Full Text Available Los Adjusted Clinical Groups (ACG son un sistema de ajuste de riesgos que clasifica a las personas según su edad y sexo y las condiciones médicas que presentan, y estas personas tienen un consumo similar de recursos sanitarios durante un periodo. Fueron desarrollados por Starfield y Weiner (Universidad Johns Hopkins, EE. UU. 1991, y su objetivo es medir el grado de enfermedad en poblaciones de pacientes basándose en sus niveles de comorbilidad. Entre sus principales aplicaciones destacan: a evaluar la eficiencia en la utilización de los servicios sanitarios, b medir la comorbilidad de la población, y c programar la financiación o pago capitativo para grupos de proveedores. Entre las ventajas del sistema ACG destaca la necesidad de un número limitado de variables para cada paciente (edad, sexo y diagnósticos y que la unidad de medida es el paciente. Se comentan algunas características de este sistema de ajuste de riesgos poblacionales.
Colais, Paola; Fantini, Maria P; Fusco, Danilo; Carretta, Elisa; Stivanello, Elisa; Lenzi, Jacopo; Pieri, Giulia; Perucci, Carlo A
Caesarean section (CS) rate is a quality of health care indicator frequently used at national and international level. The aim of this study was to assess whether adjustment for Robson's Ten Group Classification System (TGCS), and clinical and socio-demographic variables of the mother and the fetus is necessary for inter-hospital comparisons of CS rates. The study population includes 64,423 deliveries in Emilia-Romagna between January 1, 2003 and December 31, 2004, classified according to theTGCS. Poisson regression was used to estimate crude and adjusted hospital relative risks of CS compared to a reference category. Analyses were carried out in the overall population and separately according to the Robson groups (groups I, II, III, IV and V-X combined). Adjusted relative risks (RR) of CS were estimated using two risk-adjustment models; the first (M1) including the TGCS group as the only adjustment factor; the second (M2) including in addition demographic and clinical confounders identified using a stepwise selection procedure. Percentage variations between crude and adjusted RRs by hospital were calculated to evaluate the confounding effect of covariates. The percentage variations from crude to adjusted RR proved to be similar in M1 and M2 model. However, stratified analyses by Robson's classification groups showed that residual confounding for clinical and demographic variables was present in groups I (nulliparous, single, cephalic, ≥37 weeks, spontaneous labour) and III (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, spontaneous labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour) and to a minor extent in groups II (nulliparous, single, cephalic, ≥37 weeks, induced or CS before labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour). The TGCS classification is useful for inter-hospital comparison of CS section rates, but
Medida de los pesos relativos del coste de la asistencia como efecto de la aplicación retrospectiva de los adjusted clinical groups en atención primaria Measurement of relative cost weights as an effect of the retrospective application of adjusted clinical groups in primary care
Full Text Available Objetivo: El objeto del estudio es obtener los pesos relativos medios de los costes de la asistencia con la aplicación retrospectiva de los adjusted clinical groups (ACG en población atendida por equipos de atención primaria en situación de práctica clínica habitual. Métodos: Estudio descriptivo de carácter retrospectivo. Fueron incluidos en el estudio todos los pacientes atendidos por 4 equipos de atención primaria durante el año 2003. Las principales mediciones fueron: variables universales (edad y sexo, dependientes (visitas y costes y de casuística o comorbilidad. El modelo de costes para cada paciente se estableció diferenciando los costes fijos y los variables. Se efectuó un análisis de regresión lineal múltiple para la predicción de los modelos. El coste relativo de cada ACG se obtuvo dividiendo el coste medio de cada categoría entre el coste medio de toda la población de referencia. Resultados: El número total de pacientes estudiados fue de 62.311 (intensidad de uso del 76,7%, con una media de 4,8 ± 3,2 episodios y 7,8 ± 7,5 visitas/paciente/año. La distribución de los costes fue de 24.135.236,41 €, el 28,9% fijos. El coste unitario total por visita/año fue de 49,62 ± 24,71 € y el promedio paciente/año de 387,34 ± 145,87 € (pesos relativos de referencia. El poder explicativo de la clasificación ACG fue del 50,1% en las visitas y del 54,9% para los costes totales. Conclusiones: Los ACG se muestran como un aceptable sistema de clasificación de pacientes en situación de práctica clínica habitual. De confirmarse los resultados posibilitarían una mejora en la aplicación práctica de los ACG como una posible herramienta para la gestión clínica en los centros de atención primaria.Objective: The objective of the study is to obtain the cost's relative average weights of the assistance with the retrospective application of the Adjusted Clinical Groups (ACG's in four teams of Primary Care with an attended
Full Text Available Abstract Background In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription. Methods We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately. Results No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%. For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%. Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36. Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41 and -0.52 in pediatricians (p = 0.08, N = 12. Conclusion In our setting, ACG is the variable studied that explains more variability in
Aguado, Alba; Guinó, Elisabet; Mukherjee, Bhramar; Sicras, Antoni; Serrat, Josep; Acedo, Mateo; Ferro, Juan Jose; Moreno, Victor
In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription. We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately. No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%). For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%). Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36. Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41) and -0.52 in pediatricians (p = 0.08, N = 12). In our setting, ACG is the variable studied that explains more variability in pharmacy cost in adults compared to physician and center. In
Zöttl, Markus; Frommen, Joachim G; Taborsky, Michael
Environmental factors can determine which group size will maximize the fitness of group members. This is particularly important in cooperative breeders, where group members often serve different purposes. Experimental studies are yet lacking to check whether ecologically mediated need for help will change the propensity of dominant group members to accept immigrants. Here, we manipulated the perceived risk of predation for dominant breeders of the cooperatively breeding cichlid fish Neolamprologus pulcher to test their response to unrelated and previously unknown immigrants. Potential immigrants were more readily accepted if groups were exposed to fish predators or egg predators than to herbivorous fish or control situations lacking predation risk. Our data are consistent with both risk dilution and helping effects. Egg predators were presented before spawning, which might suggest that the fish adjust acceptance rates also to a potential future threat. Dominant group members of N. pulcher apparently consider both present and future need of help based on ecological demand. This suggests that acceptance of immigrants and, more generally, tolerance of group members on demand could be a widespread response to ecological conditions in cooperatively breeding animals.
