01-01

Ubiquitous smartphone ownership and reduced face-to-face teaching time may lead to students making greater use of mobile technologies in their learning. This is the first study to report on the prevalence of mobile gross anatomy software applications (apps) usage in pre-clinical chiropractic students and to ascertain if a relationship exists…

Measuring use of electronic health record functionality using system audit information.

PubMed

Bowes, Watson A

2010-01-01

Meaningful and efficient methods for measuring Electronic Health Record (EHR) adoption and functional usage patterns have recently become important for hospitals, clinics, and health care networks in the United State due to recent government initiatives to increase EHR use. To date, surveys have been the method of choice to measure EHR adoption. This paper describes another method for measuring EHR adoption which capitalizes on audit logs, which are often common components of modern EHRs. An Audit Data Mart is described which identified EHR functionality within 836 Departments, within 22 Hospitals and 170 clinics at Intermountain Healthcare, a large integrated delivery system. The Audit Data Mart successfully identified important and differing EHR functional usage patterns. These patterns were useful in strategic planning, tracking EHR implementations, and will likely be utilized to assist in documentation of "Meaningful Use" of EHR functionality.

Telemedicine Interest for Routine Follow-Up Care Among Neurology Patients in Arkansas.

PubMed

Bashiri, Maryam; Greenfield, L John; Oliveto, Alison

2016-06-01

Teleneurology in Arkansas has been used primarily for management of acute stroke with a state-funded hub-and-spoke model allowing physicians at rural hospitals to access vascular neurologists in time to facilitate tissue plasminogen activator administration. Routine neurologic care has been provided only in small pilot studies. We wished to determine patient interest in participating in teleneurology for routine follow-up visits as well as demographic and medical factors associated with interest. New and established patients of the Neurology Outpatient Clinic at the University of Arkansas for Medical Sciences (UAMS) were surveyed between March 2011 and December 2012 to assess their interest in participating in teleneurology as well as potential factors associated with their interest. Of 1,441 respondents, 52.4% were interested in telemedicine. Of those interested versus uninterested in telemedicine, respectively, 68.9% versus 36.32% traveled more than 1 h to the clinic, 64.7% versus 35.3% had difficulty secondary to neurological conditions, 22.6% versus 6.8% had missed medical appointments due to travel problems, and 43.1% versus 9.4% had travel-imposed financial hardship. Telemedicine interest for routine follow-up visits was strong among patients at the UAMS Neurology Outpatient Clinic. Factors positively associated with interest included long travel distances, travel expenses, and transportation difficulties. These results suggest that implementing a telemedicine program for follow-up visits would be acceptable to neurology patients for routine ongoing care.

Piggyback technique in adult orthotopic liver transplantation: an analysis of 1067 liver transplants at a single center

PubMed Central

Nakamura, Noboru; Vaidya, Anil; Levi, David M.; Kato, Tomoaki; Nery, Jose R.; Madariaga, Juan R.; Molina, Enrique; Ruiz, Phillip; Gyamfi, Anthony; Tzakis, Andreas G.

2006-01-01

Background. Orthotopic liver transplantation (OLT) in adult patients has traditionally been performed using conventional caval reconstruction technique (CV) with veno-venous bypass. Recently, the piggyback technique (PB) without veno-venous bypass has begun to be widely used. The aim of this study was to assess the effect of routine use of PB on OLTs in adult patients. Patients and methods. A retrospective analysis was undertaken of 1067 orthotopic cadaveric whole liver transplantations in adult patients treated between June 1994 and July 2001. PB was used as the routine procedure. Patient demographics, factors including cold ischemia time (CIT), warm ischemia time (WIT), operative time, transfusions, blood loss, and postoperative results were assessed. The effects of clinical factors on graft survival were assessed by univariate and multivariate analyses.In all, 918 transplantations (86%) were performed with PB. Blood transfusion, WIT, and usage of veno-venous bypass were less with PB. Seventy-five (8.3%) cases with PB had refractory ascites following OLT (p=NS). Five venous outflow stenosis cases (0.54%) with PB were noted (p=NS). The liver and renal function during the postoperative periods was similar. Overall 1-, 3-, and 5-year patient survival rates were 85%, 78%, and 72% with PB. Univariate analysis showed that cava reconstruction method, CIT, WIT, amount of transfusion, length of hospital stay, donor age, and tumor presence were significant factors influencing graft survival. Multivariate analysis further reinforced the fact that CIT, donor age, amount of transfusion, and hospital stay were prognostic factors for graft survival. Conclusions. PB can be performed safely in the majority of adult OLTs. Results of OLT with PB are as same as for CV. Liver function, renal function, morbidity, mortality, and patient and graft survival are similar to CV. However, amount of transfusion, WIT, and use of veno-venous bypass are less with PB. PMID:18333273

[Onyx embolization for treatment of dural arteriovenous fistula: comparison of long- distance versus routine injection method].

PubMed

He, Xiao-Yan; Zhang, Guo-Zhong; Li, Ming-Zhou; Wang, Gang; Liu, Dan; Qi, Song-Tao; Li, Wei-Guang; Feng, Wen-Feng

2016-03-01

To compare the efficacy, clinical characteristics, safety, injection time and radiation exposure of Onyx embolization using a long-distance injection method and routine injection method for management of dural arteriovenous fistula (DAVF). The clinical data were retrospectively analyzed in 59 patients with DAVF treated with Onyx embolization using long-distance injection method (28 patients) and routine injection method (31 patients). The efficacy, safety, injection time and radiation exposure during Onyx embolization were compared between the two injections methods. The average radiation dose exposure to the surgeon per procedure was significantly lower in the long-distance injection group than in the routine group. The injection time (P=0.53), injection volume (P=0.78), number of supply arteries (P=0.80), Cognard types (P=0.67), and effect of embolization (P=0.88) were all similar between the two groups. Endovaseular treatment of intracranial DAVF with Onyx embolization using the long-distance injection method is feasible, safe and effective and can reduce the radiation exposure to the surgeon.

Incidence of repeat testing and diagnoses of Chlamydia trachomatis and Neisseria gonorrhoea in swingers, homosexual and heterosexual men and women at two large Dutch STI clinics, 2006-2013.

PubMed

Dukers-Muijrers, Nicole H T M; van Rooijen, Martijn S; Hogewoning, Arjan; van Liere, Genevieve A F S; Steenbakkers, Mieke; Hoebe, Christian J P A

2017-09-01

Swingers, that is, heterosexuals who as a couple have sex with others, including group sex and bisexual behaviour, are an older-aged risk group for STIs. Here, we report on their repeat testing (reattendance) and STI yield compared with other heterosexuals and men who have sex with men (MSM, homosexual men) at two Dutch STI clinics. Swingers are routinely (since 2006, South Limburg, registration-completeness: 99%) or partially (since 2010, Amsterdam, registration-completeness: 20%) included in the clinic patient registries. Data (retrospective cohort) are analysed to assess incidence (per 100 person-years (PY)) of reattendance and STI ( Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG)) and associated factors calculating HRs. In South Limburg 7714 and in Amsterdam 2070 swinger consultations were identified. Since 2010, swingers' incidence of reattendance was 48-57/100 PY. Incidence was lower in MSM (30-39/100 PY, HR 0.56; 95% CI 0.51 to 0.61, South Limburg; HR 0.88; 95% CI 0.80 to 0.96, Amsterdam), heterosexual men (8-14/100 PY, HR 0.16; 95% CI 0.15 to 0.17, South Limburg; HR 0.33; 95% CI 0.30 to 0.36, Amsterdam) and women (13-20/100 PY, HR 0.56; 95% CI 0.51 to 0.61, South Limburg; HR 0.46; 95% CI 0.42 to 0.51, Amsterdam). Swingers' STI incidence at reattendance was 11-12/100 PY. Incidence was similar in heterosexual men (14-15/100 PY; HR 1.19; 95% CI 0.90 to 1.57, South Limburg; HR 1.20; 95% CI 0.91 to 1.59, Amsterdam) and women (12-14/100 PY; HR 1.14; 95% CI 0.88 to 1.49, South Limburg; HR 0.98; 95% CI 0.74 to 1.29, Amsterdam) and higher in MSM (18-22/100 PY; HR 1.59; 95% CI 1.19 to 2.12, South Limburg; HR 1.80; 95% CI 1.36 to 2.37, Amsterdam). Risk factors for STI incidence were partner-notified (contact-tracing), symptoms and previous STI. Swingers' positivity at any clinic attendance was 3-4% for NG (ie, higher than other heterosexuals) and 6-8% for CT (ie, lower than heterosexuals overall but higher than older heterosexuals). Systematic identification reveals that swingers are part of the normal STI clinic populations. They frequently repeat test yet are likely under-recognised in clinics which not routinely ask about swinging. Given swingers' notable STI rates, usage of services is warranted, although use may be restricted, that is, to those with an STI risk factor (as did Dutch clinics). As swingers have dense sexual networks, enhancing contact-tracing may have high impact. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A Survey on Nickel Titanium Rotary Instruments and their Usage Techniques by Endodontists in India.

PubMed

Patil, Thimmanagowda N; Saraf, Prahlad A; Penukonda, Raghavendra; Vanaki, Sneha S; Kamatagi, Laxmikant

2017-05-01

The preference and usage of nickel titanium rotary instruments varies from individual to individual based on their technique, experience with the rotary systems and the clinical situation. Very limited information is available to explain the adoption of changing concepts with respect to nickel titanium rotary instruments pertaining to the endodontists in India. The aim of this study was to conduct a questionnaire survey to acquire the knowledge concerning different NiTi rotary instruments and their usage techniques by endodontists in India. A Survey questionnaire was designed which consisted of 32 questions regarding designation, demographics, experience with rotary instruments, usage of different file systems, usage techniques, frequency of reuse, occurrence of file fracture, reasons and their management was distributed by hand in the national postgraduate convention and also disseminated via electronic medium to 400 and 600 endodontists respectively. Information was collected from each individual to gain insight into the experiences and beliefs of endodontists concerning the new endodontic technology of rotary NiTi instrumentation based on their clinical experience with the rotary systems. The questions were designed to ascertain the problems, patterns of use and to identify areas of perceived or potential concern regarding the rotary instruments and the data acquired was statistically evaluated using Fisher's-exact test and the Chi-Square test. Overall 63.8% (638) endodontists responded. ProTaper was one of the most commonly used file system followed by M two and ProTaper Next. There was a significant co relation between the years of experience and the file re use frequency, preparation technique, file separation, management of file separation. A large number of Endodontists prefer to reuse the rotary NiTi instruments. As there was an increase in the experience, the incidence of file separation reduced with increasing number of re use frequency and with experience, the management of separated file was better.

A Survey on Nickel Titanium Rotary Instruments and their Usage Techniques by Endodontists in India

PubMed Central

Saraf, Prahlad A; Penukonda, Raghavendra; Vanaki, Sneha S; Kamatagi, Laxmikant

2017-01-01

Introduction The preference and usage of nickel titanium rotary instruments varies from individual to individual based on their technique, experience with the rotary systems and the clinical situation. Very limited information is available to explain the adoption of changing concepts with respect to nickel titanium rotary instruments pertaining to the endodontists in India. Aim The aim of this study was to conduct a questionnaire survey to acquire the knowledge concerning different NiTi rotary instruments and their usage techniques by endodontists in India. Materials and Methods A Survey questionnaire was designed which consisted of 32 questions regarding designation, demographics, experience with rotary instruments, usage of different file systems, usage techniques, frequency of reuse, occurrence of file fracture, reasons and their management was distributed by hand in the national postgraduate convention and also disseminated via electronic medium to 400 and 600 endodontists respectively. Information was collected from each individual to gain insight into the experiences and beliefs of endodontists concerning the new endodontic technology of rotary NiTi instrumentation based on their clinical experience with the rotary systems. The questions were designed to ascertain the problems, patterns of use and to identify areas of perceived or potential concern regarding the rotary instruments and the data acquired was statistically evaluated using Fisher’s-exact test and the Chi-Square test. Results Overall 63.8% (638) endodontists responded. ProTaper was one of the most commonly used file system followed by M two and ProTaper Next. There was a significant co relation between the years of experience and the file re use frequency, preparation technique, file separation, management of file separation. Conclusion A large number of Endodontists prefer to reuse the rotary NiTi instruments. As there was an increase in the experience, the incidence of file separation reduced with increasing number of re use frequency and with experience, the management of separated file was better. PMID:28658903

Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study

PubMed Central

Nuss, Michelle A.; Hill, Janette R.; Cervero, Ronald M.; Gaines, Julie K.; Middendorf, Bruce F.

2014-01-01

Purpose Despite widespread use of mobile technology in medical education, medical students’ use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime. Methods This year-long (July 2012–June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis. Results Students predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates®, PDF Expert®, VisualDx®, and Micromedex®. The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime. Conclusions This mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical student's daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions. PMID:25317266

Requirements for multi-level systems pharmacology models to reach end-usage: the case of type 2 diabetes.

PubMed

Nyman, Elin; Rozendaal, Yvonne J W; Helmlinger, Gabriel; Hamrén, Bengt; Kjellsson, Maria C; Strålfors, Peter; van Riel, Natal A W; Gennemark, Peter; Cedersund, Gunnar

2016-04-06

We are currently in the middle of a major shift in biomedical research: unprecedented and rapidly growing amounts of data may be obtained today, from in vitro, in vivo and clinical studies, at molecular, physiological and clinical levels. To make use of these large-scale, multi-level datasets, corresponding multi-level mathematical models are needed, i.e. models that simultaneously capture multiple layers of the biological, physiological and disease-level organization (also referred to as quantitative systems pharmacology-QSP-models). However, today's multi-level models are not yet embedded in end-usage applications, neither in drug research and development nor in the clinic. Given the expectations and claims made historically, this seemingly slow adoption may seem surprising. Therefore, we herein consider a specific example-type 2 diabetes-and critically review the current status and identify key remaining steps for these models to become mainstream in the future. This overview reveals how, today, we may use models to ask scientific questions concerning, e.g., the cellular origin of insulin resistance, and how this translates to the whole-body level and short-term meal responses. However, before these multi-level models can become truly useful, they need to be linked with the capabilities of other important existing models, in order to make them 'personalized' (e.g. specific to certain patient phenotypes) and capable of describing long-term disease progression. To be useful in drug development, it is also critical that the developed models and their underlying data and assumptions are easily accessible. For clinical end-usage, in addition, model links to decision-support systems combined with the engagement of other disciplines are needed to create user-friendly and cost-efficient software packages.

Predictors and variation of routine home discharge in critically ill adults with cystic fibrosis.

PubMed

Oud, Lavi; Chan, Yiu Ming

2018-06-01

The short-term outcomes of patients with cystic fibrosis (CF) surviving critical illness were not examined systematically. To determine the factors associated with and variation in rates of routine home discharge among ICU-managed adult CF patients. Predictors of routine home discharge and its hospital-level variation were examined in ICU-managed adults with cystic fibrosis in Texas during 2004-2013. Older age, rural residence, and severity of illness decreased odds of routine home discharge, while hospitalization in facilities accredited as part of the Cystic Fibrosis Foundation Care Center Network nearly doubled the odds of routine home discharge. The median (interquartile) adjusted rate of routine home discharge was 62.0% (31.5-82.5). The identified determinants of routine home discharge can inform clinical decision-making, while the demonstrated wide variation in adjusted across-hospital rates of routine home discharge of ICU-managed adults with CF can provide benchmark data for future quality improvement efforts. Published by Elsevier Inc.

Clinical Effectiveness of Incentive Spirometry for the Prevention of Postoperative Pulmonary Complications.

PubMed

Eltorai, Adam E M; Szabo, Ashley L; Antoci, Valentin; Ventetuolo, Corey E; Elias, Jack A; Daniels, Alan H; Hess, Dean R

2018-03-01

Incentive spirometry (IS) is commonly prescribed to reduce pulmonary complications, despite limited evidence to support its benefits and a lack of consensus on optimal protocols for its use. Although numerous studies and meta-analyses have examined the effects of IS on patient outcomes, there is no clear evidence establishing its benefit to prevent postoperative pulmonary complications. Clinical practice guidelines advise against the routine use of IS in postoperative care. Until evidence of benefit from well-designed clinical trials becomes available, the routine use of IS in postoperative care is not supported by high levels of evidence. Copyright © 2018 by Daedalus Enterprises.

Implementation of molecular intra-operative assessment of sentinel lymph node in breast cancer.

PubMed

Khaddage, Abir; Berremila, Sid-Ali; Forest, Fabien; Clemenson, Alix; Bouteille, Catherine; Seffert, Pierre; Peoc'h, Michel

2011-02-01

Sentinel lymph node (SLN) biopsy is used as a staging procedure in early breast cancer, however, histology based intra-operative assessment of the SLN status has a low sensitivity. The one-step nucleic acid amplification (OSNA) method was developed to detect metastases by amplification of cytokeratin (CK) 19 mRNA. Experience with OSNA during a French multi-centric prospective study, as well as intra-operative clinical routine use, is reported. For the clinical study 80 SLNs from 46 patients were assessed. During routine use, the central slice of the SLN from 197 patients was investigated by permanent histology and the remainder was assessed by OSNA. During the clinical study, OSNA detected 15/17 metastases, including all the macrometastases, reaching a 96.3% concordance rate, 88.2% sensitivity and 98.4% specificity. During routine use, both OSNA and histology detected 25 patients with metastasis. OSNA is an accurate tool for intra-operative assessment of SLN status and could reduce the need for second surgery.

Hepatitis B Virus Genotyping: Is the Time Ripe for Routine Clinical Use?

PubMed Central

Madan, Kaushal; Tyagi, Pankaj

2012-01-01

Hepatitis B is one of the major causes of end-stage liver disease and liver cancer worldwide. A number of host and viral factors influence the disease course and outcomes. One such viral factor is hepatitis B virus (HBV) genotypes. There are eight major HBV genotypes described from various geographic regions of the world. Although direct sequencing appears to be the gold standard for HBV genotyping, it is expensive and laborintensive and therefore cannot be applied for routine clinical use. The newer molecular methods including serotyping have made genotyping easier and simple to apply to large number of samples rapidly. The data collected mainly over the last decade have suggested that HBV genotypes may have a bearing over the natural course of the disease and its response to therapy. This review summarizes the available literature and highlights how genotyping could be incorporated into routine clinical practice in order to improve delivery of care to HBV-infected individuals. PMID:25755425

Routine pharmacogenetic testing in clinical practice: dream or reality?

PubMed

Grossman, Iris

2007-10-01

Pharmacogenetics (PGx) has become progressively popular in recent years, thanks to growing anticipation among scientists, healthcare providers and the general public for the incorporation of genetic tests into the diagnostic arsenal at the physician's disposal. Indeed, much research has been dedicated to elucidation of genetic determinants underlying interindividual variability in pharmacokinetic parameters, as well as drug safety and efficacy. However, few PGx applications have thus far been realized in healthcare management. This review uses examples from PGx research of psychiatric drugs to illustrate why the current published findings are inadequate and insufficient for utilization as routine clinical predictors of treatment safety, efficacy or dosing. I therefore suggest the necessary steps to demonstrate the validity, utility and cost-effectiveness of PGx. These recommendations include a whole range of aspects, starting from standardization of criteria and assessment of the technical quality of genotyping assays, up to design of prospective PGx studies, providing the basis for reimbursement programs to be recognized in routine clinical practice.

Use of Order Sets in Inpatient Computerized Provider Order Entry Systems: A Comparative Analysis of Usage Patterns at Seven Sites

PubMed Central

Wright, Adam; Feblowitz, Joshua C.; Pang, Justine E.; Carpenter, James D.; Krall, Michael A.; Middleton, Blackford; Sittig, Dean F.

2012-01-01

Background Many computerized provider order entry (CPOE) systems include the ability to create electronic order sets: collections of clinically-related orders grouped by purpose. Order sets promise to make CPOE systems more efficient, improve care quality and increase adherence to evidence-based guidelines. However, the development and implementation of order sets can be expensive and time-consuming and limited literature exists about their utilization. Methods Based on analysis of order set usage logs from a diverse purposive sample of seven sites with commercially- and internally-developed inpatient CPOE systems, we developed an original order set classification system. Order sets were categorized across seven non-mutually exclusive axes: admission/discharge/transfer (ADT), perioperative, condition-specific, task-specific, service-specific, convenience, and personal. In addition, 731 unique subtypes were identified within five axes: four in ADT (S=4), three in perioperative, 144 in condition-specific, 513 in task-specific, and 67 in service-specific. Results Order sets (n=1,914) were used a total of 676,142 times at the participating sites during a one-year period. ADT and perioperative order sets accounted for 27.6% and 24.2% of usage respectively. Peripartum/labor, chest pain/Acute Coronary Syndrome/Myocardial Infarction and diabetes order sets accounted for 51.6% of condition-specific usage. Insulin, angiography/angioplasty and arthroplasty order sets accounted for 19.4% of task-specific usage. Emergency/trauma, Obstetrics/Gynecology/Labor Delivery and anesthesia accounted for 32.4% of service-specific usage. Overall, the top 20% of order sets accounted for 90.1% of all usage. Additional salient patterns are identified and described. Conclusion We observed recurrent patterns in order set usage across multiple sites as well as meaningful variations between sites. Vendors and institutional developers should identify high-value order set types through concrete data analysis in order to optimize the resources devoted to development and implementation. PMID:22819199

Reasons for excision of skin tumors: a one-year prospective study in a tertiary skin cancer unit.

