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Sample records for abca4 influence clinical

  1. Genetic and Epigenetic Factors at COL2A1 and ABCA4 Influence Clinical Outcome in Congenital Toxoplasmosis

    JAMIESON, S.E.; de Roubaix, L. A.; Cortina-Borja, M.; Tan, H K; Mui, E. J.; Cordell, H J; Kirisits, M. J.; Miller, E. N.; Peacock, C. S.; Hargrave, A. C.; Coyne, J J; Boyer, K.; Bessieres, M H; Buffolano, W.; Ferret, N

    2008-01-01

    Background: Primary Toxoplasma gondii infection during pregnancy can be transmitted to the fetus. At birth, infected infants may have intracranial calcification, hydrocephalus, and retinochoroiditis, and new ocular lesions can occur at any age after birth. Not all children who acquire infection in utero develop these clinical signs of disease. Whilst severity of disease is influenced by trimester in which infection is acquired by the mother, other factors including genetic predisposition may ...

  2. Retinal dystrophies caused by mutations in the ABCA4 gene : an evaluation of the clinical spectrum

    Klevering, Bert Jeroen

    2004-01-01

    In the past seven years, the ABCA4 gene has emerged as the most prominent gene in inherited retinal disease. Pathogenic ABCA4 mutations are the cause of all cases of Stargardt disease, and a portion of the cases of autosomal recessive retinitis pigmentosa and cone-rod dystrophy. Moreover, specific heterozygous alterations in this gene have been associated with age-related macular degeneration, although this role has been disputed by others. The papers in this thesis, joined in the six appendi...

  3. Analysis of the ABCA4 genomic locus in Stargardt disease

    Zernant, Jana; Xie, Yajing Angela; Ayuso, Carmen;

    2014-01-01

    was designed to find the missing disease-causing ABCA4 variation by a combination of next-generation sequencing (NGS), array-Comparative Genome Hybridization (aCGH) screening, familial segregation and in silico analyses. The entire 140 kb ABCA4 genomic locus was sequenced in 114 STGD patients with one...... once. Multimodal analysis suggested 12 new likely pathogenic intronic ABCA4 variants, some of which were specific to (isolated) ethnic groups. No copy number variation (large deletions and insertions) was detected in any patient suggesting that it is a very rare event in the ABCA4 locus. Many variants...... were excluded since they were not conserved in non-human primates, were frequent in African populations and, therefore, represented ancestral, and not disease-associated, variants. The sequence variability in the ABCA4 locus is extensive and the non-coding sequences do not harbor frequent mutations in...

  4. Next-generation sequencing of ABCA4: High frequency of complex alleles and novel mutations in patients with retinal dystrophies from Central Europe.

    Ścieżyńska, Aneta; Oziębło, Dominika; Ambroziak, Anna M; Korwin, Magdalena; Szulborski, Kamil; Krawczyński, Maciej; Stawiński, Piotr; Szaflik, Jerzy; Szaflik, Jacek P; Płoski, Rafał; Ołdak, Monika

    2016-04-01

    Variation in the ABCA4 locus has emerged as the most prevalent cause of monogenic retinal diseases. The study aimed to discover causative ABCA4 mutations in a large but not previously investigated cohort with ABCA4-related diseases originating from Central Europe and to refine the genetic relevance of all identified variants based on population evidence. Comprehensive clinical studies were performed to identify patients with Stargardt disease (STGD, n = 76) and cone-rod dystrophy (CRD, n = 16). Next-generation sequencing targeting ABCA4 was applied for a widespread screening of the gene. The results were analyzed in the context of exome data from a corresponding population (n = 594) and other large genomic databases. Our data disprove the pathogenic status of p.V552I and provide more evidence against a causal role of four further ABCA4 variants as drivers of the phenotype under a recessive paradigm. The study identifies 12 novel potentially pathogenic mutations (four of them recurrent) and a novel complex allele p.[(R152*; V2050L)]. In one third (31/92) of our cohort we detected the p.[(L541P; A1038V)] complex allele, which represents an unusually high level of genetic homogeneity for ABCA4-related diseases. Causative ABCA4 mutations account for 79% of STGD and 31% of CRD cases. A combination of p.[(L541P; A1038V)] and/or a truncating ABCA4 mutation always resulted in an early disease onset. Identification of ABCA4 retinopathies provides a specific molecular diagnosis and justifies a prompt introduction of simple precautions that may slow disease progression. The comprehensive, population-specific study expands our knowledge on the genetic landscape of retinal diseases. PMID:26593885

  5. Genomic screening of ABCA4 and array CGH analysis underline the genetic variability of Greek patients with inherited retinal diseases

    Maria Tsipi

    2016-06-01

    Conclusions: The ABCA4 mutation spectrum in Greek patients differs from other populations. Bioinformatic tools, segregation analysis along with clinical data from the patients seemed to be crucial for the evaluation of genetic variants and particularly for the discrimination between causative and non-causative variants.

  6. Phenotypic and genetic spectrum of Danish patients with ABCA4-related retinopathy

    Duno, Morten; Schwartz, Marianne; Larsen, Pernille L.;

    2012-01-01

    Pathogenic variations in the ABCA4 gene were originally recognized as genetic background for the autosomal recessive disorders Stargardt disease and fundus flavimaculatus, but have expanded to embrace a diversity of retinal diseases, giving rise to the new diagnostic term, ABCA4-related retinopat...

  7. Association between genotype and phenotype in families with mutations in the ABCA4 gene

    Kjellström, Ulrika

    2014-01-01

    Purpose To investigate the genotype and phenotype in families with adenosine triphosphate–binding cassette, sub-family A, member 4 (ABCA4)–associated retinal degeneration. Methods Three families with at least one family member with known homozygous or compound heterozygote mutations in the ABCA4 gene were studied. The investigations included full field electroretinography (ff-ERG), multifocal ERG (mERG), Goldmann visual fields, optical coherence tomography (OCT), and standard ophthalmological...

  8. Generalized Choriocapillaris Dystrophy, a Distinct Phenotype in the Spectrum of ABCA4-Associated Retinopathies

    Bertelsen, Mette; Zernant, Jana; Larsen, Michael;

    2014-01-01

    earliest recorded manifestation of ABCA4-associated disease was a central bull's eye type of macular dystrophy that progressed to chorioretinal atrophy of the macula with coarse rounded hyperpigmentations and expanding involvement of the periphery. The mean age at first presentation was 10.3 years, the...

  9. Rescuing Trafficking Mutants of the ATP-binding Cassette Protein, ABCA4, with Small Molecule Correctors as a Treatment for Stargardt Eye Disease.

    Sabirzhanova, Inna; Lopes Pacheco, Miquéias; Rapino, Daniele; Grover, Rahul; Handa, James T; Guggino, William B; Cebotaru, Liudmila

    2015-08-01

    Stargardt disease is the most common form of early onset macular degeneration. Mutations in ABCA4, a member of the ATP-binding cassette (ABC) family, are associated with Stargardt disease. Here, we have examined two disease-causing mutations in the NBD1 region of ABCA4, R1108C, and R1129C, which occur within regions of high similarity with CFTR, another ABC transporter gene, which is associated with cystic fibrosis. We show that R1108C and R1129C are both temperature-sensitive processing mutants that engage the cellular quality control mechanism and show a strong interaction with the chaperone Hsp 27. Both mutant proteins also interact with HDCAC6 and are degraded in the aggresome. We also demonstrate that novel corrector compounds that are being tested as treatment for cystic fibrosis, such as VX-809, can rescue the processing of the ABCA4 mutants, particularly their expression at the cell surface, and can reduce their binding to HDAC6. Thus, our data suggest that VX-809 can potentially be developed as a new therapy for Stargardt disease, for which there is currently no treatment. PMID:26092729

  10. Associations of chromosomes 17q22, 10q25.3 and ABCA4 gene polymorphisms with non-syndromic cleft lip/palate in Ningxia Hui and Han population%宁夏回汉族人群中染色体17q22、10q25.3和ABCA4基因多态性与非综合征型唇腭裂的关联

    周忠伟; 杨雄; 万应彪; 信燕华; 翟堃; 马坚; 黄永清; 姜敏; 王怡瑞

    2013-01-01

    目的 研究中国宁夏地区回汉族人群染色体17q22(rs227731)、ABCA4(rs560426)和10q25.3(7078160)位点单核苷酸多态性与非综合征型唇腭裂的相关性.方法 研究对象包括非综合征型唇腭裂患儿415例,其中汉族191例,回族224例;患儿父亲205例,母亲240例;其中完整3人核心家系158个.将他们分为单纯唇裂组、单纯腭裂组、唇腭裂组,单纯唇裂组与唇腭裂组合并为唇裂伴或不伴腭裂组;对照组为健康大学生385例,其中汉族281例,回族104例.采用TaqMan基因型鉴定技术检测3个单核苷酸多态位点的基因型,进行病例对照分析、传递不平衡检验、以家系为基础的相关性分析.结果 ①染色体17q22区段的rs227731位点在汉族单纯唇裂组等位基因频率与对照组比较存在统计学差异(P<0.05),在唇裂伴或不伴腭裂组中等位基因频率与对照组比较存在统计学差异(P<0.05).回汉族唇腭裂组等位基因频率和唇裂伴或不伴腭裂组基因型、等位基因频率比较均存在统计学差异(P=0.04,P=0.04,P=0.01);②ABCA4基因的rs560426位点在汉族单纯唇裂组基因型与等位基因频率与对照组比较存在统计学差异(P<0.05),在唇裂伴或不伴腭裂组中基因型与等位基因频率与对照组比较存在统计学差异(P<0.05),回汉族单纯唇裂组基因型、等位基因比较存在统计学差异(P=0.04,P=0.01);③染色体10q25.3区段的rs7078160位点基因型与等位基因频率与对照组比较及回汉族相互比较均无统计学差异(P<0.05).结论 在宁夏汉族人群中染色体17q22区段的rs227731位点和ABCA4基因的rs560426位点单核苷酸多态性与非综合征型唇腭裂有统计学关联,染色体10q25.3区段的rs7078160位点与非综合征型唇腭裂无统计学关联.%Objective To explore if genetic variation in chromosome 17q22 (rs22731), ABCA4 (rs560426) and 10q25. 3(rs7078160)genes contributes to non-syndromic cleft lip

  11. Single residue AAV capsid mutation improves transduction of photoreceptors in the Abca4-/- mouse and bipolar cells in the rd1 mouse and human retina ex-vivo

    Silva, SR; Charbel Issa, P; Singh, MS; Lipinski, DM; Barnea-Cramer, AO; Walker, NJ; Barnard, AR; Hankins, MW; MacLaren, RE

    2016-01-01

    Gene therapy using adeno-associated viral vectors (AAV) for the treatment of retinal degenerations has shown safety and efficacy in clinical trials. However, very high levels of vector expression may be necessary for the treatment of conditions such as Stargardt disease where a dual vector approach is potentially needed, or in optogenetic strategies for end-stage degeneration in order to achieve maximal light sensitivity. In this study, we assessed two vectors with single ca...

  12. What variables can influence clinical reasoning?

    Vahid Ashoorion

    2012-01-01

    Full Text Available Background: Clinical reasoning is one of the most important competencies that a physician should achieve. Many medical schools and licensing bodies try to predict it based on some general measures such as critical thinking, personality, and emotional intelligence. This study aimed at providing a model to design the relationship between the constructs. Materials and Methods: Sixty-nine medical students participated in this study. A battery test devised that consist four parts: Clinical reasoning measures, personality NEO inventory, Bar-On EQ inventory, and California critical thinking questionnaire. All participants completed the tests. Correlation and multiple regression analysis consumed for data analysis. Results: There is low to moderate correlations between clinical reasoning and other variables. Emotional intelligence is the only variable that contributes clinical reasoning construct (r=0.17-0.34 (R 2 chnage = 0.46, P Value = 0.000. Conclusion: Although, clinical reasoning can be considered as a kind of thinking, no significant correlation detected between it and other constructs. Emotional intelligence (and its subscales is the only variable that can be used for clinical reasoning prediction.

  13. Nursing students’ perceived stress and influences in clinical performance

    Laila Akhu-Zaheya; Insaf Shaban; Wejdan Khater

    2015-01-01

    Background: It is known that stress related to clinical training among nursing students could contribute to many physical and mental problems. However, little empirical evidence about the influence of stress in nurse students’ clinical performance Objective: The objective of this study was to assess the association between perceived stresses, stress related factors, and students’ clinical performance. Method: Using the perceived stress scale, 539 Jordanian nursing students from 2 publ...

  14. [Influence of clinical guidelines on medical practitioners].

    Arii, Shigeki

    2007-09-01

    Evidenced-based clinical guidelines for diagnosing and treating hepatocellular carcinoma patients were published in 2005, which were edited by the executive members of the Liver Cancer Study Group of Japan (Chief Editor, Professor Masatosi Makuuchi, MD). This article presents the results of two surveys investigating the validity and usefulness of those guidelines. The author's opinions regarding the evaluation of the guidelines and guideline-based clinical practice are also presented. The surveys revealed that the guidelines are well known and thought to be useful by medical practitioners. The guidelines had changed the therapeutic strategy of 20% of experts in the field. However, 43% of experts and 30% of nonexperts believed that the guidelines restricted their medical discretion. Additionally, the percentage of physicians who felt that medical malpractice suits would increase exceeded those who did not. However, the guidelines do not provide clear recommendations in about 45% of diagnostic and therapeutic points because of a lack of evidence. The recommendations on these points in the guidelines require the commonsense discretion of physicians. The guidelines should be followed based on an understanding of biology and medicine, and not based on dogmatism. PMID:17907456

  15. Intussusception: Clinical and radiographic factors influencing reducibility

    Hydrostatic reduction of intussusception by barium or air enema has been widely accepted. The five-year experience with this procedure at two children's hospitals is reviewed and the results compared to previous studies. Various clinical and radiographic factors are evaluated in relation to the reduction rate. The findings show that the more distal the intussusception is encountered, the lower the rate of reduction. However, 25% are reduced within the rectum with no evidence of increased complications. Small bowel obstruction and prolonged durations of signs and symptoms decreased the rate of reduction statistically but there is no significant increase in complication rate in those attempted, contrary to a previous report. The crescent sign (dissection sign) and age of the patient are not significant factors in reduction as reported by other studies. (orig.)

  16. Factors influencing radiation therapy student clinical placement satisfaction

    Introduction: Radiation therapy students at Queensland University of Technology (QUT) attend clinical placements at five different clinical departments with varying resources and support strategies. This study aimed to determine the relative availability and perceived importance of different factors affecting student support while on clinical placement. The purpose of the research was to inform development of future support mechanisms to enhance radiation therapy students’ experience on clinical placement. Methods: This study used anonymous Likert-style surveys to gather data from years 1 and 2 radiation therapy students from QUT and clinical educators from Queensland relating to availability and importance of support mechanisms during clinical placements in a semester. Results: The study findings demonstrated student satisfaction with clinical support and suggested that level of support on placement influenced student employment choices. Staff support was perceived as more important than physical resources; particularly access to a named mentor, a clinical educator and weekly formative feedback. Both students and educators highlighted the impact of time pressures. Conclusions: The support offered to radiation therapy students by clinical staff is more highly valued than physical resources or models of placement support. Protected time and acknowledgement of the importance of clinical education roles are both invaluable. Joint investment in mentor support by both universities and clinical departments is crucial for facilitation of effective clinical learning

  17. Influence of light source and clinical experience on shade matching

    GÁSPÁRIK, CRISTINA; TOFAN, ALINA; CULIC, BOGDAN; BADEA, MÎNDRA; DUDEA, DIANA

    2014-01-01

    Introduction Shade is one of the most important attributes when evaluating the success of a restoration. Several factors can influence the visual shade matching process, and therefore the outcome of the final restoration. Objectives 1. to assess the importance of clinical experience on shade matching accuracy; 2. to assess the influence of two standard light sources on the ability to match shade tabs; 3. to identify the area in a VITA Classical shade guide where matching errors are most likel...

  18. Transition to clinical training: influence of pre-clinical knowledge and skills, and consequences for clinical performance

    van Hell, Elisabeth A.; Kuks, Jan B. M.; Schonrock-Adema, Johanna; van Lohuizen, Mirjam T.; Cohen-Schotanus, Janke

    2008-01-01

    CONTEXT Many students experience a tough transition from pre-clinical to clinical training and previous studies suggest that this may constrict students' progress. However, clear empirical evidence of this is lacking. The aim of this study was to determine: whether the perceived difficulty of transition influences student performance during the first 2 weeks of clerkships; whether it influences students' overall performance in their first clerkship, and the degree to which the difficulty of t...

  19. Nursing students’ perceived stress and influences in clinical performance

    Laila Akhu-Zaheya

    2015-06-01

    Full Text Available Background: It is known that stress related to clinical training among nursing students could contribute to many physical and mental problems. However, little empirical evidence about the influence of stress in nurse students’ clinical performance Objective: The objective of this study was to assess the association between perceived stresses, stress related factors, and students’ clinical performance. Method: Using the perceived stress scale, 539 Jordanian nursing students from 2 public universities in Jordan participated in the study. Results: The results showed that the mean of stress perceived by students was 45.9. Students’ assignment were perceived as the main source of stress (M= 10.7, SD= 4.5 followed by stress related to patients’ care (M= 10.5, SD= 5.5 and stress from teachers and nursing staff (M= 9.6, SD= 5.3. The lowest source of stress is from students’ lack of professional knowledge and skills (M= 3.96; SD= 2.8. The mean of students’ clinical performance is 73.4%. Students’ perceived stress has a significant negative correlation with students’ clinical performance (r= -.09; p <.05. The results also showed significant negative correlation between stress related to lack of professional knowledge and skills, and stress related to patient care and students’ clinical performance. Conclusion: This study expanded on students’ stress in clinical settings, and warrants further research in assessing its impact on their performance. Teachers should be aware of and help students to overcome and cope with said stress related factors in the clinical settings effectively.

  20. Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

    Song, Jang Hyeon; Lee, Seung Jin; Jung, Hye Doo; Lim, Jae Hoon; Chang, Nam Kyu; Yim, Nam Yeol; Kim, Jae Kyu [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Lee, Keun Bae [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2011-09-15

    To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis. A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage. Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003). PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

  1. Prognostic factors influencing clinical outcomes of glioblastoma multiforme

    LI Shou-wei; QIU Xiao-guang; CHEN Bao-shi; ZHANG Wei; REN Huan; WANG Zhong-cheng; JIANG Tao

    2009-01-01

    Background Glioblastoma multiforme (GBM) is the most malignant kind of astrocytic tumors and is associated with a poor prognosis. In this retrospective study, we assessed the clinical, radiological, genetic molecular and treatment factors that influence clinical outcomes of patients with GBM.Methods A total of 116 patients with GBM who received surgery and radiation between January 2006 and December 2007 were included in this study. Kaplan-Meier survival analysis and Cox regression analysis were used to find the factors independently influencing patients' progression free survival (PFS) time and overall survival (OS) time.Results Age, preoperative Kamofsky Performance Scale (KPS) score, KPS score change at 2 weeks after operation, neurological deficit symptoms, tumor resection extent, maximal tumor diameter, involvement of eloquent cortex or deep structure, involvement of brain lobe, Ki-67 expression level and adjuvant chemotherapy were statistically significant factors (P <0.05) for both PFS and OS in the univariate analysis. Cox proportional hazards modeling revealed that age ≤50 years, preoperative KPS score ≥80, KPS score change after operation ≥0, involvement of single frontal lobe,non-eloquent area or deep structure involvement, low Ki-67 expression and adjuvant chemotherapy were independent favorable factors (P <0.05) for patients' clinical outcomes.Conclusions Age at diagnosis, preoperative KPS score, KPS score change at 2 weeks postoperation, involvement of brain lobe, involvement of eloquent cortex or deep structure, Ki-67 expression level and adjuvant chemotherapy correlate significantly with the prognosis of patients with GBM.

  2. Site Characteristics Influencing the Translation of Clinical Research Into Clinical Practice

    Smed, Marie; Getz, Kenneth A.

    2014-01-01

    to sponsor companies and may ultimately assist in positioning new products and driving commercialization success. This study evaluates site characteristics that influence the acquisition and sharing of knowledge gained through clinical trial experience. The impact of 2 central site characteristics on...... the process of translating drug experience is assessed: site location (North America/rest of the world) and site type or setting (academic/independent). The results show that investigative sites located outside North America generate and share more knowledge than those within North America....... Furthermore, although both academic and independent sites generate the same level of knowledge, academic sites share more of this knowledge with sponsor companies. This study suggests new strategies that sponsors can leverage to drive greater transfer of clinical research knowledge into clinical practice and...

  3. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.

    Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

    2010-05-01

    This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine. PMID:20436026

  4. Factors influencing radiation therapy student clinical placement satisfaction

    Bridge, Pete; Carmichael, Mary-Ann

    2014-01-01

    Introduction: Radiation therapy students at Queensland University of Technology (QUT) attend clinical placements at five different clinical departments with varying resources and support strategies. This study aimed to determine the relative availability and perceived importance of different factors affecting student support while on clinical placement. The purpose of the research was to inform development of future support mechanisms to enhance radiation therapy students’ experience on clini...

  5. Influence networks among substance abuse treatment clinics: implications for the dissemination of innovations

    Johnson, Kimberly; Quanbeck, Andrew; Maus, Adam; Gustafson, David H.; Dearing, James W.

    2015-01-01

    Understanding influence networks among substance abuse treatment clinics may speed the diffusion of innovations. The purpose of this study was to describe influence networks in Massachusetts, Michigan, New York, Oregon, and Washington and test two expectations, using social network analysis: (1) Social network measures can identify influential clinics; and (2) Within a network, some weakly connected clinics access out-of-network sources of innovative evidence-based practices and can spread th...

  6. Smoking status influences clinical outcome in collagenous colitis

    Andreas, Munch; Curt, Tysk; Johan, Bohr; Ahmed, Madisch; Bonderup, Ole Kristian; Ralf, Mohrbacher; Ralph, Mueller; Roland, Greinwald; Magnus, Ström; Stephan, Miehlke

    2015-01-01

    BACKGROUND: The relationship between clinical and histological parameters in collagenous colitis (CC) is poorly understood. Smoking is a risk factor for CC, whereas its impact on clinical activity and outcome is not well-known. METHODS: In a post-hoc analysis from pooled data of two randomized...... collagen band, inflammation of the lamina propria, total numbers of intraepithelial lymphocytes, degeneration). Moreover, we analyzed the predictive value of baseline parameters on clinical outcome in a logistic regression model. RESULTS: Pooled data from 202 patients with active CC were available thereof...

  7. Clinical Nursing Instructor Perception of the Influence of Engagement in Bedside Nursing Practice on Clinical Teaching

    Berndt, Jodi L.

    2013-01-01

    Clinical experiences are an integral component of nursing education. Because the amount of time that a student spends in clinical experiences can be as many as twelve to sixteen hours per week, the clinical instructor plays a significant role in the nursing student's development of nursing knowledge. Many nurse educators attempt to balance dual…

  8. Influence of a Regular, Standardized Meal on Clinical Chemistry Analytes

    Salvagno, Gian Luca; Lippi, Giuseppe; Gelati, Matteo; Montagnana, Martina; Danese, Elisa; Picheth, Geraldo; Guidi, Gian Cesare

    2012-01-01

    Background Preanalytical variability, including biological variability and patient preparation, is an important source of variability in laboratory testing. In this study, we assessed whether a regular light meal might bias the results of routine clinical chemistry testing. Methods We studied 17 healthy volunteers who consumed light meals containing a standardized amount of carbohydrates, proteins, and lipids. We collected blood for routine clinical chemistry tests before the meal and 1, 2, and 4 hr thereafter. Results One hour after the meal, triglycerides (TG), albumin (ALB), uric acid (UA), phosphatase (ALP), Ca, Fe, and Na levels significantly increased, whereas blood urea nitrogen (BUN) and P levels decreased. TG, ALB, Ca, Na, P, and total protein (TP) levels varied significantly. Two hours after the meal, TG, ALB, Ca, Fe, and Na levels remained significantly high, whereas BUN, P, UA, and total bilirubin (BT) levels decreased. Clinically significant variations were recorded for TG, ALB, ALT, Ca, Fe, Na, P, BT, and direct bilirubin (BD) levels. Four hours after the meal, TG, ALB, Ca, Fe, Na, lactate dehydrogenase (LDH), P, Mg, and K levels significantly increased, whereas UA and BT levels decreased. Clinically significant variations were observed for TG, ALB, ALT, Ca, Na, Mg, K, C-reactive protein (CRP), AST, UA, and BT levels. Conclusions A significant variation in the clinical chemistry parameters after a regular meal shows that fasting time needs to be carefully considered when performing tests to prevent spurious results and reduce laboratory errors, especially in an emergency setting. PMID:22779065

  9. Korean Cultural Influences on the Millon Clinical Multiaxial Inventory III.

    Gunsalus, Ae-Jung Chang; Kelly, Kevin R.

    2001-01-01

    Investigates the effect of Korean culture on the results of the Millon Clinical Multiaxial Inventory-III (MCMI-III) by comparing profiles of 147 Korean and 132 American college students. Results indicate that MCMI-III personality profile differences exist between Korean and American college students. Discusses implications for mental health…

  10. Cryptogenic fibrosing alveolitis: clinical features and their influence on survival

    Turner-Warwick, M.; Burrows, B; Johnson, A

    1980-01-01

    A retrospective analysis of 220 cases fulfilling criteria for cryptogenic fibrosing alveolitis (CFA) attending the Brompton Hospital between 1955 and 1973 has been carried out and patients have been followed for between four and 21 years. The frequency of various clinical features confirms previous reports. The 2: 1 male preponderance was similar in all age groups. The mean age at presentation was 54 years ± 12 SD; 202 (92%) of the patients presented with dyspnoea, the severity of which was r...

  11. Growth conditions influence melanization of Brazilian clinical Sporothrix schenckii isolates

    Almeida-Paes, Rodrigo; FRASES, SUSANA; Monteiro, Paulo Cezar Fialho; Gutierrez-Galhardo, Maria Clara; Zancopé-Oliveira, Rosely Maria; Nosanchuk, Joshua D.

    2009-01-01

    Sporothrix schenckii is known to produce DHN melanin on both conidial and yeast cells, however little information is available regarding the factors inducing fungal melanization. We evaluated whether culture conditions influenced melanization of 25 Brazilian S. schenckii strains and one control strain (ATCC 10212). Tested conditions included different media, pH, temperature, incubation time, glucose concentrations, and presence or absence of tricyclazole or L-DOPA. Melanization was reduced on...

  12. [Influence of chitosan on clinical-biochemical rates and protein metabolism of patients with cardiovascular diseases].

    Baĭgarin, E K; Pogozheva, A V

    2008-01-01

    The article tells about influence of combined chitosan (5 g/day) and triweekly dietotherapy on clinical-biochemical rates and nitrogen balance of patients with cardiovascular diseases. We obtained data indicating negative influence of chitosan on nitrogen balance. PMID:19227863

  13. Transition to clinical training : influence of pre-clinical knowledge and skills, and consequences for clinical performance

    van Hell, Elisabeth A.; Kuks, Jan B. M.; Schonrock-Adema, Johanna; van Lohuizen, Mirjam T.; Cohen-Schotanus, Janke

    2008-01-01

    CONTEXT Many students experience a tough transition from pre-clinical to clinical training and previous studies suggest that this may constrict students' progress. However, clear empirical evidence of this is lacking. The aim of this study was to determine: whether the perceived difficulty of transi

  14. Human REM sleep: influence on feeding behaviour, with clinical implications.

    Horne, James A

    2015-08-01

    Rapid eye movement (REM) sleep shares many underlying mechanisms with wakefulness, to a much greater extent than does non-REM, especially those relating to feeding behaviours, appetite, curiosity, exploratory (locomotor) activities, as well as aspects of emotions, particularly 'fear extinction'. REM is most evident in infancy, thereafter declining in what seems to be a dispensable manner that largely reciprocates increasing wakefulness. However, human adults retain more REM than do other mammals, where for us it is most abundant during our usual final REM period (fREMP) of the night, nearing wakefulness. The case is made that our REM is unusual, and that (i) fREMP retains this 'dispensability', acting as a proxy for wakefulness, able to be forfeited (without REM rebound) and substituted by physical activity (locomotion) when pressures of wakefulness increase; (ii) REM's atonia (inhibited motor output) may be a proxy for this locomotion; (iii) our nocturnal sleep typically develops into a physiological fast, especially during fREMP, which is also an appetite suppressant; (iv) REM may have 'anti-obesity' properties, and that the loss of fREMP may well enhance appetite and contribute to weight gain ('overeating') in habitually short sleepers; (v) as we also select foods for their hedonic (emotional) values, REM may be integral to developing food preferences and dislikes; and (vii) REM seems to have wider influences in regulating energy balance in terms of exercise 'substitution' and energy (body heat) retention. Avenues for further research are proposed, linking REM with feeding behaviours, including eating disorders, and effects of REM-suppressant medications. PMID:26122167

  15. The Influence of Postoperative Tibiofemoral Alignment on the Clinical Results of Unicompartmental Knee Arthroplasty

    Kim, Kyung Tae; Lee, Song; Kim, Tae Woo; Lee, Jung Soo; Boo, Kyung Hwan

    2012-01-01

    Purpose To evaluate the influence of postoperative tibiofemoral alignment on the clinical results and failure in patients who underwent unicompartmental knee athroplasty (UKA). Materials and Methods We reviewed 246 cases of medial UKA which were followed up for at least 5 years after the operation. The clinical results were compared between 5 groups classified according to the tibiofemoral angle that was measured at 3 months after surgery. We analyzed the relationship between the tibiofemoral...

  16. Examining rater and occasion influences in observational assessments obtained from within the clinical environment

    Clarence D. Kreiter; Adam B. Wilson; Humbert, Aloysius J.; Wade, Patricia A.

    2016-01-01

    Background: When ratings of student performance within the clerkship consist of a variable number of ratings per clinical teacher (rater), an important measurement question arises regarding how to combine such ratings to accurately summarize performance. As previous G studies have not estimated the independent influence of occasion and rater facets in observational ratings within the clinic, this study was designed to provide estimates of these two sources of error.Method: During 2 years of a...

  17. Factors influencing outcomes of clinical information systems implementation: a systematic review.

    Gruber, Dianne; Cummings, Greta G; LeBlanc, Lisa; Smith, Donna L

    2009-01-01

    Healthcare agencies spend significant resources to acquire or develop clinical information systems. However, implementation of clinical information systems often report significant failures. A systematic review of the research literature identified processes and outcomes of clinical information system implementation and factors that influenced success or failure. Of 124 original papers, 18 met the primary inclusion criteria-clinical systems implementation, healthcare facility, and outcome measures. Data extraction elements included study characteristics, outcomes, and implementation risk factors classified according to the Expanded Systems Life Cycle. The quality of each study was also assessed. Forty-nine outcomes of clinical information system implementation were identified. No single implementation strategy proved completely effective. The findings of this synthesis direct the attention of managers and decision makers to the importance of clinical context to successful implementation of clinical information systems. The highest number of factors influencing success or failure was reported during implementation and system "go-live." End-user support or lack thereof was the important factor in both successful and failed implementations, respectively. Following the Expanded Systems Life Cycle management model instead of a traditional project management approach may contribute to greater success over time, by paying particular attention to the underrecognized maintenance phase of implementation. PMID:19411944

  18. Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice

    Maastrup, Ragnhild; Hansen, Bo Moelholm; Kronborg, Hanne;

    2014-01-01

    . Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1-7.0) later establishment of exclusive breastfeeding. CONCLUSION: Breastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting...

  19. Factors Influencing Electronic Clinical Information Exchange in Small Medical Group Practices

    Kralewski, John E.; Zink, Therese; Boyle, Raymond

    2012-01-01

    Purpose: The purpose of this study was to identify the organizational factors that influence electronic health information exchange (HIE) by medical group practices in rural areas. Methods: A purposive sample of 8 small medical group practices in 3 experimental HIE regions were interviewed to determine the extent of clinical information exchange…

  20. Influence of contact with schizophrenia on implicit attitudes towards schizophrenia patients held by clinical residents

    Omori Ataru

    2012-11-01

    Full Text Available Abstract Background Patients with schizophrenia and their families have suffered greatly from stigmatizing effects. Although many efforts have been made to eradicate both prejudice and stigma, they still prevail even among medical professionals, and little is known about how contact with schizophrenia patients affects their attitudes towards schizophrenia. Methods We assessed the impact of the renaming of the Japanese term for schizophrenia on clinical residents and also evaluated the influence of contact with schizophrenia patients on attitudes toward schizophrenia by comparing the attitudes toward schizophrenia before and after a one-month clinical training period in psychiatry. Fifty-one clinical residents participated. Their attitudes toward schizophrenia were assessed twice, before and one month after clinical training in psychiatry using the Implicit Association Test (IAT as well as Link’s devaluation-discrimination scale. Results The old term for schizophrenia, “Seishin-Bunretsu-Byo”, was more congruent with criminal than the new term for schizophrenia, “Togo-Shitcho-Sho”, before clinical training. However, quite opposite to our expectation, after clinical training the new term had become even more congruent with criminal than the old term. There was no significant correlation between Link's scale and IAT effect. Conclusions Renaming the Japanese term for schizophrenia still reduced the negative images of schizophrenia among clinical residents. However, contact with schizophrenia patients unexpectedly changed clinical residents’ attitudes towards schizophrenia negatively. Our results might contribute to an understanding of the formation of negative attitudes about schizophrenia and assist in developing appropriate clinical training in psychiatry that could reduce prejudice and stigma concerning schizophrenia.

  1. Factors Influencing Support for National Health Insurance among Patients Attending Specialist Clinics in Malaysia

    Almualm, Yasmin; Alkaff, Sharifa Ezat; Aljunid, Syed; Alsagoff, Syed Sagoff

    2013-01-01

    This study was carried out to determine the level of support towards the proposed National Health Insurance scheme among Malaysian patients attending specialist clinics at the National University of Malaysia Medical centre and its influencing factors. The cross sectional study was carried out from July-October 2012. 260 patients were selected using multistage sampling method. 71.2% of respondents supported the proposed National Health insurance scheme. 61.4% of respondents are willing to pay ...

  2. Factors influencing success of clinical genome sequencing across a broad spectrum of disorders

    Taylor, Jenny C; Martin, Hilary C; Lise, Stefano; Broxholme, John; Cazier, Jean-Baptiste; Rimmer, Andy; Kanapin, Alexander; Lunter, Gerton; Fiddy, Simon; Allan, Chris; Aricescu, A Radu; Attar, Moustafa; Babbs, Christian; Becq, Jennifer; Beeson, David; Bento, Celeste; Bignell, Patricia; Blair, Edward; Buckle, Veronica J; Bull, Katherine; Cais, Ondrej; Cario, Holger; Chapel, Helen; Copley, Richard R; Cornall, Richard; Craft, Jude; Dahan, Karin; Davenport, Emma E; Dendrou, Calliope; Devuyst, Olivier; Fenwick, Aimée L; Flint, Jonathan; Fugger, Lars; Gilbert, Rodney D; Goriely, Anne; Green, Angie; Greger, Ingo H; Grocock, Russell; Gruszczyk, Anja V; Hastings, Robert; Hatton, Edouard; Higgs, Doug; Hill, Adrian; Holmes, Chris; Howard, Malcolm; Hughes, Linda; Humburg, Peter; Johnson, David; Karpe, Fredrik; Kingsbury, Zoya; Kini, Usha; Knight, Julian C; Krohn, Jonathan; Lamble, Sarah; Langman, Craig; Lonie, Lorne; Luck, Joshua; McCarthy, Davis; McGowan, Simon J; McMullin, Mary Frances; Miller, Kerry A; Murray, Lisa; Németh, Andrea H; Nesbit, M Andrew; Nutt, David; Ormondroyd, Elizabeth; Oturai, Annette Bang; Pagnamenta, Alistair; Patel, Smita Y; Percy, Melanie; Petousi, Nayia; Piazza, Paolo; Piret, Sian E; Polanco-Echeverry, Guadalupe; Popitsch, Niko; Powrie, Fiona; Pugh, Chris; Quek, Lynn; Robbins, Peter A; Robson, Kathryn; Russo, Alexandra; Sahgal, Natasha; van Schouwenburg, Pauline A; Schuh, Anna; Silverman, Earl; Simmons, Alison; Sørensen, Per Soelberg; Sweeney, Elizabeth; Taylor, John; Thakker, Rajesh V; Tomlinson, Ian; Trebes, Amy; Twigg, Stephen R F; Uhlig, Holm H; Vyas, Paresh; Vyse, Tim; Wall, Steven A; Watkins, Hugh; Whyte, Michael P; Witty, Lorna; Wright, Ben; Yau, Chris; Buck, David; Humphray, Sean; Ratcliffe, Peter J; Bell, John I; Wilkie, Andrew O M; Bentley, David; Donnelly, Peter; McVean, Gilean

    2015-01-01

    To assess factors influencing the success of whole-genome sequencing for mainstream clinical diagnosis, we sequenced 217 individuals from 156 independent cases or families across a broad spectrum of disorders in whom previous screening had identified no pathogenic variants. We quantified the number...... of candidate variants identified using different strategies for variant calling, filtering, annotation and prioritization. We found that jointly calling variants across samples, filtering against both local and external databases, deploying multiple annotation tools and using familial transmission...

  3. Influence of early post-burn enteral nutrition on clinical outcomes of patients with extensive burns

    Lu, Guozhong; Huang, Jiren; Yu, Junjie; Zhu, Yugang; Cai, Liangliang; Gu, Zaiqiu; Su, Qinghe

    2011-01-01

    Sepsis commonly occurs in severe post-burn patients, often resulting in death. We aimed to evaluate the influence of early enteral feeding on outcomes in patients with extensive burns, including infection incidence, healing and mortality. We retrospectively reviewed 60 patients with extensive burns, 35 who had received early enteral nutrition and 25 who had received parenteral nutrition. Average healing time, infection incidence and mortality were clinically observed. Hemoglobin and serum alb...

  4. Factors influencing success of clinical genome sequencing across a broad spectrum of disorders

    Taylor, Jenny C; Martin, Hilary C.; Lise, Stefano; Broxholme, John; Cazier, Jean-Baptiste; Rimmer, Andy; Kanapin, Alexander; Lunter, Gerton; Fiddy, Simon; Allan, Chris; Aricescu, A. Radu; Attar, Moustafa; Babbs, Christian; Becq, Jennifer; Beeson, David

    2015-01-01

    To assess factors influencing the success of whole genome sequencing for mainstream clinical diagnosis, we sequenced 217 individuals from 156 independent cases across a broad spectrum of disorders in whom prior screening had identified no pathogenic variants. We quantified the number of candidate variants identified using different strategies for variant calling, filtering, annotation and prioritisation. We found that jointly calling variants across samples, filtering against both local and e...

  5. Factors influencing success of clinical genome sequencing across a broad spectrum of disorders.

    Taylor, Jenny C; Martin, Hilary C; Lise, Stefano; Broxholme, John; Cazier, Jean-Baptiste; Rimmer, Andy; Kanapin, Alexander; Lunter, Gerton; Fiddy, Simon; Allan, Chris; Aricescu, A Radu; Attar, Moustafa; Babbs, Christian; Becq, Jennifer; Beeson, David; Bento, Celeste; Bignell, Patricia; Blair, Edward; Buckle, Veronica J; Bull, Katherine; Cais, Ondrej; Cario, Holger; Chapel, Helen; Copley, Richard R; Cornall, Richard; Craft, Jude; Dahan, Karin; Davenport, Emma E; Dendrou, Calliope; Devuyst, Olivier; Fenwick, Aimée L; Flint, Jonathan; Fugger, Lars; Gilbert, Rodney D; Goriely, Anne; Green, Angie; Greger, Ingo H; Grocock, Russell; Gruszczyk, Anja V; Hastings, Robert; Hatton, Edouard; Higgs, Doug; Hill, Adrian; Holmes, Chris; Howard, Malcolm; Hughes, Linda; Humburg, Peter; Johnson, David; Karpe, Fredrik; Kingsbury, Zoya; Kini, Usha; Knight, Julian C; Krohn, Jonathan; Lamble, Sarah; Langman, Craig; Lonie, Lorne; Luck, Joshua; McCarthy, Davis; McGowan, Simon J; McMullin, Mary Frances; Miller, Kerry A; Murray, Lisa; Németh, Andrea H; Nesbit, M Andrew; Nutt, David; Ormondroyd, Elizabeth; Oturai, Annette Bang; Pagnamenta, Alistair; Patel, Smita Y; Percy, Melanie; Petousi, Nayia; Piazza, Paolo; Piret, Sian E; Polanco-Echeverry, Guadalupe; Popitsch, Niko; Powrie, Fiona; Pugh, Chris; Quek, Lynn; Robbins, Peter A; Robson, Kathryn; Russo, Alexandra; Sahgal, Natasha; van Schouwenburg, Pauline A; Schuh, Anna; Silverman, Earl; Simmons, Alison; Sørensen, Per Soelberg; Sweeney, Elizabeth; Taylor, John; Thakker, Rajesh V; Tomlinson, Ian; Trebes, Amy; Twigg, Stephen R F; Uhlig, Holm H; Vyas, Paresh; Vyse, Tim; Wall, Steven A; Watkins, Hugh; Whyte, Michael P; Witty, Lorna; Wright, Ben; Yau, Chris; Buck, David; Humphray, Sean; Ratcliffe, Peter J; Bell, John I; Wilkie, Andrew O M; Bentley, David; Donnelly, Peter; McVean, Gilean

    2015-07-01

    To assess factors influencing the success of whole-genome sequencing for mainstream clinical diagnosis, we sequenced 217 individuals from 156 independent cases or families across a broad spectrum of disorders in whom previous screening had identified no pathogenic variants. We quantified the number of candidate variants identified using different strategies for variant calling, filtering, annotation and prioritization. We found that jointly calling variants across samples, filtering against both local and external databases, deploying multiple annotation tools and using familial transmission above biological plausibility contributed to accuracy. Overall, we identified disease-causing variants in 21% of cases, with the proportion increasing to 34% (23/68) for mendelian disorders and 57% (8/14) in family trios. We also discovered 32 potentially clinically actionable variants in 18 genes unrelated to the referral disorder, although only 4 were ultimately considered reportable. Our results demonstrate the value of genome sequencing for routine clinical diagnosis but also highlight many outstanding challenges. PMID:25985138

  6. Factors influencing success of clinical genome sequencing across a broad spectrum of disorders

    Lise, Stefano; Broxholme, John; Cazier, Jean-Baptiste; Rimmer, Andy; Kanapin, Alexander; Lunter, Gerton; Fiddy, Simon; Allan, Chris; Aricescu, A. Radu; Attar, Moustafa; Babbs, Christian; Becq, Jennifer; Beeson, David; Bento, Celeste; Bignell, Patricia; Blair, Edward; Buckle, Veronica J; Bull, Katherine; Cais, Ondrej; Cario, Holger; Chapel, Helen; Copley, Richard R; Cornall, Richard; Craft, Jude; Dahan, Karin; Davenport, Emma E; Dendrou, Calliope; Devuyst, Olivier; Fenwick, Aimée L; Flint, Jonathan; Fugger, Lars; Gilbert, Rodney D; Goriely, Anne; Green, Angie; Greger, Ingo H.; Grocock, Russell; Gruszczyk, Anja V; Hastings, Robert; Hatton, Edouard; Higgs, Doug; Hill, Adrian; Holmes, Chris; Howard, Malcolm; Hughes, Linda; Humburg, Peter; Johnson, David; Karpe, Fredrik; Kingsbury, Zoya; Kini, Usha; Knight, Julian C; Krohn, Jonathan; Lamble, Sarah; Langman, Craig; Lonie, Lorne; Luck, Joshua; McCarthy, Davis; McGowan, Simon J; McMullin, Mary Frances; Miller, Kerry A; Murray, Lisa; Németh, Andrea H; Nesbit, M Andrew; Nutt, David; Ormondroyd, Elizabeth; Oturai, Annette Bang; Pagnamenta, Alistair; Patel, Smita Y; Percy, Melanie; Petousi, Nayia; Piazza, Paolo; Piret, Sian E; Polanco-Echeverry, Guadalupe; Popitsch, Niko; Powrie, Fiona; Pugh, Chris; Quek, Lynn; Robbins, Peter A; Robson, Kathryn; Russo, Alexandra; Sahgal, Natasha; van Schouwenburg, Pauline A; Schuh, Anna; Silverman, Earl; Simmons, Alison; Sørensen, Per Soelberg; Sweeney, Elizabeth; Taylor, John; Thakker, Rajesh V; Tomlinson, Ian; Trebes, Amy; Twigg, Stephen RF; Uhlig, Holm H; Vyas, Paresh; Vyse, Tim; Wall, Steven A; Watkins, Hugh; Whyte, Michael P; Witty, Lorna; Wright, Ben; Yau, Chris; Buck, David; Humphray, Sean; Ratcliffe, Peter J; Bell, John I; Wilkie, Andrew OM; Bentley, David; Donnelly, Peter; McVean, Gilean

    2015-01-01

    To assess factors influencing the success of whole genome sequencing for mainstream clinical diagnosis, we sequenced 217 individuals from 156 independent cases across a broad spectrum of disorders in whom prior screening had identified no pathogenic variants. We quantified the number of candidate variants identified using different strategies for variant calling, filtering, annotation and prioritisation. We found that jointly calling variants across samples, filtering against both local and external databases, deploying multiple annotation tools and using familial transmission above biological plausibility contributed to accuracy. Overall, we identified disease causing variants in 21% of cases, rising to 34% (23/68) for Mendelian disorders and 57% (8/14) in trios. We also discovered 32 potentially clinically actionable variants in 18 genes unrelated to the referral disorder, though only four were ultimately considered reportable. Our results demonstrate the value of genome sequencing for routine clinical diagnosis, but also highlight many outstanding challenges. PMID:25985138

  7. Influence of societal and practice contexts on health professionals’ clinical reasoning: a scoping study protocol

    Carrier, Annie; Levasseur, Mélanie; Freeman, Andrew; Mullins, Gary; Quénec'hdu, Suzanne; Lalonde, Louise; Gagnon, Michaël; Lacasse, Francis

    2013-01-01

    Introduction In a context of constrained resources, the efficacy of interventions is a pivotal aim of healthcare systems worldwide. Efficacy of healthcare interventions is highly compromised if clinical reasoning (CR), the process that practitioners use to plan, direct, perform and reflect on client care, is not optimal. The CR process of health professionals is influenced by the institutional dimension (ie, legal, regulatory, administrative and organisational aspects) of their societal and practice contexts. Although several studies have been conducted with respect to the institutional dimension influencing health professionals’ CR, no clear integration of their results is yet available. The aim of this study is to synthesise and disseminate current knowledge on the influence of the institutional dimension of contexts on health professionals’ CR. Methods and analysis A scoping study of the scientific literature from January 1980 to March 2013 will be undertaken to summarise and disseminate research findings about the influence of the institutional dimension on CR. Numerous databases (n=18) from three relevant fields (healthcare, health law and politics and management) will be searched. Extended search strategies will include the manual search of bibliographies, health-related websites, public registries and journals of interest. Data will be collected and analysed using a thematic chart and content analysis. A systematic multidisciplinary team approach will allow optimal identification of relevant studies, as well as effective and valid content analysis and dissemination of the results. Discussion This scoping study will provide a rigorous, accurate and up-to-date synthesis of existing knowledge regarding: (1) those aspects of the institutional dimension of health professionals’ societal and practice contexts that impact their CR and (2) how these aspects influence health professionals’ CR. Through the synergy of a multidisciplinary research team from a

  8. An Investigation of Factors Influencing Nurses' Clinical Decision-Making Skills.

    Wu, Min; Yang, Jinqiu; Liu, Lingying; Ye, Benlan

    2016-08-01

    This study aims to investigate the influencing factors on nurses' clinical decision-making (CDM) skills. A cross-sectional nonexperimental research design was conducted in the medical, surgical, and emergency departments of two university hospitals, between May and June 2014. We used a quantile regression method to identify the influencing factors across different quantiles of the CDM skills distribution and compared the results with the corresponding ordinary least squares (OLS) estimates. Our findings revealed that nurses were best at the skills of managing oneself. Educational level, experience, and the total structural empowerment had significant positive impacts on nurses' CDM skills, while the nurse-patient relationship, patient care and interaction, formal empowerment, and information empowerment were negatively correlated with nurses' CDM skills. These variables explained no more than 30% of the variance in nurses' CDM skills and mainly explained the lower quantiles of nurses' CDM skills distribution. PMID:26906246

  9. Variables influencing presenting symptoms of patients with eating disorders at psychiatric outpatient clinics.

    Tseng, Mei-Chih Meg; Chen, Kuan-Yu; Chang, Chin-Hao; Liao, Shih-Cheng; Chen, Hsi-Chung

    2016-04-30

    Eating disorders (EDs) have been underdiagnosed in many clinical settings. This study investigates the influence of clinical characteristics on presenting symptoms of patients with EDs. Psychiatric outpatients, aged 18-45, were enrolled sequentially and received a two-phase survey for EDs in August 2010-January 2013. Their primary reasons for seeking psychiatric help were obtained at their first encounter with outpatient psychiatrists. Patients' clinical and demographic characteristics were compared according to presenting symptoms with or without eating/weight problems. Of 2140 patients, 348 (16.3%) were diagnosed with an ED (22.6% of women and 6.3% of men). The three most common reasons for seeking psychiatric help were eating/weight problems (46.0%), emotional problems (41.3%), and sleep disturbances (19.3%). The multivariate analyses suggest that when patients with EDs presented symptoms that were less related to eating/weight problems, they were significantly more likely to be those having diagnoses other than anorexia nervosa or bulimia nervosa and less severe degree of binge-eating. Further, patients with EDs who demonstrated more impulsive behaviors and poorer functioning were less likely to report their eating problems when visiting psychiatric clinics. Thus, ED should be assessed routinely in patients with complex psychopathology to facilitate comprehensive treatment. PMID:27086254

  10. A Research on Factors Influencing the Clinical Prognosis of Acute Stroke Patie.patients

    Luo Zuming; Li Manli

    2000-01-01

    Object: To search for the factors significantly influencing the clinical prognosis of acute stroke patients. Background: There are lack of prospective multivariate analysis research m acute stroke in the world. Method: We chose 17 factors possibly influencing the prognosis of acute patients, took Barthel′s Index at the end of 2 months after stroke onset and decreased percentage of neurological deficit scores (MESSS) between 72h after hospitalization and 2 months after onset as gold standard, to have a prospective, multivariate analysis research combined with univariate analysis. Results: Multivariate analysis of 106 acute stroke patients combined with univariate analysis showed the factors significantly influencing the clinical prognosis of acute stroke patients were: initial MESSS score、 age、 complication、 mass effect、 stroke location、 time of delay before emergency arrival (BDT). Time of delay after emergency arrival was not found to be a significant prognostic factor. Discussion: Barthel Index at the end of 1 month after stroke onset was strongly related to that at the end of 2 month after onset, as was the same with MESSS score. It showed there was no significant difference between 1 month and 2 months after stroke onset when we choose time interval in evaluating prognosis of acute stroke patients.Conclusion: BDT、 initial MESSS score、 age、 stroke location、 mass effect、 complication were important factors of acute stroke patients. Avoid the delay before emergency arrival after onset, prevent and treat complications after stroke, more carefully treat acute stroke patients with advanced age, advanced age, high initial MESSS scores and those with mass effect reported by CT, we can improve the outcome of stroke patients.

  11. Graeco-Roman case histories and their influence on Medieval Islamic clinical accounts.

    Alvarez Millan, C

    1999-04-01

    The medieval Islamic medical tradition was the direct heir of Classical and Hellenistic medicine thanks to an unprecedented movement of translation into Arabic, commentaries and systematizations of Greek scientific texts. In the process of assimilation, not only theoretical principles, but also literary models of presenting medical knowledge were adopted, amongst them the case history. Since the clinical account can be used as a tool for medical instruction as well as an instrument for professional self-promotion, this study seeks to investigate which purpose most motivated Islamic physicians, and to demonstrate the extent to which they were influenced by the stylistic patterns which served them as a model. This article comprises an analysis of the context, literary devices and purpose of case histories of the Epidemics, Rufus of Ephesos and Galen, and compares them with those by the tenth-century Islamic physician Abu Bakr Muhammad b. Zakariya al-Razi. Author of the largest number of case histories preserved within the medieval Islamic medical literature, al-Razi's clinical records constitute an instrument with which to study and expand medical knowledge as well as providing useful material for students' medical training. Although al-Razi fused elements from the sources which served him as a model, he did not emulate Galen's use of the clinical history to assert himself in order to gain authority and prestige, but remained faithful to the Hippocratic essence. PMID:11623808

  12. IL8 gene as modifier of cystic fibrosis: unraveling the factors which influence clinical variability.

    Furlan, Larissa Lazzarini; Marson, Fernando Augusto Lima; Ribeiro, José Dirceu; Bertuzzo, Carmen Sílvia; Salomão Junior, João Batista; Souza, Dorotéia Rossi Silva

    2016-08-01

    The severity of cystic fibrosis (CF) is associated with classes of mutations in the CFTR gene (cystic fibrosis transmembrane regulator), physical environment and modifier genes interaction. The IL8 gene (interleukin 8), according to its respective polymorphisms, influences inflammatory responses. This study analyzed IL8 gene polymorphisms (rs4073, rs2227306 and rs2227307), by means of PCR/RFLP, and their association with pulmonary function markers and clinical severity scores in 186 patients with CF, considering the CFTR genotype. There was an association between rs2227307 and precocity of the disease. The severity of lung disease was associated with the following markers: transcutaneous arterial hemoglobin oxygen saturation (SaO2) (regardless of CFTR genotype, for the polymorphisms rs4073, rs2227306 and rs2227307); mucoid Pseudomonas aeruginosa (regardless of CFTR genotype, for the polymorphisms rs2227306 and rs2227307). Pulmonary function markers (SaO2 and spirometric variables) and clinical severity scores were also associated with IL8 gene polymorphisms. This study identified the IL8 gene, represented by rs4073 and rs2227306 polymorphisms, and particularly the rs2227307 polymorphism, as potentiating factors for the degree of variability in the severity of CF, especially in pulmonary clinical manifestation correlated with increased morbidity and mortality. PMID:27209008

  13. Factors influencing clinical students' perceptions of an embedded research project and associated publication output.

    Weller, Renate; May, Stephen A

    2013-01-01

    In this article, we describe student perceptions of the value of a short, compulsory research project embedded in a clinical degree program, the research output in terms of publications, and the factors influencing this. It was hypothesized that student attitudes toward the project, student perceptions of how much the project contributed to their generic skills, and the number of publications submitted or prepared for submission would be associated with perceived quality of supervision, perceived difficulty of the project, career plans, and attitude before commencement of the project. We explored this using a questionnaire comprising 30 questions that included demographics, Likert scales, and categorical responses. Student attitudes toward research were found to be associated with student attitude before the start of the project, perceived difficulty of the project, perceived quality of supervision, and perceived relevance to the profession. Students thought that the research project contributed most to the skills of "information gathering" and "critical evaluation" and the least to "teamwork," "problem solving," and "oral communication." Research output was significantly linked to perceived quality of supervision and the help students received with data analysis and data collection, though not with the project report itself. In conclusion, although the success of the research project was influenced by many factors, the perceived quality of supervision influenced all three outcome measures. Therefore it is clear that optimization of this aspect offers the most scope for enhancing the student learning experience. PMID:23709108

  14. Sporadic inclusion body myositis: HLA-DRB1 allele interactions influence disease risk and clinical phenotype.

    Mastaglia, Frank L; Needham, Merrilee; Scott, Adrian; James, Ian; Zilko, Paul; Day, Timothy; Kiers, Lynette; Corbett, Alastair; Witt, Campbell S; Allcock, Richard; Laing, Nigel; Garlepp, Michael; Christiansen, Frank T

    2009-11-01

    Susceptibility to sIBM is strongly associated with the HLA-DRB1*03 allele and the 8.1 MHC ancestral haplotype (HLA-A1, B8, DRB1*03) but little is known about the effects of allelic interactions at the DRB1 locus or disease-modifying effects of HLA alleles. HLA-A, B and DRB1 genotyping was performed in 80 Australian sIBM cases and the frequencies of different alleles and allele combinations were compared with those in a group of 190 healthy controls. Genotype-phenotype correlations were also investigated. Amongst carriers of the HLA-DRB1*03 allele, DRB1*03/*01 heterozygotes were over-represented in the sIBM group (pHLA-DRB1*03 allele and other alleles at the DRB1 locus can influence disease susceptibility and the clinical phenotype in sIBM. PMID:19720533

  15. The Influence of Clinical Experience and Photographic Presentation on Age Assessment of Women

    Nielsen, Barbara Rubek; Linneberg, Allan; Christensen, Kaare;

    2016-01-01

    BACKGROUND: Epidemiological studies have reported that a higher perceived age is associated with poor health and higher mortality. However, the method used for the assessment of perceived age differs between studies with regard to age, gender, the number and occupation of assessors as well as the...... presentation of participants. OBJECTIVE: It is not known whether the clinical experience of the assessor or photographic presentation have an influence on the assessment of perceived age, which the present study aimed to investigate. METHODS: In a cross-sectional study of 460 women aged 25-93 years, 10...... inter-class correlation coefficient within each assessor group and photographic presentation varied from 0.66 to 0.75. Limits of agreement were in a broad range but were similar in the two assessor groups. The best inter-assessor agreement was obtained from photographs of both the face and the whole...

  16. Influence of Clinical and Pathologic Parameters on Prognosis of Cervical Carcinoma in China

    LUPing; LIANGQiudong; ZHENGQuanqing

    2003-01-01

    Objective: To explore the influence of clinical and pathologic parameters on the prognosis of squamous cell carcinoma and adenocarcinoma. Methods: 702 cases of cervical carcinoma were retrospec-tively studied. Cox regression model was informed in multi-variable analysis. Results: The retrospective analysis showed that 630 out of 702 cases of cervical carcinoma were squamous cell carcinoma, cumulative rate 89.4% and 72 case were adenocarcinoma, cumulative rate 10.6% respectively. The 5-year survival rate was lower for patients with adenocarcinoma than for patients with squamous cell carcinoma (58.3% vs 57.3%), but there was no significant difference. Cox regression model showed that the variable into equation for squamous cell carcinoma included tumor grade of differentiation, lymph node metastasis and FIGO stage, but only lymph node metastasis and FIGO stage for adenocarcinoma. Conclusion: FIGO stage and lymph node metastasis was independent parameter evaluating prognosis of cervical carcinoma.

  17. Impression materials in fixed prosthodontics: influence of choice on clinical procedure.

    Hamalian, Techkouhie A; Nasr, Elie; Chidiac, José J

    2011-02-01

    The purpose of this article is to review impression materials used for fabricating fixed restorations in dentistry. Their compositions, properties, advantages, and disadvantages are presented and compared. How these properties influence clinical decisions is also described. This review helps the clinician choose which material is more suitable for a specific case. A broad search of the published literature was performed using Medline to identify pertinent current articles. Textbooks, the Internet, and manufacturers' literature were also used to supplement this information. It is limited to impression materials used in fixed prosthodontics. The review gives basic knowledge of ideal impression material properties and discusses traditional and, primarily, more recently developed products, such as polyethers, poly(vinyl siloxane), polysulfides, and condensation silicone materials. Clear advantages and disadvantages for these impression materials are provided along with the role that compositional variations have on the outcome of the impression. This should enable clinicians and technicians to easily identify the important physical properties of each type of impression material and their primary clinical indications. PMID:21284760

  18. Factors influencing success of cement versus screw-retained implant restorations: a clinical review

    Ahmad Manawar

    2012-10-01

    Full Text Available Aim: As more and more dental practitioners are focusing on implant-supported fixed restorations, some clinicians favor the use of cement retained restorations while others consider screw retained prosthesis to be the best choice. Discussion: In screw-retained restorations, the fastening screw provides a solid joint between the restoration and the implant abutment, while in cement-retained prostheses the restorative screw is eliminated to enhance esthetics, occlusal stability, and passive fit of the restorations. The factors that influence the type of fixation of the prostheses to the implants like passivity of the framework, ease of fabrication, occlusion, esthetics, accessibility, retention and retrievability are discussed in this article with scientific studies demonstrating superior outcomes of one technique over another. Screwretained implant restorations have an advantage of predictable retention, retrievability and lack of potentially retained subgingival cement. However, a few disadvantages exist such as precise placement of the implant for optimal and esthetic location of the screw access hole and obtaining passive fit. On the other hand, cement retained restorations eliminate unesthetic screw access holes, have passive fit of castings, reduced complexity of clinical and lab procedures, enhanced esthetics, reduced cost factors and non disrupted morphology of the occlusal table. Conclusion: This article compares the advantages, potential disadvantages and limitations of screw and cement retained restorations and their specific implications in the most common clinical situation.

  19. Peer influence in clinical workplace learning : A study of medical students’ use of social comparison in clinical practice

    Raat, Adriana

    2015-01-01

    Undergraduate students in clinical workplace frequently compare their own experiences with those of peers. The research reported in this thesis shows that these so called social comparisons are vital to the process of learning in clinical practice. The first study confirms students’ tendency to comp

  20. Clinical factors influencing normalization of prothrombin time after stopping warfarin: a retrospective cohort study

    Zondag Michelle

    2008-10-01

    Full Text Available Abstract Background Anticoagulation with warfarin should be stopped 4–6 days before invasive procedures to avoid bleeding complications. Despite this routine, some patients still have high International Normalized Ratio (INR values on the day of surgery and the procedure may be cancelled. We sought to identify easily available clinical characteristics that may influence the rate of normalization of prothrombin time when warfarin is stopped before surgery or invasive procedures. Methods Clinical data were collected retrospectively from consecutive cases from two cohorts, who stopped warfarin 6 days before surgery. An INR value of 1.6 or higher on the day of surgery or requirement for reversal with vitamin K the day before surgery were criteria for slow return (S to normal INR. Results Of 202 patients, 14 (7% were classified as S. Eight of the S-patients required reversal with vitamin K one day before surgery and in another case surgery was cancelled due to high INR. Baseline INR was the only variable significantly associated with classification as S in stepwise logistic regression analysis (p = 0.003. The odds ratio for being in the normal group was 0.27 (95% confidence interval 0.12–0.62 for each unit baseline INR increased. The positive predictive value of baseline INR with a cut off at > 3.0 was only 15% and for INR > 3.5 it was 33%. Conclusion Baseline INR, but not the size of the maintenance dose, is associated with the rate of normalization of prothrombin time after stopping warfarin, but it has limited utility as predictor in clinical practice. Whenever normal hemostasis is considered crucial for the safety, the INR should be checked again before the invasive procedure.

  1. Examining rater and occasion influences in observational assessments obtained from within the clinical environment

    Clarence D. Kreiter

    2016-02-01

    Full Text Available Background: When ratings of student performance within the clerkship consist of a variable number of ratings per clinical teacher (rater, an important measurement question arises regarding how to combine such ratings to accurately summarize performance. As previous G studies have not estimated the independent influence of occasion and rater facets in observational ratings within the clinic, this study was designed to provide estimates of these two sources of error. Method: During 2 years of an emergency medicine clerkship at a large midwestern university, 592 students were evaluated an average of 15.9 times. Ratings were performed at the end of clinical shifts, and students often received multiple ratings from the same rater. A completely nested G study model (occasion: rater: person was used to analyze sampled rating data. Results: The variance component (VC related to occasion was small relative to the VC associated with rater. The D study clearly demonstrates that having a preceptor rate a student on multiple occasions does not substantially enhance the reliability of a clerkship performance summary score. Conclusions: Although further research is needed, it is clear that case-specific factors do not explain the low correlation between ratings and that having one or two raters repeatedly rate a student on different occasions/cases is unlikely to yield a reliable mean score. This research suggests that it may be more efficient to have a preceptor rate a student just once. However, when multiple ratings from a single preceptor are available for a student, it is recommended that a mean of the preceptor's ratings be used to calculate the student's overall mean performance score.

  2. Acute interventional diagnosis and treatment of upper gastrointestinal arterial hemorrhage: its clinical value and influence factors

    Objective: To evaluate emergent angiography and interventional management in treating massive upper gastrointestinal (GI) arterial hemorrhage, and to discuss the factors influencing the angiographic bleeding signs and the interventional therapeutic results. Methods: The clinical data of 56 patients with massive upper GI arterial hemorrhage, who underwent diagnostic arteriography and interventional management with trans-catheter vasopressin infusion and embolization, were retrospectively analyzed. Systolic blood pressure of both pre-and post-interventional therapy was recorded and statistically analyzed. The arteriographic positive rates were separately calculated according to the catheter tip's location, being placed at the 2nd grade branch or at the 3 rd -4 th grade branch of the artery, and the relation of the positive rate with the tip's location was analyzed. A comparison of the hemostatic effect between trans-catheter vasopressin infusion and trans-catheter embolization was made. Results: The average systolic blood pressure of pre-and post-procedure was (93.14 ± 18.63) mmHg and (11.64 ± 13.61) mmHg respectively, with a significant difference (P = 0.023). The angiographic bleeding signs were demonstrated in 12 cases (21.4%) with the catheter's tip at the 2nd grade branch and in 56 cases (100%) with the catheter's tip at the 3 rd -4 th grade branch,the difference between the two was of statistically significance (P < 0.05). The technical success rate and the clinical hemostasis rate of via catheter vasopressin infusion was 80% (16 / 20) and 55% (11/20) respectively. Of nine re-bleeding cases, seven were successfully controlled with embolization therapy by using microcatheter and two had to receive surgery because of arterial rupture which was proved by angiography. The technical and the clinical rates of success for transcatheter embolization therapy were 93% (42 / 45) and 89% (40 / 45) respectively. Recurrence of bleeding was seen in two patients who got

  3. Peer influence in clinical workplace learning: A study of medical students’ use of social comparison in clinical practice

    Raat, Adriana

    2015-01-01

    Undergraduate students in clinical workplace frequently compare their own experiences with those of peers. The research reported in this thesis shows that these so called social comparisons are vital to the process of learning in clinical practice. The first study confirms students’ tendency to compare themselves with peers and shows that their responses to the comparisons are more often stimulating for learning than discouraging. After that, an experimental study demonstrates how students’ e...