Uribe Elías, Roberto
The 2010 undergraduate medical degree curriculum at the National Autonomous University of Mexico (UNAM) faculty of medicine is based on the reality of the operating structure of the medical care units qualified for teaching. The clinical teaching/learning is based on the cooperative work of the professor and student; this means, it is based on the institutional physician responsible for medical care in a professor/assistant action together with the student being brought up. Therefore, the permanent education and training of all medical teams in the institutions offering teaching is essential. Teaching must be one distinctive characteristic of excellence for the units of the Health Ministry as it is teaching the central factor that raises the quality of medical care. The clinical evaluation must be permanent, improving the value of the daily action in front of a patient at the formative level and as a means to allow the assessment for its development, as it is the clinical aspect that is the essence of medicine.
Buus, Niels; Delgado, Cynthia; Traynor, Michael
This present study is a report of an interview study exploring personal views on participating in group clinical supervision among mental health nursing staff members who do not participate in supervision. There is a paucity of empirical research on resistance to supervision, which has traditiona......This present study is a report of an interview study exploring personal views on participating in group clinical supervision among mental health nursing staff members who do not participate in supervision. There is a paucity of empirical research on resistance to supervision, which has...... traditionally been theorized as a supervisee's maladaptive coping with anxiety in the supervision process. The aim of the present study was to examine resistance to group clinical supervision by interviewing nurses who did not participate in supervision. In 2015, we conducted semistructured interviews with 24...
Howard, Dena R; Brown, Julia M; Todd, Susan; Gregory, Walter M
Multi-arm clinical trials assessing multiple experimental treatments against a shared control group can offer efficiency advantages over independent trials through assessing an increased number of hypotheses. Published opinion is divided on the requirement for multiple testing adjustment to control the family-wise type-I error rate (FWER). The probability of a false positive error in multi-arm trials compared to equivalent independent trials is affected by the correlation between comparisons due to sharing control data. We demonstrate that this correlation in fact leads to a reduction in the FWER, therefore FWER adjustment is not recommended solely due to sharing control data. In contrast, the correlation increases the probability of multiple false positive outcomes across the hypotheses, although standard FWER adjustment methods do not control for this. A stringent critical value adjustment is proposed to maintain equivalent evidence of superiority in two correlated comparisons to that obtained within independent trials. FWER adjustment is only required if there is an increased chance of making a single claim of effectiveness by testing multiple hypotheses, not due to sharing control data. For competing experimental therapies, the correlation between comparisons can be advantageous as it eliminates bias due to the experimental therapies being compared to different control populations.
Full Text Available AIM:To observe the clinical effect of the midperipherv additional designed lenses and adjustment training on myopia in childhood.METHODS: Eighty childhood(160 eyes in allwith myopia were included in this study. All patients were divided into two groups according to the methods of correcting refractive error: the midperipherv additional designed lenses and adjustment training group(treatment group, 80 eyes of 40 casesand frame glasses group(comparison group, 80 eyes of 40 cases. The two groups had been measured myopia progress indicators and adjustment function indicators for ever 3mo. The results were compared and analyzed after 1a follow-up.RESULTS: The visual acuity, refraction, axial length had a little change after wearing lens 1a in treatment group, there was no statistically significant difference compared with wearing before(P>0.05. The visual acuity decreased, refraction and axial length increased in comparison group, the differences were statistically significant(PPPP>0.05. The difference between the two groups was statistically significant(PCONCLUSION: Midperipherv additional designed lenses and adjustment training treatment of juvenile myopia is effective, which can delay the diopters development of myopic children, improve the regulatory function, control the development of myopia, improve the adjustment function.
Ghavam Nasiri M.
Full Text Available Statement of Problem: Parafunctional habits are the most important factor in the creation of non-carious cervical lesions and correcting of these habits may affect cervical lesions. Purpose: The goal of this study was to survey the effects of one-year occlusal adjustment on clinical success of non- carious cervical restorations. Materials and Methods: In this clinical study, sixty tooth-colored cervical restorations on canines and premolars in patients with parafunctional habits (bruxism and clenching were studied. The teeth, according to the type of restorative material, were randomly divided into two groups: One group with a composite resin (Tetric Flow; Group A: n=30 and the other group with a compomer (Compoglass Flow; Group B: n=30. After restoration, each group was divided into two subgroups: (A1, B1 with occlusal adjustment (case group, (A2, B2 without occlusal adjustment (control group. The evaluation was perfumed single blind at 6 and 12 months after restorative operations according to Us Public Health Service (USPHS classification. Assessment criteria included: marginal integrity, marginal discoloration, recurrent caries, postoperative sensitivity and loss of filling. Statistical analysis was completed using Fisher’s exact test. Results: In 12 month period between two groups of compoglass Flow restorations, group B1 showed superior results than group B2, however, no significant difference was found between both groups of tetric flow restorations (A1 and A2. There was also no difference in clinical conditions between A2 and B2 groups. Conclusion: Considering the results of this study, it can be concluded that occlusal adjustment puts a considerable effect on clinical success of compoglass non- carious cervical restorations. However, it should be mentioned that such and effect was not found among Tetric flow restoration.