PubMed

Lallas, Aimilios; Longo, Caterina; Moscarella, Elvira; Lombardi, Mara; Specchio, Francesca; Raucci, Margherita; Zalaudek, Iris; Argenziano, Giuseppe

2015-01-01

Biopsies and surgical excisions represent routine procedures in clinical settings dealing with skin cancer. To evaluate the impact of clinical examination, dermoscopy, reflectance confocal microscopy and digital monitoring on the decision to excise or biopsy a lesion in routine practice. Patients scheduled for biopsy or excision of a skin lesion were prospectively enrolled. The expert dermatologist was asked to select the main factor that prompted him/her to excise or biopsy the lesion. The most common reason for melanoma excision was clinical and dermoscopic morphology (70.3%), followed by dermoscopy (11.4%), monitoring (8.9%) and clinical context (8.2%). Most basal and squamous cell carcinomas were recognized both clinically and dermoscopically, while 18.6 and 15.0%, respectively, could only be detected with dermoscopic examination. Each part of the clinical examination has a contributory role in the diagnosis of melanoma and other skin cancers.

Impact of Xpert MTB/RIF for TB diagnosis in a primary care clinic with high TB and HIV prevalence in South Africa: a pragmatic randomised trial.

PubMed

Cox, Helen S; Mbhele, Slindile; Mohess, Neisha; Whitelaw, Andrew; Muller, Odelia; Zemanay, Widaad; Little, Francesca; Azevedo, Virginia; Simpson, John; Boehme, Catharina C; Nicol, Mark P

2014-11-01

Xpert MTB/RIF is approved for use in tuberculosis (TB) and rifampicin-resistance diagnosis. However, data are limited on the impact of Xpert under routine conditions in settings with high TB burden. A pragmatic prospective cluster-randomised trial of Xpert for all individuals with presumptive (symptomatic) TB compared to the routine diagnostic algorithm of sputum microscopy and limited use of culture was conducted in a large TB/HIV primary care clinic. The primary outcome was the proportion of bacteriologically confirmed TB cases not initiating TB treatment by 3 mo after presentation. Secondary outcomes included time to TB treatment and mortality. Unblinded randomisation occurred on a weekly basis. Xpert and smear microscopy were performed on site. Analysis was both by intention to treat (ITT) and per protocol. Between 7 September 2010 and 28 October 2011, 1,985 participants were assigned to the Xpert (n = 982) and routine (n = 1,003) diagnostic algorithms (ITT analysis); 882 received Xpert and 1,063 routine (per protocol analysis). 13% (32/257) of individuals with bacteriologically confirmed TB (smear, culture, or Xpert) did not initiate treatment by 3 mo after presentation in the Xpert arm, compared to 25% (41/167) in the routine arm (ITT analysis, risk ratio 0.51, 95% CI 0.33-0.77, p = 0.0052). The yield of bacteriologically confirmed TB cases among patients with presumptive TB was 17% (167/1,003) with routine diagnosis and 26% (257/982) with Xpert diagnosis (ITT analysis, risk ratio 1.57, 95% CI 1.32-1.87, p<0.001). This difference in diagnosis rates resulted in a higher rate of treatment initiation in the Xpert arm: 23% (229/1,003) and 28% (277/982) in the routine and Xpert arms, respectively (ITT analysis, risk ratio 1.24, 95% CI 1.06-1.44, p = 0.013). Time to treatment initiation was improved overall (ITT analysis, hazard ratio 0.76, 95% CI 0.63-0.92, p = 0.005) and among HIV-infected participants (ITT analysis, hazard ratio 0.67, 95% CI 0.53-0.85, p = 0.001). There was no difference in 6-mo mortality with Xpert versus routine diagnosis. Study limitations included incorrect intervention allocation for a high proportion of participants and that the study was conducted in a single clinic. These data suggest that in this routine primary care setting, use of Xpert to diagnose TB increased the number of individuals with bacteriologically confirmed TB who were treated by 3 mo and reduced time to treatment initiation, particularly among HIV-infected participants. Pan African Clinical Trials Registry PACTR201010000255244. Please see later in the article for the Editors' Summary.

[How to Interpret and Use Routine Laboratory Data--Our Methods to Interpret Routine Laboratory Data--Chairmen's Introductory Remarks].

PubMed

Honda, Takayuki; Tozuka, Minoru

2015-09-01

In the reversed clinicopathological conference (R-CPC), three specialists in laboratory medicine interpreted routine laboratory data independently in order to understand the detailed state of a patient. R-CPC is an educational method to use laboratory data appropriately, and it is also important to select differential diagnoses in a process of clinical reasoning in addition to the present illness and physical examination. Routine laboratory tests can be performed repeatedly at a relatively low cost, and their time-series analysis can be performed. Interpretation of routine laboratory data is almost the same as taking physical findings. General findings are initially checked and then the state of each organ is examined. Although routine laboratory tests cost little, we can gain much more information from them about the patient than physical examinations.

Practice nurse involvement in primary care depression management: an observational cost-effectiveness analysis

PubMed Central

2014-01-01

Background Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the management of diabetes and obesity. This paper reports on their value in the management of depression. Methods General practices were assigned to a low or high model of care based on observed levels of practice nurse involvement in clinical-based activities for the management of depression (i.e. percentage of depression patients seen, percentage of consultation time spent on clinical-based activities). Linked, routinely collected data was used to determine patient level depression outcomes (proportion of depression-free days) and health service usage costs. Standardised depression assessment tools were not routinely used, therefore a classification framework to determine the patient’s depressive state was developed using proxy measures (e.g. symptoms, medications, referrals, hospitalisations and suicide attempts). Regression analyses of costs and depression outcomes were conducted, using propensity weighting to control for potential confounders. Results Capacity to determine depressive state using the classification framework was dependent upon the level of detail provided in medical records. While antidepressant medication prescriptions were a strong indicator of depressive state, they could not be relied upon as the sole measure. Propensity score weighted analyses of total depression-related costs and depression outcomes, found that the high level model of care cost more (95% CI: -$314.76 to $584) and resulted in 5% less depression-free days (95% CI: -0.15 to 0.05), compared to the low level model. However, this result was highly uncertain, as shown by the confidence intervals. Conclusions Classification of patients’ depressive state was feasible, but time consuming, using the classification framework proposed. Further validation of the framework is required. Unlike the analyses of diabetes and obesity management, no significant differences in the proportion of depression-free days or health service costs were found between the alternative levels of practice nurse involvement. PMID:24422622

Delivering value in dermatology: insights from skin cancer detection in routine clinical visits.

PubMed

Enamandram, Monica; Duncan, Lyn M; Kimball, Alexandra B

2015-02-01

There are increasing demands to demonstrate and report on outcomes in dermatology. Skin cancer diagnosis through skin examination has been well studied, and is promising as a value-delivering intervention. This study seeks to identify the rate of skin cancer diagnosis during routine visits to a large tertiary dermatology clinic. Medical records of patients presenting for routine dermatologic care at Massachusetts General Hospital between March 28 and September 28, 2012, were retrospectively reviewed. All patients given a diagnosis of nonmelanoma skin cancer (NMSC) confirmed on biopsy specimen were identified. Billing data were used to identify the total number of patients evaluated during the study period. NMSC was diagnosed in 1266 skin biopsy specimens from 1047 (7.0%) of the 14,829 patients who presented for routine care. In all, 55% of patients with NMSC were men (mean age 70 years). Chief symptoms of patients with NMSC included general dermatologic concerns (37%), routine cancer screening (43%), and specific lesion(s) of concern (19%). Retrospective design and restriction to a single institution may limit the generalizability of our findings. The incidence of NMSC in routine dermatology is high; these findings validate the value of care provided by dermatologists and highlight the likely increasing need for their diagnostic skills as the population ages in the United States. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature.

PubMed

Czoski-Murray, C; Lloyd Jones, M; McCabe, C; Claxton, K; Oluboyede, Y; Roberts, J; Nicholl, J P; Rees, A; Reilly, C S; Young, D; Fleming, T

2012-12-01

The evidence base which supported the National Institute for Health and Clinical Excellence (NICE) published Clinical Guideline 3 was limited and 50% was graded as amber. However, the use of tests as part of pre-operative work-up remains a low-cost but high-volume activity within the NHS, with substantial resource implications. The objective of this study was to identify, evaluate and synthesise the published evidence on the clinical effectiveness and cost-effectiveness of the routine use of three tests, full blood counts (FBCs), urea and electrolytes tests (U&Es) and pulmonary function tests, in the pre-operative work-up of otherwise healthy patients undergoing minor or intermediate surgery in the NHS. The aims of this study were to estimate the clinical effectiveness and cost-effectiveness of routine pre-operative testing of FBC, electrolytes and renal function and pulmonary function in adult patients classified as American Society of Anaesthesiologists (ASA) grades 1 and 2 undergoing elective minor (grade 1) or intermediate (grade 2) surgical procedures; to compare NICE recommendations with current practice; to evaluate the cost-effectiveness of mandating or withdrawing each of these tests in this patient group; and to identify the expected value of information and whether or not it has value to the NHS in commissioning further primary research into the use of these tests in this group of patients. The following electronic bibliographic databases were searched: (1) BIOSIS; (2) Cumulative Index to Nursing and Allied Health Literature; (3) Cochrane Database of Systematic Reviews; (4) Cochrane Central Register of Controlled Trials; (5) EMBASE; (6) MEDLINE; (7) MEDLINE In-Process & Other Non-Indexed Citations; (8) NHS Database of Abstracts of Reviews of Effects; (9) NBS Health Technology Assessment Database; and (10) Science Citation Index. To identify grey and unpublished literature, the Cochrane Register of Controlled Trials, National Research Register Archive, National Institute for Health Research Clinical Research Network Portfolio database and the Copernic Meta-search Engine were searched. A large routine data set which recorded the results of tests was obtained from Leeds Teaching Hospitals Trust. A systematic review of the literature was carried out. The searches were undertaken in March to April 2008 and June 2009. Searches were designed to retrieve studies that evaluated the clinical effectiveness and cost-effectiveness of routine pre-operative testing of FBC, electrolytes and renal function and pulmonary function in the above group of patients. A postal survey of current practice in testing patients in this group pre-operatively was undertaken in 2008. An exemplar cost-effectiveness model was constructed to demonstrate what form this would have taken had there been sufficient data. A large routine data set that recorded the results of tests was obtained from Leeds Teaching Hospitals Trust. This was linked to individual patient data with surgical outcomes, and regression models were estimated. A comprehensive and systematic search of both the clinical effectiveness and cost-effectiveness literature identified a large number of potentially relevant studies. However, when these studies were subjected to detailed review and quality assessment, it became clear that the literature provides no evidence on the clinical effectiveness and cost-effectiveness of these specific tests in the specific patient groups. The postal survey had a 17% response rate. Results reported that in ASA grade 1, patients aged < 40 years with no comorbidities undergoing minor surgery did not have routine tests for FBC, electrolytes and renal function and pulmonary function. The results from the regression model showed that the frequency of test use was not consistent with the hypothesis of their routine use. FBC tests were performed in only 58% of patients in the data set and U&E testing was carried out in only 57%. Systematic searches of the clinical effectiveness and cost-effectiveness literature found that there is no evidence on the clinical effectiveness or cost-effectiveness of these tests in this specific clinical context for the NHS. A survey of NHS hospitals found that respondent trusts were implementing current NICE guidance in relation to pre-operative testing generally, and a de novo analysis of routine data on test utilisation and post-operative outcome found that the tests were not be used in routine practice; rather, use was related to an expectation of a more complex clinical case. The paucity of published evidence is a limitation of this study. The studies included relied on non-UK health-care systems data, which may not be transferable. The inclusion of non-randomised studies is associated with an increased risk of bias and confounding. Scoping work to establish the likely mechanism of action by which tests would impact upon outcomes and resource utilisation established that the cause of an abnormal test result is likely to be a pivotal determinant of the cost-effectiveness of a pre-operative test and therefore evaluations would need to consider tests in the context of the underlying risk of specific clinical problems (i.e. risk guided rather than routine use). The time of universal utilisation of pre-operative tests for all surgical patients is likely to have passed. The evidence we have identified, though weak, indicates that tests are increasingly utilised in patients in whom there is a reason to consider an underlying raised risk of a clinical abnormality that should be taken into account in their clinical management. It is likely that this strategy has led to substantial resource savings for the NHS, although there is not a published evidence base to establish that this is the case. The total expenditure on pre-operative tests across the NHS remains significant. Evidence on current practice indicates that clinical practice has changed to such a degree that the original research question is no longer relevant to UK practice. Future research on the value of these tests in pre-operative work-up should be couched in terms of the clinical effectiveness and cost-effectiveness in the identification of specific clinical abnormalities in patients with a known underlying risk. We suggest that undertaking a multicentre study making use of linked, routinely collected data sets would identify the extent and nature of pre-operative testing in this group of patients. The National Institute for Health Research Health Technology Assessment programme.

Making sense of the shadows: priorities for creating a learning healthcare system based on routinely collected data.

PubMed

Deeny, Sarah R; Steventon, Adam

2015-08-01

Socrates described a group of people chained up inside a cave, who mistook shadows of objects on a wall for reality. This allegory comes to mind when considering 'routinely collected data'-the massive data sets, generated as part of the routine operation of the modern healthcare service. There is keen interest in routine data and the seemingly comprehensive view of healthcare they offer, and we outline a number of examples in which they were used successfully, including the Birmingham OwnHealth study, in which routine data were used with matched control groups to assess the effect of telephone health coaching on hospital utilisation.Routine data differ from data collected primarily for the purposes of research, and this means that analysts cannot assume that they provide the full or accurate clinical picture, let alone a full description of the health of the population. We show that major methodological challenges in using routine data arise from the difficulty of understanding the gap between patient and their 'data shadow'. Strategies to overcome this challenge include more extensive data linkage, developing analytical methods and collecting more data on a routine basis, including from the patient while away from the clinic. In addition, creating a learning health system will require greater alignment between the analysis and the decisions that will be taken; between analysts and people interested in quality improvement; and between the analysis undertaken and public attitudes regarding appropriate use of data. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Trends in Retail Clinic Use Among The Commercially Insured

PubMed Central

Ashwood, J. Scott; Reid, Rachel O.; Setodji, Claude M.; Weber, Ellerie; Gaynor, Martin; Mehrotra, Ateev

2012-01-01

Objective To describe trends in retail clinic usage among commercially insured patients and to identify which patient characteristics predict retail clinic use Study Design We performed a retrospective cohort analysis of commercial insurance claims sampled from a population of 13.3 million patients in 21 markets in 2007-9. Methods We identified 11 simple acute conditions that can be managed at a retail clinic. We described trends in retail clinic utilization for these conditions. We used multiple logistic regressions to identify predictors of retail clinic versus another care site for these conditions and assessed whether those predictors changed over time. Results Retail clinic use increased ten-fold from 2007 to 2009. By 2009 6.9% of all visits for the 11 conditions were to a retail clinic. Proximity to a retail clinic was the strongest predictor of use. Patients living within 1 mile of a retail clinic were 10.0% more likely to use one than those living 10-20 miles away (p-value <0.001). Women (+0.9%, p-value <0.001), young adults (+1.6%, p-value <0.001), those without a chronic condition (+1.1%, p-value <0.001), and high-income (+1.3%, p-value <0.001) patients were more likely to use retail clinics. All these associations became stronger over time. There was no association between primary care physician availability and retail clinic use. Conclusions If these trends continue health plans can expect to see a dramatic increase in retail clinic utilization. While usage is increasing on average, it is particularly increasing among young, healthy, and higher income patients who live close to retail clinics. PMID:22200061

Retrospective evaluation of exposure index (EI) values from plain radiographs reveals important considerations for quality improvement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mothiram, Ursula; Brennan, Patrick C; Robinson, John

2013-12-15

Following X-ray exposure, radiographers receive immediate feedback on detector exposure in the form of the exposure index (EI). To identify whether radiographers are meeting manufacturer-recommended EI (MREI) ranges for routine chest, abdomen and pelvis X-ray examinations under a variety of conditions and to examine factors affecting the EI. Data on 5000 adult X-ray examinations including the following variables were collected: examination parameters, EI values, patient gender, date of birth, date and time of examination, grid usage and the presence of implant or prosthesis. Descriptive statistics were used to summarize each data set and the Mann–Whitney U test was used tomore » determine significant differences, with P < 0.05 indicating significance for all tests. Most examinations demonstrated EI values that were outside the MREI ranges, with significantly higher median EI values recorded for female patient radiographs than those for male patients for all manufacturers, indicating higher detector exposures for all units except for Philips digital radiography (DR), where increased EI values indicate lower exposure (P = 0.01). Median EI values for out of hours radiography were also significantly higher compared with normal working hours for all technologies (P ≤ 0.02). Significantly higher median EI values were demonstrated for Philips DR chest X-rays without as compared to those with the employment of a grid (P = 0.03), while significantly lower median EI values were recorded for Carestream Health computed radiography (CR) chest X-rays when an implant or prosthesis was present (P = 0.02). Non-adherence to MREIs has been demonstrated with EI value discrepancies being dependent on patient gender, time/day of exposure, grid usage and the presence of an implant or prosthesis. Retrospective evaluation of EI databases is a valuable tool to assess the need of quality improvement in routine DR.« less

Developing the public health role of a front line clinical service: integrating stop smoking advice into routine podiatry services.

PubMed

Gray, Jackie; Eden, Gary; Williams, Maria

2007-06-01

Although smoking is a major public health problem, many clinicians do not routinely provide evidence-based health improvement advice to smokers to help them to quit. Plan, Do, Study, Act (PDSA) cycle methodology was used to design and implement a service development so that health improvement advice for smokers featured in all podiatry consultations provided by a Primary Care Trust in North East England. IT systems were developed to record the number and proportion of patients for whom smoking status was assessed, and the number and proportion of smokers who were given advice to quit and referred for specialist support. A questionnaire to staff explored their perceptions of the development on their clinics and consultations. During a 6-month period, smoking status was recorded for all 8831 (100%) patients attending podiatry clinics; 83% of smokers were given brief advice to quit; 7% of smokers were given help to access specialist stop smoking support services. Improvements were introduced within existing budgets and did not prolong clinics. It is straightforward and inexpensive to develop clinical services so that public health guidance is routinely implemented. More widespread implementation of similar service developments could lead to national improvements in public health.

Creatinine Clearance Is Not Equal to Glomerular Filtration Rate and Cockcroft-Gault Equation Is Not Equal to CKD-EPI Collaboration Equation.

PubMed

Fernandez-Prado, Raul; Castillo-Rodriguez, Esmeralda; Velez-Arribas, Fernando Javier; Gracia-Iguacel, Carolina; Ortiz, Alberto

2016-12-01

Direct oral anticoagulants (DOACs) may require dose reduction or avoidance when glomerular filtration rate is low. However, glomerular filtration rate is not usually measured in routine clinical practice. Rather, equations that incorporate different variables use serum creatinine to estimate either creatinine clearance in mL/min or glomerular filtration rate in mL/min/1.73 m 2 . The Cockcroft-Gault equation estimates creatinine clearance and incorporates weight into the equation. By contrast, the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate and incorporate ethnicity but not weight. As a result, an individual patient may have very different renal function estimates, depending on the equation used. We now highlight these differences and discuss the impact on routine clinical care for anticoagulation to prevent embolization in atrial fibrillation. Pivotal DOAC clinical trials used creatinine clearance as a criterion for patient enrollment, and dose adjustment and Federal Drug Administration recommendations are based on creatinine clearance. However, clinical biochemistry laboratories provide CKD-EPI glomerular filtration rate estimations, resulting in discrepancies between clinical trial and routine use of the drugs. Copyright © 2016 Elsevier Inc. All rights reserved.

Matrix-assisted laser desorption ionization time-of-flight mass spectrometry, a revolution in clinical microbial identification.

PubMed

Bizzini, A; Greub, G

2010-11-01

Until recently, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) techniques for the identification of microorganisms remained confined to research laboratories. In the last 2 years, the availability of relatively simple to use MALDI-TOF MS devices, which can be utilized in clinical microbiology laboratories, has changed the laboratory workflows for the identification of pathogens. Recently, the first prospective studies regarding the performance in routine bacterial identification showed that MALDI-TOF MS is a fast, reliable and cost-effective technique that has the potential to replace and/or complement conventional phenotypic identification for most bacterial strains isolated in clinical microbiology laboratories. For routine bacterial isolates, correct identification by MALDI-TOF MS at the species level was obtained in 84.1-93.6% of instances. In one of these studies, a protein extraction step clearly improved the overall valid identification yield, from 70.3% to 93.2%. This review focuses on the current state of use of MALDI-TOF MS for the identification of routine bacterial isolates and on the main difficulties that may lead to erroneous or doubtful identifications. © 2010 The Authors. Clinical Microbiology and Infection © 2010 European Society of Clinical Microbiology and Infectious Diseases.

Evidence-based Practices Addressed in Community-based Children’s Mental Health Clinical Supervision

PubMed Central

Accurso, Erin C.; Taylor, Robin M.; Garland, Ann F.