  4. Clinical Characteristics and Factors Influencing the Occurrence of Acute Eosinophilic Pneumonia in Korean Military Personnel.

    Yoon, Chang-Gyo; Kim, Se Jin; Kim, Kang; Lee, Ji Eun; Jhun, Byung Woo

    2016-02-01

    Acute eosinophilic pneumonia (AEP) is an uncommon inflammatory lung disease, and limited data exist concerning the clinical characteristics and factors that influence its occurrence. We retrospectively reviewed the records of AEP patients treated at Korean military hospitals between January 2007 and December 2013. In total, 333 patients were identified; their median age was 22 years, and all were men. All patients presented with acute respiratory symptoms (cough, sputum, dyspnea, or fever) and had elevated levels of inflammatory markers including median values of 13,185/µL for white blood cell count and 9.51 mg/dL for C-reactive protein. All patients showed diffuse ground glass opacity/consolidation, and most had pleural effusion (n = 265; 80%) or interlobular septal thickening (n = 265; 85%) on chest computed tomography. Most patients had normal body mass index (n = 255; 77%), and only 30 (9%) patients had underlying diseases including rhinitis, asthma, or atopic dermatitis. Most patients had recently changed smoking habits (n = 288; 87%) and were Army personnel (n = 297; 89%).The AEP incidence was higher in the Army group compared to the Navy or Air Force group for every year (P = 0.002). Both the number of patients and patients with high illness severity (oxygen requirement, intensive care unit admission, and pneumonia severity score class ≥ III) tended to increase as seasonal temperatures rose. We describe the clinical characteristics of AEP and demonstrate that AEP patients have recently changed smoking habits and work for the Army. There is an increasing tendency in the numbers of patients and those with higher AEP severity with rising seasonal temperatures. PMID:26839479

  5. Clinical oxygen enhancement ratio of tumors in carbon ion radiotherapy. The influence of local oxygenation changes

    The effect of carbon ion radiotherapy on hypoxic tumors has recently been questioned because of low linear energy transfer (LET) values in the spread-out Bragg peak (SOBP). The aim of this study was to investigate the role of hypoxia and local oxygenation changes (LOCs) in fractionated carbon ion radiotherapy. Three-dimensional tumors with hypoxic subvolumes were simulated assuming interfraction LOCs. Different fractionations were applied using a clinically relevant treatment plan with a known LET distribution. The surviving fraction was calculated, taking oxygen tension, dose and LET into account, using the repairable-conditionally repairable (RCR) damage model with parameters for human salivary gland tumor cells. The clinical oxygen enhancement ratio (OER) was defined as the ratio of doses required for a tumor control probability of 50% for hypoxic and well-oxygenated tumors. The resulting OER was well above unity for all fractionations. For the hypoxic tumor, the tumor control probability was considerably higher if LOCs were assumed, rather than static oxygenation. The beneficial effect of LOCs increased with the number of fractions. However, for very low fraction doses, the improvement related to LOCs did not compensate for the increase in total dose required for tumor control. In conclusion, our results suggest that hypoxia can influence the outcome of carbon ion radiotherapy because of the non-negligible oxygen effect at the low LETs in the SOBP. However, if LOCs occur, a relatively high level of tumor control probability is achievable with a large range of fractionation schedules for tumors with hypoxic subvolumes, but both hyperfractionation and hypofractionation should be pursued with caution. (author)

  6. Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study

    Sheikhzadeh, Mahboobeh; Lotfi, Yones; Mousavi, Abdollah; Heidari, Behzad; Monadi, Mohsen; Bakhshi, Enayatollah

    2016-01-01

    Background: Benign paroxysmal positional vertigo (BPPV) is linked to vitamin D deficiency. This clinical trial aimed to determine the influence of vitamin D supplementation on intensity of BPPV. Methods: The study population was selected consecutively and the diagnosis of BPPV was made by history and clinical examination and exclusion of other conditions. Intensity of BPVV was assessed based on VAS score (0-10). Serum 25-hydroxyvitamin D (25-OHD) was measured using ELISA method and levels < 20 ng/ml was considered a deficiency. All patients received rehabilitation treatment using Epley's maneuver one time per week for one month. Serum 25-OHD deficient patients were classified as treated and non-treated groups (rehabilitation with or without 50.000 IU cholecalciferol weekly for two months).The results of treatment were compared with vitamin D sufficient group as control. All patients were followed-up for 6 months. Results: After two months of treatment, in both vitamin D treated and non-treated groups the intensity of BPPV decreased significantly as compared with control (P=0.001 for both groups) but at endpoint, the intensity of BPPV aggravated and regressed to the baseline value in vitamin D deficient non-treated group (P=0.001) whereas, in vitamin D treated group, improvement of BPPV remained stable and unchanged over the study period. Conclusion: This study indicates that correction of vitamin D deficiency in BPPV provides additional benefit to rehabilitation therapy (Epley maneuver) regarding duration of improvement. These findings suggest serum 25-OHD measurement in recurrent BPPV. PMID:27386060

  7. Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment

    Thomason J Mark

    2009-01-01

    Full Text Available Abstract Background The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments – such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. Methods/Design Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs in three Primary Care Trust areas (n = 300 to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs and 3 (patients use qualitative focused one to one interviews with a sample of these practitioners (up to 30 and their patients (up to 60 to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. Discussion Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an

  8. Factors influencing the implementation of clinical guidelines for health care professionals: A systematic meta-review

    de Veer Anke JE

    2008-09-01

    Full Text Available Abstract Background Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field. Methods A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1 screening on the basis of references and abstracts and (2 screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews. Results Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws. A substantial proportion (although not all of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective. Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation. In addition, characteristics of professionals – e.g., awareness of the existence of the guideline and familiarity with its content – likewise affect implementation. Furthermore, patient characteristics appear to exert influence: for

  9. Epidemiology of appendicectomy in primary sclerosing cholangitis and ulcerative colitis: its influence on the clinical behaviour of these diseases

    Florin, T H J; Pandeya, N; Radford-Smith, G. L.

    2004-01-01

    Background and aims: Appendicectomy and smoking are environmental factors that are known to influence ulcerative colitis (UC). The phenotype of UC is different in patients with coexistent primary sclerosing cholangitis (PSC). This study investigates the interaction of appendicectomy and PSC on the epidemiology and clinical behaviour of colitis.

  10. What factors influence the prevalence and accuracy of nursing diagnoses documentation in clinical practice? A systematic literature review

    Paans, W.; Nieweg, R.M.B.; van der Schans, C.P.; Sermeus, W.

    2011-01-01

    Aim. To identify what determinants influence the prevalence and accuracy of nursing diagnosis documentation in clinical practice. Background. Nursing diagnoses guide and direct nursing care. They are the foundation for goal setting and provide the basis for interventions. The literature mentions sev

  11. Migrant encounters in the clinic: Bureaucratic, biomedical, and community influences on patient interactions with front-line workers.

    Smith, Sarah A

    2016-02-01

    Ethnographic research on the clinical encounter has focused almost exclusively on what happens in exam rooms-particularly patient-provider interactions-leaving much to be understood about other actors within the clinic. As part of a larger ethnographic study examining the impact of colonialism, transnational migration, discrimination, and gender relations on Chuukese migrant women's reproductive and sexual health outcomes in Guam, I conducted eight months of participant observation in three publicly funded health clinics, 24 interviews with health care workers, and 15 life-history interviews with Chuukese women between September 2012 and February 2014. Findings demonstrated differential treatment of Chuukese patients by front-line workers (FLWs), who engaged in "boundary work" with these patients. Further, care varied by clinic space and the actors in that space. This differential treatment and variation in care impacted Chuukese women's access to and experiences with health care in Guam. Utilizing the concept of "deservingness," this analysis unpacks how FLWs, like Lipsky's "street-level bureaucrats," are influenced by bureaucratic, biomedical, and community hierarchies, all contributing to differential patient treatment. This study concludes by calling for more integrated analyses of clinical environments which utilize Lipsky's concept to include community narratives of "deservingness" and incorporate the influence of clinic and community stratification. PMID:26730881

  12. The influence of thallium 201 scintigraphy on the clinical estimation of chest pain

    The histories of 60 patients without myocardial infarction complaining of chest pain, who had undergone coronary angiography, were submitted to 6 observers unaware of the angiographic findings. Results of ECGs at rest and on exertion were communicated to them. Observers were requested to estimate the likelihood (L) of coronary heart disease to be present in % and to assess the need for coronary angiography. (5-score scale, 1 = definitely not indicated, 5 = absolutely indicated). After being told the outcome of 201-T1 imaging after intravenous dipyridamol observers were again requested to estimate the likelihood of CHD and evaluate indications for angiography. In the 43 patients with CHD L was rated 75.6% +- 20.2 without knowledge of the 201-T1 findings. After being told the 201-T1 findings observers increased their estimates to 82.9% +- 23.2 (p 0.001). Indications for coronary angiography increased from 4.3 +- 0.9 to 4.5 +- 0.9 (p<0.001). In subjects without angiographic evidence of coronary disease the pre-201-T1 L was rated at 36.7 + 22.0, and the post-201-T1 L was 24,8% +- 21.0 (p<0.001). Estimated indications for angiography dropped from 2.7 +- 1.1 to 2.2 += 1.2 (p<0.001). Awareness of the findings of 201-T1 imaging after intravenous dipyridamol thus significantly improved the clinical assessment of both coronary patients and patients without coronary disease complaining of chest pain. Similarly, patient management in terms of indications for coronary angiography was favorably influenced in both groups. (Author)

  13. Factors that influence the clinical decision-making of rehabilitation professionals in long-term care settings.

    Wainwright, Susan Flannery; McGinnis, Patricia Quinn

    2009-01-01

    The purpose of this qualitative research was to evaluate the reasoning of clinicians practicing in long-term care facilities and to explore factors influencing their professional development. Eighteen participants were recruited from eight clinical sites and included seven occupational therapists, eight physical therapists, and three speech therapists distributed across three groups relative to experience. Nonparticipant observation and videotape of therapist-patient interactions were used in semi-structured interviews with each participant. Qualitative data analysis software was used during a process of open and axial coding, followed by thematic analysis. The facilitory and inhibitory factors that affect clinical reasoning and professional development were identified. Rehabilitation professionals in long-term care demonstrated clinical reasoning within the context of patient-centered goals. Well-developed and explicit programs for mentorship, professional development, and continuing education fostered their clinical reasoning abilities. Participants perceived that these factors were vital to achieving optimal patient outcomes. PMID:19753425

  14. Microenvironmental influence on pre-clinical activity of polo-like kinase inhibition in multiple myeloma: implications for clinical translation.

    Douglas W McMillin

    Full Text Available Polo-like kinases (PLKs play an important role in cell cycle progression, checkpoint control and mitosis. The high mitotic index and chromosomal instability of advanced cancers suggest that PLK inhibitors may be an attractive therapeutic option for presently incurable advanced neoplasias with systemic involvement, such as multiple myeloma (MM. We studied the PLK 1, 2, 3 inhibitor BI 2536 and observed potent (IC50<40 nM and rapid (commitment to cell death <24 hrs in vitro activity against MM cells in isolation, as well as in vivo activity against a traditional subcutaneous xenograft mouse model. Tumor cells in MM patients, however, don't exist in isolation, but reside in and interact with the bone microenvironment. Therefore conventional in vitro and in vivo preclinical assays don't take into account how interactions between MM cells and the bone microenvironment can potentially confer drug resistance. To probe this question, we performed tumor cell compartment-specific bioluminescence imaging assays to compare the preclinical anti-MM activity of BI 2536 in vitro in the presence vs. absence of stromal cells or osteoclasts. We observed that the presence of these bone marrow non-malignant cells led to decreased anti-MM activity of BI 2536. We further validated these results in an orthotopic in vivo mouse model of diffuse MM bone lesions where tumor cells interact with non-malignant cells of the bone microenvironment. We again observed that BI 2536 had decreased activity in this in vivo model of tumor-bone microenvironment interactions highlighting that, despite BI 2536's promising activity in conventional assays, its lack of activity in microenvironmental models raises concerns for its clinical development for MM. More broadly, preclinical drug testing in the absence of relevant tumor microenvironment interactions may overestimate potential clinical activity, thus explaining at least in part the gap between preclinical vs. clinical efficacy in MM

  15. Design Characteristics Influence Performance of Clinical Prediction Rules in Validation: A Meta-Epidemiological Study

    Ban, J-W.; Emparanza, J I; Urreta, I.; Burls, A

    2016-01-01

    BACKGROUND: Many new clinical prediction rules are derived and validated. But the design and reporting quality of clinical prediction research has been less than optimal. We aimed to assess whether design characteristics of validation studies were associated with the overestimation of clinical prediction rules' performance. We also aimed to evaluate whether validation studies clearly reported important methodological characteristics. METHODS: Electronic databases were searched for system...

  16. Dysfunctional Attitudes and Affective Responses to Daily Stressors: Separating Cognitive, Genetic, and Clinical Influences on Stress Reactivity

    Conway, Christopher C.; Slavich, George M.; Hammen, Constance

    2014-01-01

    Despite decades of research examining diathesis-stress models of emotional disorders, it remains unclear whether dysfunctional attitudes interact with stressful experiences to shape affect on a daily basis and, if so, how clinical and genetic factors influence these associations. To address these issues, we conducted a multi-level daily diary study that examined how dysfunctional attitudes and stressful events relate to daily fluctuations in negative and positive affect in 1...

  17. Clinical And Morphological Androgenic Status Characteristics At Children Suffering From Hypospadias And Its Influence On Results Of Surgical Correction

    F.K. Napolnikov; N.Ju. Raigorodskaya; D. A. Zharkov; E.N. Tsmokalyuk

    2009-01-01

    The goal of this article is to estimate the androgenic status and analyze its influence on the surgical treatment of hypospadias. From 2000 till 2008 there were 209 children under treatment, whose age varied from 8 months till 15 years old (average age — 4,5+ 1,5). 49 patients were subjected to clinical, humoral and morphological study. Preoperational preparation was carried out by testosterone medications. The comparison group consisted of 10 boys with cicatricial phimosis. The patients with...

  18. Does informed consent influence therapeutic outcome? A clinical trial of the hypnotic activity of placebo in patients admitted to hospital.

    Dahan, R.; Caulin, C; Figea, L; Kanis, J. A.; Caulin, F; Segrestaa, J M

    1986-01-01

    To examine whether written informed consent might influence the results of clinical trials the effect of placebo when given with or without informed consent to patients suffering from insomnia was studied. The study was a single blind observer blinded trial, and patients were paired according to sex, age, and hospital environment. Randomisation assigned the first patient of each pair to the control group (without informed consent) or the group to give informed consent. Of the 56 patients, 26 ...

  19. State anxiety and depression as factors modulating and influencing postoperative pain in dental implant surgery. A prospective clinical survey

    Gómez de Diego, Rafael; Cutando Soriano, Antonio; Montero Martín, Javier; Prados Frutos, Juan Carlos; López-Valverde Centeno, Antonio

    2014-01-01

    Objetives: To determine whether preoperative state anxiety and depression modulate or influence objective and subjective postoperative pain following dental implant insertion. Study Design: Prospective, clinical study with 7-day follow-up of a sample of 105 subjects who preoperatively completed the state anxiety questionnaire (STAI-E) and Beck Depression Inventory (BDI) and postoperatively, at 2 and 7 days, recorded objective pain with the Semmes-Weinstein mechanical esthesiometer (SW test) a...

  20. Does the choice of display system influence perception and visibility of clinically relevant features in digital pathology images?

    Kimpe, Tom; Rostang, Johan; Avanaki, Ali; Espig, Kathryn; Xthona, Albert; Cocuranu, Ioan; Parwani, Anil V.; Pantanowitz, Liron

    2014-03-01

    Digital pathology systems typically consist of a slide scanner, processing software, visualization software, and finally a workstation with display for visualization of the digital slide images. This paper studies whether digital pathology images can look different when presenting them on different display systems, and whether these visual differences can result in different perceived contrast of clinically relevant features. By analyzing a set of four digital pathology images of different subspecialties on three different display systems, it was concluded that pathology images look different when visualized on different display systems. The importance of these visual differences is elucidated when they are located in areas of the digital slide that contain clinically relevant features. Based on a calculation of dE2000 differences between background and clinically relevant features, it was clear that perceived contrast of clinically relevant features is influenced by the choice of display system. Furthermore, it seems that the specific calibration target chosen for the display system has an important effect on the perceived contrast of clinically relevant features. Preliminary results suggest that calibrating to DICOM GSDF calibration performed slightly worse than sRGB, while a new experimental calibration target CSDF performed better than both DICOM GSDF and sRGB. This result is promising as it suggests that further research work could lead to better definition of an optimized calibration target for digital pathology images resulting in a positive effect on clinical performance.

  1. Do Student Evaluations Influence the Teaching Skills of Clerkship Clinical Faculty?

    Chandrasekhar, Arcot J.; Durazo-Arvizu, Ramon; Hoyt, Amy; McNulty, John A.

    2013-01-01

    Web-based student evaluations of clinical faculty were collected over an 8-year period. There were 19,881 medical student evaluations over the 8-year period for all clinical clerkships, representing a total of 952 faculty. Students used a 5-point Likert scale to rate the teaching effectiveness of faculty. Criterion-based methods and standard…

  2. Peer influence on students' estimates of performance : social comparison in clinical rotations

    Raat, A. N. (Janet); Kuks, Jan B. M.; van Hell, E. Ally; Cohen-Schotanus, Janke

    2013-01-01

    Context During clinical rotations, students move from one clinical situation to another. Questions exist about students strategies for coping with these transitions. These strategies may include a process of social comparison because in this context it offers the student an opportunity to estimate h

  3. Multivariable analysis of clinical influence factors on liver enhancement of Gd-EOB-DTPA-enhanced 3T MRI

    The purpose of this study was to identify clinical factors influencing Gd-EOB-DTPA liver uptake in patients with healthy liver parenchyma. A total of 124 patients underwent contrast-enhanced MRI with a hepatocyte-specific contrast agent at 3T. T1-weighted volume interpolated breath-hold examination (VIBE) sequences with fat suppression were acquired before and 20 minutes after contrast injection. The relative enhancement (RE) between plain and contrast-enhanced signal intensity was calculated. Simple and multiple linear regression analyses were performed to evaluate clinical factors influencing the relative enhancement. Patients were subdivided into three groups according to their relative liver enhancement (HRE, RE ≥ 100 %; MRE, 100 % > RE > 50 %; NRE, RE ≤ 50 %) and were analyzed according to the relevant risk factors. Simple regression analyses revealed patient age, transaminases (AST, ALT, GGT), liver, spleen and delta-liver volume (the difference between the volumetrically measured liver volume and the estimated liver volume based on body weight) as significant factors influencing relative enhancement. In the multiple analysis the transaminase AST, spleen and delta liver volume remained significant factors influencing relative enhancement. Delta liver volume showed a significant difference between all analyzed groups. Liver enhancement in the hepatobiliary phase depends on a variety of factors. Body weight-adapted administration of Gd-EOB-DTPA may lead to inadequate liver enhancement after 20 minutes especially when the actual liver volume differs from the expected volume.

  4. The influence of clinical information in the histopathologic diagnosis of melanocytic skin neoplasms.

    Gerardo Ferrara

    Full Text Available BACKGROUND: We tested the relevance of clinical information in the histopathologic evaluation of melanocytic skin neoplasm (MSN. METHODS: Histopathologic specimens from 99 clinically atypical MSN were circulated among ten histopathologists; each case had clinical information available in a database with a five-step procedure (no information; age/sex/location; clinical diagnosis; clinical image; dermoscopic image; each step had a histopathologic diagnosis (D1 through D5; each diagnostic step had a level of diagnostic confidence (LDC ranging from 1 (no diagnostic certainty to 5 (absolute diagnostic certainty. The comparison of the LDC was employed with an analysis of variance (ANOVA for repeated measures. FINDINGS: In D1 (no information, 36/99 cases (36.3% had unanimous diagnosis; in D5 (full information available, 51/99 cases (51.5% had unanimous diagnosis (p for difference between proportions <0.001. The observer agreement expressed as kappa increased significantly from D1 to D5. The mean LDC linearly increased for each observer from D1 through D5 (p for linear trend <0.001. On average, each histopathologist changed his initial diagnosis in 7 cases (range: 2-23. Most diagnostic changes were in D2 (age/sex/location. INTERPRETATION: The histopathologic criteria for the diagnosis of MSN can work as such, but the final histopathologic diagnosis is a clinically-aided interpretation. Clinical data sometimes reverse the initial histopathologic evaluation.

  5. Influence of saliva and mucin on the adhesion of Candida oral clinical isolates

    Seabra, C.; Botelho, C.M.; Oliveira, Ana C. N.; Henriques, Mariana

    2015-01-01

    Objectives: This research work intends to clarify the role of artificial saliva, in particularly the role of mucin, a salivary protein, on the surface properties and adhesion ability of Candida spp. oral clinical isolates to abiotic surfaces. Methods: Four oral clinical isolates of Candida spp. were used: two Candida albicans strains (AC; AM) and two Candida parapsilosis strains (AD; AM2). The strains were isolated from patients using oral prosthesis. The microorganisms were cultured in the a...

  6. Influence of clerks’ personality on their burnout in the clinical workplace: a longitudinal observation

    Lin, Cheng-Chieh; Lin, Blossom Yen-Ju; Lin, Chia-Der

    2016-01-01

    Background The clinical training of medical students in clerkship is crucial to their future practice in healthcare services. This study investigates burnout during a 2-year clerkship training period as well as the role of personality traits on burnout during training. Methods Ninety-four clerks at a tertiary medical centre who provided at least 10 responses to a routine survey on clinical rotation were included in this study, which spanned September 2013 to April 2015. Web-based, validated, ...

  7. Problems for clinical judgement: 5. Principles of influence in medical practice

    Donald A Redelmeier; Cialdini, Robert B.

    2002-01-01

    THE BASIC SCIENCE OF PSYCHOLOGY HAS IDENTIFIED specific ingrained responses that are fundamental elements of human nature, underpin common influence strategies and may apply in medical settings. People feel a sense of obligation to repay a perceived debt. A request becomes more attractive when preceded by a marginally worse request. The drive to act consistently will persist even if demands escalate. Peer pressure is intense when people face uncertainty. The image of the requester influences ...

  8. Factors influencing the establishment and maintenance of a clinical PET imaging service

    Full text: Interest in PET (Positron Emission Tomography) Imaging has increased and many Imaging Units will be confronted by the prospect of introducing a PET service. Using our experience of setting up and maintaining a Clinical PET imaging service, we will demonstrate the issues to be considered in establishing a safe and effective service Areas to be covered include: instrumentation and Quality Control for imaging and accessory equipment radiopharmaceutical availability; utilisation of time and space for planning and scheduling, radiation safety for staff, patients and visitors, adequate staffing levels to maintain service and low doses, training for clinical and technical staff, and the costs associated with the running of a unit. We hope to show some of the various aspects to consider when providing a Clinical PET Imaging service and how we have tackled it without compromising quality or safety. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  9. Influence of the curve density relative electron in dosimetry clinic in treatments stereo tactics

    The objective of this study is to analyze the difference between clinical dosimetry in the treatments with radiosurgery and stereotactic radiotherapy fractional obtained from the relative Electron density curve (Schneider 1996) tabulated and provided with the scanner's radiation therapy. (Author)

  10. Differential influence of vemurafenib and dabrafenib on patients’ lymphocytes despite similar clinical efficacy in melanoma

    Schilling, B.; Sondermann, W.; Zhao, F; Griewank, K. G.; Livingstone, E.; Sucker, A; Zelba, H.; Weide, B.; Trefzer, U.; Wilhelm, T; Loquai, C; Berking, C; Hassel, J.; Kähler, K. C.; Utikal, J

    2014-01-01

    In this study, we demonstrate that vemurafenib but not dabrafenib reduces peripheral lymphocyte counts in melanoma patients while both agents show similar clinical efficacy. Within the lymphocyte compartment, vemurafenib selectively decreases circulating CD4+ T cells and changes their phenotype and function. This indicates that selective BRAFi need to be assessed individually for immunomodulatory effects, especially, when planning combinations with immunotherapies.

  11. Acoustic neuroma ingrowth in the cochlear nerve: does it influence the clinical presentation?

    Forton, G.E.J.; Cremers, C.W.R.J.; Offeciers, E.E.

    2004-01-01

    We examined the clinical presentation in patients with a histologically proven ingrowth of the cochlear nerve by acoustic neuroma to see whether this differs from what is known from large acoustic neuroma series. In total, 85 acoustic neuromas had an en bloc dissection to study histologically the re

  12. The influence of family history on prostate cancer risk : implications for clinical management

    Madersbacher, Stephan; Alcaraz, Antonio; Emberton, Mark; Hammerer, Peter; Ponholzer, Anton; Schroeder, Fritz H.; Tubaro, Andrea

    2011-01-01

    A family history of prostate cancer has long been identified as an important risk factor for developing the disease. This risk factor can be easily assessed in clinical practice and current guidelines recommend to initiate prostate cancer early detection 5 years earlier (i.e. around the age of 40 ye

  13. How Conceptual Frameworks Influence Discovery and Depictions of Emotions in Clinical Relationships

    Duchan, Judith Felson

    2011-01-01

    Although emotions are often seen as key to maintaining rapport between speech-language pathologists and their clients, they are often neglected in the research and clinical literature. This neglect, it is argued here, comes in part from the inadequacies of prevailing conceptual frameworks used to govern practices. I aim to show how six such…

  14. Prognostic influence of clinical and pathological factors in medullary thyroid carcinoma: a study of 53 cases

    Lenine G. Brandão

    2009-01-01

    Full Text Available OBJECTIVES AND INTRODUCTION: Medullary thyroid carcinoma, a neoplasia of intermediate prognosis and differentiation, does not always respond predictably to known treatments. This study aimed to correlate the clinical progression of surgically treated patients with clinical and pathological data. METHODS: A total of 53 patients were followed for 75 months (mean average in tertiary-care hospital. The clinical status of patients at the end of the study period was characterized to determine correlations with a range of disease aspects. A value of p < 0.05 was considered statistically significant. RESULTS: Twenty-two patients (41.5% were alive and disease-free at the end of the follow-up period; twenty-three patients (43.4% had persistent disease; and eight patients (15.1% had recurrent disease. Four patients (7.6% died from medullary thyroid carcinoma with clinical and/or imaging evidence of neoplasia. The following aspects demonstrated statistically significant correlations with the final medical condition: positive initial cervical examination (p = 0.002; neoplastic extensions to the thyroid capsule (p = 0.004 and adjacent tissues (p = 0.034; cervical lymph node metastases (p < 0.001; diameter of neoplasia (p = 0.018; TNM (tumor, node and metastasis Stage (p = 0.001 and evidence of distant and/or cervical diseases in the absence of a cure (p = 0.011. Through logistic regression, the presence of cervical lymph node metastases was considered an independent variable (p < 0.001. CONCLUSIONS: Clinical and pathological aspects of patients with surgically treated medullary thyroid carcinomas are predictors of disease progression. Specifically, even treated cervical lymph node metastases are significantly correlated with disease progression.

  15. Prognostic influence of clinical stage for distant failure in conservation treatment of early breast cancer

    One-hundred twelve patients with clinical stage I-II mammary carcinoma treated with radiation therapy following breast-conserving surgery from 1975 through 1985 were evaluated. Median follow-up was 21 months (range, 2-80 months). This study demonstrates the importance of evaluating patients on the basis of tumor and axillary node findings rather than by clinical stage alone. In the authors' series, all T1 patients with positive axillary lymph nodes achieved the same excellent local and distant control as node-negative T1 and T2 patients. Distant failure occurred in 70% of T2 N1 patients despite systemic chemotherapy given to the majority of patients. The significance of these data regarding future trials are discussed

  16. The influence of job characteristics on job outcomes of pharmacists in hospital, clinic, and community pharmacies.

    Lin, Blossom Yen-Ju; Yeh, Ying-Chen; Lin, Wen-Hung

    2007-06-01

    This study examines the relationship between job characteristics and job outcomes of pharmacists in hospital, clinic, and community pharmacies in Taiwan. The structured questionnaires covered the items of job characteristics, job outcomes, and demographics of pharmacists, and were distributed between Feb 2004 and April 2004. Two hundred and ninety-eight pharmacists responded. Data were analyzed descriptively, and univariate analyses, factor analysis, and multiple regression analyses were used. It found the more enriched the job, the greater the job satisfaction and less intention to leave. And community pharmacists reported greater job enrichment and job satisfaction and less intention to leave than did hospital and clinic pharmacists. It suggests pharmacy managers could recognize the needs of pharmacists to redesign and enrich their work arrangements. PMID:17622026

  17. Influence of Body Mass Index and Albumin on Perioperative Morbidity and Clinical Outcomes in Resected Pancreatic Adenocarcinoma

    Hendifar, Andrew; Osipov, Arsen; Khanuja, Jasleen; Nissen, Nicholas; Naziri, Jason; Yang, Wensha; Li, Quanlin; Tuli, Richard

    2016-01-01

    Obesity is a known risk factor for PDA and recent reports suggest obesity has a negative impact on clinical outcomes in patients with PDA. Pretreatment body mass index (BMI) and serum albumin (SA) have been shown to be associated with worse overall survival in patients with advanced and metastatic PDA. However, minimal data exists on the impact of BMI and SA on perioperative and long-term clinical outcomes in patients with early-stage resected PDA. Herein, we report on the impact of these variables on perioperative clinical outcomes, overall survival (OS) and disease free survival (DFS) in patients with resected PDA. With IRB approval, we evaluated 1,545 patients with PDA treated at a single institution from 2007–2013 and identified 106 patients who underwent upfront resection with curative intent. BMI and SA were calculated preoperatively and at the time of last clinical evaluation. Influence of preoperative BMI, SA, change in either variable, and influence of other clinical and pathologic variables on perioperative morbidity and mortality was assessed. The impact of these variables on DFS and OS was assessed with cox regression modeling and ANOVA. Actuarial estimates for DFS and OS were calculated using Kaplan-Meier methods. Median follow up time was 16 months (3–89). Mean age was 68 years. Median survival was 14 months (3–65) and median time to recurrence was 11 months (1–79). Length of hospital stay was associated with BMI (p = .023), change in BMI (p = .003) and SA (p = .004). Post-operative transfusion rate was associated with SA (p = .021). There was a strong correlation between BMI change and positive margin (p = .04) and lymph node status (p = .01). On multivariate analysis, change in SA (p = .03) and node positivity (p = .008) were associated with decreased DFS. Additionally, preoperative SA (p = .023), node positivity (p = .026) and poor differentiation (p = .045) were associated with worse OS on multivariate analysis. Low preoperative SA was

  18. Influence of Body Mass Index and Albumin on Perioperative Morbidity and Clinical Outcomes in Resected Pancreatic Adenocarcinoma.

    Hendifar, Andrew; Osipov, Arsen; Khanuja, Jasleen; Nissen, Nicholas; Naziri, Jason; Yang, Wensha; Li, Quanlin; Tuli, Richard

    2016-01-01

    Obesity is a known risk factor for PDA and recent reports suggest obesity has a negative impact on clinical outcomes in patients with PDA. Pretreatment body mass index (BMI) and serum albumin (SA) have been shown to be associated with worse overall survival in patients with advanced and metastatic PDA. However, minimal data exists on the impact of BMI and SA on perioperative and long-term clinical outcomes in patients with early-stage resected PDA. Herein, we report on the impact of these variables on perioperative clinical outcomes, overall survival (OS) and disease free survival (DFS) in patients with resected PDA. With IRB approval, we evaluated 1,545 patients with PDA treated at a single institution from 2007-2013 and identified 106 patients who underwent upfront resection with curative intent. BMI and SA were calculated preoperatively and at the time of last clinical evaluation. Influence of preoperative BMI, SA, change in either variable, and influence of other clinical and pathologic variables on perioperative morbidity and mortality was assessed. The impact of these variables on DFS and OS was assessed with cox regression modeling and ANOVA. Actuarial estimates for DFS and OS were calculated using Kaplan-Meier methods. Median follow up time was 16 months (3-89). Mean age was 68 years. Median survival was 14 months (3-65) and median time to recurrence was 11 months (1-79). Length of hospital stay was associated with BMI (p = .023), change in BMI (p = .003) and SA (p = .004). Post-operative transfusion rate was associated with SA (p = .021). There was a strong correlation between BMI change and positive margin (p = .04) and lymph node status (p = .01). On multivariate analysis, change in SA (p = .03) and node positivity (p = .008) were associated with decreased DFS. Additionally, preoperative SA (p = .023), node positivity (p = .026) and poor differentiation (p = .045) were associated with worse OS on multivariate analysis. Low preoperative SA was associated

  19. Influence of Body Mass Index and Albumin on Perioperative Morbidity and Clinical Outcomes in Resected Pancreatic Adenocarcinoma.

    Andrew Hendifar

    Full Text Available Obesity is a known risk factor for PDA and recent reports suggest obesity has a negative impact on clinical outcomes in patients with PDA. Pretreatment body mass index (BMI and serum albumin (SA have been shown to be associated with worse overall survival in patients with advanced and metastatic PDA. However, minimal data exists on the impact of BMI and SA on perioperative and long-term clinical outcomes in patients with early-stage resected PDA. Herein, we report on the impact of these variables on perioperative clinical outcomes, overall survival (OS and disease free survival (DFS in patients with resected PDA. With IRB approval, we evaluated 1,545 patients with PDA treated at a single institution from 2007-2013 and identified 106 patients who underwent upfront resection with curative intent. BMI and SA were calculated preoperatively and at the time of last clinical evaluation. Influence of preoperative BMI, SA, change in either variable, and influence of other clinical and pathologic variables on perioperative morbidity and mortality was assessed. The impact of these variables on DFS and OS was assessed with cox regression modeling and ANOVA. Actuarial estimates for DFS and OS were calculated using Kaplan-Meier methods. Median follow up time was 16 months (3-89. Mean age was 68 years. Median survival was 14 months (3-65 and median time to recurrence was 11 months (1-79. Length of hospital stay was associated with BMI (p = .023, change in BMI (p = .003 and SA (p = .004. Post-operative transfusion rate was associated with SA (p = .021. There was a strong correlation between BMI change and positive margin (p = .04 and lymph node status (p = .01. On multivariate analysis, change in SA (p = .03 and node positivity (p = .008 were associated with decreased DFS. Additionally, preoperative SA (p = .023, node positivity (p = .026 and poor differentiation (p = .045 were associated with worse OS on multivariate analysis. Low preoperative SA was

  20. Problems for clinical judgement: 5. Principles of influence in medical practice.

    Redelmeier, Donald A; Cialdini, Robert B

    2002-06-25

    The basic science of psychology has identified specific ingrained responses that are fundamental elements of human nature, underpin common influence strategies and may apply in medical settings. People feel a sense of obligation to repay a perceived debt. A request becomes more attractive when preceded by a marginally worse request. The drive to act consistently will persist even if demands escalate. Peer pressure is intense when people face uncertainty. The image of the requester influences the attractiveness of a request. Authorities have power beyond their expertise. Opportunities appear more valuable when they appear less available. These 7 responses were discovered decades ago in psychology research and seem intuitively understood in the business world, but they are rarely discussed in medical texts. An awareness of these principles can provide a framework for physicians to help patients change their behaviour and to understand how others in society sometime alter patients' choices. PMID:12126325

  1. Shared Genetic Influences Between Attention-Deficit/Hyperactivity Disorder (ADHD) Traits in Children and Clinical ADHD

    Stergiakouli, Evie; Martin, Joanna; Hamshere, Marian L.; Langley, Kate; Evans, David M.; St Pourcain, Beate; Timpson, Nicholas J.; Owen, Michael J.; O'Donovan, Michael; Thapar, Anita; Davey Smith, George

    2015-01-01

    Objective Twin studies and genome-wide complex trait analysis (GCTA) are not in agreement regarding heritability estimates for behavioral traits in children from the general population. This has sparked a debate on the possible difference in genetic architecture between behavioral traits and psychiatric disorders. In this study, we test whether polygenic risk scores associated with variation in attention-deficit/hyperactivity disorder (ADHD) trait levels in children from the general population predict ADHD diagnostic status and severity in an independent clinical sample. Method Single nucleotide polymorphisms (SNPs) with p < .5 from a genome-wide association study of ADHD traits in 4,546 children (mean age, 7 years 7 months) from the Avon Longitudinal Study of Parents and Children (ALSPAC; general population sample) were selected to calculate polygenic risk scores in 508 children with an ADHD diagnosis (independent clinical sample) and 5,081 control participants. Polygenic scores were tested for association with case-control status and severity of disorder in the clinical sample. Results Increased polygenic score for ADHD traits predicted ADHD case-control status (odds ratio = 1.17 [95% CI = 1.08–1.28], p = .0003), higher ADHD symptom severity (β = 0.29 [95% CI = 0.04–0.54], p = 0.02), and symptom domain severity in the clinical sample. Conclusion This study highlights the relevance of additive genetic variance in ADHD, and provides evidence that shared genetic factors contribute to both behavioral traits in the general population and psychiatric disorders at least in the case of ADHD. PMID:25791149

  2. Clinical Factors and Viral Load Influencing Severity of Acute Hepatitis A.

    Hyun Woong Lee

    Full Text Available Clinical manifestations of hepatitis A virus (HAV infection vary from mild to fulminant hepatic failure (FHF in adults. We investigated the relationship between laboratory findings, including viral load, and clinical outcomes in patients with acute hepatitis A (AHA and evaluated predictive factors for severe acute hepatitis (s-AH.We analyzed the clinical manifestations of AHA in 770 patients. Patients with a prothrombin time (PT of less than 40% of normal were classified as s-AH and included 4 patients with FHF, 11 patients with acute renal failure, and 3 patients with prolonged jaundice (n = 128. Other patients were defined as mild acute hepatitis (m-AH (n = 642. Serum samples were obtained from 48 patients with acute hepatitis A. Among them, 20 with s-AH, and 28 with m-AH, were tested for HAV RNA titer.In a multivariate analysis, age (HR = 1.042, P = 0.041, peak creatinine (HR = 4.014, P = 0.001, bilirubin (HR = 1.153, P = 0.003, alanine aminotransferase (ALT (HR = 1.001, P < 0.001, initial lactate dehydrogenase (LDH (HR = 1.000, P = 0.045 and total cholesterol (HR = 0.978, P < 0.001 were independent factors for s-AH. Serum HAV RNA was detected in 20/20 (100% patients with s-AH and 22/28 (78.6% patients with m-AH. In a multivariate analysis of the 48 patients who were tested for HAV RNA, peak ALT (HR = 1.001, P = 0.004 and HAV RNA titer (HR = 2.076, P = 0.012 were independent factors for s-AH.Clinical factors including age, peak creatinine, bilirubin, ALT, initial LDH and total cholesterol were independent factors for s-AH in a multivariate analysis. In particular, HAV load strongly correlated with the severity of hepatitis A.

  3. Incentives and barriers that influence clinical computerization in Hong Kong: A population-based physician survey

    Leung, Gabriel M.; Yu, Philip L.H.; Wong, Irene O L; Johnston, Janice M.; Tin, Keith Y. K.

    2003-01-01

    Objective: Given the slow adoption of medical informatics in Hong Kong and Asia, we sought to understand the contributory barriers and potential incentives associated with information technology implementation. Design and Measurements: A representative sample of 949 doctors (response rate = 77.0%) was asked through a postal survey to rank a list of nine barriers associated with clinical computerization according to self-perceived importance. They ranked seven incentives or catalysts that may ...

  4. Delusional Disorder over the Reproductive Life Span: The Potential Influence of Menopause on the Clinical Course

    Alexandre González-Rodríguez; Oriol Molina-Andreu; Rafael Penadés; Marina Garriga; Alexandre Pons; Rosa Catalán; Miguel Bernardo

    2015-01-01

    Background and Objectives. Recent evidence supports an association between estrogen levels and severity of psychopathology in schizophrenia women. Our main goal was to investigate whether delusional disorder (DD) women with premenopausal onset and those with postmenopausal onset differ in demographic and clinical features. Methods. Psychopathological symptoms were assessed in 80 DD women (DSM-IV-TR), at baseline and after six and 24 months. Scores in the PANSS, PSP for functionality, HRSD 17 ...

  5. Trauma reactivation under the influence of propranolol: an examination of clinical predictors

    Poundja, Joaquin; Sanche, Steven; Tremblay, Jacques; Brunet, Alain

    2012-01-01

    Background: In two recent studies conducted by our group, a treatment combining propranolol with a brief reactivation session subsequently reduced posttraumatic stress disorder (PTSD) symptom severity and diagnosis, as well as reducing psychophysiological responses during trauma-related script-driven imagery. One likely explanation for those results is that memory reconsolidation was blocked by propranolol. Objective: We explored the influence of various predictors on treatment outcome (i.e.,...

  6. Factors influencing the outcome of intrauterine insemination (IUI): age, clinical variables and significant thresholds

    Speyer, B.; Abramov, B.; Saab, W.; Doshi, A.; Sarna, U.; Harper, J. C.; Serhal, P

    2013-01-01

    The aim was to investigate the influence of various biological factors upon the outcome of intrauterine insemination (IUI). The total IUI history (856 cycles) of 352 couples was studied. Live-birth showed a strong negative correlation with female age but no correlation with male age. Antimullerian hormone (AMH) and antral follicle count (AFC) correlated negatively with female age, and follicle stimulating hormone (FSH) correlated positively. Significant thresholds were found for all three var...

  7. The Influence of BMX Gene Polymorphisms on Clinical Symptoms after Mild Traumatic Brain Injury

    Yu-Jia Wang

    2014-01-01

    Full Text Available Mild traumatic brain injury (mTBI is one of the most common neurological disorders. Most patients diagnosed with mTBI could fully recover, but 15% of patients suffer from persistent symptoms. In recent studies, genetic factors were found to be associated with recovery and clinical outcomes after TBI. In addition, results from our previous research have demonstrated that the bone marrow tyrosine kinase gene in chromosome X (BMX, a member of the Tec family of kinases, is highly expressed in rats with TBI. Therefore, our aim in this study was to identify the association between genetic polymorphisms of BMX and clinical symptoms following mTBI. Four tagging single nucleotide polymorphisms (tSNPs of BMX with minimum allele frequency (MAF >1% were selected from the HapMap Han Chinese database. Among these polymorphisms, rs16979956 was found to be associated with the Beck anxiety inventory (BAI and dizziness handicap inventory (DHI scores within the first week after head injury. Additionally, another SNP, rs35697037, showed a significant correlation with dizziness symptoms. These findings suggested that polymorphisms of the BMX gene could be a potential predictor of clinical symptoms following mTBI.

  8. Trauma reactivation under the influence of propranolol: an examination of clinical predictors

    Joaquin Poundja

    2012-02-01

    Full Text Available In two recent studies conducted by our group, a treatment combining propranolol with a brief reactivation session subsequently reduced posttraumatic stress disorder (PTSD symptom severity and diagnosis, as well as reducing psychophysiological responses during trauma-related script-driven imagery. One likely explanation for those results is that memory reconsolidation was blocked by propranolol.We explored the influence of various predictors on treatment outcome (i.e., PTSD severity, and whether the treated individuals improved in other important domains of functioning associated with PTSD.Thirty-three patients with longstanding PTSD participated in a 6-week open-label trial consisting of actively recalling one's trauma under the influence of propranolol, once a week.Treated patients reported a better quality of life, less comorbid depressive symptoms, less negative emotions in their daily life and during trauma recollections. Women were also found to improve more than men. Type of trauma (childhood vs. adulthood, time elapsed since trauma, borderline personality traits, depressive symptoms severity, Axis I comorbidity, and age did not influence treatment outcome.These results must await publication of a randomized-controlled trial to further delineate effectiveness with this novel treatment approach.For the abstract or full text in other languages, please see Supplementary files under Reading Toolsonline

  9. Can the clinical course of cancer be influenced by non-antineoplastic drugs?

    Brandes, L. J.; Friesen, L A

    1995-01-01

    Laboratory and anecdotal clinical evidence suggests that some common non-antineoplastic drugs may affect the course of cancer. The authors present two cases that appear to be consistent with such a possibility: that of a 63-year-old woman in whom a high-grade angiosarcoma of the forehead improved after discontinuation of lithium therapy and then progressed rapidly when treatment with carbamazepine was started, and that of a 74-year-old woman with metastatic adenocarcinoma of the colon that re...

  10. The influence of clinical and pharmacological factors on enuresis treatment with imipramine.

    Fernández de Gatta, M M; P. Galindo; Rey, F.; Gutierrez, J; Tamayo, M; García, M. J.; Domínguez-Gil, A

    1990-01-01

    1. The aim of this study has been to evaluate the response to imipramine treatment in enuretic children through the use of a series of clinical and pharmacological variables and by applying a multivariate (principal components) analysis technique. 2. The study was carried out on 146 children whose ages ranged from 5 to 14 years, and who received variable doses of imipramine (12.5 to 100 mg day-1). 3. The quantitative variables analyzed were: drug dosage, serum levels of imipramine and its met...

  11. Influence of zoledronic acid on disseminated tumor cells in bone marrow and survival: results of a prospective clinical trial

    The presence of disseminated tumor cells (DTC) in bone marrow (BM) of breast cancer patients is associated with reduced clinical outcome. Bisphosphonate treatment was shown to eradicate DTC from BM in several studies. This controlled randomized open-label multi-center study aimed to investigate the influence of zoledronic acid (ZOL) on DTC and survival of breast cancer patients (Clinical Trial Registration Number: NCT00172068). Patients with primary breast cancer and DTC-positive bone marrow were randomized to treatment with ZOL plus adjuvant systemic therapy (n = 40) or adjuvant systemic therapy alone (n = 46) between 03/2002 and 12/2004. DTC were identified by immunocytochemistry using the pancytokeratin antibody A45B/B3 and by cytomorphology. The change in DTC numbers at 12 months and 24 months versus baseline, as well as patient outcomes were evaluated. 86 patients could be included into survival analysis (median follow-up: 88 months, range: 8–108 mths). Patients in the control group were more likely to die during follow-up than those in the ZOL-group (11% vs. 2%, p = 0.106). 15% of patients in the control group presented with relapse whereas only 8% of ZOL group patients developed metastatic or recurrent disease during follow-up (p = 0.205). At 24 months, 16% of patients from the control group were still DTC positive, whereas all patients treated with ZOL became DTC negative (p = 0.032). Patients presenting with persistent DTC 12 months after diagnosis had significantly shorter overall survival (p = 0.011). Bisphosphonate therapy contributes to eradication of disseminated tumor cells. The positive influence of bisphosphonates on survival in the adjuvant setting may be due to their effects on DTC. ClinicalTrials.gov Identifier: http://clinicaltrials.gov/show/NCT00172068 [Zoledronic Acid in the Treatment of Breast Cancer With Minimal Residual Disease in the Bone Marrow (MRD-1)

  12. Genetic modifiers of sickle cell anemia in the BABY HUG cohort: influence on laboratory and clinical phenotypes.

    Sheehan, Vivien A; Luo, Zhaoyu; Flanagan, Jonathan M; Howard, Thad A; Thompson, Bruce W; Wang, Winfred C; Kutlar, Abdullah; Ware, Russell E

    2013-07-01

    The recently completed BABY HUG trial investigated the safety and efficacy of hydroxyurea in infants with sickle cell anemia (SCA). To investigate the effects of known genetic modifiers, genomic DNA on 190 randomized subjects were analyzed for alpha thalassemia, beta-globin haplotype, polymorphisms affecting endogenous fetal hemoglobin (HbF) levels (XmnI, BCL11A, and HBS1L-MYB), UGT1A1 promoter polymorphisms, and the common G6PD A(-) mutation. At study entry, infants with alpha thalassemia trait had significantly lower mean corpuscular volume, total bilirubin, and absolute reticulocyte count. Beta-globin haplotypes associated with milder disease had significantly higher hemoglobin and %HbF. BCL11A and XmnI polymorphisms had significant effects on baseline HbF, while UGT1A1 promoter polymorphisms significantly influenced baseline serum bilirubin. At study exit, subjects randomized to placebo still exhibited laboratory effects of alpha thalassemia and other modifiers, while those assigned hydroxyurea had treatment effects that exceeded most genetic influences. The pain phenotype was influenced by HbF modifiers in both treatment groups. These data document that genetic polymorphisms do modify laboratory and clinical phenotypes even in very young patients with SCA. The hydroxyurea effects are more potent, however, indicating that treatment criteria should not be limited to certain genetic subsets, and supporting the use of hydroxyurea for all young patients with SCA. PMID:23606168

  13. Episiotomy and its relationship to various clinical variables that influence its performance

    Ballesteros-Meseguer, Carmen; Carrillo-García, César; Meseguer-de-Pedro, Mariano; Canteras-Jordana, Manuel; Martínez-Roche, Mª Emilia

    2016-01-01

    Objective: to understand the episiotomy rate and its relationship with various clinical variables. Method: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. Variables: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. Results: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. Conclusions: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure. PMID:27224064

  14. Influence of clinical and socioeconomic indicators on dental trauma in preschool children

    Patrícia CORRÊA-FARIA

    2015-01-01

    Full Text Available The aim of the present study was to determine the prevalence of traumatic dental injury (TDI in the primary dentition and investigate associations with clinical and socioeconomic indicators. A population-based, cross-sectional study was carried out with a randomly selected sample of 301 children aged one to five years. Data were collected through clinical oral examinations and interviews with parents/guardians during immunization campaigns. Statistical analysis involved Pearson’s Chi-squared test and Poisson regression with robust variance. The prevalence of TDI was 33.9%. TDI was more prevalent in children with overjet > 3 mm (p < 0.001 and those with inadequate lip coverage (p < 0.001. A statistically significant association was also found between TDI and household income (p = 0.024. According to the adjusted Poisson regression model, greater prevalence rates of TDI were found for children from families with a monthly income ≥ twice the Brazilian minimum monthly wage (PR: 1.52; 95%CI: 1.10-2.12, those with accentuated overjet (PR: 1.53; 95%CI: 1.05-2.22 and those with inadequate lip coverage (PR: 2.00; 95%CI: 1.41-2.84. The prevalence of TDI was high in the present study and was associated with a higher family income, accentuated overjet and inadequate lip coverage.

  15. The influence of family history on prostate cancer risk: implications for clinical management.

    Madersbacher, Stephan; Alcaraz, Antonio; Emberton, Mark; Hammerer, Peter; Ponholzer, Anton; Schröder, Fritz H; Tubaro, Andrea

    2011-03-01

    • The most recent evidence for the link between a family history of prostate cancer and individual risk for future disease was examined, with the aim of understanding what the existence and nature of a family history of prostate cancer does to a man's risk of developing the disease. • Our findings highlighted the clear association between a family history of prostate cancer and increased risk of developing the disease; with a greater proximity of relatedness, greater number of family members affected and/or earlier age at diagnosis of the family member elevating risk further. • These findings have important clinical implications for the identification and subsequent management of men deemed to be at increased risk of developing prostate cancer. The evidence for prostate cancer risk reduction with the mono 5α-reductase inhibitor (5ARI) finasteride in a low-risk population and, more recently, with the dual 5ARI dutasteride in a population at increased risk of developing the disease, has potential to expand management options for men at risk of developing prostate cancer beyond more frequent and/or earlier surveillance. • Given that family history can be easily assessed in routine clinical practice, it should be regarded as an important parameter to consider alongside PSA level for prostate cancer risk assessment. PMID:21166744

  16. Quantum noise influencing human behaviour could fake effectiveness of drugs in clinical trials

    Janzing, D; Janzing, Dominik; Beth, Thomas

    2002-01-01

    To test the effectiveness of a drug one can advice two randomly selected groups of patients to take or not to take it, respectively. It is well-known that the causal effect cannot be identified if not all patients comply. This holds even when the non-compliers can be identified afterwards since latent factors like patient's personality can influence both his decision and his physical response. However, one can still give bounds on the effectiveness of the drug depending on the rate of compliance. Remarkably, the proofs of these bounds given in the literature rely on models that represent all relevant latent factors (including noise) by hidden classical variables. In strong analogy to the violation of Bell's inequality, some of these bounds fail if patient's behavior is influenced by latent quantum processes (e.g. in his nervous system). Quantum effects could fake an increase of the recovery rate by about 13% although the drug would hurt as many patients as it would help if everyone took it. The other bounds a...

  17. Should the host reaction to anisakiasis influence the treatment?: Different clinical presentations in two cases

    Stefano Pontone

    2012-12-01

    Full Text Available Gastrointestinal anisakiasis is a parasitic infection occurring in people that consume raw or inadequately cooked fish or squid. It is frequently characterized by severe epigastric pain, nausea and vomiting caused by the penetration of the larvae into the gastric wall. Acute gastric anisakiasis with severe chest discomfort is rarely reported in Italy. On the other hand, gastro-allergic anisakiasis with rash, urticaria and isolated angioedema or anaphylaxis is a clinical entity that has been described only recently. Also, if patients usually develop symptoms within 12 hours after raw seafood ingestion, not always endoscopic exploration can promptly identify the Anisakis larvae. Moreover, some authors consider the prevailing allergic reaction as a natural and effective defense against the parasitic attack. We report two cases of peculiar manifestations of anisakiasis in both acute and chronic forms (severe chest discomfort and anaphylactoid reaction.

  18. Lifelong learning in obstetrics and gynaecology: how theory can influence clinical practice.

    Mukhopadhyay, S; Smith, S; Cresswell, J

    2011-08-01

    Lifelong learning refers to the systematic acquisition, renewal, updating and completion of knowledge. It is synonymous with the term 'self-directed learning'. This is a new educational strategy meant to consolidate knowledge in a fashion that is reproducible for a lifetime with successful application to both known and unknown clinical exercises. The development of lifelong learning is based on the principles of andragogy (autonomy and independence in one's learning activities), reflection and learning from experience. This paper deals with the development of these theories culminating in the advent of self-directed learning. Evidence to support experiential, reflective and self-directed learning is provided, including the use of rating scales. An example from obstetrics is used to highlight the application of these principles. There are barriers to adopting a new educational paradigm, however, lifelong learning remains an excellent tool for continuous professional development. PMID:21823841

  19. Factors influencing the outcome of intrauterine insemination (IUI): age, clinical variables and significant thresholds.

    Speyer, B E; Abramov, B; Saab, W; Doshi, A; Sarna, U; Harper, J C; Serhal, P

    2013-10-01

    The aim was to investigate the influence of various biological factors upon the outcome of intrauterine insemination (IUI). The total IUI history (856 cycles) of 352 couples was studied. Live-birth showed a strong negative correlation with female age but no correlation with male age. Antimüllerian hormone (AMH) and antral follicle count (AFC) correlated negatively with female age, and follicle stimulating hormone (FSH) correlated positively. Significant thresholds were found for all three variables, and also for total motile count (TMC) in the prepared sperm. Calculating pregnancy losses per positive pregnancy showed a strong correlation with increasing female age. This was highly significant for biochemical losses but not for fetal heart miscarriages. Male age had no effect on rate of pregnancy loss. In conclusion, female age, FSH, AMH and TMC are good predictive factors for live-birth and therefore relate to essential in vivo steps in the reproductive process. PMID:24127958

  20. Differential influence of vemurafenib and dabrafenib on patients’ lymphocytes despite similar clinical efficacy in melanoma

    Schilling, B.; Sondermann, W.; Zhao, F.; Griewank, K. G.; Livingstone, E.; Sucker, A.; Zelba, H.; Weide, B.; Trefzer, U.; Wilhelm, T.; Loquai, C.; Berking, C.; Hassel, J.; Kähler, K. C.; Utikal, J.; Al Ghazal, P.; Gutzmer, R.; Goldinger, S. M.; Zimmer, L.; Paschen, A.; Hillen, U.; Schadendorf, D.

    2014-01-01

    Background Since the majority of melanomas eventually become resistant and progress, combining selective BRAF inhibitors (BRAFi) with immunotherapies has been proposed to achieve more durable treatment responses. Here, we explored the impact of selective BRAFi on the hosts' immune system. Patients and methods Clinical data, whole blood counts (WBC) and serum lactate dehydrogenase (LDH) of 277 vemurafenib- and 65 dabrafenib-treated melanoma patients were evaluated. The frequency and phenotype of lymphocyte subpopulations were determined by flow cytometry while T cell cytokine secretion was measured by multiplex assays. Results Progression-free survival (PFS) as well as overall survival (OS) were similar in patients treated with either BRAFi. High pretreatment LDH was associated with shorter PFS and OS in both groups. During therapy, peripheral lymphocytes decreased by 24.3% (median, P < 0.0001) in vemurafenib-treated patients but remained unchanged in dabrafenib-treated patients (+1.2%, P = 0.717). Differentiation of peripheral lymphocytes of vemurafenib-treated patients showed a significant decrease in CD4+ T cells (P < 0.05). Within CD4+ T cells obtained during treatment, an increase in CCR7+CD45RA+ (naïve) and a decrease in CCR7+CD45RA− (central memory) populations were found (P < 0.01 for both). Furthermore, secretion of interferon-γ and interleukin-9 by CD4+ T cells was significantly lower in samples obtained during vemurafenib treatment compared with baseline samples. Conclusion While both compounds have comparable clinical efficacy, vemurafenib but not dabrafenib decreases patients peripheral lymphocyte counts and alters CD4+ T cell phenotype and function. Thus, selective BRAFi can significantly affect patients' peripheral lymphocyte populations. Fully understanding these effects could be critical for successfully implementing combinatorial therapies of BRAFi with immunomodulatory agents. PMID:24504444

  1. An innovative OSCE clinical log station: a quantitative study of its influence on Log use by medical students

    Hudson Judith N

    2012-11-01

    Full Text Available Abstract Background A Clinical Log was introduced as part of a medical student learning portfolio, aiming to develop a habit of critical reflection while learning was taking place, and provide feedback to students and the institution on learning progress. It was designed as a longitudinal self-directed structured record of student learning events, with reflection on these for personal and professional development, and actions planned or taken for learning. As incentive was needed to encourage student engagement, an innovative Clinical Log station was introduced in the OSCE, an assessment format with established acceptance at the School. This study questions: How does an OSCE Clinical Log station influence Log use by students? Methods The Log station was introduced into the formative, and subsequent summative, OSCEs with careful attention to student and assessor training, marking rubrics and the standard setting procedure. The scoring process sought evidence of educational use of the log, and an ability to present and reflect on key learning issues in a concise and coherent manner. Results Analysis of the first cohort’s Log use over the four-year course (quantified as number of patient visits entered by all students revealed limited initial use. Usage was stimulated after introduction of the Log station early in third year, with some improvement during the subsequent year-long integrated community-based clerkship. Student reflection, quantified by the mean number of characters in the ‘reflection’ fields per entry, peaked just prior to the final OSCE (mid-Year 4. Following this, very few students continued to enter and reflect on clinical experience using the Log. Conclusion While the current study suggested that we can’t assume students will self-reflect unless such an activity is included in an assessment, ongoing work has focused on building learner and faculty confidence in the value of self-reflection as part of being a competent

  2. Clinical indicators of child development in the capitals of nine Brazilian states: the influence of regional cultural factors

    André Laranjeira de Carvalho

    2008-01-01

    Full Text Available OBJECTIVE: Evaluating the interaction between mother or caregiver and infant through the Clinical Indicators of Risks in Infant Development and investigating whether local and cultural influences during infant development affect these clinical indicators. INTRODUCTION: The Clinical Indicators of Risks in Infant Development was created in order to fully assess infants' development and the subjective relationship between the babies and their caregivers. The absence of two or more Clinical Indicators of Risks in Infant Developments suggests a possibly inadequate mental development. Given the continental size of Brazil and its accentuated cultural differences, one might question how trustworthy these indicators can be when applied to each of the geographical regions of the country. METHODS: This was a cross-sectional study with 737 infants from the capitals of 9 Brazilian states. The size of the initial sample population was based on a pilot study carried out in the cities of São Paulo and Brasília. The ages of children were grouped: 0-3 months, 4-7 months, 8-11 months and 12-18 months. The chi-square test was used together with analyses by the statistical software SPSS 13.0. RESULTS: Statistical analysis of results from the different municipalities against the total sample did not reveal any statistically significant differences. Municipalities represented were Belém (p=0.486, Brasília (p=0.371, Porto Alegre (p=0.987, Fortaleza (p=0.259, Recife (p=0.630, Salvador (0.370, São Paulo (p=0.238, Curitiba (p=0.870, and Rio de Janeiro (p= 0.06. DISCUSSION: Care for mental development should be considered a public health issue. Its evaluation and follow-up should be part of the already available mother-child assistance programs, which would then be considered to provide "full" care to children. CONCLUSIONS: Local habits and culture did not affect the results of the Clinical Indicators of Risks in Infant Development indicators. Clinical Indicators of

  3. Astrocytic IL-6 Influences the Clinical Symptoms of EAE in Mice.

    Erta, Maria; Giralt, Mercedes; Jiménez, Silvia; Molinero, Amalia; Comes, Gemma; Hidalgo, Juan

    2016-01-01

    Interleukin-6 (IL-6) is a multifunctional cytokine that not only plays major roles in the immune system, but also serves as a coordinator between the nervous and endocrine systems. IL-6 is produced in multiple cell types in the CNS, and in turn, many cells respond to it. It is therefore important to ascertain which cell type is the key responder to IL-6 during both physiological and pathological conditions. In order to test the role of astrocytic IL-6 in neuroinflammation, we studied an extensively-used animal model of multiple sclerosis, experimental autoimmune encephalomyelitis (EAE), in mice with an IL-6 deficiency in astrocytes (Ast-IL-6 KO). Results indicate that lack of astrocytic IL-6 did not cause major changes in EAE symptomatology. However, a delay in the onset of clinical signs was observed in Ast-IL-6 KO females, with fewer inflammatory infiltrates and decreased demyelination and some alterations in gliosis and vasogenesis, compared to floxed mice. These results suggest that astrocyte-secreted IL-6 has some roles in EAE pathogenesis, at least in females. PMID:27196935

  4. Astrocytic IL-6 Influences the Clinical Symptoms of EAE in Mice

    Maria Erta

    2016-05-01

    Full Text Available Interleukin-6 (IL-6 is a multifunctional cytokine that not only plays major roles in the immune system, but also serves as a coordinator between the nervous and endocrine systems. IL-6 is produced in multiple cell types in the CNS, and in turn, many cells respond to it. It is therefore important to ascertain which cell type is the key responder to IL-6 during both physiological and pathological conditions. In order to test the role of astrocytic IL-6 in neuroinflammation, we studied an extensively-used animal model of multiple sclerosis, experimental autoimmune encephalomyelitis (EAE, in mice with an IL-6 deficiency in astrocytes (Ast-IL-6 KO. Results indicate that lack of astrocytic IL-6 did not cause major changes in EAE symptomatology. However, a delay in the onset of clinical signs was observed in Ast-IL-6 KO females, with fewer inflammatory infiltrates and decreased demyelination and some alterations in gliosis and vasogenesis, compared to floxed mice. These results suggest that astrocyte-secreted IL-6 has some roles in EAE pathogenesis, at least in females.

  5. Delusional Disorder over the Reproductive Life Span: The Potential Influence of Menopause on the Clinical Course

    Alexandre González-Rodríguez

    2015-01-01

    Full Text Available Background and Objectives. Recent evidence supports an association between estrogen levels and severity of psychopathology in schizophrenia women. Our main goal was to investigate whether delusional disorder (DD women with premenopausal onset and those with postmenopausal onset differ in demographic and clinical features. Methods. Psychopathological symptoms were assessed in 80 DD women (DSM-IV-TR, at baseline and after six and 24 months. Scores in the PANSS, PSP for functionality, HRSD 17 items, C-SSRS for suicide, and the SUMD were considered outcome variables. For comparison purposes, t- and χ2-tests were performed and nonparametric tests when necessary. Analysis of Covariance (ANCOVA was conducted for multivariate comparisons. Results. 57 out of 80 DD women completed the study. When unadjusted, DD with premenopausal onset had a longer DUP, higher educational level, and a tendency toward higher rates of gynaecological disorders. Erotomanic type was most frequent in DD women premenopausal onset, and somatic and jealous types were most frequent in those with postmenopausal onset. After 24 months, DD women with premenopausal onset showed higher depressive symptoms and a tendency toward higher rates of psychotic relapses. Conclusions. Our results support that some aspects of psychopathology and insight may differ according to the onset of DD and the reproductive status.