Hamm, Jill V.; Schmid, Lorrie; Farmer, Thomas W.; Locke, Belinda
This study integrates diverse literatures on peer group influence by conceptualizing and examining the relationship of peer group injunctive norms to the academic adjustment of a large and ethnically diverse sample of rural early adolescents' academic adjustment. Results of three-level hierarchical linear modeling indicated that peer groups were…
Tabuteau-Harrison, Sophie L; Haslam, Catherine; Mewse, Avril J
Multiple sclerosis (MS) is typically associated with life-long adjustment to wide-ranging, changeable symptoms and psychosocial disruption as all relationships are changed or lost. Despite accumulating evidence, the therapeutic impact of harnessing social group factors in MS management and rehabilitation remains largely unexplored. We investigated their role specific to adjusting to MS. A qualitative approach was used with thematic analysis to induce a rich and developing account of the impact of social groups on adjustment for 15 individuals with MS. An adjustment questionnaire was used to provide a framework for its organisation and discussion. The analysis revealed three themes associated with loss, change and social processes that influenced adjustment. These features distinguished between those who were more or less able to adjust, and resonated well with processes previously identified as central to identity loss and change. Social factors enhanced adjustment through easing transition between pre- and post-MS diagnosis lives. Notably, maintenance of pre-existing social roles and relationships was critical in providing a meaningful basis for integrating the old with new senses of self. The capacity to join new social groups was as key in adjustment as was awareness of having access to multiple social groups to avoid being solely defined by MS. These concepts provided a more stable grounding upon which to nurture value systems and employ collective support to counter the negative consequences of living with MS.
Hou, Yan; Ding, Victoria; Li, Kang; Zhou, Xiao-Hua
In clinical trials, examining the adjusted treatment difference has become the preferred way to establish non-inferiority (NI) in cases involving a binary endpoint. However, current methods are inadequate in the area of covariate adjustment. In this paper, we introduce two new methods, nonparametric and parametric, of using the probability and probability (P-P) curve to address the issue of unadjusted categorical covariates in the traditional assessment of NI in clinical trials. We also show that the area under the P-P curve is a valid alternative for assessing NI using the adjusted treatment difference, and we compute this area using Mann-Whitney nonparametric statistics. Our simulation studies demonstrate that our proposed methods can not only control type I error at a predefined significance level but also achieve higher statistical power than those of traditional parametric and nonparametric methods that overlook covariate adjustment, especially when covariates are unbalanced in the two treatment groups. We illustrate the effectiveness of our methodology with data from clinical trials of a therapy for coronary heart disease.
Lee, Dong Yul
Moderately retarded institutionalized residents received 10 weeks of structured group counseling focused on five areas of social and personal adjustment. Results showed that in each of the above variables, the experimental group showed a greater mean score than that of the control group. (Author)
Patterson, G. R.; Forgatch, Marion S.
Issues related to the use of outcome and process data from the treatment of antisocial children to predict future childhood adjustment were examined through a study of 69 children. Data supported the hypothesis that measures of processes thought to produce changes in child behavior would serve to predict future adjustment. (SLD)
Høybye, Mette Terp; Dalton, S O; Deltour, I;
BACKGROUND: We conducted a randomised study to investigate whether providing a self-guided Internet support group to cancer patients affected mood disturbance and adjustment to cancer. METHODS: Baseline and 1-, 6- and 12-month assessments were conducted from 2004 to 2006 at a national...... rehabilitation centre in Denmark. A total of 58 rehabilitation course weeks including 921 survivors of various cancers were randomly assigned to a control or an intervention group by cluster randomisation. The intervention was a lecture on the use of the Internet for support and information followed...... by participation in an Internet support group. Outcome measures included self-reported mood disturbance, adjustment to cancer and self-rated health. Differences in scores were compared between the control group and the intervention group. RESULTS: The effect of the intervention on mood disturbance and adjustment...
Kim, Jung Yin
This study examines, from a sociocultural perspective, the factors that explain why a group of seven Korean students attending an undergraduate business program in a US university are initially labelled as silent participants when first engaging in group work, and how these factors impacted the students' overall adjustment process. Data came from…
Shimura, Masashi; Gosho, Masahiko; Hirakawa, Akihiro
Group sequential designs are widely used in clinical trials to determine whether a trial should be terminated early. In such trials, maximum likelihood estimates are often used to describe the difference in efficacy between the experimental and reference treatments; however, these are well known for displaying conditional and unconditional biases. Established bias-adjusted estimators include the conditional mean-adjusted estimator (CMAE), conditional median unbiased estimator, conditional uniformly minimum variance unbiased estimator (CUMVUE), and weighted estimator. However, their performances have been inadequately investigated. In this study, we review the characteristics of these bias-adjusted estimators and compare their conditional bias, overall bias, and conditional mean-squared errors in clinical trials with survival endpoints through simulation studies. The coverage probabilities of the confidence intervals for the four estimators are also evaluated. We find that the CMAE reduced conditional bias and showed relatively small conditional mean-squared errors when the trials terminated at the interim analysis. The conditional coverage probability of the conditional median unbiased estimator was well below the nominal value. In trials that did not terminate early, the CUMVUE performed with less bias and an acceptable conditional coverage probability than was observed for the other estimators. In conclusion, when planning an interim analysis, we recommend using the CUMVUE for trials that do not terminate early and the CMAE for those that terminate early. Copyright © 2017 John Wiley & Sons, Ltd.