2013-01-01

Context Clinical supervision is the principal method of training for psychotherapeutic practice, however there is virtually no research on supervision practice in community settings. Of particular interest is the role supervision might play in facilitating implementation of evidence-based (EB) care in routine care settings. Objective This study examines the format and functions of clinical supervision sessions in routine care, as well as the extent to which supervision addresses psychotherapeutic practice elements common to EB care for children with disruptive behavior problems, who represent the majority of patients served in publicly-funded routine care settings. Methods Supervisors (n=7) and supervisees (n=12) from four publicly-funded community-based child mental health clinics reported on 130 supervision sessions. Results Supervision sessions were primarily individual in-person meetings lasting one hour. The most common functions included case conceptualization and therapy interventions. Coverage of practice elements common to EB treatments was brief. Discussion Despite the fact that most children presenting to public mental health services are referred for disruptive behavior problems, supervision sessions are infrequently focused on practice elements consistent with EB treatments for this population. Supervision is a promising avenue through which training in EB practices could be supported to improve the quality of care for children in community-based “usual care” clinics. PMID:24761163

[Shared decision-making in acute psychiatric medicine : Contraindication or a challenge?

PubMed

Heres, S; Hamann, J

2017-09-01

The concept of shared decision-making (SDM) has existed since the 1990s in multiple fields of somatic medicine but has only been poorly applied in psychiatric clinical routine despite broad acceptance and promising outcomes in clinical studies on its positive effects. The concept itself and its practicability in mental health are carefully assessed and strategies for its future implementation in psychiatric medicine are presented in this article. Ongoing clinical studies probing some of those strategies are further outlined. On top of the ubiquitous shortage of time in clinical routine, psychiatrists report their concern about patients' limited abilities in sharing decisions and their own fear of potentially harmful decisions resulting from a shared process. Misinterpretation of shared decision-making restricting the health care professional to rather an informed choice scenario and their own adhesion to the traditional paternalistic decision-making approach further add to SDM's underutilization. Those hurdles could be overcome by communication skill workshops for all mental health care professionals, including nursing personnels, psychologists, social workers and physicians, as well as the use of decision aids and training courses for patients to motivate and empower them in sharing decisions with the medical staff. By this, the patient-centered treatment approach demanded by guidelines, carers and users could be further facilitated in psychiatric clinical routine.

Social Withdrawal Among Individuals Receiving Psychiatric Care: Derivation of a Scale Using Routine Clinical Assessment Data to Support Screening and Outcome Measurement.

PubMed

Rios, Sebastian; Perlman, Christopher M

2017-04-24

Social withdrawal is a symptom experienced by individuals with an array of mental health conditions, particularly those with schizophrenia and mood disorders. Assessments of social withdrawal are often lengthy and may not be routinely integrated within the comprehensive clinical assessment of the individual. This study utilized item response and classical test theory methods to derive a Social Withdrawal Scale (SWS) using items embedded within a routine clinical assessment, the RAI-Mental Health (RAI-MH). Using data from 60,571 inpatients in Ontario, Canada, a common factor analysis identified seven items from the RAI-MH that measure social withdrawal. A graded response model found that six items had acceptable discrimination parameters: lack of motivation, reduced interaction, decreased energy, flat affect, anhedonia, and loss of interest. Summing these items, the SWS was found to have strong internal consistency (Cronbach's alpha = 0.82) and showed a medium to large effect size (d = 0.77) from admission to discharge. Fewer individuals with high SWS scores participated in social activity or reported having a confidant compared to those with lower scores. Since the RAI-MH is available across clinical subgroups in several jurisdictions, the SWS is a useful tool for screening, clinical decision support, and evaluation.

Medical cost reductions associated with the usage of novel oral anticoagulants vs warfarin among atrial fibrillation patients, based on the RE-LY, ROCKET-AF, and ARISTOTLE trials.

PubMed

Deitelzweig, Steve; Amin, Alpesh; Jing, Yonghua; Makenbaeva, Dinara; Wiederkehr, Daniel; Lin, Jay; Graham, John

2012-01-01

The randomized clinical trials, RE-LY, ROCKET-AF, and ARISTOTLE, demonstrate that the novel oral anticoagulants (NOACs) are effective options for stroke prevention among non-valvular atrial fibrillation (AF) patients. This study aimed to evaluate the medical cost reductions associated with the use of individual NOACs instead of warfarin from the US payer perspective. Rates for efficacy and safety clinical events for warfarin were estimated as the weighted averages from the RE-LY, ROCKET-AF and ARISTOTLE trials, and event rates for NOACs were determined by applying trial hazard ratios or relative risk ratios to such weighted averages. Incremental medical costs to a US health payer of an AF patient experiencing a clinical event during 1 year following the event were obtained from published literature and inflation adjusted to 2010 cost levels. Medical costs, excluding drug costs, were evaluated and compared for each NOAC vs warfarin. Sensitivity analyses were conducted to determine the influence of variations in clinical event rates and incremental costs on the medical cost reduction. In a patient year, the medical cost reduction associated with NOAC usage instead of warfarin was estimated to be -$179, -$89, and -$485 for dabigatran, rivaroxaban, and apixaban, respectively. When clinical event rates and costs were allowed to vary simultaneously, through a Monte Carlo simulation, the 95% confidence interval of annual medical costs differences ranged between -$424 and +$71 for dabigatran, -$301 and +$135 for rivaroxaban, and -$741 and -$252 for apixaban, with a negative number indicating a cost reduction. Of the 10,000 Monte-Carlo iterations 92.6%, 79.8%, and 100.0% were associated with a medical cost reduction >$0 for dabigatran, rivaroxaban, and apixaban, respectively. Usage of the NOACs, dabigatran, rivaroxaban, and apixaban may be associated with lower medical (excluding drug costs) costs relative to warfarin, with apixaban having the most substantial medical cost reduction.

Skin acceptability of a cosmetic moisturizer formulation in female subjects with sensitive skin.

PubMed

Nisbet, Stephanie J

2018-01-01

This 3-week, open-label, noncomparative clinical study evaluated the skin acceptability of a cosmetic moisturizer in subjects with sensitive skin, by monitoring adverse events (AEs) and cutaneous discomfort related to normal usage. Female subjects aged between 18-60 years, with Fitzpatrick phototype classification I-IV and sensitive skin, verified by a positive reaction on the stinging test at screening, were included. Subjects applied the moisturizer to their face and body twice daily for 21±2 days at home and recorded study product usage and feelings of cutaneous discomfort (eg, dryness, prickling, stinging, and itching) in a diary; any AEs were reported to the clinic. At study end, skin acceptability of the moisturizer was investigator-assessed based on the nature of AEs and subjects' self-reported feelings of discomfort, and by clinical evaluation of skin reactions in the area of moisturizer application (appearance of erythema, formation of edema, and skin desquamation; scored according to an adapted Draize and Kligman scale). Only subjects with a treatment compliance of ≥80% were included in the final analysis. In total, 35 subjects initiated and completed the study; all were compliant to the minimum study product usage. Per investigator clinical dermatological assessment at study end, none of the 35 subjects had skin reactions in the area of moisturizer application and there were no reported AEs. One subject reported sensations of mild prickling and itching immediately after applying the moisturizer (not classified as AEs), which spontaneously remitted after complete absorption of the product and were noted only in exposed areas. These events were considered by the investigator as being possibly/probably related to the use of study product; however, no clinical signs of skin reaction were observed in the exposed areas. This cosmetic moisturizer appears generally well tolerated and suitable for topical use in subjects with sensitive skin.

Skin acceptability of a cosmetic moisturizer formulation in female subjects with sensitive skin

PubMed Central

Nisbet, Stephanie J

2018-01-01

Purpose This 3-week, open-label, noncomparative clinical study evaluated the skin acceptability of a cosmetic moisturizer in subjects with sensitive skin, by monitoring adverse events (AEs) and cutaneous discomfort related to normal usage. Materials and methods Female subjects aged between 18–60 years, with Fitzpatrick phototype classification I–IV and sensitive skin, verified by a positive reaction on the stinging test at screening, were included. Subjects applied the moisturizer to their face and body twice daily for 21±2 days at home and recorded study product usage and feelings of cutaneous discomfort (eg, dryness, prickling, stinging, and itching) in a diary; any AEs were reported to the clinic. At study end, skin acceptability of the moisturizer was investigator-assessed based on the nature of AEs and subjects’ self-reported feelings of discomfort, and by clinical evaluation of skin reactions in the area of moisturizer application (appearance of erythema, formation of edema, and skin desquamation; scored according to an adapted Draize and Kligman scale). Only subjects with a treatment compliance of ≥80% were included in the final analysis. Results In total, 35 subjects initiated and completed the study; all were compliant to the minimum study product usage. Per investigator clinical dermatological assessment at study end, none of the 35 subjects had skin reactions in the area of moisturizer application and there were no reported AEs. One subject reported sensations of mild prickling and itching immediately after applying the moisturizer (not classified as AEs), which spontaneously remitted after complete absorption of the product and were noted only in exposed areas. These events were considered by the investigator as being possibly/probably related to the use of study product; however, no clinical signs of skin reaction were observed in the exposed areas. Conclusion This cosmetic moisturizer appears generally well tolerated and suitable for topical use in subjects with sensitive skin. PMID:29750047

Paying and playing with plastic. The meaning of plastics, plasticity, and plastic surgery.

PubMed

Williams, D

1996-11-01

Plastics are not only the proverbial everyday commodity, but they also permeate almost every aspect of medical devices, from technology to clinical application. This article addresses some of the confusing features of plasticity as they relate to the materials called plastics, to the phenomena of material plasticity, and to the clinical and biological usage of the word.

Credibility, Replicability, and Reproducibility in Simulation for Biomedicine and Clinical Applications in Neuroscience

PubMed Central

Mulugeta, Lealem; Drach, Andrew; Erdemir, Ahmet; Hunt, C. A.; Horner, Marc; Ku, Joy P.; Myers Jr., Jerry G.; Vadigepalli, Rajanikanth; Lytton, William W.

2018-01-01

Modeling and simulation in computational neuroscience is currently a research enterprise to better understand neural systems. It is not yet directly applicable to the problems of patients with brain disease. To be used for clinical applications, there must not only be considerable progress in the field but also a concerted effort to use best practices in order to demonstrate model credibility to regulatory bodies, to clinics and hospitals, to doctors, and to patients. In doing this for neuroscience, we can learn lessons from long-standing practices in other areas of simulation (aircraft, computer chips), from software engineering, and from other biomedical disciplines. In this manuscript, we introduce some basic concepts that will be important in the development of credible clinical neuroscience models: reproducibility and replicability; verification and validation; model configuration; and procedures and processes for credible mechanistic multiscale modeling. We also discuss how garnering strong community involvement can promote model credibility. Finally, in addition to direct usage with patients, we note the potential for simulation usage in the area of Simulation-Based Medical Education, an area which to date has been primarily reliant on physical models (mannequins) and scenario-based simulations rather than on numerical simulations. PMID:29713272

Credibility, Replicability, and Reproducibility in Simulation for Biomedicine and Clinical Applications in Neuroscience.

PubMed

Mulugeta, Lealem; Drach, Andrew; Erdemir, Ahmet; Hunt, C A; Horner, Marc; Ku, Joy P; Myers, Jerry G; Vadigepalli, Rajanikanth; Lytton, William W

2018-01-01

Modeling and simulation in computational neuroscience is currently a research enterprise to better understand neural systems. It is not yet directly applicable to the problems of patients with brain disease. To be used for clinical applications, there must not only be considerable progress in the field but also a concerted effort to use best practices in order to demonstrate model credibility to regulatory bodies, to clinics and hospitals, to doctors, and to patients. In doing this for neuroscience, we can learn lessons from long-standing practices in other areas of simulation (aircraft, computer chips), from software engineering, and from other biomedical disciplines. In this manuscript, we introduce some basic concepts that will be important in the development of credible clinical neuroscience models: reproducibility and replicability; verification and validation; model configuration; and procedures and processes for credible mechanistic multiscale modeling. We also discuss how garnering strong community involvement can promote model credibility. Finally, in addition to direct usage with patients, we note the potential for simulation usage in the area of Simulation-Based Medical Education, an area which to date has been primarily reliant on physical models (mannequins) and scenario-based simulations rather than on numerical simulations.

A genotypic method for determining HIV-2 coreceptor usage enables epidemiological studies and clinical decision support.

PubMed

Döring, Matthias; Borrego, Pedro; Büch, Joachim; Martins, Andreia; Friedrich, Georg; Camacho, Ricardo Jorge; Eberle, Josef; Kaiser, Rolf; Lengauer, Thomas; Taveira, Nuno; Pfeifer, Nico

2016-12-20

CCR5-coreceptor antagonists can be used for treating HIV-2 infected individuals. Before initiating treatment with coreceptor antagonists, viral coreceptor usage should be determined to ensure that the virus can use only the CCR5 coreceptor (R5) and cannot evade the drug by using the CXCR4 coreceptor (X4-capable). However, until now, no online tool for the genotypic identification of HIV-2 coreceptor usage had been available. Furthermore, there is a lack of knowledge on the determinants of HIV-2 coreceptor usage. Therefore, we developed a data-driven web service for the prediction of HIV-2 coreceptor usage from the V3 loop of the HIV-2 glycoprotein and used the tool to identify novel discriminatory features of X4-capable variants. Using 10 runs of tenfold cross validation, we selected a linear support vector machine (SVM) as the model for geno2pheno[coreceptor-hiv2], because it outperformed the other SVMs with an area under the ROC curve (AUC) of 0.95. We found that SVMs were highly accurate in identifying HIV-2 coreceptor usage, attaining sensitivities of 73.5% and specificities of 96% during tenfold nested cross validation. The predictive performance of SVMs was not significantly different (p value 0.37) from an existing rules-based approach. Moreover, geno2pheno[coreceptor-hiv2] achieved a predictive accuracy of 100% and outperformed the existing approach on an independent data set containing nine new isolates with corresponding phenotypic measurements of coreceptor usage. geno2pheno[coreceptor-hiv2] could not only reproduce the established markers of CXCR4-usage, but also revealed novel markers: the substitutions 27K, 15G, and 8S were significantly predictive of CXCR4 usage. Furthermore, SVMs trained on the amino-acid sequences of the V1 and V2 loops were also quite accurate in predicting coreceptor usage (AUCs of 0.84 and 0.65, respectively). In this study, we developed geno2pheno[coreceptor-hiv2], the first online tool for the prediction of HIV-2 coreceptor usage from the V3 loop. Using our method, we identified novel amino-acid markers of X4-capable variants in the V3 loop and found that HIV-2 coreceptor usage is also influenced by the V1/V2 region. The tool can aid clinicians in deciding whether coreceptor antagonists such as maraviroc are a treatment option and enables epidemiological studies investigating HIV-2 coreceptor usage. geno2pheno[coreceptor-hiv2] is freely available at http://coreceptor-hiv2.geno2pheno.org .

Self-reported "communication technology" usage in patients attending a cardiology outpatient clinic in a remote regional hospital.

PubMed

Gandiya, Tariro; Dua, Anahita; King, Gerry; Mazzocco, Thomas; Hussain, Amir; Leslie, Stephen J

2012-04-01

This study assessed the perceived usage of, and attitudes toward, communication technologies (mobile phone and texting, e-mail, and the World Wide Web) in patients attending a cardiology clinic with a view to guiding future health service redesign. This was performed in a remote regional hospital serving both urban and rural populations. A self-completion questionnaire was completed by a convenience sample of 221 patients attending a general cardiology clinic. The questions asked about patients' access to and use of technology at home. Data collected also included age, gender, travel time to the clinic, mode of travel, and whether the respondent was accompanied to the clinic. Appropriate statistical tests were used with significance taken at the 0.05 level. Age was the strongest predictor of use of communication technologies, with younger patients more likely to use e-mail, Web, mobile phone, and texting. However, frequency of use of e-mail was not related to age. It is encouraging that over 99% of patients used at least one communication technology. This study has highlighted that there may be several potential barriers to the widespread implementation of communication technologies in general cardiology patients. Cognizance should be taken of these findings when attempting service redesign.

The Self-Perception and Usage of Medical Apps amongst Medical Students in the United States: A Cross-Sectional Survey

PubMed Central

Craft, Noah

2016-01-01

Background. Mobile medical software applications (apps) are used for clinical decision-making at the point of care. Objectives. To determine (1) the usage, reliability, and popularity of mobile medical apps and (2) medical students' perceptions of app usage effect on the quality of patient-provider interaction in healthcare settings. Methods. An anonymous web-based survey was distributed to medical students. Frequency of use, type of app used, and perceptions of reliability were assessed via univariate analysis. Results. Seven hundred thirty-one medical students responded, equating to a response rate of 29%. The majority (90%) of participants thought that medical apps enhance clinical knowledge, and 61% said that medical apps are as reliable as textbooks. While students thought that medical apps save time, improve the care of their patients, and improve diagnostic accuracy, 53% of participants believed that mobile device use in front of colleagues and patients makes one appear less competent. Conclusion. While medical students believe in the utility and reliability of medical apps, they were hesitant to use them out of fear of appearing less engaged. Higher levels of training correlated with a greater degree of comfort when using medical apps in front of patients. PMID:27688752

The Effect of Curanderismo on Chronic Non-malignant Pain: A Case Report.

PubMed

Kennedy, Laura; Gonzales, Erin; Corbin, Lisa

2016-01-01

This case study describes the effects of the use of curanderismo, an indigenous healing modality combining techniques in massage, sound, and aromatherapy, on a patient with chronic pain. Despite being a commonly used health practice in certain populations, little is reported in the medical literature about the use of curanderismo. Case report as part of a larger randomized trial of curanderismo for chronic pain. Setting was a community-based hospital affiliated primary care clinic. An adult patient with chronic, opioid dependent back pain following an injury, and subsequent spinal fusion was treated. Intervention was the patient received 33 curanderismo treatment sessions over 10 months in addition to ongoing conventional treatment at a community-based chronic pain management clinic. Main outcomes measures were self-reported assessments of pain, functional ability, mood, insomnia, and narcotic usage. Secondary outcome measure was qualitative interview. Although there was no change in quantitative self-reported pain measures, the patient reported improved function, mood, and sleep as well as decreased narcotic usage. Curanderismo, in addition to conventional pain management, improved patient reported symptoms and functional ability, led to healthy lifestyle changes, and decreased narcotic usage. Controlled studies are needed to confirm the benefit of curanderismo as safe, non-interventional, and cost-effective adjunct for chronic pain management. Copyright © 2016 Elsevier Inc. All rights reserved.

The significance of routines in nursing practice.

PubMed

Rytterström, Patrik; Unosson, Mitra; Arman, Maria

2011-12-01

The aim of this study was to illuminate the significance of routines in nursing practice. Clinical nursing is performed under the guidance of routines to varying degrees. In the nursing literature, routine is described as having both negative and positive aspects, but use of the term is inconsistent, and empirical evidence is sparse. In the research on organisational routines, a distinction is made between routine as a rule and routine as action. A qualitative design using a phenomenological-hermeneutic approach. Data collection from three focus groups focused on nurses' experience of routines. Seventeen individual interviews from a previous study focusing on caring culture were also analysed in a secondary qualitative analysis. All participants were employed as 'qualified nursing pool' nurses. Routines are experienced as pragmatic, obstructive and meaningful. The aim of the pragmatic routine was to ensure that daily working life works; this routine is practised more on the basis of rational arguments and obvious intentions. The obstructive routine had negative consequences for nursing practice and was described as nursing losing its humanity and violating the patient's integrity. The meaningful routine involved becoming one with the routine and for the nurses, it felt right and meaningful to adapt to it. Routines become meaningful when the individual action is in harmony with the cultural pattern on which the nursing work is based. Instead of letting contemporary practice passively become routine, routines can be assessed and developed using research and theoretical underpinnings as a starting point for nursing practice. Leaders have a special responsibility to develop and support meaningful routines. One approach could be to let wards examine their routines from a patient perspective on the basis of the themes of pragmatic, meaningful and obstructive routine. © 2010 Blackwell Publishing Ltd.

Trends in bednet ownership and usage, and the effect of bednets on malaria hospitalization in the Kilifi Health and Demographic Surveillance System (KHDSS): 2008-2015.

PubMed

Kamau, Alice; Nyaga, Victoria; Bauni, Evasius; Tsofa, Benjamin; Noor, Abdisalan M; Bejon, Philip; Scott, J Anthony G; Hammitt, Laura L

2017-11-15

Use of bednets reduces malaria morbidity and mortality. In Kilifi, Kenya, there was a mass distribution of free nets to children < 5 years in 2006. In 2009, a new policy was implemented to offer bednets to pregnant women and children < 5 years free of charge. Nets were again distributed to children and adults through national mass campaigns in 2012 and 2015. We aimed to evaluate trends in bednet ownership and usage, and the effect of bednets on the incidence of malaria hospitalization in children < 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS). Bednet ownership and usage were assessed during eight routine enumeration rounds of the KHDSS between 2008 and 2015. Malaria admissions (i.e. admissions to hospital with P. falciparum > 2500 parasitemia per μl) among children < 5 years were captured using a system of continuous vital registration that links admissions at Kilifi County Hospital to the KHDSS population register. Survival analysis was used to assess relative risk of hospitalization with malaria among children that reported using a bednet compared to those who did not. We observed 63% and 62% mean bednet ownership and usage, respectively, over the eight-survey period. Among children < 5 years, reported bednet ownership in October-December 2008 was 69% and in March-August 2009 was 73% (p < 0.001). An increase was also observed following the mass distribution campaigns in 2012 (62% in May-July 2012 vs 90% in May-October 2013, p < 0.001) and 2015 (68% in June-September 2015 vs 93% in October-November 2015, p < 0.001). Among children <5 years who reported using a net the night prior to the survey, the incidence of malaria hospitalization per 1000 child-years was 2.91 compared to 4.37 among those who did not (HR = 0.67, 95% CI: 0.52, 0.85 [p = 0.001]). On longitudinal surveillance, increasing bednet ownership and usage corresponded to mass distribution campaigns; however, this method of delivering bednets did not result in sustained improvements in coverage. Among children < 5 years old bednet use was associated with a 33% decreased incidence of malaria hospitalization.