  6. The influence of clinical and pharmacological factors on enuresis treatment with imipramine.

    Fernández de Gatta, M M; Galindo, P; Rey, F; Gutierrez, J; Tamayo, M; García, M J; Domínguez-Gil, A

    1990-11-01

    1. The aim of this study has been to evaluate the response to imipramine treatment in enuretic children through the use of a series of clinical and pharmacological variables and by applying a multivariate (principal components) analysis technique. 2. The study was carried out on 146 children whose ages ranged from 5 to 14 years, and who received variable doses of imipramine (12.5 to 100 mg day-1). 3. The quantitative variables analyzed were: drug dosage, serum levels of imipramine and its metabolite desipramine, the relationship between them both, the duration of treatment, age and weight. 4. The qualitative variables were: compliance, presence of side-effects, enuretic and/or psychiatric antecedents, intelligence quotient (I.Q.), the existence (or absence) of related pathologies, sex, and the type of enuresis. 5. The response to treatment was quantified by means of the percentage of decrease in frequency of enuresis as compared with the initial frequency. 6. The results obtained show that the variables which are most associated with the reduction of enuresis are, in decreasing order: the dosage of imipramine administered, the duration of treatment, compliance and the level/dose ratio for the sum of the drug and metabolite levels. PMID:2271368

  7. Influence of weight loss on the clinical manifestations of osteoarthritis of the knee-joints.

    Inna Vladimirovna Solov'eva

    2014-10-01

    Full Text Available Obesity consistently associated with the development of a number of chronic diseases, leading to a decrease in quality of life, disability and death. The article examines the connection between obesity and disease of the musculoskeletal system, describes the mechanisms by means of which obesity leads to the development of osteoarthritis. It is evident that reduction of body mass can slow the progression of osteoporosis. The own experience of non-pharmacological and pharmacological treatment of obesity with the use of orlistat in 50 obese patients with osteoarthritis of the knee II–III stage is presented. Treatment has resulted in a decrease in body weight, waist circumference, accompanied by a decrease in symptoms osteoarthritis among all the patients. Our results showed that the addition of orlistat to standard osteoarthritis scheme leads to significant reduction in weight and reduction of clinical manifestations of osteoarthritis. According to the above, the drugs that have impact on weight loss, should be included in the treatment regimen of patients with osteoarthritis and obesity.

  8. Delusional Disorder over the Reproductive Life Span: The Potential Influence of Menopause on the Clinical Course.

    González-Rodríguez, Alexandre; Molina-Andreu, Oriol; Penadés, Rafael; Garriga, Marina; Pons, Alexandre; Catalán, Rosa; Bernardo, Miguel

    2015-01-01

    Background and Objectives. Recent evidence supports an association between estrogen levels and severity of psychopathology in schizophrenia women. Our main goal was to investigate whether delusional disorder (DD) women with premenopausal onset and those with postmenopausal onset differ in demographic and clinical features. Methods. Psychopathological symptoms were assessed in 80 DD women (DSM-IV-TR), at baseline and after six and 24 months. Scores in the PANSS, PSP for functionality, HRSD 17 items, C-SSRS for suicide, and the SUMD were considered outcome variables. For comparison purposes, t- and χ (2)-tests were performed and nonparametric tests when necessary. Analysis of Covariance (ANCOVA) was conducted for multivariate comparisons. Results. 57 out of 80 DD women completed the study. When unadjusted, DD with premenopausal onset had a longer DUP, higher educational level, and a tendency toward higher rates of gynaecological disorders. Erotomanic type was most frequent in DD women premenopausal onset, and somatic and jealous types were most frequent in those with postmenopausal onset. After 24 months, DD women with premenopausal onset showed higher depressive symptoms and a tendency toward higher rates of psychotic relapses. Conclusions. Our results support that some aspects of psychopathology and insight may differ according to the onset of DD and the reproductive status. PMID:26600949

  9. Influence of Peritoneal Transport Characteristics on Nutritional Status and Clinical Outcome in Chinese Diabetic Nephropathy Patients on Peritoneal Dialysis

    Ji-Chao Guan; Wei Bian; Xiao-Hui Zhang; Zhang-Fei Shou; Jiang-Hua Chen

    2015-01-01

    Background:High peritoneal transport status was previously thought to be a poor prognostic factor in peritoneal dialysis (PD) patients.However,its effect on diabetic nephropathy PD patients is unclear in consideration of the adverse impact of diabetes itself.The purpose of this study was to investigate the influence of peritoneal transport characteristics on nutritional status and clinical outcome in diabetic nephropathy patients on PD.Methods:One hundred and two diabetic nephropathy patients on PD were enrolled in this observational cohort study.According to the initial peritoneal equilibration test result,patients were divided into two groups:Higher transport group (HT,including high and high average transport) and lower transport group (LT,including low and low-average transport).Demographic characteristics,biochemical data,dialysis adequacy,and nutritional status were evaluated.Clinical outcomes were compared.Risk factors for death-censored technique failure and mortality were analyzed.Results:Compared with LT group (n =37),serum albumin was significantly lower and the incidence of malnutrition by subjective global assessment was significantly higher in HT group (n =65) (P < 0.05).Kaplan-Meier analyses showed that death-censored technique failure and mortality were significantly increased in HT group compared with that in LT group.On multivariate Cox analyses,higher peritoneal transport status and lower residual renal function (RRF) were independent predictors of death-censored technique failure when adjusted for serum albumin and total weekly urea clearance (Kt/V).Independent predictors of mortality were advanced age,anemia,hypoalbuminemia,and lower RRF,but not higher peritoneal transport status.Conclusions:Higher peritoneal transport status has an adverse influence on nutrition for diabetic nephropathy patients on PD.Higher peritoneal transport status is a significant independent risk factor for death-censored technique failure,but not for mortality in

  10. Influence of hydrotherapy on clinical and cardiac autonomic function in migraine patients

    M U Sujan

    2016-01-01

    Full Text Available Background: Migraine is associated with autonomic symptoms. The growing body of literature suggests that the dysfunctional autonomic nervous system might play a pivotal role in the pathogenesis of migraine. Thermal therapies have been hypothesized to modulate these changes and alleviate pain. However, data regarding the efficacy of hydrotherapy in migraine remain scant. We evaluated the effect of add on hydrotherapy procedure (a hot arm and foot bath with ice massage to head in migraine patients. Methods: Forty chronic migraine patients fulfilling the International Classification of Headache Disorders II criteria were recruited from the neurology outpatient clinic. Patients were randomized to receive either hydrotherapy plus conventional pharmacological care (n = 20 or conventional medication only (n = 20. Hydrotherapy group received treatment with hot arm and foot bath (103°F to 110°F and ice massage to head daily for 20 min for 45 days. Patients were assessed using headache impact test (HIT, visual analog scale for pain and cardiac autonomic function by heart rate variability (HRV before and after intervention period. Results: There was a significant decrease in HIT score, frequency, and intensity of headaches following treatment in both the groups. However, it was more evident in add on hydrotherapy group compared to pharmacological treatment alone group. There was also significant improvement in the HRV parameters. In particular, there was a significant decrease in heart rate (P = 0.017, increase in high frequency (HF (P = 0.014 and decrease in low frequency/HF ratio (P = 0.004 in add on hydrotherapy group. Conclusion: Our study shows that add on hydrotherapy enhanced the vagal tone in addition to reducing the frequency and intensity of headaches in migraine patients.

  11. Influence of the training: " Clinical practice based on the evidence " in the daily practice of the nurse

    Ligia Rojas Valenciano

    2013-10-01

    Full Text Available The aim of this article is to present the results of the project Not. 421-B1-261: Influence of the training of theClinical Practice Based on the Evidence on the daily practice of the professional of nursing, approved by the Vicerrectoríaof Investigation of the University of Costa Rica. The commitment to renew the practice of Nursing in Costa Rica relates in adirect way to the improvement of the health of the society both in the collective thing and in the individual thing, in order toreduce the mistakes in the practice. A search was realized in EBSCO's databases, PubMed, Academic Research Completes,MedLine Plus and Scielo. A preliminary search was carried out, then limits of search interfered per date and describers;finally, for the critical analysis they were included only to complete text by title and they summarize 30 documents thatincluded reviews of literature, primary studies and conceptual frames that were relevant to give response to the clinicalquestion. Of 30 documents only it was considered six of them by your content, methodological structure and quality.Though there was not situated a forceful and direct response to the clinical question raised in this study, for the effectedreview it is possible to conclude that the professionals of Nursing consider to be essential the enrichment of a clinicalpractice based on the evidence, which generates a major quality and safety in the executed care.

  12. Intrinsic and extrinsic factors influencing the clinical course of B-cell chronic lymphocytic leukemia: prognostic markers with pathogenetic relevance

    Gaidano Gianluca

    2009-08-01

    Full Text Available Abstract B-cell chronic lymphocytic leukemia (CLL, the most frequent leukemia in the Western world, is characterized by extremely variable clinical courses with survivals ranging from 1 to more than 15 years. The pathogenetic factors playing a key role in defining the biological features of CLL cells, hence eventually influencing the clinical aggressiveness of the disease, are here divided into "intrinsic factors", mainly genomic alterations of CLL cells, and "extrinsic factors", responsible for direct microenvironmental interactions of CLL cells; the latter group includes interactions of CLL cells occurring via the surface B cell receptor (BCR and dependent to specific molecular features of the BCR itself and/or to the presence of the BCR-associated molecule ZAP-70, or via other non-BCR-dependent interactions, e.g. specific receptor/ligand interactions, such as CD38/CD31 or CD49d/VCAM-1. A putative final model, discussing the pathogenesis and the clinicobiological features of CLL in relationship of these factors, is also provided.

  13. Influences of season, parity, lactation, udder area, milk yield, and clinical symptoms on intramammary infection in dairy cows.

    Zhang, Z; Li, X P; Yang, F; Luo, J Y; Wang, X R; Liu, L H; Li, H S

    2016-08-01

    The aim of this study was to evaluate the influences of season, parity, lactation, udder area, milk yield, and clinical symptoms on bacterial intramammary infection (IMI) in dairy cows. A total of 2,106 mastitis pathogens in 12 species were isolated from 125 dairy farms distributed in 30 different cities in China, and the information about these factors was recorded at the same time. Mastitis pathogens were isolated from 63.43% of the milk samples, whereas Streptococcus agalactiae accounted for 38.61% of all pathogens, followed by Str. dysgalactiae (28.16%), Staphylococcus aureus (19.10%), Escherichia coli (6.90%), and other pathogens (7.23%). According to our investigation, IMI was more common in spring with the isolation rate of pathogens at 81.04%, and lowest in winter (52.34%). Cows were more likely to be infected by environmental pathogens (E. coli or Str. uberis) in summer, in rear quarters and in cows with higher daily milk yield or lower somatic cell count. In addition, Str. dysgalactiae exhibited a higher prevalence with increased parity. Different clinical symptoms of quarters with bacterial IMI were seen in this study, and mastitis pathogens were isolated from healthy quarters. PMID:27265170

  14. A Clinical Investigation into the Factors Influencing the Prognosis of Patients with Primary Liver Cancer after Hepatectomy

    Ji Xi-qing; Li Chao-long; Sheng Xing-hua

    2005-01-01

    Objective To explore the factors influencing the prognosis of patients with primary liver cancer(PLC) after hepatectomy on purpose to provide the preventive measures for improving the long-term effect.Methods All of the 189 patients who underwent hepatectomy with PLC from May,1994 to January,1998 were included by reviewing their clinical pathological characteristics and treatments. Totally, 22 factors contributed to the long-term survival rate(SR)and the disease-free SR were analysed . All patients were followed up at least 5 years. Results The 3- and 5-year cumulative SRs in the total group were 63% and 45% respectively. The 3- and 5-year SRs and disease-free SRs in the curative resection (CR) group (n=162) were 67%,47%,and 45% and 26% respectively. It was showed that the way by which a tumor was found, tumor size, portal thrombi, satellite nodule, cirrhosis type, TNM stage, tumor envelope, recurrence and treatment, vascular exclusion and transfusion, differentiation grade and CR were prognostic factors by individual variable analysis. A multivariable analysis showed that CR , tumor size and reoperation were significant factors associated with the prognosis. Conclusion The type of CR and tumor size are determinants influencing the prognosis. Early diagnosis of small carcinoma and CR as soon as possible is essential to improving the prognosis of PLC. Avoiding transfusion and controlling the progress of cirrhosis are expected to improve the disease-free SR.

  15. Access to reliable information about long-term prognosis influences clinical opinion on use of lifesaving intervention.

    Stephen Honeybul

    Full Text Available BACKGROUND: Decompressive craniectomy has been traditionally used as a lifesaving rescue treatment in severe traumatic brain injury (TBI. This study assessed whether objective information on long-term prognosis would influence healthcare workers' opinion about using decompressive craniectomy as a lifesaving procedure for patients with severe TBI. METHOD: A two-part structured interview was used to assess the participants' opinion to perform decompressive craniectomy for three patients who had very severe TBI. Their opinion was assessed before and after knowing the predicted and observed risks of an unfavourable long-term neurological outcome in various scenarios. RESULTS: Five hundred healthcare workers with a wide variety of clinical backgrounds participated. The participants were significantly more likely to recommend decompressive craniectomy for their patients than for themselves (mean difference in visual analogue scale [VAS] -1.5, 95% confidence interval -1.3 to -1.6, especially when the next of kin of the patients requested intervention. Patients' preferences were more similar to patients who had advance directives. The participants' preferences to perform the procedure for themselves and their patients both significantly reduced after knowing the predicted risks of unfavourable outcomes, and the changes in attitude were consistent across different specialties, amount of experience in caring for similar patients, religious backgrounds, and positions in the specialty of the participants. CONCLUSIONS: Access to objective information on risk of an unfavourable long-term outcome influenced healthcare workers' decision to recommend decompressive craniectomy, considered as a lifesaving procedure, for patients with very severe TBI.

  16. The clinical potential of influencing Nrf2 signaling in degenerative and immunological disorders

    Gao B

    2014-02-01

    Full Text Available Bifeng Gao, An Doan, Brooks M HybertsonDepartment of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USAAbstract: Nuclear factor (erythroid-derived 2-like 2 (Nrf2; encoded in humans by the NFE2L2 gene is a transcription factor that regulates the gene expression of a wide variety of cytoprotective phase II detoxification and antioxidant enzymes through a promoter sequence known as the antioxidant-responsive element (ARE. The ARE is a promoter element found in many cytoprotective genes; therefore, Nrf2 plays a pivotal role in the ARE-driven cellular defense system against environmental stresses. Agents that target the ARE/Nrf2 pathway have been tested in a wide variety of disorders, with at least one new Nrf2-activating drug now approved by the US Food and Drug Administration. Examination of in vitro and in vivo experimental results, and taking into account recent human clinical trial results, has led to an opinion that Nrf2-activating strategies – which can include drugs, foods, dietary supplements, and exercise – are likely best targeted at disease prevention, disease recurrence prevention, or slowing of disease progression in early stage illnesses; they may also be useful as an interventional strategy. However, this rubric may be viewed even more conservatively in the pathophysiology of cancer. The activation of the Nrf2 pathway has been widely accepted as offering chemoprevention benefit, but it may be unhelpful or even harmful in the setting of established cancers. For example, Nrf2 activation might interfere with chemotherapies or radiotherapies or otherwise give tumor cells additional growth and survival advantages, unless they already possess mutations that fully activate their Nrf2 pathway constitutively. With all this in mind, the ARE/Nrf2 pathway remains of great interest as a possible target for the pharmacological control of degenerative and

  17. Hepatitis B and liver transplantation: molecular and clinical features that influence recurrence and outcome.

    Ghaziani, Tahereh; Sendi, Hossein; Shahraz, Saeid; Zamor, Philippe; Bonkovsky, Herbert L

    2014-10-21

    Hepatitis B virus (HBV) continues to be a major cause of morbidity and mortality worldwide. It is estimated that about 350 million people throughout the world are chronically infected with HBV. Some of these people will develop hepatic cirrhosis with decompensation and/or hepatocellular carcinoma. For such patients, liver transplantation may be the only hope for cure or real improvement in quality and quantity of life. Formerly, due to rapidity of recurrence of HBV infection after liver transplantation, usually rapidly progressive, liver transplantation was considered to be contraindicated. This changed dramatically following the demonstration that hepatitis B immune globulin (HBIG), could prevent recurrent HBV infection. HBIG has been the standard of care for the past two decades or so. Recently, with the advent of highly active inhibitors of the ribose nucleic acid polymerase of HBV (entecavir, tenofovir), there has been growing evidence that HBIG needs to be given for shorter lengths of time; indeed, it may no longer be necessary at all. In this review, we describe genetic variants of HBV and past, present, and future prophylaxis of HBV infection during and after liver transplantation. We have reviewed the extant medical literature on the subject of infection with the HBV, placing particular emphasis upon the prevention and treatment of recurrent HBV during and after liver transplantation. For the review, we searched PubMed for all papers on the subject of "hepatitis B virus AND liver transplantation". We describe some of the more clinically relevant and important genetic variations in the HBV. We also describe current practices at our medical centers, provide a summary and analysis of comparative costs for alternative strategies for prevention of recurrent HBV, and pose important still unanswered questions that are in need of answers during the next decade or two. We conclude that it is now rational and cost-effective to decrease and, perhaps, cease altogether

  18. Clinical relevance of the biochemical, metabolic, and genetic factors that influence low-density lipoprotein heterogeneity.

    Kwiterovich, Peter O

    2002-10-17

    increased levels of free fatty acids in plasma, increased flux of free fatty acids back to the liver, enhanced production of TGs, decreased proteolysis of apo B-100, and increased VLDL production. Decreased removal of postprandial TGs often accompanies these metabolic abnormalities. Genes regulating the expression of the major players in this metabolic cascade, such as LPL, cholesterol ester transfer protein, and hepatic lipase, can modulate the expression of small, dense LDL but these are not the major defects. New candidates for major gene effects have been identified on chromosome 1. Regardless of their fundamental causes, small, dense LDL (compared with normal LDL) particles have a prolonged residence time in plasma, are more susceptible to oxidation because of decreased interaction with the LDL receptor, and enter the arterial wall more easily, where they are retained more readily. Small, dense LDL promotes endothelial dysfunction and enhanced production of procoagulants by endothelial cells. Both in animal models of atherosclerosis and in most human epidemiologic studies and clinical trials, small, dense LDL (particularly when present in increased numbers) appears more atherogenic than normal LDL. Treatment of patients with small, dense LDL particles (particularly when accompanied by low HDL and hypertriglyceridemia) often requires the use of combined lipid-altering drugs to decrease the number of particles and to convert them to larger, more buoyant LDL. The next critical step in further reduction of CAD will be the correct diagnosis and treatment of patients with small, dense LDL and the dyslipidemia that accompanies it. PMID:12419479

  19. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data – The Influence of Different Parameters in a Routine Clinical Microbiology Laboratory

    Kohlmann, Rebekka; Gatermann, Sören G

    2016-01-01

    Introduction Many clinical microbiology laboratories report on cumulative antimicrobial susceptibility testing (cAST) data on a regular basis. Criteria for generation of cAST reports, however, are often obscure and inconsistent. Whereas the CLSI has published a guideline for analysis and presentation of cAST data, national guidelines directed at clinical microbiology laboratories are not available in Europe. Thus, we sought to describe the influence of different parameters in the process of c...

  20. Birch pollen influence the severity of atopic eczema – prospective clinical cohort pilot study and ex vivo penetration study

    Fölster-Holst R

    2015-10-01

    Full Text Available Regina Fölster-Holst,1 Jagoda Galecka,1 Sigo Weißmantel,1 Ute Dickschat,2 Frank Rippke,3 Kerstin Bohnsack,3 Thomas Werfel,4 Katja Wichmann,4 Matthias Buchner,1 Thomas Schwarz,1 Annika Vogt,5 Jürgen Lademann,5 Martina C Meinke5 1Department of Dermatology, Venerology and Allergy, University of Kiel, 2Wörth, 3Beiersdorf AG, Hamburg, 4Department of Dermatology, Venerology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, 5Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin, Berlin, Germany Abstract: There is little clinical evidence for a correlation between the severity of atopic eczema (AE and pollen exposition. To obtain more data, we performed a clinical cohort pilot study about the influence of pollen on AE between sensitized and nonsensitized subjects and an experimental study addressing the cutaneous penetration of pollen into the skin. Fifty-five patients were monitored during birch pollen season. To study the cutaneous penetration, grass pollen allergens were applied on excised skin and the uptake in CD1c-expressing dendritic cells was investigated. The correlation between environmental pollen load and severity of the Scoring Atopic Dermatitis (SCORAD score and pruritus was observed, regardless of the status of sensitization. The sensitized group recovered significantly worse after the birch pollen season. Remarkably higher amounts of pollen allergens taken up by CD1c cells were detected in epidermal cells derived from skin explants with a disturbed epidermal barrier. These findings suggest an exacerbating role of pollen in AE utilizing the epidermal route. Keywords: aeroallergens, atopic eczema, seasonality, skin antigen-presenting cells, skin barrier penetration

  1. Experimental ovine toxoplasmosis: influence of the gestational stage on the clinical course, lesion development and parasite distribution.

    Castaño, Pablo; Fuertes, Miguel; Regidor-Cerrillo, Javier; Ferre, Ignacio; Fernández, Miguel; Ferreras, M Carmen; Moreno-Gonzalo, Javier; González-Lanza, Camino; Pereira-Bueno, Juana; Katzer, Frank; Ortega-Mora, Luis Miguel; Pérez, Valentín; Benavides, Julio

    2016-01-01

    The relation between gestational age and foetal death risk in ovine toxoplasmosis is already known, but the mechanisms involved are not yet clear. In order to study how the stage of gestation influences these mechanisms, pregnant sheep of the same age and genetic background were orally dosed with 50 oocysts of Toxoplasma gondii (M4 isolate) at days 40 (G1), 90 (G2) and 120 (G3) of gestation. In each group, four animals were culled on the second, third and fourth week post infection (pi) in order to evaluate parasite load and distribution, and lesions in target organs. Ewes from G1 showed a longer period of hyperthermia than the other groups. Abortions occurred in all groups. While in G2 they were more frequent during the acute phase of the disease, in G3 they mainly occurred after day 20 pi. After challenge, parasite and lesions in the placentas and foetuses were detected from day 19 pi in G3 while in G2 or G1 they were only detected at day 26 pi. However, after initial detection at day 19 pi, parasite burden, measured through RT-PCR, in placenta or foetus of G3 did not increase significantly and, at in the third week pi it was lower than that measured in foetal liver or placenta from G1 to G3 respectively. These results show that the period of gestation clearly influences the parasite multiplication and development of lesions in the placenta and foetus and, as a consequence, the clinical course in ovine toxoplasmosis. PMID:26983883

  2. Clinical And Morphological Androgenic Status Characteristics At Children Suffering From Hypospadias And Its Influence On Results Of Surgical Correction

    F.K. Napolnikov

    2009-09-01

    Full Text Available The goal of this article is to estimate the androgenic status and analyze its influence on the surgical treatment of hypospadias. From 2000 till 2008 there were 209 children under treatment, whose age varied from 8 months till 15 years old (average age — 4,5+ 1,5. 49 patients were subjected to clinical, humoral and morphological study. Preoperational preparation was carried out by testosterone medications. The comparison group consisted of 10 boys with cicatricial phimosis. The patients with the medium and back forms of hypospadias suffered from the androgenic deficit characterized by proximal level of meatus ectopia, diminution of penis length and prostate volume, decrease of blood vessels in deep layers of penis skin. The testosterone pre-operational medication of patients makes possible to improve the results of surgical correction due to blood supply of plastic material. On the basis of recieved data logistically regressive model has been worked out and the prognosis of results has been estimated

  3. Influence of Obesity on Breast Density Reduction by Omega-3 Fatty Acids: Evidence from a Randomized Clinical Trial.

    Sandhu, Narinder; Schetter, Susann E; Liao, Jason; Hartman, Terryl J; Richie, John P; McGinley, John; Thompson, Henry J; Prokopczyk, Bogdan; DuBrock, Cynthia; Signori, Carina; Hamilton, Christopher; Calcagnotto, Ana; Trushin, Neil; Aliaga, Cesar; Demers, Laurence M; El-Bayoumy, Karam; Manni, Andrea

    2016-04-01

    Preclinical data indicate that omega-3 fatty acids (n-3FA) potentiate the chemopreventive effect of the antiestrogen (AE) tamoxifen against mammary carcinogenesis. The role of n-3FA in breast cancer prevention in humans is controversial. Preclinical and epidemiologic data suggest that n-3FA may be preferentially protective in obese subjects. To directly test the protective effect of n-3FA against breast cancer, we conducted a 2-year, open-label randomized clinical trial in 266 healthy postmenopausal women (50% normal weight, 30% overweight, 20% obese) with high breast density (BD; ≥25%) detected on their routine screening mammograms. Eligible women were randomized to one of the following five groups (i) no treatment, control; (ii) raloxifene 60 mg; (iii) raloxifene 30 mg; (iv) n-3FA lovaza 4 g; and (v) lovaza 4 g plus raloxifene 30 mg. The 2-year change in BD, a validated biomarker of breast cancer risk, was the primary endpoint of the study. In subset analysis, we tested the prespecified hypothesis that body mass index (BMI) influences the relationship between plasma n-3FA on BD. While none of the interventions affected BD in the intention-to-treat analysis, increase in plasma DHA was associated with a decrease in absolute breast density but only in participants with BMI >29. Our results suggest that obese women may preferentially experience breast cancer risk reduction from n-3FA administration.Cancer Prev Res; 9(4); 275-82. ©2015 AACR. PMID:26714774

  4. Clinical effects of liraglutide are possibly influenced by hypertriglyceridemia and remaining pancreatic β-cell function in subjects with type 2 diabetes mellitus.

    Tanabe, Akihito; Kaneto, Hideaki; Kamei, Shinji; Hirukawa, Hidenori; Shimoda, Masashi; Kimura, Tomohiko; Obata, Atsushi; Okauchi, Seizo; Tatsumi, Fuminori; Kohara, Kenji; Mune, Tomoatsu; Kaku, Kohei

    2016-08-01

    We searched for factors influencing the clinical effects of GLP-1 analogue liraglutide in subjects with type 2 diabetes. Multivariate analyses showed that hypertriglyceridemia and baseline HbA1c levels were independent predictors for the efficacy of liraglutide and that CPR index was an independent predictor for the durability of liraglutide. PMID:27220544

  5. Influence of implant position on clinical crown length and peri-implant soft tissue dimensions at implant-supported single crowns replacing maxillary central incisors

    Peng, Min; Fei, Wei; Hosseini, Mandana;

    2013-01-01

    The aims of the present study were to evaluate the influence of implant position on clinical crown length and marginal soft tissue dimensions at implant-supported single crowns of maxillary central incisors, and to validate the papilla index score (PIS). Twenty-five patients, who had lost one of ...

  6. CLINICAL, HISTOLOGICAL AND RADIOLOGICAL ASPECTS REGARDING THE INFLUENCE OF SOME EXTERNAL FACTORS ON THE PULP-DENTIN COMPLEX

    C. Giuroiu

    2012-12-01

    Full Text Available The present study aimed at assesssing – by clinical, histological and radiological investigations – the influence of some external factors on the pulp-dentin complex, and at providing a causal interpretation of the structural changes observed. Materials and methods. Clinical and radiological exams were performed on 65 old patients with ages between 60-75, and also on 40 young patients with ages between 20-35, presenting different dental-periodontal pathologies. The pulp-dentin complex was submitted to a morphopathological examination, to highlight the structural changes observed at microscopic level. Fragments of dental pulp were imersed in a 4% formaldehyde solution with phosphate buffer 0.1 M., pH 7.2, for 12 -14 hours, at a temperature of 4ºC, and 3-5 µm thick slices were prepared. The slices were coloured with hematoxylin-eosine (HE, by the trichromic technique – Masson. Photographies were taken with a Zeiss microscope, with Kodak 200 ASA. Results. Significant differences were observed, between the two groups of patients, as to the external factors that produce structural changes on pulp-dentin organ. In the group of young patients dental caries and coronal fillings prevailed, while the group of old patients was mostly associated with atrition and chronic marginal periodontitis. Out of the 40 young patients, 30 presented chronic dental caries (75%, while, among the 65 old patients, only 24 presented dental caries (36.9%. The percentages of coronary fillings between the two study groups were close, which could be considered as one of the causes producing changes in the pulp-dentin organ, following aggresive preparation of cavities, the action of materials used for the protection of pulp-dentin complex or of the materials used for coronry fillings. Conclusions. Dental pulp has a remarkable ability to counteract the action of harmful factors, producing a mineral barrier and stimulating the reparatory processes. Changes in the endodontic

  7. Clinical evaluation of the efficacy and influencing factors for stent placement in treating benign and malignant esophageal stenosis

    Objective: To evaluate clinical effectiveness and influence factors in the treatment of benign and malignant esophageal stenosis by placing esophageal stent. Methods: A series of this research comprised of 29 cases with esophageal cancer, 10 cardiac carcinoma, 5 cardiac achalasia, 6 benign esophageal stricture after operation. The lengths of lesion ranged from 2 to 14 cm in length with mean of 7.3 cm. Fistula were found among malignant esophageal stenosis in 6 cases. According to the dysphagia scores, 12 cases were designated at I grade, 31 with II, and 14 with III. 46 cases of malignancy were undertaken radiation therapy combined with transcatheter arterial chemotherapy from 15 to 30 days after stent placement. Results: 62 stents were placed in 57 cases (52 domestic stents, 10 Boston ultraflex), including 4 cases with 2 stents being once placed, 1 case with second time stent placement because of restenosis 4 month later. All stents were placed successfully without serious complications, such as esophageal perforation, massive hemorrhage. 5 cases of cardiac achalasia and 6 cases of benign esophageal stricture are still alive now. The survival rates of 6, 12, 24 and 36 months in 46 malignant cases, were 67.4%(31/46), 43.5%(20/46), 26.1%(12/46), and 19.6(9/46) respectively. Dysphagia were relieved significantly from 7 to 15 days after stent placement. Conclusions: Esophageal stent placement combined with radiation therapy and transcatheter arterial chemotherapy could improve patient life qualities and survival rates significantly in malignant stricture. The effects on benign esophageal stricture by stent placement are comparable with that of surgical treatment

  8. Influence of combined botanical extract preparation on body composition – results from double blind randomized clinical trial

    Łucja Pilaczyńska-Szcześniak

    2006-09-01

    Full Text Available Introduction: Obesity is becoming a great cause of concern in many countries. To shift the energy balance towards expenditure, dietary supplements should be designed to increase thermogenesis, lipolysis, loss of body water, and activation of digestive enzymes. Material and methods: Double blind randomized placebo-controlled clinical trial to evaluate a botanical water extract composed of green tea extract, bean peel and asparagus. During 56 days of the study body composition, anthropometric measurements and biochemical parameters were estimated in fifty-one healthy, moderately obese subjects. Results: Forty-two subjects completed the study according to the protocol. In the active preparation group, weight, BMI, percent of body fat, waist, hip and waist-to-hip ratio were not statistically different compared to placebo. The sum of skinfolds differed significantly. When selecting a subgroup of patients with hypercholesterolaemia (n=21, in the active extract group the change in body composition index (BCI and fat mass (FM were significant (p=0.037 and p=0.019 respectively in patients with hypercholesterolaemia when compared to normocholesterolaemic patients. Fat-free mass (FFM did not change significantly in the active extract group (p=0.083 when hypercholesterolaemic and normocholesterolaemic patients were compared. None of the parallel parameters (FM and FFM change, BCI changed significantly in the placebo group when compared to hypercholesterolaemic and normocholesterolaemic subjects. Conclusions: There was no statistically significant change in weight, BMI or percent of body fat measured by bioimpedance in the active extract and placebo groups. Obese patients with hypercholesterolaemia benefited from the active extract, with reduced total fat mass and a positive influence on the body composition improvement index.

  9. Factors influencing the choice of antidepressants: A study of antidepressant prescribing practice at University psychiatric clinic in Belgrade

    Marić Nađa P.

    2012-01-01

    Full Text Available Background/Aim. Antidepressants are a widely used class of drugs. The aim of this study was to investigate different aspects of antidepressant prescribing practice at University Psychiatric Clinic in Belgrade. Methods. This cross-sectional study was carried out by retrospective analysis of the patient's medical charts. The study included all patients with antidepressant prescribed at discharge during 2009 (n = 296. The evaluation was focused on patient- related factors (socio-demographic and illness related, psychiatrist-related factors (sex and duration of working experience and drug related factors (type of antidepressant, dose, polypharmacy and reimbursement by national health insurance. Results. Antidepressants were prescribed for unipolar depression (F32-34, ICD X either without comorbidity (46.2% or with comorbidity (24.7%, mostly as a monotherapy (91% had one antidepressant, to the patients who were 65% female, aged 50.1 ± 8.9, most of them with 12 years of education (52.6%, married (69.3% and employed (55.9%. The majority of patients had a history of two hospitalizations (Med 2; 25th-75th perc. 1-4 during nine years (Med 9; 25th-75th perc. 2-15 after the first episode of depression. Among them, 19% were found to be suicidal in a lifetime. The single most prescribed antidepressant was sertraline (20.4%, followed by fluoxetine (13.3% and maprotiline (11.7%. Utilization of antidepressants was positively correlated with the rate of reimbursement (p < 0.01. The most prescribed antidepressant group was selective serotonin reuptake inhibitors (SSRI (47.8%, followed by tricyclic antidepresants (TCA (25.3% and new antidepressants - venlafaxine, tianeptine, mirtazapine, bupropion, trazodone (15.1%. Most of the drugs were prescribed in doses which are at the lower end of the recommended dose-range. Regarding severity of the actual depressive episode, TCA were prescribed for severe depression with psychotic features, while SSRI were choice for

  10. Influence of postoperative low-level laser therapy on the osseointegration of self-tapping implants in the posterior maxilla: A 6-week split-mouth clinical study

    Mandić Borka; Lazić Zoran; Marković Aleksa; Mandić Bojan; Mandić Miška; Đinić Ana; Miličić Biljana

    2015-01-01

    Background/Aim. Low-level laser therapy (LLLT) has been proven to stimulate bone repair, affecting cellular proliferation, differentiation and adhesion, and has shown a potential to reduce the healing time following implant placement. The aim of this clinical study was to investigate the influence of postoperative LLLT osseointegration and early success of self-tapping implants placed into low-density bone. Methods. Following the split-mouth design, self-ta...

  11. Daytime of Sampling, Tooth-Brushing and Ascorbic Acid Influence Salivary Thiobarbituric Acid Reacting Substances – A Potential Clinical Marker of Gingival Status

    Július Hodosy; Peter Celec

    2005-01-01

    Background. Salivary thiobarbituric acid reacting substances (TBARS) have been previously shown to correlate with the impairment of gingival tissue. Although the details on the origin and the composition of this heterogeneous group of compounds in saliva are unknown, the potential clinical usefulness makes necessary the studies of factors influencing the salivary TBARS levels. Aim. To observe the effects of daily dynamics, tooth-brushing and ascorbic acid administration on salivary TBARS leve...

  12. Clinical perspectives on the influence of drug formulation on patient tolerability and use of commonly prescribed antidepressants in major depressive disorder

    Matthew A Fuller

    2013-01-01

    Full Text Available The purpose of this review is to summarize the formulation options for currently available antidepressants, and discuss examples of the influence that formulation may have on the pharmacologic and clinical profiles of the medications. A review of current literature suggests that differences in drug-delivery technologies can lead to variations in the pharmacokinetic and pharmacodynamic profiles of generic and branded drugs, despite generic drugs being required to meet bioequivalence standards compared with their branded counterparts. These differences may influence the effectiveness and tolerability of treatment. Recent reports have highlighted the need for individualized treatment regimens and careful assessment of tolerability and efficacy when switching patients from brand to generic formulations. There is a growing body of evidence indicating that differences in formulation can substantially impact drug pharmacokinetics and pharmacodynamics, which in turn, can affect drug effects. The clinical impact of these differences remains unclear. Further research is needed to clarify the influence of antidepressant formulations on treatment adherence, patient preference, and quality of life, and how this impacts clinical practice with regard to brand versus generic treatment selection.

  13. Positive Outcomes Influence the Rate and Time to Publication, but Not the Impact Factor of Publications of Clinical Trial Results

    Suñé, Pilar; Suñé, Josep Maria; Montoro, J. Bruno

    2013-01-01

    Objectives: Publication bias may affect the validity of evidence based medical decisions. The aim of this study is to assess whether research outcomes affect the dissemination of clinical trial findings, in terms of rate, time to publication, and impact factor of journal publications. Methods and Findings: All drug-evaluating clinical trials submitted to and approved by a general hospital ethics committee between 1997 and 2004 were prospectively followed to analyze their fate and publication....

  14. Decision Making in the PICU: An Examination of Factors Influencing Participation Decisions in Phase III Randomized Clinical Trials

    Slosky, Laura E; Marilyn Stern; Burke, Natasha L.; Siminoff, Laura A.

    2014-01-01

    Background. In stressful situations, decision making processes related to informed consent may be compromised. Given the profound levels of distress that surrogates of children in pediatric intensive care units (PICU) experience, it is important to understand what factors may be influencing the decision making process beyond the informed consent. The purpose of this study was to evaluate the role of clinician influence and other factors on decision making regarding participation in a randomiz...

  15. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data--The Influence of Different Parameters in a Routine Clinical Microbiology Laboratory.

    Rebekka Kohlmann

    Full Text Available Many clinical microbiology laboratories report on cumulative antimicrobial susceptibility testing (cAST data on a regular basis. Criteria for generation of cAST reports, however, are often obscure and inconsistent. Whereas the CLSI has published a guideline for analysis and presentation of cAST data, national guidelines directed at clinical microbiology laboratories are not available in Europe. Thus, we sought to describe the influence of different parameters in the process of cAST data analysis in the setting of a German routine clinical microbiology laboratory during 2 consecutive years.We developed various program scripts to assess the consequences ensuing from different algorithms for calculation of cumulative antibiograms from the data collected in our clinical microbiology laboratory in 2013 and 2014.One of the most pronounced effects was caused by exclusion of screening cultures for multi-drug resistant organisms which decreased the MRSA rate in some cases to one third. Dependent on the handling of duplicate isolates, i.e. isolates of the same species recovered from successive cultures on the same patient during the time period analyzed, we recorded differences in resistance rates of up to 5 percentage points for S. aureus, E. coli and K. pneumoniae and up to 10 percentage points for P. aeruginosa. Stratification by site of care and specimen type, testing of antimicrobials selectively on resistant isolates, change of interpretation rules and analysis at genus level instead of species level resulted in further changes of calculated antimicrobial resistance rates.The choice of parameters for cAST data analysis may have a substantial influence on calculated antimicrobial resistance rates. Consequently, comparability of cAST reports from different clinical microbiology laboratories may be limited. We suggest that laboratories communicate the strategy used for cAST data analysis as long as national guidelines for standardized cAST data

  16. Computational challenges and human factors influencing the design and use of clinical research participant eligibility pre-screening tools

    Pressler Taylor R

    2012-05-01

    Full Text Available Abstract Background Clinical trials are the primary mechanism for advancing clinical care and evidenced-based practice, yet challenges with the recruitment of participants for such trials are widely recognized as a major barrier to these types of studies. Data warehouses (DW store large amounts of heterogenous clinical data that can be used to enhance recruitment practices, but multiple challenges exist when using a data warehouse for such activities, due to the manner of collection, management, integration, analysis, and dissemination of the data. A critical step in leveraging the DW for recruitment purposes is being able to match trial eligibility criteria to discrete and semi-structured data types in the data warehouse, though trial eligibility criteria tend to be written without concern for their computability. We present the multi-modal evaluation of a web-based tool that can be used for pre-screening patients for clinical trial eligibility and assess the ability of this tool to be practically used for clinical research pre-screening and recruitment. Methods The study used a validation study, usability testing, and a heuristic evaluation to evaluate and characterize the operational characteristics of the software as well as human factors affecting its use. Results Clinical trials from the Division of Cardiology and the Department of Family Medicine were used for this multi-modal evaluation, which included a validation study, usability study, and a heuristic evaluation. From the results of the validation study, the software demonstrated a positive predictive value (PPV of 54.12% and 0.7%, respectively, and a negative predictive value (NPV of 73.3% and 87.5%, respectively, for two types of clinical trials. Heuristic principles concerning error prevention and documentation were characterized as the major usability issues during the heuristic evaluation. Conclusions This software is intended to provide an initial list of eligible patients to a

  17. Influence of Body Mass Index and Albumin on Perioperative Morbidity and Clinical Outcomes in Resected Pancreatic Adenocarcinoma

    Andrew Hendifar; Arsen Osipov; Jasleen Khanuja; Nicholas Nissen; Jason Naziri; Wensha Yang; Quanlin Li; Richard Tuli

    2016-01-01

    Obesity is a known risk factor for PDA and recent reports suggest obesity has a negative impact on clinical outcomes in patients with PDA. Pretreatment body mass index (BMI) and serum albumin (SA) have been shown to be associated with worse overall survival in patients with advanced and metastatic PDA. However, minimal data exists on the impact of BMI and SA on perioperative and long-term clinical outcomes in patients with early-stage resected PDA. Herein, we report on the impact of these var...

  18. Influence of Birth Weight on the Renal Development and Kidney Diseases in Adulthood: Experimental and Clinical Evidence

    Franco, Maria C. P.; Vanessa de Oliveira; Beatriz Ponzio; Marina Rangel; Zaira Palomino; Frida Zaladek Gil

    2012-01-01

    Several clinical and experimental studies support the hypothesis that foetal programming is an important determinant of nephropathy, hypertension, coronary heart disease, and type 2 diabetes during adulthood. In this paper, the renal repercussions of foetal programming are emphasised, and the physiopathological mechanisms are discussed. The programming of renal diseases is detailed based on the findings of kidney development and functional parameters.

  19. Influence of Birth Weight on the Renal Development and Kidney Diseases in Adulthood: Experimental and Clinical Evidence

    Maria C. P. Franco

    2012-01-01

    Full Text Available Several clinical and experimental studies support the hypothesis that foetal programming is an important determinant of nephropathy, hypertension, coronary heart disease, and type 2 diabetes during adulthood. In this paper, the renal repercussions of foetal programming are emphasised, and the physiopathological mechanisms are discussed. The programming of renal diseases is detailed based on the findings of kidney development and functional parameters.

  20. Influence of the sFlt-1/PlGF Ratio on Clinical Decision-Making in Women with Suspected Preeclampsia

    Klein, Evelyn; Schlembach, Dietmar; Ramoni, Angela; Langer, Elena; Bahlmann, Franz; Grill, Sabine; Schaffenrath, Helene; van der Does, Reinhard; Messinger, Diethelm; Verhagen-Kamerbeek, Wilma D. J.; Reim, Manfred; Hund, Martin; Stepan, Holger

    2016-01-01

    Objective To evaluate the influence of the soluble fms-like tyrosine kinase 1/placental growth factor ratio in physicians’ decision making in pregnant women with signs and symptoms of preeclampsia in routine clinical practice. Methods A multicenter, prospective, open, non-interventional study enrolled pregnant women presenting with preeclampsia signs and symptoms in several European perinatal care centers. Before the soluble fms-like tyrosine kinase 1/placental growth factor ratio result was known, physicians documented intended clinical procedures using an iPad® application (data locked/time stamped). After the result was available, clinical decisions were confirmed or revised and documented. An independent adjudication committee evaluated the appropriateness of decisions based on maternal/fetal outcomes. Clinician decision making with regard to hospitalization was the primary outcome. Results In 16.9% of mothers (20/118) the hospitalization decision was changed after knowledge of the ratio. In 13 women (11.0%), the initial decision to hospitalize was changed to no hospitalization. In seven women (5.9%) the revised decision was hospitalization. All revised decisions were considered appropriate by the panel of adjudicators (McNemar test; p preeclampsia. This is the first study to demonstrate the impact of angiogenic biomarkers on decision making in a routine clinical practice. PMID:27243815

  1. Comparative Genomics Reveal That Host-Innate Immune Responses Influence the Clinical Prevalence of Legionella pneumophila Serogroups.

    Mohammad Adil Khan

    Full Text Available Legionella pneumophila is the primary etiologic agent of legionellosis, a potentially fatal respiratory illness. Amongst the sixteen described L. pneumophila serogroups, a majority of the clinical infections diagnosed using standard methods are serogroup 1 (Sg1. This high clinical prevalence of Sg1 is hypothesized to be linked to environmental specific advantages and/or to increased virulence of strains belonging to Sg1. The genetic determinants for this prevalence remain unknown primarily due to the limited genomic information available for non-Sg1 clinical strains. Through a systematic attempt to culture Legionella from patient respiratory samples, we have previously reported that 34% of all culture confirmed legionellosis cases in Ontario (n = 351 are caused by non-Sg1 Legionella. Phylogenetic analysis combining multiple-locus variable number tandem repeat analysis and sequence based typing profiles of all non-Sg1 identified that L. pneumophila clinical strains (n = 73 belonging to the two most prevalent molecular types were Sg6. We conducted whole genome sequencing of two strains representative of these sequence types and one distant neighbour. Comparative genomics of the three L. pneumophila Sg6 genomes reported here with published L. pneumophila serogroup 1 genomes identified genetic differences in the O-antigen biosynthetic cluster. Comparative optical mapping analysis between Sg6 and Sg1 further corroborated this finding. We confirmed an altered O-antigen profile of Sg6, and tested its possible effects on growth and replication in in vitro biological models and experimental murine infections. Our data indicates that while clinical Sg1 might not be better suited than Sg6 in colonizing environmental niches, increased bloodstream dissemination through resistance to the alternative pathway of complement mediated killing in the human host may explain its higher prevalence.

  2. INHALED NITRIC OXIDE: CLINICAL EFFECTS AND INFLUENCE ON THE PROFILE OF INFLAMMATORY MARKERS IN PATIENTS WITH IDIOPATHIC PULMONARY HYPERTENSION

    T. V. Martynyuk; S. N. Nakonechnikov; V P Masenko; I. E. Chazova

    2015-01-01

    Aim. To study the effect of treatment with inhaled nitric oxide (iNO) on the clinical status of patients with idiopathic pulmonary hypertension (IPH), and the profile of proinflammatory cytokines in peripheral blood. Material and methods. Patients with IPH (n=48) were included into the study. Evaluation of the IPH functional class (FC), the 6-minute walk test (6MWT) with the assessment of the Borg index, echocardiography , laboratory tests [blood count, evaluation of high-sensitivity C-reacti...

  3. Clinical significance of chemosensitivity in chronic heart failure: influence on neurohormonal derangement, Cheyne-Stokes respiration and arrhythmias

    Giannoni, Alberto; Emdin, Michele; Poletti, Roberta; Bramanti, Francesca; Prontera, Concetta; Piepoli, Massimo; Passino, Claudio

    2007-01-01

    Abstract Increased chemosensitivity has been observed in heart failure (HF). To investigate its pathophysiological and clinical relevance, we evaluated its impact on neurohormonal balance, breathing pattern, response to exercise, and arrhythmic profile. Sixty patients with chronic HF (age 66?1 years, left ventricular ejection fraction, EF, 31?1%, mean?SEM) underwent assessment of hypoxic-normocapnic (HVR) and hypercapnic-normoxic ventilatory response (HCVR), neurohormonal evaluat...

  4. An innovative OSCE clinical log station: a quantitative study of its influence on Log use by medical students

    Hudson Judith N; Rienits Helen; Corrin Linda; Olmos Martin

    2012-01-01

    Abstract Background A Clinical Log was introduced as part of a medical student learning portfolio, aiming to develop a habit of critical reflection while learning was taking place, and provide feedback to students and the institution on learning progress. It was designed as a longitudinal self-directed structured record of student learning events, with reflection on these for personal and professional development, and actions planned or taken for learning. As incentive was needed to encourage...

  5. Terbium to Quantum Dot FRET Bioconjugates for Clinical Diagnostics: Influence of Human Plasma on Optical and Assembly Properties

    Niko Hildebrandt; Blanco-Canosa, Juan B.; Dawson, Philip E.; Stewart, Michael H.; Kimihiro Susumu; W. Russ Algar; Frank Morgner; Igor L. Medintz; Daniel Geißler; Stefan Stufler

    2011-01-01

    Förster resonance energy transfer (FRET) from luminescent terbium complexes (LTC) as donors to semiconductor quantum dots (QDs) as acceptors allows extraordinary large FRET efficiencies due to the long Förster distances afforded. Moreover, time-gated detection permits an efficient suppression of autofluorescent background leading to sub-picomolar detection limits even within multiplexed detection formats. These characteristics make FRET-systems with LTC and QDs excellent candidates for clinic...

  6. Influence of clinical features, serum antinuclear antibodies, and lung function on survival of patients with systemic sclerosis

    Jacobsen, Søren; Ullman, S; Shen, G Q;

    2001-01-01

    of all new patients with SSc. Disease onset was defined as the time of onset of cutaneous sclerosis. Vital status and causes of death were determined at the end of the observation period. Data on clinical status and pulmonary function were obtained. Antitopoisomerase I (anti-topo I), anticentromere...... the presence of anti-topo I and anti-RNAP antibody. The prognostic value of these autoantibodies may lie in the early course of the disease when specific morbidity has not yet evolved....

  7. The influence of genetic variation in thirty selected genes on the clinical characteristics of early onset breast cancer

    Tapper, William; Hammond, Victoria; Gerty, Sue; Ennis, Sarah; Simmonds, Peter; Collins, Andrew; Eccles, Diana

    2008-01-01

    Introduction: common variants that alter breast cancer risk are being discovered. Here, we determine how these variants influence breast cancer prognosis, risk and tumour characteristics. Methods: we selected 1,001 women with early onset nonfamilial invasive breast cancer from the Prospective study of Outcomes in Sporadic versus Hereditary breast cancer (POSH) cohort and genotyped 206 single nucleotide polymorphisms (SNPs) across 30 candidate genes. After quality control, 899 cases and 13...

  8. Influence of Clinical Status and Parasite Load on Erythropoiesis and Leucopoiesis in Dogs Naturally Infected with Leishmania (Leishmania) chagasi

    Trópia de Abreu, Raquel; Carvalho, Maria das Graças; Carneiro, Cláudia Martins; Giunchetti, Rodolfo Cordeiro; Teixeira-Carvalho, Andréa; Martins-Filho, Olindo Assis; Coura-Vital, Wendel; Corrêa-Oliveira, Rodrigo; Reis, Alexandre Barbosa

    2011-01-01

    Background The bone marrow is considered to be an important storage of parasites in Leishmania-infected dogs, although little is known about cellular genesis in this organ during canine visceral leishmaniasis (CVL). Methodology/Principal Findings The aim of the present study was to evaluate changes in erythropoiesis and leucopoiesis in bone marrow aspirates from dogs naturally infected with Leishmania chagasi and presenting different clinical statuses and bone marrow parasite densities. The evolution of CVL from asymptomatic to symptomatic status was accompanied by increasing parasite density in the bone marrow. The impact of bone marrow parasite density on cellularity was similar in dogs at different clinical stages, with animals in the high parasite density group. Erythroid and eosinophilic hypoplasia, proliferation of neutrophilic precursor cells and significant increases in lymphocytes and plasma cell numbers were the major alterations observed. Differential bone marrow cell counts revealed increases in the myeloid:erythroid ratio associated to increased numbers of granulopoietic cells in the different clinical groups compared with non-infected dogs. Conclusions Analysis of the data obtained indicated that the assessment of bone marrow constitutes an additional and useful tool by which to elaborate a prognosis for CVL. PMID:21572995

  9. Cultures in hospitals and their influence on attitudes to, and satisfaction with, the use of clinical information systems.

    Callen, Joanne L; Braithwaite, Jeffrey; Westbrook, Johanna I

    2007-08-01

    Studies have identified the importance of hospitals' organisational culture in clinical information system diffusion, but few have quantified its role. This study measured organisational culture in two Australian hospitals to explore whether clinicians' perceptions of culture related to their attitudes to, and satisfaction with, a computerised provider order entry system (CPOE). Data were collected using the Organisational Culture Inventory and a user-satisfaction survey administered to a population of 249 clinicians from the two hospitals. One hospital used CPOE to order clinical laboratory and radiology tests and view results, and the other used the test viewing function only, the ordering facility being planned for later implementation. We found a relationship between culture and clinicians' attitudes, with those in the constructive culture hospital more likely to express positive attitudes towards CPOE, whereas those in the aggressive/defensive hospital were more likely to be negative. The relationship between culture and attitudes towards clinical information systems should be taken into account when planning for their adoption. PMID:17475380

  10. Influence of Antidiabetic Herbal Medicine to a Decrease Blood Glucose Levels of Diabetes Mellitus Patients at The ‘Hortus Medicus’ Scientification of Jamu Clinic Tawangmangu, Karanganyar

    Emalia O. Rahayu

    2016-04-01

    Full Text Available Diabetes mellitus (DM was an annual disease characterized by parennials of blood glucose levels exceeding normal and impaired metabolism of carbohydrates, fat and protein caused by defficiency of insulin hormone relative as well as absolute. Management of patients with DM can be done by some effort, among others was consume an antidiabetic drug or antidiabetics herbal medicine. Antidiabetic herbal medicine were consisting of bitter, brotowali, salam leaf, and AAI (analegtic, antiinflamation, and immunomodulator. The resesarch aimed to know the influence of antidiabetic herbal medicine to decrese blood glucose levels in patient with DM at The ‘Hortus Medicus’ Scientification of Jamu Clinic, Tawangmangu, Karanganyar. The method was quasi experimental with one group pre-post test. The samples were 37 people of the patients with DM diagnose with purposive sampling technique methode. The research report that among 37 respondents, 32 (86.5% of respondent got a decreased blood glucose levels. The mean value of blood glucose level before consuming antidiabetic herbal medicine was 290.30 mg/dl and the mean value after consuming the herbal medicine was 241.78 mg/dl with difference of the mean value before and after consuming the herbal medicine was 48.52 mg/dl. There were influence of antidiabetic herbal medicine to decrease blood glucose levels of diabetes mellitus patients at the clinic with p value=0.00 (p<0.05.

  11. Influence of clinical and laboratory variables on faecal antigen ELISA results in dogs with canine parvovirus infection.

    Proksch, A L; Unterer, S; Speck, S; Truyen, U; Hartmann, K

    2015-06-01

    False negative faecal canine parvovirus (CPV) antigen ELISA results in dogs with CPV infection are common, but the factors that lead to these false negative results are still unknown. The aim of this study was to investigate whether dogs with a false negative faecal CPV antigen ELISA result have milder clinical signs and laboratory changes, a lower faecal virus load, higher faecal and serum CPV antibody titres and a faster recovery than dogs with a positive result. Eighty dogs with CPV infection, confirmed by the presence of clinical signs and a positive faecal CPV polymerase chain reaction (PCR), were assigned to two groups according to their faecal antigen ELISA result. Time until presentation, severity of symptoms, laboratory parameters, faecal virus load, faecal and serum antibody titres, and CPV sequencing data were compared between both groups. In 38/80 dogs that were hospitalised until recovery, the time to recovery, mortality, and the course of the disease were compared between dogs with positive and negative faecal antigen ELISA results. Of the 80 dogs included, 41 (51.3%) had a false negative faecal antigen ELISA result. ELISA-negative dogs had a significantly shorter time until presentation, lower frequency of defaecation, lower faecal virus load, and higher serum antibody concentrations than ELISA-positive dogs. Laboratory changes, CPV shedding, and outcomes were not associated with faecal antigen ELISA results. In conclusion, low faecal CPV load and antibodies binding to CPV antigen in faeces are likely to be important reasons for false negative faecal antigen ELISA results. Dogs with clinical signs of CPV infection should be retested by faecal PCR. PMID:25920770

  12. Factors influencing insulin acceptance among type 2 diabetes mellitus patients in a primary care clinic: a qualitative exploration

    Abu Hassan, Hasliza; Tohid, Hizlinda; Mohd Amin, Rahmah; Long Bidin, Mohamed Badrulnizam; Muthupalaniappen, Leelavathi; OMAR, Khairani

    2013-01-01

    Background Many Type 2 Diabetes Mellitus (T2DM) patients refuse insulin therapy even when they require this modality of treatment. However, some eventually accept insulin. This study aimed to explore the T2DM patients’ reasons for accepting insulin therapy and their initial barriers to use insulin. Methods This qualitative study interviewed twenty-one T2DM patients at a primary care clinic who had been on insulin for more than a year through three in-depth interviews and three focus group dis...

  13. Terbium to Quantum Dot FRET Bioconjugates for Clinical Diagnostics: Influence of Human Plasma on Optical and Assembly Properties

    Niko Hildebrandt

    2011-10-01

    Full Text Available Förster resonance energy transfer (FRET from luminescent terbium complexes (LTC as donors to semiconductor quantum dots (QDs as acceptors allows extraordinary large FRET efficiencies due to the long Förster distances afforded. Moreover, time-gated detection permits an efficient suppression of autofluorescent background leading to sub-picomolar detection limits even within multiplexed detection formats. These characteristics make FRET-systems with LTC and QDs excellent candidates for clinical diagnostics. So far, such proofs of principle for highly sensitive multiplexed biosensing have only been performed under optimized buffer conditions and interactions between real-life clinical media such as human serum or plasma and LTC-QD-FRET-systems have not yet been taken into account. Here we present an extensive spectroscopic analysis of absorption, excitation and emission spectra along with the luminescence decay times of both the single components as well as the assembled FRET-systems in TRIS-buffer, TRIS-buffer with 2% bovine serum albumin, and fresh human plasma. Moreover, we evaluated homogeneous LTC-QD FRET assays in QD conjugates assembled with either the well-known, specific biotin-streptavidin biological interaction or, alternatively, the metal-affinity coordination of histidine to zinc. In the case of conjugates assembled with biotin-streptavidin no significant interference with the optical and binding properties occurs whereas the histidine-zinc system appears to be affected by human plasma.

  14. Influence of volatile constituents of fruit peels of Citrus reticulata Blanco on clinically isolated pathogenic microorganisms under In-vitro

    Husain Shahnaz Sultana; Mohammed Ali; Bibhu Prasad Panda

    2012-01-01

    Objective: To investigate the antimicrobial activity of volatile constituents of fruit peels of Citrus reticulata Blanco on clinically isolated pathogenic microorganisms. Methods: Extraction of volatile oil was carried out by Clevenger’s apparatus. Volatile chemical components were measured by GC-MS. Antimicrobial activity was carried by Agar well diffusion assay with reference to standard fluconazole and tetracycline. Results: The chemical composition of volatile oil of the fruit peels of Citrus reticulata Blanco (Rutaceae) of Delhi Region was composed mainly monoterpenes (99.1 %) constituting l-limonene (92.4 %), γ-terpene (2.6 %) andβ-phellandrene (1.8 %). The volatile oil showed antibacterial and antifungal activities against the clinically isolated pathogenic microbial strains Escherichia coli, Staphylococcus aureus, Aspergillus flavus, Aspergillus niger, Aspergillus fumigatus and Candida albicans under in vitro condition. Conclusions: The potential antimicrobial activity of volatile oil present in fruit peels of C. reticulata can be useful for treatment of skin disorder and/or in aroma. Therapy, it can be incorporated into cosmetic formulations.

  15. Viral competition and maternal immunity influence the clinical disease caused by very virulent infectious bursal disease virus.

    Jackwood, Daral J

    2011-09-01

    The very virulent form of infectious bursal disease virus (vvIBDV) causes an immunosuppressive disease that is further characterized by the rapid onset of morbidity and high mortality in susceptible chickens. In 2009, vvIBDV was first reported in California, U. S. A., and since that time only a few cases of acute infectious bursal disease attributed to vvIBDV have been recognized in California. In other countries where vvIBDV has become established, it rapidly spreads to most poultry-producing regions. Two factors that may be involved in limiting the spread or reducing the severity of the clinical disease caused by vvIBDV in the U. S. A. are maternal immunity and competition with endemic variant strains of the virus. In this study, the ability of vvIBDV to infect and cause disease in maternally immune layer chickens was examined at weekly intervals over a 5-wk period during which their neutralizing maternal antibodies waned. Birds inoculated with vvIBDV at 2, 3, and 4 wk of age seemed healthy throughout the duration of the experiment, but macroscopic and microscopic lesions were observed in their bursa tissues. A real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay also confirmed the presence of vvIBDV RNA in their bursa tissues, indicating this virus was infecting the birds even at 2 wk of age when neutralizing maternal antibodies to infectious bursal disease virus were still relatively high (> 2000 geometric mean antibody titer). No mortality was observed in any birds when inoculated at 2, 3, or 4 wk of age; however, inoculation at 5 and 6 wk of age resulted in 10% and 20% mortality, respectively. Three experiments on the competition between vvIBDV and the two variant viruses T1 and FF6 were conducted. In all three experiments, specific-pathogen-free (SPF) birds that were inoculated with only the vvIBDV became acutely moribund, and except for Experiment 1 (62% mortality) all succumbed to the infection within 4 days of being exposed. When the

  16. PRISMA-Compliant Article: Clinical Characteristics and Factors Influencing Prognosis of Patients With Hepatoid Adenocarcinoma of the Stomach in China.

    Qu, Bao-Ge; Bi, Wei-Min; Qu, Bao-Teng; Qu, Tao; Han, Xing-Hai; Wang, Hui; Liu, Yuan-Xun; Jia, Yi-Guo

    2016-04-01

    Most previous studies have been single case reports, and studies with large samples are presently lacking. In addition, no studies have investigated the associations between the clinical characteristics and prognosis of hepatoid adenocarcinoma of the stomach (HAS).The aim of this study was to explore the associations of different clinical characteristics with the ages, serum alpha-fetoprotein (AFP) levels, and survival times of HAS patients.The present study was conducted using the CBM disc, HowNet, Wanfang and VIP data resource systems, and PubMed. According to the PRISMA Flow Diagram, certain case reports from the same center, those that did not provide patient age or sex, and those that did not report serum AFP levels or AFP immunohistochemistry results were excluded. A total of 131 relevant articles, including 124 case reports, 5 reviews, and 2 postgraduate Master's theses, were reported in the above-mentioned five databases. We applied inclusion criteria to case reports on the clinical characteristics and prognosis of HAS, which resulted in the ultimate inclusion of 180 patients from 62 case reports for statistical analyses.The main finding was that the age of the men was significantly higher than that of the women (P = 0.004). In addition, the serum AFP levels of the participants with antral disease were significantly higher than those with nonantral disease (P = 0.001). The median serum AFP levels and survival times significantly differed among the patients with the three lesion types (P = 0.001 and 0.019, respectively). The serum AFP levels of the participants with ulcerative-upheaval-type tumors and purely ulcerative tumors were significantly higher than those with upheaval-type tumors (P = 0.000 and 0.017, respectively). In addition, the serum AFP levels of the participants with ulcerative-upheaval-type tumors were significantly higher than those with ulcerative-type tumors (P = 0.019), and their survival time was also significantly

  17. A clinical study of the influence of percutaneous nephroureterolithotomy on renal function using 99mTc-DMSA renal scintigraphy

    To clarify the influence of percutaneous nephroureterolithotomy (PNL) on renal function, 99mTc-DMSA renal scientigraphy was performed preoperatively and 3, 6 and 12 months after the procedure. In 50 stone-containing renal units, 48 patients, changes of DMSA renal uptake rate were investigated for determination of individual renal function. In 3 cases with staghorn calculi which complicated with pyelonephritis during PNL procedure, DMSA renal uptake rate was decreased after PNL. On the other hand, DMSA renal uptake rate was almost stationary after PNL in other cases. In 21 renal units (42 %), the postoperative renal scintigrams showed low uptake or cold areas at nephrostomy tracts. These results indicate that control of infection during PNL is important to maintain renal function. (author)

  18. Data calibration and reduction allows to visualize behavioural profiles of psychosocial influences in mice towards clinical domains.

    Badowska, Dorota M; Brzózka, Magdalena M; Chowdhury, Ananya; Malzahn, Dörthe; Rossner, Moritz J

    2015-09-01

    Psychosocial stress-particularly in combination with genetic vulnerability-is a critical environmental risk factor for psychiatric diseases in humans. Isolation rearing (IR) and social defeat (SD) paradigms model psychosocial risk factors in rodents, while enriched environment (EE) protects them from behavioural deficits. Studying the influence of various environmental conditions, e.g., on genetic mouse models can help to dissect the complex gene-environment relationships underlying human psychiatric diseases. Such studies may require analysing multiple mouse cohorts; however, the comparability of behavioural experiments is challenging and often compromised by practical limitations such as group sizes and influences of handling. Therefore, protocol standardization as well as appropriate statistical normalization is necessary to compare different experiments. In this study, we analysed two independent cohorts to compare the behavioural profiles of wild-type male mice subjected to IR and SD. In both cases, EE conditions served as a reference. Multivariate statistics was applied to merge the data from individual measures into broader categories (such as curiosity, anxiety and fear memory) by estimating their calibrated joint effect within a category. Plotting and overlaying these calibrated effect sizes in a single graph allowed intuitive comparison of IR and SD behavioural profiles. This approach allows analysing multiple behavioural tests at once, which is more relevant to psychiatric syndromes than focusing on single behavioural measures. Our method revealed that motivation and fear memory are impaired by both conditions, whereas ambulation and pain sensitivity are affected only by IR and curiosity is mainly diminished upon SD. Thus, IR could be a paradigm of choice in studies focusing on positive symptoms, while SD might be more relevant for negative and cognitive symptoms. PMID:25236183

  19. Clinical feasibility of Axillary Reverse Mapping and its influence on breast cancer related lymphedema: a systematic review.