Skowron, Elizabeth A.
This study focused on examining the cross-cultural validity of Bowen family systems theory (M. Bowen, 1978), namely differentiation of self for individuals of color. Ethnic minority men and women completed measures of differentiation of self, ethnic group belonging, and 3 indices of personal adjustment. Initial support for the cross-cultural…
Takach Lapner, Sarah; Julian, Jim A; Linkins, Lori-Ann; Bates, Shannon; Kearon, Clive
Two new strategies for interpreting D-dimer results have been proposed: i) using a progressively higher D-dimer threshold with increasing age (age-adjusted strategy) and ii) using a D-dimer threshold in patients with low clinical probability that is twice the threshold used in patients with moderate clinical probability (clinical probability-adjusted strategy). Our objective was to compare the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE). We performed a retrospective analysis of clinical data and blood samples from two prospective studies. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using two D-dimer interpretation strategies: the age-adjusted strategy, which uses a progressively higher D-dimer threshold with increasing age over 50 years (age in years × 10 µg/L FEU); and the clinical probability-adjusted strategy which uses a D-dimer threshold of 1000 µg/L FEU in patients with low clinical probability and 500 µg/L FEU in patients with moderate clinical probability. A total of 1649 outpatients with low or moderate clinical probability for a first suspected deep vein thrombosis or pulmonary embolism were included. The NPV of both the clinical probability-adjusted strategy (99.7 %) and the age-adjusted strategy (99.6 %) were similar. However, the proportion of patients with a negative result was greater with the clinical probability-adjusted strategy (56.1 % vs, 50.9 %; difference 5.2 %; 95 % CI 3.5 % to 6.8 %). These findings suggest that clinical probability-adjusted D-dimer interpretation is a better way of interpreting D-dimer results compared to age-adjusted interpretation.
Turnwald, Grant; Stone, Elizabeth; Bristol, David; Fuentealba, Carmen; Hardie, Lizette; Hellyer, Peter; Jaeger, Laurie; Kerwin, Sharon; Kochevar, Deborah; Lissemore, Kerry; Olsen, Christopher; Rogers, Kenita; Sabin, Beth; Swanson, Cliff; Warner, Angeline
This report describes proposed new models for assessment of eight of the nine clinical competencies the American Veterinary Medical Association Council on Education requires for accreditation. The models were developed by discussion groups at the Association of American Veterinary Medical Colleges' Clinical Competency Symposium. Clinical competencies and proposed models (in parentheses) are described. Competency 1: comprehensive patient diagnosis (neurologic examination on a dog, clinical reasoning skills); Competency 2: comprehensive treatment planning (concept mapping, computerized case studies); Competency 3: anesthesia, pain management (student portfolio); Competency 4: surgery skills (objective structured clinical examination, cased-based examination, "super dog" model); Competency 5: medicine skills (clinical reasoning and case management, skills checklist); Competency 6: emergency and intensive care case management (computerized case study or scenario); Competency 7: health promotion, disease prevention/biosecurity (360 degrees evaluation, case-based computer simulation); Competency 8: client communications and ethical conduct (Web-based evaluation forms, client survey, communicating with stakeholders, telephone conversation, written scenario-based cases). The report also describes faculty recognition for participating in clinical competency assessments.
Validación retrospectiva del Johns-Hopkins ACG Case-Mix System en la población Española Validating the Adjusted Clinical Groups [ACG] Case-mix System in a Spanish population setting: a multicenter study
Full Text Available Introducción: Validar la aplicación retrospectiva de los Adjusted Clinical Groups (ACG en varios centros de atención primaria y especializada en la población española. Métodos: Estudio restrospectivo-multicéntrico, realizado a partir de los registros de sujetos atendidos en 5 equipos de atención primaria (AP y dos hospitalarios, durante el año 2005. Las principales mediciones fueron dependientes (visitas, episodios, coste en AP y coste total y de casuística/morbilidad con el ACG Case-Mix-System. Cálculo del poder explicativo: cociente de determinación, pPurpose: To validate the Johns Hopkins ACG case-mix system used in various primary and specialized care centers attending a defined population in Spain. Methods: A retrospective, multicenter study was carried out by applying the ACG case-mix system to the clinical records of patients attending five primary care teams and two hospitals over a 1-year period in 2005. The main measurements were dependent variables (visits, episodes, primary care costs, and total costs, and morbidity. The determination coefficient (R²; p<0.05 was used to measure the explained variability. Results: A total of 81,873 patients were included with a mean (standard deviation number of 4.8 (3.5 episodes and 8.0 (8.1 visits/patient/year. The explained variance (R² of ACG classification was 73.1% (75.5% log transformation for episodes, 43.2% (54.0% log transformation for visits, 19.6% (54.8% log transformation for primary care costs, and 22.7% (48.3% log transformation for total costs (p<0.001. Conclusion: The ACG system classified a defined population on the basis of morbidity and individual resource consumption. Moreover, the ACG system was useful to assess the clinical (comorbidity and economical information of each center.