Cost Effectiveness Analysis of Clinically Driven versus Routine Laboratory Monitoring of Antiretroviral Therapy in Uganda and Zimbabwe

PubMed Central

Medina Lara, Antonieta; Kigozi, Jesse; Amurwon, Jovita; Muchabaiwa, Lazarus; Nyanzi Wakaholi, Barbara; Mujica Mota, Ruben E.; Walker, A. Sarah; Kasirye, Ronnie; Ssali, Francis; Reid, Andrew; Grosskurth, Heiner; Babiker, Abdel G.; Kityo, Cissy; Katabira, Elly; Munderi, Paula; Mugyenyi, Peter; Hakim, James; Darbyshire, Janet; Gibb, Diana M.; Gilks, Charles F.

2012-01-01

Background Despite funding constraints for treatment programmes in Africa, the costs and economic consequences of routine laboratory monitoring for efficacy and toxicity of antiretroviral therapy (ART) have rarely been evaluated. Methods Cost-effectiveness analysis was conducted in the DART trial (ISRCTN13968779). Adults in Uganda/Zimbabwe starting ART were randomised to clinically-driven monitoring (CDM) or laboratory and clinical monitoring (LCM); individual patient data on healthcare resource utilisation and outcomes were valued with primary economic costs and utilities. Total costs of first/second-line ART, routine 12-weekly CD4 and biochemistry/haematology tests, additional diagnostic investigations, clinic visits, concomitant medications and hospitalisations were considered from the public healthcare sector perspective. A Markov model was used to extrapolate costs and benefits 20 years beyond the trial. Results 3316 (1660LCM;1656CDM) symptomatic, immunosuppressed ART-naive adults (median (IQR) age 37 (32,42); CD4 86 (31,139) cells/mm3) were followed for median 4.9 years. LCM had a mean 0.112 year (41 days) survival benefit at an additional mean cost of $765 [95%CI:685,845], translating into an adjusted incremental cost of $7386 [3277,dominated] per life-year gained and $7793 [4442,39179] per quality-adjusted life year gained. Routine toxicity tests were prominent cost-drivers and had no benefit. With 12-weekly CD4 monitoring from year 2 on ART, low-cost second-line ART, but without toxicity monitoring, CD4 test costs need to fall below $3.78 to become cost-effective (<3xper-capita GDP, following WHO benchmarks). CD4 monitoring at current costs as undertaken in DART was not cost-effective in the long-term. Conclusions There is no rationale for routine toxicity monitoring, which did not affect outcomes and was costly. Even though beneficial, there is little justification for routine 12-weekly CD4 monitoring of ART at current test costs in low-income African countries. CD4 monitoring, restricted to the second year on ART onwards, could be cost-effective with lower cost second-line therapy and development of a cheaper, ideally point-of-care, CD4 test. PMID:22545079

Safety of ranibizumab in routine clinical practice: 1-year retrospective pooled analysis of four European neovascular AMD registries within the LUMINOUS programme.

PubMed

Holz, Frank G; Bandello, Francesco; Gillies, Mark; Mitchell, Paul; Osborne, Aaron; Sheidow, Tom; Souied, Eric; Figueroa, Marta S

2013-09-01

Evaluation of 1-year safety profile of intravitreal ranibizumab 0.5 mg in neovascular age-related macular degeneration (NV-AMD) within routine clinical practice. The LUMINOUS programme comprises a prospective observational study assessing ranibizumab 'real-world' safety and clinical effectiveness across licensed indications worldwide and an annual retrospective pooled safety analysis from completed NV-AMD ranibizumab registries. 1-year data from four European registries are available. This retrospective pooled safety analysis assessed 1-year incidence rates for safety events of particular interest (key ocular or systemic events possibly related to the injection procedure or vascular endothelial growth factor inhibition) together with treatment exposure. Patients were treated according to local protocols within the ranibizumab licence. Data of 4444 patients from registries in Germany (n=3470), the Netherlands (n=243), Belgium (n=260) and Sweden (n=471) were retrospectively pooled. Between 70.4% and 84.4% of enrolled patients completed 1 year of follow-up. Most frequent overall ocular events of particular interest were retinal pigment epithelial tears (27 patients; <1%) and intraocular pressure-related events (12 patients; <0.3%). Most frequent non-ocular event of particular interest was stroke (19 patients; 0.4%); annual incidence of stroke was low across all registries (0.0-0.5%). Ranibizumab demonstrated favourable 1-year safety profile for NV-AMD in this routine clinical practice sample, consistent with previous reported trial data. Additional data from a larger patient population are needed to better describe the long-term safety profile of ranibizumab in routine clinical practice and further evaluate risk for infrequent but serious events in 'real-life' settings. The 5-year LUMINOUS prospective observational study will address this need.

Safety of ranibizumab in routine clinical practice: 1-year retrospective pooled analysis of four European neovascular AMD registries within the LUMINOUS programme

PubMed Central

Holz, Frank G; Bandello, Francesco; Gillies, Mark; Mitchell, Paul; Osborne, Aaron; Sheidow, Tom; Souied, Eric; Figueroa, Marta S

2013-01-01

Purpose Evaluation of 1-year safety profile of intravitreal ranibizumab 0.5 mg in neovascular age-related macular degeneration (NV-AMD) within routine clinical practice. Methods The LUMINOUS programme comprises a prospective observational study assessing ranibizumab ‘real-world’ safety and clinical effectiveness across licensed indications worldwide and an annual retrospective pooled safety analysis from completed NV-AMD ranibizumab registries. 1-year data from four European registries are available. This retrospective pooled safety analysis assessed 1-year incidence rates for safety events of particular interest (key ocular or systemic events possibly related to the injection procedure or vascular endothelial growth factor inhibition) together with treatment exposure. Patients were treated according to local protocols within the ranibizumab licence. Results Data of 4444 patients from registries in Germany (n=3470), the Netherlands (n=243), Belgium (n=260) and Sweden (n=471) were retrospectively pooled. Between 70.4% and 84.4% of enrolled patients completed 1 year of follow-up. Most frequent overall ocular events of particular interest were retinal pigment epithelial tears (27 patients; <1%) and intraocular pressure-related events (12 patients; <0.3%). Most frequent non-ocular event of particular interest was stroke (19 patients; 0.4%); annual incidence of stroke was low across all registries (0.0–0.5%). Conclusions Ranibizumab demonstrated favourable 1-year safety profile for NV-AMD in this routine clinical practice sample, consistent with previous reported trial data. Additional data from a larger patient population are needed to better describe the long-term safety profile of ranibizumab in routine clinical practice and further evaluate risk for infrequent but serious events in ‘real-life’ settings. The 5-year LUMINOUS prospective observational study will address this need. PMID:23850682

Impact of a Routine, Opt-Out HIV Testing Program on HIV Testing and Case Detection in North Carolina Sexually-Transmitted Disease Clinics

PubMed Central

Klein, Pamela W.; Messer, Lynne C.; Myers, Evan R.; Weber, David J.; Leone, Peter A.; Miller, William C.

2016-01-01

The impact of routine, opt-out HIV testing programs in clinical settings is inconclusive. The objective of this study was to estimate the impact of an expanded, routine HIV testing program in North Carolina sexually transmitted disease (STD) clinics on HIV testing and case detection. Adults aged 18–64 who received an HIV test in a North Carolina STD clinic July 1, 2005 through June 30, 2011 were included in this analysis, dichotomized at the date of implementation on November 1, 2007. HIV testing and case detection counts and rates were analyzed using interrupted time series analysis, and Poisson and multilevel logistic regression. Pre-intervention, 426 new HIV-infected cases were identified from 128,029 tests (0.33%), whereas 816 new HIV-infected cases were found from 274,745 tests post-intervention (0.30%). Pre-intervention, HIV testing increased by 55 tests per month (95% confidence interval [CI]: 41, 72), but only 34 tests per month (95% CI: 26, 42) post-intervention. Increases in HIV testing rates were most pronounced in females and non-Hispanic whites. A slight pre-intervention decline in case detection was mitigated by the intervention (mean difference [MD]=0.01; 95% CI: −0.02, 0.05). Increases in case detection rates were observed among females and non-Hispanic blacks. The impact of a routine HIV screening in North Carolina STD clinics was marginal, with the greatest benefit among persons not traditionally targeted for HIV testing. The use of a pre-intervention comparison period identified important temporal trends that otherwise would have been ignored. PMID:24825338

Short communication prevalence of susceptibility to etravirine by genotype and phenotype in samples received for routine HIV type 1 resistance testing in the United States.

PubMed

Picchio, Gaston; Vingerhoets, Johan; Tambuyzer, Lotke; Coakley, Eoin; Haddad, Mojgan; Witek, James

2011-12-01

Abstract The prevalence of susceptibility to etravirine was investigated among clinical samples submitted for routine clinical testing in the United States using two separate weighted genotypic scoring systems. The presence of etravirine mutations and susceptibility to etravirine by phenotype of clinical samples from HIV-1-infected patients, submitted to Monogram Biosciences for routine resistance testing between June 2008 and June 2009, were analyzed. Susceptibility by genotype was determined using the Monogram and Tibotec etravirine-weighted genotypic scoring systems, with scores of ≤3 and ≤2, respectively, indicating full susceptibility. Susceptibility by phenotype was determined using the PhenoSense HIV assay, with lower and higher clinical cut-offs of 2.9 and 10, respectively. The frequency of individual etravirine mutations and the impact of the K103N mutation on susceptibility to etravirine by genotype were also determined. Among the 5482 samples with ≥1 defined nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations associated with resistance, 67% were classed as susceptible to etravirine by genotype by both scoring systems. Susceptibility to etravirine by phenotype was higher (76%). The proportion of first-generation NNRTI-resistant samples with (n=3598) and without (n=1884) K103N with susceptibility to etravirine by genotype was 77% and 49%, respectively. Among samples susceptible to first-generation NNRTIs (n=9458), >99% of samples were susceptible to etravirine by phenotype (FC <2.9); the remaining samples had FC ≥2.9-10. In summary, among samples submitted for routine clinical testing in the United States, a high proportion of samples with first-generation NNRTI resistance was susceptible to etravirine by genotype and phenotype. A higher proportion of NNRTI-resistant samples with K103N than without was susceptible to etravirine.

Vascular access clinic results before and after implementing a multidisciplinary approach adding routine Doppler ultrasound.

PubMed

Aragoncillo Sauco, Inés; Ligero Ramos, José Manuel; Vega Martínez, Almudena; Morales Muñoz, Ángel Luis; Abad Estébanez, Soraya; Macías Carmona, Nicolás; Ruiz Chiriboga, Diego; García Pajares, Rosario; Cervera Bravo, Teresa; López-Gómez, Juan Manuel; Manzano Grossi, Soledad; Menéndez Sánchez, Elena; Río Gomez, Javier; García Prieto, Ana María; Linares Grávalos, Tania; Garcia Boyano, Fernando; Reparaz Asensio, Luis Manuel; Albalate Ramón, Marta; de Sequera Ortiz, Patricia; Gil Casares, Beatriz; Ampuero Mencía, Jara; Castellano, Sandra; Martín Pérez, Belén; Conty, José Luís Martín; Santos Garcia, Alba; Luño Fernandez, José

2018-06-11

A multidisciplinary approach and Doppler ultrasound (DU) assessment for the creation and maintenance of arteriovenous fistulas (AVF) for haemodialysis can improve prevalence and patency. The aim of this study was to analyse the impact of a new multidisciplinary vascular access (VA) clinic with routine DU. We analysed the VA clinic results from 2014 and 2015, before and after the implementation of a multidisciplinary team protocol (vascular surgeon/nephrologist) with routine DU in preoperative mapping and prevalent AVF. We analysed 345 and 364 patients from 2014 and 2015 respectively. The number of surgical interventions was similar in both periods (p=.289), with a trend towards an increase in preventive surgical repair of AVF in 2015 (17 vs. 29, p=.098). 155 vs. 169 new AVF were performed in 2014 and 2015, with a significantly lower primary failure rate in 2015 (26.4 vs. 15.3%, p=.015), and a non-significant increase in radiocephalic AVF, 25.8 vs. 33.2% (n=40 vs. 56), p=.159. The concordance between the indication at the clinic and the surgery performed also increased (81.3 vs. 93.5%, p=.001). Throughout 2015 fewer complementary imaging test were requested from the clinic (78 vs. 35, p <.001), with a corresponding reduction in costs (€87,716 vs. €59,445). Multidisciplinary approach with routine DU can improve VA results, with a decrease in primary failure rate, higher likelihood of radiocephalic AVF, better management of dis-functioning AVF and lower radiological test costs. Copyright © 2018 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Predicate Argument Structure Frames for Modeling Information in Operative Notes

PubMed Central

Wang, Yan; Pakhomov, Serguei; Melton, Genevieve B.

2015-01-01

The rich information about surgical procedures contained in operative notes is a valuable data source for improving the clinical evidence base and clinical research. In this study, we propose a set of Predicate Argument Structure (PAS) frames for surgical action verbs to assist in the creation of an information extraction (IE) system to automatically extract details about the techniques, equipment, and operative steps from operative notes. We created PropBank style PAS frames for the 30 top surgical action verbs based on examination of randomly selected sample sentences from 3,000 Laparoscopic Cholecystectomy notes. To assess completeness of the PAS frames to represent usage of same action verbs, we evaluated the PAS frames created on sample sentences from operative notes of 6 other gastrointestinal surgical procedures. Our results showed that the PAS frames created with one type of surgery can successfully denote the usage of the same verbs in operative notes of broader surgical categories. PMID:23920664

The efficacy of routine hyperventilation for seizure activation during prolonged video-electroencephalography monitoring.

PubMed

Abubakr, Abuhuziefa; Ifeayni, Iwuchukwu; Wambacq, Ilse

2010-12-01

Hyperventilation (HV) is considered to be one of the activation procedures that provokes epileptic potentials and clinical seizures. However, the true clinical yield of HV is not well established. We retrospectively reviewed the records of all patients admitted to JFK Hospital, Edison, New Jersey, between October 2001 and December 2004 for long-term video-electroencephalography (EEG). A total of 475 patients (193 males; 282 females; age range 5-89 years) were included in the study. All patients underwent routine 3-minute HV as part of the evaluation of their clinical episodes. During the initial assessment, 165 patients did not experience a seizure event, 92 had non-epileptic events, 16 experienced psychogenic non-epileptic seizures (PNES) and six had a clinical event. During HV, of the 43 patients who had primary generalized epilepsy, nine had an abnormal EEG and two experienced seizures; however, out of the 159 patients who had partial seizures, only one patient demonstrated an abnormal EEG. Our study demonstrates that routine HV generally has a very low yield in our Epilepsy-Monitoring Unit. This finding also lends support to the idea that partial seizures are relatively resistant to HV activation. Copyright © 2010 Elsevier Ltd. All rights reserved.

Routine clinical application of virtual reality in abdominal surgery.

PubMed

Sampogna, Gianluca; Pugliese, Raffaele; Elli, Marco; Vanzulli, Angelo; Forgione, Antonello

2017-06-01

The advantages of 3D reconstruction, immersive virtual reality (VR) and 3D printing in abdominal surgery have been enunciated for many years, but still today their application in routine clinical practice is almost nil. We investigate their feasibility, user appreciation and clinical impact. Fifteen patients undergoing pancreatic, hepatic or renal surgery were studied realizing a 3D reconstruction of target anatomy. Then, an immersive VR environment was developed to import 3D models, and some details of the 3D scene were printed. All the phases of our workflow employed open-source software and low-cost hardware, easily implementable by other surgical services. A qualitative evaluation of the three approaches was performed by 20 surgeons, who filled in a specific questionnaire regarding a clinical case for each organ considered. Preoperative surgical planning and intraoperative guidance was feasible for all patients included in the study. The vast majority of surgeons interviewed scored their quality and usefulness as very good. Despite extra time, costs and efforts necessary to implement these systems, the benefits shown by the analysis of questionnaires recommend to invest more resources to train physicians to adopt these technologies routinely, even if further and larger studies are still mandatory.

Direct Microscopy: A Useful Tool to Diagnose Oral Candidiasis in Children and Adolescents.

PubMed

Marty, Mathieu; Bourrat, Emmanuelle; Vaysse, Frédéric; Bonner, Mark; Bailleul-Forestier, Isabelle

2015-12-01

Oral candidiasis is one of the most common opportunistic fungal infections of the oral cavity in human. Among children, this condition represents one of the most frequent affecting the mucosa. Although most diagnoses are made based on clinical signs and features, a microbiological analysis is sometimes necessary. We performed a literature review on the diagnosis of oral candidiasis to identify the techniques most commonly employed in routine clinical practice. A Medline-PubMed search covering the last 10 years was performed. Microbiological techniques were used in cases requiring confirmation of the clinical diagnosis. In such cases, direct microscopy was the method most commonly used for diagnosing candidiasis. Direct microscopy appears as the method of choice for confirming clinical diagnosis and could become a routine chair-side technique.

Characteristics of Real-World Metastatic Non-Small Cell Lung Cancer Patients Treated with Nivolumab and Pembrolizumab During the Year Following Approval.

PubMed

Khozin, Sean; Abernethy, Amy P; Nussbaum, Nathan C; Zhi, Jizu; Curtis, Melissa D; Tucker, Melisa; Lee, Shannon E; Light, David E; Gossai, Anala; Sorg, Rachael A; Torres, Aracelis Z; Patel, Payal; Blumenthal, Gideon Michael; Pazdur, Richard

2018-03-01

Evidence from cancer clinical trials can be difficult to generalize to real-world patient populations, but can be complemented by real-world evidence to optimize personalization of care. Further, real-world usage patterns of programmed cell death protein 1 (PD-1) inhibitors following approval can inform future studies of subpopulations underrepresented in clinical trials. We performed a multicenter analysis using electronic health record data collected during routine care of patients treated in community cancer care clinics in the Flatiron Health network. Real-world metastatic non-small cell lung cancer (NSCLC) patients who received nivolumab or pembrolizumab in the metastatic setting ( n  = 1,344) were selected from a starting random sample of 55,969 NSCLC patients with two or more documented visits from January 1, 2011, through March 31, 2016. The primary study outcome measurement was demographic and treatment characteristics of the cohort. Median age at PD-1 inhibitor initiation was 69 years (interquartile range 61-75). Patients were 56% male, 88% smokers, 65% nonsquamous histology, and 64% diagnosed at stage IV. Of 1,344 patients, 112 (8%) were tested for programmed death-ligand 1 expression. Overall, 50% received nivolumab or pembrolizumab in the second line, with a substantial proportion of third and later line use that began to decline in Q4 2015. During the year following U.S. regulatory approval of PD-1 inhibitors for treatment of NSCLC, real-world patients receiving nivolumab or pembrolizumab were older at treatment initiation and more had smoking history relative to clinical trial cohorts. Studies of outcomes in underrepresented subgroups are needed to inform real-world treatment decisions. Evidence gathered in conventional clinical trials used to assess safety and efficacy of new therapies is not necessarily generalizable to real-world patients receiving these drugs following regulatory approval. Real-world evidence derived from electronic health record data can yield complementary evidence to enable optimal clinical decisions. Examined here is a cohort of programmed cell death protein 1 inhibitor-treated metastatic non-small cell lung cancer patients in the first year following regulatory approval of these therapies in this indication. The analysis revealed how the real-world cohort differed from the clinical trial cohorts, which will inform which patients are underrepresented and warrant additional studies. © AlphaMed Press 2018.

Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital.

PubMed

Khan, Junaid H; Green, Emily A; Chang, Jimmin; Ayala, Alexandria M; Barkin, Marilyn S; Reinys, Emily E; Stanton, Jeffrey; Stanten, Russell D

2017-12-01

Blood product usage is a quality outcome for patients undergoing cardiac surgery. To address an increase in blood product usage since the discontinuation of aprotinin, blood conservation strategies were initiated at a tertiary hospital in Oakland, CA. Improving transfusion rates for open heart surgery patients requiring Cardiopulmonary bypass (CPB) involved multiple departments in coordination. Specific changes to conserve blood product usage included advanced CPB technology upgrades, and precise individualized heparin dose response titration assay for heparin and protamine management. Retrospective analysis of blood product usage pre-implementation, post-CPB changes and post-Hemostasis Management System (HMS) implementation was done to determine the effectiveness of the blood conservation strategies. Statistically significant decrease in packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelet usage over the stepped implementation of both technologies was observed. New oxygenator and centrifugal pump technologies reduced active circuitry volume and caused less damage to blood cells. Individualizing heparin and protamine dosing to a patient using the HMS led to transfusion reductions as well. Overall trends toward reductions in hospital length of stay and intensive care unit stay, and as a result, blood product cost and total hospitalization cost are positive over the period of implementation of both CPB circuit changes and HMS implementation. Although they are multifactorial in nature, these trends provide positive enforcement to the changes implemented.

Comparison of salt taste thresholds and salt usage behaviours between adults in Myanmar and Korea.