    Gebruers, Nick; Tjalma, Wiebren A A

    2016-05-01

    Breast cancer is the most common malignancy in women worldwide. Fortunately, the overall survival is good. Therefore it is important to focus on the morbidities related to breast cancer treatment. One of the most dreaded morbidities is lymphedema. In 2007 the Axillary Reverse Mapping (ARM) was introduced to limit the invasiveness in the axilla during breast cancer surgery. It is hypothesized that ARM is able to limit the incidence of breast cancer related lymphedema (BCRL) considerably. This systematic review aims to answer the following research questions: (1) which approaches for ARM are described? (2) Is ARM surgical feasible and oncological safe? (3) Does ARM decrease the incidence of lymphedema after sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND)? In total 27 papers were retrieved using four electronic databases (PubMed, Web of Science, Medline and Cochrane clinical trials; assessed until May 13, 2015. The level of evidence of these studies was low (mostly level 3). Therefore the conclusions are that the ARM procedure is feasible although ARM-node rates have a broad range. Additionally, from a theoretical point there is a clear benefit from ARM in terms of lymphedema prevention. From a practical point there is little scientific data to support this due to the lack of studies; and especially because of the different methods and definitions for lymphedema used in the different studies. PMID:27019287

  20. The influence of HCV coinfection on clinical, immunological and virological responses to HAART in HIV-patients

    Ricardo A. Carmo

    2008-06-01

    Full Text Available The potential impact of the hepatitis C virus (HCV on clinical, immunological and virological responses to initial highly active antiretroviral therapy (HAART of patients infected with human immunodeficiency virus (HIV is important to evaluate due to the high prevalence of HIV-HCV coinfection. A historical cohort study was conducted among 824 HIV-infected patients starting HAART at a public referral service in Belo Horizonte, Brazil, to assess the impact of HCV seropositivity on appearance of a new AIDS-defining opportunistic illness, AIDS-related death, suppression of viral load, and an increase in CD4-cell count. A total of 76 patients (9.2% had a positive HCV test, 26 of whom (34.2% had a history of intravenous drug use. In multivariate analysis, HCV seropositivity was associated with a smaller CD4-cell recovery (RH=0.68; 95% CI [0.49-0.92], but not with progression to a new AIDS-defining opportunistic illness or to AIDS-related death (RH=1.08; 95% CI [0.66-1.77], nor to suppression of HIV-1 viral load (RH=0.81; 95% CI [0.56-1.17] after starting HAART. These results indicate that although associated with a blunted CD4-cell recovery, HCV coinfection did not affect the morbidity or mortality related to AIDS or the virological response to initial HAART.

  1. Variable tellurite resistance profiles of clinically-relevant Shiga toxin-producing Escherichia coli (STEC) influence their recovery from foodstuffs.

    Kerangart, Stéphane; Douëllou, Thomas; Delannoy, Sabine; Fach, Patrick; Beutin, Lothar; Sergentet-Thévenot, Delphine; Cournoyer, Benoit; Loukiadis, Estelle

    2016-10-01

    Tellurite (Tel)-amended selective media and resistance (Tel-R) are widely used for detecting Shiga toxin-producing Escherichia coli (STEC) from foodstuffs. Tel-R of 81 O157 and non-O157 STEC strains isolated from animal, food and human was thus investigated. Variations of STEC tellurite minimal inhibitory concentration (MIC) values have been observed and suggest a multifactorial and variable tellurite resistome between strains. Some clinically-relevant STEC were found highly susceptible and could not be recovered using a tellurite-based detection scheme. The ter operon was highly prevalent among highly Tel-R STEC but was not always detected among intermediately-resistant strains. Many STEC serogroup strains were found to harbor sublines showing a gradient of MIC values. These Tel-R sublines showed statistically significant log negative correlations with increasing tellurite concentration. Whatever the tellurite concentration, the highest number of resistant sublines was observed for STEC belonging to the O26 serogroup. Variations in the number of these Tel-R sublines could explain the poor recovery of some STEC serogroups on tellurite-amended media especially from food products with low levels of contamination. Comparison of tellurite MIC values and distribution of virulence-related genes showed Tel-R and virulence to be related. PMID:27375242

  2. Dietary approaches to stop hypertension influence on insulin receptor substrate-1gene expression: A randomized controlled clinical trial

    Marzieh Kafeshani

    2015-01-01

    Full Text Available Background: Insulin receptor substrate (IRS Type 1 is a main substrate for the insulin receptor, controls insulin signaling in skeletal muscle, adipose tissue, and the vascular, so it is an important candidate gene for insulin resistance (IR. We aimed to compare the effects of the Dietary Approaches to Stop Hypertension (DASH and Usual Dietary Advices (UDA on IRS1 gene expression in women at risk for cardiovascular disease. Materials and Methods: A randomized controlled clinical trial was performed in 44 women at risk for cardiovascular disease. Participants were randomly assigned to a UDA diet or the DASH diet. The DASH diet was rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains, and sweets, with a total of 2400 mg/day sodium. The UDA diet was a regular diet with healthy dietary advice. Gene expression was assessed by the real-time polymerase chain reaction at the first of study and after 12 weeks. Independent sample t-test and paired-samples t-test were used to compare means of all variables within and between two groups respectively. Results: IRS1 gene expression was increased in DASH group compared with UDA diet (P = 0.00. Weight and waist circumference decreased in DASH group significantly compared to the UDA group (P < 0.05 but the results between the two groups showed no significant difference. Conclusion: DASH diet increased IRS1 gene expression and probably has beneficial effects on IR risks.

  3. Bacterial Lysine Decarboxylase Influences Human Dental Biofilm Lysine Content, Biofilm Accumulation and Sub-Clinical Gingival Inflammation

    Lohinai, Z.; Keremi, B.; Szoko, E.; Tabi, T.; Szabo, C.; Tulassay, Z.; Levine, M.

    2012-01-01

    Background Dental biofilms contain a protein that inhibits mammalian cell growth, possibly lysine decarboxylase from Eikenella corrodens. This enzyme decarboxylates lysine, an essential amino acid for dentally attached cell turnover in gingival sulci. Lysine depletion may stop this turnover, impairing the barrier to bacterial compounds. The aims of this study were to determine biofilm lysine and cadaverine contents before oral hygiene restriction (OHR), and their association with plaque index (PI) and gingival crevicular fluid (GCF) after OHR for a week. Methods Laser-induced fluorescence after capillary electrophoresis was used to determine lysine and cadaverine contents in dental biofilm, tongue biofilm and saliva before OHR and in dental biofilm after OHR. Results Before OHR, lysine and cadaverine contents of dental biofilm were similar and 10-fold greater than in saliva or tongue biofilm. After a week of OHR, the biofilm content of cadaverine increased and that of lysine decreased, consistent with greater biofilm lysine decarboxylase activity. Regression indicated that PI and GCF exudation were positively related to biofilm lysine post-OHR, unless biofilm lysine exceeded the minimal blood plasma content in which case PI was further increased but GCF exudation was reduced. Conclusions After OHR, lysine decarboxylase activity seems to determine biofilm lysine content and biofilm accumulation. When biofilm lysine exceeds minimal blood plasma content after OHR, less GCF appeared despite more biofilm. Lysine appears important for biofilm accumulation and the epithelial barrier to bacterial proinflammatory agents. Clinical Relevance Inhibiting lysine decarboxylase may retard the increased GCF exudation required for microbial development and gingivitis. PMID:22141361

  4. The Influence of Sunlight Exposure on Serum Vitamin D Concentration and Bone Turnover; a controlled clinical trial

    A Ataie-Jafari

    2008-11-01

    Full Text Available "nBackground: Sunlight exposure is one of the ways for vitamin D synthesis. However, its effect on vitamin D status via experimental studies is poorly understood. This study was undertaken to address the possibility that sunlight exposure may increase the levels of serum vitamin D, and alter bone turnover in healthy young girls."nMethods: In a controlled clinical trial, young girls were assigned to the test group (n= 45 or control group (n= 80. An out­door swimming pool was considered for this project and the test group was required to participate in these sessions at least for 8 sessions and to expose to direct sunlight at least for 20 minutes in each session. They were not allowed to use sun­screen during this time. Control group continued their usual manner of sun exposing. Serum levels of vitamin D, calcium, alkaline phosphatase, parathormone, osteocalcin and crossLaps were measured before and after duration of the study in both groups and compared between them."nResults: Subjects aged 27.46±8.78 years. Serum levels of vitamin D and bone markers were constant during the study in both groups. Changes of these variables were not significant between the groups after the study. Serum vitamin D in sub­jects with white skin color correlated with total time of direct sun exposing after the study (P= 0.002."nConclusion: Sunlight exposure did not affect the serum vitamin D and bone turnover in healthy young girls. However, sub­jects with bright skin complexion benefit from sunlight exposing more than those with a dark skin color in the case of vita­min D improvement.  

  5. Towards the clinical use of concentric electrodes in ECG recordings: influence of ring dimensions and electrode position

    Prats-Boluda, G.; Ye-Lin, Y.; Bueno-Barrachina, JM; Rodriguez de Sanabria, R.; Garcia-Casado, J.

    2016-02-01

    To overcome the limited spatial resolution of standard 12-lead ECG recordings, concentric ring electrodes (CRE) have been proposed to provide valuable data for the diagnosis of a wide range of cardiac abnormalities, including infarction and arrhythmia. Although theoretical studies indicate that the dimensions of the CRE regulate the depth of the electric dipoles sensed by these electrodes, this has not been experimentally confirmed. The aim of this work was to analyze the influence of CRE dimensions and position of a wireless multi-CRE sensor node on the cardiac signal recorded. For this, four wireless multichannel ECG recording nodes based on flexible multi-ring electrodes were placed at positions CMV1 (position comparable to V1), CMV2, CMV4R and CMV5; each node providing three bipolar concentric ECG signals (BC-ECG). Standard 12-lead ECG and 12 BC-ECG signals were recorded in 29 volunteers. The results revealed that a ring with an outer diameter of 33.5 mm achieves a balance between the ease-of-use and spatial resolution of smaller electrodes and improved detectability and higher amplitudes of signals from larger ring electrodes. Although a standard 12-lead ECG outperforms BC-ECC recordings in detectability of cardiac waves, if the relative amplitude of the wave is also considered, BC-ECG at CMV1 proved superior at picking up atrial activity. In fact, in most of the BC-ECG signals picked up at CMV1, P1 and P2 atrial activity waves were more clearly identified than in simultaneous 12-Lead ECG signals. Likewise, BC-ECG signals revealed higher spatial resolution in detecting anomalous electrical activity in local regions, such as impaired intraventricular driving, or atrioventricular blocks. Finally, the wireless multi-CRE sensor node provides enhanced comfort and handling to both patient and clinician over wired systems.

  6. Influence of the Timing of Percutaneous Coronary Intervention on Clinical Outcomes in Non-ST-Elevation Myocardial Infarction

    Cagliyan, Caglar Emre; Tanboga, Ibrahim Halil; Balli, Mehmet; Uysal, Onur Kadir; Ozkan, Bugra; Arik, Osman Ziya; Cayli, Murat

    2013-01-01

    Background and Objectives We have intended to investigate the influence of the timing of invasive procedures on all-cause mortality, recurrent myocardial infarction (MI), re-hospitalization due to cardiac causes and left ventricular function over a 3-month period among patients with Non-ST-elevation myocardial infarction (NSTEMI). Subjects and Methods A total of 131 NSTEMI patients with moderate-high Thrombolysis in Myocardial Infarction risk scores, who had been admitted to our department between July 2011-December 2011 were included in our study. They had been randomized into 2 groups according to the timing of the percutaneous coronary intervention (PCI). Patient undergoing PCI in the first 24 hours of hospitalization were named the "Early Invasive Group" and those undergoing PCI between 24-72 hours of hospitalization were named the "Delayed Invasive Group". All patients were followed up for 3 months. Results Third month left ventricular ejection fraction (LVEF) values were higher in the early invasive group (59.9±6.0% vs. 54.1±8.7%; p<0.001). Recurrent MI rates were lower in the early invasive group (2.9% vs. 14.5%; p=0.016). Similarly, hospitalization rates due to cardiac events were lower in the early invasive group (8.7% vs. 30.6%; p=0.001). All cause mortality appeared to be lower in the early invasive group, although not to a statistically significant degree (0% vs. 4.8%; p=0.065). Conclusion The early invasive strategy appears to be more effective for the reduction of recurrent MI, re-hospitalization due to cardiac events, and the preservation of 3rd month LVEF in patients with moderate-high risk NSTEMI when compared to a delayed invasive strategy. PMID:24363747

  7. The role of computed tomography in evaluating body composition and the influence of reduced muscle mass on clinical outcome in abdominal malignancy: a systematic review.

    Gibson, D J; Burden, S T; Strauss, B J; Todd, C; Lal, S

    2015-10-01

    It is estimated that there were 3.45 million new cases and 1.75 million deaths from cancer in Europe in 2012. Colorectal cancer was one of the most common cancers, accounting for 13% of new cases and 12.2% of all deaths. Conditions causing reduced muscle mass, such as sarcopenia, can increase the morbidity and mortality of people with cancer. Computed tomography (CT) scans can provide accurate, high-quality information on body composition, including muscle mass. To date, there has been no systematic review on the role of CT scans in identifying sarcopenia in abdominal cancer. This review aimed to examine the role of CT scans in determining the influence of reduced muscle mass on clinical outcome in abdominal cancer. A systematic review of English-language articles published in 2000 or later was conducted. Articles included cohort, randomised controlled trials and validation studies. Participants were people diagnosed with abdominal cancer who had undergone a CT scan. Data extraction and critical appraisal were undertaken. Ten cohort studies met the inclusion criteria. Seven studies demonstrated that low muscle mass was significantly associated with poor clinical outcome, with six specifically demonstrating reduced survival rates. Eight studies demonstrated that a greater number of patients (27.3-66.7%) were identified as sarcopenic using CT scans compared with numbers identified as malnourished using body mass index. CT scans can identify reduced muscle mass and predict negative cancer outcomes in people with abdominal malignancies, where traditional methods of assessment are less effective. PMID:25782424

  8. 护士职业倦怠的影响因素分析%Study on Clinical Nurses’ job Burnout and its Influencing Factors

    夏晶

    2015-01-01

    目的:探讨杭州地区临床护士职业倦怠的现状及其影响因素。方法采用护士职业倦怠量表对浙江省杭州市3所三级甲等医院658名临床护士进行问卷调查。结果临床护士职业倦怠程度高于常模(P<0.05);职称、用工性质、月收入是影响护士职业倦怠的重要因素。结论被调查护士职业倦怠明显,护理管理者应加强组织支持,降低临床护士的职业倦怠,进而稳定护理队伍。%Objective To explore the nurses’ job burnout and its influencing factors in Hangzhou. Methods 658 clinical nurses from 3 hospitals in Hangzhou were interviewed with job burnout scale. Results The score of nurses’ job burnout was higher the norm (P<0.05). Professional title, nature of employment, monthly income were the influencing factors of job burnout. Conclusion The nurses’ job burnout were obvious in Hangzhou, the managers should build good organizational support in order to reduce nurses’ job burnout and stable care team.

  9. INHALED NITRIC OXIDE: CLINICAL EFFECTS AND INFLUENCE ON THE PROFILE OF INFLAMMATORY MARKERS IN PATIENTS WITH IDIOPATHIC PULMONARY HYPERTENSION

    T. V. Martynyuk

    2015-12-01

    Full Text Available Aim. To study the effect of treatment with inhaled nitric oxide (iNO on the clinical status of patients with idiopathic pulmonary hypertension (IPH, and the profile of proinflammatory cytokines in peripheral blood. Material and methods. Patients with IPH (n=48 were included into the study. Evaluation of the IPH functional class (FC, the 6-minute walk test (6MWT with the assessment of the Borg index, echocardiography , laboratory tests [blood count, evaluation of high-sensitivity C-reactive protein (hsCRP, interleukins (IL, interferon-γ (INFγ, tumor necrosis factor a (TNFa, macrophage inflammatory protein a (MIP1 a, soluble adhesion molecules (sICAM-1, sVCAM-1 in peripheral blood] were performed at baseline and on day 21 of iNO therapy course. The iNO course 40 ppm during 5 hours a day for 21 days was carried out additionally to the standard IPH therapy under the toxicity control by the PrinterNOx (England. Results. Increase in exercise tolerance, improvement of IPH FC (from 3.35±0.52 to 2.71±0.56; p=0.008, reduction in systolic pulmonary artery pressure (SPAP by Doppler echocardiography (from 96.23±23.65 to 82.36±20.92 mmHg; p<0.05 were found in IPH patients as a result of iNo therapy. The significance of inflammation in IPH pathogenesis was confirmed due to assessment of the initial levels of proinflammatory cytokines. iNO therapy resulted in significant decrease in proinflammatory cytokines-IL-1β, IL-6, IL-8, TNFa levels. iNO induced significant dynamics of IL-1β and sVCAM in patients with IPH FC II. It reduced IL-8 and TNFa and increase INFγ (p<0.05 in patients with IPH FC III-IV. Changes in IL-1β and sVCAM levels (ΔIL-1β and ΔsVCAM by the 21 day of iNO therapy in comparison with these at baseline correlated with ΔSPAP , and ΔIL-6 correlated with ΔFC and Δ6MWT distance (30.5 [21.0; 53.0] m; p<0.001. This allows considering these indicators as markers of iNO treatment efficacy. Conclusions. 21-day iNO therapy in IPH patients

  10. Influence of Clinical Nursing Students' Empathy Ability on Effect of Practice%实习护生共情能力对实习效果的影响

    杨敏; 肖丽

    2013-01-01

    Objective To explore the correlation between the clinical nursing students' empathy ability and practice effect so as to determine the influencing factors of clinical practice to improve their clinical practice effect. Methods Self-designed empathy ability questionnaire and nursing department internship practice effect feedback questionnaire were used to assess the correlation between empathy ability and practice effect among the selected 98 nursing students. Results There is a relatively positive correlation between empathy ability and practice effect (r=0. 924,P0. 05). Conclusion According to the result of this study, empathy ability and practice effect of clinical nursing students are all relatively well. In order to improve the effect of practice, nursing administrators should train and improve the empathy ability of practice nursing students,especially the nursing knowledge and communicative skills.%目的 探讨实习护生共情能力与实习效果之间的关系,为培养护生的共情能力及提高其实习效果提供依据.方法 应用自行设计的共情能力调查问卷和护理部的实习效果反馈表,对98名护生进行调查,对共情能力与实习效果进行相关性分析.结果 实习护生共情能力与实习效果之间呈显著正相关(r=0.924,P<0.01),共情能力与实习效果中的理论知识(r=0.823,P0.05).结论 实习护生的共情能力及实习效果均相对较好,而加强实习护生的共情能力可进一步提高其临床实习质量,尤其是护生的理论知识及沟通能力.

  11. Influence of treatment with alendronate on the speed of sound, an ultrasound parameter, of the calcaneus in postmenopausal Japanese women with osteoporosis: a clinical practice-based observational study

    Iwamoto J; Takada T; Sato Y; Matsumoto H

    2012-01-01

    Jun Iwamoto,1 Tetsuya Takada,2 Yoshihiro Sato,3 Hideo Matsumoto11Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, 2Department of Internal Medicine, Hiyoshi Medical Clinic, Kanagawa, 3Department of Neurology, Mitate Hospital, Fukuoka, JapanPurpose: The influence of alendronate (ALN) treatment on the quantitative ultrasound parameters of the calcaneus remains to be established in Japanese patients. The aim of the present clinical practice-based observational ...

  12. Influence of postoperative low-level laser therapy on the osseointegration of self-tapping implants in the posterior maxilla: A 6-week split-mouth clinical study

    Mandić Borka

    2015-01-01

    Full Text Available Background/Aim. Low-level laser therapy (LLLT has been proven to stimulate bone repair, affecting cellular proliferation, differentiation and adhesion, and has shown a potential to reduce the healing time following implant placement. The aim of this clinical study was to investigate the influence of postoperative LLLT osseointegration and early success of self-tapping implants placed into low-density bone. Methods. Following the split-mouth design, self-tapping implants (n = 44 were inserted in the posterior maxilla of 12 patients. One jaw side randomly received LLLT (test group, while the other side was placebo (control group. For LLLT, a 637 nm gallium-aluminum-arsenide (GaAlAs laser (Medicolaser 637, Technoline, Belgrade, Serbia with an output power of 40 mW and continuous wave was used. Low-level laser treatment was performed immediately after the surgery and then repeated every day in the following 7 days. The total irradiation dose per treatment was 6.26 J/cm² per implant. The study outcomes were: implant stability, alkaline-phosphatase (ALP activity and early implant success rate. The follow-up took 6 weeks. Results. Irradiated implants achieved a higher stability compared with controls during the entire follow-up and the difference reached significance in the 5th postoperative week (paired t-test, p = 0.030. The difference in ALP activity between the groups was insignificant in any observation point (paired t-test, p > 0.05. The early implant success rate was 100%, regardless of LLLT usage. Conclusion. LLLT applied daily during the first postoperative week expressed no significant influence on the osseointegration of selftapping implants placed into low density bone of the posterior maxilla. Placement of self-tapping macro-designed implants into low density bone could be a predictable therapeutic procedure with a high early success rate regardless of LLLT usage.

  13. Clinical pharmacology of 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy": the influence of gender and genetics (CYP2D6, COMT, 5-HTT.

    Ricardo Pardo-Lozano

    Full Text Available The synthetic psychostimulant MDMA (± 3,4-methylenedioxymethamphetamine, ecstasy acts as an indirect serotonin, dopamine, and norepinephrine agonist and as a mechanism-based inhibitor of the cytochrome P-450 2D6 (CYP2D6. It has been suggested that women are more sensitive to MDMA effects than men but no clinical experimental studies have satisfactorily evaluated the factors contributing to such observations. There are no studies evaluating the influence of genetic polymorphism on the pharmacokinetics (CYP2D6; catechol-O-methyltransferase, COMT and pharmacological effects of MDMA (serotonin transporter, 5-HTT; COMT. This clinical study was designed to evaluate the pharmacokinetics and physiological and subjective effects of MDMA considering gender and the genetic polymorphisms of CYP2D6, COMT, and 5-HTT. A total of 27 (12 women healthy, recreational users of ecstasy were included (all extensive metabolizers for CYP2D6. A single oral weight-adjusted dose of MDMA was administered (1.4 mg/kg, range 75-100 mg which was similar to recreational doses. None of the women were taking oral contraceptives and the experimental session was performed during the early follicular phase of their menstrual cycle. Principal findings show that subjects reached similar MDMA plasma concentrations, and experienced similar positive effects, irrespective of gender or CYP2D6 (not taking into consideration poor or ultra-rapid metabolizers or COMT genotypes. However, HMMA plasma concentrations were linked to CYP2D6 genotype (higher with two functional alleles. Female subjects displayed more intense physiological (heart rate, and oral temperature and negative effects (dizziness, sedation, depression, and psychotic symptoms. Genotypes of COMT val158met or 5-HTTLPR with high functionality (val/val or l/* determined greater cardiovascular effects, and with low functionality (met/* or s/s negative subjective effects (dizziness, anxiety, sedation. In conclusion, the contribution

  14. Does the organizational model of the maternity health clinic have an influence on women’s and their partners’ experiences? A service evaluation survey in Southwest Finland

    Tuominen Miia

    2012-09-01

    Full Text Available Abstract Background In high-income countries, great disparities exist in the organizational characteristics of maternity health services. In Finland, primary maternity care is provided at communal maternity health clinics (MHC. At these MHCs there are public health nurses and general practitioners providing care. The structure of services in MHCs varies largely. MHCs are maintained independently or merged with other primary health care sectors. A widely used organizational model of services is a combined maternity and child health clinic (MHC & CHC where the same public health nurse takes care of the family from pregnancy until the child is at school age. The aim of this study was to determine how organizational model, MHC independent or combined MHC & CHC, influence on women’s and their partners’ service experiences. Methods A comparative, cross-sectional service evaluation survey was used. Women (N = 995 and their partners (N = 789 were recruited from the MHCs in the area of Turku University Hospital. Four months postpartum, the participants were asked to evaluate the content and amount of the MHC services via a postal questionnaire. Comparisons were made between the clients of the separate MHCs and the MHCs combined to the child health clinics. Results Women who had used the combined MHC & CHCs generally evaluated services more positively than women who had used the separate MHCs. MHC’s model was related to several aspects of the service which were evaluated “good” (the content of the service or “much” (the amount of the service. Significant differences accumulated favoring the combined MHC & CHCs’ model. Twelve aspects of the service were ranked more often as “good” or “much” by the parents who had used the combined MHC & CHC, only group activities regarding delivery were evaluated better by women who had used the separate MHCs. Conclusions Based on the women’s and partners’ experiences an organizational

  15. Influence of NG-nitro-L-arginine methyl ester on clinical and biochemical effects of methylene blue in pentylenetetrazole-evoked convulsions

    Jelenković Ankica

    2012-01-01

    Full Text Available Background/Aim. Despite years of research in a number of experimental models the question whether nitric oxide (NO and methylene blue (MB have pro- or anticonvulsant effects remains to be fully resolved. Methods. In adult Wistar rats the influence of a nonselective inhibitor of nitric oxide synthase NG-nitro-L-arginine methyl ester (LNAME, 10µg on clinical and biochemical effects of MB (10µg given before the intraperitoneally administered chemical convulsant pentylenetetrazole (PTZ, 80 mg/kg was examined. MB and L-NAME were applied intracerebroventricularly. PTZ application was followed by a 4- minute observation time, after which rats were sacrificed and elements of oxido-reductive balance were measured in a crude mitochondrial fraction of forebrain cortex, hippocampus and striatum. Results. Convulsive responses (forelimb dystonia - FLD, generalised clonic- and clonic-tonic convulsions - GCC and GCTC respectively were observed in all rats received PTZ, together with significantly decreased lipid peroxidation in the forebrain cortex and striatum and increased superoxide dismutase activity in the hippocampus, in comparison to controls (saline treated. It was registered anticonvulsant effects of L-NAME pretreatment. However, these effects were insignificant. In the hippocampus of these animals there was decreased lipid peroxidation (p < 0.01, p < 0.05 vs saline-treated and PTZ-treated rats, respectively and reverted PTZ-induced increase of superoxide dismutase activity. But MB individually pretreatment significantly decreased the incidence of CTCs and GCCs (FLD: p = 0.0513, prolonged the convulsive latent time for FLD, GCTCs and GCCs, in all the examined brain regions increased lipid peroxidation and decreased the level of superoxide anion. Administration of L-NAME 10 minutes before MB reverted all MB-evoked clinical and biochemical effects. Conclusion. Methylene blue applied individually before PTZ has strong anticonvulsant effects that were

  16. Clinical Holistic Medicine: Factors Influencing The Therapeutic Decision-Making. From Academic Knowledge to Emotional Intelligence and Spiritual “Crazy” Wisdom

    Søren Ventegodt

    2007-01-01

    Full Text Available Scientific holistic medicine is built on holistic medical theory, on therapeutic and ethical principles. The rationale is that the therapist can take the patient into a state of salutogenesis, or existential healing, using his skills and knowledge. But how ever much we want to make therapy a science it remains partly an art, and the more developed the therapist becomes, the more of his/her decisions will be based on intuition, feeling and even inspiration that is more based on love and human concern and other spiritual motivations than on mental reason and rationality in a simple sense of the word. The provocative and paradoxal medieval western concept of the “truth telling clown”, or the eastern concepts of “crazy wisdom” and “holy madness” seems highly relevant here. The problem is how we can ethically justify this kind of highly “irrational” therapeutic behavior in the rational setting of a medical institution. We argue here that holistic therapy has a very high success rate and is doing no harm to the patient, and encourage therapists, psychiatrists, psychologist and other academically trained “helpers” to constantly measure their own success-rate. This paper discusses many of the important factors that influence clinical holistic decision-making. Sexuality could, as many psychoanalysts from Freud to Reich and Searles have believed, be the most healing power that exists and also the most difficult for the mind to comprehend, and thus the most “crazy-wise” tool of therapy.

  17. Beyond KRAS mutation status: influence of KRAS copy number status and microRNAs on clinical outcome to cetuximab in metastatic colorectal cancer patients

    Mekenkamp Leonie JM

    2012-07-01

    Full Text Available Abstract Background KRAS mutation is a negative predictive factor for treatment with anti-epidermal growth factor receptor (EGFR antibodies in metastatic colorectal cancer (mCRC. Novel predictive markers are required to further improve the selection of patients for this treatment. We assessed the influence of modification of KRAS by gene copy number aberration (CNA and microRNAs (miRNAs in correlation to clinical outcome in mCRC patients treated with cetuximab in combination with chemotherapy and bevacizumab. Methods Formalin-fixed paraffin-embedded primary tumour tissue was used from 34 mCRC patients in a phase III trial, who were selected based upon their good (n = 17 or poor (n = 17 progression-free survival (PFS upon treatment with cetuximab in combination with capecitabine, oxaliplatin, and bevacizumab. Gene copy number at the KRAS locus was assessed using high resolution genome-wide array CGH and the expression levels of 17 miRNAs targeting KRAS were determined by real-time PCR. Results Copy number loss of the KRAS locus was observed in the tumour of 5 patients who were all good responders including patients with a KRAS mutation. Copy number gains in two wild-type KRAS tumours were associated with a poor PFS. In KRAS mutated tumours increased miR-200b and decreased miR-143 expression were associated with a good PFS. In wild-type KRAS patients, miRNA expression did not correlate with PFS in a multivariate model. Conclusions Our results indicate that the assessment of KRAS CNA and miRNAs targeting KRAS might further optimize the selection of mCRC eligible for anti-EGFR therapy.

  18. [Influence of a low-calorie diet with inclusion of probiotic product containing bacterias Lactobacillus plantarum Tensia DSM 21380 on clinical and metabolic characteristics in patients with obesity and arterial hypertension].

    Sharafetdinov, Kh Kh; Plotnikova, O A; Alekseeva, R I; Sentsova, T B; Kaganov, B S

    2012-01-01

    In a number of studies it is shown that regular use of the probiotic products containing Lactobacillus plantarum Tensia DSM 21380 in complex dietary treatment, not only modulates intestinal microflora, but also has a positive influence on a functional condition of cardiovascular system including levelels of systolic and diastolic blood pressure. The aim of this research was to study the influence of dietotherapy with inclusion of the probiotic product containing Lactobacillus plantarum Tensia DSM 21380, on clinical and metabolic characteristics in patients with obesity and accompanying arterial hypertension (AH). PMID:22642170

  19. Factors influencing clinical trial site selection in Europe: the Survey of Attitudes towards Trial sites in Europe (the SAT-EU Study)

    Gehring, Marta; Taylor, Rod S; Mellody, Marie; Casteels, Brigitte; Piazzi, Angela; Gensini, Gianfranco; Ambrosio, Giuseppe

    2013-01-01

    Objectives Applications to run clinical trials in Europe fell 25% between 2007 and 2011. Costs, speed of approvals and shortcomings of European Clinical Trial Directive are commonly invoked to explain this unsatisfactory performance. However, no hard evidence is available on the actual weight of these factors or has it been previously investigated whether other criteria may also impact clinical trial site selection. Design The Survey of Attitudes towards Trial sites in Europe (SAT-EU Study) w...

  20. Clinical and virological factors influencing the performance of a NS1 antigen-capture assay and potential use as a marker of dengue disease severity.

    Veasna Duong

    2011-07-01

    Full Text Available BACKGROUND: Detection of dengue NS1 antigen in acute infection has been proposed for early diagnosis of dengue disease. The aim of this study was to evaluate the clinical and virological factors influencing the performance of the Platelia NS1 Ag kit (BioRad and to assess the potential use of NS1 antigen and dengue viral loads as markers of dengue disease severity. METHODOLOGY/PRINCIPAL FINDINGS: Blood specimens were collected from patients hospitalized at the Kampong Cham hospital during the 2006 and 2007 dengue epidemics in Cambodia. Dengue infection was confirmed in 243/339 symptomatic patients and in 17 asymptomatic individuals out of 214 household members tested. Overall sensitivity and specificity of Platelia NS1 Ag kit were 57.5% and 100% respectively. NS1 Ag assay combined with IgM antibody capture ELISA significantly increased the sensitivity for dengue diagnosis. NS1 Ag positivity rate was found significantly higher in DF than in DHF/DSS, in primary than in secondary infections, in patients with a high viremia (>5 log/mL and in patients infected with DENV-1. In asymptomatic individuals, the NS1 Ag capture sensitivity tends to be lower than that in symptomatic patients. Milder disease severity was observed independently in patients with RNA copy number >5 log10 cDNA equivalents/mL or in high level of NS1 antigen ratio or in DENV-1 infection. CONCLUSIONS: Overall sensitivity of NS1 Ag detection kit varied widely across the various forms of dengue infection or disease. Sensitivity was highest in patients sampled during the first 3 days after onset of fever, in patients with primary infection, DENV-1 infection, with high level of viremia and in DF rather than DHF/DSS. In asymptomatic patients, RT-PCR assay has proved to be more sensitive than NS1 antigen detection. The NS1 antigen level correlated significantly with viremia and a low NS1 antigen ratio was associated with more severe disease.

  1. ASSESSMENT OF THE FACTORS INFLUENCING AND COMPARING THE INTRAOCULAR PRESSURE WITH THE HELP OF SCHIOTZ INDENTATION TONOMETER AND GOLDMANN’S APPLANATION TONOMETER: A CLINICAL STUDY

    Mridula V Amarnath, Christina Samuel, Sundararajan D

    2015-01-01

    Full Text Available Background: Intraocular pressure (IOP is the fluid pressure inside the eye and is maintained by the equilibrium between the forces determining the formation of aqueous humour and the alteration in the resistance to its outflow. IOP is important to evaluate patients who are at an increased risk of glaucoma. Clinically measurement of IOP is based on principles of indentation and applanation and such a method is called Tonometry. The tonometers used today are the Schiotz Indentataion Tonometer (ST and the Goldmann’s Applanation Tonometer (GAT. However the latter is accepted as the standard one. Aim: 1 To estimate the normal mean IOP for the population under study.2 To study the various factors- age, sex, refractive errors that influence the IOP.3 Merits and demerits of the individual tonometers. Method: A sample size of 100 cases of 200 sets of eyes was taken and divided into 2 groups, Group A with emmetropia, myopia, hypermetropia of both sexes and Group B with frank glaucomatous changes of both sexes. 3 consecutive measurements with GAT were recorded in each eye followed by ST with 5.5gm weight first followed by ST with 7.5gm weight. The whole database was recorded and statistically analysed. Results: Out of the total 200 eyes studied, Group A consisted of 168 apparently normal eyes which included emmetropes, myopes and hypermetropes and Group B comprised of 32 eyes which were frank glaucomatous cases with glaucomatous field defects. On estimating the mean IOP with the help of GAT and ST between the 2 eyes there was not a significant difference. On comparing the refractive status, myopes showed a higher IOP than hypermetropes and emmetropes. With both GAT and ST females had higher IOP than males. The mean IOP increased as age progressed. Group B studies which had frank glaucoma cases showed that the IOP measured with GAT was higher and more accurate to the actual IOP value whereas the readings with Schiotz were variable and unreliable

  2. The Influence of Family and Significant Others on Women's Decisions to Obtain an Abortion: A Study of a Northwest Louisiana Abortion Clinic

    Solomon, Bertina Loutrice

    2011-01-01

    This study researched whether family members and significant others influence a woman's decision to obtain an abortion. Influence is defined by Merriam-Webster (2011) as the power or capacity of causing an effect in indirect or intangible ways; power exerted over the minds or behaviors of others. The theoretical framework that will be used in…

  3. Multivariable analysis of clinical influence factors on liver enhancement of Gd-EOB-DTPA-enhanced 3T MRI; Multivariable Analyse klinischer Einflussfaktoren auf die Signalintensitaet bei Gd-EOB-DTPA 3T-MRT der Leber

    Verloh, N.; Haimerl, M.; Stroszczynski, C.; Fellner, C.; Wiggermann, P. [University Hospital Regensburg (Germany). Dept. of Radiology; Zeman, F. [University Hospital Regensburg (Germany). Center for Clinical Trials; Teufel, A. [University Hospital Regensburg (Germany). Dept. of Gastroenterology; Lang, S. [University Hospital Regensburg (Germany). Dept. of Surgery

    2015-01-15

    The purpose of this study was to identify clinical factors influencing Gd-EOB-DTPA liver uptake in patients with healthy liver parenchyma. A total of 124 patients underwent contrast-enhanced MRI with a hepatocyte-specific contrast agent at 3T. T1-weighted volume interpolated breath-hold examination (VIBE) sequences with fat suppression were acquired before and 20 minutes after contrast injection. The relative enhancement (RE) between plain and contrast-enhanced signal intensity was calculated. Simple and multiple linear regression analyses were performed to evaluate clinical factors influencing the relative enhancement. Patients were subdivided into three groups according to their relative liver enhancement (HRE, RE ≥ 100 %; MRE, 100 % > RE > 50 %; NRE, RE ≤ 50 %) and were analyzed according to the relevant risk factors. Simple regression analyses revealed patient age, transaminases (AST, ALT, GGT), liver, spleen and delta-liver volume (the difference between the volumetrically measured liver volume and the estimated liver volume based on body weight) as significant factors influencing relative enhancement. In the multiple analysis the transaminase AST, spleen and delta liver volume remained significant factors influencing relative enhancement. Delta liver volume showed a significant difference between all analyzed groups. Liver enhancement in the hepatobiliary phase depends on a variety of factors. Body weight-adapted administration of Gd-EOB-DTPA may lead to inadequate liver enhancement after 20 minutes especially when the actual liver volume differs from the expected volume.

  4. Examining Factors Influencing Colorectal Cancer Screening of Rural Nebraskans Using Data from Clinics Participating in an Accountable Care Organization: A Study Protocol [v1; ref status: indexed, http://f1000r.es/5me

    Lufei Young

    2015-07-01

    Full Text Available Background: Although mortality rates of colorectal cancer (CRC can be significantly reduced through increased screening, rural communities are still experiencing lower rates of screening compared to urban counterparts. Understanding and eliminating barriers to cancer screening will decrease cancer burden and lead to substantial gains in quality and quantity of life for rural populations. However, existing studies have shown inconsistent findings and fail to address how contextual and provider-level factors impact CRC screening in addition to individual-level factors.  Purpose: The purpose of the study is to examine multi-level factors related to CRC screening, and providers’ perception of barriers and facilitators of CRC screening in rural patients cared for by accountable care organization (ACO clinics. Methods/Design: This is a convergent mixed method design. For the quantitative component, multiple data sources, such as electronic health records (EHRs, Area Resource File (ARF, and provider survey data, will be used to examine patient-, provider-, clinic-, and county-level factors. About 21,729 rural patients aged between 50 and 75 years who visited the participating ACO clinics in the past 12 months are included in the quantitative analysis. The qualitative methods include semi-structured in-depth interviews with healthcare professionals in selected rural clinics. Both quantitative and qualitative data will be merged for result interpretation. Quantitative data identifies “what” factors influence CRC screening, while qualitative data explores “how” these factors interact with CRC screening. The study setting is 10 ACO clinics located in nine rural Nebraska counties. Discussion: This will be the first study examining multi-level factors related to CRC screening in the new healthcare delivery system (i.e., ACO clinics in rural communities. The study findings will enhance our understanding of how the ACO model, particularly in rural

  5. An exploration of family therapists' beliefs about the ethics of conversion therapy: the influence of negative beliefs and clinical competence with lesbian, gay, and bisexual clients.

    McGeorge, Christi R; Carlson, Thomas Stone; Toomey, Russell B

    2015-01-01

    The majority of the literature on conversion therapy has focused on clients' experiences and rationales for seeking such therapy. This study sought to explore differences in the beliefs and clinical competence of therapists who practice and believe in the ethics of conversion therapy and those who do not. The sample for this study included 762 family therapists who were members of the American Association of Marriage and Family Therapy. Data were collected using electronic surveys that assessed participants' negative beliefs about and perceived clinical competence with lesbian, gay, and bisexual (LGB) individuals. Results indicate that those who believe in the ethics of and/or practice conversion therapy report statistically higher levels of negative beliefs about LGB individuals and lower levels of clinical competence working with LGB clients. Implications for clinical practice and organizational policy are discussed. PMID:24750074

  6. No (Wo)Man Is an Island-The Influence of Physicians' Personal Predisposition to Labia Minora Appearance on Their Clinical Decision Making : A Cross-Sectional Survey

    Reitsma, Welmoed; Mourits, Marian J. E.; Koning, Merel; Pascal, Astrid; van der Lei, Berend

    2011-01-01

    Introduction. Physicians are increasingly presented with women requesting a labia minora reduction procedure. Aim. To assess the influencing factor of personal predisposition in general practitioners, gynecologists, and plastic surgeons to labia minora appearance in relation to their willingness to

  7. A genome-wide association study of cleft lip with and without cleft palate identifies risk variants near MAFB and ABCA4

    Beaty, Terri H; Murray, Jeffrey C; Marazita, Mary L;

    2010-01-01

    Case-parent trios were used in a genome-wide association study of cleft lip with and without cleft palate. SNPs near two genes not previously associated with cleft lip with and without cleft palate (MAFB, most significant SNP rs13041247, with odds ratio (OR) per minor allele = 0.704, 95% CI 0...

  8. The influence of variations in eating disorder-related symptoms on processing of emotional faces in a non-clinical female sample: An eye-tracking study.

    Sharpe, Emma; Wallis, Deborah J; Ridout, Nathan

    2016-06-30

    This study aimed to: (i) determine if the attention bias towards angry faces reported in eating disorders generalises to a non-clinical sample varying in eating disorder-related symptoms; (ii) examine if the bias occurs during initial orientation or later strategic processing; and (iii) confirm previous findings of impaired facial emotion recognition in non-clinical disordered eating. Fifty-two females viewed a series of face-pairs (happy or angry paired with neutral) whilst their attentional deployment was continuously monitored using an eye-tracker. They subsequently identified the emotion portrayed in a separate series of faces. The highest (n=18) and lowest scorers (n=17) on the Eating Disorders Inventory (EDI) were compared on the attention and facial emotion recognition tasks. Those with relatively high scores exhibited impaired facial emotion recognition, confirming previous findings in similar non-clinical samples. They also displayed biased attention away from emotional faces during later strategic processing, which is consistent with previously observed impairments in clinical samples. These differences were related to drive-for-thinness. Although we found no evidence of a bias towards angry faces, it is plausible that the observed impairments in emotion recognition and avoidance of emotional faces could disrupt social functioning and act as a risk factor for the development of eating disorders. PMID:27138825

  9. Interplay between patient global assessment, pain, and fatigue and influence of other clinical disease activity measures in patients with active rheumatoid arthritis

    Egsmose, Emilie Lund; Madsen, Ole Rintek

    2015-01-01

    analog scales (VAS) in the daily clinic by patients with active rheumatoid arthritis (RA). Associations with other measures of disease activity were also examined. Traditional disease activity data on 221 RA patients with active disease planned to initiate biological treatment were extracted from the...

  10. Mediterranean diet or extended fasting's influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study

    Schwickert Myriam

    2005-12-01

    Full Text Available Abstract Background Alterations in the intestinal bacterial flora are believed to be contributing factors to many chronic inflammatory and degenerative diseases including rheumatic diseases. While microbiological fecal culture analysis is now increasingly used, little is known about the relationship of changes in intestinal flora, dietary patterns and clinical outcome in specific diseases. To clarify the role of microbiological culture analysis we aimed to evaluate whether in patients with rheumatoid arthritis (RA or fibromyalgia (FM a Mediterranean diet or an 8-day fasting period are associated with changes in fecal flora and whether changes in fecal flora are associated with clinical outcome. Methods During a two-months-period 51 consecutive patients from an Integrative Medicine hospital department with an established diagnosis of RA (n = 16 or FM (n = 35 were included in the study. According to predefined clinical criteria and the subjects' choice the patients received a mostly vegetarian Mediterranean diet (n = 21; mean age 50.9 +/-13.3 y or participated in an intermittent modified 8-day fasting therapy (n = 30; mean age 53.7 +/- 9.4 y. Quantitative aerob and anaerob bacterial flora, stool pH and concentrations of secretory immunoglobulin A (sIgA were analysed from stool samples at the beginning, at the end of the 2-week hospital stay and at a 3-months follow-up. Clinical outcome was assessed with the DAS 28 for RA patients and with a disease severity rating scale in FM patients. Results We found no significant changes in the fecal bacterial counts following the two dietary interventions within and between groups, nor were significant differences found in the analysis of sIgA and stool ph. Clinical improvement at the end of the hospital stay tended to be greater in fasting vs. non-fasting patients with RA (p = 0.09. Clinical outcome was not related to alterations in the intestinal flora. Conclusion Neither Mediterranean diet nor fasting

  11. A randomised clinical trial on the influence of splinted and unsplinted oral implants in mandibular overdenture therapy. A 3-year report.

    Naert, I E; Gizani, S; Vuylsteke, M; van Steenberghe, D

    1997-06-01

    A randomised clinical trial was performed to investigate whether there is a need or advantage to splint two implants in the mandible retaining a hinging overdenture. Furthermore, patient satisfaction was evaluated for different attachment systems retaining the overdenture. Thirty-six edentulous patients were randomised into three groups of equal size and treated with either magnets, ball attachments or straight bars (reference group). After 3 years of observation no implants were lost in any of the groups. Besides, no statistically significant differences were noted for the peri-implant outcome. Although the bar group presented the highest retention force, the general satisfaction of the patients in the three groups did not differ. The patients with bar retentions showed less prosthetic complications of the retention elements but more at the level of the denture-supporting mucosa. Finally, the clinical outcome of all groups confirms that overdenture treatment demands regular controls with limited time intervals. PMID:9552823

  12. 浅谈临床护理教学质量的影响因素及对策%Influence of Clinic Nursing Teaching Quality and Measure

    朱爱华

    2012-01-01

    临床实习是学校护理教育的深化和延续,要为护理队伍培养出品德高尚、心理素质好、业务精的接班人,就必须不断提高护理临床教学质量,去除不良影响因素。%Clinic practice is an integral part of college nursing education.To educate nurse with noble character,good mental quality and profession it is to improve the quality of nursing teaching with the method of improving clinic teaching,inspiring student nurse motivation to learn,improved teacher comprehensive quality.

  13. The influence of ionizing radiation of high intensity on the functional status of monkey brain. Clinical picture of early postirradiation period

    In experiments with Macaca fascicularis a study was made of early manifestations of the central nervous system (CNS) disturbances caused by exposure to 24 MeV electrons (45 Gy). The results obtained permit us to distinguish two main ways (stereotypes) by which a clinical picture of early postirradiation period develops: comatose and noncomatose. A general clinical characteristic of each stereotype and stages of their development are presented. The postirradiation disturbances of nervous and psychis activity of monkeys are considered within the framework of the concept concerning acute reactions of exogenous type. It is suggested that the course of the early postirradiation period is conditioned by the involvement of some phylogenically determined, universal systemic mechanisms of the CNS response to external harmful effects

  14. Use of the Theory of Planned Behaviour to assess factors influencing the identification of students at clinical high-risk for psychosis in 16+ Education

    Russo, Debra A.; Stochl, Jan; Painter, Michelle; Shelley, Gillian F.; Peter B Jones; Perez, Jesus

    2015-01-01

    Background The longer psychotic disorders are untreated the worse their prognosis. Increasing the awareness of early psychosis by professionals who come into regular contact with young people is one strategy that could reduce treatment delay. As teachers engage with students on a daily basis, their role could be exploited to increase awareness of the early signs of psychosis. This study employed the Theory of Planned Behaviour (TPB) to identify and measure factors that influence identificatio...

  15. Clinical Course of Ophthalmic Findings and Potential Influence Factors of Herpesvirus Infections: 18 Month Follow-Up of a Closed Herd of Lipizzaners

    Rushton, James O.; Jolanta Kolodziejek; Alexander Tichy; Norbert Nowotny; Barbara Nell

    2013-01-01

    BACKGROUND: To date the influence of herpesviruses on the development of equine ocular diseases has not been clearly determined. OBJECTIVE: The purpose of this study was to illustrate the course of equine ocular findings over a period of 18 months at 6 month intervals, in correlation with the results of herpesvirus detection. METHODS: 266 Lipizzaners in 3 federal states of Austria underwent complete ophthalmologic examination 4 times. Blood samples, nasal- and conjunctival swabs were obtained...

  16. Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China

    Qing, Yunbo; Hu, Guijie; Chen, Qingyun; Peng, Hailun; Li, Kailan; Wei, Jinling; Yi, Yanhua

    2015-01-01

    Purpose: To produce competent undergraduate-level medical doctors for rural township health centers (THCs), the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs) starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. Methods: An internet-ba...

  17. Clinical predictors of severe cerebral amyloid angiopathy and influence of APOE genotype in persons with pathologically-verified Alzheimer’s disease

    Ringman, John M.; Sachs, Michael C.; Zhou, Yan; Monsell, Sarah E.; Saver, Jeffrey L.; Vinters, Harry V.

    2014-01-01

    Importance Though cerebral amyloid angiopathy (CAA) has important clinical implications, our understanding of it and ability to diagnose it is limited. Objective We sought to determine pathological correlates and clinical factors identifiable during life that predict the presence of severe CAA in persons with pathologically-confirmed Alzheimer’s disease (AD). Design We compared demographic and clinical variables at the earliest visit during life at which subjects were found to have cognitive impairment, and pathological variables between persons ultimately found to have no or severe CAA at autopsy using logistic regression. Analyses were repeated separately for carriers and non-carriers of the APOE ε4 allele. Setting Data were obtained from the Uniform Data Set that comprises longitudinal clinical assessments performed in the Alzheimer’s Disease Centers funded by the National Institute on Aging. Participants 193 persons with severe CAA and 232 persons with no CAA. All subjects had cognitive impairment and met NIA-Reagan neuropathological criteria for AD. Main Outcome Measures Prevalence of demographic characteristics and the APOE ε4 allele and odds ratios of clinical variables for the prediction of severe CAA. Results Persons with severe CAA were more likely to carry an APOE ε4 allele (64.9% vs. 42.8%), to be Hispanic (6.8% vs. 1.3%, p = 0.003), to have had a transient ischemic attack (TIA, 12.5% vs. 6.1%, OR = 2.1, 95% CI = 1 – 4.4), and had lower degrees of diffuse amyloid plaque pathology (mean CERAD scores 1.2 vs. 1.4, p = 0.01) than persons with no CAA. Intracerebral hemorrhage (9.3% vs. 3.5%, p = 0.01), cortical microinfarcts (20.7% vs. 12.9%, p = 0.03), and subcortical leukoencephalopathy (20.5% vs. 12.1%, p = 0.02) were more common in persons with CAA. A higher prevalence of stroke (11.1% vs. 3.9%, OR = 3.8, 95% CI 1.0 – 14.6) and hypercholesterolemia (50% vs. 33.3%, OR = 2.3, CI 1.1 – 4.7) were found in non-carriers of the ε4 allele with

  18. Influence of HIV infection on the clinical presentation and outcome of adults with acute community-acquired pneumonia in Yaounde, Cameroon: a retrospective hospital-based study

    Yone Eric Walter

    2012-08-01

    Full Text Available Abstract Background The impact of HIV infection on the evolution of acute community-acquired pneumonia (CAP is still controversial. The aim of this study was to investigate possible differences in the clinical presentation and in-hospital outcomes of patients with CAP with and without HIV infection in a specialised service in Yaounde. Methods Medical files of 106 patients (51 men aged 15 years and above, admitted to the Pneumology service of the Yaounde Jamot Hospital between January 2008 and May 2012, were retrospectively studied. Results Sixty-two (58.5% patients were HIV infected. The median age of all patients was 40 years (interquartile range: 31.75-53 and there was no difference in the clinical and radiological profile of patients with and without HIV infection. The median leukocyte count (interquartile range was 14,600/mm3 (10,900-20,600 and 10,450/mm3 (6,400-16,850 respectively in HIV negative and HIV positive patients (p = 0.002. Median haemoglobin level (interquartile range was 10.8 g/dl (8.9-12 in HIV negative and 9.7 g/dl (8–11.6 in HIV positive patients (p = 0.025. In-hospital treatment failure on third day (39.5% vs. 25.5.1%, p = 0.137 and mortality rates (9% vs. 14.5%, p = 0.401 were similar between HIV negative and HIV positive patients. Conclusion Clinical and radiological features as well as response to treatment and in hospital fatal outcomes are similar in adult patients hospitalised with acute community-acquired pneumonia in Yaounde. In contrast, HIV infected patients tend to be more anaemic and have lower white cell counts than HIV negative patients. Larger prospective studies are needed to consolidate these findings.

  19. Study of the positioning of the films of the MLC by a Test of bands and your influence in the clinic dosimetry in IMRT

    We performed a test of adjacent bands inspired by the proposed in AAPM Report No. 72, we provides a parameter characterizing the state of the MLC as to the actual position of its blades. This test has been validated by studying repeatability and reproducibility and has found the correlation between the parameter and creep detected by the ILD. Subsequently it has studied the impact of changes in the positioning of the blades on clinical dosimetry in IMRT patients, reconstructing the patient dose by Matrix Evolution team and Compass software, IBA Dosimetry. (Author)

  20. Hydrocortisone concentration influences time to clinically significant healing of acute inflammation of the ocular surface and adnexa – results from a double-blind randomized controlled trial

    Sergiyenko, Nikolay; Sukhina, Ludmila; Bezdetko, Pavel; Kovalenko, Yuriy; Nikitin, Nikolai; Merzberger, Matthias; Groß, Dorothea; Kohnen, Ralf

    2014-01-01

    Background The efficacy of topical ophthalmic corticosteroids depends upon small modifications in preparations, such as drug concentration. The aim of this study was to confirm that hydrocortisone acetate (HC-ac) ophthalmic ointments of 2.5% and 1% are more effective than a 0.5% eye ointment. Methods In this randomized, double-blind, placebo-controlled, parallel-group clinical study, the change of signs and symptoms of acute inflammation of the ocular surface and adnexa was evaluated in 411 s...

  1. Standardized manual palpation of myofascial trigger points in relation to neck/shoulder pain; the influence of clinical experience on inter-examiner reproducibility

    Myburgh, Corrie; Lauridsen, Henrik Hein; Larsen, Anders H;

    2011-01-01

    A diagnosis of Myofascial Pain Syndrome (MPS) requires palpation for the identification of at least one clinically relevant trigger point (TP). However, few comparable, high quality studies currently exist from which to draw firm conclusions regarding the robustness of TP examination. An inter...... asymptomatic and the remainder suffering from neck/shoulder pain. Examiners received psychomotor skills training and video feedback analysis to improve protocol standardization. Kappa co-efficient calculations indicated good agreement between the experienced pairing (κ = 0.63), moderate agreement between the...

  2. Influence of interleukin-8 (IL-8) and IL-8 receptors on the migration of human keratinocytes, the role of PLC-γ and potential clinical implications

    Jiang, Wen G; Sanders, Andrew J.; Ruge, Fiona; HARDING, KEITH G.

    2011-01-01

    Interleukin (IL)-8 is a pro-inflammatory cytokine that has a direct effect on immune cells, including polymorphonuclear cells. Keratinocytes are a rich source of IL-8. However, there is little knowledge on the role of IL-8 in clinical wound healing and the direct biological effect of IL-8 on keratinocytes. In this study, the effect of recombinant human IL-8 (rhIL-8) on migration and adhesion was tested using HaCaT keratinocytes as a cell model. The cell functions were evaluated using impedanc...

  3. Dietary beliefs and eating patterns influence metabolic health in type 2 diabetes: A clinic-based study in urban North India

    Colles, Susan L.; Shweta Singh; Chhavi Kohli; Ambrish Mithal

    2013-01-01

    Background: Almost 15% of India′s urban adult populace now lives with type 2 diabetes. This study aimed to characterize the eating patterns, knowledge, beliefs, and determinants of food choice, and assess associations with the metabolic health among urban Asian Indians with type 2 diabetes. Materials and Methods: A cross-sectional study of 258 individuals (mean age 55.7 ± 10 years; body mass index 27.1 ± 4.8 kg/m 2 ; diabetes duration 10.1 ± 6.5 years) attending two out-patient clinics in New...

  4. Influence of treatment with alendronate on the speed of sound, an ultrasound parameter, of the calcaneus in postmenopausal Japanese women with osteoporosis: a clinical practice-based observational study

    Iwamoto J

    2012-06-01

    Full Text Available Jun Iwamoto,1 Tetsuya Takada,2 Yoshihiro Sato,3 Hideo Matsumoto11Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, 2Department of Internal Medicine, Hiyoshi Medical Clinic, Kanagawa, 3Department of Neurology, Mitate Hospital, Fukuoka, JapanPurpose: The influence of alendronate (ALN treatment on the quantitative ultrasound parameters of the calcaneus remains to be established in Japanese patients. The aim of the present clinical practice-based observational study was to examine the influence of ALN treatment for 1 year on the speed of sound (SOS of the calcaneus and bone turnover markers in postmenopausal Japanese women with osteoporosis.Patients and methods: Forty-five postmenopausal Japanese women with osteoporosis who had received treatment with ALN for more than 1 year were enrolled in the study. The SOS and bone turnover markers were monitored over 1 year of ALN treatment.Results: The urinary levels of cross-linked N-terminal telopeptides of type I collagen and serum levels of alkaline phosphatase decreased significantly from the baseline values (–44.9% at 3 months and –22.2% at 12 months, respectively. The SOS increased modestly, but significantly, from the baseline value (0.6% at both 6 and 12 months. The percentage decrease in the urinary levels of cross-linked N-terminal telopeptides of type I collagen at 3 months was significantly correlated with the percentage increase in the SOS only at 6 months (correlation coefficient, 0.299.Conclusion: The present study confirmed that ALN treatment suppressed bone turnover, producing a clinically significant increase in the SOS of the calcaneus in postmenopausal Japanese women with osteoporosis.Keywords: postmenopausal osteoporosis, quantitative ultrasound (QUS, SOS, bone turnover, biochemical markers

  5. Dosimetry, clinical factors and medication intake influencing urinary symptoms after prostate radiotherapy: An analysis of data from the RADAR prostate radiotherapy trial

    Purpose/objective: To identify dosimetry, clinical factors and medication intake impacting urinary symptoms after prostate radiotherapy. Material and methods: Data describing clinical factors and bladder dosimetry (reduced with principal component (PC) analysis) for 754 patients treated with external beam radiotherapy accrued by TROG 03.04 RADAR prostate radiotherapy trial were available for analysis. Urinary symptoms (frequency, incontinence, dysuria and haematuria) were prospectively assessed using LENT-SOMA to a median of 72 months. The endpoints assessed were prevalence (grade ⩾1) at the end of radiotherapy (representing acute symptoms), at 18-, 36- and 54-month follow-ups (representing late symptoms) and peak late incidence including only grade ⩾2. Impact of factors was assessed using multivariate logistic regression models with correction for over-optimism. Results: Baseline symptoms, non-insulin dependent diabetes mellitus, age and PC1 (correlated to the mean dose) impact symptoms at >1 timepoints. Associations at a single timepoint were found for cerebrovascular condition, ECOG status and non-steroidal anti-inflammatory drug intake. Peak incidence analysis shows the impact of baseline, bowel and cerebrovascular condition and smoking status. Conclusions: The prevalence and incidence analysis provide a complementary view for urinary symptom prediction. Sustained impacts across time points were found for several factors while some associations were not repeated at different time points suggesting poorer or transient impact

  6. INFLUENCE OF LOCAL RONKOLEIKIN TREATMENT UPON CLINICAL COURSE OF PURULENT WOUNDS AND FUNCTIONAL ACTIVITY OF WOUND PHAGOCYTES IN PATIENTS WITH ODONTOGENIC PHLEGMONAE

    I. I. Dolgushin

    2009-01-01

    Full Text Available Abstract. The aim of the work was to evaluate clinical features of purulent wounds trend and functional activity of local wound phagocytes in the patients with odontogenic phlegmones in the course of local treatment with Ronkoleukin. A randomized clinical study was performed which included sixty-five patients with odontogenic phlegmones. Their age ranged from 18 to 74 years old. The group was divided in two parts, i.e., patients of a comparison group (n = 33 receiving a conventional combined drug therapy, and the persons from study group (n = 32 who were subject to local immunotherapy with Ronkoleukin, applied along with conventional therapy. It was established that the local therapy with Ronkoleikin exerts distinct positive effects, i.e., increase in wound-located lymphocytes and macrophages, acceleration of phasic dynamics of inflammatory events, augmentation of an lysosomal luminescence index (2.3-fold, enhancement of phagocytosis intensity in wound neutrophiles and macrophages (1.9-2-fold, strengthening the reserve abilities of wound neutrophils (1.3-fold. These effects create favorable conditions for elimination of pathogen and optimal healing of purulent wounds in the patients with odontogenic phlegmones.

  7. The influence of psychoeducation on regulating biological rhythm in a sample of patients with bipolar II disorder: a randomized clinical trial

    Faria AD

    2014-06-01

    Full Text Available Augusto Duarte Faria,1 Luciano Dias de Mattos Souza,2 Taiane de Azevedo Cardoso,2 Karen Amaral Tavares Pinheiro,2 Ricardo Tavares Pinheiro,2 Ricardo Azevedo da Silva,2 Karen Jansen21Department of Clinical and Health Psychology, Universidade Federal do Rio Grande – FURG, Rio Grande, RS, Brazil; 2Health and Behavior Postgraduate Program, Universidade Católica de Pelotas – UCPEL, Pelotas, RS, BrazilIntroduction: Changes in biological rhythm are among the various characteristics of bipolar disorder, and have long been associated with the functional impairment of the disease. There are only a few viable options of psychosocial interventions that deal with this specific topic; one of them is psychoeducation, a model that, although it has been used by practitioners for some time, only recently have studies shown its efficacy in clinical practice.Aim: To assess if patients undergoing psychosocial intervention in addition to a pharmacological treatment have better regulation of their biological rhythm than those only using medication.Method: This study is a randomized clinical trial that compares a standard medication intervention to an intervention combined with drugs and psychoeducation. The evaluation of the biological rhythm was made using the Biological Rhythm Interview of Assessment in Neuropsychiatry, an 18-item scale divided in four areas (sleep, activity, social rhythm, and eating pattern. The combined intervention consisted of medication and a short-term psychoeducation model summarized in a protocol of six individual sessions of 1 hour each.Results: The sample consisted of 61 patients with bipolar II disorder, but during the study, there were 14 losses to follow-up. Therefore, the final sample consisted of 45 individuals (26 for standard intervention and 19 for combined. The results showed that, in this sample and time period evaluated, the combined treatment of medication and psychoeducation had no statistically significant impact on the

  8. The influence of different contrast medium concentrations and injection protocols on quantitative and clinical assessment of FDG–PET/CT in lung cancer

    Verburg, Frederik A., E-mail: fverburg@ukaachen.de [RWTH Aachen University Hospital, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany); Maastricht University Medical Center, Department of Nuclear Medicine, P. Debyelaan 25, 6229 HX Maastricht (Netherlands); Kuhl, Christiane K. [RWTH Aachen University Hospital, Department of Diagnostic and Interventional Radiology, Pauwelsstraße 30, 52074 Aachen (Germany); Pietsch, Hubertus [Bayer Pharma AG, Berlin, Müllerstrasse 178, 13353 Berlin (Germany); Palmowski, Moritz [RWTH Aachen University Hospital, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany); Mottaghy, Felix M. [RWTH Aachen University Hospital, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany); Maastricht University Medical Center, Department of Nuclear Medicine, P. Debyelaan 25, 6229 HX Maastricht (Netherlands); Behrendt, Florian F. [RWTH Aachen University Hospital, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany)

    2013-10-01

    Objectives: To compare the effects of two different contrast medium concentrations for use in computed X-ray tomography (CT) employing two different injection protocols on positron emission tomography (PET) reconstruction in combined 2-{sup 18}F-desoxyglucose (FDG) PET/CT in patients with a suspicion of lung cancer. Methods: 120 patients with a suspicion of lung cancer were enrolled prospectively. PET images were reconstructed with the non-enhanced and venous phase contrast CT obtained after injection of iopromide 300 mg/ml or 370 mg/ml using either a fixed-dose or a body surface area adapted injection protocol. Maximum and mean standardized uptake values (SUVmax and SUVmean) and contrast enhancement (HU) were determined in the subclavian vein, ascending aorta, abdominal aorta, inferior vena cava, portal vein, liver and kidney and in the suspicious lung lesion. PET data were evaluated visually for the presence of malignancy and image quality. Results: At none of the sites a significant difference in the extent of the contrast enhancement between the four different protocols was found. However, the variability of the contrast enhancement at several anatomical sites was significantly greater in the fixed dose groups than in the BSA groups for both contrast medium concentrations. At none of the sites a significant difference was found in the extent of the SUVmax and SUVmean increase as a result of the use of the venous phase contrast enhanced CT for attenuation. Visual clinical evaluation of lesions showed no differences between contrast and non-contrast PET/CT (P = 0.32). Conclusions: Contrast enhanced CT for attenuation correction in combined PET/CT in lung cancer affects neither the clinical assessment nor image quality of the PET-images. A body surface adapted contrast medium protocol reduces the interpatient variability in contrast enhancement.