Menichetti, J; Giusti, L; Fossati, I; Vegni, E
The main purpose of the present study was to understand the subjective experience of patients adjusting to cancer by focusing on how that experience might be affected by participating in a psychodramatic group intervention. In-depth interviews using an interpretative-phenomenological approach were conducted with eight cancer patients involved in a psychodrama group. Four key themes were identified: (1) outside and inside relationships; (2) identities: nurturing other selves; (3) a feelings' gym: performing the internal world; and (4) many ends: mourning death and dying. Participation in cancer group using a psychodramatic approach provided positive results. In detail, the group setting: (1) favoured relationships in which it was possible to freely express oneself and (2) empowered patients in their feelings of being able to give and receive help; the psychodramatic approach: (1) supported the physical mobilisation of sense of agency and (2) permitted to deal with the grieving process. Cancer healthcare pathways would benefit from psychotherapeutic programmes using a similar approach, since psychodrama by actively involving body seems to works on areas that are often underwhelmed by other approaches, such as (i.e., physical mobilisation, body engagement, grieving adjustment). Psychodrama supports patients to achieve insights into their own possibilities to actively participate in their own life situations despite having cancer and undergoing treatment for it.
Appelt, Ane Lindegaard; Vogelius, Ivan R
Several clinical risk factors for radiation induced toxicity have been identified in the literature. Here, we present a method to quantify the effect of clinical risk factors on radiation dose-response curves and apply the method to adjust the dose-response for radiation pneumonitis for patients...
Huang, I-Chan; Frangakis, Constantine; Dominici, Francesca; Diette, Gregory B; Wu, Albert W
Objectives To develop a propensity score-based risk adjustment method to estimate the performance of 20 physician groups and to compare performance rankings using our method to a standard hierarchical regression-based risk adjustment method. Data Sources/Study Setting Mailed survey of patients from 20 California physician groups between July 1998 and February 1999. Study Design A cross-sectional analysis of physician group performance using patient satisfaction with asthma care. We compared the performance of the 20 physician groups using a novel propensity score-based risk adjustment method. More specifically, by using a multinomial logistic regression model we estimated for each patient the propensity scores, or probabilities, of having been treated by each of the 20 physician groups. To adjust for different distributions of characteristics across groups, patients cared for by a given group were first stratified into five strata based on their propensity of being in that group. Then, strata-specific performance was combined across the five strata. We compared our propensity score method to hierarchical model-based risk adjustment without using propensity scores. The impact of different risk-adjustment methods on performance was measured in terms of percentage changes in absolute and quintile ranking (AR, QR), and weighted κ of agreement on QR. Results The propensity score-based risk adjustment method balanced the distributions of all covariates among the 20 physician groups, providing evidence for validity. The propensity score-based method and the hierarchical model-based method without propensity scores provided substantially different rankings (75 percent of groups differed in AR, 50 percent differed in QR, weighted κ=0.69). Conclusions We developed and tested a propensity score method for profiling multiple physician groups. We found that our method could balance the distributions of covariates across groups and yielded substantially different profiles
Liu, Yuan-Hao; Nievaart, Sander; Tsai, Pi-En; Liu, Hong-Ming; Moss, Ray; Jiang, Shiang-Huei
In order to provide an improved and reliable neutron source description for treatment planning in boron neutron capture therapy (BNCT), a spectrum adjustment procedure named coarse-scaling adjustment has been developed and applied to the neutron spectrum measurements of both the Tsing Hua Open-pool Reactor (THOR) epithermal neutron beam in Taiwan and the High Flux Reactor (HFR) in The Netherlands, using multiple activation detectors. The coarse-scaling adjustment utilizes a similar idea as the well-known two-foil method, which adjusts the thermal and epithermal neutron fluxes according to the Maxwellian distribution for thermal neutrons and 1/ E distribution over the epithermal neutron energy region. The coarse-scaling adjustment can effectively suppress the number of oscillations appearing in the adjusted spectrum and provide better smoothness. This paper also presents a sophisticated 9-step process utilizing twice the coarse-scaling adjustment which can adjust a given coarse-group spectrum into a fine-group structure, i.e. 640 groups, with satisfactory continuity and excellently matched reaction rates between measurements and calculation. The spectrum adjustment algorithm applied in this study is the same as the well-known SAND-II.
Nurdan Eren Bodur
Full Text Available In this study it was aimed to assess and evaluate the impact of the levels of dyadic adjustment in infertile couples on stress related with infertility and marital adjustment. The study included 104 couples with primary or secondary infertility and 44 healthy couples with children for the control group. Control group was given the Hospital Anxiety Depression Scale (HADS, Dyadic Adjustment Scale (DAS and Multidimensional Scale of Perceived Social Support (MSPSS. Infertile group was given HADS, DAS, MSPSS and also Fertility Problem Inventory. Women in infertile couples reported greater psychological symptoms and more decreased marital adjustment than men in infertile couples; but the couples did not show any significant difference with those in control groups regarding these parameters. It was determined that, in general, while marital adjustment in infertile couples increases, depression and anxiety levels decrease. These results showed that psychosocial problems in infertile couples should be evaluated with specific scales. Psychosocial support which will be given to infertile couples and motivating social support systems while providing this service would have positive effects especially on men. [Cukurova Med J 2013; 38(1.000: 51-62
Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Kayrak, Mehmet; Ciray, Hilal; Cizmecioglu, Ahmet; Tonbul, Halil Zeki; Turk, Suleyman
Many drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the "American College of Physicians Drug Prescribing in Renal Failure, fifth Edition." Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 ± 14.6 years, and the mean hospitalization duration was 8.5 ± 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.