PubMed

Cho, Hyungjin; Kim, So Mi; Jeong, Seong Su; Kim, Soon Bae

2016-12-01

Excessive oral salt intake can induce hypertension. According to previous studies, the prevalence of hypertension is higher in Myanmar than in Korea. We postulated that Myanmar adults had higher salt taste thresholds and eat much saltier food. This study aimed to compare salt taste thresholds and salt usage behaviour scores between adults in Myanmar and Korea. This cross-sectional study enrolled patients who visited volunteer medical service clinics at Ansung in Korea and Hlegu and Bago in Myanmar in August 2014. We measured the vital signs, heights, and weights of each patient and evaluated detection thresholds, recognition thresholds, and salt preferences. All patients underwent urinalysis and spot urine Na tests. Additionally, they each completed a salt usage behaviour questionnaire. A total of 131 patients were enrolled, including 64 Myanmarese patients and 67 Korean patients. Blood pressure was significantly higher in the Myanmarese than in the Koreans. Detection and recognition thresholds, salt preferences, and spot urine sodium and salt usage behaviour scores were also higher in the Myanmarese than in the Korean subjects. We calculated correlation coefficients between systolic blood pressure and parameters that were related to salt intake. The detection and recognition thresholds were significantly correlated with systolic blood pressure. All parameters related to salt intake, including detection and recognition thresholds, salt preference, salt usage behaviour scores and spot urine sodium concentrations, are significantly higher in Myanmarese than in Korean individuals.

Individualized radiotherapy by combining high-end irradiation and magnetic resonance imaging.

PubMed

Combs, Stephanie E; Nüsslin, Fridtjof; Wilkens, Jan J

2016-04-01

Image-guided radiotherapy (IGRT) has been integrated into daily clinical routine and can today be considered the standard especially with high-dose radiotherapy. Currently imaging is based on MV- or kV-CT, which has clear limitations especially in soft-tissue contrast. Thus, combination of magnetic resonance (MR) imaging and high-end radiotherapy opens a new horizon. The intricate technical properties of MR imagers pose a challenge to technology when combined with radiation technology. Several solutions that are almost ready for routine clinical application have been developed. The clinical questions include dose-escalation strategies, monitoring of changes during treatment as well as imaging without additional radiation exposure during treatment.

Molecular and antimicrobial susceptibility characterization of Globicatella sulfidifaciens isolated from sow's urinary tract infection.

PubMed

Matajira, Carlos E C; Moreno, Luisa Z; Gomes, Vasco T M; Silva, Ana Paula S; Mesquita, Renan E; Amigo, Cristina R; Christ, Ana Paula G; Sato, Maria Inês Z; Moreno, Andrea M

2017-12-01

The Globicatella genus comprises Gram-positive, facultative anaerobic, α-hemolytic and catalase negative cocci morphologically and phenotypically very similar to Streptococcus and Aerococcus genus which can lead to misidentification and underestimation of this pathogen. Globicatella species have already been isolated from human and animals with heart and brain disorders. Their clinical relevance in animals, and its zoonotic potential, remains unknown due to the difficulty in their identification. To present the isolation, phenotypic and molecular characterization of G. sulfidifaciens from urinary tract infection in sows. Urine samples from 140 sows of two swine herds located in São Paulo State (Brazil) yielded the isolation of three presumptive G. sulfidifaciens strains. Identification and species confirmation were done by MALDI-TOF MS and 16S rRNA sequencing. Strains were further characterized by single enzyme amplified fragments length polymorphism (SE-AFLP) and broth microdilution techniques. All three isolates were confirmed as G. sulfidifaciens. The SE-AFLP genotyping resulted in distinct fingerprint patterns for each strain. All isolates presented high MIC values to tetracycline, sulphonamides, aminoglycosides and tylosin tartrate, which present high usage in human and animal medicine. Globicatella sulfidifaciens could be related to sporadic urinary tract infections in swine and appear to present alarming antimicrobial susceptibility profile. It is necessary to differentiate Streptococcus-like microorganisms in routine laboratory diagnostics for the correct identification of underestimated species potentially pathogenic to animals.

Advances in PET myocardial perfusion imaging: F-18 labeled tracers.

PubMed

Rischpler, Christoph; Park, Min-Jae; Fung, George S K; Javadi, Mehrbod; Tsui, Benjamin M W; Higuchi, Takahiro

2012-01-01

Coronary artery disease and its related cardiac disorders represent the most common cause of death in the USA and Western world. Despite advancements in treatment and accompanying improvements in outcome with current diagnostic and therapeutic modalities, it is the correct assignment of these diagnostic techniques and treatment options which are crucial. From a diagnostic standpoint, SPECT myocardial perfusion imaging (MPI) using traditional radiotracers like thallium-201 chloride, Tc-99m sestamibi or Tc-99m tetrofosmin is the most utilized imaging technique. However, PET MPI using N-13 ammonia, rubidium-82 chloride or O-15 water is increasing in availability and usage as a result of the growing number of medical centers with new-generation PET/CT systems taking advantage of the superior imaging properties of PET over SPECT. The routine clinical use of PET MPI is still limited, in part because of the short half-life of conventional PET MPI tracers. The disadvantages of these conventional PET tracers include expensive onsite production and inconvenient on-scanner tracer administration making them unsuitable for physical exercise stress imaging. Recently, two F-18 labeled radiotracers with longer radioactive half-lives than conventional PET imaging agents have been introduced. These are flurpiridaz F 18 (formerly known as F-18 BMS747158-02) and F-18 fluorobenzyltriphenylphosphonium. These longer half-life F-18 labeled perfusion tracers can overcome the production and protocol limitations of currently used radiotracers for PET MPI.

Impact of self-funding on patient experience of oral anticoagulation self-monitoring: a qualitative study

PubMed Central

Tompson, Alice; Heneghan, Carl; Sutton, Stephen; Fitzmaurice, David; Ward, Alison

2016-01-01

Objective To explore the impact self-funding has on patient experience of oral anticoagulation therapy self-monitoring. Design Semistructured, qualitative interviews were conducted. Transcripts were analysed thematically using constant comparison. Setting England. Participants Interviewees were participants of the Cohort Study of Anticoagulation Self-Monitoring (CASM). Cohort members were recruited as they bought a monitor from the major manufacturer in the UK. A purposive sample was invited to be interviewed on completion of the 12-month cohort follow-up. Data Patient narratives on their experiences of self-monitoring their oral anticoagulation therapy in non-trial conditions. Results 26 interviews were completed. Interviewees viewed purchasing the monitoring device as a long-term commitment balancing the limitations of clinic-based monitoring against the cost. They were unable to try out the monitor prior to purchase and therefore had to be confident in their own ability to use it. The variable provision of self-monitoring equipment caused resentment, and interviewees were uncomfortable negotiating with healthcare professionals. High test strip usage while learning how to use the monitor caused anxiety that was exacerbated by worries about their cost. However, self-funding did mean that interviewees felt a sense of ownership and were determined to persevere to overcome problems. Conclusions Self-funding has negative implications in terms of equity of access; however, the money invested acts as a barrier to discontinuation. If oral anticoagulation therapy self-monitoring devices and consumables were provided free of charge in routine care, the training and support available in England may need to be reviewed to prevent discontinuation rates rising to those observed in clinical trials. PMID:28011812

Building better research partnerships by understanding how Aboriginal health communities perceive and use data: a semistructured interview study.

PubMed

Young, Christian; Tong, Allison; Sherriff, Simone; Kalucy, Deanna; Fernando, Peter; Muthayya, Sumithra; Craig, Jonathan C

2016-04-25

To describe the attitudes and beliefs of health professionals working in Aboriginal Community Controlled Health Services (ACCHS) towards the access, usage and potential value of routinely obtained clinical and research data. Face-to-face, semistructured interviews were conducted with 35 health professionals from 2 urban and 1 regional ACCHS in New South Wales. The interviews were transcribed and themes were identified using an adapted grounded theory approach. Six major themes were identified: occupational engagement (day-to-day relevance, contingent on professional capacity, emphasising clinical relevance), trust and assurance (protecting ownership, confidence in narratives, valuing local sources), motivation and empowerment (engaging the community, influencing morale, reassuring and encouraging clients), building research capacity (using cultural knowledge, promoting research aptitude, prioritising specific data), optimising service provision (necessity for sustainable services, guiding and improving services, supporting best practice), and enhancing usability (ensuring ease of comprehension, improving efficiency of data management, valuing accuracy and accessibility). Participants were willing to learn data handling procedures that could further enhance health service delivery and enable more ACCHS-led research, but busy workloads restrict these opportunities. Staff held concerns regarding the translation of research data into beneficial services, and believed that the outcome and purpose of data collection could be communicated more clearly. Promoting research partnerships, ensuring greater awareness of positive health data and the purposes of data collection, and communicating data in a user-friendly format are likely to encourage greater data use, build research capacity and improve health services within the Aboriginal community. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Digital breast tomosynthesis (DBT): recommendations from the Italian College of Breast Radiologists (ICBR) by the Italian Society of Medical Radiology (SIRM) and the Italian Group for Mammography Screening (GISMa).

PubMed

Bernardi, Daniela; Belli, Paolo; Benelli, Eva; Brancato, Beniamino; Bucchi, Lauro; Calabrese, Massimo; Carbonaro, Luca A; Caumo, Francesca; Cavallo-Marincola, Beatrice; Clauser, Paola; Fedato, Chiara; Frigerio, Alfonso; Galli, Vania; Giordano, Livia; Giorgi Rossi, Paolo; Golinelli, Paola; Morrone, Doralba; Mariscotti, Giovanna; Martincich, Laura; Montemezzi, Stefania; Naldoni, Carlo; Paduos, Adriana; Panizza, Pietro; Pediconi, Federica; Querci, Fiammetta; Rizzo, Antonio; Saguatti, Gianni; Tagliafico, Alberto; Trimboli, Rubina M; Zappa, Marco; Zuiani, Chiara; Sardanelli, Francesco

2017-10-01

This position paper, issued by ICBR/SIRM and GISMa, summarizes the evidence on DBT and provides recommendations for its use. In the screening setting, DBT in adjunct to digital mammography (DM) increased detection rate by 0.5-2.7‰ and decreased false positives by 0.8-3.6% compared to DM alone in observational and double-testing experimental studies. The reduction in recall rate could be less prominent in those screening programs which already have low recall rates with DM. The increase in radiation exposure associated with DM/DBT protocols has been solved by the introduction of synthetic mammograms (sDM) reconstructed from DBT datasets. Thus, whenever possible, sDM/DBT should be preferred to DM/DBT. However, before introducing DBT as a routine screening tool for average-risk women, we should wait for the results of randomized controlled trials and for a statistically significant and clinically relevant reduction in the interval cancer rate, hopefully associated with a reduction in the advanced cancer rate. Otherwise, a potential for overdiagnosis and overtreatment cannot be excluded. Studies exploring this issue are ongoing. Screening of women at intermediate risk should follow the same recommendations, with particular protocols for women with previous BC history. In high-risk women, if mammography is performed as an adjunct to MRI or in the case of MRI contraindications, sDM/DBT protocols are suggested. Evidence exists in favor of DBT usage in women with clinical symptoms/signs and asymptomatic women with screen-detected findings recalled for work-up. The possibility to perform needle biopsy or localization under DBT guidance should be offered when DBT-only findings need characterization or surgery.

HipMatch: an object-oriented cross-platform program for accurate determination of cup orientation using 2D-3D registration of single standard X-ray radiograph and a CT volume.

PubMed

Zheng, Guoyan; Zhang, Xuan; Steppacher, Simon D; Murphy, Stephen B; Siebenrock, Klaus A; Tannast, Moritz

2009-09-01

The widely used procedure of evaluation of cup orientation following total hip arthroplasty using single standard anteroposterior (AP) radiograph is known inaccurate, largely due to the wide variability in individual pelvic orientation relative to X-ray plate. 2D-3D image registration methods have been introduced for an accurate determination of the post-operative cup alignment with respect to an anatomical reference extracted from the CT data. Although encouraging results have been reported, their extensive usage in clinical routine is still limited. This may be explained by their requirement of a CAD model of the prosthesis, which is often difficult to be organized from the manufacturer due to the proprietary issue, and by their requirement of either multiple radiographs or a radiograph-specific calibration, both of which are not available for most retrospective studies. To address these issues, we developed and validated an object-oriented cross-platform program called "HipMatch" where a hybrid 2D-3D registration scheme combining an iterative landmark-to-ray registration with a 2D-3D intensity-based registration was implemented to estimate a rigid transformation between a pre-operative CT volume and the post-operative X-ray radiograph for a precise estimation of cup alignment. No CAD model of the prosthesis is required. Quantitative and qualitative results evaluated on cadaveric and clinical datasets are given, which indicate the robustness and the accuracy of the program. HipMatch is written in object-oriented programming language C++ using cross-platform software Qt (TrollTech, Oslo, Norway), VTK, and Coin3D and is transportable to any platform.

Reaching out to the forgotten: providing access to medical care for the homeless in Italy

PubMed Central

De Maio, Gianfranco; Van den Bergh, Rafael; Garelli, Silvia; Maccagno, Barbara; Raddi, Freja; Stefanizzi, Alice; Regazzo, Costantina; Zachariah, Rony

2014-01-01

Background A program for outpatient and intermediate inpatient care for the homeless was pioneered by the humanitarian organization Médecins Sans Frontières (MSF) in Milan, Italy, during the winter of 2012-2013. We aimed to document the characteristics and clinical management of inpatients and outpatients seen during this program. Methods A clinic providing outpatient and intermediate inpatient care (24 bed capacity) was set up in an existing homeless hostel. Patients were admitted for post-hospitalization intermediate care or for illnesses not requiring secondary care. This study was a retrospective audit of the routine program data. Results Four hundred and fifty four individuals presented for outpatient care and 123 patients were admitted to inpatient intermediary care. On average one outpatient consultation was conducted per patient per month, most for acute respiratory tract infections (39.8%; 522/1311). Eleven percent of all outpatients suffered from an underlying chronic condition and 2.98% (38/1311) needed referral to emergency services or secondary care facilities. Most inpatients were ill patients referred through public reception centers (72.3%; 89/123), while 27.6% (34/123) were post-hospitalization patients requiring intermediate care. Out of all inpatients, 41.4% (51/123) required more than 1 week of care and 6.5% (8/123) needed counter-referral to secondary care. Conclusions The observed service usage, morbidity patterns, relatively long lengths of stay, high referral completion and need for counter-referrals, all reflect the important gap-filling role played by an intermediate care facility for this vulnerable population. We recommend that in similar contexts, medical non-governmental organizations (NGOs) focus on the setup of inpatient intermediary care services; while outpatient services are covered by the public health system. PMID:24505079

Positron emission tomography in oncology: the most sophisticated imaging technology.

PubMed

Lacić, M; Maisey, M N; Kusić, Z

1997-01-01

The primary aim of this paper is to present a new nuclear medicine technology, which has just recently crossed over the clinical-research barrier. Positron emission tomography (PET) has become one of the routine functional imaging techniques in the most developed countries. The biggest advantage of PET is the usage of short-lived positron emission radionuclides, e.g., fluorine-18 (F-18), carbon-11 (C-11), nitrogen-13, and oxygen-15 (0-15). These radionuclides could be incorporated (H2O15) or linked (F-18 fluorodeoxyglucose (FDG) to different metabolically active molecules. In this way, it is possible to image and quantify the metabolic activity of various disorders and diseases including different types of tumors. The authors have concentrated on the PET rule in oncology. FDG and C-11 methionine are the most widely used PET radiopharmaceuticals in tumor imaging today, thus the results of human PET studies with FDG and C-11 methionine in the evaluation of tumors have been reviewed. The facts about the mechanism of uptake of both metabolic PET radiopharmaceuticals as well as the kinetics of tracers in normal and tumor tissue are described. The problem of accumulation of these tracers in some benign lesions is also mentioned. PET could be used for the evaluation of tumor response to therapy and duration of therapeutic effects in follow-up studies. PET offers a unique possibility to fully quantify the tumor metabolic activity, although semi-quantitative approaches are clinically more convenient. At the end, comparative studies of FDG and C-11 methionine in tumor evaluation are analyzed. A double-tracer FDG and C-11 methionine scanning protocol has been suggested as very useful for the assessment of brain tumor. This finding was also supported by the authors' data.

New Delivery Model for Rising-Risk Patients: The Forgotten Lot?

PubMed

Cheung, Lauren; Norden, Justin; Harrington, Robert A; Desai, Sumbul A

2017-08-01

Shared-risk models encourage providers to engage young patients early. Telemedicine may be well suited for younger, healthier patients although it is unclear how best to incorporate telemedicine into routine clinical care. We test the assumptions surrounding the use of telemedicine, younger and rising-risk patients, and primary care in ClickWell Care (CWC), a care model developed at our institution for our own accountable care organization. CWC's team of physicians and wellness coaches work together to provide comprehensive primary care through in-person, phone, and video visits. This study examines usage of the clinic over its initial year in operation. 1,464 unique patients conducted a total of 3,907 visits. 2,294 (58.7%) visits were completed virtually (1,382 [35.4%] by phone and 912 [23.3%] by video). Patients were more inclined to see the physician in-person for a new visit (1,065 visits [70.5%] vs. 362 [24%] phone and 83 [6%] video) and more likely to see the physician virtually for a return visit (606 [43.2%] phone and 249 [17.7%] video vs. 548 [39.1%] in-person), a statistically significant difference (X 2  = 306.7, p < 0.00001). This new care model successfully engaged a younger population of patients. However, our data suggest young patients may not be inclined to establish care with a primary care physician virtually and, in fact, choose an initial in-person touch point, although many are willing to conduct return visits virtually. This new model of care could have a large impact on how care is delivered to low- and rising-risk patients.

Assessment of Tobacco Habits, Attitudes, and Education Among Medical Students in the United States and Italy: A Cross-sectional Survey

PubMed Central

Armstrong, Grayson W.; George, Paul F.; Montroni, Isacco; Ugolini, Giampaolo

2017-01-01

Objectives Medical students represent a primary target for tobacco cessation training. This study assessed the prevalence of medical students’ tobacco use, attitudes, clinical skills, and tobacco-related curricula in two countries, the US and Italy, with known baseline disparities in hopes of identifying potential corrective interventions. Methods From September to December 2013, medical students enrolled at the University of Bologna and at Brown University were recruited via email to answer survey questions assessing the prevalence of medical students’ tobacco use, attitudes and clinical skills related to patients’ smoking, and elements of medical school curricula related to tobacco use. Results Of the 449 medical students enrolled at Brown and the 1426 enrolled at Bologna, 174 Brown students (38.7%) and 527 Bologna students (36.9%) participated in this study. Italian students were more likely to smoke (29.5% vs. 6.1%; p<0.001) and less likely to receive smoking cessation training (9.4% vs. 80.3%; p<0.001) than their American counterparts, even though the majority of students in both countries desired smoking cessation training (98.6% at Brown, 85.4% at Bologna; p<0.001). Additionally, negative beliefs regarding tobacco usage, the absence of formal training in smoking cessation counseling, and a negative interest in receiving specific training on smoking cessation were associated with a higher risk of not investigating a patient’s smoking status during a routine history and not offering tobacco cessation treatment to patients. Conclusions Medical curricula on tobacco-related health hazards and on smoking cessation should be mandatory in order to reduce smoking among medical students, physicians, and patients, thereby improving tobacco-related global health. PMID:28605889

Statistical reporting of clinical pharmacology research.

PubMed

Ring, Arne; Schall, Robert; Loke, Yoon K; Day, Simon

2017-06-01

Research in clinical pharmacology covers a wide range of experiments, trials and investigations: clinical trials, systematic reviews and meta-analyses of drug usage after market approval, the investigation of pharmacokinetic-pharmacodynamic relationships, the search for mechanisms of action or for potential signals for efficacy and safety using biomarkers. Often these investigations are exploratory in nature, which has implications for the way the data should be analysed and presented. Here we summarize some of the statistical issues that are of particular importance in clinical pharmacology research. © 2017 The British Pharmacological Society.

Delivery of electroconvulsive therapy in Canada: a first national survey report on usage, treatment practice, and facilities.

PubMed

Martin, Barry A; Delva, Nicholas John; Graf, Peter; Gosselin, Caroline; Enns, Murray W; Gilron, Ian; Jewell, Mark; Lawson, James Stuart; Milev, Roumen; Patry, Simon; Chan, Peter K Y

2015-06-01

The aims of this study were to document electroconvulsive therapy use in Canada with respect to treatment facilities and caseloads based on a survey of practice (Canadian Electroconvulsive Therapy Survey/Enquete Canadienne Sur Les Electrochocs-CANECTS/ECANEC) and to consider these findings in the context of guideline recommendations. All 1273 registered hospitals in Canada were contacted, and 175 sites were identified as providing electroconvulsive therapy; these sites were invited to complete a comprehensive questionnaire. The survey period was calendar year 2006 or fiscal year 2006/2007. National usage rates were estimated from the responses. Sixty-one percent of the sites completed the questionnaire; a further 10% provided caseload data. Seventy were identified as general; 31, as university teaching; and 21, as provincial psychiatric/other single specialty (psychiatric) hospitals. Caseload volumes ranged from a mean of fewer than 2 to greater than 30 treatments per week. Estimated national usage during the 1-year survey period was 7340 to 8083 patients (2.32-2.56 per 10,000 population) and 66,791 to 67,424 treatments (2.11-2.13 per 1000 population). The diagnostic indications, admission status, and protocols for course end points are described. The usage rates are in keeping with earlier Canadian data and with those from other jurisdictions. The difficulty obtaining caseload data from individual hospitals is indicative of the need for standardized data collection to support both clinical research and quality assurance. The wide variation in protocols for number of treatments per course indicates a need for better informed clinical guidelines. The broad range of caseload volumes suggests the need to review the economies of scale in the field.

Information needs of generalists and specialists using online best-practice algorithms to answer clinical questions.