  9. The influence of different contrast medium concentrations and injection protocols on quantitative and clinical assessment of FDG–PET/CT in lung cancer

    Objectives: To compare the effects of two different contrast medium concentrations for use in computed X-ray tomography (CT) employing two different injection protocols on positron emission tomography (PET) reconstruction in combined 2-18F-desoxyglucose (FDG) PET/CT in patients with a suspicion of lung cancer. Methods: 120 patients with a suspicion of lung cancer were enrolled prospectively. PET images were reconstructed with the non-enhanced and venous phase contrast CT obtained after injection of iopromide 300 mg/ml or 370 mg/ml using either a fixed-dose or a body surface area adapted injection protocol. Maximum and mean standardized uptake values (SUVmax and SUVmean) and contrast enhancement (HU) were determined in the subclavian vein, ascending aorta, abdominal aorta, inferior vena cava, portal vein, liver and kidney and in the suspicious lung lesion. PET data were evaluated visually for the presence of malignancy and image quality. Results: At none of the sites a significant difference in the extent of the contrast enhancement between the four different protocols was found. However, the variability of the contrast enhancement at several anatomical sites was significantly greater in the fixed dose groups than in the BSA groups for both contrast medium concentrations. At none of the sites a significant difference was found in the extent of the SUVmax and SUVmean increase as a result of the use of the venous phase contrast enhanced CT for attenuation. Visual clinical evaluation of lesions showed no differences between contrast and non-contrast PET/CT (P = 0.32). Conclusions: Contrast enhanced CT for attenuation correction in combined PET/CT in lung cancer affects neither the clinical assessment nor image quality of the PET-images. A body surface adapted contrast medium protocol reduces the interpatient variability in contrast enhancement

  10. Dietary beliefs and eating patterns influence metabolic health in type 2 diabetes: A clinic-based study in urban North India

    Susan L Colles

    2013-01-01

    Full Text Available Background: Almost 15% of India′s urban adult populace now lives with type 2 diabetes. This study aimed to characterize the eating patterns, knowledge, beliefs, and determinants of food choice, and assess associations with the metabolic health among urban Asian Indians with type 2 diabetes. Materials and Methods: A cross-sectional study of 258 individuals (mean age 55.7 ± 10 years; body mass index 27.1 ± 4.8 kg/m 2 ; diabetes duration 10.1 ± 6.5 years attending two out-patient clinics in New Delhi, India. Food-related information was collected during a semi-structured interview. Clinical, anthropometric, and biochemical data were recorded. Results: Beliefs related to health and diabetes played a role determining food choice and dietary patterns; erroneous views were associated with the poor food choices and greater metabolic perturbations. Average consumption of fruits/vegetables was low. Intakes were positively associated with intentions to manage diabetes; inversely associated with the waist circumference and negatively correlated with one′s degree of personal responsibility for food choice. Household saturated fat usage was common. High fat intakes were positively associated with the taste preference, ratings of perceived "health-value;" waist circumference, glycosylated haemoglobin percentage (HbA1c% and lipids. Conclusions: Strategies to enhance diabetes control among Asian Indians are required and should encourage fruit/vegetable intake, personal accountability, and consider individual beliefs and preferences. Greater emphasis and resources directed to regular dietary and behavioral counseling may assist.`

  11. 运用自我SWOT分析模型对实习生临床护理能力影响的研究%Study on influence of self SWOT analysis model on clinical nursing ability of interns

    黎剑云; 韦丽华; 吴彬; 徐冬英; 黄秋萍; 陈文玲; 黄柱英; 刘礼礼; 蒙金

    2014-01-01

    [目的]探讨运用自我 SWOT 分析模型对实习生临床护理能力的影响。[方法]将护理实习生84人按照分层随机分配原则,分为试验组与对照组,每组42人;对照组采用常规临床护理实习生培养计划进行培养,试验组则在培养过程中对实习生使用自我 SWOT 分析模型进行带教。[结果]两组临床护理能力、病人满意度、理论考试成绩差异有统计学意义(P<0.05)。[结论]在临床带教过程中运用自我 SWOT 分析模型可提高护理实习生临床护理能力,增加实习生对临床护理的认识,得到病人的认可。%Obj ective:To probe into the influence of self SWOT analysis model on the clinical nursing ability of interns.Methods:A total of 84 nursing interns were randomly divided into experimental group and con-trol group based on stratified random allocation principles,42 cases in each.The patients in control group were trained with the routine training program of clinical nursing interns,while in experimental group the self SWOT analysis model was used for teaching of interns during the train-ing.Results:There was statistically significant difference in clinical nurs-ing ability,patients’satisfaction and the examination marks between ex-perimental group and control group(P<0.05).Conclusion:During clini-cal teaching,self SWOT analysis model can promote the clinical nursing ability of nursing interns,increase the cognition of interns on clinical nursing,and make the nursing interns get the patients’approval.

  12. Interaction of MIF Family Proteins in Myocardial Ischemia/Reperfusion Damage and Their Influence on Clinical Outcome of Cardiac Surgery Patients

    Rex, Steffen; Goetzenich, Andreas; Kraemer, Sandra; Emontzpohl, Christoph; Soppert, Josefin; Averdunk, Luisa; Sun, Yu; Rossaint, Rolf; Lue, Hongqi; Huang, Caleb; Song, Yan; Pantouris, Georgios; Lolis, Elias; Leng, Lin; Schulte, Wibke; Bucala, Richard; Weber, Christian

    2015-01-01

    Abstract Aims: Cardiac surgery involves myocardial ischemia/reperfusion (I/R) with potentially deleterious consequences. Macrophage migration inhibitory factor (MIF) is a stress-regulating chemokine-like cytokine that protects against I/R damage, but functional links with its homolog, d-dopachrome tautomerase (MIF-2), and the circulating soluble receptor CD74 (sCD74) are unknown. In this study, we investigate the role of MIF, MIF-2, sCD74, and MIF genotypes in patients scheduled for elective single or complex surgical procedures such as coronary artery bypass grafting or valve replacement. Results: MIF and MIF-2 levels significantly increased intraoperatively, whereas measured sCD74 decreased correspondingly. Circulating sCD74/MIF complexes were detectable in 50% of patients and enhanced MIF antioxidant activity. Intraoperative MIF levels were independently associated with a reduced risk for the development of atrial fibrillation (AF) (odds ratio 0.99 [0.98–1.00]; p=0.007). Circulating levels of MIF-2, but not MIF, were associated with an increased frequency of organ dysfunction and predicted the occurrence of AF (area under the curve [AUC]=0.663; p=0.041) and pneumonia (AUC=0.708; p=0.040). Patients with a high-expression MIF genotype exhibited a reduced incidence of organ dysfunction compared with patients with low-expression MIF genotypes (3 vs. 25; p=0.042). Innovation: The current study comprehensively highlights the kinetics and clinical relevance of MIF family proteins and the MIF genotype in cardiac surgery patients. Conclusion: Our findings suggest that increased MIF levels during cardiac surgery feature organ-protective properties during myocardial I/R, while the soluble MIF receptor, sCD74, may enhance MIF antioxidant activity. In contrast, high MIF-2 levels are predictive of the development of organ dysfunction. Importantly, we provide first evidence for a gene–phenotype relationship between variant MIF alleles and clinical outcome in cardiac

  13. Influence of vitamin D status and vitamin D3 supplementation on genome wide expression of white blood cells: a randomized double-blind clinical trial.

    Arash Hossein-nezhad

    Full Text Available BACKGROUND: Although there have been numerous observations of vitamin D deficiency and its links to chronic diseases, no studies have reported on how vitamin D status and vitamin D3 supplementation affects broad gene expression in humans. The objective of this study was to determine the effect of vitamin D status and subsequent vitamin D supplementation on broad gene expression in healthy adults. (Trial registration: ClinicalTrials.gov NCT01696409. METHODS AND FINDINGS: A randomized, double-blind, single center pilot trial was conducted for comparing vitamin D supplementation with either 400 IUs (n = 3 or 2000 IUs (n = 5 vitamin D3 daily for 2 months on broad gene expression in the white blood cells collected from 8 healthy adults in the winter. Microarrays of the 16 buffy coats from eight subjects passed the quality control filters and normalized with the RMA method. Vitamin D3 supplementation that improved serum 25-hydroxyvitamin D concentrations was associated with at least a 1.5 fold alteration in the expression of 291 genes. There was a significant difference in the expression of 66 genes between subjects at baseline with vitamin D deficiency (25(OHD20 ng/ml. After vitamin D3 supplementation gene expression of these 66 genes was similar for both groups. Seventeen vitamin D-regulated genes with new candidate vitamin D response elements including TRIM27, CD83, COPB2, YRNA and CETN3 which have been shown to be important for transcriptional regulation, immune function, response to stress and DNA repair were identified. CONCLUSION/SIGNIFICANCE: Our data suggest that any improvement in vitamin D status will significantly affect expression of genes that have a wide variety of biologic functions of more than 160 pathways linked to cancer, autoimmune disorders and cardiovascular disease with have been associated with vitamin D deficiency. This study reveals for the first time molecular finger prints that help explain the nonskeletal health

  14. Influence of the CYP2D6 isoenzyme in patients treated with venlafaxine for major depressive disorder: clinical and economic consequences.

    Antoni Sicras-Mainar

    Full Text Available Antidepressant drugs are the mainstay of drug therapy for sustained remission of symptoms. However, the clinical results are not encouraging. This lack of response could be due, among other causes, to factors that alter the metabolism of the antidepressant drug.to evaluate the impact of concomitant administration of CYP2D6 inhibitors or substrates on the efficacy, tolerability and costs of patients treated with venlafaxine for major depressive disorder in clinical practice.We designed an observational study using the medical records of outpatients. Subjects aged ≥ 18 years who started taking venlafaxine during 2008-2010 were included. Three study groups were considered: no combinations (reference, venlafaxine-substrate, and venlafaxine-inhibitor. The follow-up period was 12 months. The main variables were: demographic data, comorbidity, remission (Hamilton <7, response to treatment, adverse events and costs. The statistical analysis included logistic regression models and ANCOVA, with p values <0.05 considered significant.A total of 1,115 subjects were recruited. The mean age was 61.7 years and 75.1% were female. Approximately 33.3% (95% CI: 30.5 to 36.1 were receiving some kind of drug combination (venlafaxine-substrate: 23.0%, and venlafaxine-inhibitor: 10.3%. Compared with the venlafaxine-substrate and venlafaxine-inhibitor groups, patients not taking concomitant drugs had a better response to therapy (49.1% vs. 39.9% and 34.3%, p<0.01, greater remission of symptoms (59.9% vs. 50.2% and 43.8%, p<0.001, fewer adverse events (1.9% vs. 7.0% and 6.1%, p<0.05 and a lower mean adjusted cost (€2,881.7 vs. €4,963.3 and €7,389.1, p<0.001, respectively. All cost components showed these differences.The patients treated with venlafaxine alone showed a better response to anti-depressant treatment, greater remission of symptoms, a lower incidence of adverse events and lower healthcare costs.

  15. The influence of emotion-focused rumination and distraction on depressive symptoms in non-clinical youth: a meta-analytic review.

    Rood, Lea; Roelofs, Jeffrey; Bögels, Susan M; Nolen-Hoeksema, Susan; Schouten, Erik

    2009-11-01

    This review examined evidence for some core predictions of the response styles theory (RST) concerning the relation between response styles and symptoms of depression and gender differences in the use of response styles in non-clinical children and adolescents. In summarizing the literature, effect sizes (pooled correlation coefficients) were calculated for cross-sectional and longitudinal studies. Stability of the obtained effect sizes was evaluated by means of a fail-safe N analysis. Results indicated that stable and significant effect sizes were found for rumination being associated with concurrent and future levels of depression. When controlling for baseline levels of depression, effect sizes for rumination and distraction were not stable, indicating that these findings should be interpreted with considerable caution. Finally, significant and stable effect sizes for gender differences in response styles were found only for rumination among adolescents. Taken together, the findings partly support the predictions of the response styles theory examined in this meta-analysis and may implicate that rumination is a cognitive vulnerability factor for depressive symptoms among adolescents. PMID:19682781

  16. Clinical Observation on Influence of Chinese Medicines for Promoting Blood Circulation to Remove Blood Stasis on FIB and DD in Plasma of Patients with Cerebral Thrombosis

    梁晖; 陈甦; 陈少芳

    2002-01-01

    Objective: to study the influence of Chinese medicines for promoting blood circulation to remove blood stasis on fibrinogen (FIB) and D-dimer (DD) in plasma of patients with cerebral thrombosis. Method: 73 inpatients with acute cerebral thrombosis were randomly divided into a control group of 34 cases and a treatment group of 39 cases. The content of FIB and DD in plasma was detected before treatment and on the 7th and 14th days after treatment. Result: FIB content in plasma after treatment was lower than that before treatment in the control group (P<0.01) and more remarkable in the treatment group (P<0.001). There was an obvious difference in DD content before and after treatment in both groups. DD content on the 7th and 14th days after treatment in the treatment group was obviously higher than that in the control group (P<0.01 and P<0.05 respectively). Conclusion: Chinese medicines for promoting blood circulation to remove blood stasis can reduce the FIB content in plasma of patients with cerebral thrombosis, raise the DD content in plasma, cause the peak of DD content appear earlier and obviously improve hypercoagulability of blood in patients with cerebral thrombosis.

  17. Influence of clinical and radiological variables on the extent and distribution of periprosthetic osteolysis in total hip arthroplasty with a hydroxyapatite-coated multiple-hole acetabular component: a magnetic resonance imaging study.

    Pérez-Coto, Iván; Hernández-Vaquero, Daniel; Suárez-Vázquez, Abelardo; Sandoval-García, Manuel Ángel; Escandon-Rodriguez, Ana

    2014-10-01

    Polyethylene wear-induced osteolysis constitutes the most severe long-term complication of total hip arthroplasties (THA). Our aim was to assess through MRI the severity and growth pattern of osteolysis, as well as the influence clinical-radiographic variables exert. We analyzed 75 THA with an average evolution time of 13.67years. The implant was a titanium alloy, non-cemented, multiple-hole model with hydroxyapatite coating. Osteolysis was found with a peripheral pattern in 48 and a central pattern in 6; in 52 cases it was continuous, and in 4, isolated. Out of 118 screws, 20 exhibited lysis. There was a proportional correlation between osteolysis severity and wear rate with age, physical activity and acetabular abduction, as well as an association between said variables and peripheral and continuous patterns. PMID:24986509

  18. 影响药物非临床安全性评价的供试品相关问题%Factors Related to Test Articles Influencing Non-clinical Safety Evaluation of Drugs

    苏敏; 王京昆

    2015-01-01

    Objective:To promote the effective management of test articles to avoid unnecessary mistakes and losses in the process of new drug research and development. Methods:Based on work experience and peer exchanges, the main issues related to test articles and inlfuencing factors in non-clinical safety evaluation were summarized and sorted.Results:In this paper, the influence of issues related to test articles and influencing factors in drug safety evaluation were revealed from different aspects.Conclusion:Only by attaching importance to the problems in all links of test article management and constantly improving the management, can the accuracy and reliability of results of non-clinical safety evaluation be guaranteed.%目的:促进供试品有效管理,避免新药研发过程中不必要的失误和损失。方法:通过自身工作实践及同行交流,对主要影响药物非临床安全性评价的供试品相关问题及因素进行梳理和总结。结果:从不同角度揭示了影响药物安全性评价的供试品相关问题。结论:只有全面重视供试品管理中各个环节的问题,并不断提高和完善,才能真正保障新药安全性评价结果的准确和可靠。

  19. Syncope as a health risk for soldiers:Influence of medical history and clinical findings on the sensitivity of head-up tilt table testing

    Hans-Joachim Gilfrich; Lena Marie Heidelmann; Franziska Grube; Hagen Frickmann; Sven Andreas Jungblut

    2015-01-01

    Background: Syncope is a relevant health problem in military environments. Reliable diagnosis is challenging. Tilt table testing is an important tool for syncope diagnosis. The aim of this study was to determine whether signs such as prodromal symptoms, co-morbidity, frequency of syncopal events, body length, body mass index, and electrocardiography (ECG) abnormalities can be used to predict the success of tilt table testing at diagnosing syncope. Methods: Data from 100 patients with histories of syncope or pre-syncope, who were diagnosed using head-up tilt table testing, were retrospectively analyzed in a cross-sectional analysis. The diagnostic procedure was based upon a modified version of the Westminster protocol without any pharmacological provocation. Results: Patients showing pathological reaction patterns during tilt table testing suffered from prodromal symptoms, such as dizziness and sweating, significantly more often. The patients reported more injuries resulting from syncopal events and more previous syncopal events, and the prevalence of co-morbidity was greater among patients presenting negative findings during tilt testing. An asthenic-leptosomal physique was not confirmed as a risk factor for syncopal events as is the case for idiopathic arterial hypotension. However, patients with pathological reaction patterns during tilt table testing were significantly taller. This finding was detected for both females and males. No significant predictors were found in the ECG patterns of patients showing syncope during tilt table testing. Conclusions: Frequency of prior syncope and prodromal symptoms, and increased body length with an otherwise good state of health influence the predictive value of tilt table testing for syncope diagnosis. In particular, if these factors are present, tilt table testing should be considered part of the diagnostic algorithm for soldiers with recurrent syncope.

  20. Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China

    Yunbo Qing

    2015-07-01

    Full Text Available Purpose: To produce competent undergraduate-level medical doctors for rural township health centers (THCs, the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. Methods: An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. Results: Among 4,669 medical students, 1,523 (33% had a positive attitude and 2,574 (55% had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary. Conclusion: Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.

  1. The influence of resistance exercise with emphasis on specific contractions (concentric vs. eccentric on muscle strength and post-exercise autonomic modulation: a randomized clinical trial

    Mariana O. Gois

    2014-01-01

    Full Text Available Background: Compared to eccentric contractions, concentric contractions result in higher cardiovascular stress. However, we do not know how these two types of contractions influence cardiac autonomic modulation during the post-exercise recovery period. Objective: to compare the effect of resistance training that is performed with concentric vs. eccentric emphasis on muscle strength and on post-exercise recovery which was assessed by examining heart rate variability (HRV, for the knee extensor muscle group in young healthy adults. Methods: For this study, 105 men between 18 and 30 years of age were randomized into 4 groups: concentric control (CONCC, eccentric control (ECCC, concentric training (CONCT and eccentric training (ECCT. The CONCC and ECCC groups underwent one session of resistance exercise (RE using the knee extensor muscle group (3 sets of 1 repetition at 100% of the maximal repetition [1MR] and the CONCT and ECCT groups performed 10 training sessions. The HRV was analyzed at baseline and across four recovery periods (T1, T2, T3 and T4. Results: The ECCT group exhibited increased muscle strength at the end of the study. Regarding cardiac autonomic modulation, the CONCC and ECCC groups exhibited increases in overall variability (SDNN and SD2 at T1 compared to baseline, and the ECCT group demonstrated increases in variables reflecting vagal modulation and the recovery process (RMSSD, SD1 and HF [ms2] at T1, T2 and T4 compared to baseline. Conclusions: Resistance training with emphasis on eccentric contractions promoted strength gain and an increase in cardiac vagal modulation during recovery compared to baseline.

  2. CLINICAL BIOCHEMISTRY

    Assessment of the health status of animals through measurement of cellular, biochemical, and macromolecular constituents in blood, secretions, and excretions has been variously referred to as clinical chemistry, clinical biochemistry, or clinical pathology. he genesis of this dis...

  3. Influence of sequence protocol variations on MR image texture at 3.0 Tesla : implications for texture-based pattern classification in a clinical setting

    The purpose of our study project was to (1) investigate the sensitivity of quantitative texture features of different categories to clinically feasible variations of NA (number of acquisitions), TR (repetition time), TE (echo time), and SBW (sampling bandwidth), and the dependence of such sensitivity on the spatial resolution; (2) determine whether MR image interpolation at the pixel or k-space level can enhance textural differences between tissues with physically different patterns; and (3) assess the feasibility of texture analysis for classification of liver cysts and hemangiomas on routine, non-enhanced T1- and T2-weighted MR images, respectively, at 3.0 Tesla. To determine the sensitivities of texture features, as well as the effects of MR image interpolation, we used PSAG (polystyrene spheres and agar gel) phantoms with different sphere sizes, ranging from 0.8 to 3.15 mm, as test objects, and a micro-imaging gradient insert for acquisition of high-resolution, T2-weighted MSME sequences. The results of these experiments clearly show that, although texture features of all categories are increasingly sensitive to acquisition parameter variations with increasing spatial resolution, variations of NA, TR, TE, and SBW have little effect on the results of pattern discrimination, as long as the resolution is sufficiently high. Co-occurrence matrix features are particularly useful for pattern discrimination if datasets are heterogeneous with regard to different acquisition parameters, including spatial resolution. MR image interpolation can improve the results of pattern classification, at least based on texture features derived from the co-occurrence matrix, run-length matrix, or absolute gradient. Unless spatial resolution is very poor, zero-filling is the interpolation technique of choice. For this reason, zero-fill interpolation was used to enhance texture-based pattern classification of liver cysts and hemangiomas using routine, zero-fill interpolated MR images

  4. Specialty clinic's influence on parents' asthma knowledge%专科门诊对患儿家长哮喘知识掌握的影响

    王娟梅; 李云; 方亦兵

    2011-01-01

    Objective: To explore the most effective control methods of asthma in the comparison between the parents of the first visit children and the return visit children, who had known well in the asthma knowledge. Methods: We made a investigation of the parents' asthma knowledge and behavior between 62 first visit children and 85 return visit children who have been done treatment for more than 3 months, the differences of two groups were evaluated and compared. Results: On the nature of the asthma, symptoms, incitingfactors, acute performance and the connections between asthma and rhinitis, passive smoking and access to plush toys, as well as whether they could participate in sports during asthma control period and whether to insist in using medicines, the parents of the return visit children knew more and done better than the parents of the first visit children (ρ<0.05). But parents of two groups did not know enough about the knowledge of whether regular use of inhaled steroid would affect the growth and development of the children and how to do emergency treatment of acute attacks, there was no significant differences in the groups (ρ>0.05). Conclusion: Continuous education on the parents of asthma children in the specialty clinic can deepen the understanding about asthma, but strengthen education repeatedly is necessary.%目的:通过对比哮喘门诊复诊与首诊患儿家长对哮喘知识的掌握,探索有利的哮喘防治方式.方法:对85例治疗>3个月的复诊患儿家长及62例首诊患儿家长进行哮喘知识及行为调查,评价并比较两组的差异.结果:通过调查家长对哮喘本质、症状、诱发因素、急性发作表现,其与鼻炎、被动吸烟、接触毛绒玩具的关系及哮喘控制可否参加运动、是否坚持用药等方面的知识的掌握情况,两组比较差异有统计学意义(P0.05).结论:哮喘门诊的不断教育可加深患儿家长对哮喘的认识,但仍需反复加强教育.

  5. OBSERVATION ON CLINICAL THERAPEUTIC EFFECT OF MRI-AIDED ENCLOSURE NEEDLING IN THE TREATMENT OF STROKE AND ITS INFLUENCE ON BLOOD RHEOLOGY

    江钢辉; 李艳慧; 庄子齐; 潘文宇; 黄勇; 李健萍

    2003-01-01

    Objective: To observe clinical therapeutic effect of magnetic resonance imaging (MRl)-aided enclosure needling in the treatment of stroke patients and changes of the related blood rheology. Methods: A total of 61stroke patients were randomized into MR I-aided enclosure needling group (MRI-aided acupuncture group) (n = 31 ) and conventional acupuncture group (n= 30). For patients of MRl-aided acupuncture group, acupuncture needles were inserted into the subcutaneous tissues around the focus-projection scalp area displayed by MRI, with the needle tips toward the center of the projection region and with two needles being about 2 crn apart, combined with other acupoints according to the concrete syndromes or symptoms. For patients of conventional acupuncture group, Motor Area (MS 6)and Sensory Area (MS 7) on the contralateral side of the focus were punctured. The treatment was conducted once daily, continuously for 30 days. Results: After treatment, of the 31 cases in MRl-aided acupuncture group, 20 werecured basically, 10 responded with significant improvement of symptoms and signs, one case had some improvement.While in conventional acupuncture group, of the 30 cases, 11 were cured basically, 15 responded with striking amelioration of symptoms and signs and 4 had some amelioration. Ridit analysis showed that the therapeutic effect of MRI-aided acupuncture group was significantly superior to that of conventional acupuncture group (P < 0.05). After treatment,the whole blood viscosity, plasma viscosity, hematocrit, whole blood reduction viscosity, hemagglutination index, and the total score of the two groups all decreased significantly in comparison with those of pre-treatment of each group,while whole blood viscosity, hematocrit, vascular sclerosis index and the total score of MRl-aided acupuncture group were obviously lower than those of conventional acupuncture group ( P< 0.05- 0.01 ), suggesting that the effect of theformer group in bettering blood rheology was

  6. Determination of normal values range for lower limbs muscles perfusion indexes at Rest and after exercise in patients after 50 years of age, with the possibility of assessment of age influence on these values case of their clinical application

    Introduction: Nuclear Medicine allows for defining slight changes in muscle perfusion at rest and after exercise. The assessment of perfusion in elderly patients allows for significant for the age determination of lower limbs muscles perfusion indexes. Aim. The determination of the range of normal values for lower limbs muscle perfusion indexes at rest and after exercise in patient after 50 years of age with the assessment of the age influence on these values. Material: In 24 patients, after the exclusion of circulatory disturbances in lower limbs muscles, Radioisotopic examinations of perfusion were performed. Methods: 1.Examinations: basic, blood tests, USG, vascular examinations; 2. Radioisotopic examinations of lower limbs perfusion with gamma-camera, after the injection of Tc99mMIBI and with the own program ALLP. Results: The results of basic examinations, blood tests, USG and vascular ones without any deviation from norm. Radioisotopic method allowed for determination of normal values for calves and thighs perfusion indexes in patients after 50 years. The comparison between the groups of age 20-45 and after 50 showed a statistically significant difference between them in both upper and lower range. The increase of 9% of the lower and 7% of the upper range of indexes value was observed. In both groups, at rest and after exercise, a similar difference between the indexes of lower and upper range was observed. A similar, positive influence of exercise of perfusion was observed. Conclusions: In patients after 50, a difference between the perfusion indexes is observed, similar to the younger ones. A statistically significant increase of indexes was stated in patients after 50. In both groups, similar, positive influence of exercise on perfusion was observed. The analysis of the results justifies the clinical necessity of determination of lower limbs perfusion indexes in elderly patients. (author)

  7. Analysis the influencing factors on the clinical pregnancy rate of intrauterine insemination with husband sperm%夫精宫腔内人工授精影响因素与临床妊娠率关系分析

    周军英; 朱立华; 孙秀芬; 周瑾; 许玉刚; 欧建平

    2011-01-01

    目的 探讨宫腔内人工授精(IUI)影响因素与临床妊娠率的关系,以提高IUI治疗的临床效果.方法 对252个IUI治疗周期的159例患者的年龄、不孕年限、促排卵方案、人工授精时机、IUI治疗周期数、不孕原因与临床妊娠率的关系进行分析.结果 促排卵周期显著提高临床妊娠率(P<0.05);小于等于30岁组临床妊娠率显著高于30以上组(P<0.05);随不孕年限延长临床妊娠率降低、单次排卵前、单次排卵后和双次授精妊娠率无统计学差异;IUI治疗周期数以3个周期为宜、不孕原因与临床妊娠率有关但无统计学差异.结论 促排卵方案和年龄是影响临床妊娠率的主要因素.%Objective: To investigate the influencing factors of intrauterine insemination (IUI) in order to improve the clinical outcome of IUI treatment. Methods: 159 couples in 252 cycles who underwent IUI treatment were collected. The correlation between pregnancy rate and the following factors were analyzed, such as the stimulation protocols, age of women, the duration of infertility,timing of intrauterine insemination, treatment cycles of IUI, causes of infertility. Results: IUI treatment with ovarian stimulation significantly increased clinical pregnancy rate ( P < 0. 05). The pregnancy rate was significantly higher in younger women group (less than 30 years old) than those women whose were more than 30 years old ( P < 0. 05). With the increase in duration of infertility,the pregnancy rate was decreased. There was no significant difference in the pregnancy rate between single insemination and twice inseminations before and/after ovulation. 3 cycles was suitable for IUI treatment. There was no significant difference in the pregnancy rate between primary and secondary infertility, the same to reasons of infertility. Conclusion: The protocols of ovarian stimulation and age of women were two major influencing factors for clinical pregnancy rate in IUI treatment.

  8. Investigation and Analysis of Life Satisfaction of Nurses in Clinic and Its Influencing Factors%临床护士生活满意度及其影响因素的调查分析

    许梅; 唐媛; 陈美娇

    2012-01-01

    Objective To survey the life satisfaction of nurses in clinic and its influencing factors,and analyze the relationships between them. Methods Life satisfaction assessment form was used to surrey the life satisfaction of clinical nurses of 318 nurses in two municipal hospitals in our city. Spearman rank correlation was use to analyze the life satisfaction and its influencing factors. Logistic regression model was performed to analyze the influence of relevant factors on life satisfaction. Results All 170 (53. 5% ) nurses had a high life satisfaction and 148(46.5% ) nurses had low life satisfaction. Individual characteristics had impact on the life satisfaction. The spearman correlation analysis showed that the correlation coefficient between the fatigue score,the pressure score,negative coping,positive coping and life satisfaction were separately r1 = -0.602,r2 = -0.395,r3 = -0.407, r4 = 0.368 (P < 0.01). The results of logistic regression analysis showed the fatigue, pressure and negative were the risk factors of nurse life satisfaction, and their OR values were respectively 1.239,1.646 and 1.116. Conclusion The life satisfaction of clinical nurse is disappointed. 46.5% of the nurses in clinic shards low life satisfaction. Life satisfaction is affected by fatigue, pressure and coping styles. There is a positive correlation between life satisfaction and positive response and negative correlation between life satisfaction and work stress, negative coping and fatigue.%目的 调查临床护士生活满意度,分析其影响因素,探讨生活满意度与其影响因素的相关性.方法 采用《生活满意度评定表》对湛江市2家市级医院的318名临床护士进行问卷调查,了解临床护士的生活满意度,用Spearman等级相关分析法分析临床护士生活满意度及其影响因素的相关性,用Logistic回归模型分析相关因素对生活满意度的影响.结果 318名被调查的临床护士中,170人(53.5%)生活满意度高,148人

  9. Clinical biophysics

    Anbar, M.; Spangler, R.A.; Scott, P.

    1985-01-01

    Chapters are included on clinical decision making, principles of biomedical engineering, computers and their medical uses, clinical radiobiology, diagnostic x-ray radiology, clinical applications of ultrasonics, nuclear medicine, NMR imaging, diagnostic imaging, bioelectric techniques in diagnosis and therapy, biophysical aspects of the clinical laboratory, and biophysical aspects of modern surgery.

  10. Magnesium in Clinical Practice

    E.L. Trisvetova

    1989-01-01

    Magnesium is a macronutrient that is needed for normal body functions. Magnesium deficiency resulting from the influence of exogenous and endogenous factors, is diagnosed by clinical manifestations, resembling the known disease. Magnesium deficiency corrected with the magnesium therapy. Studies show the effectiveness of magnesium orotate for many cardiovascular diseases.

  11. Analysis of situation and influencing factors in learning motivation of continuing education in clinical nurses%临床护士继续教育学习动机现状及影响因素分析

    常燕; 周文琦; 刘晓霞; 高泽宇

    2013-01-01

    目的 调查影响临床护士学习的动机因素,为临床护理管理者制定培养策略提供依据,促进护理人员自主学习.方法 采用“临床护士学习动机调查问卷”对469名临床护士进行学习动机问卷调查,并分析其影响因素.结果 共发放问卷469份,回收有效问卷428份,回收有效率为91.2%.临床护士学习动机6个维度的得分由高到低的排序依次为:职业发展、利他服务、认知兴趣、外界期望、社会接触、社会刺激,总分为(114.34±20.95)分;学习动机排在前3位的条目分别是为晋升奠定基础(4.01±0.97)分,更加胜任自己的工作(3.95±0.95)分,获取知识(3.92±1.02)分.多元回归分析显示职称和工作年限为临床护士学习动机的影响因素,差异有统计学意义(t分别为-2.949,-2.037;P<0.05).结论 继续教育管理部门需加强对社会刺激方面的管理,对不同职称和工作年限的护士进行针对性的干预,提高护士参与继续教育的主动性.%Objective To investigate the effects of clinical nurses learning motivation factors,provide the basis for the formulation of strategies for cultivating clinical nurses,promote autonomous learning in nursing staff.Methods Four hundreds and sixty-nine clinical nurses were surveyed by the "clinical nurses learning motivation questionnaire".The influencing factors in learning motivation of continuing education in clinical nurses were analyzed by the SPSS 16.0 software package,including descriptive statistics,multiple regression analysis.Results Tatals of 469 questionnaires were sent out,and 428 were recycled,the effective responsive rate was 91.2%.The scores of six dimensions of learning motivation of continuing education in clinical nurses were from high to low in order occupation development,altruistic service,cognitive interests,expectations from outside,social contact and social stimuli.The occupation development motivation got the highest score (3.68 ± 0

  12. Factors influencing patients' satisfaction on the esthetics of anterior restorations and their clinic implications%前牙美容修复满意度的影响因素及临床美学指导

    石亚红

    2011-01-01

    随着美容口腔科学的兴起以及人们审美观念的提升,前牙美容修复在临床中的应用日益增加,逐渐成为患者主动选择的治疗方式;同时,前牙美容修复的效果也越发受到患者的重视.然而,许多患者对修复体不满意,希望能够改善其美学效果,临床医生对此应予以重视.进行美容修复时,要同时从患者和专业角度出发,以实现成功修复.本文就影响患者对修复体满意度的因素及美学参数在临床中的应用作一综述.%Dental esthetics has become an increasingly important and rewarding discipline in dentistry as patients have began to request anterior restorations of high esthetic quality. Many patients were dissatisfied with their restorations and desired the improvement of dental esthetics. Therefore, dentists should pay much attention to it Practically, dentists should try to consider both patients and clinical factors in order to achieve esthetic restorations. This article is to review factors influencing patients satisfaction on the esthetics of anterior restorations, and the use of these esthetic parameters in clinic.

  13. Factors Influencing Goal Attainment in Patients with Post-Stroke Upper Limb Spasticity Following Treatment with Botulinum Toxin A in Real-Life Clinical Practice: Sub-Analyses from the Upper Limb International Spasticity (ULIS-II Study

    Klemens Fheodoroff

    2015-04-01

    Full Text Available In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A treatment in 456 adults with post-stroke upper limb spasticity (ULS. Patients with primary goals categorised as passive function had greater motor impairment (p < 0.001, contractures (soft tissue shortening [STS] (p = 0.006 and spasticity (p = 0.02 than those setting other goal types. Patients with goals categorised as active function had less motor impairment (0.0001, contracture (p < 0.0001, spasticity (p < 0.001 and shorter time since stroke (p = 0.001. Patients setting goals for pain were older (p = 0.01 with more contractures (p = 0.008. The proportion of patients achieving their primary goal was not impacted by timing of first-ever BoNT-A injection (medium-term (≤1 year vs. longer-term (>1 year post-stroke (80.0% vs. 79.2% or presence or absence of severe contractures (76.7% vs. 80.6%, although goal types differed. Earlier BoNT-A intervention was associated with greater achievement of active function goals. Severe contractures impacted negatively on goal achievement except in pain and passive function. Goal setting by patients with ULS is influenced by impairment severity, age and time since stroke. Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.

  14. The mairl factors of influence quality in clinical nursing students and its countermeasures%影响护生临床实习质量的主要因素及对策

    吴丹凤; 陆祥兰; 高书琴; 芮立美

    2013-01-01

    Objective:To investigate the main factors of influence quality of clinical practice of nursing students,to improve the quality of teaching.Methods:A questionnaire from February 2011 to July 2012 in our hospital,randomly selected 80 nursing students,took the principle of voluntary near before the end of clinical practice were investigated.Results:It sends out questionnaire 80,recovered 68 copies,the effective rate was 85 %.Impact factors:teachers attitude was to 98.52%,the teacher's knowledge level was 91.18%,nursing students learn seriously enthusiasm was not high for 58.82%.Conclusion:The effect of clinical nursing quality of the major factors for the teachers and the students own internship,nursing students needed and teachers to communicate with each other,adopt corresponding countermeasures,in order to improve the teaching quality,to improve the quality of nursing students.%目的:探讨影响护生实习质量的主要因素,以提高带教质量.方法:选择2011年2月~2012年7月本院护理实习生80名,采取自愿原则在临近实习结束前进行问卷调查.结果:发出问卷80份,收回有效问卷68份,有效回收率85%.影响因素中:带教老师的态度98.52%,带教老师专业知识程度91.18%,实习生学习不认真积极性不高为58.82%.结论:当前影响临床护理实习质量的主要因素为带教老师和实习护生自身方面,护生需要与带教老师相互沟通,采取相应对策,以提高带教质量,从而提高护生实习质量.

  15. 小儿心肺复苏的临床特点及预后的影响因素%Clinical characteristics and the influence factors of prognosis of pediatric cardiopulmonary resuscitation

    王昕

    2015-01-01

    Objective:To analyze the clinical characteristics and the influence factors of prognosis of pediatric cardiopulmonary resuscitation.Methods:46 patients with pediatric cardiopulmonary resuscitation treatment were selected from May 2010 to May 2014.18 cases used cardiopulmonary resuscitation because of cardiac arrest;28 cases used cardiopulmonary resuscitation because of respiratory arrest.The clinical characteristics and prognosis of pediatric cardiopulmonary resuscitation were detailedly analyzed. Results:The cardiopulmonary resuscitation rate 42.9% of respiratory arrest children was higher than the cardiopulmonary resuscitation rate 16.7% of cardiac arrest children,and the difference was statistically significant(P<0.05).The children common diseases caused pediatric cardiopulmonary resuscitation were accidental injuries,infectious diseases and cardiovascular diseases and so on.Conclusion:More attention should be paid to the causes and clinical characteristics of pediatric cardiopulmonary resuscitation.Popularization of pediatric first-aid knowledge and doing a good job in the publicity and education work can effectively improve the rescue success rate of pediatric cardiopulmonary resuscitation and improve prognosis.%目的:分析小儿心肺复苏的临床特点及预后的影响因素。方法:2010年5月-2014年5月收治小儿心肺复苏治疗患者46例,其中因心跳停止采用心肺复苏18例,因呼吸停止采用心肺复苏28例,详细分析小儿心肺复苏的临床特点和预后。结果:呼吸停止患儿的心肺复苏率42.9%高于心跳停止患儿的心肺复苏率16.7%,差异具有统计学意义(P<0.05);引起小儿心肺复苏的患儿常见疾病有意外伤害、感染性疾病以及心血管疾病等。结论:应更加重视引起小儿心肺复苏的原因和临床特点,普及儿科急救的相关知识,做好宣传教育工作,有效提高小儿心肺复苏抢救成功率,改善预后。

  16. Clinical Trials

    Clinical trials are research studies that test how well new medical approaches work in people. Each study answers ... prevent, screen for, diagnose, or treat a disease. Clinical trials may also compare a new treatment to a ...

  17. Influence of Various Bases on Clinical Efficacy and Safety of Drugs%不同盐基对药物临床效果和安全性的影响分析

    方松; 廖祥茹

    2014-01-01

    成盐是改善活性药物分子( API)成药性的一个重要手段,目前活性成分相同而盐基不同的药物不断出现,本文就盐基对药物药动学、药效学及药物不良反应三个方面的影响作简要综述,以对临床遴选治疗药物及新药盐基的选择提供参考。%Salt formation is the most important method for increasing druggability of active pharmaceutical ingredients ( API) . Nowadays, API containing different bases are emerging continuously. In this paper, the influence of various bases on the pharmacokinetics, pharmacodynamics and side effects of drugs was reviewed, which can provide reference for the selection of clinical therapeutic drugs and the base choice for new drugs.

  18. Clinical Wisdom among Proficient Nurses

    Uhrenfeldt, Lisbeth; Hall, Elisabeth

    2007-01-01

    This paperexamines clinical wisdom which has emerged from a broader study anout nurse managers´influence on proficient registered nurse turnover and retention. The purpose of the study was to increase understanding of proficient nurses´experience and clinical practice by giving voice to the nurses...

  19. 实习护生积极心理品质水平及其影响因素研究%Positive psychological qualities of nursing students during clinical practice and influencing factors analysis

    曹洁

    2014-01-01

    Objective To explore the positive psychological qualities of nursing students during clinical practice, and analyze its influencing factors , to provide a theoretical basis for improving the positive psychological quality level of nursing students .Methods Totals of 232 nursing students were enrolled in this study, and investigated with a related demographic information questionnaire and Positive Psychological Qualities Questionnaire.SPSS 17.0 statistical software was used to analyze the data .Results These nursing students got the highest score in the dimension of interpersonal relationship , followed by transcendence , justice, temperance, cognition, and emotion.The score of emotion, interpersonal relationship and transcendence were ( 3.24 ± 0.66), (3.62 ±0.52) and (3.52 ±0.48), respectively, which were significantly lower than the norm of college students (t=-8.54, -2.45, -3.61, respectively;P<0.05).There were several factors influencing nursing students ’ positive psychological qualities , such as parents ’ education , communication with tutors , relationship with other students , motivation of choosing nursing major , character , recognition of tutors and patients, academic performance and tutors ’ attention.Conclusions Nursing students who are undergoing clinical practice have lower level of positive psychological quality than Chinese college students , and it is affected by different factors .Therefore the clinical nursing educators should take effective measures to improve nursing students ’ positive psychological qualities and promote their physical and mental health of nursing students .%目的:调查护生临床实习期间的积极心理品质水平,并分析其影响因素,为提高实习护生积极心理品质水平提供理论依据。方法采用一般资料调查表、中国大学生积极心理品质量表对232名实习护生进行问卷调查。结果实习护生积极心理品质6个维度得分从高到低分别为人际、

  20. Analysis Negative Influence on the Clinical Pregnancy Rate of Intrauterine Insemination in Infertility Women with Advancing Age%高龄不孕妇女IUI临床妊娠的不利影响因素分析

    陈孟循; 马文敏; 朱莉; 吴雅琴; 司徒艳球; 谭晓慧

    2014-01-01

    目的:分析影响高龄不孕妇女IUI获临床妊娠的不利因素,并找出高龄妇女转变助孕方式的时机。方法回顾佛山市妇幼保健院生殖中心自2008年1月~2012年1月行IUI助孕325对夫妇550个IUI周期的资料,统计分析女方不同年龄段、不孕类型、不孕年限、接受IUI的周期数、3种促排卵周期和自然周期对高龄妇女IUI临床妊娠率的影响。结果≧40岁组临床妊娠率明显低于35~36岁组(=0.028);≧5年组临床妊娠率明显低于1~2年组(=0.037);HMG/丽申宝促排卵周期临床妊娠率明显高于自然周期和CC/CC+HMG周期(P值分别为0.012、0.020),40岁及以上患者使用CC/CC+HMG促排卵共21周期,未见有临床妊娠,而HMG/丽申宝促排卵周期临床妊娠率为9.0%(6/67);≧40岁且不孕年限≧5年妇女行IUI助孕共有33周期,仅有1例获临床妊娠,妊娠率为3.0%(1/33);≧40岁妇女接受第3次及以上助孕周期共15周期,未有获临床妊娠者。结论不孕年限及促排卵方案是影响高龄妇女IUI获临床妊娠的重要因素,40岁以上患者通过IUI的获临床妊娠率机会低下。高龄妇女行IUI建议使用Gn促排卵,避免使用CC,进行2个周期的IUI助孕治疗后可考虑转其他助孕方式,特别是对不孕年限≧5年或40岁及以上妇女;不孕年限达5年或者以上,并且患者≧40岁,则建议直接行IVF/ICSI助孕。%Objective To investigate and analyze factors that influence pregnancy rate of intrauterine insemination (IUI)with husband sperm in women of advancing age,to find the best timing to change assisted reproductive technology.Methods The clinical data of 325 infertile couples undergoing 550 IUI were analyzed in Center,Foshan Maternal &Children Health Hospital.Relationships between pregnancy rate and maternal age,infertile types,infertile time,natural cycle and 3 types of ovulation induction cycle were investigated.Results The clinical pregnancy rate was significantly lower in

  1. Clinical Research and Clinical Trials

    ... Meetings, Conferences & Events Partnering & Donating to the NICHD Staff Directory ... Clinical Research Skip sharing on social media links Share this: Page Content Clinical research is research that directly involves a ...

  2. 有创血压与无创血压准确性的评价以及对治疗的影响%The accuracy evaluation of invasive and noninvasive blood pressure monitoring and its influence on clinical use

    王丽霞; 沈健; 丁正年

    2013-01-01

    背景 血压监测在麻醉诱导期至关重要,准确及时地监测血压对指导麻醉期间用药和保障患者的安全具有重要意义.在临床中同一患者的有创血压(invasive blood pressure,IBP)值和无创血压(non-invasive blood pressure,NIBP)值存在一定差异. 目的 就不同患者IBP及NIBP值的差异以及对治疗的影响作一综述. 内容 当患者血压较高时IBP值高于NIBP值,血压较低时IBP值低于NIBP值,使用NIBP和IBP同时监测能降低患者围手术期血管活性药物以及血液制品的使用率. 趋向 围手术期同时使用NIBP和IBP监测,可以帮助我们得到更可靠的血流动力学信息,及时发现病情变化,做出准确及时的处理.%Background Blood pressure monitoring is a part of the standard of care for anesthesia induction,which is also very important for the guidance of clinical medication and the safety of patients.Objective This review summarizes the difference between non-invasive blood pressure (NIBP) and invasive blood pressure (IBP) of different patients and its influence on clinical application.Content Compared with IBP,NIBP is likely to be higher than IBP at lower pressure,and lower than IBP at higher pressures.Concomitant use of NIBP with IBP is associated with decreased use of transfusion,vasopressors,and antihypertensives compared with the use of IBP alone.Trend Compared with the use of IBP measurement alone,the use of NIBP monitoring to supplement IBP measurement is usually associated with getting more reliable hemodynamic information and dealing with relevant problem in a more timely manner.

  3. Survey of characteristics and influencing factors of the adolescent with anxiety disorders in psychological clinic%心理门诊青少年焦虑症患者的特征及影响因素调查

    张昌; 王永柏; 李柳; 杨妍; 杨丹

    2015-01-01

    目的::探索心理门诊青少年焦虑症患者的影响因素及其特征。方法:采用自编的一般情况调查表、汉密尔顿焦虑量表、自尊量表、青少年生活事件量表、父母养育方式评价量表、艾森克人格测验,对170名青少年焦虑症患者进行调查。结果:青少年焦虑症患者在年龄、性别等人口学特征均无显著性差异。与汉密尔顿焦虑相关的因素:自尊、健康适应、内向外向和神经质。与躯体焦虑相关的因素:母亲惩罚、严厉、神经质。与精神焦虑相关的因素:自尊、受惩罚、健康适应、其他:母亲过分干涉、过分保护、精神质、内向外向、神经质。结论:自尊、健康适应、内向外向和神经质是青少年焦虑患者的相关因素。%Objective: To explore characteristics and influencing factors of the adolescent with anxiety disorders in psychologi-cal clinic. Methods: 170 cases of the adolescent with anxiety disorders in psychological clinic were investigated with general condition questionnaire, Hamilton anxiety scale (HAMA), self-esteem scale (SES), adolescent self-rating life events check List (ASLEC), Egma Minnen av Bardndosna uppforstran (EMBU), and Eysenck Personality Questionnaire (EPQ). Results: There were no signifi-cant differences of the adolescent with anxiety disorders in demographic characteristics, such as age, gender, and so on. The related factors of HAMA were: self-esteem, healthy adaptation, introversion and extroversion, and neuroticism. The related factors of somatic anxiety were: mother's punishment, stringency, and neuroticism. The related factors of Psychic anxiety were: self-esteem, punish-ment, and healthy adaptation. The other factors were too much interference and too much protection of the mother, psychoticism, psy-choticism, introversion and extroversion, and neuroticism. Conclusions: Self-esteem, healthy adaptation, extraversion and introver-sion, and neuroticism

  4. 注入前向运动精子数对人工授精临床妊娠率的影响%The influence of processed total motile sperm count on clinical pregnancy rate of intrauterine insemination

    王明勇; 付莉; 廖运梅; 陈绍威; 王芳; 黄桂英; 毛熙光

    2014-01-01

    Objective To investigate the influence of processed total motile sperm (PTMS) count of husband on clinical pregnan-cy rate of intrauterine insemination(IUI) .Methods We retrospectively analyzed a total of 229 cycles of IUI among 131 patients in our hospital during the past three years .The cycles were divided into 5 groups according to the PTMS count :group A(0 .05) among five groups .Conclusion Ideal clinical pregnancy can be achieved when the PTMS count is between 3 × 106 and 5 × 106 .%目的:探讨注入前向运动精子总数对丈夫精液宫腔内人工授精(IUI)临床妊娠率的影响。方法回顾分析2010年4月至2013年4月在该院行IUI助孕治疗的不孕症夫妇131例患者,229个IUI周期,按宫腔内注入前向运动精子数(PTMS)分为5组:A组(<5×106),B组(5×106~<10×106),C组(10×106~<20×106),D组(20×106~<30×106),E组(≥30×106),比较组间临床妊娠率。结果131例患者IUI治疗,临床妊娠率为26.72%,229个周期,周期临床妊娠率为15.28%。周期临床妊娠率分别为A组23.08%、B组15%、C组18.18%、D组13.46%、E组13.48%。各组间差异无统计学意义(P>0.05)。

  5. 影响抑郁症患者精神专科门诊治疗的相关因素研究%Research on relatively factors which influence depressions' therapy in psychosis clinic

    刘霞; 杨金华; 高玉娥

    2009-01-01

    目的 探讨影响抑郁症患者在精神专科门诊治疗的相关因素,为提高治疗依从性提供科学依据.方法 采用简明精神病量表(BPRS)和自制问卷调查79例精神专科医院门诊就诊的抑郁症患者,分析影响在专科治疗的因素,进行健康指导,采取预约复诊或电话回访随访1年.结果 63.29%的抑郁症患者首诊选择非精神科诊治;53.16%的患者未到精神科就诊的原因是不知道患抑郁症;首诊于精神专科的患者诊断、首次连续治疗时间、用药、疗效均明显优于首诊于非精神科患者(P<0.01);系统健康教育后治疗依从性提高,差异有统计学意义(P<0.01).结论 对医护人员、患者及家属开展积极有效的精神卫生知识宣传与普及是提高早期诊断、早期治疗、提高疗效、防止复发的关键.%Objective To investigate the factors which influence the depressions' therapy in psychosis clinic,provide Scientific basis for improving the level of treatment compliance.Methods The Brief Psychiatric Rating Scale and home-made questionnaire were used to investigate 79 depressions patients who took treatment in psychosis clinic,to analyse the influencing factors,and to give them the Health guide.Appointment for further consultation or call to follow up were carried out for 1 year.Results There were 63.29% depressions chose the general hospital to see the doctor at first time,53.16% patients did not go to the psychiatric hospital because they didn' t know their disease feature;the diagnosis,treatment session,medication,effect are obviously prior in the patients seeing the psychiatrists at first time(P < 0.01);patients' therapeutic compliance improved after Systemic health education,the discrepancy is statistically significant.(P < 0.01).Condnsions To make active and valid propaganda on mental healthy is the key points to diagnosis and therapy prophase,can also prevent the recrudesce.

  6. The Clinical Value of the Influence of Maternal BMI on Birth Weight%体重指数对新生儿体重影响的临床价值分析

    覃利美; 许建玉; 陈静芬

    2012-01-01

    目的:分析体重指数(BMI)对新生儿体重影响的临床价值.方法:收集2008年6月至2011年6月在我院产科分娩的BMI≥28的孕妇359例作为产前肥胖组,同期分娩的BMI<28的孕妇359例作为产前体重正常组,分析其分娩前BMI与新生儿体重的相关性.结果:产前肥胖组新生儿体重及巨大儿的发生率高于产前体重正常组,两者比较差异均具有显著性(P<0.05).结论:分娩前BMI与新生儿体重密切相关,高BMI增加巨大儿的发生风险.%Objective:To analyze the clinical value of the influence of maternal BMI on birth weight.Methods:359 cases of pregnant women with BMI>28 for regular prenatal care and laboring in our hospital between Mar.2008 and Jun.2011 were collected as the antenatal obesity group, 359 cases of pregnant women with BMK28 as antenatal normal weight group. Analyzing the correlation between the BMI and birth weight.Resuits:The birth weight of the antenatal obesity group were higher than that of the antenatal normal weight group, the difference were statistically significant (P<0.05); The incidence of fetal growth of the antenatal obesity group were higher than that of the antenatal normal weight group, the difference were statistically significant (P<0.05). Conclusion:The birth weight is closely related to BMI, high BMI can increase the risk of fetal growth.

  7. 心血管疾病患者参与临床决策倾向性的影响因素研究%The influence factors of clinical decision making in patients with cardiovascular disease

    刘金涛; 杜昕; 马长生; 张萍; 吴雪松

    2014-01-01

    目的 分析影响心血管疾病患者参与临床决策倾向性的因素.方法 抽取符合入选标准的心血管疾病患者258例,采用问卷调查方法,对患者的就医过程及对其临床决策倾向性的影响进行探讨.问卷调查的具体内容包括:①一般人口学资料;②疾病状况;③患者心理健康状况评估;④患者参与临床决策的意愿.结果 患者平均年龄(64±13)岁;男性占55.8%(144/258),女性占44.2%(114/258);88.0%(227/258)的患者可以报销医疗费用;82.2%的患者家庭月收入≥3 000元;89例(34.5%)患者在做临床决策时倾向于"医生根据医学知识做出决策",61例(23.7%)患者在做临床决策时倾向于"医生在询问患者需求后做出决策",94例(36.4%)患者倾向于"和医生共同做出决策",14例(5.4%)患者倾向于"和医生讨论后自己做出决策".无患者依据自己的知识独立做出决策.患者对医生的信任评分:最低7分,最高10分,平均(9.7±0.5)分;文化程度(OR=4.052,95%CI:1.800~9.126)是患者和医生做出共同决策的危险因素,对医生的信任评分(OR=0.071,95%CI:0.016~0.309)是患者和医生做出共同决策的保护因素.结论 心血管疾病患者对医生的信任度很高,患者的临床决策倾向性主要取决于患者对医生的信任程度.%Objective To analyze the influence factors of clinical decision making in patients with cardiovascular disease. Methods Totally 258 patients with cardiovascular disease were selected; the treatment process of patients and its effect on clinical decision preference were discussed by questionnaire investigation. The specific content of questionnaire included: ①general demographic data; ②the disease status; ③assessment of mental health status for patients; ④the willingness of clinical decision making participating in patients. Results The average age of patients was (64±13) years; there were 55.8%(144/258)of males, 44.2%(114/258)of female; 88.0%(227/258) of the

  8. Influences of clinical nurses' occupational stress, anxiety and depression on serum cortisol levels%临床护士工作应激及焦虑抑郁对血清总皮质醇的影响

    陈偶英; 焦娜; 彭芳; 叶曼; 张静平

    2011-01-01

    目的 探讨临床护士工作应激及焦虑抑郁情绪对其血清总皮质醇的影响.方法 对104名临床护士采用护士工作应激源量表及Zung焦虑、抑郁自评量表进行调查,同时检测其血清总皮质醇.结果 临床护士工作应激源总评分为(529.85±176.87)分,SAS评分(36.84±7.20)分,SDS评分(41.21±7.22)分;血清总皮质醇正常12人,高于正常值92人;护理工作量过大、护患关系紧张等12项负性事件评分与临床护士血清总皮质醇呈正相关(P<0.05,P<0.01),血清总皮质醇与抑郁呈正相关,护士应激源进入血清总皮质醇的回归方程.结论 临床护士的工作应激及焦虑抑郁水平可影响血清总皮质醇.护理管理者应采取合理配置人力资源,提高护士的社会地位,更新护士知识层次,建立同事支持系统,加强对护士心理知识的培训等措施帮助护士降低各种应激源,以保持临床护士的身心健康,提高护理服务质量.%Objective To explore the influences of clinical nurses' occupational stress, anxiety and depression on serum cortisol levels. Methods Totally, 104 nurses were surveyed with the Nursing Occupational Stressor Scale, Zung Self-rating Anxiety Scale and Zung Self-rating Depression Scale. At the same time, nurses' serum eortisol levels were detected. Results The total score of clinical nurses' occupational stressor was 529.85 ± 176.87, SAS and SDS scored 36.84 ± 7.20 and 41.21 ± 7.22 respectively. There were 12 nurses with serum cortisol levels at normal level, and 92 nurses beyond normal. The scores of 12 negative events including over workload and strained nurse-patient relationship, ect. were positively related with nurses' serum cortisol levels (P<0.05,P< 0.01)4 Besides, the serum cortisol levels were also positively correlated with depression. Nurses' stressor entered the regression equation of serum cortisol. Conclusion Clinical nurses' occupational stress, anxiety and depression

  9. 临床护士针刺伤后自我效能水平及其影响因素分析%Self-efficacy and influencing factors of clinical nurses with needlestick injuries

    梁培荣; 薛小玲; 孟红燕; 阮爱超; 王姗姗

    2013-01-01

    目的 了解发生针刺伤临床护士自我效能状况及其相关影响因素,探讨提高临床护士自我效能的有效途径.方法 采用便利及分层抽样相结合的方法,用一般资料问卷和自我效能感量表对713名发生过针刺伤的临床护士进行问卷调查.结果 针刺伤后护士的自我效能感平均得分为(2.70--0.52)分,69.1%的护士具有中等水平的自我效能,仅19.1%的护士具有高水平的自我效能.性别、职称、科室、主动报告、职业环境、职业安全培训与针刺伤护士的自我效能水平显著相关.结论 发生针刺伤的临床护士自我效能大多数处于中等水平,有待进一步提高.应寻找其他影响针刺伤后护士自我效能的因素,以便针对其主要影响因素采取相应的管理措施,从而提高其自我效能.%Objective To investigate the level and influencing factors of self-efficacy among nurses with needlestick injuries and explore effective strategies to improve self-efficacy.Methods 713 clinical nurses with needlestick injuries had been enrolled by convenience and stratified sampling method to comphte the investigation using the self-designed demographic questionnaire and General Self-Efficacy Scale.Results The average score of the self-efficacy was (2.70 ±0.52) points.69.1% of the needlestick injury nurses had the sclf-efficacy score at the middle level; only 19.1% of them had a higher level score on self-efficacy.Gender,title,section,initiative report,work environment,and occupational safety training were identified as the influencing factors of the self-efficiency.Conclusions Even though more than half of the nurses with needlestick injuries had a middle level self-efficacy,they need further improvement.Other influencing factors should be explored in future in order to develop the corresponding management intervention which can strengthen the self-efficacy of nurses with needlestick injuries.

  10. Clinical Research

    Christensen, Irene

    2016-01-01

    This paper is about the logic of problem solving and the production of scientific knowledge through the utilisation of clinical research perspective. Ramp-up effectiveness, productivity, efficiency and organizational excellence are topics that continue to engage research and will continue doing so...... for years to come. This paper seeks to provide insights into ramp-up management studies through providing an agenda for conducting collaborative clinical research and extend this area by proposing how clinical research could be designed and executed in the Ramp- up management setting....

  11. Clinical Influence of Tangshenan Prescription on Inflammation Factors in Diabetic Nephropathy%糖肾安对糖尿病肾病炎症因子影响的临床研究

    冯天保; 陈灯德; 王倩; 谢桂权

    2012-01-01

    Objective: To observe the clinical influence of Tangshenan, a compound prescription of supplementing qi and nourishing yin and dispelling stasis to promote regeneration, on inflammation factors in diabetic nephropathy (DN). Method: Forty-five DN patients were divided into treatment group ( n = 30) and control group ( n = 15 ) at random. And each of the two groups was treated with western medicine routinely, and the treatment group was combined with Tangshenan on this basis of western medicine. The two groups were both for a treatment course of 8 weeks. Then the variations of patients' clinical responses, fasting blood glucose (FBG) , serum total cholesterol ( TC ) , Triglyceride ( TG) , the inflammation factors of high-sensitivity c-reactive protein ( hs-CRP) , tumor necrosis factor (TNF-α) and interleukin-6 (IL-6) , were investigated. Result: After treatment, the total effectiveness of treatment group was 86. 7% , and the control group was 53. 3% , with significant difference (P < 0. 05). For both the two teams, FBG, TC and TG were decreased significantly ( P < 0. 05 , P < 0. 01) after treatment. And the treatment group' s TC and TG' s decreasement was better than that in the control group. The treatment group's Hs-CRP, IL-6 and TNF-a were decreased significantly (P<0. 05, P <0. 01) after treatment. The control group' s Hs-CRP level was also decreased significantly (P < 0.01 ) after treatment, but the improvement of IL-6 and TNF-a were not obvious. Conclusion: On the basis of western medicine, if combined with Tangshenan, the curative effect can be improved, the blood lipid metabolism can be improved, and the regular inflammation factors can be down-regulated.%目的:观察益气养阴、祛瘀生新复方(糖肾安)对糖尿病肾病(DN)炎症因子的影响.方法:将45例DN患者随机分为治疗组30例,对照组15例,两组均予西医常规治疗,治疗组在此基础上配合糖肾安治疗,疗程均为8周.观察患者临床疗效及空腹血糖(FBG)、

  12. 心理护理干预对抑郁症患者临床疗效的影响%The influence of psychological nursing intervention to effect of clinic therapy on depression.