Ellis, Michael V.; And Others
Conducted two studies to clarify nature of anchoring errors in clinical judgments. Judgments from 103 undergraduates in Study 1 evidenced neither anchoring errors nor gender differences. Judgments from 157 psychologists in Study 2 affirmed adjustment and mitigation hypotheses over anchoring hypothesis alone. Mitigation process appeared adaptable…
Full Text Available In this paper the author traces the experiences of the psychological work carried out in institutions, not just into the schools, for which she has used the group both as a main tool in primary and secondary prevention intervention of disease, as well as a supporter of mental well-being of children and teachers. On the basis of group-analytic theory and using different theoretical references during time, author highlights differences, points of contact, and transformations. These practices, described by F. Di Maria and G. Lo Verso (2002, have a common ground in the concepts of "context", "set-setting" and "culture". They represent a progress in the thoughts of people that use these devices not exclusively in psychotherapeutic work with groups.Keywords: Institution, Context, Culture, Device Group, Set-Setting
In this paper the author traces the experiences of the psychological work carried out in institutions, not just into the schools, for which she has used the group both as a main tool in primary and secondary prevention intervention of disease, as well as a supporter of mental well-being of children and teachers. On the basis of group-analytic theory and using different theoretical references during time, author highlights differences, points of contact, and transformations. These practices, ...
Seyed Hossein Mousavi
Full Text Available Due to the role of sports in youth social adjustment and social skills in their interpersonal relationships and social skills associated with academic achievement and their role in reducing mental and psychological problems ,we conducted this study to examine the role of physical activity in different sport fields. In order to compare the social skills of male students participating in the team and individual sports in Islamic Azad University of Zanjan, we chose 30 randomly as the sample size. In order to gather information, two questionnaires-i-e-demographic questionnaire and social skills questionnaire (social adjustment section Albert J. Petitpas F (2004 with a reliability of 0.90 were used. For data analysis, descriptive statistics and T-test were used. Results showed significant differences between team and individual sports athletes with the soccer ranking higher than the rest of the field. Gymnastics athletes would have better social adjustment than the rest of athletes and the rowing athletes had less social adjustment, but this difference was not statistically significant and the results showed no significant relationship between age and marital status with the Social Adjustment. The results of this study confirm a considerable effect of team sports on levels of social adjustment compared with individual sports.
Daniels, Morris J.
This interim report discusses the adjustments auditing firms are making as a result of the advent of the computer. Data were obtained from (1) a review of the literature, (2) attendance at professional association meetings, and (3) a series of interviews with accountants. The findings to date indicate that the normative patterns governing the…
Studer, Jeannine R.; Allton, Judith A.
Addresses factors that contribute to the adjustment difficulties of children and adolescents when their parents divorce. Gender issues, custody, age, parenting style, visitation patterns, socioeconomic considerations, the support system, family size, and the reconstituted family are all discussed. Describes a model for an effective support group…
Rulison, Kelly L.; Gest, Scott D.; Loken, Eric; Welsh, Janet A.
The association between affiliating with aggressive peers and behavioral, social and psychological adjustment was examined. Students initially in 3rd, 4th, and 5th grade (N = 427) were followed biannually through 7th grade. Students' peer-nominated groups were identified. Multilevel modeling was used to examine the independent contributions of…
Boehnlein, J K; Sparr, L F
In this assessment of group therapy with WWII ex-POWs, the small cohort limits generalizations; however, we offer a longitudinal perspective on group process. Posttraumatic suppression and denial of emotions appears to be adaptive for time-limited periods but is not a long-term solution. More lasting changes in self-esteem and social interaction may be partially achieved through a supportive group environment that fosters cognitive synthesis and reorganization.
Vicente J. Camps
Full Text Available Purpose. To validate clinically a new method for estimating the corneal power (Pc using a variable keratometric index (nkadj in eyes with previous laser refractive surgery. Setting. University of Alicante and Medimar International Hospital (Oftalmar, Alicante, (Spain. Design. Retrospective case series. Methods. This retrospective study comprised 62 eyes of 62 patients that had undergone myopic LASIK surgery. An algorithm for the calculation of nkadj was used for the estimation of the adjusted keratometric corneal power (Pkadj. This value was compared with the classical keratometric corneal power (Pk, the True Net Power (TNP, and the Gaussian corneal power (PcGauss. Likewise, Pkadj was compared with other previously described methods. Results. Differences between PcGauss and Pc values obtained with all methods evaluated were statistically significant (p<0.01. Differences between Pkadj and PcGauss were in the limit of clinical significance (p<0.01, loA [−0.33,0.60] D. Differences between Pkadj and TNP were not statistically and clinically significant (p=0.319, loA [−0.50,0.44] D. Differences between Pkadj and previously described methods were statistically significant (p<0.01, except with PcHaigisL (p=0.09, loA [−0.37,0.29] D. Conclusion. The use of the adjusted keratometric index (nkadj is a valid method to estimate the central corneal power in corneas with previous myopic laser refractive surgery, providing results comparable to PcHaigisL.