PubMed

Cook, David A; Sorensen, Kristi J; Linderbaum, Jane A; Pencille, Laurie J; Rhodes, Deborah J

2017-07-01

To better understand clinician information needs and learning opportunities by exploring the use of best-practice algorithms across different training levels and specialties. We developed interactive online algorithms (care process models [CPMs]) that integrate current guidelines, recent evidence, and local expertise to represent cross-disciplinary best practices for managing clinical problems. We reviewed CPM usage logs from January 2014 to June 2015 and compared usage across specialty and provider type. During the study period, 4009 clinicians (2014 physicians in practice, 1117 resident physicians, and 878 nurse practitioners/physician assistants [NP/PAs]) viewed 140 CPMs a total of 81 764 times. Usage varied from 1 to 809 views per person, and from 9 to 4615 views per CPM. Residents and NP/PAs viewed CPMs more often than practicing physicians. Among 2742 users with known specialties, generalists ( N  = 1397) used CPMs more often (mean 31.8, median 7 views) than specialists ( N  = 1345; mean 6.8, median 2; P  < .0001). The topics used by specialists largely aligned with topics within their specialties. The top 20% of available CPMs (28/140) collectively accounted for 61% of uses. In all, 2106 clinicians (52%) returned to the same CPM more than once (average 7.8 views per topic; median 4, maximum 195). Generalists revisited topics more often than specialists (mean 8.8 vs 5.1 views per topic; P  < .0001). CPM usage varied widely across topics, specialties, and individual clinicians. Frequently viewed and recurrently viewed topics might warrant special attention. Specialists usually view topics within their specialty and may have unique information needs. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

[Exploring nurse, usage effectiveness of mobile nursing station].

PubMed

Chang, Fang-Mei; Lee, Ting-Ting

2013-04-01

A mobile nursing station is an innovative cart that integrates a wireless network, information technology devices, and online charts. In addition to improving clinical work and workflow efficiencies, data is integrated among different information systems and hardware devices to promote patient safety. This study investigated the effectiveness of mobile nursing cart use. We compared different distributions of nursing activity working samples to evaluate the nursing information systems in terms of interface usability and usage outcomes. There were two parts of this study. Part one used work sampling to collect nursing activity data necessary to compare a unit that used a mobile nursing cart (mobile group, n = 18) with another that did not (traditional group, n = 14). Part two applied a nursing information system interface usability questionnaire to survey the mobile unit with nurses who had used a mobile nursing station (including those who had worked in this unit as floating nurses) (n = 30) in order to explore interface usability and effectiveness. We found that using the mobile nursing station information system increased time spent on direct patient care and decreased time spent on indirect patient care and documentation. Results further indicated that participants rated interface usability as high and evaluated usage effectiveness positively. Comments made in the open-ended question section raised several points of concern, including problems / inadequacies related to hardware devices, Internet speed, and printing. This study indicates that using mobile nursing station can improve nursing activity distributions and that nurses hold generally positive attitudes toward mobile nursing station interface usability and usage effectiveness. The authors thus encourage the continued implementation of mobile nursing stations and related studies to further enhance clinical nursing care.

Isothermal multiple displacement amplification: a methodical approach enhancing molecular routine diagnostics of microcarcinomas and small biopsies.

PubMed

Mairinger, Fabian D; Walter, Robert Fh; Vollbrecht, Claudia; Hager, Thomas; Worm, Karl; Ting, Saskia; Wohlschläger, Jeremias; Zarogoulidis, Paul; Zarogoulidis, Konstantinos; Schmid, Kurt W

2014-01-01

Isothermal multiple displacement amplification (IMDA) can be a powerful tool in molecular routine diagnostics for homogeneous and sequence-independent whole-genome amplification of notably small tumor samples, eg, microcarcinomas and biopsies containing a small amount of tumor. Currently, this method is not well established in pathology laboratories. We designed a study to confirm the feasibility and convenience of this method for routine diagnostics with formalin-fixed, paraffin-embedded samples prepared by laser-capture microdissection. A total of 250 μg DNA (concentration 5 μg/μL) was generated by amplification over a period of 8 hours with a material input of approximately 25 cells, approximately equivalent to 175 pg of genomic DNA. In the generated DNA, a representation of all chromosomes could be shown and the presence of elected genes relevant for diagnosis in clinical samples could be proven. Mutational analysis of clinical samples could be performed without any difficulty and showed concordance with earlier diagnostic findings. We established the feasibility and convenience of IMDA for routine diagnostics. We also showed that small amounts of DNA, which were not analyzable with current molecular methods, could be sufficient for a wide field of applications in molecular routine diagnostics when they are preamplified with IMDA.

[Clinical effect of different sequences of debridement-antibiotic therapy in treatment of severe chronic periodontitis].

PubMed

Li, Yi; Xu, Li; Lu, Rui-fang; An, Yue-bang; Wang, Xian-e; Song, Wen-li; Meng, Huan-xi

2015-02-18

To evaluate the feasibility of full-mouth debridement (subgingival scaling and root planning, SRP) by 2 times within 1 week and compare the clinical effects of different sequences of debridement-antibiotic usage in patients with severe chronic periodontitis (CP). A double-blinded, placebo-controlled, randomized clinical trial was conducted in 30 severe CP patients (14 males and 16 females, 40.5 ± 8.4 years old on average from 35 to 60) receiving 3 different sequences of debridement-antibiotictherapy: Group A, antibiotic usage (metronidazole, MTZ, 0.2 g, tid, 7 d; amoxicillin, AMX 0.5 g, tid, 7 d) was started together with SRP (completed by 2 times in 7 d); Group B, antibiotic usage (MTZ 0.2 g, tid, 7 d; AMX 0.5 g, tid, 7 d) was started 1 d after SRP(completed by 2 times in 7 d); Group C, SRP alone[probing depth (PD), bleeding index (BI) and tooth mobility] was examined. The average full-mouth probing depth, the average full-mouth proximal probing depth (pPD), the percentage of sites with PD>5 mm (PD>5 mm%), the percentage of sites with proximal PD>5 mm (pPD>5 mm%), the average bleeding index (BI) and the percentage of sites with bleeding on probing (BOP%) were calculated. Clinical examinations were performed at baseline and 2 months post therapy. (1) Compared with baseline conditions, all the subjects showed clinical improvements in all the parameters evaluated 2 months post therapy, P<0.05. (2) Significant difference were observed in the average PD changes between Group A [(2.15 ± 0.42) mm], Group B [(1.76 ± 0.29) mm] and Group C [(1.57 ± 0.33) mm], P<0.05. No significant difference was observed in the average PD changes between Group B and Group C, P=0.354. Significant differences were observed in the average pPD changes between Group A [(2.45 ± 0.43)mm] and Group C[(1.90 ± 0.48) mm], P<0.05. No significant difference was observed in BI and BOP% changes between Group A,Group B and Group C. For patients with severe chronic periodontitis, it is safe and feasible to receive full-mouth SRP by 2 times within 1 week. The short-term (2 months) advantages in PD changes are observed in patients receiving SRP and antibiotic usage at the same time comparing with patients using antibiotics after SRP or SRP alone.

Ensuring correct use of skincare products on peristomal skin.

PubMed

Brewster, Liz

Peristomal skin requires careful management to maintain its health and integrity. Although a wide range of skincare products is available, these should be used in response to clinical need, rather than routinely. This article discusses risks to peristomal skin, routine care, and use of products when the health of skin is compromised.

Clinical routine utility of basophil activation testing for diagnosis of hymenoptera-allergic patients with emphasis on individuals with negative venom-specific IgE antibodies.

PubMed

Korošec, Peter; Šilar, Mira; Eržen, Renato; Čelesnik, Nina; Bajrović, Nissera; Zidarn, Mihaela; Košnik, Mitja

2013-01-01

Previous reports suggest the usefulness of basophil activation testing (BAT) in Hymenoptera-allergic patients with negative venom-specific IgE antibodies. We sought to evaluate the diagnostic utility of this testing in a routine clinical laboratory setting. Twenty-one patients with anaphylactic reactions to Hymenoptera sting (median grade III) and negative venom-specific IgE were routinely and prospectively tested with BAT. We were able to diagnose 81% (17 of 21) of patients with BAT and 57% (12 of 21) with intradermal skin testing. Three wasp venom-allergic patients showed IgE positivity to rVes v 5. Four patients (19%) were negative for all tests. In the case of double-positive BAT, the culprit insect correlated with the venom that induced a significantly higher basophil response. BAT allows the identification of severe Hymenoptera-allergic patients with negative specific IgE and skin tests. The routine use of this cellular test should facilitate prescription of venom immunotherapy in complex cases with inconclusive diagnostic results. Copyright © 2013 S. Karger AG, Basel.

Factors Associated with Routine Dental Attendance among Aboriginal Australians.

PubMed

Amarasena, Najith; Kapellas, Kostas; Skilton, Michael R; Maple-Brown, Louise J; Brown, Alex; Bartold, Mark; O'Dea, Kerin; Celermajer, David; Jamieson, Lisa M

2016-01-01

To determine factors associated with routine dental attendance in Aboriginal Australians. Data of 271 Aboriginal adults residing in Australia's Northern Territory were used. Routine dental attendance was defined as last visiting a dentist less than one year ago or visiting a dentist for a check-up. Both bivariate and multivariable analytical techniques were used. While 27% visited a dentist in the past year, 29% of these visited for a check-up. In bivariate analysis, being female, low psychological distress, and low clinical attachment loss (CAL) were associated with visiting a dentist within last year. Being aged younger than 39 years, male, no oral health impairment, being caries-free, low CAL, and low apolipoprotein B were associated with visiting for a check-up. Clinical attachment loss remained associated with visiting a dentist less than one year ago while being younger than 39 years and having no oral health impairment remained associated with usually visiting for a check-up in multivariable analysis. Younger age, no oral health impairment, and low CAL were associated with routine dental attendance among Indigenous Australians.

Factors Associated with Routine Dental Attendance among Aboriginal Australians.

PubMed

Amarasena, Najith; Kapellas, Kostas; Skilton, Michael R; Maple-Brown, Louise J; Brown, Alex; Bartold, Mark; O'Dea, Kerin; Celermajer, David; Jamieson, Lisa M

2016-02-01

To determine factors associated with routine dental attendance in Aboriginal Australians. Data of 271 Aboriginal adults residing in Australia's Northern Territory were used. Routine dental attendance was defined as last visiting a dentist less than one year ago or visiting a dentist for a check-up. Both bivariate and multivariable analytical techniques were used. While 27% visited a dentist in the past year, 29% of these visited for a check-up. In bivariate analysis, being female, low psychological distress, and low clinical attachment loss (CAL) were associated with visiting a dentist within last year. Being aged younger than 39 years, male, no oral health impairment, being caries-free, low CAL, and low apolipoprotein B were associated with visiting for a check-up. Clinical attachment loss remained associated with visiting a dentist less than one year ago while being younger than 39 years and having no oral health impairment remained associated with usually visiting for a check-up in multivariable analysis. Younger age, no oral health impairment, and low CAL were associated with routine dental attendance among Indigenous Australians.

The impact of using student-dictated oral review stories on science vocabulary, content knowledge, and non-fiction writing skills of first grade students

NASA Astrophysics Data System (ADS)

Bishoff, Sandra Wells

The purpose of this study was to determine if using an intervention called Student Dictated Oral Review Stories (SDORS) had an effect on science vocabulary usage and content knowledge for ninety-three students in six first grade classrooms and the subgroup of economically disadvantaged students in a mid-sized north Texas school district. The five science units involved in the study were written incorporating the strand of physical science. Data from pre- and posttests from each unit and an end-of-study assessment were compiled and analyzed. This study also looked at integration of science with literacy through analysis of students' science journal writings. Journal writings were analyzed for vocabulary usage and non-fiction writing skills of capitalization and punctuation. Average sentence length was also analyzed for Units 1--5 of the treatment group. It was anticipated that the outcomes of this study would allow school districts and curriculum writers to determine how to best integrate key concepts and important vocabulary with literacy particularly in the area of science. Results from the study showed significant differences in the end-of-study assessment, vocabulary usage as evidenced in journal writings, and average sentence length. Although there was gain over time for every student in the study in vocabulary and content knowledge, these gains could not be attributed to the intervention. This study also hoped to establish whether students were using science vocabulary routinely in their discussions and their writings and were building and continually assessing their own schemas about scientific concepts through using Student Dictated Oral Review Stories.

Effects of Pre-Existing Liver Disease on Acute Pain Management Using Patient-Controlled Analgesia Fentanyl With Parecoxib After Major Liver Resection: A Retrospective, Pragmatic Study.

PubMed

Lim, K I; Chiu, Y C; Chen, C L; Wang, C H; Huang, C J; Cheng, K W; Wu, S C; Shih, T H; Yang, S C; Juang, S E; Huang, C E; Jawan, B; Lee, Y E

2016-05-01

The aim of this study was to compare the outcomes of pain management with the use of patient-controlled analgesia (PCA) fentanyl with IV parecoxib between patients with healthy liver with patients with diseased liver undergoing major liver resection. Patients with healthy liver undergoing partial hepatectomy as liver donors for liver transplantation (group 1) and patients with liver cirrhosis (Child's criteria A) undergoing major liver resection for hepatoma (group 2) were identified retrospectively. Both groups routinely received post-operative IV PCA fentanyl and a single dose of parecoxib 40 mg. They were followed up for 3 days or until PCA fentanyl was discontinued post-operatively. Daily Visual Analog Scale, PCA fentanyl usage, rescue attempts, and common drug side effects were collected and analyzed with the use of SPSS version 20. One hundred one patients were included in the study: 54 in group 1, and 47 in group 2. There were no statistical differences between the two groups in terms of the daily and total fentanyl usage, VAS resting, and incidence of itchiness. The rate of rescue analgesia on post-operative day (POD) 1 was lower in group 2, with a value of P = .045. VAS dynamics were better on POD 1 and 2 for group 2, with P = .05 and P = .012, respectively. We found that combining a single dose of IV parecoxib 40 mg with PCA fentanyl is an easy and effective method of acute pain control after major liver resection. We propose the careful usage of post-operative fentanyl and parecoxib in patients with diseased liver, given the difference in effect as compared with healthy liver. Copyright © 2016 Elsevier Inc. All rights reserved.

Surfing the best practice guidelines: national clinical guideline clearinghouse in development.

PubMed

1997-08-01

The growth in development and usage of clinical guidelines during the last five years has been remarkable. Not only are health care practitioners reaching for what's deemed to be the best in protocols and practice, consumers, too, are looking toward standards and guidelines as they become more educated about the quality and quantity of health care services they should be receiving.

Feasibility of real-time capture of routine clinical data in the electronic health record: a hospital-based, observational service-evaluation study

PubMed Central

Archbold, R Andrew; Weerackody, Roshan; Barnes, Michael R; Lee, Aaron M; Janjuha, Surjeet; Gutteridge, Charles; Robson, John; Timmis, Adam

2018-01-01

Objectives The electronic health record (EHR) is underused in the hospital setting. The aim of this service evaluation study was to respond to National Health Service (NHS) Digital’s ambition for a paperless NHS by capturing routinely collected cardiac outpatient data in the EHR to populate summary patient reports and provide a resource for audit and research. Design A PowerForm template was developed within the Cerner EHR, for real-time entry of routine clinical data by clinicians attending a cardiac outpatient clinic. Data captured within the PowerForm automatically populated a SmartTemplate to generate a view-only report that was immediately available for the patient and for electronic transmission to the referring general practitioner (GP). Results During the first 8 months, the PowerForm template was used in 61% (360/594) of consecutive outpatient referrals increasing from 42% to 77% during the course of the study. Structured patient reports were available for immediate sharing with the referring GP using Cerner Health Information Exchange technology while electronic transmission was successfully developed in a substudy of 64 cases, with direct delivery by the NHS Data Transfer Service in 29 cases and NHS mail in the remainder. In feedback, the report’s immediate availability was considered very or extremely important by >80% of the patients and GPs who were surveyed. Both groups reported preference of the patient report to the conventional typed letter. Deidentified template data for all 360 patients were successfully captured within the Trust system, confirming availability of these routinely collected outpatient data for audit and research. Conclusion Electronic template development tailored to the requirements of a specialist outpatient clinic facilitates capture of routinely collected data within the Cerner EHR. These data can be made available for audit and research. They can also be used to enhance communication by populating structured reports for immediate delivery to patients and GPs. PMID:29523565

Correlation of PROMIS Physical Function and Pain CAT Instruments With Oswestry Disability Index and Neck Disability Index in Spine Patients.

PubMed

Papuga, Mark O; Mesfin, Addisu; Molinari, Robert; Rubery, Paul T

2016-07-15

A prospective and retrospective cross-sectional cohort analysis. The aim of this study was to show that Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) assessments for physical function and pain interference can be efficiently collected in a standard office visit and to evaluate these scores with scores from previously validated Oswestry Disability Index (ODI) and Neck Disability Index (NDI) providing evidence of convergent validity for use in patients with spine pathology. Spinal surgery outcomes are highly variable, and substantial debate continues regarding the role and value of spine surgery. The routine collection of patient-based outcomes instruments in spine surgery patients may inform this debate. Traditionally, the inefficiency associated with collecting standard validated instruments has been a barrier to routine use in outpatient clinics. We utilized several CAT instruments available through PROMIS and correlated these with the results obtained using "gold standard" legacy outcomes measurement instruments. All measurements were collected at a routine clinical visit. The ODI and the NDI assessments were used as "gold standard" comparisons for patient-reported outcomes. PROMIS CAT instruments required 4.5 ± 1.8 questions and took 35 ± 16 seconds to complete, compared with ODI/NDI requiring 10 questions and taking 188 ± 85 seconds when administered electronically. Linear regression analysis of retrospective scores involving a primary back complaint revealed moderate to strong correlations between ODI and PROMIS physical function with r values ranging from 0.5846 to 0.8907 depending on the specific assessment and patient subsets examined. Routine collection of physical function outcome measures in clinical practice offers the ability to inform and improve patient care. We have shown that several PROMIS CAT instruments can be efficiently administered during routine clinical visits. The moderate to strong correlations found validate the utility of computer adaptive testing when compared with the gold standard "static" legacy assessments. 4.

Utility of routine postoperative visit after appendectomy and cholecystectomy with evaluation of mobile technology access in an urban safety net population.

PubMed

Chen, Diane W; Davis, Rachel W; Balentine, Courtney J; Scott, Aaron R; Gao, Yue; Tapia, Nicole M; Berger, David H; Suliburk, James W

2014-08-01

The value of routine postoperative visits after general surgery remains unclear. The objective of this study was to evaluate the utility of routine postoperative visits after appendectomy and cholecystectomy and to determine access to mobile technology as an alternative platform for follow-up. Retrospective review of 219 appendectomies and 200 cholecystectomies performed at a safety net hospital. One patient underwent both surgeries. Patient demographics, duration of clinic visit, and need for additional imaging, tests or readmissions were recorded. Access to mobile technology was surveyed by a validated questionnaire. Of 418 patients, 84% percent completed a postoperative visit. At follow-up, 58 patients (14%) required 70 interventions, including staple removal (16, 23%), suture removal (4, 6%), drain removal (8, 11%), additional follow-up (20, 28%), medication action (16, 21%), additional imaging (3, 4%), and readmission (1, 1%). Occupational paperwork (62) and nonsurgical clinic referrals (28) were also performed. Average check-in to check-out time was 100 ± 54 min per patient. One intervention was performed for every 7.8 h of time in the clinic. Additionally, 88% of the surveyed population reported access to cell phone technology, and 69% of patients <40 y had smartphone access. Routine in-person follow-up after surgery consumes significant time and resources for patients and healthcare systems but has little impact on patient care. Most of the work done in the clinic is administrative and could be completed using mobile technology, which is pervasive in our population. Copyright © 2014 Elsevier Inc. All rights reserved.

The use of routine EEG in acute ischemic stroke patients without seizures: generalized but not focal EEG pathology is associated with clinical deterioration.

PubMed

Wolf, Marc E; Ebert, Anne D; Chatzikonstantinou, Anastasios

2017-05-01

Specialized electroencephalography (EEG) methods have been used to provide clues about stroke features and prognosis. However, the value of routine EEG in stroke patients without (suspected) seizures has been somewhat neglected. We aimed to assess this in a group of acute ischemic stroke patients in regard to short-term prognosis and basic stroke features. We assessed routine (10-20) EEG findings in 69 consecutive acute ischemic stroke patients without seizures. Associations between EEG abnormalities and NIHSS scores, clinical improvement or deterioration as well as MRI stroke characteristics were evaluated. Mean age was 69 ± 18 years, 43 of the patients (62.3%) were men. Abnormal EEG was found in 40 patients (58%) and was associated with higher age (p = 0.021). The most common EEG pathology was focal slowing (30; 43.5%). No epileptiform potentials were found. Abnormal EEG in general and generalized or focal slowing in particular was significantly associated with higher NIHSS score on admission and discharge as well as with hemorrhagic transformation of the ischemic lesion. Abnormal EEG and generalized (but not focal) slowing were associated with clinical deterioration ( p = 0.036, p = 0.003). Patients with lacunar strokes had no EEG abnormalities. Abnormal EEG in general and generalized slowing in particular are associated with clinical deterioration after acute ischemic stroke. The study demonstrates the value of routine EEG as a simple diagnostic tool in the evaluation of stroke patients especially with regard to short-term prognosis.

Laboratory and clinical evaluation of on-site urine drug testing.