    许丽霞; 王秀芬; 孙惠萍; 曹志坤; 周策

    2011-01-01

    目的:探讨心理护理干预对抑郁症患者临床疗效的影响.方法:对我院住院治疗的76例抑郁症患者随机分成治疗组和对照组各38例,两组同时服用相同的抗抑郁药舍曲林25~75 mg,每日1次,并给予常规护理,治疗组增加心理护理干预措施,包括精神分析、认知疗法、音乐疗法等,同时给患者讲解抑郁症的相关知识,做好健康教育,督促患者定期复查,做好随访工作.分别在治疗前后2、4、8周末用汉密顿抑郁量表(HAMD)评分和四级疗效评定、服药依从性比较.结果:心理干预前两组HAMD评分无统计学差异(P>0.05),护理干预8周末HAMD评分治疗组明显低于对照组,服药依从性明显高于对照组,具有显著性差异(P<0.01),两组疗效评定治疗组显效率明显高于对照组(P<0.05).结论:心理护理干预可提高临床疗效及服药依从性,降低复发率,提高生活质量.%Objective :To explore the influence of pchcological nursing intervention to effect of clinic therapy on depression.Methods :76 cases with depression who were treated in our hospital from were randomly divided into therapy group and control group with 38 cased respectively.Two group inpatients takod the same midicine at the same time (Sertralin 25 -75 mg,PO once a day) and routine nursing care.In therapy group, the inpatients were increased psychcological nursing intervention measures.The intervention measurs included psychological analysis, cognitive therapy and music therapy etc.Meanwhile doctors instructed the study inpatients the relative knowladge ,gave heathy education and arranged the patients to check up regularly.Two groups patients were evaluated before intervention and after intervention by HAMD and compared with the compliance.Results:There was no significant statistic difference between two groups before intervention evaluated by HAMD (P > 0.05 ).After 8 weeks intervention, the therapy group patients had a higher scores by HAM D and

  13. 院前急救护理对脑出血患者预后质量的临床影响分析%Clinical Influence of Prognosis of Pre-hospital Emergency Care on Patients with Cerebral Hemorrhage

    蒙敏华

    2015-01-01

    目的:探究院前急救护理对于脑出血患者预后质量的临床效果,并分析其作用价值。方法:选取2013年1月-2014年12月笔者所在医院收治的急救脑出血患者82例,按照随机数字表法将其分为对照组和观察组,每组41例。对照组患者未采取院前急救护理,而观察组患者采取院前急救护理,统计两组患者的治疗结果和并发症情况。结果:对照组患者治疗的总有效率为70.73%,12例患者出现并发症,观察组患者治疗的总有效率为92.68%,4例患者出现并发症,即观察组的总体有效率明显要高于对照组,并发症例数少于对照组,差异有统计学意义(P<0.05)。结论:院前急救护理对于脑出血患者预后质量影响显著,能够明显改善患者的治疗结果,降低并发症的发生率,适合在临床上推广使用,应引起广大医学卫生工作者的关注。%Objective:To explore the clinical influence on prognosis of pre-hospital emergency care of patients with cerebral hemorrhage,and analyze its function value.Method:82 patients with emergency cerebral hemorrhage from January 2013 to December 2014 in our hospital were selected, they were randomly divided into the control group and the observation group,41 cases in each group.Patients in the control group did not take pre-hospital emergency care,the observation group was given pre-hospital emergency care,counted treatment results and complications of two groups. Result:The treatment effective rate of the Control group was 70.73%,12 patients occurred complications,the total effective rate of the observation group was 92.68%,4 patients occurred complications,the total effective rate of the observation group was significantly higher than that of the control group, complications were less than that of the control group,the differences were statistically significant(P<0.05).Conclusion:Pre-hospital emergency care can significantly improvement prognosis

  14. 再发心肌梗死的临床特点及其对一年预后的影响%The Characteristics and Influences of Recurrent Myocardial Infarction on 1 Year Clinical Outcomes

    王林; 孙根义; Seung-Woon Rha

    2012-01-01

    Objective: To investigate the characteristics of recurrent myocardial infarction (MI) and the influence of prior MI on the clinical outcomes in patients with myocardial recurrent MI. Methods: The current data came from the Korea Acute Myocardial Infarction Registry (KAMIR) study, which consisted of 10 384 consecutive acute MI patients from May 2005 to April 2008. According to the medical history, patients were divided into two groups, the first MI group (n=9 450) and recurrent MI group (n=934). The clinical data were recorded including age, gender, cardiovascular disease risk factors (hypertension, diabetes, dyslipidemia), smoking history, family history, comorbidities, admission vital signs, body mass index (BMI), heart function (KILLIP' s classification), routine blood test, blood lipids, myocardial enzymes, renal function, left ventricular ejection fraction (LVEF) and medication. The occurrence of adverse cardiovascular events (MACE) in 12 months after operation, recurrent myocardial infarction and the clinical features, and their prognostic impact in one year were recorded by clinic or telephone follow-up. Results: Patients were older in recurrent MI group than those in the first MI group. A high proportion of men, a high proportion of those with cardiovascular disease risk factors and those with combined peripheral arterial diseases and cerebrovascular diseases were found in recurrent MI group (P< 0.05). The poor cardiac functions were found in patients at admission with LVEF 0.471 9±0.1167νs0.512 l±0.1074and 17.77% νs 10.28% of KILLIP's Ⅲ-Ⅳ(P< 0.05). The incidence of major adverse cardiovascular events was significantly higher in patients with recurrent MI than that of patients with the first MI (12.63%νs 8.78%, P < 0.05). Compared with patients with the first MI, OR was 1.481(95% CI 1.222-1.796, P < 0.05) in patients with recurrent MI. After adjusting for age, gender, KILLIP's grade, diabetes and percutaneous coronary intervention (PCI) treatment

  15. Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period

    Brembilla-Perrot, Béatrice; Olivier, Arnaud; Sellal, Jean-Marc; Manenti, Vladimir; Brembilla, Alice; Villemin, Thibaut; Admant, Philippe; Beurrier, Daniel; Bozec, Erwan; Girerd, Nicolas

    2016-01-01

    Objectives There are very little data on pre-excitation syndrome (PS) in the elderly. We investigated the influence of advancing age on clinical presentation, treatment and long-term outcome of PS. Setting Single-centre retrospective study of patient files. Participants In all, 961 patients (72 patients ≥60 years (mean 68.5±6), 889 patients <60 years (mean 30.5±14)) referred for overt pre-excitation and indication for electrophysiological study (EPS) were followed for 5.3±5 years. Usual care included 24 h Holter monitoring, echocardiography and EPS. Patients underwent accessory pathway (AP) ablation if necessary. Primary and secondary outcome measures Occurrence of atrial fibrillation (AF) or procedure-induced adverse event. Results Electrophysiological data and recourse to AP ablation (43% vs 48.5%, p=0.375) did not significantly differ between the groups. Older patients more often had symptomatic forms (81% vs 63%, p=0.003), history of spontaneous AF (8% vs 3%, p=0.01) or adverse presentation (poorly tolerated arrhythmias: 18% vs 7%, p=0.0009). In multivariable analysis, patients ≥60 years had a significantly higher risk of history of AF (OR=4.2, 2.1 to 8.3, p=0.001) and poorly tolerated arrhythmias (OR=3.8, 1.8 to 8.1, p=0.001). Age ≥60 years was associated with an increased major AP ablation complication risk (10% vs 1.9%, p=0.006). During follow-up, occurrence of AF (13.9% vs 3.6%, p<0.001) and incidence of poorly tolerated tachycardia (4.2% vs 0.6%, p=0.001) were more frequent in patients ≥60 years, although frequency of ablation failure or recurrence was similar (20% vs 15.5%, p=0.52). In multivariable analysis, patients ≥60 years had a significantly higher risk of AF (OR=2.9, 1.2 to 6.8, p≤0.01). Conclusions In this retrospective monocentre study, patients ≥60 years referred for PS work up appeared at higher risk of AF and adverse presentation, both prior and after the work up. These results suggest that, in elderly

  16. 护理实习生人际交往效能感的调查分析%The level and influencing factors of nursing students' sense of interpersonal relations efficacy during clinical practice

    乔祎; 戈晓华; 章雅青

    2012-01-01

    Objective To investigate the level and influencing factors of nursing students' interpersonal relations efficacy during clinical practice. Method Totally 81 full-time baccalaureate nursing students in grade four and 91 full-time associate degree nursing students in grade three were recruited from 8 universities by convenience sampling method. They were investigated with the College Students Sense of Interpersonal Relations Efficacy Questionnaire. Results The average score of interpersonal relations efficacy was (14428± 1537) points. There was significant difference between male and female students(P0,05). Conclusion Nursing students need to shape good individual characters and the teachers should improve the curriculum design to train nurses with skills in interpersonal interaction.%目的 调查护理实习生人际交往效能感现状,并分析其在性别、学历等一般资料上的差异.方法 方便抽取8所护理院校(系)全日制四年级本科生81名和三年级大专生91名,采用大学生人际交往效能感问卷对其进行调查.结果 护理实习生人际交往效能感得分为(144.28±15.37)分;人际交往效能感得分在学历、生源地、家庭来源、临床实习时间等方面差异无统计学意义(P>0.05),但在性别上差异有统计学意义(P<0.05).结论 护理实习生人际交往效能感有待提高.护理实习生应注重塑造良好的个性品质,而学校应完善课程设置,培养学生人际交往的相关技巧.

  17. Influencing Up

    Cohen, Allan R

    2012-01-01

    The authors of the classic Influence Without Authority explain the unique challenges of influencing powerful people Learn to overcome your difficulties with a boss who is uninterested in your concerns, or resistant to giving needed support. Or discover how to win the cooperation of senior managers who are hard to reach, and hard to sell on your ideas, products, or services. In their classic book, Influence Without Authority, Allan Cohen and David Bradford provided a universal model of how to influence someone you don't control. Influencing Up applies those ideas to problematic bosses and other

  18. The influence of oocyte maturation on embryo development and clinical outcomes in intracytoplasmicsperm injection cycles%ICSI 周期卵子成熟度对胚胎发育与临床结局的影响

    蒋益群; 王珊珊; 张宁媛; 徐志鹏; 孙海翔

    2015-01-01

    Objectives:To investigate the influence of oocyte maturation on fertilization,embryo develop-ment and clinical outcomes in intracytoplasmic sperm injection (ICSI)cycles.Methods:33 patients with immature oocyte (MI oocytes or GV oocytes)accounted for more than half of the total in fresh cycle of ICSI cycles,from March 201 2 to December 201 3,were selected as group A.1 38 patients,of whom the number of immature oocyte was less than 20% of the number of retrieved oocytes of ICSI cycles,from September 201 2 to December 201 2,were selected as group B.Fertilization rate,naomal fertilization rate,multinuclear rate,high quality embryos rate,clini-cal pregnancy rate and embryo implantation rate of the two groups were compared.Results:From group A,261 oo-cytes were obtained;the number of mature oocytes was 1 1 8;the fertilization rate was 80.51 %;normal fertilization rate was 72.88%;multinuclear rate was 6.78%;high quality embryos rate was 47.37%;clinical pregnancy rate was 30.30% and embryo implantation rate was 1 9.30%.From group B in,1 330 oocytes were obtained;the num-ber of mature oocyte was 1 1 46;the fertilization rate was 89.97%;normal fertilization rate was 86.39%;multinu-clear rate was 1 .1 3%;high quality embryos rate was 61 .64%;clinical pregnancy rate was 59.42% and embryo implantation rate was 40.88%.The level of fertilization rate,normal fertilization,high quality embryos rate,clini-cal pregnancy rate and embryo implantation rate in group A were obviously higher than those of group B,while the level of multinuclear rate in group A was lower.Conclusion:The overabundance of immature oocyte in ICSI cycles will decrease the embryo utility rate and affect the pregnancy outcome.%目的:研究卵胞浆内单精子注射(ICSI)周期中卵子成熟度对受精、胚胎发育以及临床结局的影响。方法:收集我院从2012年3月至2013年12月,新鲜周期中未成熟卵子(MⅠ或 GV)占获卵数50%及以上的 ICSI 周期为 A 组(n =33

  19. Stress Influences on Anoikis

    Sood, Anil K; Lutgendorf, Susan K.

    2011-01-01

    It long has been suspected that psychosocial factors affect cancer development and progression. Although the connections between stress and cancer causation are not strong, epidemiological and clinical studies have provided strong links between cancer progression and several stress-related factors including chronic stress, depression, and social isolation. Recent molecular and biological studies have identified specific signaling pathways that influence cancer growth and metastasis. In partic...

  20. Handicaps for Evidence-based Practice and Its Influencing Factors in Clinical Nurses in Zhejiang Province%浙江省临床护士循证实践障碍及影响因素分析

    李春燕; 黄丽华; 叶向红; 叶旭琴

    2013-01-01

    Objective To fully understand the handicaps for evidence-based practice and its influencing factors and to provide evidence for intervention. Methods With Chinese version of Handicap Inventory Short Form about Evaluation of Evidence-Based Nursing Practice developed by LIU Xiao-hua, a cross-sectional survey was conducted among 831 clinical nurses in Zhejiang Province. Results Though with well knowledge of evidence-based practice in nursing, 70.7%of the nurses proposed there existed handicaps in evidence-based practice. Insufficient resources of implementing evidence-based practice and low quality of nursing search report scored higher. There were less handicaps among nurses after training of evidence-based practice in nursing, those with senior positions and those in department of nursing administration, emergency and ICU (P<0.05). Conclusion There are many handicaps for evidence-based practice in nursing. Great emphasis should be laid to scientific research of nursing. Sufficient evidence-based practice resources and various evidence-based practice in nursing education for nurses would contribute to the development of evidence-based nursing practice.%  目的全面了解浙江省临床护士的循证实践障碍现状,并分析其影响因素,为护理管理者实施干预提供可靠的参考依据.方法采用刘晓华等研制的中文版循证护理实践障碍量表,对浙江全省11个行政区22所医院共831名临床护士进行横断面调查.结果70.7%的临床护士认为自己循证实践存在障碍,但对循证护理的认识较好,得分较高的是开展循证护理的资源条件不足和护理研究报道的质量不高.参加过循证护理培训、职务较高和在护理部、急诊室、ICU等部门工作的护士循证实践障碍较小(P<0.05).结论浙江省临床护士循证实践障碍较严重,管理者应重视护理科研,营造良好的科研氛围;提供简单有效的循证资源,完善图书馆、数据库

  1. Clinical cases

    This presentation is about clinical cases and the contribution of the PET - CT Fag application in the diagnosis and treatment of different types of cancer. The cases presented were: neck diseases, epidermoid carcinoma, liver damage and metastasize, lymphoma, thrombosis, colonic cancer and lung disease

  2. The Future of Clinical Dentistry.

    Slavkin, Harold C.

    1998-01-01

    Discussion of the future of clinical dentistry looks at a variety of influences, including historical development factors; demographic trends; the role of the Human Genome Project in the development of scientific knowledge; a paradigm shift in approaches to oral infection and systemic disease; advancing technology; and reforms resulting from these…

  3. Clinical biochemistry

    Alexander, W. C.; Leach, C. S.; Fischer, C. L.

    1975-01-01

    The objectives of the biochemical studies conducted for the Apollo program were (1) to provide routine laboratory data for assessment of preflight crew physical status and for postflight comparisons; (2) to detect clinical or pathological abnormalities which might have required remedial action preflight; (3) to discover as early as possible any infectious disease process during the postflight quarantine periods following certain missions; and (4) to obtain fundamental medical knowledge relative to man's adjustment to and return from the space flight environment. The accumulated data presented suggest that these requirements were met by the program described. All changes ascribed to the space flight environment were subtle, whereas clinically significant changes were consistent with infrequent illnesses unrelated to the space flight exposure.

  4. Followership, clinical leadership and social identity.

    Mannion, Hester; McKimm, Judy; O'Sullivan, Helen

    2015-05-01

    This article explores how the concepts of followership, social identity and social influence help clinical leaders and followers better understand how leadership processes function within and between individuals, teams and complex organizations. PMID:25959938

  5. The Relationship between Clinical Competence and Clinical Self-efficacy among Nursing and Midwifery Students

    Shahla Mohamadirizi; Shahnaz Kohan; Fatemeh Shafei; Soheila Mohamadirizi

    2015-01-01

    Introduction  Self-efficacy in clinical performance had an important role in applying competencies; also competencies and self-efficacy in clinical performance influenced to quality care of nursing and midwifery students. So the present study aimed to define the relationship between clinical competencies and clinical self-efficacy among nursing and midwifery students. Materials and Methods  This is a cross-sectional study conducted on 150 of nursing and midwifery students in Isfahan Universit...

  6. Influence of the curve density relative electron in dosimetry clinic in treatments stereo tactics; Influencia de la curva de densidad electronica relativa en la dosimetria clinica en tratamientos estereotaxicos

    Moreno Saiz, C.; Benitez Villegas, E. M.; Casado Villalon, F. J.; Parra Osorio, V.; Bodineau Gil, C.; Garcia Pareja, S.

    2013-07-01

    The objective of this study is to analyze the difference between clinical dosimetry in the treatments with radiosurgery and stereotactic radiotherapy fractional obtained from the relative Electron density curve (Schneider 1996) tabulated and provided with the scanner's radiation therapy. (Author)

  7. Clinical study of the influence of laryngopharyngeal reflux on quality of life in patients with dysphonia%咽喉反流对嗓音疾病患者生活质量影响的临床研究

    王宇光; 张立红; 余力生; 李晶兢; 李进让; 赵一馨; 曹杰

    2015-01-01

    目的 研究咽喉反流(laryngopharyngal reflux,LPR)在嗓音疾病患者中的患病率;探讨咽喉反流对嗓音疾病患者SF-36健康调查(36-item shortform health survey,SF-36)量表及嗓音障碍指数(voice handicap index,VHI)量表各项指标的影响.方法 选取因嗓音疾病来北京大学人民医院耳鼻咽喉科门诊就诊及住院手术的患者127例,填写反流症状指数(reflux symptom index,RSI)量表、反流体征评分(reflux finding score,RFS)量表、VHI量表及SF-36健康调查量表,并进行24 h双探头pH监测.另外,通过体检、门诊、病房及网络微信平台等途径收集RSI资料2 643例.结果 经24 h pH监测的127例嗓音疾病患者中,LPR的患病率为46.4%(59/127);收集RSI量表2 643例中,第一条目"声嘶或发音障碍"得分大于0的有1 241例,初步诊断咽喉反流性疾病(laryngopharyngal reflux disease,LPRD)(RSI得分>13)807例,占"声嘶或发音障碍"患者的65.0%(807/1 241);在127例嗓音疾病患者中,以24 h双探头pH监测作为诊断依据,LPR 阳性组与 LPR阴性组在VHI量表得分中,总分和情感方面得分差异有统计学意义(P<0.05),而功能和生理方面得分差异无统计学意义(P>0.05),SF-36健康调查量表的生理职能、总体健康、活力、社会功能、情感职能和精神健康等方面得分差异有统计学意义(P<0.05),而在生理功能、躯体疼痛等方面差异无统计学意义(P>0.05).结论 嗓音疾病中LPR患病率较高,治疗同时要关注患者生活质量.%Objective To explore the morbidity of laryngopharyngeal reflux in patients with dysphonic diseases and to investigate the influence of LPR on the patients.Methods One hundred and twenty-seven patients with dysphonic diseases were encountered in Peking University of the People Hospital.Under the agreement, the patients were asked to fill in the scales of RSI, RFS, VHI and SF-36.24-hour ambulatory double pH monitoring was applied to diagnose LPR

  8. 围绝经期妇女焦虑、抑郁障碍的临床特征及影响因素分析%Clinical features of depression and anxiety disorders and their influence factors in perimenopausal women

    郭珍; 刘飞; 张欣尚; 陆峥

    2015-01-01

    Objective To investigate the clinical features of depression and anxiety disorders and their influence factors in women during perimenopause .Methods Fifty-seven cases of first hospitalized perimenopausal patients with anxiety and depression symptoms evaluated by Hamilton Depression Rating Scale for Depression (HAMD) ,Hamilton Anxiety Scale for Anxiety (HAMA) and Life Event Scale (LES) ,and detected of hormone levels .All of the data were input into a database and analyzed with de‐scriptive statistics ,Spearman correlation analysis and multiple linear regression analysis .Results All 57 patients in the HAMD total score of (22 .56 ± 8 .48) ,HAMA total score of (15 .21 ± 7 .88) ,mainly mild or moderate depression and definite anxiety .Most of the patients affected by life events ,especial the negative life events .Linear correlation analysis showed that the incidence of postmenopausal was posi‐tively correlated with depressive disorder ,the correlation coefficient was 0 .275;there was no significant correlation factor with anxiety disorders .Linear regression analysis showed that estradiol was negatively correlation with depressive disorders;pituitary prolactin ,economically disadvantaged families ,children long - term leaving home was positively correlated with depression (the regression coefficients were-0 .823 ,0 .230 ,1 .017 ,0 .783 ,respectively);economically disadvantaged families ,bad marital relations was positively correlated with anxiety disorders (the regression coefficient were 0 .802 ,0 .553) .Conclu‐sions Perimenopausal women were mainly in mild or moderate anxiety and depression ,were affected by hormones and social family factors .%目的:探讨围绝经期妇女焦虑、抑郁障碍的主要临床特征及相关影响因素。方法采用HAMD和HAMA对57例首次入院治疗的围绝经期焦虑、抑郁障碍患者进行临床症状评估,生活事件量表(LES)评估,以及检测每位患者体内激素水平,并用描述性统

  9. Clinical arthrography

    Arndt, R.; Horns, J.W.; Gold, R.H.; Blaschke, D.D.

    1985-01-01

    This book deals with the method and interpretation of arthrography of the shoulder, knee, ankle, elbow, hip, wrist, and metacarpophalangeal, interphalangeal, and temporomandibular joints. The emphasis is on orthopaedic disorders, usually of traumatic origin, which is in keeping with the application of arthrography in clinical practice. Other conditions, such as inflammatory and degenerative diseases, congenital disorders and, in the case of the hip, arthrography of reconstructive joint surgery, are included. Each chapter is devoted to one joint and provides a comprehensive discussion on the method of arthrography, including single and double contrast techniques where applicable, normal radiographic anatomy, and finally, the interpretation of the normal and the abnormal arthrogram.

  10. Towards clinical bioethics (or a return to clinical ethics?).

    Petrini, C

    2013-01-01

    Medical ethics has traditionally been oriented towards the clinical setting. Since the middle of the last century, however, various circumstances (associated mainly, though not exclusively, with rapid advances in technology and knowledge) have considerably broadened both the field of enquiry and the scope of this discipline. This is due partly to the overlap between medical ethics and bioethics, which in recent decades has acquired its own identity and concerns a multitude of ethical aspects in the biomedical field. Clinical ethics taps into the vast wealth of deontology, so that it has no need for additional criteria or principles, or for the definition of new values: rather, it recognizes the need to apply existing criteria, principles and values to contingent circumstances and contexts. A special role is reserved for ethics committees and, above all, for clinical ethics consultants, although in some countries the former are concerned mainly with authorisations for clinical trials. Clinical ethics consultants, however, may have a more incisive influence in clinical decisions: the special requisites and skills they need have been defined and discussed in various documents which are mentioned briefly in the present article. The presence of these consultants does not exonerate clinical physicians from their responsibilities or from liability for their decisions, in the formation of which they must refer constantly to codes of professional ethics. PMID:24424236

  11. Clinical guidelines.

    Uppal, Elaine

    2016-01-01

    This article is part of the Advancing practice series which is aimed at exploring practice issues in more depth, considering topics that are frequently encountered and facilitating the development of new insights. Elaine Uppal focuses on the importance of all midwives developing guideline writing skills to ensure that local, national and international midwifery/maternity guidelines are up to date, relevant and reflect midwifery knowledge alongside 'gold' standard evidence. The article aims to consider the development, use and critical appraisal of clinical guidelines. It will define and explain guidelines; discuss their development and dissemination; and consider issues relating to their use in practice. Techniques to critique and develop guidelines using the AGREE tool will be outlined in the form of practice challenges to be undertaken by the individual or in a group. PMID:26975126

  12. Clinical myths of forensic neuropsychology.

    Greiffenstein, Manfred F

    2009-02-01

    Clinical myths and lore are unfounded beliefs that still influence practice decisions. I examine the validity of six beliefs commonly encountered in forensic neuropsychology practice: the admissibility of test batteries; avoidance of practice effects; forewarning insures good effort; average deficits in bright persons; 15% chronic impairment in mild brain injury; and examiner bias causing malingering. I show these beliefs are invalid because of material misunderstandings of case law and literature, falsification by empirical findings, and lack of authoritative sources. The benefits, costs, and persistence of clinical myths are discussed. PMID:18609338

  13. CME ON CLINICAL RESEARCH

    Suneel. I. Majagi

    2012-06-01

    , monitor and supervise the clinical trials or the research projects. Ethical decision is taken without coercion, influence, inducement and intimidation. Dr.S.S.Torgal (JNMC spoke on “Introduction to clinical trials”. A systematic study of a new drug in human subjects to generate data for discovering and/or verifying the clinical, pharmacological (pharmacodynamic / pharmacokinetic and/or adverse effects with the objective of determining safety and/or efficacy of the new drug is known as clinical trial (Phase I, II, III and IV. There are many types of trials viz., Prevention trials, Screening trials, Diagnostic trials, Treatment trials, Quality of life trials and Compassionate use trials. The Clinical Trials Registry-India (CTRI is an online register of clinical trials being conducted in India.In the second scientific session, Dr.A.Shrivastav (KLE Hospital talked on “Conducting clinical trials-Investigators perspective”. He explained about good clinical practice, role of primary investigator, CROs, DCGI, site management office (SMO, regulatory requirements and data management. Essential trial documents include protocol, informed consent form, investigators brochure etc. Study team at site consists of investigator, co/sub-investigator, clinical research/study coordinator, research nurse, pharmacist, unblinded personnel etc. Dr.S.I.Majagi (JNMC gave a lecture on “Pharmacovigilance” which is a science of activities relating to the detection, assessment, understanding and prevention of adverse drug reactions (ADR or any other medicine related problem. He explained about history, need, objectives, applications, methods (spontaneous reports etc, organizations involved (WHO, National pharmacovigilance center etc in pharmacovigilance, Risk assessment, Risk management (RM, goals of RM, Risk minimization action plan(Risk MAP, tools of RM process and Signal: detection, sources, data, data interpretation, selection or rejection, strengthening (by assessment criteria

  14. 2~6岁儿童牙科诊室行为影响因素研究%2~6 Years Old Children's Dental Clinic Behavior Influence Factor

    赵娟

    2015-01-01

    Objective To study the effect of 2~6 years old children's dental clinic behavior factors. Methods Choose 71 cases of 2~6 years old children, were divided into group A (group) and group B (don't deserve to form); For children's emotional types and daily behavior characteristic, the children's mother dental anxiety, children's parent materials of oral health awareness. Results A, B two groups of children with age, emotional stress, significant difference (P<0.05);Parents of children with children's oral diseases responsibility, performance, treatment duration in the park and children's dental clinic behavior correlation (P<0.05). Conclusion The degree of parental responsibility, children in performance, treatment duration is 2~6 years old children's dental clinic behavior of the main factors.%目的:探讨影响2~6岁儿童牙科诊室行为的因素。方法选取71例2~6岁儿童,分为A组(配合组)、B组(不配合组);获取儿童的情绪类型以及日常的行为特点、儿童母亲的牙科焦虑状况、儿童家长的口腔健康意识等资料。结果A、B两组患儿的年龄、情绪应激性差异有统计学意义(P<0.05);家长对儿童口腔疾病的责任承担度、患儿入园表现、治疗持续时间与儿童的牙科诊室行为存在相关性(P<0.05)。结论家长的责任承担度、患儿入园表现、治疗的持续时间是影响2~6岁儿童牙科诊室行为的主要因素。

  15. Let-7 miRNA-binding site polymorphism in the KRAS 3′UTR; colorectal cancer screening population prevalence and influence on clinical outcome in patients with metastatic colorectal cancer treated with 5-fluorouracil and oxaliplatin +/− cetuximab

    Kjersem Janne B

    2012-11-01

    Full Text Available Abstract Background Recent studies have reported associations between a variant allele in a let-7 microRNA complementary site (LCS6 within the 3′untranslated region (3′UTR of KRAS (rs61764370 and clinical outcome in metastatic colorectal cancer (mCRC patients receiving cetuximab. The variant allele has also been associated with increased cancer risk. We aimed to reveal the incidence of the variant allele in a colorectal cancer screening population and to investigate the clinical relevance of the variant allele in mCRC patients treated with 1st line Nordic FLOX (bolus 5-fluorouracil/folinic acid and oxaliplatin +/− cetuximab. Methods The feasibility of the variant allele as a risk factor for CRC was investigated by comparing the LCS6 gene frequencies in 197 CRC patients, 1060 individuals with colorectal polyps, and 358 healthy controls. The relationship between clinical outcome and LCS6 genotype was analyzed in 180 mCRC patients receiving Nordic FLOX and 355 patients receiving Nordic FLOX + cetuximab in the NORDIC-VII trial (NCT00145314. Results LCS6 frequencies did not vary between CRC patients (23%, individuals with polyps (20%, and healthy controls (20% (P = 0.50. No statistically significant differences were demonstrated in the NORDIC-VII cohort even if numerically increased progression-free survival (PFS and overall survival (OS were found in patients with the LCS6 variant allele (8.5 (95% CI: 7.3-9.7 months versus 7.8 months (95% CI: 7.4-8.3 months, P = 0.16 and 23.5 (95% CI: 21.6-25.4 months versus 19.5 months (95% CI: 17.8-21.2 months, P = 0.31, respectively. Addition of cetuximab seemed to improve response rate more in variant carriers than in wild-type carriers (from 35% to 57% versus 44% to 47%, however the difference was not statistically significant (interaction P = 0.16. Conclusions The LCS6 variant allele does not seem to be a risk factor for development of colorectal polyps or CRC. No statistically significant effect of the

  16. 临床药师药学干预呼吸内科抗生素使用的研究%Influence of clinical pharmacists’pharmaceutical intervention on reasonable use of antibiotics in department of respiratory medicine

    朱惠新

    2015-01-01

    目的:探讨临床药师药学干预对呼吸内科合理使用抗生素的影响。方法随机抽取临床药师药学干预前后呼吸内科病例资料各300份,比较干预前后抗生素使用情况、抗感染效果、合理使用等差异。结果干预后抗生素使用率明显低于干预前(71.3%VS 95.7%,P=0.000);单联抗生素使用率明显高于干预前(28.7%VS 19.0%,P =0.028),三联及以上抗生素明显低于干预前(20.0%VS 43.3%,P =0.000);平均住院费用明显少于干预前[(1965.7±265.7) VS (2600.8±316.5)元,P<0.01];抗生素使用不合理性明显低于干预前(20.1%VS 34.2%,P<0.01)。结论临床药师药学干预可促进呼吸内科合理使用抗生素,指导医生用药行为。%Objective To investigate the effect of clinical pharmacists ’pharmaceutical intervention on reasonable use of antibi-otics in department of respiratory medicine .Methods The clinical data of 300 cases before and after clinical pharmacists ’pharmaceuti-cal intervention were randomly collected .The differences in application of antibiotics ,anti-infection effect and reasonable use before and after intervention were compared.Results After the intervention,antibiotics usage were significantly lower (71.3% vs 95.7%,P =0.000),single union antibiotics usage was significantly higher (28.7%vs 19.0%,P =0.028) and sanlian and above antibiotics were significantly lower(20.0%vs 43.3%,P =0.0001) when compared to before the intervention .The hospitalization cost was also signifi-cantly less than before intervention(1965.7 ±265.7)yuan vs (2600.8 ±316.5 yuan)].The irrational antibiotic use was significantly lower than before intervention(20.1% vs 34.2%).Conclusion Clinical pharmacists’pharmaceutical intervention can promote rea-sonable use of antibiotics ,and regulate behavior of doctor ’s medication .

  17. Should the host reaction to anisakiasis influence the treatment?: Different clinical presentations in two cases ¿Debe la reacción frente la anisakiasis influir sobre el tratamiento?: Presentación clínica

    Stefano Pontone

    2012-12-01

    Full Text Available Gastrointestinal anisakiasis is a parasitic infection occurring in people that consume raw or inadequately cooked fish or squid. It is frequently characterized by severe epigastric pain, nausea and vomiting caused by the penetration of the larvae into the gastric wall. Acute gastric anisakiasis with severe chest discomfort is rarely reported in Italy. On the other hand, gastro-allergic anisakiasis with rash, urticaria and isolated angioedema or anaphylaxis is a clinical entity that has been described only recently. Also, if patients usually develop symptoms within 12 hours after raw seafood ingestion, not always endoscopic exploration can promptly identify the Anisakis larvae. Moreover, some authors consider the prevailing allergic reaction as a natural and effective defense against the parasitic attack. We report two cases of peculiar manifestations of anisakiasis in both acute and chronic forms (severe chest discomfort and anaphylactoid reaction.

  18. Community Nursing Willingness and Its Influencing Factors of Clinical Nurses in Wenzhou%温州市部分临床护士从事社区护理工作的意愿及其影响因素

    胡晓秋; 严笑金

    2011-01-01

    目的 了解临床护士从事社区护理的意愿,分析影响临床护士从事社区护理的因素,为上级行政部门在建设社区护士队伍的过程中提供政策依据.方法 2010年3-7月,采取分层抽样与整群抽样结合的方式,选取温州地区3所医院的393名临床护士为调查对象,对其进行自填式问卷调查,对临床护士从事社区护理工作的意愿进行Logistic回归分析.结果 温州市49.10%的护士愿意从事社区护理工作,当前温州市社区护理工作的客观条件满意度总评分为3.07分.医院等级、工作年限、职称、年薪、是否参加过有关学习或培训这5个变量对温州市临床护士从事社区护理工作的意愿具有显著影响(P<0.05).结论 较小的工作压力、良好的行业发展前景是吸引临床护士从事社区护理工作的主要因素,而较低的社会认同度、一般的工作环境和不太高的薪资待遇则是临床护士不愿意从事社区护理工作的主要原因.%Objective To comprehend the community nursing willingness of clinical nurses, and analyze the factors affecting the community nursing willingness,so as to provide the policy basis for the administrative department in the process of developping community nurses. Methods Using the stratified sampling and cluster sampling methods,393 nurses from three hospitals in Wenzhou were selected for the investigation of the community care willingness from March to July 2010. A self-administered questionnaire was adopted for the community nursing willingness in clinical nurses and the results were analyzed by Logistic regression. Results Totally 49. 10% of the nurses were willing to engage in community nursing work. The total score of objective conditions was 3. 07 points for current wenzhou community nursing work. The five variables of hospital level,service year,title,salary,whether attending the learning or training have significant effect in the community nursing willingness of

  19. Cytogenetic abnormalities additional to t(11;14) correlate with clinical features in leukaemic presentation of mantle cell lymphoma, and may influence prognosis: a study of 60 cases by FISH.

    Parry-Jones, N; Matutes, E; Morilla, R; Brito-Babapulle, V; Wotherspoon, A; Swansbury, G J; Catovsky, D

    2007-04-01

    Mantle cell lymphoma (MCL), characterised by t(11;14)(q13;q32), has a poor prognosis. Many cases have additional cytogenetic abnormalities, and often have a complex karyotype. Fluorescence in situ hybridisation (FISH) was used to study 60 cases with leukaemic presentation of MCL, to determine the frequency, clinical correlations and prognostic impact of a panel of molecular cytogenetic abnormalities: 17p13 (TP53 locus), 13q14, 12 p11.1-q11 (centromere), 6q21 and 11q23. CD38 expression, of prognostic value in chronic lymphocytic leukaemia (CLL), was also studied, and correlations with clinical and cytogenetic abnormalities sought. Eighty per cent of cases had at least one abnormality in addition to t(11;14). Deletions at 17p13 (TP53) and 13q14 were most frequent and involved the majority of the leukaemic clone. Cases with TP53 deletion were more likely to have splenomegaly and marked leucocytosis (>30 x 10(9)/l), and less likely to have lymphadenopathy than those without deletion. Deletions at 11q23 and 6q21 were associated with extranodal disease. 13q14 and 11q23 deletions showed a trend towards worse prognosis by univariate analysis. In multivariate analysis, deletions at 13q14 and 6q21 were independent predictors of poor outcome. Deletion at 17p13 did not show prognostic impact in this series. CD38, positive in two-thirds of cases, was associated with male gender and nodal disease but not with any cytogenetic abnormality, or with survival. PMID:17391491

  20. Organisational strategies for changing clinical practice: how trusts are meeting the challenges of clinical governance

    Wallace, L.; Freeman, T.; Latham, L; Walshe, K; Spurgeon, P

    2001-01-01

    Objectives—To describe the use, perceived effectiveness, and predicted future use of organisational strategies for influencing clinicians' behaviour in the approach of NHS trusts to clinical governance, and to ascertain the perceived benefits of clinical governance and the barriers to change.

  1. Philosophy of clinical psychopharmacology.

    Aragona, Massimiliano

    2013-03-01

    The renewal of the philosophical debate in psychiatry is one exciting news of recent years. However, its use in psychopharmacology may be problematic, ranging from self-confinement into the realm of values (which leaves the evidence-based domain unchallenged) to complete rejection of scientific evidence. In this paper philosophy is conceived as a conceptual audit of clinical psychopharmacology. Its function is to criticise the epistemological and methodological problems of current neopositivist, ingenuously realist and evidence-servant psychiatry from within the scientific stance and with the aim of aiding psychopharmacologists in practicing a more self-aware, critical and possibly useful clinical practice. Three examples are discussed to suggest that psychopharmacological practice needs conceptual clarification. At the diagnostic level it is shown that the crisis of the current diagnostic system and the problem of comorbidity strongly influence psychopharmacological results, new conceptualizations more respondent to the psychopharmacological requirements being needed. Heterogeneity of research samples, lack of specificity of psychotropic drugs, difficult generalizability of results, need of a phenomenological study of drug-induced psychopathological changes are discussed herein. At the methodological level the merits and limits of evidence-based practice are considered, arguing that clinicians should know the best available evidence but that guidelines should not be constrictive (due to several methodological biases and rhetorical tricks of which the clinician should be aware, sometimes respondent to extra-scientific, economical requests). At the epistemological level it is shown that the clinical stance is shaped by implicit philosophical beliefs about the mind/body problem (reductionism, dualism, interactionism, pragmatism), and that philosophy can aid physicians to be more aware of their beliefs in order to choose the most useful view and to practice coherently

  2. Shared clinical decision making

    AlHaqwi, Ali I.; AlDrees, Turki M.; AlRumayyan, Ahmad; AlFarhan, Ali I.; Alotaibi, Sultan S.; AlKhashan, Hesham I.; Badri, Motasim

    2015-01-01

    Objectives: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia. Methods: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences. Results: The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008). Conclusion: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes. PMID:26620990

  3. 感染性心内膜炎患者临床特征与预后影响因素分析%Clinical characteristics and influencing factors of prognosis of infective endocarditis

    张苑; 任鹏涛; 杨婧; 刘婷婷; 闫庆辉; 张国建

    2016-01-01

    OBJECTIVE To investigate the clinical characteristics and prognostic factors of infective endocarditis ,so as to provide basis for improving the prognosis of patients with endocarditis .METHODS A total of 900 patients with infective endocarditis in the hospital from Jan .2010 to Dec .2014 were selected ,and their clinical data were retrospectively analyzed .Clinical characteristics of the patients and their performance were analyzed .The prognos‐tic factors were analyzed by univariate and multivariate logistic regression analyses ,the results were statistically analyzed by using SPSS 20 .0 software .RESULTS Totally 869 patients had underlying heart diseases among the 900 patients with infective endocarditis ,accounting for 96 .56% .The univariate analysis showed artificial valve , fever ≥39 ℃ ,hypersensitive C‐reactive protein ≥60 mg/L ,hemoglobin <90 g/L ,serum albumin <30 g/L and surgical treatment were the related prognostic factors (P< 0 .05) .The multivariate logistic regression analysis showed that hemoglobin <90 g/L ,serum albumin <30g/L and surgical treatment were the independent prognos‐tic factors (P<0 .05) .CONCLUSION The results show that most patients with infective endocarditis have under‐lying heart diseases ,the majority of patients have normal ECG .Levels of hemoglobin and serum albumin as well as surgical treatment are prognostic risk factors in infective endocarditis .%目的:探讨感染性心内膜炎患者的临床特征及预后影响因素,为提高心内膜炎患者预后提供参考依据。方法回顾性分析2010年1月-2014年12月医院收治的900例感染性心内膜炎患者临床资料,分析患者的临床特征及表现,预后影响因素进行单因素及多因素logistic回归分析,结果采用SPSS 20.0软件进行统计分析。结果900例感染性心内膜炎患者中有基础心脏疾病患者869例占96.56%;单因素分析显示,人工瓣膜、发热≥39

  4. Clinical image quality evaluation for panoramic radiography in Korean dental clinics

    Choi, Bo-ram; Choi, Da-Hye; Huh, Kyung-Hoe; Yi, Won-Jin; Heo, Min-Suk; Choi, Soon-Chul; Bae, Kwang-Hak; Lee, Sam-Sun

    2012-01-01

    Purpose The purpose of this study was to investigate the level of clinical image quality of panoramic radiographs and to analyze the parameters that influence the overall image quality. Materials and Methods Korean dental clinics were asked to provide three randomly selected panoramic radiographs. An oral and maxillofacial radiology specialist evaluated those images using our self-developed Clinical Image Quality Evaluation Chart. Three evaluators classified the overall image quality of the p...

  5. Thr(118Met amino acid substitution in the peripheral myelin protein 22 does not influence the clinical phenotype of Charcot-Marie-Tooth disease type 1A due to the 17p11.2-p12 duplication

    W. Marques Jr.

    2003-10-01

    Full Text Available The Thr(118Met substitution in the peripheral myelin protein 22 (PMP22 gene has been detected in a number of families with demyelinating Charcot-Marie-Tooth (CMT1 neuropathy or with the hereditary neuropathy with liability to pressure palsy, but in none of them has it consistently segregated with the peripheral neuropathy. We describe here a CMT1 family (a 63-year-old man, his brother and his niece in which two mutations on different chromosomes were found in the PMP22 gene, the 17p duplication, detected by fluorescent semiquantitative polymerase chain reaction (PCR of microsatellite markers localized within the duplicated region on chromosome 17p11.2-p12, and the Thr(118Met substitution, detected by direct sequencing the four coding exons of the PMP22 gene. A genotype/phenotype correlation study showed that the neuropathy segregates with the duplication and that the amino acid substitution does not seem to modify the clinical characteristics or the severity of the peripheral neuropathy. We did not find any evidence to characterize this substitution as a polymorphism in the population studied and we propose that the high frequency reported for this point mutation in the literature suggests that the Thr(118Met substitution may be a hotspot for mutations in the PMP22 gene.

  6. Influence of Clinical Psychological Counseling on Preventing Postpartum Depression%临床心理疏导与支持对预防产后抑郁的分析

    杨家爱

    2015-01-01

    218 puerperae were investigated about the psychological depression.The survey result showed the population characteristics which was prone to postpartum depression.The reason of postpartum depression was discussed.Finally,according to the psychological states of puerpera before and after the delivery, the clinical psychological counseling and strategies to prevent postpartum depression were put forward.The effective means,including the proper postpartum education,harmonious family relationship,efficient psychological counseling,had positive role to alleviate and eliminate the anxiety and depression of puerpera.%选取218例产妇进行心理抑郁调查,得出了易于发生产后抑郁的人群特征。讨论产妇发生产后抑郁的原因,分析产妇分娩前后的心理状态,提出了预防产后抑郁的临床心理疏导与支持策略。正确的产后教育、和谐的家庭及社会支持系统、有效的心理疏导、温馨的互换关系,具有减轻和消除产妇的焦虑和抑郁心情的作用。

  7. How Clinical Instructors Can Enhance the Learning Experience of Physical Therapy Students in an Introductory Clinical Placement

    Cole, Beverley; Wessel, Jean

    2008-01-01

    Purpose: There is little understanding of how physical therapy students are influenced by clinical instructors (CIs) particularly at the outset of their clinical learning. The purpose of this study was to evaluate physical therapy students' perceptions of their learning experiences during an introductory clinical placement. Methods: Subjects were…

  8. Influence of Nonverbal Behavior on Doctor-Patient Relationship in Clinical Activities——Based on the Survey Data of Five Top-Class Hospitals in X City%诊疗中非言语行为对医患关系的影响——基于某市5所三甲医院的调查研究

    孙咏莉; 王晓燕; 梁立智; 关丽征; 宋晓霞; 焦峰

    2011-01-01

    There is a significant difference in expectation of speech tone, gestures, distance, eye contact, facial expressions, standing and sitting posture in clinical activities between doctors and patients, that was shown in this investigation. And these unmatched non - verbal elements to some extent influenced the construction of harmonious Doctor - Patient Relationship.%本次调查发现,在诊疗活动中,医患双方对医务人员讲话的语气、手势、问诊距离、眼神、表情、职业坐姿和职业站姿等非言语行为要素的期待存在明显差异,这些不匹配的非言语行为要素在一定程度上影响了和谐医患关系的构建.

  9. Writing clinical scenarios for clinical science questions.

    Smith, Phil Em; Mucklow, John C

    2016-04-01

    Written knowledge assessments for physicians in training typically involve multiple-choice questions that use a clinical scenario in a single-best-answer format. The Royal College of Physicians Part 1 MRCP(UK) examination includes basic sciences themes that are challenging to assess through a clinical scenario. A realistic clinical setting based on everyday clinical practice and integral to the question is the clearest demonstration that the knowledge being assessed is clinically relevant. However, without special attention to detail, the scenario in a clinical science question can appear redundant or artificial. Reading unnecessary material frustrates candidates and threatens the reputation of the assessment. In this paper we discuss why a clinical scenario is important for basic science questions and offer advice on setting realistic and plausible clinical scenarios for such questions. PMID:27037383

  10. Discussion on Influence of Physiques Bias on Treatment and Clinical Effect of Uveitis%针对葡萄膜炎患者体质偏畸在临床治疗及其疗效的探讨

    赵建英; 郝小波

    2012-01-01

    目的:从中医纠正葡萄膜炎患者体质偏畸的方法,了解该方法在临床的试用情况.方法:在一定范围了解葡萄膜炎患者中医体质类型分布情况;运用相关干预体质偏畸的手段观察该病患者在不同时间段的复发情况.结果:调查中发现广西地区葡萄膜炎患者体质类型具有独有的偏畸性;所选患者在治疗中其体质均有所改善的同时临床复发率也明显降低.结论:祖国医学在临床治疗上讲究所谓的“三因制宜”,应用该理论指导临床,配合使用中药及中医的相关治疗手段,以达到在治疗上不但重视局部,更注重整体的理念,最终达到缩短葡萄膜炎患者病程或减少葡萄膜炎复发率,最终达到综合性提高葡萄膜炎患者治疗疗效的目的,该疗法进一步体现了中医治疗方向是“以人为本”而不是单纯以“病”入手的这样一种理念.%Objective: Though the TCM method of correcting physical bias of uveitis patients to understand the method in the clinical trial. Methods : To understand the distribution of Chinese constitutional types in a certain range of uveitis patients; the interventions were used to observe the recurrence at different times. Results:The survey found that uveitis patients in Guangxi had a unique physical type;the treatment of selected patients had improved their physical fitness,while significantly lowered the recurrence rate. Conclusion: TCM pays attention to the treatment which is so-called three conditions for clinical applications, in conjunction with the relevant Chinese medicine treatment in order to treat not only the local,but the whole,and to shorten the duration of uveitis or reduce the recurrence rate, and ultimately obtaining a comprehensive treatment of uveitis. The TCM treatment further demonstrates the direction of people-oriented, which is not simply to treat a disease.

  11. Artificial Neural Networks for differential diagnosis of breast lesions in MR-Mammography: A systematic approach addressing the influence of network architecture on diagnostic performance using a large clinical database

    Rationale and objectives: Differential diagnosis of lesions in MR-Mammography (MRM) remains a complex task. The aim of this MRM study was to design and to test robustness of Artificial Neural Network architectures to predict malignancy using a large clinical database. Materials and methods: For this IRB-approved investigation standardized protocols and study design were applied (T1w-FLASH; 0.1 mmol/kgBW Gd-DTPA; T2w-TSE; histological verification after MRM). All lesions were evaluated by two experienced (>500 MRM) radiologists in consensus. In every lesion, 18 previously published descriptors were assessed and documented in the database. An Artificial Neural Network (ANN) was developed to process this database (The-MathWorks/Inc., feed-forward-architecture/resilient back-propagation-algorithm). All 18 descriptors were set as input variables, whereas histological results (malignant vs. benign) was defined as classification variable. Initially, the ANN was optimized in terms of “Training Epochs” (TE), “Hidden Layers” (HL), “Learning Rate” (LR) and “Neurons” (N). Robustness of the ANN was addressed by repeated evaluation cycles (n: 9) with receiver operating characteristics (ROC) analysis of the results applying 4-fold Cross Validation. The best network architecture was identified comparing the corresponding Area under the ROC curve (AUC). Results: Histopathology revealed 436 benign and 648 malignant lesions. Enhancing the level of complexity could not increase diagnostic accuracy of the network (P: n.s.). The optimized ANN architecture (TE: 20, HL: 1, N: 5, LR: 1.2) was accurate (mean-AUC 0.888; P: <0.001) and robust (CI: 0.885–0.892; range: 0.880–0.898). Conclusion: The optimized neural network showed robust performance and high diagnostic accuracy for prediction of malignancy on unknown data.

  12. The clinical course of non-muscle invasive bladder cancer after transuretral resection of the tumor with or without subsequent intravesical application of bacillus Calmette-Guérin: The influence of patients gender and age

    Milošević Radovan

    2015-01-01

    Full Text Available Bacground/Aim. The therapy with intravesical instillation of bacillus Calmette-Guérin (BCG after transurethral resection (TUR of tumor is the gold standard of treatment of non-muscle invasive bladder cancer (NMIBC. The role and importance of BCG intravesical therapy in various shape of tumors, were confirmed by our previous investigation. The aim of this study was to examine whether incidence of recurrence and tumor regression differs depending on sex and age of patients. Methods. This study included a total of 899 patients suffering from NIMBC, treated at our institution from January 1, 2007 to March 1, 2013. Two groups of patients were formed: patients underwent TUR + BCG therapy (the group I and the group II with patients in whom TUR was performed as only therapy. These two groups of patients were divided into subgroups of respondents male and female, age 60 years or younger and older than 60 years. Statistical analysis was performed using χ2 test and the Kolmogorov-Smirnov test. Results. This research suggests that if the frequency of recurrence is seen as the only parameter, considering all the subjects, the lowest recurrence rate was determined in the male subjects, aged 60 years and younger who had received BCG after TUR. A high statistical significance was found in the incidence of recurrence in patients younger than 60 years, depending on the response to the therapy, while in those older than 60 years, the difference was at the level of statistical significance. This can be attributed to a certain degree of infravesical obstruction in older men. Conclusions. Sex and age of patients may have a significant influence on the course and outcome of NMIBC. The disease has the most malignant and most aggressive behavior when present in males older than 60 years.

  13. Second generation plant health clinics in Uganda

    Danielsen, Solveig; Matsiko, Frank; Mutebi, Emmanuel;

    of clinic operation were well understood by all organisations, there were no common standards for record keeping, data management, monitoring and reporting, either internally in the clinic organisations or externally from the backstopping institutions. There was also no functional system to refer samples...... to measure performance and health outcomes. The modified plant health system model was based on six system components: Service delivery, Plant health workforce, Plant health information, Input supply, Finance, and Policy, governance and leadership. As plant clinic performance indicators we used Clinic...... to enhance the coverage of existing extension services. Many factors influenced the performance of plant health clinics, from practical, everyday concerns of clinic staff to the policy framework that shapes public sector activities and relationships with the NGO and private sectors. While the basic aspects...

  14. Participating in Clinical Trials

    Full Text Available ... this page please turn Javascript on. Participating in Clinical Trials About Clinical Trials A Research Study With Human Subjects A clinical ... to treat or cure a disease. Phases of Clinical Trials Clinical trials of drugs are usually described based ...

  15. The influence of spasmodic torticollis on the clinical prognosis of patients with neurogenic dysphagia%神经源性吞咽障碍伴痉挛性斜颈的临床治疗观察

    郭钢花; 王国胜; 李哲

    2012-01-01

    目的 观察痉挛性斜颈对神经源性吞咽障碍患者康复预后的影响及不同治疗方法的疗效比较.方法 选取神经源性吞咽障碍患者103例,其中伴有痉挛性斜颈患者82例,采用随机数字表法分为单纯训练组(21例,仅给予常规吞咽康复训练)、药物训练组(21例,给予常规吞咽康复训练及药物治疗)、支持训练组(20例,给予常规吞咽康复训练及一般性支持治疗)及联合治疗组(20例,给予常规吞咽康复训练、药物及一般性支持治疗),余21例无痉挛性斜颈的神经源性吞咽障碍患者则归入无斜颈组(给予常规吞咽康复训练).于治疗前、治疗2个月对各组患者吞咽功能改善情况进行评定.结果 治疗前药物训练组、支持训练组、联合治疗组和单纯训练组吞咽功能均显著低于无斜颈组(P<0.05);各组患者分别经2个月治疗后,发现5组患者吞咽功能均较治疗前显著改善(P<0.05),其中药物训练组、支持训练组、联合治疗组和无斜颈组吞咽功能均显著优于单纯训练组(P<0.05);联合治疗组吞咽功能亦显著优于药物训练组及支持训练组(P<0.05);联合治疗组和无斜颈组吞咽功能组间差异无统计学意义(P>0.05).结论 痉挛性斜颈能影响神经源性吞咽障碍患者吞咽功能恢复,对痉挛性斜颈进行治疗可明显提高神经源性吞咽障碍患者吞咽功能.%Objective To observe the influence of spasmodic torticollis on the rehabilitation prognoses of patients with neurogenic dysphagia.Methods One hundred and three dysphagic patients were recruited,of which 82 had spasmodic torticollis and 21 did not.The subjects with spasmodic torticollis were divided randomly into a medication therapy group (21 cases) which accepted medication plus swallowing training,a common therapy group (20 cases) accepting common support treatment plus swallowing training,a combined therapy group (20 cases) accepting common support treatment

  16. Barrett's esophagus: clinical features, obesity, and imaging.

    Quigley, Eamonn M M

    2011-09-01

    The following includes commentaries on clinical features and imaging of Barrett\\'s esophagus (BE); the clinical factors that influence the development of BE; the influence of body fat distribution and central obesity; the role of adipocytokines and proinflammatory markers in carcinogenesis; the role of body mass index (BMI) in healing of Barrett\\'s epithelium; the role of surgery in prevention of carcinogenesis in BE; the importance of double-contrast esophagography and cross-sectional images of the esophagus; and the value of positron emission tomography\\/computed tomography.

  17. Participating in Clinical Trials

    Full Text Available ... Participating in Clinical Trials: About Clinical Trials In This Topic About Clinical Trials Risks and Benefits Terms ... with Your Doctor Taking Medicines The information in this topic was provided by the National Library of ...

  18. Participating in Clinical Trials

    Full Text Available ... Clinical Trials In This Topic About Clinical Trials Risks and Benefits Terms to Know Finding a Clinical ... researchers may gather information about experimental treatments, their risks, and how well they work compare existing therapies ...

  19. Participating in Clinical Trials

    Full Text Available Home > Health topics A-Z > Participating in Clinical Trials: About Clinical Trials In This Topic About Clinical Trials Risks ... centers across the country. The National Institutes of Health funds much of this basic research. Screening Trials ...

  20. Participating in Clinical Trials

    Full Text Available ... Participating in Clinical Trials About Clinical Trials A Research Study With Human Subjects A clinical trial is a research study that involves human subjects. The purpose of ...

  1. Participating in Clinical Trials

    Full Text Available ... on. Participating in Clinical Trials About Clinical Trials A Research Study With Human Subjects A clinical trial is a research study that involves human subjects. The purpose ...

  2. Neurocognition: Clinical and Functional Outcomes in Schizophrenia

    Lepage, Martin; Bodnar, Michael; Bowie, Christopher R.

    2014-01-01

    Schizophrenia is characterized by significant heterogeneity in outcome. The last decades have witnessed a significant interest in identifying factors that can moderate or influence clinical and functional outcomes in people with schizophrenia. One factor of particular interest is neurocognition, as performance on various measures of cognitive abilities, such as memory, attention, and executive functions, have been consistently related to functional outcome and, to a lesser extent, clinical ou...

  3. Exploring Clinical Overview

    Fleron, Benedicte

    Clinical overview is explored at four emergency departments (EDs) during the introduction of a new IT system to support hereof. Important aspects of clinical overview are described for the clinical practice and for the further development of the IT system.......Clinical overview is explored at four emergency departments (EDs) during the introduction of a new IT system to support hereof. Important aspects of clinical overview are described for the clinical practice and for the further development of the IT system....

  4. Influencing factors of clinical nurses working for aged nursing basing on theory of planned behavior%基于计划行为理论的临床护士从事老年护理意愿的影响因素分析

    孙亚男; 赵斌; 贺生; 于双成; 李玉玲; 安文秀

    2016-01-01

    Objective To investigate influencing factors of clinical nurses working for aged nursing basing on theory of planned behavior(TPB), so as to provide reference for motivating nurses to work on aged nursing, and to predict possibilities of clinical nurses to work on the industry of aged nursing. Methods Questionnaire scale was designed basing on TPB and characteristics of aged nursing industry, and was handed out to 172 nurse practitioners in 4 hospitals in a city of Sichuan. Results Determination coefficients of attitude towards the behavior, subjective norm, and perceived behavioral control of clinical nurses′intention to work on aged nursing industry, R2 were respectively 0. 32,0. 45 and 0. 01. Determination coefficient of attitude towards the behavior, subjective norm, and perceived behavioral control of nurses′intention to work on aged nursing, was R2 =0. 36 (P<0. 05). Conclusions Subjective norm has the most remarkable influences on nurses′intention to work on aged nursing industry, followed by attitude towards the behavior, with the least of perceived behavioral control;it is feasible to apply TPB in exploring influencing factors for clinical nurses working on aged nursing.%目的:应用计划行为理论研究影响护士从事老年护理意愿的因素,为促进护理人员投入老年护理工作提供参考,预测临床护士选择老年护理行业的可能性。方法依据计划行为理论结合老年护理行业自身特点设计问卷调查量表,对四川省某市4家医院的执业护士共计172人进行问卷调查。结果行为态度、主观规范和知觉行为控制对临床护士从事老年护理行业意愿的确定系数为R2值分别为0.32,0.45,0.01,行为态度、主观规范和知觉行为控制三者对护士从事老年护理的行为意向的确定系数为R2=0.36(P<0.05)。结论主观规范对医院护士从事老年护理行业意愿的影响最显著,行为态度影响次之,知觉行为控制影响程度不显著

  5. Future requirements. Clinical investigations

    Qvist, V.

    2002-01-01

    Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics......Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics...

  6. 消毒供应中心应用组长负责制管理模式对工作合格率及临床满意率的影响%Influence on the Job Qualification Rate and Clinical Satisfaction Rate by Application of CSSD Team Leader Responsibility System Management Mold

    王东梅

    2015-01-01

    目的:观察消毒供应中心应用组长负责管理模式对工作合格率及临床满意率的影响。方法自2013年6月起于该院消毒供应中心应用组长负责制管理模式,对消毒供应中心每个环节开展管理与质量控制。将2012年6月—2013年5月未开展组长负责制前我院消毒供应中心的工作合格率与临床满意率作为对照,分析应用组长负责制对消毒供应中心工作合格率及临床满意率的影响。结果应用组长负责制管理模式后,该院消毒供应中心各环节工作合格率与临床满意率均明显高于应用前,不同时间段对比差异有统计学意义(P<0.05)。结论在医院消毒供应中心应用组长负责制管理模式,可提高消毒供应中心工作的合格率,提升临床科室对消毒质量的满意度,促进消毒供应中心服务质量的持续改进,值得推广。%Objectives To observe the influence on the job qualification rate and clinical satisfaction rate by the application of CSSD team leader responsibility system management mold.Methods Since June, 2013, our hospital CSSD has applied team leader responsibility system management mold, and implemented control and management on each link in CSSD. The job qualification rate and clinical satisfaction rate from June 2012 to the end of May 2013 before applying team leader responsibility system management mold were given contrast to the period when applying team leader responsibility system management mold, so as to research the influence on the job qualification rate and clinical satisfaction rate by applying CSSD team leader responsibility system management mold.Results After applying the CSSD team leader responsibility system management mold, the job qualification rate and clinical satisfaction rate of each link were obviously higher than the period when the system was not applied. The contrast differences of different time period had statistical significant differences (P< 0

  7. 山东省护理院校教学医院带教老师的核心能力及其影响因素%Core Competency and Its Influencing Factors of Clinical Teachers in Affiliated Teaching Hospitals of Universities in Shandong Province

    高晖; 王贞慧; 冯晨秋; 娄凤兰

    2012-01-01

    目的 了解山东省本科护理院校教学医院临床带教老师的核心能力及其影响因素.方法 采用注册护士核心能力量表对山东省6所本科护理院校附属教学医院的358名带教老师(以多阶段抽样法选取)进行问卷调查,共发放问卷358份,回收有效问卷355份,问卷有效率回收率为99.2%.结果 山东省本科护理院校带教老师核心能力总均分为(3.06±0.47)分,法律/伦理实践评分最高,批判性思维/科研评分最低;不同年龄、工作年限、带教年限、职称、第一学历、科室、工作满意度护士核心能力评分差异均有统计学意义;带教老师核心能力受技术职称、工作满意度、带教年限等因素影响.结论 山东省护理院校临床带教老师核心能力水平中等偏上,医院管理部门应重视其批判性思维及科研能力的培养,主动关心带教老师的身心特点和从业心态,多角度地提高临床带教师资的核心能力.%Objective To know the core competency and its influencing factors of clinical teachers in the affiliated teaching hospitals of universities in Shandong Province. Methods Totally 358 clinical teachers in the affiliated hospitals of 6 universities were investigated with the competency inventory for registered nurses. Of the 358 questionnaires,355 were valid and the effective rate was 99. 2%. Results The mean score of core competency was 3. 06±0. 47,and the highest score was detected in dimensions of legal/ethical practice and the lowest score was in dimensions of critical thinking/research aptitude. The core competency of nurse was statistically different in the dimensions in terms of nurses with different age,working time,teaching time,job title,education,department and job satisfaction. The demographic influencing factors were job title,job satisfaction and teaching time. Conclusion The overall core competency is at the upper middle level for clinical teachers from the affiliated hospitals of

  8. Influencing Factors of Disease-free Survival Rate and Clinical Significance of The Number of Axillary Lymph Node Detection in Breast Cancer%乳腺癌术后无瘤生存率的影响因素及腋窝淋巴结检测数目的临床意义

    朱亚东

    2014-01-01

    Objective To investigate the relative factors influencing disease-free survival(DFS)rate in breast cancer and clinical significance of the number of axillary lymph node dissection .Methods Clinical data of 138 cases of breast cancer pa-tients who received modified radical mastectomy and axillary lymph node dissection were studied retrospectively .Positive axillary lymph nodes and disease-free survival time and influencing factors of patients with negative axillary lymph node were analyzed by Kaplan-Meier and multivariate logistic regression analysis .Results 5-year overall survival rate and DFS rate in patients with negative lymph nodes were 90.7% and 86.7%,respectively.5-year overall survival rate and DFS rate in patients with positive lymph nodes were 72.6%and 64.7%,respectively.There had statistical difference(P<0.05).Single factor analysis and multi-variate logistic regression analysis showed that the number of positive lymph node ,the number of lymph node dissection ,HER-2 were risk factors influencing the 5-year DFS of patients with positive lymph node .HER-2 was the main risk factor influencing the 5-year DFS of patients with negative lymph node .Conclusion Axillary lymph node metastasis and HER-2 are major factors in-fluencing the 5-year DFS of breast cancer patients .Increase the number of lymph nodes detection could improve the 5-year DFS of breast cancer patients .%目的:探讨乳腺癌术后无瘤生存率的影响因素及腋窝淋巴结清扫及检测个数的临床意义。方法回顾性分析138例行乳腺癌手术并腋窝淋巴结清扫患者的临床资料,采用Kaplan-Meier法和Logistic多因素回归分析腋窝淋巴结阳性和腋窝淋巴结阴性患者的无瘤生存时间及影响因素。结果淋巴结阴性患者5年总生存率为90.7%,5年无瘤生存率为86.7%,淋巴结阳性患者5年总生存率为72.6%,5年无瘤生存率为64.7%,2组差异具有统计学意义( P<0.05)。单因素分析

  9. Identification of Genetic Defects in 33 Probands with Stargardt Disease by WES-Based Bioinformatics Gene Panel Analysis.

    Wei Xin

    Full Text Available Stargardt disease (STGD is the most common hereditary macular degeneration in juveniles, with loss of central vision occurring in the first or second decade of life. The aim of this study is to identify the genetic defects in 33 probands with Stargardt disease. Clinical data and genomic DNA were collected from 33 probands from unrelated families with STGD. Variants in coding genes were initially screened by whole exome sequencing. Candidate variants were selected from all known genes associated with hereditary retinal dystrophy and then confirmed by Sanger sequencing. Putative pathogenic variants were further validated in available family members and controls. Potential pathogenic mutations were identified in 19 of the 33 probands (57.6%. These mutations were all present in ABCA4, but not in the other four STGD-associated genes or in genes responsible for other retinal dystrophies. Of the 19 probands, ABCA4 mutations were homozygous in one proband and compound heterozygous in 18 probands, involving 28 variants (13 novel and 15 known. Analysis of normal controls and available family members in 12 of the 19 families further support the pathogenicity of these variants. Clinical manifestation of all probands met the diagnostic criteria of STGD. This study provides an overview of a genetic basis for STGD in Chinese patients. Mutations in ABCA4 are the most common cause of STGD in this cohort. Genetic defects in approximately 42.4% of STGD patients await identification in future studies.

  10. Children and Clinical Studies: Why Clinical Studies Are Important

    Full Text Available ... Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & Clinical Studies NHLBI Trials Clinical Trial Websites ...

  11. Clinical Trials in Vision Research

    ... Eye Health Information > Clinical Trials in Vision Research Clinical Trials in Vision Research Listen Clinical studies depend on ... vision research in the United States. Basics of Clinical Trials What is a clinical trial? Clinical trials are ...

  12. Good clinical practice in clinical interventional studies

    Pieterse, Herman; Diamant, Zuzana

    2014-01-01

    Good clinical practice (GCP) guidelines should always be implemented and obeyed in clinical interventional studies. In this mini-review, we will address several burning questions relating to GCP in a concise ‘frequently asked questions’ format.While compliance to current rules and regulations is our mission, we also wish to play devil’s advocate attempting to translate the rules into sizeable chunks using a high dose of common sense.Keywords: clinical interventional studies; quality; safety; ...

  13. Motivation and influencing factors of the choice of the secondary disciplines by eight-year clinical medical students%八年制临床医学专业学生二级学科选择的动机与影响因素研究

    韩侨宇; 胡梦雨; 李章来; 冉姗姗; 马利加; 于晨

    2015-01-01

    Objective To understand the intention, motivation and influencing factors of the choice of the secondary disciplines by eight-year clinical medical students, provide the theoratic basis for the rational choice of the secondary disciplines by undergraduate clinical students and provide references for the effective implementation of medical professional spirit education.Methods The eight-year clinical medical students in one medical college were surveyed with a self-made questionnaire.Results There were a total of 320 questionnaires released, of which 308 valid questionnaires were recovered, with an effective recovery rate of 96.3%.The survey results showed that :①The secondary disciplines most wanted by the eight-year clinical medical students to be engaged in were surgery (39.6%) and internal medicine (34.7%).②The major reasons for eight-year clinical medical students to choose the secondary disciplines were their interests(76.6%)and development prospects(38.3%).③A variety of factors including the individual, family and occupation had produced different effects on the choice of the secondary disciplines by eight-year clinical medical students.The influence of the three factors including different stages, the difficulty levels of getting a work position and employment pressure all had a statistical significance (P<0.05) on the choice of the secondary disciplines.And multiple factors in occupation factors had significant differences between different stages.Conclusions ① Eight-year clinical medical students have a variety of motives to choose the secondary disciplines, mainly personal interests and development prospects.② The choice motivation of the secondary disciplines is influenced by a number of factors including the individual, family and occupation.③ Professional spirit education and guidance provided by colleges and society is in much more demand by students of the second stage.%目的 了解八年制临床医学专业学生二级学

  14. [Social aspect of clinical research in Poland].

    Masełbas, Wojciech; Czarkowski, Marek

    2007-12-01

    Each year more than 400 new clinical studies are registered in Poland. They gather above 50.000 of study participants. Social opinion on clinical trials is an important factor. The paper presents the review of actual opinions on clinical research in Poland. It provides the description of standards of protection of study participants, benefits and risks related to the participation in clinical research and the role of media in creating and influencing of the social perception of clinical trials. Results of conducted questionnaire studies imply that Poles correctly identify and assess the risk of participation in clinical experiments. The primary reason for the participation seams to be the possibility to help other patients, contribution to the progress of science and standards of medical care and potential benefits for other sufferers. The need of testing the safety and efficacy of the new medication in man is generally well recognized. At the same time a substantial part of the society is concerned with the possible corruption of investigators and unethical behaviour of sponsors. The social perception of clinical research in Poland is in majority of analyzed parameters not substantially different from opinions in other member states of EU. However, the medical society should be more active in influencing and changing some negative impressions. PMID:18432135

  15. Nursing students in clinical practice--developing a model for clinical supervision.

    Häggman-Laitila, Arja; Elina, Eriksson; Riitta, Meretoja; Kirsi, Sillanpää; Leena, Rekola

    2007-11-01

    The aim of this study was to develop a model for clinical supervision to promote the clinical practice of nursing students. The study was implemented in Finland and it was carried out in three phases. Firstly, data were collected by means of a literature review and focus group interviews. Secondly, the data were analysed and described in expert groups, and finally the model itself was evaluated by 23 nursing experts. The data of literature review and focus group interviews consisted of 27 studies and four groups from three organisations: nurses (n=7), managers (n=6), teachers (n=8) and students (n=6). The data were analysed by qualitative content analysis. The model devolved from the study includes the concepts describing prerequisites, content and influence of clinical supervision. The prerequisites are nursing skills, a holistic view of the nursing curriculum, pedagogical, organisational, development, cooperation and interaction competence and decision-making skills. The content of clinical supervision includes support of professional development, pedagogical competence, research and development activities and collaborative working. Clinical supervision has influence on students' professional and personal development and conception of the future of nursing profession, students' preparedness for career planning and the teacher's and preceptor's professional development. The model could unify the notions of all parties concerned of the prerequisites, content and influence of clinical supervision. Furthermore, the entire supervision process and its control could be clarified. The model may be utilised in selecting and educating preceptors and evaluating the quality of clinical supervision. PMID:17936544

  16. Clinical Decision Making of Rural Novice Nurses

    Seright, Teresa J.