Full Text Available BACKGROUND: Caesarean delivery (CD rates are commonly used as an indicator of quality in obstetric care and risk adjustment evaluation is recommended to assess inter-institutional variations. The aim of this study was to evaluate whether the Ten Group classification system (TGCS can be used in case-mix adjustment. METHODS: Standardized data on 15,255 deliveries from 11 different regional centers were prospectively collected. Crude Risk Ratios of CDs were calculated for each center. Two multiple logistic regression models were herein considered by using: Model 1- maternal (age, Body Mass Index, obstetric variables (gestational age, fetal presentation, single or multiple, previous scar, parity, neonatal birth weight and presence of risk factors; Model 2- TGCS either with or without maternal characteristics and presence of risk factors. Receiver Operating Characteristic (ROC curves of the multivariate logistic regression analyses were used to assess the diagnostic accuracy of each model. The null hypothesis that Areas under ROC Curve (AUC were not different from each other was verified with a Chi Square test and post hoc pairwise comparisons by using a Bonferroni correction. RESULTS: Crude evaluation of CD rates showed all centers had significantly higher Risk Ratios than the referent. Both multiple logistic regression models reduced these variations. However the two methods ranked institutions differently: model 1 and model 2 (adjusted for TGCS identified respectively nine and eight centers with significantly higher CD rates than the referent with slightly different AUCs (0.8758 and 0.8929 respectively. In the adjusted model for TGCS and maternal characteristics/presence of risk factors, three centers had CD rates similar to the referent with the best AUC (0.9024. CONCLUSIONS: The TGCS might be considered as a reliable variable to adjust CD rates. The addition of maternal characteristics and risk factors to TGCS substantially increase the
Appelt, Ane L; Vogelius, Ivan R.; Farr, Katherina P.
Background. Understanding the dose-response of the lung in order to minimize the risk of radiation pneumonitis (RP) is critical for optimization of lung cancer radiotherapy. We propose a method to combine the dose-response relationship for RP in the landmark QUANTEC paper with known clinical risk......-only QUANTEC model and the model including risk factors. Subdistribution cumulative incidence functions were compared for patients with high/low-risk predictions from the two models, and concordance indices (c-indices) for the prediction of RP were calculated. Results. The reference dose- response relationship...... factors, in order to enable individual risk prediction. The approach is validated in an independent dataset. Material and methods. The prevalence of risk factors in the patient populations underlying the QUANTEC analysis was estimated, and a previously published method to adjust dose...
Lv Jiuan; Ma Jiani; Huangfu Pengbo; Yang Shan [Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, Department of Chemistry, Northwest University, Xi' an 710069 (China); Gong Yongkuan [Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, Department of Chemistry, Northwest University, Xi' an 710069 (China)], E-mail: firstname.lastname@example.org
A new monolayer film with tunable hydrophilicity and hydrophobicity was constructed on glass coverslips by stepwise grafting with both phosphorylcholine (PC) and stearyl groups. The glass coverslips were firstly hydroxylized to provide reactive sites on the surfaces. Subsequently, chlorodimethyl-n-octadecylsilane was chemically adsorbed onto the surface to impart the required hydrophobicity. The remaining hydroxyl groups were grafted with 1,6-diisocyanatohexane. Finally, 2-hydroxy-2-ethylphosphorylcholine was grafted onto the attached isocyanate groups. Dynamic contact angle (DCA) measurement and X-ray photoelectron spectroscopy (XPS) analysis confirmed that the step-by-step modification process was successful. The adsorption of bovine serum albumin and bovine plasma fibrinogen, as well as the adhesion and aggregation of platelets were suppressed with the introduction of phospholipid moieties on the surfaces. This tunable surface may have potential applications in the fields of separation science, tissue engineering, cytobiology, drug delivery and gene therapy.
Deepa, Vanamala A. Alwar, Karuna Rameshkumar & Cecil Ross
Objectives: The study was undertaken to correlate the blood groups and clinical presentations in malaria patientsand to understand the differential host susceptibility in malaria.Methods: From October 2007 to September 2008, malaria positive patients’ samples were evaluated in thisstudy. Hemoglobin, total leukocyte count, and platelet count of each patient were done on an automated cellcounter. After determining the blood groups, malarial species and the severity of clinical course were corr...
accidental and violent injuries are at the 0.10 level. To further evaluate the significantly reduced risk in the observed diagnostic categories, we examined...entertained. For instance, although not statistically significant, the lower rates of mental disorders and accidental injuries among the winter-over group...References Adler, R., MacRitchie, K, & Engel, G.L. (1971). Psychologic process and ischemic stroke (occlusive cerebrovascular disease): I. Observations
Full Text Available ABSTRACT Blood samples of 189 healthy Holstein cows classified as high-producers, low-producers, or dry cows, were collected with the purpose of establishing reference values for several biochemical analytes in Mexican dairy farms. Mean values were calculated for: 1 Energy profile: glucose, cholesterol, triglycerides, β-hydroxybutyrate, and non-esterified fatty acids, 2 Protein profile: urea, albumin, globulin, and total protein, 3 Mineral profile: calcium, phosphorus, sodium, potassium, magnesium, chlorine, carbon dioxide, bicarbonate, and anion gap, and 4 Hepatic enzyme: γ-glutamyl transpeptidase. The resulting data set was analyzed using Gaussian distribution and descriptive statistics. Confidence intervals of 95% were established. The linear relationships between the biochemical analytes were quantified, and an analysis of variance was performed to compare the mean values between the three production groups. The overall concentrations of the described analytes are consistent with values reported by international literature. However, lower values were found for urea, calcium, and sodium; higher values were found for cholesterol, and γ-glutamyl transpeptidase. Negative correlations were found between β-hydroxybutyrate and glucose or urea, γ-glutamyl transpeptidase and urea, and bicarbonate and urea or phosphorus or anion gap. Positive correlations were found between β-hydroxybutyrate and cholesterol or anion gap, non-esterified fatty acids and anion gap, cholesterol and globulin, different analytes of mineral profile and anion gap or urea or glucose, and between sodium and calcium. Differences among the three production groups were observed for β-hydroxybutyrate and cholesterol concentrations. The γ-glutamyl transpeptidase concentration was similar in high and low-producing cows but was higher in comparison to serum levels of dry cows. Calcium showed differences between high-producing cows and the other two groups, and sodium showed
Appelt, Ane L; Vogelius, Ivan R.; Farr, Katherina P.;
Background. Understanding the dose-response of the lung in order to minimize the risk of radiation pneumonitis (RP) is critical for optimization of lung cancer radiotherapy. We propose a method to combine the dose-response relationship for RP in the landmark QUANTEC paper with known clinical risk...... factors, in order to enable individual risk prediction. The approach is validated in an independent dataset. Material and methods. The prevalence of risk factors in the patient populations underlying the QUANTEC analysis was estimated, and a previously published method to adjust dose......-response relationships for clinical risk factors was employed. Effect size estimates (odds ratios) for risk factors were drawn from a recently published meta-analysis. Baseline values for D50 and γ50 were found. The method was tested in an independent dataset (103 patients), comparing the predictive power of the dose......-only QUANTEC model and the model including risk factors. Subdistribution cumulative incidence functions were compared for patients with high/low-risk predictions from the two models, and concordance indices (c-indices) for the prediction of RP were calculated. Results. The reference dose- response relationship...