PubMed

Beck, Olof; Carlsson, Sten; Tusic, Marinela; Olsson, Robert; Franzen, Lisa; Hulten, Peter

2014-11-01

Products for on-site urine drug testing offer the possibility to perform screening for drugs of abuse directly at the point-of-care. This is a well-established routine in emergency and dependency clinics but further evaluation of performance is needed due to inherent limitations with the available products. Urine drug testing by an on-site product was compared with routine laboratory methods. First, on-site testing was performed at the laboratory in addition to the routine method. Second, the on-site testing was performed at a dependency clinic and urine samples were subsequently sent to the laboratory for additional analytical investigation. The on-site testing products did not perform with assigned cut-off levels. The subjective reading between the presence of a spot (i.e. negative test result) being present or no spot (positive result) was difficult in 3.2% of the cases, and occurred for all parameters. The tests performed more accurately in drug negative samples (specificity 96%) but less accurately for detecting positives (sensitivity 79%). Of all incorrect results by the on-site test the proportion of false negatives was 42%. The overall agreement between on-site and laboratory testing was 95% in the laboratory study and 98% in the clinical study. Although a high degree of agreement was observed between on-site and routine laboratory urine drug testing, the performance of on-site testing was not acceptable due to significant number of false negative results. The limited sensitivity of on-site testing compared to laboratory testing reduces the applicability of these tests.

[Clinical applications of molecular imaging methods for patients with ischemic stroke].

PubMed

Yamauchi, Hiroshi; Fukuyama, Hidenao

2007-02-01

Several molecular imaging methods have been developed to visualize pathophysiology of cerebral ischemia in humans in vivo. PET and SPECT with specific ligands have been mainly used as diagnostic tools for the clinical usage of molecular imaging in patients with ischemic stroke. Recently, cellular MR imaging with specific contrast agents has been developed to visualize targeted cells in human stroke patients. This article reviews the current status in the clinical applications of those molecular imaging methods for patients with ischemic stroke.

Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis.

PubMed

Meshaal, Marwa Sayed; Kassem, Hussein Heshmat; Samir, Ahmad; Zakaria, Ayman; Baghdady, Yasser; Rizk, Hussein Hassan

2015-01-01

Infective endocarditis (IE) is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs). These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA) is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE. From July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke's criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥ 5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention. The mean age was 30.43 ± 8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%). Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32%) had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%). The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture. Routine brain CT/CTA resulted in changes in the treatment plan in a significant proportion of patients with IE, even those without clinically evident neurological disease. Routine brain CT/CTA may be indicated in all hospitalized patients with IE.

Elaboration of the Gothenburg model of person-centred care.

PubMed

Britten, Nicky; Moore, Lucy; Lydahl, Doris; Naldemirci, Oncel; Elam, Mark; Wolf, Axel

2017-06-01

Person-centred care (PCC) is increasingly advocated as a new way of delivering health care, but there is little evidence that it is widely practised. The University of Gothenburg Centre for Person-Centred Care (GPCC) was set up in 2010 to develop and implement person-centred care in clinical practice on the basis of three routines. These routines are based on eliciting the patient's narrative to initiate a partnership; working the partnership to achieve commonly agreed goals; and using documentation to safeguard the partnership and record the person's narrative and shared goals. In this paper, we aimed to explore professionals' understanding of PCC routines as they implement the GPCC model in a range of different settings. We conducted a qualitative study and interviewed 18 clinician-researchers from five health-care professions who were working in seven diverse GPCC projects. Interviewees' accounts of PCC emphasized the ways in which persons are seen as different from patients; the variable emphasis placed on the person's goals; and the role of the person's own resources in building partnerships. This study illustrates what is needed for health-care professionals to implement PCC in everyday practice: the recognition of the person is as important as the specific practical routines. Interviewees described the need to change the clinical mindset and to develop the ways of integrating people's narratives with clinical practice. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Impact of Xpert MTB/RIF for TB Diagnosis in a Primary Care Clinic with High TB and HIV Prevalence in South Africa: A Pragmatic Randomised Trial

PubMed Central

Cox, Helen S.; Mbhele, Slindile; Mohess, Neisha; Whitelaw, Andrew; Muller, Odelia; Zemanay, Widaad; Little, Francesca; Azevedo, Virginia; Simpson, John; Boehme, Catharina C.; Nicol, Mark P.

2014-01-01

Background Xpert MTB/RIF is approved for use in tuberculosis (TB) and rifampicin-resistance diagnosis. However, data are limited on the impact of Xpert under routine conditions in settings with high TB burden. Methods and Findings A pragmatic prospective cluster-randomised trial of Xpert for all individuals with presumptive (symptomatic) TB compared to the routine diagnostic algorithm of sputum microscopy and limited use of culture was conducted in a large TB/HIV primary care clinic. The primary outcome was the proportion of bacteriologically confirmed TB cases not initiating TB treatment by 3 mo after presentation. Secondary outcomes included time to TB treatment and mortality. Unblinded randomisation occurred on a weekly basis. Xpert and smear microscopy were performed on site. Analysis was both by intention to treat (ITT) and per protocol. Between 7 September 2010 and 28 October 2011, 1,985 participants were assigned to the Xpert (n = 982) and routine (n = 1,003) diagnostic algorithms (ITT analysis); 882 received Xpert and 1,063 routine (per protocol analysis). 13% (32/257) of individuals with bacteriologically confirmed TB (smear, culture, or Xpert) did not initiate treatment by 3 mo after presentation in the Xpert arm, compared to 25% (41/167) in the routine arm (ITT analysis, risk ratio 0.51, 95% CI 0.33–0.77, p = 0.0052). The yield of bacteriologically confirmed TB cases among patients with presumptive TB was 17% (167/1,003) with routine diagnosis and 26% (257/982) with Xpert diagnosis (ITT analysis, risk ratio 1.57, 95% CI 1.32–1.87, p<0.001). This difference in diagnosis rates resulted in a higher rate of treatment initiation in the Xpert arm: 23% (229/1,003) and 28% (277/982) in the routine and Xpert arms, respectively (ITT analysis, risk ratio 1.24, 95% CI 1.06–1.44, p = 0.013). Time to treatment initiation was improved overall (ITT analysis, hazard ratio 0.76, 95% CI 0.63–0.92, p = 0.005) and among HIV-infected participants (ITT analysis, hazard ratio 0.67, 95% CI 0.53–0.85, p = 0.001). There was no difference in 6-mo mortality with Xpert versus routine diagnosis. Study limitations included incorrect intervention allocation for a high proportion of participants and that the study was conducted in a single clinic. Conclusions These data suggest that in this routine primary care setting, use of Xpert to diagnose TB increased the number of individuals with bacteriologically confirmed TB who were treated by 3 mo and reduced time to treatment initiation, particularly among HIV-infected participants. Trial registration Pan African Clinical Trials Registry PACTR201010000255244 Please see later in the article for the Editors' Summary PMID:25423041

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application.

PubMed

Barkhausen, Jörg; Kahn, Thomas; Krombach, Gabriele A; Kuhl, Christiane K; Lotz, Joachim; Maintz, David; Ricke, Jens; Schönberg, Stefan O; Vogl, Thomas J; Wacker, Frank K

2017-07-01

Background  MRI is attractive for the guiding and monitoring of interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure physiologic parameters like flow and cardiac function. Method  The current status of interventional MRI for the clinical routine was analyzed. Results  The effort needed for the development of MR-safe monitoring systems and instruments initially resulted in the application of interventional MRI only for procedures that could not be performed by other means. Accordingly, biopsy of lesions in the breast, which are not detectable by other modalities, has been performed under MRI guidance for decades. Currently, biopsies of the prostate under MRI guidance are established in a similar fashion. At many sites blind biopsy has already been replaced by MR-guided biopsy or at least by the fusion of MR images with ultrasound. Cardiovascular interventions are performed at several centers for ablation as a treatment for atrial fibrillation. Conclusion  Interventional MRI has been established in the clinical routine for a variety of indications. Broader application can be expected in the clinical routine in the future owing to the multiple advantages compared to other techniques. Key points   · Due to the significant technical effort, MR-guided interventions are only recommended in the long term for regions in which MRI either facilitates or greatly improves the intervention.. · Breast biopsy of otherwise undetectable target lesions has long been established in the clinical routine. Prostate biopsy is currently being introduced in the clinical routine for similar reasons. Other methods such as MR-guided focused ultrasound for the treatment of uterine fibroids or tumor ablation of metastases represent alternative methods and are offered in many places.. · Endovascular MR-guided interventions offer advantages for a number of indications and have already been clinically established for the treatment of children with congenital heart defects and for atrial ablation at individual centers. Greater application can be expected in the future.. Citation format · Barkhausen J, Kahn T, Krombach GA et al. White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application. Fortschr Röntgenstr 2017; 189: 611 - 623. © Georg Thieme Verlag KG Stuttgart · New York.

Variability in the Propagation Phase of CFD-Based Noise Prediction: Summary of Results From Category 8 of the BANC-III Workshop

NASA Technical Reports Server (NTRS)

Lopes, Leonard; Redonnet, Stephane; Imamura, Taro; Ikeda, Tomoaki; Zawodny, Nikolas; Cunha, Guilherme

2015-01-01

The usage of Computational Fluid Dynamics (CFD) in noise prediction typically has been a two part process: accurately predicting the flow conditions in the near-field and then propagating the noise from the near-field to the observer. Due to the increase in computing power and the cost benefit when weighed against wind tunnel testing, the usage of CFD to estimate the local flow field of complex geometrical structures has become more routine. Recently, the Benchmark problems in Airframe Noise Computation (BANC) workshops have provided a community focus on accurately simulating the local flow field near the body with various CFD approaches. However, to date, little effort has been given into assessing the impact of the propagation phase of noise prediction. This paper includes results from the BANC-III workshop which explores variability in the propagation phase of CFD-based noise prediction. This includes two test cases: an analytical solution of a quadrupole source near a sphere and a computational solution around a nose landing gear. Agreement between three codes was very good for the analytic test case, but CFD-based noise predictions indicate that the propagation phase can introduce 3dB or more of variability in noise predictions.

Analytical Eco-Scale for Assessing the Greenness of a Developed RP-HPLC Method Used for Simultaneous Analysis of Combined Antihypertensive Medications.

PubMed

Mohamed, Heba M; Lamie, Nesrine T

2016-09-01

In the past few decades the analytical community has been focused on eliminating or reducing the usage of hazardous chemicals and solvents, in different analytical methodologies, that have been ascertained to be extremely dangerous to human health and environment. In this context, environmentally friendly, green, or clean practices have been implemented in different research areas. This study presents a greener alternative of conventional RP-HPLC methods for the simultaneous determination and quantitative analysis of a pharmaceutical ternary mixture composed of telmisartan, hydrochlorothiazide, and amlodipine besylate, using an ecofriendly mobile phase and short run time with the least amount of waste production. This solvent-replacement approach was feasible without compromising method performance criteria, such as separation efficiency, peak symmetry, and chromatographic retention. The greenness profile of the proposed method was assessed and compared with reported conventional methods using the analytical Eco-Scale as an assessment tool. The proposed method was found to be greener in terms of usage of hazardous chemicals and solvents, energy consumption, and production of waste. The proposed method can be safely used for the routine analysis of the studied pharmaceutical ternary mixture with a minimal detrimental impact on human health and the environment.

Insurance Coverage and Clinical Trials

Cancer.gov

Most health insurance plans are required to cover routine patient care costs in clinical trials under certain conditions. Learn about the conditions that insurance plans take into account and how to work with your insurance company.

Rapid targeted somatic mutation analysis of solid tumors in routine clinical diagnostics.

PubMed

Magliacane, Gilda; Grassini, Greta; Bartocci, Paola; Francaviglia, Ilaria; Dal Cin, Elena; Barbieri, Gianluca; Arrigoni, Gianluigi; Pecciarini, Lorenza; Doglioni, Claudio; Cangi, Maria Giulia

2015-10-13

Tumor genotyping is an essential step in routine clinical practice and pathology laboratories face a major challenge in being able to provide rapid, sensitive and updated molecular tests. We developed a novel mass spectrometry multiplexed genotyping platform named PentaPanel to concurrently assess single nucleotide polymorphisms in 56 hotspots of the 5 most clinically relevant cancer genes, KRAS, NRAS, BRAF, EGFR and PIK3CA for a total of 221 detectable mutations. To both evaluate and validate the PentaPanel performance, we investigated 1025 tumor specimens of 6 different cancer types (carcinomas of colon, lung, breast, pancreas, and biliary tract, and melanomas), systematically addressing sensitivity, specificity, and reproducibility of our platform. Sanger sequencing was also performed for all the study samples. Our data showed that PentaPanel is a high throughput and robust tool, allowing genotyping for targeted therapy selection of 10 patients in the same run, with a practical turnaround time of 2 working days. Importantly, it was successfully used to interrogate different DNAs isolated from routinely processed specimens (formalin-fixed paraffin embedded, frozen, and cytological samples), covering all the requirements of clinical tests. In conclusion, the PentaPanel platform can provide an immediate, accurate and cost effective multiplex approach for clinically relevant gene mutation analysis in many solid tumors and its utility across many diseases can be particularly relevant in multiple clinical trials, including the new basket trial approach, aiming to identify appropriate targeted drug combination strategies.

Design and implementation of a controlled clinical trial to evaluate the effectiveness and efficiency of routine opt-out rapid human immunodeficiency virus screening in the emergency department.

PubMed

Haukoos, Jason S; Hopkins, Emily; Byyny, Richard L; Conroy, Amy A; Silverman, Morgan; Eisert, Sheri; Thrun, Mark; Wilson, Michael; Boyett, Brian; Heffelfinger, James D

2009-08-01

In 2006, the Centers for Disease Control and Prevention (CDC) released revised recommendations for performing human immunodeficiency virus (HIV) testing in health care settings, including implementing routine rapid HIV screening, the use of an integrated opt-out consent, and limited prevention counseling. Emergency departments (EDs) have been a primary focus of these efforts. These revised CDC recommendations were primarily based on feasibility studies and have not been evaluated through the application of rigorous research methods. This article describes the design and implementation of a large prospective controlled clinical trial to evaluate the CDC's recommendations in an ED setting. From April 15, 2007, through April 15, 2009, a prospective quasi-experimental equivalent time-samples clinical trial was performed to compare the clinical effectiveness and efficiency of routine (nontargeted) opt-out rapid HIV screening (intervention) to physician-directed diagnostic rapid HIV testing (control) in a high-volume urban ED. In addition, three nested observational studies were performed to evaluate the cost-effectiveness and patient and staff acceptance of the two rapid HIV testing methods. This article describes the rationale, methodologies, and study design features of this program evaluation clinical trial. It also provides details regarding the integration of the principal clinical trial and its nested observational studies. Such ED-based trials are rare, but serve to provide valid comparisons between testing approaches. Investigators should consider similar methodology when performing future ED-based health services research.

Audit of the autoantibody test, EarlyCDT®-lung, in 1600 patients: an evaluation of its performance in routine clinical practice.

PubMed

Jett, James R; Peek, Laura J; Fredericks, Lynn; Jewell, William; Pingleton, William W; Robertson, John F R

2014-01-01

EarlyCDT(®)-Lung may enhance detection of early stage lung cancer by aiding physicians in assessing high-risk patients through measurement of biological markers (i.e., autoantibodies). The test's performance characteristics in routine clinical practice were evaluated by auditing clinical outcomes of 1613 US patients deemed at high risk for lung cancer by their physician, who ordered the EarlyCDT-Lung test for their patient. Clinical outcomes for all 1613 patients who provided HIPAA authorization are reported. Clinical data were collected from each patient's treating physician. Pathology reports when available were reviewed for diagnostic classification. Staging was assessed on histology, otherwise on imaging. Six month follow-up for the positives/negatives was 99%/93%. Sixty-one patients (4%) were identified with lung cancer, 25 of whom tested positive by EarlyCDT-Lung (sensitivity=41%). A positive EarlyCDT-Lung test on the current panel was associated with a 5.4-fold increase in lung cancer incidence versus a negative. Importantly, 57% (8/14) of non-small cell lung cancers detected as positive (where stage was known) were stage I or II. EarlyCDT-Lung has been extensively tested and validated in case-control settings and has now been shown in this audit to perform in routine clinical practice as predicted. EarlyCDT-Lung may be a complementary tool to CT for detection of early lung cancer. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Clinical protein mass spectrometry.

PubMed

Scherl, Alexander

2015-06-15

Quantitative protein analysis is routinely performed in clinical chemistry laboratories for diagnosis, therapeutic monitoring, and prognosis. Today, protein assays are mostly performed either with non-specific detection methods or immunoassays. Mass spectrometry (MS) is a very specific analytical method potentially very well suited for clinical laboratories. Its unique advantage relies in the high specificity of the detection. Any protein sequence variant, the presence of a post-translational modification or degradation will differ in mass and structure, and these differences will appear in the mass spectrum of the protein. On the other hand, protein MS is a relatively young technique, demanding specialized personnel and expensive instrumentation. Many scientists and opinion leaders predict MS to replace immunoassays for routine protein analysis, but there are only few protein MS applications routinely used in clinical chemistry laboratories today. The present review consists of a didactical introduction summarizing the pros and cons of MS assays compared to immunoassays, the different instrumentations, and various MS protein assays that have been proposed and/or are used in clinical laboratories. An important distinction is made between full length protein analysis (top-down method) and peptide analysis after enzymatic digestion of the proteins (bottom-up method) and its implication for the protein assay. The document ends with an outlook on what type of analyses could be used in the future, and for what type of applications MS has a clear advantage compared to immunoassays. Copyright © 2015 Elsevier Inc. All rights reserved.

Use of the Ion PGM and the GeneReader NGS Systems in Daily Routine Practice for Advanced Lung Adenocarcinoma Patients: A Practical Point of View Reporting a Comparative Study and Assessment of 90 Patients.

PubMed

Heeke, Simon; Hofman, Véronique; Long-Mira, Elodie; Lespinet, Virginie; Lalvée, Salomé; Bordone, Olivier; Ribeyre, Camille; Tanga, Virginie; Benzaquen, Jonathan; Leroy, Sylvie; Cohen, Charlotte; Mouroux, Jérôme; Marquette, Charles Hugo; Ilié, Marius; Hofman, Paul

2018-03-21

Background : With the integration of various targeted therapies into the clinical management of patients with advanced lung adenocarcinoma, next-generation sequencing (NGS) has become the technology of choice and has led to an increase in simultaneously interrogated genes. However, the broader adoption of NGS for routine clinical practice is still hampered by sophisticated workflows, complex bioinformatics analysis and medical interpretation. Therefore, the performance of the novel QIAGEN GeneReader NGS system was compared to an in-house ISO-15189 certified Ion PGM NGS platform. Methods : Clinical samples from 90 patients (60 Retrospectively and 30 Prospectively) with lung adenocarcinoma were sequenced with both systems. Mutations were analyzed and EGFR , KRAS , BRAF , NRAS , ALK , PIK3CA and ERBB2 genes were compared and sampling time and suitability for clinical testing were assessed. Results : Both sequencing systems showed perfect concordance for the overlapping genes. Correlation of allele frequency was r ² = 0.93 for the retrospective patients and r ² = 0.81 for the prospective patients. Hands-on time and total run time were shorter using the PGM system, while the GeneReader platform provided good traceability and up-to-date interpretation of the results. Conclusion : We demonstrated the suitability of the GeneReader NGS system in routine practice in a clinical pathology laboratory setting.

Biotherapeutics as alternatives to antibiotics

USDA-ARS?s Scientific Manuscript database

Increasing pressure to limit antibiotic use in agriculture is heightening the need for alternative methods to reduce the adverse effects of clinical and subclinical disease on livestock performance that are currently managed by in-feed antibiotic usage. Immunomodulators have long been sought as such...

Validation of the Italian version of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM).

PubMed

Palmieri, Gaspare; Evans, Chris; Hansen, Vidje; Brancaleoni, Greta; Ferrari, Silvia; Porcelli, Piero; Reitano, Francesco; Rigatelli, Marco

2009-01-01

The Clinical Outcomes in Routine Evaluation--Outcome Measure (CORE-OM) was translated into Italian and tested in non-clinical (n = 263) and clinical (n = 647) samples. The translation showed good acceptability, internal consistency and convergent validity in both samples. There were large and statistically significant differences between clinical and non-clinical datasets on all scores. The reliable change criteria were similar to those for the UK referential data. Some of the clinically significant change criteria, particularly for the men, were moderately different from the UK cutting points. The Italian version of the CORE-OM showed respectable psychometric parameters. However, it seemed plausible that non-clinical and clinical distributions of self-report scores on psychopathology and functioning measures may differ by language and culture. *A good quality Italian translation of the CORE-OM, and hence the GP-CORE, CORE-10 and CORE-5 measures also, is now available for use by practitioners and anyone surveying or exploring general psychological state. The measures can be obtained from CORE-IMS or yourself and practitioners are encouraged to share anonymised data so that good clinical and non-clinical referential databases can be established for Italy.

Vacuum-assisted venous return reduces blood usage.