    2010-01-01

    The purpose of this study was to develop substantive theory regarding decision making by the novice nurse in a rural hospital setting. Interviews were guided by the following research questions: What cues were used by novice rural registered nurses in order to make clinical decisions? What were the sources of feedback which influenced subsequent…

  17. Clinical Trial Results: A Clinical Trial Bazaar!

    Fojo, Antonio Tito; Bates, Susan E.

    2014-01-01

    The Oncologist’s Clinical Trial Results section welcomes both positive and negative results in an effort to share information, speed discovery, and inform the field. Clinical Trial Results submissions have shown how succinctly the salient features of a submission can be presented, with more in-depth information to be found online.

  18. Genetic and epigenetic influences on schizotypal cognition

    Leach, Emma Leah

    2013-01-01

    Genetically-based risk for schizophrenia, a highly polygenic condition, may contribute to a continuum of schizophrenia-related phenotypes between clinical populations and healthy populations. Using data from the literature as well as novel genotype and methylation data, I present evidence that schizophrenia risk alleles influence cognition in non-clinical populations, both individually, and together. Additionally, I find evidence that these alleles may be maintained across evolutionary time d...

  19. Doctors and nurses on wards with greater access to clinical dietitians have better focus on clinical nutrition

    Thoresen, L.; Rothenberg, E.; Beck, Anne Marie;

    2008-01-01

    According to the Council of Europe, clinical dietitians should assume a more central role in nutritional support. The aim of this study was to assess the opinions among doctors, nurses and clinical dietitians regarding the use of clinical dietitians' expertise in the hospital units and, further, to...... assess whether the presence of clinical dietitians in hospital departments influenced doctors and nurses focus on clinical nutrition. A questionnaire about the use of clinical nutrition was mailed to 6000 doctors and 6000 nurses working in hospital units where undernutrition is documented to be common......, as well as to 678 clinical dietitians working in Scandinavian hospitals. The response rate of clinical dietitians, nurses and doctors were 53%, 46% and 29%, respectively. Nurses and doctors who saw clinical dietitians often found it less difficult to identify undernourished patients and found that...

  20. SUITO Index for Evaluation of Clinical Islet Transplantation

    Takita, Morihito; Matusmoto, Shinichi

    2012-01-01

    The major endpoints for clinical islet transplantation for type 1 diabetes are insulin independence and reduction of hypoglycemic episodes. Both endpoints are influenced by patients’ and physicians’ preferences regarding the use of exogenous insulin. Therefore, development of an objective endpoint for assessing clinical islet transplantation is desirable. HOMA-beta score is useful in assessing functional β-cell mass. However, this score uses blood insulin levels that are influenced by exogeno...

  1. Genome-wide association study of clinical dimensions of schizophrenia

    Fanous, Ayman H; Zhou, Baiyu; Aggen, Steven H;

    2012-01-01

    Multiple sources of evidence suggest that genetic factors influence variation in clinical features of schizophrenia. The authors present the first genome-wide association study (GWAS) of dimensional symptom scores among individuals with schizophrenia.......Multiple sources of evidence suggest that genetic factors influence variation in clinical features of schizophrenia. The authors present the first genome-wide association study (GWAS) of dimensional symptom scores among individuals with schizophrenia....

  2. Children and Clinical Studies: Why Clinical Studies Are Important

    Full Text Available ... Children & Clinical Studies NHLBI Trials Clinical Trial Websites Children and Clinical Studies Learn more about Children and Clinical Studies Importance of Children in Clinical Studies Children have often had to ...

  3. 临床实习初期带教教师支持、个人应激、个人应对方式对护生身心健康的影响%Study on the influence of nursing students' perceptions of instructors' support, stress and coping strategies on their physiopsycho-social response in initial period of clinical practice

    彭玉洁; 周兰姝; 张译文; 顾李妍; 冀鹏飞; 林莉; 李娟

    2013-01-01

    Objective: To explore the influence of nursing students' perceptions of clinical instructors' support, stress and coping strategy on their physio-psycho-social response in initial period of clinical practice. Methods: A convenient sample of 370 nursing students in a tertiary class-A hospital in Shanghai in initial period of clinical practice were surveyed with Nursing Students' Perceptions of Instructor Caring (NSPIC), Perceived Stress Scale(PSS), Coping Behavior Inventory (CBI) and Professional Identification Scale(PIS). Results: It showed a significant positive correlation between stress, avoidance and physio-psycho-social response (P<0.01), as well as a significant negative correlation between instructors' support, staying optimistic, problem solving and physio-psycho-social response (P<0.01). Multi-stepwise regression analysis showed instructors' support, stress and coping strategy are the predictors of physio-psycho-social response. Conclusion: The clinical instructors should strengthen the support for the nursing students in initial period of clinical practice, encourage them to develop positive and efficient coping strategies, and increase their problem solving ability, therefore to reduce their physio-psycho-social response, and improve their physio-psycho-social health status.%目的:了解护生在临床实习初期临床带教教师支持、个人应激、个人应对方式对其身心健康的影响.方法:采用《教师支持问卷》《护生临床学习应激量表》《应对行为问卷》《生理-心理-社会反应量表》,对在上海某三级甲等医院实习1~3个月的370名护生进行调查.结果:护生临床实习初期应激水平、回避行为与生理-心理-社会反应呈正相关(P<0.01),教师支持、乐观应对、解决问题与生理-心理-社会反应呈负相关(P<0.01);多元线性逐步同归分析显示,教师支持、个人应激、个人应对方式是生理-心理-社会反应的影响因素.结论:在

  4. Maternal characteristics and clinical diagnoses influence obstetrical outcomes in Indonesia.

    Adisasmita, Asri; Smith, Carl V; El-Mohandes, Ayman A E; Deviany, Poppy Elvira; Ryon, Judith J; Kiely, Michele; Rogers-Bloch, Quail; Gipson, Reginald F

    2015-07-01

    This Indonesian study evaluates associations between near-miss status/death with maternal demographic, health care characteristics, and obstetrical complications, comparing results using retrospective and prospective data. The main outcome measures were obstetric conditions and socio-economic factors to predict near-miss/death. We abstracted all obstetric admissions (1,358 retrospective and 1,240 prospective) from two district hospitals in East Java, Indonesia between 4/1/2009 and 5/15/2010. Prospective data added socio-economic status, access to care and referral patterns. Reduced logistic models were constructed, and multivariate analyses used to assess association of risk variables to outcome. Using multivariate analysis, variables associated with risk of near-miss/death include postpartum hemorrhage (retrospective AOR 5.41, 95 % CI 2.64-11.08; prospective AOR 10.45, 95 % CI 5.59-19.52) and severe preeclampsia/eclampsia (retrospective AOR 1.94, 95 % CI 1.05-3.57; prospective AOR 3.26, 95 % CI 1.79-5.94). Associations with near-miss/death were seen for antepartum hemorrhage in retrospective data (AOR 9.34, 95 % CI 4.34-20.13), and prospectively for poverty (AOR 2.17, 95 % CI 1.33-3.54) and delivering outside the hospital (AOR 2.04, 95 % CI 1.08-3.82). Postpartum hemorrhage and severe preeclampsia/eclampsia are leading causes of near-miss/death in Indonesia. Poverty and delivery outside the hospital are significant risk factors. Prompt recognition of complications, timely referrals, standardized care protocols, prompt hospital triage, and structured provider education may reduce obstetric mortality and morbidity. Retrospective data were reliable, but prospective data provided valuable information about barriers to care and referral patterns. PMID:25656716

  5. Factors associated with clinical and sub-clinical anal human papillomavirus infection in homosexual men.

    Law, C L; Qassim, M; Thompson, C. H.; Rose, B R; Grace, J.; Morris, B.J.; Cossart, Y E

    1991-01-01

    OBJECTIVES--(I) to determine the relative sensitivities of clinical examination, cytology and HPV DNA hybridisation for the detection of anal human papillomavirus infection; and (ii) to examine various factors which may influence presentation of anal human papillomavirus infection in homosexual men. METHODS AND RESULTS--112 unselected homosexual men attending a Sydney STD clinic for routine screening underwent a complete anogenital and physical examination, during which blood samples (for hae...

  6. Participating in Clinical Trials

    Full Text Available ... Trials About Clinical Trials A Research Study With Human Subjects A clinical trial is a research study ... lifestyle changes, such as exercising more, getting more sleep, keeping mentally active, or eating nutritious foods, can ...

  7. Clinical Laboratory Fee Schedule

    U.S. Department of Health & Human Services — Outpatient clinical laboratory services are paid based on a fee schedule in accordance with Section 1833(h) of the Social Security Act. The clinical laboratory fee...

  8. NIH Clinical Centers

    Federal Laboratory Consortium — The NIH Clinical Center consists of two main facilities: The Mark O. Hatfield Clinical Research Center, which opened in 2005, houses inpatient units, day hospitals,...

  9. Participating in Clinical Trials

    Full Text Available ... trial is to find out if an experimental drug, therapy, medical device, lifestyle change, or test will ... disease. Phases of Clinical Trials Clinical trials of drugs are usually described based on their phase. The ...

  10. HISTIOCYTOSIS X: CLINICAL OBSERVATIONS

    E. Y. Ponomareva

    2014-07-01

    Full Text Available Two clinical cases of pulmonary Langerhans cell histiocytosis X have been analyzed demonstrating lung and other inner organ pathology, common clinical and X-ray features but different life prognosis.

  11. HISTIOCYTOSIS X: CLINICAL OBSERVATIONS

    E. Y. Ponomareva; A. P. Rebrov; E. E. Archangelskaja; A. A. Roshchina; R. N. Steshenko; A. S. Bukia; N. V. Dvornikova; N. N. Moskaleva

    2014-01-01

    Two clinical cases of pulmonary Langerhans cell histiocytosis X have been analyzed demonstrating lung and other inner organ pathology, common clinical and X-ray features but different life prognosis.

  12. Research Areas - Clinical Trials

    Information about NCI programs and initiatives that sponsor, conduct, develop, or support clinical trials, including NCI’s Clinical Trial Network (NCTN) and NCI Community Oncology Research Program (NCORP) initiatives.

  13. Research Areas: Clinical Trials

    Information about NCI programs and initiatives that sponsor, conduct, develop, or support clinical trials, including NCI’s Clinical Trial Network (NCTN) and NCI Community Oncology Research Program (NCORP) initiatives.

  14. Fertility Clinic Success Rates

    ... and Autism 2013 Assisted Reproductive Technology Fertility Clinic Success Rates Report Recommend on Facebook Tweet Share Compartir 2013 ART Fertility Clinic Success Rates Report [PDF - 1MB] Bookmarks and thumbnails are ...

  15. Participating in Clinical Trials

    Full Text Available ... was provided by the National Library of Medicine Topic last reviewed: December 2013 For an enhanced version of this page please turn Javascript on. Participating in Clinical Trials About Clinical Trials A Research Study With Human Subjects A clinical trial is ...

  16. Evolution of Clinical Enzymology

    Büttner, J

    1981-01-01

    The evolution of clinical enzymology is discussed in relation to the history of general enzymology and clinical chemistry. The discussion is limited to the period from 1835 (definition of catalysis by Berzelius) to 1935 (description of the optical test by Warburg). In conclusion, a general account is given of the introduction of the concept of quantitative enzyme activity determination into clinical medicine.

  17. Clinical Process Intelligence

    Vilstrup Pedersen, Klaus

    2006-01-01

    Ideally, clinical guidelines are created from evidence based medicine. Translating the narrative semi-structured article for-mat of the clinical guidelines into a computable language makes it possible to utilize this information in IT-supported clinical reasoning, and thereby bring the relevant...

  18. Clinical document architecture.

    Heitmann, Kai

    2003-01-01

    The Clinical Document Architecture (CDA), a standard developed by the Health Level Seven organisation (HL7), is an ANSI approved document architecture for exchange of clinical information using XML. A CDA document is comprised of a header with associated vocabularies and a body containing the structural clinical information. PMID:15061557

  19. Participating in Clinical Trials

    Full Text Available ... topic was provided by the National Library of Medicine Topic last reviewed: December 2013 For an enhanced version of this page please turn Javascript on. Participating in Clinical Trials About Clinical Trials A Research Study With Human Subjects A clinical trial is a research study ...

  20. Spina Bifida Clinic Directory

    ... 798,163.html Back to top Missouri Children’s Mercy Hospital & Clinics Spinal Defects Clinic (pediatric only-will ... 234-3790 or (816) 234 3005 www.childrens-mercy.org/ Cardinal Glennon Children’s Medical Center Myelomeningocele Clinic ( ...

  1. Clarifying students' feedback-seeking behaviour in clinical clerkships

    Bok, H.G.; Teunissen, P.W.; Spruijt, A.; Fokkema, J.P.; Beukelen, P. van; Jaarsma, D.A.; Vleuten, C.P.M. van der

    2013-01-01

    CONTEXT: Why and how do students seek feedback on their performance in the clinical workplace and which factors influence this? These questions have remained largely unanswered in research into workplace learning during clinical clerkships. Research on feedback has focused mainly on feedback provide

  2. Influência das concavidades radiculares nas perdas clínicas de inserção, detectadas no exame clínico periodontal inicial The influence of root concavities on clinical attachment loss diagnosed at the initial evaluation of periodontal patients

    Francisco Emilio PUSTIGLIONI

    1999-12-01

    Full Text Available O propósito deste estudo foi estabelecer a influência das concavidades radiculares na perda clínica de inserção (PCI diagnosticada no exame clínico periodontal inicial. Os dados de PCI foram obtidos dos primeiros e segundos pré-molares, caninos, incisivos laterais e centrais superiores e inferiores, de 163 pacientes. Os dados foram coletados das fichas periodontais dos pacientes que procuraram a Clínica do curso de Pós-Graduação em Periodontia da FOUSP. Foi realizada sondagem em todos os dentes para que se obtivesse as seguintes medidas: distância da linha esmalte cemento à margem gengival, profundidade clínica de sondagem (PCS nos sítios distovestibular (DV, centrovestibular (CV, mesiovestibular (MV, distolingual (DL, centrolingual (CL e mesiolingual (ML. Os dados foram incluídos no estudo quando pelo menos um dos sítios apresentasse PCI ³ 4 mm. Após a análise estatística (Friedman ANOVA test CV e CL mostraram valores de PCI estatisticamente menores para todos os dentes superiores e inferiores. Clinicamente CV mostrou os menores valores de perda clínica de inserção entre todos os dentes analisados, seguido de CL. Embora, baseados em nossos resultados, não exista correlação estatística entre PCI e a presença de concavidades radiculares, não podemos subestimar as últimas no exame clínico inicial, diagnóstico, prognóstico, planejamento cirúrgico e na fase de controle e manutenção do tratamento periodontal.The purpose of this study was to establish the influence of root concavities on clinical attachment loss (CAL that was diagnosed at the initial evaluation of periodontal patients. CAL data were analyzed in the following teeth of 163 patients: upper and lower second and first bicuspids, cuspids, lateral and central incisors. Data were retrieved from the initial dental chart of patients seeking treatment at the Periodontics Graduate Clinic, School of Dentistry, University of São Paulo. Probing was accomplished

  3. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

    Malling, Bente Vigh; Mortensen, Lene S.; Scherpbier, Albert J J;

    2010-01-01

    The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate in...... clinical departments and the leadership skills of clinical consultants responsible for education....

  4. Factors influencing dental decision making.

    Grembowski, D; Milgrom, P; Fiset, L

    1988-01-01

    In clinical decision making, dentists routinely choose between alternative treatments such as crown vs amalgam/composite buildup, root canal vs extraction, fixed bridge vs removable partial denture, and prophylaxis vs subgingival curettage or periodontal scaling. A number of technical and patient factors can influence dentists' choice of treatment in these situations; however, little is known about their relative importance. To address this issue, a list of technical (e.g., periodontal status and caries rate) and patient (e.g., cost and patient preference) factors possibly influencing choice of treatment was developed for each pair of services. Responding to a mail questionnaire, 156 general dentists in Washington State listed the top three factors influencing their choice of service in each pair. Results revealed that dentists took different factors into account in choosing among alternative treatments. Technical factors dominated over patient concerns; only about 33 percent of the dentists considered patient factors important in choosing alternative therapies. The latter group was less preventively oriented, were solo practitioners, worked longer hours, and had lower prices. Results suggest patients may have little influence on prescriptions of therapy among experienced general dentists. PMID:3045303

  5. 月经初潮年龄对中国女性乳腺癌临床病理特征及分子表型的影响%Influence of age at menarche on clinical pathological features and molecular phenotype in Chinese female breast cancer

    孙刚; 王珂

    2015-01-01

    目的:探索中国女性月经初潮年龄对乳腺癌临床病理特征及分子表型的影响。方法:收集本院收治的女性乳腺癌临床资料共210例,按月经初潮年龄分为≤13岁组和>13岁组,采用卡方检验分别比较各组间临床病理特征及分子表型的差异。结果:月经初潮年龄越早(≤13岁),腋窝淋巴结转移几率越高,同时肿瘤分期越晚(P <0.05);初潮年龄越早,非 Luminal 型出现的比例越高(P <0.05)。结论:月经初潮越早,乳腺癌的恶性程度越高并且多呈现出非 Luminal 型的分子表型。%Objective:To investigate the influence of age at menarche on tumor clinical characteristics and molec-ular subtypes in Chinese females with breast cancer.Methods:The clinical findings of 2 1 0 Chinese females with breast cancer were divided into 2 groups:≤13 years old and >13 years old,then analyzed as age at menarche retro-spectively.Results:The age of menarche ≤13 years old was a higher risk factor of axillary lymph nodes metastasis, later TNMstaging and non -Luminal subtype than that of >13 years old(P <0.05).Conclusion:Earlier age at menarche might be related to higher grade malignancy,TNMstaging and appearance of non -Luminal subtype in Chi-nese females with breast cancer.

  6. Integrating clinical research into clinical decision making

    Mark R Tonelli

    2011-01-01

    Full Text Available Evidence-based medicine has placed a general priority on knowledge gained from clinical research for clinical decision making. However, knowledge derived from empiric, population-based research, while valued for its ability to limit bias, is not directly applicable to the care of individual patients. The gap between clinical research and individual patient care centers on the fact that empiric research is not generally designed to answer questions of direct relevance to individual patients. Clinicians must utilize other forms of medical knowledge, including pathophysiologic rationale and clinical experience, in order to arrive at the best medical decision for a particular patient. In addition, clinicians must also elucidate and account for the goals and values of individual patients as well as barriers and facilitators of care inherent in the system in which they practice. Evidence-based guidelines and protocols, then, can never be prescriptive. Clinicians must continue to rely on clinical judgment, negotiating potentially conflicting warrants for action, in an effort to arrive at the best decision for a particular patient.

  7. Clinical photography among African cleft caregivers

    Peter Babatunde Olaitan

    2011-01-01

    Full Text Available Objective: The aim of this paper is to document the practice of photography among clinicians whose daily work depends and is influenced so much by medical photography. Materials and Methods: Questionnaires documenting the bio data, place of practice, and experience of cleft caregivers with clinical photography were distributed. Knowledge of rules guiding clinical photography and adherence to them were also asked. Types of camera used were documented and knowledge of the value of clinical photographs were also inquired. Results: Plastic surgeons constitute the highest proportion of 27 (38.6%, followed by Oral and Maxillofacial surgeons with 14 (20.0%. Twenty one (30.0% of the respondents always, 21 (30.0% often, 12 (17.1% frequently, while 9 respondents sometimes took photographs of their patients. Suggested uses of clinical photographs included training, 52 (74.3%, education, 51 (72.9%, medicolegal, 44 (62.9% and advertisement, 44 (62.9% among others. Twenty two (31.4% did not know that there were standard guidelines for taking clinical photographs. Twenty three (32.9% of them did not seek the consent of the patients before taking clinical photographs. Conclusion: While the practice of clinical photography is high among African cleft caregivers, there is a need for further education on the issues of standard rules and obtaining consent from patients.

  8. Clinical vampirism: blending myth and reality.

    Jaffé, P D; DiCataldo, F

    1994-01-01

    Vampires arouse strong popular interest and attract large print and film audiences. Their influence is also notable in clinical vampirism, a rare condition described in the forensic literature covering some of humanity's most shocking behaviors. Definitions of vampirism involve aspects of necrophilia, sadism, cannibalism, and a fascination with blood. Its relationships with established diagnostic categories, particularly schizophrenia and psychopathy, are also examined and illustrated by the presentation of a "modern" vampire. As myth and reality are disentangled, clinical vampirism reveals the complex mother-child dyad's blood ties running amok. PMID:7718926

  9. Children and Clinical Studies: Why Clinical Studies Are Important

    Full Text Available ... NHLBI Trials Clinical Trial Websites Children and Clinical Studies Learn more about Children and Clinical Studies Importance of Children in Clinical Studies Children have often had to accept medicines and ...

  10. 苗族村寨留守老年患者门诊服务利用及影响因素分析%Utilization of out-patient clinic service and influencing factors among left-behind old people in Miao minority villages

    胡健; 武飚; 武学丽; 冉晓鸣

    2012-01-01

    . Conclusion The level of out-patient clinic service utilization was low among the left-behind old people. The utilization was influenced by health care knowledge, severity of illness, and the distance from the residence to the medical facility.%目的 了解苗族村寨农村留守老年人患病时门诊服务利用状况,分析其影响因素.方法 2011年7月选取贵州省黔东南苗族侗族自治州施秉县梨山坪、屯上、板屯3个苗族村寨112例≥60岁留守老年患者进行面访问卷调查,采用多元logistic逐步回归方法分析影响因素.结果 留守老年人2周患者就诊率为47.3% (53/112),2周患者未就诊率为52.7% (59/112);53例农村留守老年人就诊地点为村卫生室占66.0%( 35/53),乡镇卫生院及以上医疗机构占34.0% (18/53);候诊时间≥1h占73.6% (39/53),<1h占26.4%( 14/53);医生在患者就诊时未告诉患者相关卫生保健知识占79.2% (42/53),告诉占20.8% (11/53);未向患者清晰解释病情占64.2%( 34/53),清晰解释病情占35.8%(19/53);医生未很好地介绍治疗方案占52.8% (28/53),很好地介绍治疗方案者占47.2% (25/53);就诊满意占52.8% (28/53),不满意占47.2% (25/53);留守老年人患者不同说汉语能力、医疗单位距离、卫生保健知识、自感患病严重2周患者就诊情况比较,差异均有统计学意义(x2=6.02、5.11、8.21、7.08,P<0.05或P<0.01);卫生保健知识(OR =4.13)、自感患病严重(OR=2.27)对门诊服务利用具有正向预测作用,医疗单位距离( OR =0.43)具有负向预测作用.结论 留守老年人门诊服务利用程度较低,卫生保健知识、自感患病严重、医疗单位距离对门诊服务利用有影响.

  11. Fatores clínicos e anatomopatológicos que influenciam a sobrevida de pacientes com câncer de mama e derrame pleural neoplásico Clinical and pathological factors influencing the survival of breast cancer patients with malignant pleural effusion

    Giovana Tavares dos Santos

    2012-08-01

    Full Text Available OBJETIVO: O objetivo deste estudo foi identificar os fatores clínicos e anatomopatológicos que possam influenciar o prognóstico de pacientes com câncer de mama e sintomas clínicos de derrame pleural neoplásico. MÉTODOS: Trata-se de um estudo clínico de coorte, no qual foram analisados os prontuários médicos de pacientes que receberam diagnóstico de derrame pleural neoplásico entre 2006 e 2010. Por meio da análise dos prontuários, identificamos as pacientes com história de câncer de mama. Para essas pacientes, coletamos dados anatomopatológicos relacionados ao tumor primário e dados citopatológicos relacionados à metástase pleural. RESULTADOS: Das 145 pacientes avaliadas, 87 (60% apresentaram, no exame citológico, resultado positivo para células neoplásicas no líquido pleural; além disso, 119 (82% apresentaram tipo histológico ductal. O fenótipo triplo-negativo foi observado em 25 pacientes (17%, as quais apresentaram o pior prognóstico, com queda acentuada na curva de sobrevida. Das 25 pacientes, 20 (80% evoluíram a óbito durante o período de seguimento (até junho de 2011. A sobrevida média após a identificação de derrame pleural neoplásico foi de 6 meses. CONCLUSÕES: Em pacientes com câncer de mama triplo-negativo e exame citológico com resultado positivo para células neoplásicas no líquido pleural, o prognóstico é ruim e a sobrevida é menor.OBJECTIVE: The objective of this study was to identify the clinical and pathological factors that can influence the prognosis of breast cancer patients with clinical symptoms of malignant pleural effusion. METHODS: This was a clinical cohort study, in which we analyzed the medical charts of patients diagnosed with malignant pleural effusion between 2006 and 2010. By examining the charts, we identified the female patients with a history of breast cancer. For those patients, we collected pathology data related to the primary tumor and cytopathology data related

  12. Influence of Cements for Bonding Fiber Posts and Clinical Experience of Dentists on the Coronal Microleakage of Post-core Restoration%不同粘结系统及操作者临床经验及对纤维桩冠方微渗漏的影响

    张志闻; 何海波; 杭东跃

    2013-01-01

    Objective :To evaluate Influence of cements for bonding fiber posts and clinical experience of dentists on the coronal microleakage of post-core restoration .Methods :Selected 60 teeth were randomly divided into three groups ac-cording to the kind of cements .Each of the group was randomly divided into two subgroups according to the clinical ex-perience of dentists ,expert and resident doctor .Bongding the posts to prepared root canals and reconstruct cores .The specimens were immersed in distilled water for one month .After dye and transparent .Each tooth was observed under stereoscopic microscope and the dyeing scores were recorded .Results:The microleakage degrees among three resin bonding cements were significantly different ,and group Paracore 5ml showed the least microleakage compared with oth-er three cements .Group RelyX Unicem showed the biggest microleakage .Conclusion:Dinfferent kinds of resin bonding cement have different degrees of the cronal microleakage of post-core restoratios .When the instructions for use of the resin cements were followed strictly ,the microleakage degrees were not affected by the clinical experience of dentists .%目的:为了评价不同粘结系统及操作者临床经验及对纤维桩冠方微渗漏的影响。方法:60颗人上颌前牙经过根管预备处理后根据使用的粘结系统随机分为3组,RelyX Unicem组,Clearfil DC Core Automix 组,Paracore 5ml组,分别为每组20个样本。以上3组每组再根据粘结操作者的临床经验随机分为两个亚组,一组为专家组,一组为医师组。将纤维桩粘结至根管并制作树脂核后,将样本置入37℃水中存储1个月。经染色及透明化处理。在体式显微镜下记录各亚组的微渗漏得分。结果:RelyX Unicem组纤维桩冠方微渗漏最严重。Paracore 5ml组纤维桩冠方微渗漏最轻。Clearfil DC Core Automix组微渗漏程度位于两者之间。纤维桩的粘结后的微渗漏情况不受临床

  13. Clinical Genomic Database

    Solomon, Benjamin D.; Nguyen, Anh-Dao; Bear, Kelly A.; Wolfsberg, Tyra G.

    2013-01-01

    Technological advances have greatly increased the availability of human genomic sequencing. However, the capacity to analyze genomic data in a clinically meaningful way lags behind the ability to generate such data. To help address this obstacle, we reviewed all conditions with genetic causes and constructed the Clinical Genomic Database (CGD) (http://research.nhgri.nih.gov/CGD/), a searchable, freely Web-accessible database of conditions based on the clinical utility of genetic diagnosis and...

  14. CME ON CLINICAL RESEARCH

    Suneel. I. Majagi; S. S. Torgal; S. V. Hiremath

    2012-01-01

    Safety and efficacy are the two major concerns for any drug therapy. Globally clinical research plays an inevitable role in bringing a new molecule into the market after its synthesis by the pharmaceutical industries. Availability of large patient population, highly educated and skilled manpower, wide spectrum of diseases and favorable economic environment imply India’s potential as a global hub for clinical research. Pharmaceutical companies and Clinical Research Organization (CRO)s will req...

  15. Compliance in clinical trials.

    Pullar, T; Kumar, S; Feely, M

    1989-01-01

    Compliance with treatment can be an important determinant of the outcome of clinical trials. To date there is no completely satisfactory method of measuring compliance and some of the most widely used methods are inadequate. The various methods of measuring compliance and how they have been applied to clinical trials are described, and improvements in the standard of the measurement and reporting of compliance in clinical trials are suggested.

  16. 左乙拉西坦对癫痫患者认知功能及情绪影响的临床研究%The Clinical Study about Levetiracetam of Cognitive Function and Emotional Influence in the Patients with Epilepsy

    赵建法; 赵汉清; 乔莉霞; 陈升东; 于苏文

    2012-01-01

    目的:探讨左乙拉西坦对癫痫患者认知功能及情绪的临床影响.方法:选择同期癫痫患者60例,随机均分为对照组(n=30例)和观察组(n=30例),对照组患者给予丙戊酸钠治疗,观察组患者给予左乙拉西坦治疗,治疗第4w、8w、12w、16w比较两组患者蒙特利尔认知评估量表(MoCA)、神经电生理P300电位检查、焦虑自评量表(SAS)和抑郁自评量表(SDS)情况.结果:两组患者治疗第4w、第8w、第12w和第16w的MoCA评分和P300电位潜伏期时长比较,差异均具有统计学意义(P<0.05),观察组显著优于对照组;治疗第12w和第16w的SAS评分和SDS评分比较,差异均具有统计学意义(P<0.05),对照组显著优于观察组.结论:在癫痫患者的药物治疗过程中,左乙拉西坦对患者认知功能的改善优于丙戊酸钠,但对情绪的负性影响较丙戊酸钠明显.%Objective: To investigate the clinical influence about Levetiracetam of cognitive function and emotional influence in the patients with epilepsy. Method: 60 patients with epilepsy were collected. 30 patients were divided into the control group treated by Valproate, while 30 patients were divided into the observation group treated by Levetiracetam. MoCA Scale, Neuroelectrophysiological P300 potentials, SAS Scale and SDS Scale was detected at the 4th week's, 8th week's, 12th week's and 16th week's treatment. Result: There was significantdifference (P<0.05) in the MoCA score and P300 potential latency duration after the 4th week's, 8th week's,12th week's and 16th week's treatment, which was better in observation group than in control group. There was significantdifference(P<0.05) in the SAS Scale and SDS Scale after the 12th week's and 16th week's treatment, the control group showed better result than the observation group. Conclusion: In the process of treating the patients with epilepsy by drug, Levetiracetam is superior to Valproate on the improvement of cognitive function, but Levetiracetam

  17. A influência de variáveis sociodemográficas, clínicas e funcionais sobre a qualidade de vida de idosos com artroplastia total do quadril The influence of sociodemographic, clinical and functional variables on the quality of life of elderly people with total hip arthroplasty

    Mariana K. Rampazo

    2010-06-01

    Full Text Available OBJETIVOS: Avaliar a qualidade de vida relacionada à saúde (QVRS de idosos com Artroplastia Total de Quadril (ATQ e investigar a relação e a influência de variáveis sociodemográficas, clínicas e funcionais nesses sujeitos. MÉTODOS: A QVRS foi avaliada por meio das versões brasileiras dos instrumentos genérico The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36 e específico Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC em 88 idosos com ATQ primária e unilateral de ambos os gêneros. Os dados foram submetidos às análises estatísiticas: descritiva; análise de variância univariada (ANOVA e multivariada (MANOVA para verificar a influência das variáveis estudadas nas dimensões do SF-36 e do WOMAC e testes de Mann-Whitney e Kruskal-Wallis para comparação dos escores dos instrumentos entre as variáveis. RESULTADOS: A amostra estudada teve predomínio das mulheres, e a média de idade foi de 68,8(±7,4 anos. A função do quadril, avaliada pelo Harris Hip Score, foi a variável que apresentou influência significativa na QVRS sob a perspectiva do instrumento genérico e do específico. O uso de acessórios para a locomoção, a função do quadril e a satisfação com a cirurgia foram as principais variáveis que apresentaram diferenças significativas nas dimensões do SF-36 e do WOMAC. CONCLUSÕES: Investimentos no âmbito funcional e programas de reabilitação direcionados às peculiaridades dos idosos com ATQ podem beneficiar essa população.OBJECTIVES: To evaluate the health-related quality of life (HRQOL of elderly people with total hip arthroplasty (THA and to investigate the relationships and influences of the sociodemographic, clinical and functional variables of these subjects. METHODS: The HRQOL was evaluated by means of the Brazilian versions of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36, a general instrument, and the Western Ontario and Mc

  18. Clinical research informatics

    Richesson, Rachel L

    2012-01-01

    This book provides foundational coverage of key areas, concepts, constructs, and approaches of medical informatics as it applies to clinical research activities, in both current settings and in light of emerging policies. The field of clinical research is fully characterized (in terms of study design and overarching business processes), and there is emphasis on information management aspects and informatics implications (including needed activities) within various clinical research environments. The purpose of the book is to provide an overview of clinical research (types), activities, and are

  19. American Association for Clinical Chemistry

    ... indispensable patient care tool. Learn more IN CLINICAL CHEMISTRY ddPCR Quantification of Lymphoma Mutations Researchers have developed ... Online Harmonization.net Commission on Accreditation in Clinical Chemistry American Board of Clinical Chemistry Clinical Chemistry Trainee ...

  20. Developing an empirical base for clinical nurse specialist education.

    Stahl, Arleen M; Nardi, Deena; Lewandowski, Margaret A

    2008-01-01

    This article reports on the design of a clinical nurse specialist (CNS) education program using National Association of Clinical Nurse Specialists (NACNS) CNS competencies to guide CNS program clinical competency expectations and curriculum outcomes. The purpose is to contribute to the development of an empirical base for education and credentialing of CNSs. The NACNS CNS core competencies and practice competencies in all 3 spheres of influence guided the creation of clinical competency grids for this university's practicum courses. This project describes the development, testing, and application of these clinical competency grids that link the program's CNS clinical courses with the NACNS CNS competencies. These documents guide identification, tracking, measurement, and evaluation of the competencies throughout the clinical practice portion of the CNS program. This ongoing project will continue to provide data necessary to the benchmarking of CNS practice competencies, which is needed to evaluate the effectiveness of direct practice performance and the currency of graduate nursing education. PMID:18438164

  1. Clinical decision modeling system

    Lyons-Weiler James

    2007-08-01

    Full Text Available Abstract Background Decision analysis techniques can be applied in complex situations involving uncertainty and the consideration of multiple objectives. Classical decision modeling techniques require elicitation of too many parameter estimates and their conditional (joint probabilities, and have not therefore been applied to the problem of identifying high-performance, cost-effective combinations of clinical options for diagnosis or treatments where many of the objectives are unknown or even unspecified. Methods We designed a Java-based software resource, the Clinical Decision Modeling System (CDMS, to implement Naïve Decision Modeling, and provide a use case based on published performance evaluation measures of various strategies for breast and lung cancer detection. Because cost estimates for many of the newer methods are not yet available, we assume equal cost. Our use case reveals numerous potentially high-performance combinations of clinical options for the detection of breast and lung cancer. Results Naïve Decision Modeling is a highly practical applied strategy which guides investigators through the process of establishing evidence-based integrative translational clinical research priorities. CDMS is not designed for clinical decision support. Inputs include performance evaluation measures and costs of various clinical options. The software finds trees with expected emergent performance characteristics and average cost per patient that meet stated filtering criteria. Key to the utility of the software is sophisticated graphical elements, including a tree browser, a receiver-operator characteristic surface plot, and a histogram of expected average cost per patient. The analysis pinpoints the potentially most relevant pairs of clinical options ('critical pairs' for which empirical estimates of conditional dependence may be critical. The assumption of independence can be tested with retrospective studies prior to the initiation of

  2. Pharmacogenetics : the science of predictive clinical pharmacology

    Fenech, Anthony G; Grech, Godfrey

    2014-01-01

    The study of pharmacogenetics has expanded from what were initially casual family-based clinical drug response observations, to a fully-fledged science with direct therapeutic applications, all within a time-span of less than 60 years. A wide spectrum of polymorphisms, located within several genes, are now recognised to influence the pharmacokinetics and pharmacodynamics of the majority of drugs within our therapeutic armamentarium. This information forms the basis for the new development of ...

  3. Clinical decision making in veterinary practice

    Everitt, Sally

    2011-01-01

    Aim The aim of this study is to develop an understanding of the factors which influence veterinary surgeons’ clinical decision making during routine consultations. Methods The research takes a qualitative approach using video-cued interviews, in which one of the veterinary surgeon’s own consultations is used as the basis of a semi-structured interview exploring decision making in real cases. The research focuses primarily on small animal consultations in first opinion practice, how...

  4. TARGET POPULATION FOR CLINICAL TRIALS ON SARCOPENIA

    Cesari, Matteo; Pahor, Marco

    2008-01-01

    The term “sarcopenia” describes the progressive decline of muscle mass, strength and function occurring with aging. It is not considered a disease, but the direct consequence of the aging process on the skeletal muscle. Multiple demographic (e.g. gender, race), biological (e.g. inflammatory status) and clinical (e.g. diabetes, metabolic syndrome, congestive heart failure, medications) factors are able to influence (positively or negatively) the skeletal muscle quality and quantity. The extrem...

  5. Determinantes clínicos com influência no prognóstico da discectomia lombar: análise multifatorial Determinantes clínicos que influyen en el pronóstico de la disectomía lumbar: análisis multifactorial Clinical determinants' influence on lumbar discectomy prognosis: multi-factor analysis

    Paulo Jorge Da Rocha Carvalho

    2010-03-01

    lumbares, los cuales fueron sometidos a la discectomía entre 2003 y 2007. El seguimiento promedio fue de 3.9±0.1 años. Los resultados clínicos fueron evaluados utilizando el JOA (Japonese Orthopaedic Association Assessment Scoring System score (JOA=29. RESULTADOS: los resultados postoperatorios buenos y excelentes fueron obtenidos en 75% de los pacientes. Enfermos del sexo masculino y la preponderancia de síntomas subjetivos sobre síntomas clínicos estuvieron asociados con los mejores resultados clínicos y con el regreso más precoz a la actividad laboral. El tiempo de espera para la cirugía no influyó en el resultado final. La necesidad de cirugía fue cuestionada en la ausencia de déficits neurológicos significativos (JOA para resultados clínicos >3/6. Un valor JOA preoperatorio > 15 (debilidad inicial baja está correlacionado con los peores resultados clínicos postoperatorios. CONCLUSIONES: el JOA score se presenta de fácil aplicación para clínicos y enfermos, uniformiza datos subjetivos y presenta un valor predictivo para los resultados de los pacientes sometidos a la discectomía lumbar.Inappropriate patient selection and timing for lumbar disc surgery are still the the major causes of failures. OBJECTIVE: We evaluated the clinical outcome and predictive factors that influence the prognosis of patients submitted to lumbar discectomy using a multivariate analysis model. METHODS: We report a prospective series of 68 patients with herniated lumbar disc who underwent limited discectomy during 2003 to 2007. The average follow-up period was 3.9±0.1 years. Clinical findings were evaluated using Japonese Orthopaedic Association Assessment Scoring System (JOA=29. RESULTS: Excellent and good postoperative improvement rates were obtained in 75% of the patients. Male gender and preponderance of subjective symptoms over clinical signs were associated with better clinical outcomes and faster return to work. Waiting time for surgery had no consistent effect on the

  6. Participating in Clinical Trials

    Full Text Available ... In This Topic About Clinical Trials Risks and Benefits Terms to Know Finding a Clinical Trial Informed ... for more information Scientists usually do years of experiments in the laboratory and in animals before they even consider testing an experimental treatment ...

  7. Clinical coding. Code breakers.

    Mathieson, Steve

    2005-02-24

    --The advent of payment by results has seen the role of the clinical coder pushed to the fore in England. --Examinations for a clinical coding qualification began in 1999. In 2004, approximately 200 people took the qualification. --Trusts are attracting people to the role by offering training from scratch or through modern apprenticeships. PMID:15768716

  8. Clinical Psychology in Pakistan

    Riffat Moazam Zaman

    1991-01-01

    This article reviews the state of psychology in Pakistan, with special reference to clinical psychology. The issues of statutory recognition, credentials required for practice, public perception of psychology, the practice of indigenous "clinical psychology", sources of payment for psychological services, and relations between psychologists and psychiatrists are reviewed.

  9. Developing Clinical Competence

    P.F. Wimmers (Paul)

    2006-01-01

    textabstractThe development of clinical competence is the main purpose of medical education. The long road to become clinically competent starts on the first day of medical school, and every institution strives to select the best students. The responsibility of medical schools is to train th

  10. Participating in Clinical Trials

    Full Text Available ... In This Topic About Clinical Trials Risks and Benefits Terms to Know Finding a Clinical Trial Informed ... years of experiments in the laboratory and in animals before they even ... this early research occurs at universities and medical centers across the ...

  11. CLINICAL TRIALS.GOV

    ClinicalTrials.gov provides patients, family members, health care professionals, and members of the public easy access to information on clinical trials for a wide range of diseases and conditions. The U.S. National Institutes of Health (NIH), through its National Library of Medi...

  12. Clinical PET application

    Lim, Sang-Moo; Hong, S. W.; Choi, C. W.; Yang, S. D.; Choi, J. S.; Kweon, O. J. et al. [Korea Cancer Center Hospital, Seoul (Korea)

    2000-12-01

    PET gives various metabolic images, and is very important, new diagnostic modality in clinical oncology. In Korea Cancer Center Hospital, PET is installed as a research tool of long-mid-term atomic research project. For the efficient use of PET for clinical and research projects, income from the patients should be managed to get the raw material, equipment, manpower, and also for the clinical PET research. 1. Support the clinical application of PET in oncology. 2. Budgetary management of income, costs for raw material, equipment, manpower, and the clinical PET research project. In this year, 1,327 cases of PET images were obtained, which resulted total income of 829,770,000won. Increased demand for {sup 18}FDG in and outside KCCH need more than 2 times production of {sup 18} in a day. Manpower should be added for the second PET operation and RI production. 10 figs., 4 tabs. (Author)

  13. Influência das características sociodemográficas e clínicas e do nível de dependência na qualidade de vida de pacientes com DPOC em oxigenoterapia domiciliar prolongada Influence that sociodemographic variables, clinical characteristics, and level of dependence have on quality of life in COPD patients on long-term home oxygen therapy

    Simone Cedano

    2012-06-01

    of dependence. METHODS: This was a cross-sectional analytical study involving COPD patients on LTOT followed at the Oxygen Therapy Outpatient Clinic of the Federal University of São Paulo Hospital São Paulo, in the city of São Paulo, Brazil. Sociodemographic, clinical, and biochemical data were collected. We assessed QoL and level of dependence using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36 and the Katz index, respectively. Multiple linear regression models were constructed in order to determine the influence of these variables on QoL. RESULTS: We included 80 patients in the study. The mean age was 69.6 ± 9.1 years, and 51.3% were female. The lowest SF-36 scores were for the physical functioning and role-physical domains. All sociodemographic characteristics (except gender were found to correlate significantly with the SF-36 domains mental health, vitality, role-physical, and social functioning. We also found that body mass index, PaO2, post-bronchodilator FEV1, hemoglobin, and Katz index correlated significantly with the physical functioning, mental health, role-physical, and bodily pain domains. In addition, oxygen flows were found to correlate negatively with the physical functioning, mental health, vitality, and role-emotional domains. CONCLUSIONS: Low scores for SF-36 domains, as well as the variables that negatively influence them, should be considered and analyzed during the development and implementation of strategies for improving the QoL of COPD patients on LTOT.

  14. Body composition in clinical practice.

    Andreoli, Angela; Garaci, Francesco; Cafarelli, Francesco Pio; Guglielmi, Giuseppe

    2016-08-01

    Nutritional status is the results of nutrients intake, absorption and utilization, able to influence physiological and pathological conditions. Nutritional status can be measured for individuals with different techniques, such as CT Body Composition, quantitative Magnetic Resonance Imaging, Ultrasound, Dual-Energy X-Ray Absorptiometry and Bioimpendance. Because obesity is becoming a worldwide epidemic, there is an increasing interest in the study of body composition to monitor conditions and delay in development of obesity-related diseases. The emergence of these evidence demonstrates the need of standard assessment of nutritional status based on body weight changes, playing an important role in several clinical setting, such as in quantitative measurement of tissues and their fluctuations in body composition, in survival rate, in pathologic condition and illnesses. Since body mass index has been shown to be an imprecise measurement of fat-free and fat mass, body cell mass and fluids, providing no information if weight changes, consequently there is the need to find a better way to evaluate body composition, in order to assess fat-free and fat mass with weight gain and loss, and during ageing. Monitoring body composition can be very useful for nutritional and medical interventional. This review is focused on the use of Body Composition in Clinical Practice. PMID:26971404

  15. Issues about the nocebo phenomena in clinics

    WU Zhen-yu; LI Kang

    2009-01-01

    @@ During clinical work, some side-effects may occur to patients, part of which are caused by the specific pharmacological effects of drugs and some of which are non-specific. Although these phenomena happen from time to time, burdening the anguish and expenditure of patients, their nature is still less understood. Recently, as the research of the placebo effect become deeper and deeper, clinicians and researchers have gradually realized that mind plays an important role in the occurrence of non-specific side-effects, which is called "nocebo effect" professionally, the evil side of placebo effect. This article would expatiate on nocebo effect in detail from several aspects, such as its mechanism, effect, influencing factors and discuss how to make it known and treated in clinical practice and clinical trials.

  16. Clinical medical librarian: the last unicorn?

    Demas, J M; Ludwig, L T

    1991-01-01

    In the information age of the 1990s, the clinical medical librarian (CML) concept, like many other personalized library services, is often criticized as being too labor-intensive and expensive; others praise its advantages. To determine the attitudes of medical school library directors and clinical department heads toward implementation and feasibility of a CML program, forty randomly selected medical schools were surveyed. A double-blind procedure was used to sample department heads in internal medicine, pediatrics, and surgery, as well as health sciences library directors identified by the Association of Academic Health Sciences Library Directors (AAHSLD) annual statistics. The survey instrument was designed to measure responses to the following attitudinal variables: acceptance and nonacceptance of a CML program; importance to patient care, education, and research; influence on information-seeking patterns of health care professionals; ethical issues; CML extension services; and costs. Seventy-nine usable questionnaires out of a total of 120 (66%) were obtained from clinical medical personnel, and 30 usable questionnaires out of a total of 40 (75%) were obtained from medical school library directors. Survey results indicated significant differences between clinical medical personnel and library personnel regarding attitudes toward CML influence on information-seeking patterns, ethics, alternative CML services, and costs. Survey results also indicated a continuing strong support for CML programs in the medical school setting; however, differences of opinion existed toward defining the role of the CML and determining responsibility for funding. PMID:1998816

  17. Copper and Anesthesia: Clinical Relevance and Management of Copper Related Disorders

    Adrian Langley; Dameron, Charles T.

    2013-01-01

    Recent research has implicated abnormal copper homeostasis in the underlying pathophysiology of several clinically important disorders, some of which may be encountered by the anesthetist in daily clinical practice. The purpose of this narrative review is to summarize the physiology and pharmacology of copper, the clinical implications of abnormal copper metabolism, and the subsequent influence of altered copper homeostasis on anesthetic management.

  18. Clinical PET application

    Lim, Sang Moo; Hong, Song W.; Choi, Chang W.; Yang, Seong Dae [Korea Cancer Center Hospital, Seoul (Korea)

    1997-12-01

    PET gives various methabolic images, and is very important, new diagnostic modality in clinical oncology. In Korea Cancer Center Hospital, PET is installed as a research tool of long-mid-term atomic research project. For the efficient use of PET for clinical and research projects, income from the patients should be managed to get the raw material, equipment, manpower, and also for the clinical PET research. 1. Support the clinical application of PET in oncology. 2. Budgetary management of income, costs for raw material, equipment, manpower, and the clinical PET research project. In this year, 250 cases of PET images were obtained, which resulted total income of 180,000,000 won. 50,000,000 won was deposited for the 1998 PET clinical research. Second year PET clinical research should be managed under unified project. Increased demand for {sup 18}FDG in and outside KCCH need more than 2 times production of {sup 18}FDG in a day purchase of HPLC pump and {sup 68}Ga pin source which was delayed due to economic crisis, should be done early in 1998. (author). 2 figs., 3 tabs.

  19. Influência dos níveis de prolactina e tamanho tumoral na função hipofisária pós-operatória em macroadenomas hipofisários clinicamente não-funcionantes Influence of hyperprolactinemia and tumoral size in the postoperative pituitary function in clinically nonfuncioning pituitary macroadenomas

    Ana Luiza Vidal Fonseca

    2002-09-01

    Full Text Available OBJETIVO: Estudar a influência da hiperprolactinemia e de tamanho tumoral na função hipofisária em macroadenomas hipofisários clinicamente não funcionantes. MÉTODOS: Foram analisados 23 pacientes com macroadenomas hipofisários clinicamente não funcionantes, com exames de imagem (tomografia computadorizada ou ressonância magnética e dosagens hormonais basais; 16 tinham provas de função hipotálamo-hipofisária (megateste pré-operatórios. Todos os tumores tiveram diagnóstico histológico e em 17 foi realizado também estudo imuno-histoquímico para os hormônios adeno-hipofisários. A análise estatística foi feita por meio dos testes t de Student, qui-quadrado, exato de Fisher e de Mc Neman. O nível de significância adotado foi 5% (pOBJECTIVE: To study the influence of hyperprolactinemia and tumoral size in the pituitary function in clinically nonfuncioning pituitary macroadenomas. METHODS: Twenty three patients with clinically nonfuncioning pituitary macroadenomas were evaluated by image studies (computed tomography or magnetic resonance and basal hormonal level; 16 had preoperative hypothalamus-hypophysial function tests (megatests. All tumors had histological diagnosis and in seventeen immunohistochemical study for adenohypophysial hormones was also performed. Student's t test, chi square test, exact test of Fisher and Mc Neman test were used for the statistics analysis . The level of significance adopted was 5% (p<0.05. RESULTS: Tumoral diameter varied of 1.1 to 4.7 cm (average=2.99 cm ± 1.04. In the preoperative, 5 (21.7% patients did not show laboratorial hormonal deficit, 9 (39.1% developed hyperprolactinemia, 13 (56,5% normal levels of prolactin (PRL and 1 (4.3% subnormal; 18 (78.3% patients developed hypopituitarism (4 pan-hypopituitarism. Nineteen patients (82.6% underwent transsfenoidal approach, 3 (13% craniotomy and 1 (4.4% combined access. Only 6 patients had total tumoral resection. Of the 17 immunohistochemical

  20. 正念行为训练联合音乐疗法对围绝经期临床护士心理状态及睡眠质量的影响%THE INFLUENCE OF MINDFULNESS TRAINING COMBINED WITH MUSIC BEHAVIORAL THERAPY TO THE PSYCHOLOGICAL STATUS AND SLEEP QUALITY OF PERIMENOPAUSAL CLINICAL NURSES

    郝晶; 李淑杏; 陈长香; 王素娟; 雷鹏琼

    2016-01-01

    Objective To discusses the influence of mindfulness behavior training combined with music ther‐apy to the psychological status and sleep quality of perimenopausal clinical nurses .Method 110 perimeno‐pausal clinical nurses were randomly divided into two groups ,control group (55 cases) and the experimen‐tal group (55 cases) .The control group adopted music therapy ,and the experimental group adopted mind‐fulness behavior training on the basis of music therapy .After 6 weeks intervention ,all nurses'depression and anxiety were evaluated with depression scale (GDS) and Zung self rating anxiety scale (SAS);their sleep quality were evaluated with Pittsburgh sleep quality index scale (PSQI) and their mindfulness level were evaluated with Mindful Athention Awareness Scale (MAAS) .Result Before the intervention ,the differences of GDS ,Zung ,PSQI and MAAS score between the two groups had no statistical significance (P>0 .05);After the intervention ,the GDS ,Zung ,PSQI and MAAS score were improved ,and the differ‐ences had statistical significance (P<0 .05) .Compared with the control group after treatment ,the score of GDS and Zung decreased ,the PSQI and MAAS scores improved ,and the differences were statistically sig‐nificant different (P< 0 .05) .Conclusion The mindfulness behavior training combined with music therapy can effectively improve the nurses'psychological state of menopause ,improve their sleep quality .%目的:探讨正念行为训练联合音乐疗法对围绝经期临床护士的心理状态及睡眠质量的干预效果。方法选取110例围绝经期临床护士随机分为对照组(55例)和观察组(55例)。对照组采用音乐疗法,观察组在此基础上加以正念行为训练。所有护士在干预6周后,均采用抑郁量表和Zung焦虑自评量表评测抑郁、焦虑;匹兹堡睡眠质量指数量表评价睡眠质量情况;正念注意知觉量表评价正念尿平。结果干预前,二组焦虑、抑郁

  1. 阿法骨化醇对维持性血液透析患者甲状旁腺激素的影响及临床意义%Clinical significance and influence of alfacalcidol on intact parathyroid hormone in maintenance hemodialysis patients

    王东辉; 杜娟; 高寒; 胡曼丽; 田小海

    2015-01-01

    目的:观察阿法骨化醇对维持性血液透析患者甲状旁腺激素(iPTH)的影响,并探讨其临床意义。方法24例慢性肾衰竭尿毒症期行维持性血液透析治疗6个月以上患者作为血液透析组(HD组),同期体检健康人群22例作为健康对照组(Con组)。治疗开始HD组患者口服阿法骨化醇,1μg/d,元素钙2000 mg。共观察12周。Con组患者及HD组患者用药前后均查肾功能及血电解质,用放免法检测iPTH和骨钙素(BGP)。结果用药前HD组与Con组比较, iPTH, BGP及血肌酐(Cre)明显升高,血钙(Ca)降低,血磷(P)升高,差异有统计学意义(P<0.05)。用药后HD组iPTH和BGP明显下降,血钙升高,差异有统计学意义(P<0.05)。结论补充阿法骨化醇,可以降低维持性血液透析患者血清iPTH水平,进而改善肾性骨病,为临床治疗提供了新思路。%Objective To observe the influence of alfacalcidol on intact parathyroid hormone (iPTH) in maintenance hemodialysis patients, and to investigate its clinical significance.Methods Hemodialysis group (HD group) contained 24 patients with maintenance hemodialysis of chronic renal failure uremia for more than 6 months, and health control group (Con group) contained 22 health people in the same time period. HD group received 1μg/d of alfacalcidol and 2000 mg of calcium through oral administration. The observation lasted for 12 weeks. The renal function and blood electrolytes were detected in the two groups before and after treatment. Intact parathyroid hormone and bone gla protein (BGP) were detected by radioimmunoassay method.Results HD group had higher iPTH, BGP and serum creatinine (Cre), decreased blood calcium (Ca), and increased serum phosphate (P) than the Con group before treatment. The difference had statistical significance (P<0.05). The iPTH and BGP decreased and blood calcium increased in HG group after treatment, and the difference had statistical significance (P<0.05).Conclusion Supplement of

  2. Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena

    Mannix, Judy; Wilkes, Lesley; Jackson, Debra

    2013-01-01

    Background Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses’ clinicians’ views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses’ understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. Methods A descriptive interpretative qualitative approach using semi-struct...

  3. Participating in Clinical Trials

    Full Text Available ... experimental drug, therapy, medical device, lifestyle change, or test will help treat, find, or prevent a disease. A clinical trial may compare experimental products or tests to those already available or may compare existing ...

  4. Clinical specular microscopy

    Hirst, L.W.; Laing, R.A.

    1987-01-01

    This book provides the general ophthalmologist with a guide to the clinical applications of specular microscopy. Important material is included on laser injury, cataract surgery, corneal transplants, glaucoma, uveitis, and trauma.

  5. Participating in Clinical Trials

    Full Text Available ... that could identify a disease in its early stages. Usually, trial participants must show signs of the ... Trials Clinical trials of drugs are usually described based on their phase. The U.S. Food and Drug ...

  6. Leprosy neuropathy: clinical presentations.

    Nascimento, Osvaldo J M

    2013-09-01

    Leprosy is a chronic infectious peripheral neuropathy caused by Mycobacterium leprae. The different clinical presentations of the disease are determined by the quality of the host immune response. Early detection of leprosy and treatment by multidrug therapy are the most important steps in preventing deformity and disability. Thus the early recognition of the clinical leprosy presentation is essential. Mononeuritis, mononeuritis multiplex (MM), polyneuritis (MM summation) are the most frequent. The frequent anesthetic skin lesions are absent in the pure neuritic leprosy presentation form. Isolated peripheral nerve involvement is common, including the cranial ones. Arthritic presentation is occasionally seen, usually misdiagnosed as rheumatoid arthritis. Attention should be given to autonomic dysfunctions in leprosy. There are clinical presentations with severe neuropathic pain - painful small-fiber neuropathy. Leprous late-onset neuropathy (LLON) clinical presentation should be considered facing a patient who develop an inflammatory neuropathy many years after a previous skin leprosy treatment. PMID:24141500

  7. Clinical Trial Basics

    ... Human Services Search the NIH Website NIH Employee Intranet Staff Directory En Español Site Menu Home Health ... am thinking about participating? Xsandra/iStock Risks and benefits Clinical trials involve risks, just as routine medical ...

  8. Fidelity in clinical simulation

    Jensen, Sanne; Nøhr, Christian; Rasmussen, Stine Loft

    2013-01-01

    Clinical simulation may be used to identify user needs for context sensitive functionalities in e-Health. The objective with this paper is to describe how user requirements and use cases in a large EHR-platform procurement may be validated by clinical simulation using a very low-fidelity prototype...... without any existing test data. Instead of using test scenarios and use cases, the healthcare professionals who are participating in the clinical simulation are generating both scenario and patient data themselves. We found that this approach allows for an imaginative discussion, not restricted by known...... functionalities and limitations, of the ideal EHR-platform. Subsequently, we discuss benefits and challenges of using an extremely low fidelity environment and discuss the degree of fidelity necessary for conducting clinical simulation....

  9. Participating in Clinical Trials

    Full Text Available ... was provided by the National Library of Medicine Topic last reviewed: December 2013 For an enhanced version of this page please turn Javascript on. Participating in Clinical Trials ...

  10. Clinical Case Registries (CCR)

    Department of Veterans Affairs — The Clinical Case Registries (CCR) replaced the former Immunology Case Registry and the Hepatitis C Case Registry with local and national databases. The CCR:HIV and...

  11. ClinicalTrials.gov

    U.S. Department of Health & Human Services — Provides patients, family members, health care professionals, and members of the public easy access to information on clinical trials for a wide range of diseases...

  12. Participating in Clinical Trials

    Full Text Available ... Learn More Participating in Clinical Trials Videos quiz yourself MedlinePlus for More Information National Institute on Aging Related Topics Talking with Your Doctor Taking Medicines The information in ...

  13. Towards sustainable clinical trials

    Group, Sustainable Trials Study

    2007-01-01

    Currently, few researchers think about the carbon footprint of their trial. The Sustainable Trials Study Group reports that clinical trials are carbon intensive and suggests ways to make them more efficient

  14. Participating in Clinical Trials

    Full Text Available ... Clinical Trials Videos quiz yourself MedlinePlus for More Information National Institute on Aging Related Topics Talking with Your Doctor Taking Medicines The information in this topic was provided by the National ...

  15. Consolidated Clinical Microbiology Laboratories

    Sautter, Robert L.; Thomson, Richard B.

    2014-01-01

    The manner in which medical care is reimbursed in the United States has resulted in significant consolidation in the U.S. health care system. One of the consequences of this has been the development of centralized clinical microbiology laboratories that provide services to patients receiving care in multiple off-site, often remote, locations. Microbiology specimens are unique among clinical specimens in that optimal analysis may require the maintenance of viable organisms. Centralized laborat...

  16. Urine in clinical proteomics.

    Decramer, Stéphane; Gonzalez de Peredo, Anne; Breuil, Benjamin; Mischak, Harald; Monsarrat, Bernard; Bascands, Jean-Loup; Schanstra, Joost P

    2008-01-01

    Urine has become one of the most attractive biofluids in clinical proteomics as it can be obtained non-invasively in large quantities and is stable compared with other biofluids. The urinary proteome has been studied by almost any proteomics technology, but mass spectrometry-based urinary protein and peptide profiling has emerged as most suitable for clinical application. After a period of descriptive urinary proteomics the field is moving out of the discovery phase into an era of validation ...

  17. Statistics in clinical practice

    Coggon, David

    2002-01-01

    These days a basic knowledge of statistics is essential for good clinical practice, which presents a daunting challenge to health professionals who are not mathematically inclined. This book is aimed at clinicians and students who view statistics as a necessary evil. It covers the summary and presentation of data as might be required for a clinical meeting, audit or the planning of services, and explains how to interpret the p-values and confidence intervals that are reported in medical and scientific journals.

  18. Clinical careers film.

    2015-09-01

    Those interested in developing clinical academic careers might be interested in a short animated film by Health Education England (HEE) and the National Institute for Health Research. The three-minute film, a frame from which is shown below, describes the sort of opportunities that are on offer to all professionals as part of the HEE's clinical academic careers framework. You can view the film on YouTube at tinyurl.com/pelb95c. PMID:26309005

  19. The clinical nanomedicine handbook

    Brenner, Sara

    2013-01-01

    Designed to foster a stronger awareness and exploration of the subject by practicing clinicians, medical researchers and scientists, The Clinical Nanomedicine Handbook discusses the integration of nanotechnology, biology, and medicine from a clinical point of view. The book highlights relevant research and applications by specialty; it examines nanotechnology in depth, and the potential to solve medical problems. It also increases literacy in nanotechnology, and allows for more effective communication and collaboration between disciplines. Details worldwide developments in nanomedicine Provide

  20. Pediatric Anthrax Clinical Management

    Bradley, John S.; Peacock, Georgina; Krug, Steven E.; Bower, William A.; Cohn, Amanda C.; Meaney-Delman, Dana; Pavia, Andrew T.

    2014-01-01

    Anthrax is a zoonotic disease caused by Bacillus anthracis, which has multiple routes of infection in humans, manifesting in different initial presentations of disease. Because B anthracis has the potential to be used as a biological weapon and can rapidly progress to systemic anthrax with high mortality in those who are exposed and untreated, clinical guidance that can be quickly implemented must be in place before any intentional release of the agent. This document provides clinical guidanc...

  1. Clinical trials in Huntington's disease: Interventions in early clinical development and newer methodological approaches.

    Sampaio, Cristina; Borowsky, Beth; Reilmann, Ralf

    2014-09-15

    Since the identification of the Huntington's disease (HD) gene, knowledge has accumulated about mechanisms directly or indirectly affected by the mutated Huntingtin protein. Transgenic and knock-in animal models of HD facilitate the preclinical evaluation of these targets. Several treatment approaches with varying, but growing, preclinical evidence have been translated into clinical trials. We review major landmarks in clinical development and report on the main clinical trials that are ongoing or have been recently completed. We also review clinical trial settings and designs that influence drug-development decisions, particularly given that HD is an orphan disease. In addition, we provide a critical analysis of the evolution of the methodology of HD clinical trials to identify trends toward new processes and endpoints. Biomarker studies, such as TRACK-HD and PREDICT-HD, have generated evidence for the potential usefulness of novel outcome measures for HD clinical trials, such as volumetric imaging, quantitative motor (Q-Motor) measures, and novel cognitive endpoints. All of these endpoints are currently applied in ongoing clinical trials, which will provide insight into their reliability, sensitivity, and validity, and their use may expedite proof-of-concept studies. We also outline the specific opportunities that could provide a framework for a successful avenue toward identifying and efficiently testing and translating novel mechanisms of action in the HD field. PMID:25216371

  2. Interprofessional clinical education: clinicians' views on the importance of leadership.

    Missen, Karen; Jacob, Elisabeth R; Barnett, Tony; Walker, Lorraine; Cross, Merylin

    2012-01-01

    The current shortage of health professionals necessitates new approaches to clinical education that can expand the number of undergraduate students undertaking clinical placements without increasing the burden on clinical staff or placing patients at risk. Interprofessional education has the potential to help increase clinical capacity whilst enriching students' clinical experience. This paper reports on a project which investigated the potential for interprofessional education to increase undergraduate clinical placement capacity in clinical settings. The project utilised an exploratory descriptive methodology to obtain the views of health care professionals about the use of interprofessional education in clinical education at three rural health facilities in Victoria, Australia. Participants (n = 57) had a key role with each health care facility in coordinating and facilitating undergraduate clinical placements. This paper examines the clinicians' views about the central role that leadership plays in actioning interprofessional education in the clinical setting. Whilst interprofessional education was regarded favourably by the majority of participants, data indicated that leadership from education providers, health services, and regulatory authorities was crucial to enable interprofessional education to be implemented and sustained within the clinical learning environment. Without leadership from each of these three spheres of influence, interprofessional education will continue to be difficult to implement for undergraduate students and compromise their exposure to an important aspect of the working life of health care professionals. Such a failure will limit graduates' readiness for collaborative and cross-disciplinary practice. PMID:23362604

  3. Clinical Studies with Epothilones

    Altmann, Karl-Heinz

    As indicated in previous chapters, epothilone research so far has delivered seven new chemical entities that have been advanced to clinical trials in humans (Fig. 1). However, the amount of clinical data publicly available at this time strongly varies between individual compounds, depending on their development stage, but also on the general publication policy of the developing company. The compound that has been most comprehensively characterized in the clinical literature is ixabepilone (BMS-247550), for which trial results have been described in a number of articles in peer-reviewed journals and which has been granted FDA approval for two clinical indications on Oct. 16, 2007. For all other compounds, most of the information on clinical trials is available only in abstract form. In all these cases it remains uncertain, whether the content of these abstracts fully reflects the content of the subsequent (poster or oral) presentations at the corresponding meeting; in fact, it seems likely that additional data will have been included in the actual meeting presentations that may not have been available at the time of abstract submission. As this is unknown to the author, such additional information cannot be considered in this chapter, which is solely based on information documented in accessible abstracts or journal publications. It should also be kept in mind that the interpretation of data from ongoing clinical trials or forward looking statements based on data from completed trials are always preliminary in character.