PubMed

Banbury, Michael K; White, Jennifer A; Blackstone, Eugene H; Cosgrove, Delos M

2003-09-01

To determine whether vacuum-assisted venous return has clinical advantages over conventional gravity drainage apart from allowing the use of smaller cannulas and shorter tubing. A total of 150 valve operations were performed at our institution between February and July 1999 using vacuum-assisted venous return with small venous cannulas connected to short tubing. These were compared with (1) 83 valve operations performed between April 1997 and January 1998 using the initial version of vacuum-assisted venous return, and (2) 124 valve operations performed between January and April of 1997 using conventional gravity drainage. Priming volume, hematocrit value, red blood cell usage, and total blood product usage were compared multivariably. These comparisons were covariate and propensity adjusted for dissimilarities between the groups and confirmed by propensity-matched pairs analysis. Priming volume was 1.4 +/- 0.4 L for small-cannula vacuum-assisted venous return, 1.7 +/- 0.4 L for initial vacuum-assisted venous return, and 2.0 +/- 0.4 L for gravity drainage (P <.0001). Smaller priming resulted in higher hematocrit values both at the beginning of cardiopulmonary bypass (27% +/- 5% compared with 26% +/- 4% and 25% +/- 4%, respectively, P <.0001) and at the end (30% +/- 4% compared with 28% +/- 4% and 27% +/- 4%, respectively, P <.0001). Red cell transfusions were used in 17% of the patients having small-cannula vacuum-assisted venous return, 27% of the initial patients having vacuum-assisted venous return, and 37% of the patients having gravity drainage (P =.001); total blood product usage was 19%, 27%, and 39%, respectively (P =.002). Although ministernotomy also was associated with reduced blood product usage (P <.004), propensity matching on type of sternotomy confirmed the association of vacuum-assisted venous return with lowered blood product usage. Vacuum-assisted venous return results in (1) higher hematocrit values during cardiopulmonary bypass and (2) decreased red cell and total blood product usage.

Utility of routine psychological screening in the childhood cancer survivor clinic.

PubMed

Recklitis, Christopher; O'Leary, Tara; Diller, Lisa

2003-03-01

This study examined the utility of routine psychologic screening in a childhood cancer survivor clinic by evaluating patient acceptance, comparing subjects' symptoms to normative data, examining the utility of specific tests, and identifying risk factors associated with psychological distress. During their annual clinic visit, 101 adult survivors of childhood cancer (median age, 25 years) completed the Symptom Checklist 90 Revised (SCL-90), as well as the Short Form 36 (SF-36), Beck Depression Inventory (BDI), and one additional suicide question. Psychological distress was operationally defined according to the published SCL-90 clinical case rule, classifying subjects with a consistent pattern of symptom elevations as clinical cases. The majority of subjects (80%) completed the screening in less than 30 minutes and reported little (15%) or no (84%) distress. Sixty-four percent believed it would help "very much" or "moderately" in getting to know them, and 35% thought it would help "slightly." On the SCL-90, 32 subjects (31.7%) had a positive screen, indicating significant psychological distress. All subjects with clinically significant symptoms on the BDI and SF-36 Mental Health Scale were cases on the SCL-90 (case-positive). Suicidal symptoms were reported in 13.9% of the sample, all of whom were SCL-90 cases. In a logistic regression model, subjects' dissatisfaction with physical appearance, poor physical health, and treatment with cranial radiation were associated with psychological distress. Results demonstrate that routine psychological screening can be successfully integrated into the cancer survivor clinic and may be effective in identifying those survivors with significant distress who require further evaluation.

MALDI-TOF-mass spectrometry applications in clinical microbiology.

PubMed

Seng, Piseth; Rolain, Jean-Marc; Fournier, Pierre Edouard; La Scola, Bernard; Drancourt, Michel; Raoult, Didier

2010-11-01

MALDI-TOF-mass spectrometry (MS) has been successfully adapted for the routine identification of microorganisms in clinical microbiology laboratories in the past 10 years. This revolutionary technique allows for easier and faster diagnosis of human pathogens than conventional phenotypic and molecular identification methods, with unquestionable reliability and cost-effectiveness. This article will review the application of MALDI-TOF-MS tools in routine clinical diagnosis, including the identification of bacteria at the species, subspecies, strain and lineage levels, and the identification of bacterial toxins and antibiotic-resistance type. We will also discuss the application of MALDI-TOF-MS tools in the identification of Archaea, eukaryotes and viruses. Pathogenic identification from colony-cultured, blood-cultured, urine and environmental samples is also reviewed.

Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios.

PubMed

Azzam, Pierre N; Gopalan, Priya; Brown, Jennifer R; Aquino, Patrick R

2016-04-01

As clinical psychiatry has evolved to mirror the patient care model followed in other medical specialties, psychiatrists are called upon increasingly to utilize general medical skills in routine practice. Psychiatrists who practice in academic settings are often required to generate broad differential diagnoses that include medical and neurologic conditions and, as a result, benefit from incorporating physical examination into their psychiatric assessments. Physical examination allows psychiatrists to follow and to teach patient-informed clinical practices and comprehensive treatment approaches. In this commentary, the authors encourage routine use of a targeted physical examination and outline common scenarios in which physical examination would be useful for the academic psychiatrist: delirium, toxidromes, and unexplained medical conditions (e.g., somatic symptom disorders).

Semantic Technologies for Re-Use of Clinical Routine Data.

PubMed

Kreuzthaler, Markus; Martínez-Costa, Catalina; Kaiser, Peter; Schulz, Stefan

2017-01-01

Routine patient data in electronic patient records are only partly structured, and an even smaller segment is coded, mainly for administrative purposes. Large parts are only available as free text. Transforming this content into a structured and semantically explicit form is a prerequisite for querying and information extraction. The core of the system architecture presented in this paper is based on SAP HANA in-memory database technology using the SAP Connected Health platform for data integration as well as for clinical data warehousing. A natural language processing pipeline analyses unstructured content and maps it to a standardized vocabulary within a well-defined information model. The resulting semantically standardized patient profiles are used for a broad range of clinical and research application scenarios.

Initial observations of electronic medical record usage during CT and MRI interpretation: Frequency of use and impact on workflow.

PubMed

Lin, Abraham; Harris, Mitchell; Zalis, Michael

2010-07-01

Electronic medical record (EMR) systems permit integration of contextual nonimaging EMR data into examination interpretation; however, the extra effort required to search and review these nonradiologic data are not well characterized. We assessed the gross frequency and pattern of EMR usage in the interpretation of diagnostic CT and MRI examinations. We defined nonradiologic EMR data as laboratory data, nonimaging specialty report, clinical note, and administrative data not available on PACS. For abdominal, neuroradiologic, and musculoskeletal CT and MRI, we prospectively recorded the time required for image analysis (including prior imaging studies and their reports), nonradiologic EMR use, and initial report drafting by fellows and staff in randomized sessions. We assessed EMR use as a fraction of work activity and according to technique, subspecialty, inpatient status, and radiologist experience. We observed 372 CT and MRI interpretations by 33 radiologists. For CT, radiologists used the EMR in 34% of abdominal, 57% of neuroradiologic, and 38% of musculoskeletal interpretations. For MRI, EMR was used in 73% of abdominal, 56% of neuroradiologic, and 33% of musculoskeletal interpretations. For CT, EMR usage comprised 18%, 14%, and 18% of diagnostic effort (image analysis plus EMR use) for abdominal, neuroradiologic, and musculoskeletal interpretations, respectively; for MRI, EMR usage comprised 21%, 16%, and 15% of diagnostic effort for abdominal, neuroradiologic, and musculoskeletal interpretations, respectively. Frequency of EMR use was significantly greater for neuroradiology CT and abdominal MRI (p < 0.05, Fisher's test). EMR usage was not consistently related to inpatient status for CT or radiologist experience. For CT and MRI interpretation, EMR usage is frequent and comprises a significant fraction of diagnostic effort.

Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey.

PubMed

Payne, Karl Frederick Braekkan; Wharrad, Heather; Watts, Kim

2012-10-30

Smartphone usage has spread to many settings including that of healthcare with numerous potential and realised benefits. The ability to download custom-built software applications (apps) has created a new wealth of clinical resources available to healthcare staff, providing evidence-based decisional tools to reduce medical errors.Previous literature has examined how smartphones can be utilised by both medical student and doctor populations, to enhance educational and workplace activities, with the potential to improve overall patient care. However, this literature has not examined smartphone acceptance and patterns of medical app usage within the student and junior doctor populations. An online survey of medical student and foundation level junior doctor cohorts was undertaken within one United Kingdom healthcare region. Participants were asked whether they owned a Smartphone and if they used apps on their Smartphones to support their education and practice activities. Frequency of use and type of app used was also investigated. Open response questions explored participants' views on apps that were desired or recommended and the characteristics of apps that were useful. 257 medical students and 131 junior doctors responded, equating to a response rate of 15.0% and 21.8% respectively. 79.0% (n=203/257) of medical students and 74.8% (n=98/131) of junior doctors owned a smartphone, with 56.6% (n=115/203) of students and 68.4% (n=67/98) of doctors owning an iPhone.The majority of students and doctors owned 1-5 medical related applications, with very few owning more than 10, and iPhone owners significantly more likely to own apps (Chi sq, p<0.001). Both populations showed similar trends of app usage of several times a day. Over 24 hours apps were used for between 1-30 minutes for students and 1-20 minutes for doctors, students used disease diagnosis/management and drug reference apps, with doctors favouring clinical score/calculator apps. This study found a high level of smartphone ownership and usage among medical students and junior doctors. Both groups endorse the development of more apps to support their education and clinical practice.

Usage of the www.2aida.org AIDA diabetes software Website: a pilot study.

PubMed

Lehmann, Eldon D

2003-01-01

AIDA is a diabetes-computing program freely available from www.2aida.org on the Web. The software is intended to serve as an educational support tool, and can be used by anyone who has an interest in diabetes, whether they be patients, relatives, health-care professionals, or students. In previous "Diabetes Information Technology & WebWatch" columns various indicators of usage of the AIDA program have been reviewed, and various comments from users of the software have been documented. One aspect of AIDA, though, that has been of considerable interest has been to investigate its Web-based distribution as a wider paradigm for more general medically related usage of the Internet. In this respect we have been keen to understand in general terms: (1) why people are turning to the Web for health-care/diabetes information; (2) more specifically, what sort of people are making use of the AIDA software; and (3) what benefits they feel might accrue from using the program. To answer these types of questions we have been conducting a series of audits/surveys via the AIDA Website, and via the software program itself, to learn as much as possible about who the AIDA end users really are. The rationale for this work is that, in this way, it should be possible to improve the program as well as tailor future versions of the software to the interests and needs of its users. However, a recurring observation is that data collection is easiest if it is as unobtrusive and innocuous as possible. One aspect of learning as much as possible about diabetes Website visitors and users may be to apply techniques that do not necessitate any visitor or user interaction. There are various programs that can monitor what pages visitors are viewing at a site. As these programs do not require visitors to do anything special, over time some interesting insights into Website usage may be obtained. For the current study we have reviewed anonymous logstats data, which are automatically collected at many Websites, to try and establish a baseline level of usage for the AIDA site. For the initial pilot study the analysis was performed from October 1, 2000 to November 1, 2001. The study has yielded an interesting insight into how the AIDA Website is being used. The results also confirm those of previous audits based on different self-reported methodologies, confirming, amongst other things, what countries people are visiting from and what operating systems/computers they are using. These analyses have been informative and useful. Given this, it is proposed to repeat the current pilot survey approach on a routine basis, in the future, as a way of monitoring on-going usage of the AIDA Website.

Retrospective study for risk factors for febrile UTI in spinal cord injury patients with routine concomitant intermittent catheterization in outpatient settings.

PubMed

Mukai, S; Shigemura, K; Nomi, M; Sengoku, A; Yamamichi, F; Fujisawa, M; Arakawa, S

2016-01-01

Retrospective study. The objective of this study was to investigate the clinical risk factors for febrile urinary tract infection (UTI) in spinal cord injury-associated neurogenic bladder (NB) patients who perform routine clean intermittent catheterization (CIC). Rehabilitation Hospital, Kobe, Japan. Over a 3-year period, we retrospectively assessed the clinical risk factors for febrile UTI in 259 spinal cord injury patients diagnosed as NB and performing routine CIC with regard to the factors such as gender, the presence of pyuria and bacteriuria, and the categories of the American Spinal Injury Association (ASIA) impairment scale. A total of 67 patients had febrile UTI in the follow-up period, with 57 cases of pyelonephritis, 11 cases of epididymitis and 2 cases of prostatitis, including the patients with plural infectious diseases. The causative bacteria were ranked as follows: Escherichia coli (74 cases), Pseudomonas aeruginosa (17 cases), Enterococcus faecalis (14 cases) and Klebsiella pneumoniae (12 cases). Antibiotic-resistant E. coli were seen, with 10.5% instances of extended-spectrum β-lactamase (ESBL) production and 23.8% of fluoroquinolone resistance. Multivariate analyses of clinical risk factors for febrile UTI showed that gender (male, P=0.0431), and ASIA impairment scale C or more severe (P=0.0266) were significantly associated with febrile UTI occurrence in NB patients with routine CIC. Our data demonstrated gender (male) and ASIA impairment scale C or more severe were significantly associated with febrile UTI occurrence in NB patients using routine CIC. Further prospective studies are necessary to define the full spectrum of possible risk factors for febrile UTI in these patients.

The Necessity for Routine Pre-operative Ultrasound Mapping Before Arteriovenous Fistula Creation: A Meta-analysis.

PubMed

Georgiadis, G S; Charalampidis, D G; Argyriou, C; Georgakarakos, E I; Lazarides, M K

2015-05-01

Existing guidelines suggest routine use of pre-operative color Doppler ultrasound (DUS) vessel mapping before the creation of arteriovenous fistulae (AVF); however, there is controversy about its benefit over traditional clinical examination or selective ultrasound use. This was a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing routine DUS mapping before the creation of AVF with patients for whom the decision for AVF placement was based on clinical examination and selective ultrasound use. A search of MEDLINE/PubMed, SCOPUS, and the Cochrane Library was carried out in June 2014. The analyzed outcome measures were the immediate failure rate and the early/midterm adequacy of the fistula for hemodialysis. Additionally, assessment of the methodological quality of the included studies was carried out. Five studies (574 patients) were analyzed. A random effects model was used to pool the data. The pooled odds ratio (OR) for the immediate failure rate was 0.32 (95% confidence interval [CI] 0.17-0.60; p < .01), which was significantly in favor of the DUS mapping group. The pooled OR for the early/midterm adequacy for hemodialysis was 0.66 (95% CI 0.42-1.03; p = .06), with a trend in favor of the DUS mapping group; however, subgroup analysis revealed that routine DUS mapping was more beneficial than selective DUS (p < .05). The available evidence, based mainly on moderate quality RCTs, suggests that the pre-operative clinical examination should always be supplemented with routine DUS mapping before AVF creation. This policy avoids negative surgical explorations and significantly reduces the immediate AVF failure rate. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Impact of nurse-targeted care on HIV outcomes among immunocompromised persons: a before-after study in Uganda

PubMed Central

Kiragga, Agnes N.; Nalintya, Elizabeth; Morawski, Bozena M.; Kigozi, Joanita; Park, Benjamin J.; Kaplan, Jonathan E.; Boulware, David R.; Meya, David B.; Manabe, Yukari C.

2016-01-01

Introduction Improving HIV outcomes among severely immunocompromised HIV-infected persons who have increased morbidity and mortality remains an important issue in sub-Saharan Africa. We sought to evaluate the impact of targeted clinic- based nurse care on ART initiation and retention among severely immunocompromised HIV-infected persons. Methods The study included ART-naïve patients with CD4<100 cells/μL registered in seven urban clinics in Kampala, Uganda. Data were retrospectively collected on patients enrolled from July to December 2011 (routine care cohort). Between July 2012 and September 2013, one additional nurse per clinic was hired (nurse counselor cohort) to identify new patients, expedite ART initiation and trace those loss-to-follow-up. We compared time to ART initiation and 6-month retention in care between cohorts and used a generalized linear model to estimate the relative risk of retention. Results The study included 258 patients in the routine care cohort and 593 in the nurse counselor cohort. The proportion of patients who initiated ART increased from 190 (73.6%) in the routine care cohort to 506 (85.3%) in the nurse counselor cohort (p<0.001). At 6 months, 62% of the routine care cohort were retained in care versus 76% in the nurse counselor cohort (p=0.001). A 21% increase in likelihood of retention in the nurse counselor cohort (relative risk 1.21, 95% CI, 1.09–1.34) compared with the routine care cohort was observed. Conclusion Implementation of targeted nurse–led care of severely immunocompromised HIV-infected patients in public outpatient health care facilities resulted in decreased time to ART initiation and increased retention. PMID:27003494

Patient acceptability, efficacy, and skin biophysiology of a cream and cleanser containing lipid complex with shea butter extract versus a ceramide product for eczema.

PubMed

Hon, K L; Tsang, Y C; Pong, N H; Lee, Vivian W Y; Luk, N M; Chow, C M; Leung, T F

2015-10-01

To investigate patient acceptability, efficacy, and skin biophysiological effects of a cream/cleanser combination for childhood atopic dermatitis. Paediatric dermatology clinic at a university teaching hospital in Hong Kong. Consecutive paediatric patients with atopic dermatitis who were interested in trying a new moisturiser were recruited between 1 April 2013 and 31 March 2014. Swabs and cultures from the right antecubital fossa and the worst eczematous area, disease severity (SCORing Atopic Dermatitis index), skin hydration, and transepidermal water loss were obtained prior to and following 4-week usage of a cream/cleanser containing lipid complex with shea butter extract (Ezerra cream; Hoe Pharma, Petaling Jaya, Malaysia). Global or general acceptability of treatment was documented as 'very good', 'good', 'fair', or 'poor'. A total of 34 patients with atopic dermatitis were recruited; 74% reported 'very good' or 'good', whereas 26% reported 'fair' or 'poor' general acceptability of treatment of the Ezerra cream; and 76% reported 'very good' or 'good', whereas 24% reported 'fair' or 'poor' general acceptability of treatment of the Ezerra cleanser. There were no intergroup differences in pre-usage clinical parameters of age, objective SCORing Atopic Dermatitis index, pruritus, sleep loss, skin hydration, transepidermal water loss, topical corticosteroid usage, oral antihistamine usage, or general acceptability of treatment of the prior emollient. Following use of the Ezerra cream, mean pruritus score decreased from 6.7 to 6.0 (P=0.036) and mean Children's Dermatology Life Quality Index improved from 10.0 to 8.0 (P=0.021) in the 'very good'/'good' group. There were no statistically significant differences in the acceptability of wash (P=0.526) and emollients (P=0.537) with pre-trial products. When compared with the data of another ceramide-precursor moisturiser in a previous study, there was no statistical difference in efficacy and acceptability between the two products. The trial cream was acceptable in three quarters of patients with atopic dermatitis. Patients who accepted the cream had less pruritus and improved quality of life than the non-accepting patients following its usage. The cream containing shea butter extract did not differ in acceptability or efficacy from a ceramide-precursor product. Patient acceptability is an important factor for treatment efficacy. There is a general lack of published clinical trials to document the efficacy and skin biophysiological effects of many of the proprietary moisturisers.

Microplates in liquid chromatography--new solution in clinical research? A review.

PubMed

Krcmova, Lenka; Solichova, Dagmar; Solich, Petr

2013-10-15

Microplates are routinely used in Radio- or Immuno-assays. Recently, microplates have found use not only in analytical but also in the pre-analytical phase in bioanalyses (sample storage, sample preparation). New connection of this technology to liquid chromatography could be economical, fast and simple solution for many routine laboratories handling large sequences of biological samples. This review summarises the application of microplates in bioanalytical laboratories. Different types of sorbents, materials and shapes of microplates are discussed, and the main advantages and disadvantages of microplates used in clinical research are presented. Copyright © 2013 Elsevier B.V. All rights reserved.

Routine identification of medical fungi by the new Vitek MS matrix-assisted laser desorption ionization-time of flight system with a new time-effective strategy.

PubMed

Iriart, Xavier; Lavergne, Rose-Anne; Fillaux, Judith; Valentin, Alexis; Magnaval, Jean-François; Berry, Antoine; Cassaing, Sophie

2012-06-01

We report here a clinical evaluation of the Vitek MS system for rapid fungal identification. A strategy that uses a single deposit without prior protein extraction was utilized to save time and money. Clinical isolates from the Toulouse University hospital were used to evaluate the performance of the Vitek MS compared to that of both routine laboratory techniques and Vitek2. The Vitek MS performed well in the identification of yeasts and Aspergillus fungi (93.2% of correct identifications).

Low levels of antiretroviral-resistant HIV infection in a routine clinic in Cameroon that uses the World Health Organization (WHO) public health approach to monitor antiretroviral treatment and adequacy with the WHO recommendation for second-line treatment.

PubMed

Kouanfack, Charles; Montavon, Celine; Laurent, Christian; Aghokeng, Avelin; Kenfack, Alain; Bourgeois, Anke; Koulla-Shiro, Sinata; Mpoudi-Ngole, Eitel; Peeters, Martine; Delaporte, Eric

2009-05-01

A cross-sectional study, performed at a routine human immunodeficiency virus (HIV)/AIDS clinic in Cameroon that uses the World Health Organization public health approach, showed low rates of virological failure and drug resistance at 12 and 24 months after initiation of antiretroviral therapy. Importantly, the cross-sectional study also showed that the World Health Organization recommendation for second-line treatment would be effective in almost all patients with HIV drug resistance mutations.

Predictors of Early-Onset Permanent Hearing Loss in Malnourished Infants in Sub-Saharan Africa

ERIC Educational Resources Information Center

Olusanya, Bolajoko O.

2011-01-01

The objective of this study was to determine the predictors of early-onset permanent hearing loss (EPHL) among undernourished infants in a low-income country where routine screening for developmental disabilities in early childhood is currently unattainable. All infants attending four community-based clinics for routine immunization who met the…