  4. Clinical toxinology specialty training.

    White, Julian

    2013-07-01

    Clinical toxinology is the medical discipline dealing with the diagnosis, treatment and prevention of toxin diseases caused by exposure to venomous animals and poisonous animals, plants and mushrooms. Currently there is no national or international organisation accrediting or training doctors in this discipline, but the role of the IST in this area is the subject of a recently approved revised Constitution. A few courses covering some aspects of clinical toxinology exist, either with limited curricula, or with only a minor clinical focus, or with a very regional, non-global focus. The only comprehensive clinical toxinology course is the one provided in Adelaide, Australia, running regularly since 1997. This course may form the nucleus from which IST can develop a global accredited training scheme in clinical toxinology. Such a scheme will require input from diverse global regions and will be far more comprehensive and over a much longer time than the current Short Course, though may incorporate the Short Course in some way, or a derivative of it. Accreditation of medical expertise in clinical toxinology will be required at the national level and this might be accomplished by the IST working with existing national medical specialty organisations and governments, with the IST supervising the training and accreditation requirements and the national organisations providing the framework for registration of medical expertise at the local level. PMID:23524067

  5. Fundamentals of clinical trials

    Friedman, Lawrence M; DeMets, David L; Reboussin, David M; Granger, Christopher B

    2015-01-01

    This is the fifth edition of a very successful textbook on clinical trials methodology, written by recognized leaders who have long and extensive experience in all areas of clinical trials. The three authors of the first four editions have been joined by two others who add great expertise.  Most chapters have been revised considerably from the fourth edition.  A chapter on regulatory issues has been included and the chapter on data monitoring has been split into two and expanded.  Many contemporary clinical trial examples have been added.  There is much new material on adverse events, adherence, issues in analysis, electronic data, data sharing, and international trials.  This book is intended for the clinical researcher who is interested in designing a clinical trial and developing a protocol. It is also of value to researchers and practitioners who must critically evaluate the literature of published clinical trials and assess the merits of each trial and the implications for the care and treatment of ...

  6. Clinical dosimetry using mosfets

    Purpose: The use of metal oxide-silicon field effect transistors (MOSFETs) as clinical dosimeters is demonstrated for a number of patients with targets at different clinical sites. Methods and Materials: Commercially available MOSFETs were characterized for energy response, angular dependency of response, and effect of accumulated dose on sensitivity and some inherent properties of MOSFETs. The doses determined both by thermoluminescence dosimetry (TLD) and MOSFETs in clinical situation were evaluated and compared to expected doses determined by calculation. Results: It was observed that a standard calibration of 0.01 Gy/mV gave MOSFET determined doses which agreed with expected doses to within 5% at the 95% confidence limit for photon beams from 6 to 25 MV and electron beams from 5 to 14 MeV. An energy-dependent variation in response of up to 28% was observed between two orientations of a MOSFET. The MOSFET doses compared very well with the doses estimated by TLDs, and the patients tolerated MOSFETs very well. A standard deviation of 3.9% between expected dose and MOSFET determined dose was observed, while for TLDs the standard deviation was 5.1%. The advantages and disadvantages of using MOSFETs for clinical dosimetry are discussed in detail. Conclusion: It was concluded that MOSFETs can be used as clinical dosimeters and can be a good alternative to TLDs. However, they have limitations under certain clinical situations

  7. 低分子量肝素对胸外科高龄患者术后凝血功能影响的临床研究%Clinical study of influence of low molecular weight heparin on coagulation function in elderly patients after thoracic surgery

    张霓; 付向宁; 徐沁孜

    2010-01-01

    Objective To compare the changes of blood coagulation system and the clinical interventional effect of low molecular weight heparin (LMWH) in elderly patients who had received thoracic surgery. Methods Ninety-six thoracic surgery patients (age≥70 years) were divided into control group ( 54 cases ) and experimental group ( 42 cases ) ( postoperative 1-7 days, subcutaneous injection with LMWH ) from September 2007 to December 2009 by random digits table. Observed perioperative changes in prothrombin time (PT),activated partial thromboplastin time (APTT),platelet (Plt),D-dimer (D-D),fibrinogen (Fib), anti- X a activity, and clinical performances. Also observed the influence of diabetes mellitus of surgery coagulation function. Results The preoperative indexes of coagulation function were no significant (P > 0.05 ). In control group PT prolonged, Fib and D-D increased, the differences between preoperative and postoperative each time were significant (P < 0.05 ). Fib and D-D in control group increased than those in experimental group postoperative each time (P < 0.05 ). In experimental group anti- X a activity increased postoperative each time (P < 0.05 ),compared with control group was also significant (P < 0.05 ). Diabetes mellitus had no significant influence on coagulation function. One patient appeared pulmonary thromboembolism in control group,and no one appeared venous thromboembelism and bleeding adverse reactions in experimental group. Conclusion Thoracic surgery in elderly patients have high blood coagulation state, prone to venous thromboembolism, LMWH given early postoperative prophylactic treatment is beneficial to improve the hypercoagulable state and have better security.%目的 对比研究胸外科高龄患者术后凝血功能变化及低分子量肝素的临床干预效果.方法 选取2007年9月至2009年12月接受开胸手术的96例高龄患者,用随机数字表法分为对照组54例和试验组42例(术后第1~7天皮下注射

  8. Collaborative learning of clinical skills in health professions education

    Tolsgaard, Martin G; Kulasegaram, Kulamakan M; Ringsted, Charlotte V

    2016-01-01

    . Training efficiency may therefore be improved if the outcomes of collaborative learning of clinical skills are superior or equivalent to those attained through individual learning. HOW: According to a social interaction perspective, collaborative learning of clinical skills mediates its effects through......, scaffolding and cognitive co-construction are outweighed by reductions in hands-on experience and time on task. CONCLUSIONS: Collaborative learning of clinical skills has demonstrated promising results in the simulated setting. However, further research into how collaborative learning of clinical skills may......OBJECTIVES: This study is designed to provide an overview of why, how, when and for whom collaborative learning of clinical skills may work in health professions education. WHY: Collaborative learning of clinical skills may influence learning positively according to the non-medical literature...

  9. Children and Clinical Studies: Why Clinical Studies Are Important

    Full Text Available ... Systematic Evidence Reviews & Clinical Practice Guidelines Resources Continuing Education Researchers Funding Training & Career Development Division of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & ...

  10. Influência da extensão da artrodese lombossacra nos resultados clínicos e funcionais Influencia de la extensión de la artrodesis lumbosacra en los resultados clínicos y funcionales Influence of the extent of lumbosacral arthrodesis in clinical and functional outcomes

    Alberto Ofenhejm Gotfryd

    2012-01-01

    de medicamentos analgésicos y satisfacción con el tratamiento y la escala analógica visual para el dolor lumbar y la ciática. Por otra parte, se aplicaran los cuestionarios Oswestry y SF-36 para evaluar la calidad de vida. RESULTADOS: El SF-36 mostró resultados de buenos niveles de calidad de vida en ambos grupos, excepto en el campo "Aspectos Físicos". No hubo correlación significativa entre la magnitud de la artrodesis y los resultados clínicos. CONCLUSIONES: Los pacientes que fueron sometidos a artrodesis posterolateral mostraron calidad de vida satisfactoria, con excepción de disminución de la aptitud física. Sin embargo, el mayor número de niveles fusionados no tuvo un impacto negativo en los aspectos clínicos y funcionales.OBJECTIVE: Investigate the influence of the extent of posterolateral lumbosacral fusion and its impact on clinical and functional results. METHODS: We evaluated 22 patients with central or foraminal stenosis or lumbar disc herniation associated with segmental instability that underwent to surgery for nerve decompression and posterolateral arthrodesis. Patients were divided into two groups according to the number of levels fused: Group 1: fusion at one level and Group 2: fusion of two or more levels. Patients completed questionnaires regarding postoperative follow-up (use of analgesic medications and treatment satisfaction and visual analog scale for lumbar pain and sciatica. Moreover, the questionnaires Oswestry and SF-36 were administered to assess quality of life. RESULTS: SF-36 showed good levels of quality of life in both groups, except the field "Physical Aspects". There was no significant correlation between the extent of the arthrodesis and clinical outcomes. CONCLUSIONS: Patients who underwent posterolateral arthrodesis showed satisfactory quality of life, except for a decrease of physical fitness. However, the higher number of levels fused did not have negative impact on clinical and functional aspects.

  11. Manufacturing process influences properties of probiotic bacteria

    Grzeskowiak, Lukasz; Isolauri, Erika; Salminen, Seppo; Gueimonde Fernández, Miguel

    2011-01-01

    Production and manufacturing methods and the food carrier may influence the properties of probiotic strains, and have an impact on the outcome of clinical intervention studies. The aim of the present study was to establish whether the properties of a specific probiotic strain, Lactobacillus rhamnosus GG, may differ depending on the product and source of the strain. In total, fifteen different L. rhamnosus isolates, among them fourteen labelled as L. rhamnosus GG, were isolated from specific p...

  12. Using a scorecard to demonstrate clinical nurse specialists' contributions.

    Jepsen, Stacy

    2015-01-01

    Clinical nurse specialists (CNSs) have the expertise to influence change at the patient, nurse, and system levels. They are clinical experts who understand the challenges of the current health care environment: decreasing costs, ensuring high-quality care, and achieving outcomes. Evidence has demonstrated CNSs' influence on improving patient outcomes. Although CNSs often lead the work, they can be invisible when the outcomes are presented. A scorecard to display this work could be invaluable to the CNS role, as it would bring transparency to the evidence-based work done. This article describes the development of a CNS scorecard in a 627-bed tertiary hospital. PMID:25594479

  13. How Do Clinical Trials Work?

    ... Trials Clinical Trial Websites How Do Clinical Trials Work? If you take part in a clinical trial, ... kol). This plan explains how the trial will work. The trial is led by a principal investigator ( ...

  14. Effects of feedback of information on clinical practice: a review.

    Mugford, M; Banfield, P; O'Hanlon, M

    1991-01-01

    OBJECTIVE--To establish what is known about the role of feedback of statistical information in changing clinical practice. DESIGN--Review of 36 studies of interventions entailing the use of statistical information for audit or practice review, which used a formal research design. SUBJECTS--Papers identified from computer searches of medical and health service management publications, of which 36 describing studies of interventions designed to influence clinical care and including information ...

  15. Clinical effect and influence in cognitive function of aripiprazole and risperidone in patients with schizophrenia%阿立哌唑与利培酮对精神分裂症患者的临床疗效及认知功能的影响

    刘旭; 程哲; 杨芳; 程传宝

    2013-01-01

    [Objective]To explore the clinical effect and safety of aripiprazole and risperidone in patients with schizophrenia, and the influence in cognitive function of patients. [ Methods] 156 schizophrenia patients were randomly divided into two groups, 78 cases in each group. The research group was treated with aripiprazole orally, and the control group was given risperidone, for 8 weeks. Before treatment and at the end of the 4th and 8th week of treatment, the clinical effect was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression ( CGIS) , and the adverse reactions were evaluated with the Treatment Emergent Symptom Scale (TESS). Before treatment and at the end of the 8th week of treatment, the cognitive functions of patients was assessed with the Wechsler Adult Intelligence Scale (WAIS) , the Wechsler memory scale (WMS) and the Wisconsin Card Sorting Test (WCST). The evaluation results of two groups were analyzed and compared. [ Results] At the end of 4th week of treatment, the total and each factors scores of PANSS, as well as CGIS score decreased significantly as compared with those before treatment (P 0.05). At the end of 8th week of treatment, the obvious effective rate and effective rate in the research group was 73.08% and 96.15% respectively, and that in the control group was 71. 79% and 92. 31% respectively, which showed no significantly difference (X2 = 0. 032, 0. 806,P >0.05). At the end of 8th week, the error answers and non-persistent error of WCST of two groups decreased significantly than those before treatment, while factor scores of WMS in the recognition, regeneration, comprehension, memory quotient were significantly higher than those before treatment (P 0.05). Adverse reactions of both groups were mild, and appeared at the beginning of treatment. The incidence rates of extrapyramidal reactions, menstrual disorders, lactation and weight gain in the research group were significantly lower than those in the

  16. Clinical Usefulness of Arbekacin.

    Lee, Jae Hoon; Lee, Chang-Seop

    2016-03-01

    Arbekacin is a broad-spectrum aminoglycoside used to treat methicillin-resistant Staphylococcus aureus (MRSA). Arbekacin has antibacterial activities against high-level gentamicin-resistant Enterococci, multidrug-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii et al. Here, we reviewed in vitro data on arbekacin in Staphylococci and Gram-negative microorganisms. We also reviewed clinical studies for clinical efficacy and microbiologic efficacy data in patients with identified MRSA and suspected MRSA infections. The overall clinical efficacy ranged from 66.7% to 89.7%. The microbiologic efficacy rate ranged from 46.2% to 83%. In comparative studies between arbekacin and glycopeptides, arbekacin was similar to other glycopeptides with respect to clinical and microbiological efficacy rates. Combination trials with other antibiotics suggest that arbekacin will be a promising strategy to control Enterococcus spp. multi-drug resistant P. aeruginosa. The major adverse reaction was nephrotoxicity/hepatotoxicity, but patients recovered from most adverse reactions without any severe complications. Based on these results, arbekacin could be a good alternative to vancomycin/teicoplanin in MRSA treatment. Finally, therapeutic drug monitoring is recommended to maximize clinical efficacy and decrease nephrotoxicity. PMID:27104010

  17. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

    Malling, Bente Vigh; Mortensen, Lene Sundahl; Scherpbier, Albert J J;

    2010-01-01

    The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate ...... clinical departments and the leadership skills of clinical consultants responsible for education.......The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate in...

  18. [Terminology in clinical bioethics].

    Herreros, Benjamín; Moreno-Milán, Beatriz; Pacho-Jiménez, Eloy; Real de Asua, Diego; Roa-Castellanos, Ricardo Andrés; Valentia, Emanuele

    2015-01-01

    In this article some of the most relevant terms in clinical bioethics are defined. The terms were chosen based on three criteria: impact on the most important problems in clinical bioethics, difficulty in understanding, and need to clarify their meaning. For a better understanding, the terms were grouped into 5 areas: general concepts (conflict of values, deliberation, conflict of interest, conscientious objection); justice (justice, distributive justice, models of justice, triage); clinical matters (information, competency, capability, informed consent, mature minor, coercion, secrecy, privacy, confidentiality, professional secrecy); end of life (prior instructions, limitation of therapeutic efforts, professional obstinacy, futility, palliative care, palliative sedation, principle of double effect, euthanasia, assisted suicide, persistent vegetative state, minimally conscious state, locked-in syndrome, brain death), and beginning of life (assisted reproduction, genetic counseling, preimplantation genetic diagnosis). PMID:26506495

  19. Clinical analysis of parotid carcinoma

    The histopathology of parotid carcinoma is varied, and in many cases, it is difficult to make a diagnosis preoperatively. A clinical analysis was performed on 28 cases of parotid carcinoma initially treated between 1994 and 2011. We compared preoperative diagnosis based on fine-needle aspiration biopsy (FNA) or frozen section biopsy (FSB) with the final diagnosis. Sensitivity for malignancy was 45.8% in FNA and 85.7% in FSB. Diagnostic accuracy for histologic diagnosis was 20.8% in FNA and 42.9% in FSB. We performed a superficial lobectomy conserving the facial nerve in classified T1 or T2, and low-grade malignancy. We also performed a total or extended parotidectomy with total removal of the facial nerve in classified T3 or T4 and high-grade malignancy. Neck dissection was performed in 11 patients. Supraomohyoid neck dissection was performed in 6 patients and total neck dissection in 5 patients with high-grade T3 or T4, and clinically positive neck metastasis. Postoperative radiotherapy was performed in 12 patients with close safety margin, pathological T3 or T4, high-grade malignancy, multiple neck metastasis and extranodal extension. The factors influencing a poor outcome were high-grade malignancy (p=0.0268), stage IV (p=0.0069), and N+ stage (p=0.0005). Of 10 deaths, causes were local failure in 3 and distant failure in 5. We consider that preoperative histologic diagnosis is important for deciding surgical management. Appropriate surgery and indications for postoperative radiotherapy and chemotherapy are required in patients with high-grade malignancy, stage IV, and N+. (author)

  20. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

    Scherpbier Albert JJ; Mortensen Lene S; Malling Bente; Ringsted Charlotte

    2010-01-01

    Abstract Background The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate in clinical departments and the leadership skills of clinical consultants responsible for education. Methods The study was a trans-sectional correlation study. The educational clim...

  1. Clinical pharmacology and malaria.

    Breckenridge, A M; Winstanley, P A

    1997-10-01

    The role of clinical pharmacology in improving the prevention and treatment of malaria is reviewed. A series of general and specific issues is discussed, concentrating on risk-benefit and cost-effectiveness. The techniques of clinical pharmacokinetics play an important role in the optimal use of drugs and this is illustrated by studies on quinine and proguanil. In discussing amodiaquine toxicity, the role of the pharmacologist and the chemist in designing out drug toxicity lends hope for producing a new generation of antimalarial drugs. PMID:9625927

  2. Influences of doctor - nurse integrated management mode on self - efficacy and sense of job control of clinical nurses%医护一体化管理模式对临床护士自我效能及工作控制感的影响

    彭叶莲

    2016-01-01

    Objective:To discuss influences of doctor - nurse integrated management mode on self - efficacy and sense of job control of clinical nurses. Meth-ods:Selected 80 registered nurses from January 2014 to January 2015 as objects of investigation,and randomly divided them into observation group and con-trol group equally. Doctor - nurse integrated management mode was adopted for observation group,while usual nursing management mode was adopted for control group. Patients from both groups were assessed with Self - Efficacy Scale and Sense of Job Control Scale. Nurse satisfaction degree with doctor -nurse integrated management mode,doctor satisfaction degree with nursing work and patient satisfaction degree were assessed as well. Results:Self - efficacy and sense of job control of observation group were higher than those of control group significantly(P < 0. 05). Nurse satisfaction degree with doctor - nurse integrated management mode,doctor satisfaction degree with nursing work and patient satisfaction degree of observation group were higher than those of con-trol group(P < 0. 05). Conclusion:Doctor - nurse integrated management mode can help nurses to increase self - efficacy and sense of job control,promote cooperation between doctors and nurses,and improve satisfaction degrees of doctors and patients.%目的:探讨医护一体化管理模式对临床护士自我效能及工作控制感的影响。方法:2014年1月~2015年1月选择80名注册护理人员进行调查,随机等分为观察组和对照组,观察组实施医护一体化管理模式,对照组采用常规的护理管理模式,两组采用自我效能量表和工作控制感量表对两组患者进行测定,并对护理人员对医护一体化管理的满意度、医师对护理工作的满意度和患者满意度进行评测。结果:观察组自我效能和工作控制感明显高于对照组(P <0.05);护理人员对医护一体化管理的满意度、医师对护理工作的满

  3. The influence of gestational age and birth weight in the clinical assesment of the muscle tone of healthy term and preterm newborns A influência da idade gestacional e do peso ao nascimento na avaliação clínica do tono muscular de recém nascidos a termo e prematuros hígidos

    Edla S. da Silva

    2005-12-01

    Full Text Available OBJECTIVE: To evaluate the influence of gestational age (GA and birth weight (BW in the clinical assessment of the muscle tone of healthy term and preterm newborns. METHOD: Cross sectional study. The muscle tone of healthy 42 preterm and 47 term newborns was quantified and measured with a goniometer (an instrument for measuring angles respectively between 7th-14th day of life and 24-48 hours of life. Newborns were grouped according to GA and BW and evaluated at fixed time intervals by one examiner. Preterm newborns were matched to term at 40 weeks postconceptional age (PCA. RESULTS: The evolution of muscle tone in the preterm occurred gradually, following PCA, independent of birth weight. Preterm newborns had lower scores in all muscle tone indicators when compared to term at the first assessment. Differences were observed among preterm small for GA and adequate to GA for the indicator heel to ear (pOBJETIVO: Verificar a influência da idade gestacional (IG e do peso ao nascimento (PN na avaliação do tono muscular de recém nascidos (RN a termo e prematuros hígidos. MÉTODO: Estudo transversal. O tono muscular de 42 RN prematuros e 47 termo foi quantificado e mensurado com goniômetro (instrumento para medir ângulos, respectivamente entre 7-14 dias de vida e 24-48 horas de vida. Os RN foram agrupados de acordo com IG e PN, sendo avaliados em intervalos fixos. RN prematuros foram comparados aos a termo na 40ª semana de idade concepcional (IC. RESULTADOS: A evolução do tono muscular nos RN prematuros ocorreu de forma gradual de acordo com IC e independente do PN. RN prematuros, na primeira avaliação apresentaram escores de tono muscular inferiores aos de RN a termo em todos os indicadores. Foram observadas diferenças entre RN prematuros pequenos e adequados para a IG em relação ao indicador calcanhar-orelha (p<0,001. O pareamento dos grupos na 40ª semana de IC mostra, exceto pela postura, diferença significativa entre os grupos (p< 0

  4. Influence of Compliance of Patients with Chronic Periodontitis on Clinical Effect during Periodontal Maintenance%慢性牙周炎患者牙周维护期间依从性不同对临床疗效的影响分析

    关天燕

    2015-01-01

    Objective:To observe the different influence of compliance of patients with chronic periodontitis on clinical effect during periodontal maintenance.Methods:70 cases of patients with chronic periodontitis were selected in our hospital.According to patient compliance,they were divided into complete compliance group and incomplete compliance group,35 cases in each group.All patients were given the foundation treatment for 4 weeks and patients without operation indication were given periodontal maintenance therapy and regular reexamination.Before treatment and after 12 months of treatment in patients with plaque index (Plaque,index,PI),gingival index (Gingival,index,GI) and the depth of periodontal pocket (Probing depth,PD) and other indicators.Results:Before treatment,PI,GI and PD of two groups of patients had no significant difference.After 12 months of treatment,PI,GI and PD of the complete compliance group were (0.23±0.14),(0.84±0.23) and (0.23±0.14),PI,GI and PD of incomplete compliance group were (0.81±0.19),(1.12±0.30) and (0.81±0.19),(P<0.05).Conclusion:Better compliance of the chronic periodontitis patients had better curative effect than the poor compliance of patients.%目的:观察慢性牙周炎患者牙周维护期间依从性不同对临床疗效的影响.方法:临床纳入慢性牙周炎患者70例,根据患者依从性差异分为完全依从性组以及不完全依从性组,每组35例.所有患者均首先进行为期4周的基础治疗,对于无手术指征者给予牙周维护治疗,并进行定期复查.观察治疗前与治疗12个月后患者菌斑指数(Plaque index,PI)、牙龈指数(Gingival index,GI)以及牙周袋深度(Probing depth,PD)、探针出血(BOP)阳性率、临床附着水平(CAL)等指标.结果:治疗前,两组患者PI、GI、PD、BOP阳性率、CAL水平等差异无显著性;完全依从性组患者治疗6个月、12个月的PI、GI、PD评分、BOP阳性率、CAL水平均明显优于不完全依从性组(P<0.05),

  5. Influences of depressive emotions on clinical symptoms of pa-tients with diarrhea-predominant irritable bowel syndrome%抑郁情绪对腹泻型肠易激综合征患者临床症状的影响

    苏秀丽; 张英剑; 金建军

    2016-01-01

    目的:探讨抑郁情绪对腹泻型肠易激综合征患者临床症状的影响。方法对84例腹泻型肠易激综合征患者进行生活一般状况、症状程度、抑郁状况筛查,依据汉密顿抑郁量表评分结果将其分为抑郁组和非抑郁组,对两组临床典型症状特征及躯体症状发生率进行对比分析。结果抑郁组临床典型症状严重程度显著重于非抑郁组(P<0.05),两组发作频率及每次持续时间比较差异有显著性( P<0.05或0.01)。抑郁组躯体症状发生率为100%,非抑郁组为33.3%,抑郁组显著高于非抑郁组(χ2=43.45,P<0.01)。患者典型症状严重程度、发作频率、持续时间与汉密顿抑郁量表评分呈显著正相关( P<0.05或0.01)。结论抑郁情绪可加重腹泻型肠易激综合征患者的典型症状,常表现为明显的躯体症状。%Objective To explore the influences of depressive emotions on clinical symptoms of patients with diarrhea‐predominant irritable bowel syndrome (D‐IBS) .Methods General living status ,symptom degrees and depressive status were screened in 84 D‐IBS patients ,they assigned to depression and non‐de‐pression group according to the Hamilton Depression Scale (HAMD) scores ,and contrastive analyses of typical and physical symptoms incidences conducted between 2 groups .Results The severities of typical symptoms were significantly greater (P< 0 .05) and episode frequencies and duration/time longer (P<0 .05 or 0 .01) in depression than in non‐depression group .The incidence of physical symptoms were re‐spectively 100% in depression and 33 .3% in non‐depression group ,the former significantly higher than the latter (χ2 = 43 .45 ,P< 0 .01) .Patients’ severity of typical symptoms ,episode frequencies and duration were positively related to the HAMD score notably (P<0 .05 or 0 .01) .Conclusion Depressive emotions could aggravate the typical symptoms of D

  6. Clinical image quality evaluation for panoramic radiography in Korean dental clinics

    The purpose of this study was to investigate the level of clinical image quality of panoramic radiographs and to analyze the parameters that influence the overall image quality. Korean dental clinics were asked to provide three randomly selected panoramic radiographs. An oral and maxillofacial radiology specialist evaluated those images using our self-developed Clinical Image Quality Evaluation Chart. Three evaluators classified the overall image quality of the panoramic radiographs and evaluated the causes of imaging errors. A total of 297 panoramic radiographs were collected from 99 dental hospitals and clinics. The mean of the scores according to the Clinical Image Quality Evaluation Chart was 79.9. In the classification of the overall image quality, 17 images were deemed 'optimal for obtaining diagnostic information,' 153 were 'adequate for diagnosis,' 109 were 'poor but diagnosable,' and nine were 'unrecognizable and too poor for diagnosis'. The results of the analysis of the causes of the errors in all the images are as follows: 139 errors in the positioning, 135 in the processing, 50 from the radiographic unit, and 13 due to anatomic abnormality. Panoramic radiographs taken at local dental clinics generally have a normal or higher-level image quality. Principal factors affecting image quality were positioning of the patient and image density, sharpness, and contrast. Therefore, when images are taken, the patient position should be adjusted with great care. Also, standardizing objective criteria of image density, sharpness, and contrast is required to evaluate image quality effectively.

  7. Influencing Your Colleagues.

    Walker, Alice D.

    1993-01-01

    This fifteenth article in a series on the principles of the AECT (Association for Educational Communications and Technology) Code of Professional Ethics focuses on members using coercive means to influence decisions of colleagues, using an example of a professor trying to influence a colleague to include his name on a research proposal. (LRW)

  8. Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions.

    Hunter, Sharyn; Arthur, Carol

    2016-05-01

    Graduate nurses may have knowledge and adequate clinical psychomotor skills however they have been identified as lacking the clinical reasoning skills to deliver safe, effective care suggesting contemporary educational approaches do not always facilitate the development of nursing students' clinical reasoning. While nursing literature explicates the concept of clinical reasoning and develops models that demonstrate clinical reasoning, there is very little published about nursing students and clinical reasoning during clinical placements. Semi-structured interviews were conducted with ten clinical educators to gain an understanding of how they recognised, developed and appraised nursing students' clinical reasoning while on clinical placement. This study found variability in the clinical educators' conceptualisation, recognition, and facilitation of students' clinical reasoning. Although most of the clinical educators conceptualised clinical reasoning as a process those who did not demonstrated the greatest variability in the recognition and facilitation of students' clinical reasoning. The clinical educators in this study also described being unable to adequately appraise a student's clinical reasoning during clinical placement with the use of the current performance assessment tool. PMID:27235568

  9. The influence factors of fixation failure in the proximal femoral and the clinical effect total hip arthroplasty treatment%股骨转子间骨折内固定失败的相关因素及全髋关节置换术治疗效果分析

    张喜海; 叶俊武; 卓乃强

    2015-01-01

    Objective To investigate the influence factors of fixation failure in the proximal femoral and the clinical effect total hip arthro-plasty treatment. Methods A retrospective analysis were performed in our hospital from 2010 to 2012. Total 119 cases of femoral intertrochanteric fractures and tibial fractures were admitted. The information in all patients were collected included basic information and clinical data. A statisti-cally significant indicators were choosen into multiple Logistic regression model,adjusting for confounding variables,and exploring the factors that may affect patients with hip fracture fixation failure. Results Univariate analysis showed that the medial bone type,bone mass,fractures reason, a fixed location,extent and reset after cortical distance were the main risk factors affecting the patient fixation failure. A significant factors were in-cluded in the Logistic regression model. The results showed that the type of fracture,bone mass,bone fixation failure reset extent the impact of hip fracture patients were the main risk factors. Among them,the fracture type is the biggest factor( OR = 5. 331). After fixation failure,patients were treated with total hip arthroplasty. The results showed that Harris score,pain score,walking score,score,activity scores were significantly higher compared with patients before surgery( P ﹤ 0. 05). Conclusion The type of fracture,bone mass,bone reset extent were the main risk factors for hip fracture patient fixation. Among them,the fracture type is the biggest factor(OR = 5. 331). After fixation failure in the patients with total hip arthroplasty for re - treatment can obtain satisfactory results.%目的:探讨股骨转子间骨折内固定失败的相关因素及全髋关节置换术的治疗效果。方法回顾性分析2010~2012年收治得股骨转子间骨折及股骨胫骨骨折患者119例,收集其基本信息及临床资料,将单因素分析结果具有统计学意义的指标纳入到 Logistic

  10. 透刺电针治疗神经根型颈椎病临床观察及对患者血浆TNF-α和IL1β的影响%Clinical Observation of Electroacupuncture Point-through-point Treatment of Nerve Root Type of Cervical Spondylosis and Influence of TNF-α and IL1β

    万碧江; 黄伟; 张压西; 陈汉跃; 张荒生; 陈培红; 肖凤英; 付兰萍; 张蕾

    2013-01-01

    xObjective: To observe the effect of point - through - point electroacupuncture on nerve root type of cervical disease (CSR) patients and the influence on plasma levels of TNF - a and ILlβ. Methods: 160 cases of CSR patients were randomly divided into 3 groups. 60 cases of point — through — point electroacupuncture group which was treated point — through - point electroacupuncture; 60 cases were treated with penetration needling Jiaji points; 40 cases in Jingfukang group were treated with oral Jingfukang treatment. Assessment of clinical efficacy, and the changes of TNF - a and IL1β were observed before and after treatment. Results: (1) The cure rate of point - through - point electroacupuncture group was 68.9% , the total efficiency was 100% ; in electroacupuncture at Jiaji acupoints group, the cure rate was 39. 2% , the total efficiency was 91.61% ; in Jingfukang group, the cure rate was 22. 8% , the total effective rate was 82. 8% ; comparison of cure rate and the total efficiency among the three groups had significant difference(x2 =20. 1, 9. 7, P < 0. 01). (2) In three groups after the treatment, plasma levels of TNF - a and IL1 p were decreased, but the point -through - point electroacupuncture group were significantly decreased, compared with that before treatment, there was a significant difference ( P < 0.01) , compared with electroacupuncture at Jiaji acupoints group and Jingfukang group, there was significant difference ( P < 0. 05 ). Jingfukang group was superior to the Jiaji acupoints group on plasma TNF - a level decrease, and ILlp regulation in electroacupuncture at Jiaji group was better than that in Jingfukang group. Conclusion-. The clinical efficacy of acupuncture is better than electroacupuncture Jiaji group and Jingfukang group; penetration acupuncture can regulate levels of TNF — a and IL1 β of the nerve root type of cervical spondylosis patients to restore balance , thereby it can reduce inflammatory reaction and obtain the anti

  11. Analysis of quality data based on national clinical databases

    Utzon, Jan; Petri, A.L.; Christophersen, S.

    2009-01-01

    There is little agreement on the philosophy of measuring clinical quality in health care. How data should be analyzed and transformed to healthcare information is an ongoing discussion. To accept a difference in quality between health departments as a real difference, one should consider to which...... extent the selection of patients, random variation, confounding and inconsistency may have influenced results. The aim of this article is to summarize aspects of clinical healthcare data analyses provided from the national clinical quality databases and to show how data may be presented in a way which...

  12. ClinicalAccess: a clinical decision support tool.

    Crowell, Karen; Vardell, Emily

    2015-01-01

    ClinicalAccess is a new clinical decision support tool that uses a question-and-answer format to mirror clinical decision-making strategies. The unique format of ClinicalAccess delivers concise, authoritative answers to more than 120,000 clinical questions. This column presents a review of the product, a sample search, and a comparison with other point-of-care search engines. PMID:25927513

  13. Prolactinomas : clinical studies

    Kars, Marleen

    2008-01-01

    Prolactinoma are treated with dopamine agonists, which are effective in reducing prolactin and tumor size. Studies reporting clinical and radiological outcome are scarce. The study described in chapter 2, assesses long-term outcome in patients treated with dopamine agonists for macroprolactinoma. An

  14. The Clinical Supervision Process.

    Ramsey, MaryLou

    This document defines clinical supervision as an intensive, interpersonally-focused, one-to-one relationship in which one person is designated to facilitate the development of therapeutic competence in the other person. Ways in which supervision is similar to, and different from, therapy are explained. The following stages in the clinical…

  15. Participating in Clinical Trials

    Full Text Available ... to find out if an experimental drug, therapy, medical device, lifestyle change, or test will help treat, find, or prevent a disease. A clinical trial may compare experimental products or ... universities and medical centers across the country. The National Institutes of ...

  16. The Unstructured Clinical Interview

    Jones, Karyn Dayle

    2010-01-01

    In mental health, family, and community counseling settings, master's-level counselors engage in unstructured clinical interviewing to develop diagnoses based on the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed., text rev.; "DSM-IV-TR"; American Psychiatric Association, 2000). Although counselors receive education about…

  17. Clinically isolated laryngeal sarcoidosis

    Plaschke, Christina Caroline; Owen, Hanne Hoejris; Rasmussen, Niels

    2011-01-01

    combination of CO(2)-laser excision of supraglottic tissue and closure of the incision with sutures. All serological tests were negative or normal, including angiotensin 1 converting enzyme. The clinical expression was uniform with pale, smooth swellings of the supraglottic structures. Surgery proved...

  18. Clinical spectrum of onchodermatitis

    To describe the frequency and to see various dermatological presentations of onchocerciasis in black Africans of Sierra Leone. Local black patients of all age groups, attending dermatology outpatient department of Pak Field Hospital (established as a part of UN peacekeeping mission in Sierra Leone) with clinical diagnosis of onchodermatitis, based on symptomatology and morphological features of the disease, were included. UN troops were excluded. Laboratory investigations including blood complete picture and skin snips were carried out in all patients. Skin biopsy and nodule biopsy was performed in selected cases. Skin manifestations were recorded and categorized into various clinical patterns, i.e. acute, chronic, lichenified, onchocercoma, etc. Data was analyzed by using descriptive statistics in Instat. A total of 3011 patients, belonging to different local tribes, having a variety of skin disorders, were seen during the study period. One hundred and eighty-seven (6.2%) patients were found to have onchodermatitis. Patients were of all ages and both sexes, their ages ranging from 1 month to 73 years. Gender ratio was almost equal. A whole clinical spectrum of onchodermatitis was observed, chronic papular onchodermatitis being the most common pattern. Onchodermatitis with a large spectrum of clinical manifestations was seen in black Africans of the eastern part of Sierra Leone. (author)

  19. Hepatitis C: Clinical Trials

    ... Reports Clinician Tools Clinician Tools Home Guidelines and Best Practices Topic Reviews Algorithms, Screens, Toolkits Provider Education Provider ... about federally and privately supported clinical research in human volunteers. Site gives information about a trial's purpose, who may participate, locations, and phone ... Forms State and Local Resources Strat Plan FY 2014-2020 VA Plans, Budget, & ...

  20. Radioimmunoimaging in clinical oncology

    In the thesis radiolabeled antibodies were tested for screening of cancer in patients without previous knowledge of tumour histopathology. They were tested as well targeting known cancer, sometimes in unknown clinical stage. Methods for detection enhancement utilizing double-tracer techniques and alternative routes of administration were also investigated. (385 refs., 11 tabs.)

  1. Clinical Positioning Space

    Williams, Lars Peter Hedegaard; Christensen, Mette Krogh; Rytter, Carsten;

    2014-01-01

    In this article, we present a case study of residents’ clinical experiences and communication in outpatient oncology consultations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncology residents and patients situate themselves as persons with rights and d...

  2. Clinical Mastery of Hypnosis.

    Horevitz, Richard P.

    Hypnosis is an increasingly popular clinical intervention. The number of training courses in hypnosis is growing each year. Research on hypnosis training appears to show that limited exposure to training, as is typical in the common 3 to 5 day format of mass training, produces limited results. Only when training is extended over time do the…

  3. OARSI Clinical Trials Recommendations

    Kraus, V B; Blanco, F J; Englund, M;

    2015-01-01

    The objective of this work was to describe requirements for inclusion of soluble biomarkers in osteoarthritis (OA) clinical trials and progress toward OA-related biomarker qualification. The Guidelines for Biomarkers Working Group, representing experts in the field of OA biomarker research from b...

  4. [Clinical examination of vertigo].

    Topka, Helge Roland

    2016-07-01

    Acute vertigo may originate from peripheral or central vestibular disorders. As central vestibular symptoms may indicate severe brainstem or cerebellar ischemia, rapid clinical differentiation is required. To this end, evaluation of spontaneous or gaze-evoked nystagm, head-impulse test as well identification of skew deviation are most helpful. PMID:27464281

  5. Integrated clinical information system.

    Brousseau, G

    1995-01-01

    SIDOCI (Système Informatisé de DOnnées Cliniques Intégrées) is a Canadian joint venture introducing newly-operating paradigms into hospitals. The main goal of SIDOCI is to maintain the quality of care in todayUs tightening economy. SIDOCI is a fully integrated paperless patient-care system which automates and links all information about a patient. Data is available on-line and instantaneously to doctors, nurses, and support staff in the format that best suits their specific requirements. SIDOCI provides a factual and chronological summary of the patient's progress by drawing together clinical information provided by all professionals working with the patient, regardless of their discipline, level of experience, or physical location. It also allows for direct entry of the patient's information at the bedside. Laboratory results, progress notes, patient history and graphs are available instantaneously on screen, eliminating the need for physical file transfers. The system, incorporating a sophisticated clinical information database, an intuitive graphical user interface, and customized screens for each medical discipline, guides the user through standard procedures. Unlike most information systems created for the health care industry, SIDOCI is longitudinal, covering all aspects of the health care process through its link to various vertical systems already in place. A multidisciplinary team has created a clinical dictionary that provides the user with most of the information she would normally use: symptoms, signs, diagnoses, allergies, medications, interventions, etc. This information is structured and displayed in such a manner that health care professionals can document the clinical situation at the touch of a finger. The data is then encoded into the patient's file. Once encoded, the structured data is accessible for research, statistics, education, and quality assurance. This dictionary complies with national and international nomenclatures. It also

  6. Clinical Data Warehousing - A Survey

    Pedersen, Torben Bach; Jensen, Christian Søndergaard

    1998-01-01

    In this article we present the concept of data warehousing, and its use in the clinical area. Clinical data warehousing will become very important in the near future, as healthcare enterprises need to gain more information from their clinical, administrative, and financial data, in order to impro...... the area, and providing criteria for comparing clinical data warehouse systems....

  7. Vasectomy reversal: a clinical update.

    Patel, Abhishek P; Smith, Ryan P

    2016-01-01

    Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery. PMID:26975488

  8. Vasectomy reversal: a clinical update

    Abhishek P Patel

    2016-01-01

    Full Text Available Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.

  9. Clinical applications of functional MRI in epilepsy

    The role of functional MRI (fMRI) in the presurgical evaluation of patients with intractable epilepsy is being increasingly recognized. Real-time fMRI is an easily performable diagnostic technique in the clinical setting. It has become a noninvasive alternative to intraoperative cortical stimulation and the Wada test for eloquent cortex mapping and language lateralization, respectively. Its role in predicting postsurgical memory outcome and in localizing the ictal activity is being recognized. This review article describes the biophysical basis of blood-oxygen-level-dependent (BOLD) fMRI and the methodology adopted, including the design, paradigms, the fMRI setup, and data analysis. Illustrative cases have been discussed, wherein the fMRI results influenced the seizure team's decisions with regard to diagnosis and therapy. Finally, the special issues involved in fMRI of epilepsy patients and the various challenges of clinical fMRI are detailed

  10. Clinical Outcomes after Traumatic Brain Injury.

    Sandsmark, Danielle K

    2016-06-01

    Traumatic brain injury (TBI) is a major cause of death and disability that often affects young people. After injury, the degree of recovery can be highly variable, with some people regaining near complete function while others remain severely disabled. Understanding what factors influence recovery is important for counseling patients and families in the acute period after injury and can help guide therapeutic decisions in the acute period following injury. In this review, prognostic algorithms useful for clinicians are discussed. Tools for grading patient outcomes, their role in clinical care and research studies, and their limitations are reviewed. Ongoing work focusing on the development of biomarkers to track TBI recovery and the refinement of clinical outcome metrics is summarized. PMID:27072952

  11. Clinical guidelines and their civil law effects.

    Hulst, E

    2002-01-01

    The number of clinical guidelines or protocols for medical treatment is growing. Considered as an important instrument for increasing the quality of medicine, these originally intended technical guidelines turn out to influence doctor's civil liability. Ignoring those guidelines in itself may cause a breach of a doctor's duty of care according to civil law and he may be charged to produce evidence that his medical treatment was correct. This development is taking place in several countries as France, Germany, United Kingdom and the Netherlands. PMID:15795994

  12. Social Influence for Security

    Florin Iftode

    2014-08-01

    Full Text Available The main aim of this work marks the reveling of scientific premises intended to structure the issue of social influence for security. The approach has as aim the identification of those elements that define and characterize the social influence in order to manage conflict, from the perspective of public communication. The proposed approach establishes some synthetic, clear boundaries through the method of research and analysis of the concept of security, social influence, revealing the specifics of public communication in conflict management.

  13. Clinical Decision Making among Dental Students and General Practitioners.

    Grembowski, David; And Others

    1989-01-01

    Senior dental students and family dental practitioners were surveyed concerning their choice of pairs of alternative treatments and the technical and patient factors influencing their decisions. Greater agreement in clinical decision-making was found among dentists than among students for all four pairs of alternative services. (MSE)

  14. Cortisol exposure, cognition and clinical course of bipolar disorder

    Spijker, Anne Titia

    2012-01-01

    In this dissertation, we aimed to identify the influence of cortisol exposure and cognitive performance on the clinical course of bipolar disorder. Data regarding sociodemographics, disease characteristics and genetic analysis of the cortisol receptors, were collected of 366 patients with bipolar d

  15. OARSI Clinical Trials Recommendations

    McAlindon, T. E.; Driban, J. B.; Henrotin, Y.;

    2015-01-01

    members voted we calculated the median score among the nine members of the working group who completed the score. The document includes 25 recommendations regarding randomization, blocking and stratification, blinding, enhancing accuracy of patient-reported outcomes (PRO), selecting a study population and......The goal of this document is to update the original OARSI recommendations specifically for the design, conduct, and reporting of clinical trials that target symptom or structure modification among individuals with knee osteoarthritis (OA). To develop recommendations for the design, conduct, and...... reporting of clinical trials for knee OA we initially drafted recommendations through an iterative process. Members of the working group included representatives from industry and academia. After the working group members reviewed a final draft, they scored the appropriateness for recommendations. After the...

  16. Clinical ethics and happiness.

    Devettere, R J

    1993-02-01

    Most contemporary accounts of clinical ethics do not explain why clinicians should be ethical. Those few that do attempt an explanation usually claim that clinicians should be ethical because ethical behavior provides an important good for the patient--better care. Both these approaches ignore the customary traditional reason for being ethical, namely, the good of the moral agent. This good was commonly called 'happiness'. The following article shows how the personal happiness of the moral agent provided a major reason for being ethical in the ancient philosophical and biblical traditions and how it continues to play a role in the more modern rights-based, Kantian and utilitarian theories. This history suggests that the personal happiness of the clinician, rightly understood, is a legitimate and important goal of clinical ethics. PMID:8433049

  17. Clinical nuclear medicine

    The importance of nuclear methods within today's medicine derives decisively from the field of diagnostics. Among the clinical treatment possibilities on the whole, therapy with unsealed radioactive sources is for the time being restricted to few diseases. The use of radioactive labeling in biology, biochemistry and, especially, pharmacology and the rest of fundamental medical research does not belong to the actual specialty of nuclear medicine. Nuclear in-vitro diagnostics, which currently account for about two thirds of all activities in nuclear medicine, are largely excluded from this survey, which is mainly restricted to nuclear diagnostics in vivo. This presentation of nuclear diagnostics in vivo is addressed above all to non-specialists who are to be made familiar with the modern methods of clinical nuclear medicine so that these investigation methods could be more effectively used in future both with qualitative and quantitative regards. (orig./MG)

  18. Clinical Relevance of Adipokines

    Matthias Blüher

    2012-10-01

    Full Text Available The incidence of obesity has increased dramatically during recent decades. Obesity increases the risk for metabolic and cardiovascular diseases and may therefore contribute to premature death. With increasing fat mass, secretion of adipose tissue derived bioactive molecules (adipokines changes towards a pro-inflammatory, diabetogenic and atherogenic pattern. Adipokines are involved in the regulation of appetite and satiety, energy expenditure, activity, endothelial function, hemostasis, blood pressure, insulin sensitivity, energy metabolism in insulin sensitive tissues, adipogenesis, fat distribution and insulin secretion in pancreatic β-cells. Therefore, adipokines are clinically relevant as biomarkers for fat distribution, adipose tissue function, liver fat content, insulin sensitivity, chronic inflammation and have the potential for future pharmacological treatment strategies for obesity and its related diseases. This review focuses on the clinical relevance of selected adipokines as markers or predictors of obesity related diseases and as potential therapeutic tools or targets in metabolic and cardiovascular diseases.

  19. Clinical Applications for Estetrol

    Visser M

    2010-01-01

    Full Text Available In this paper the potential clinical applications for the human fetal estrogen estetrol (E4 are presented based on recently obtained data in preclinical and clinical studies. In the past E4 has been classified as a weak estrogen due to its rather low estrogen receptor affinity. However, recent research has demonstrated that due to its favorable pharmacokinetic properties, especially the slow elimination and long half-life, E4 is an effective orally bioavailable estrogen agonist with estrogen antagonistic effects on the breast in the presence of estradiol. Based on the pharmacokinetic properties, the pharmacological profile and the safety and efficacy results in human studies, E4 seems potentially suitable as a drug for human use in applications such as hormone replacement therapy (vaginal atrophy and vasomotor symptoms, contraception, osteoporosis and breast cancer.

  20. Clinical physiopathology of hypernatremia

    F. Sgambato

    2013-05-01

    Full Text Available BACKGROUND The maintenance of sodium levels at normal ranges has to be considered one of the most important and crucial physiological balance in order to preserve life. The increase of natremia determines the leakage of H2O from the inside of cells and the consequent brain cells withering, that causes encephalopathy at different stages and in some cases it can even lead to death. AIM OF THE STUDY The fundamentals of general physiopathology are analysed together with systems of compensation and brain adaptation in the three different aetiopathogenetic forms: primary increase of sodium (hypervolemic and haedematose form; missed introduction of pure water (mainly euvolemic form, with no aedema; loss of hypotonic fluids (hypovolemic form with dehydration. The three different clinical entities with their relative clinical approaches have been described.

  1. Prolactinomas: clinical studies

    Kars, Marleen

    2008-01-01

    Prolactinoma are treated with dopamine agonists, which are effective in reducing prolactin and tumor size. Studies reporting clinical and radiological outcome are scarce. The study described in chapter 2, assesses long-term outcome in patients treated with dopamine agonists for macroprolactinoma. An increased risk of cardiac valve disease has been reported in patients treated with cabergoline for Parkinson’s disease. Stimulation of serotonin receptors on cardiac valves by dopamine agonists re...

  2. Clinical multiphoton FLIM tomography

    König, Karsten

    2012-03-01

    This paper gives an overview on current clinical high resolution multiphoton fluorescence lifetime imaging in volunteers and patients. Fluorescence lifetime imaging (FLIM) in Life Sciences was introduced in Jena/Germany in 1988/89 based on a ZEISS confocal picosecond dye laser scanning microscope equipped with a single photon counting unit. The porphyrin distribution in living cells and living tumor-bearing mice was studied with high spatial, temporal, and spectral resolution. Ten years later, time-gated cameras were employed to detect dental caries in volunteers based on one-photon excitation of autofluorescent bacteria with long fluorescence lifetimes. Nowadays, one-photon FLIM based on picosecond VIS laser diodes are used to study ocular diseases in humans. Already one decade ago, first clinical twophoton FLIM images in humans were taken with the certified clinical multiphoton femtosecond laser tomograph DermaInspectTM. Multiphoton tomographs with FLIM modules are now operating in hospitals at Brisbane, Tokyo, Berlin, Paris, London, Modena and other European cities. Multiple FLIM detectors allow spectral FLIM with a temporal resolution down to 20 ps (MCP) / 250 ps (PMT) and a spectral resolution of 10 nm. Major FLIM applications include the detection of intradermal sunscreen and tattoo nanoparticles, the detection of different melanin types, the early diagnosis of dermatitis and malignant melanoma, as well as the measurement of therapeutic effects in pateints suffering from dermatitis. So far, more than 1,000 patients and volunteers have been investigated with the clinical multiphoton FLIM tomographs DermaInspectTM and MPTflexTM.

  3. Rural health clinics infrastructure

    Olson, K.

    1997-12-01

    The author discusses programs which were directed at the installation of photovoltaic power systems in rural health clinics. The objectives included: vaccine refrigeration; ice pack freezing; lighting; communications; medical appliances; sterilization; water purification; and income generation. The paper discusses two case histories, one in the Dominican Republic and one in Colombia. The author summarizes the results of the programs, both successes and failures, and offers an array of conclusions with regard to the implementation of future programs of this general nature.

  4. Dabigatran in clinical practice

    Ageno, Walter; Eikelboom, John; Lip, Gregory Y H

    2016-01-01

    confirmed, but VKA use is complicated by need for regular monitoring of the international normalized ratio and multiple drug and food interactions. Dabigatran is an oral direct thrombin inhibitor that can be used with fixed doses, without the need for routine anticoagulation laboratory monitoring and the...... agent for dabigatran has been approved by FDA and EU. This review provides a summary of publications assessing clinical utility of dabigatran for different indications....

  5. Horizons in clinical nanomedicine

    Karagkiozaki, Varvara

    2014-01-01

    Nanomedicine-the application of nanotechnology to health sciences-has the potential to address many important medical problems by exploiting the advanced physicochemical characteristics of nanostructured materials and devices. It can revolutionize conventional medicine by offering cutting-edge developments in the processes of diagnosing, treating, and preventing diseases, injuries, or genetic disorders. Thus, clinical nanomedicine holds promise to preserve and improve human health.This book provides a comprehensive overview on the forefront developments of nanotechnology in various domains of

  6. Pharmacovigilance using Clinical Text.

    Lependu, Paea; Iyer, Srinivasan V; Bauer-Mehren, Anna; Harpaz, Rave; Ghebremariam, Yohannes T; Cooke, John P; Shah, Nigam H

    2013-01-01

    The current state of the art in post-marketing drug surveillance utilizes voluntarily submitted reports of suspected adverse drug reactions. We present data mining methods that transform unstructured patient notes taken by doctors, nurses and other clinicians into a de-identified, temporally ordered, patient-feature matrix using standardized medical terminologies. We demonstrate how to use the resulting high-throughput data to monitor for adverse drug events based on the clinical notes in the EHR. PMID:24303315

  7. Psychiatrists and clinical psychologists

    Ajai R. Singh

    2006-03-01

    Full Text Available Psychiatrists and clinical psychologists share an inevitable, if rather uneasy, relationship. So very much like a modern marriage. Can't do without it, can't get out of it. Both sides contemplate divorce often. Think of separation by mutual consent. Even keep threatening as they rave and rant. Have secret, and not so secret, flings on the side. But, like the proverbial homing bird, or the conservative Indian arranged marriage, have no option but to stick it out with each other. Psychiatrists are otherwise good people. But that does not make them immune to handling clinical psychologists with the condescending tolerance and patronizing acceptance that teachers, for example, have towards rambling students. Or the rich have towards the poor. This does not take long to get converted into exasperation and smirky asides in the less charitable amongst the psychiatrists. Not that clinical psychologists are very helpful in motivating the psychiatrists to change for the better. For they, like most people in their position, over react and get aggressive when confronted with this attitude. And understandably so. However, it is time both realized their attitudes were not helpful either for mutual interaction, or growth of the Mental Health Movement at large. We can understand why psychiatrists behave the way they do. They are exposed to this same condescending-patronising attitude from their own peers in the medical profession. Their medical colleagues have yet to develop a feeling of healthy respect for psychiatry. Psychiatrists, no doubt, feel this is unjustified, but their peers are still in a position to deny them the respect and acceptance they seek. What they get from their medical colleagues, they unwittingly pass on to their clinical psychologist colleagues. But understanding why it occurs does not absolve them of their responsibility to behave more rationally, rather than emotionally, with the latter. [No abstract available.

  8. Clinical Applications of Capnography

    NIKOLOVA-TODOROVA, ZORICA

    2008-01-01

    This article gives a short review of the basic definitions of capnography and its use. The introduction gives an overview of the historical development of this procedure. Technical features of the method are presented, followed by several definitions for understanding the basic terms needed to realize the applications of capnography. The last section is a descriptive part that explains the most important clinical applications of capnography, the strengths and limitations of this method. This ...

  9. Randomised clinical trial

    Meineche-Schmidt, V.; Christensen, E.; Bytzer, P.

    2011-01-01

    Background: Response to proton pump inhibitor (PPI) treatment in dyspepsia is unpredictable. Aim: To identify symptoms associated with response to esomeprazole in order to target patients for empirical treatment. Methods: Eight hundred and five uninvestigated, primary care patients with upper GI ....... Conclusions In patients with uninvestigated dyspepsia, PPI responders can be reliably identified by a simple pocket chart using symptoms and patient characteristics (ClinicalTrials.gov NCT00318968). © 2010 Blackwell Publishing Ltd....

  10. Clinical vaccine development

    Han, Seunghoon

    2015-01-01

    Vaccination is regarded as one of the biggest triumphs in the history of medicine. We are living in the most successful period of vaccine development. The accumulation of multidisciplinary knowledge and the investment of massive funding have enabled the development of vaccines against many infectious diseases as well as other diseases including malignant tumors. The paradigm of clinical vaccine evaluation and licensure has also been modernized based on scientific improvements and historical e...

  11. Hyponatraemia in clinical practice

    Biswas, M.; Davies, J S

    2007-01-01

    Hyponatraemia is defined as a serum sodium concentration below 135 mmol/l. It causes major diagnostic and management problems in practice. Hyponatraemic disorders are divided into euvolaemic, hypervolaemic and hypovolaemic. In the evaluation of the hyponatraemic patient, history taking should focus on identifying the potential cause, duration and symptomatology. Clinical examination should include assessment of volume status. Acute hyponatraemia of less than 48 h duration requires prompt corr...

  12. Are personality patterns and clinical syndromes associated with patients' motives and percieved outcome of othognathic surgery?

    Petersen, Jesper Øland; Jensen, J.; Melsen, Birte;

    2010-01-01

    A study of surgical-orthodontic patients was performed to assess whether signs of personality patterns and psychologically defined clinical syndromes influenced patients' motives for treatment, perceived oral function, self-concept, social interaction, and overall satisfaction with treatment....

  13. STRUCTURED CLINICAL EVALUATION

    Arabela Maria Barbosa Sampaio

    2014-05-01

    Full Text Available In a world experiencing profound technological and socio-political changes in areas of knowledge and capacity, healthcare can not remain static. A new kind of professional is required, whose practice is based on ethics, scientific standards, integrity, citizenship, and health promotion, who develops skills beyond healthcare, such as decision making, communication,leadership, management, and continuing education. No single method can assess all of these elements (knowledge, skills, and attitudes, and only a combination of methods is able to produce a valid evaluation. An alternative method exists: structured clinical assessments based on observation of "to do, or how to do" that aim to complete this evaluation by focusing attention on the performance of specific skills. In order to broaden the scope of evaluation methods that have been used in health education, this article, a literature review, intends to offer readers an overview of the diverse types of structured clinical evaluation, emphasizing Objective Structured Clinical Examination, the most widely used in Brazil, with a goal of advancing opportunities for health professionals to make use of this evaluative tool.

  14. Gateways to clinical trials.

    Bayes, M; Rabasseda, X; Prous, J R

    2002-01-01

    Gateways to Clinical Trials is a guide to the most recent clinical trials in current literature and congresses, which has been retrieved from the Clinical Studies knowledge area of Prous Science Integrity, the world's first drug discovery and development portal, providing information on study design, treatments, conclusions and references. This issue focuses on the following selection of drugs: Abacavir sulfate; abciximab; abetimus sodium; adalimumab; aldesleukin; almotriptan; alteplase; amisulpride; amitriptyline hydrochloride; amoxicillin trihydrate; atenolol; atorvastatin calcium; atrasentan; Beclometasone dipropionate; bosentan; Captopril; ceftriaxone sodium; cerivastatin sodium; cetirizine hydrochloride; cisplatin; citalopram hydrobromide; Dalteparin sodium; darusentan; desirudin; digoxin; Efalizumab; enoxaparin sodium; ertapenem sodium; esomeprazole magnesium; estradiol; ezetimibe; Famotidine; farglitazar; fluorouracil; fluticasone propionate; fosamprenavir sodium; Glibenclamide; glucosamine sulfate; Heparin sodium; HSPPC-96; hydrochlorothiazide; Imatinib mesilate; implitapide; Lamivudine; lansoprazole; lisinopril; losartan potassium; l-Propionylcarnitine; Melagatran; metformin hydrochloride; methotrexate; methylsulfinylwarfarin; Nateglinide; norethisterone; Olmesartan medoxomil; omalizumab; omapatrilat; omeprazole; oseltamivir phosphate; oxatomide; Pantoprazole; piperacillin sodium; pravastatin sodium; Quetiapine hydrochloride; Rabeprazole sodium; raloxifene hydrochloride; ramosetron hydrochloride; ranolazine; rasburicase; reboxetine mesilate; recombinant somatropin; repaglinide; reteplase; rosiglitazone; rosiglitazone maleate; rosuvastatin calcium; Sertraline; simvastatin; sumatriptan succinate; Tazobactam sodium; tenecteplase; tibolone; tinidazole; tolterodine tartrate; troglitazone; Uniprost; Warfarin sodium; Ximelagatran. PMID:11980386

  15. Myocarditis in Clinical Practice.

    Sinagra, Gianfranco; Anzini, Marco; Pereira, Naveen L; Bussani, Rossana; Finocchiaro, Gherardo; Bartunek, Jozef; Merlo, Marco

    2016-09-01

    Myocarditis is a polymorphic disease characterized by great variability in clinical presentation and evolution. Patients presenting with severe left ventricular dysfunction and life-threatening arrhythmias represent a demanding challenge for the clinician. Modern techniques of cardiovascular imaging and the exhaustive molecular evaluation of the myocardium with endomyocardial biopsy have provided valuable insight into the pathophysiology of this disease, and several clinical registries have unraveled the disease's long-term evolution and prognosis. However, uncertainties persist in crucial practical issues in the management of patients. This article critically reviews current information for evidence-based management, offering a rational and practical approach to patients with myocarditis. For this review, we searched the PubMed and MEDLINE databases for articles published from January 1, 1980, through December 31, 2015, using the following terms: myocarditis, inflammatory cardiomyopathy, and endomyocardial biopsy. Articles were selected for inclusion if they represented primary data or were review articles published in high-impact journals. In particular, a risk-oriented approach is proposed. The different patterns of presentation of myocarditis are classified as low-, intermediate-, and high-risk syndromes according to the most recent evidence on prognosis, clinical findings, and both invasive and noninvasive testing, and appropriate management strategies are proposed for each risk class. PMID:27489051

  16. Basic and clinical immunology

    Chinen, Javier; Shearer, William T.

    2003-01-01

    Progress in immunology continues to grow exponentially every year. New applications of this knowledge are being developed for a broad range of clinical conditions. Conversely, the study of primary and secondary immunodeficiencies is helping to elucidate the intricate mechanisms of the immune system. We have selected a few of the most significant contributions to the fields of basic and clinical immunology published between October 2001 and October 2002. Our choice of topics in basic immunology included the description of T-bet as a determinant factor for T(H)1 differentiation, the role of the activation-induced cytosine deaminase gene in B-cell development, the characterization of CD4(+)CD25(+) regulatory T cells, and the use of dynamic imaging to study MHC class II transport and T-cell and dendritic cell membrane interactions. Articles related to clinical immunology that were selected for review include the description of immunodeficiency caused by caspase 8 deficiency; a case series report on X-linked agammaglobulinemia; the mechanism of action, efficacy, and complications of intravenous immunoglobulin; mechanisms of autoimmunity diseases; and advances in HIV pathogenesis and vaccine development. We also reviewed two articles that explore the possible alterations of the immune system caused by spaceflights, a new field with increasing importance as human space expeditions become a reality in the 21st century.

  17. Factors Influencing Biotite Weathering

    Reed, Ryan R.

    2000-01-01

    Factors Influencing Biotite Weathering by Ryan Reed Lucian W. Zelazny, Chairman Crop and Soil Environmental Sciences (ABSTRACT) Weathering of biotite supplies nutrients such as K+ and weathers into vermiculite/montmorillonite or kaolinite, which have varying influences on soil properties and characteristics. This study was conducted to determine if the weathering mechanisms of biotite are controlled by temperature, or if other factors, such as vegetation or leaching inten...

  18. Social media influencer marketing

    Isosuo, Heli

    2016-01-01

    The marketing field is changing simultaneously with the digital world. Social media is getting more and more important to marketers, and there is a need to stand out in the social media noise. Social media influencer marketing could be a good alternative to other types of marketing. A need from the consignor and the interest of the author were the motivations for conducting the study. Sääskilahti Consulting has a social media influencer network Somevaikuttajat, which is offering social media ...

  19. A framework for effective management of change in clinical practice: dissemination and implementation of clinical practice guidelines

    Moulding, N. T.; Silagy, C. A.; Weller, D P

    1999-01-01

    Theories from social and behavioural science can make an important contribution to the process of developing a conceptual framework for improving use of clinical practice guidelines and clinician performance. A conceptual framework for guideline dissemination and implementation is presented which draws on relevant concepts from diffusion of innovation theory, the transtheoretical model of behaviour change, health education theory, social influence theory, and social ec...

  20. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

    Scherpbier Albert JJ

    2010-09-01

    Full Text Available Abstract Background The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate in clinical departments and the leadership skills of clinical consultants responsible for education. Methods The study was a trans-sectional correlation study. The educational climate was investigated by a survey among all doctors (specialists and trainees in the departments. Leadership skills of the consultants responsible for education were measured by multi-source feedback scores from heads of departments, peer consultants, and trainees. Results Doctors from 42 clinical departments representing 21 specialties participated. The response rate of the educational climate investigation was moderate 52% (420/811, Response rate was high in the multisource-feedback process 84.3% (420/498. The educational climate was scored quite high mean 3.9 (SD 0.3 on a five-point Likert scale. Likewise the leadership skills of the clinical consultants responsible for education were considered good, mean 5.4 (SD 0.6 on a seven-point Likert scale. There was no significant correlation between the scores concerning the educational climate and the scores on leadership skills, r = 0.17 (p = 0.29. Conclusions This study found no relation between the educational climate and the leadership skills of the clinical consultants responsible for postgraduate medical education in clinical departments with the instruments used. Our results indicate that consultants responsible for education are in a weak position to influence the educational climate in the clinical department. Further studies are needed to explore, how heads of departments and other factors related to the clinical organisation could influence the educational climate.