Anastasia, Annalisa; Colletti, Chiara; Cuoco, Valentina; Quartini, Adele; Urso, Stefania; Rinaldi, Raffaella; Bersani, Giuseppe
Introduction Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. Methods A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry “A. Fiorini” Hospital, Terracina (Latina, Italy), was performed. Results The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium–high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. Conclusion Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications. PMID:27099504
Ataíde Lima, Raquel Patrícia; de Carvalho Pereira, Danielle; Cristhine Pordeus Luna, Rafaella; Rodrigues Gonçalves, Maria da Conceição; Teixeira de Lima, Roberto; Batista Filho, Malaquias; Gouveia Filizola, Rosália; de Moraes, Ronei Marcos; Rios Asciutti, Luiza Sonia; de Carvalho Costa, Maria José
Objective: In Brazil, demographic, socioeconomic and epidemiological changes over time have led to a transition in nutritional standards, resulting in a gradual reduction of malnutrition and an increased prevalence of overweight and obese individuals, similar to the situation in developed countries in previous decades. This study assessed the body mass index (BMI) and the prevalence of an overweight status and obesity, adjusted for various factors, in a population in northeastern Brazil including all age groups. Methods: This is a cross-sectional population-based epidemiological study using single sampling procedure composed of levels. Given the heterogeneity of the variable “income” and the relationship between income, prevalence of diseases and nutrition, a stratified sampling on blocks in the first level was used. In this, city districts were classified by income into 10 strata, according to information obtained from IBGE. A systematic sampling was applied on randomly selected blocks in order to choose the residences that would be part of the sample (second level), including 1165 participants from all age groups. Results and Discussion: The prevalence of an overweight status or obesity was adjusted for demographic, socioeconomic and lifestyle variables. When the Chi-square test was applied, a relationship was observed between the prevalence of an overweight status or obesity and the age group, gender, educational level and income of the participants. Regarding lifestyle parameters, only smoking was associated with the prevalence of an overweight status or obesity, in both adults and in the total sample. The results for the following groups were significant (p < 0.05): the age group from 20 to 59 years, when the individual presented an educational level greater than or equal to high school; and the age group ≥ 60 years, when the individual was female. It is noteworthy that educational level and being female were significant in adjusting for the total
Raquel Patrícia Ataíde Lima
Full Text Available Objective: In Brazil, demographic, socioeconomic and epidemiological changes over time have led to a transition in nutritional standards, resulting in a gradual reduction of malnutrition and an increased prevalence of overweight and obese individuals, similar to the situation in developed countries in previous decades. This study assessed the body mass index (BMI and the prevalence of an overweight status and obesity, adjusted for various factors, in a population in northeastern Brazil including all age groups. Methods: This is a cross-sectional population-based epidemiological study using single sampling procedure composed of levels. Given the heterogeneity of the variable “income” and the relationship between income, prevalence of diseases and nutrition, a stratified sampling on blocks in the first level was used. In this, city districts were classified by income into 10 strata, according to information obtained from IBGE. A systematic sampling was applied on randomly selected blocks in order to choose the residences that would be part of the sample (second level, including 1165 participants from all age groups. Results and Discussion: The prevalence of an overweight status or obesity was adjusted for demographic, socioeconomic and lifestyle variables. When the Chi-square test was applied, a relationship was observed between the prevalence of an overweight status or obesity and the age group, gender, educational level and income of the participants. Regarding lifestyle parameters, only smoking was associated with the prevalence of an overweight status or obesity, in both adults and in the total sample. The results for the following groups were significant (p < 0.05: the age group from 20 to 59 years, when the individual presented an educational level greater than or equal to high school; and the age group ≥ 60 years, when the individual was female. It is noteworthy that educational level and being female were significant in adjusting for
Full Text Available Objective To introduce the application of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus. Methods Twenty-four patients with normal pressure hydrocephalus implanted adjustable shunt valve underwent ventriculo-peritoneal shunt surgery and nursing care. Results After operation, cerebrospinal pressure was regulated for 0-6 (1.88 ± 1.52 times. Clinical symptoms were improved, especially in gait disturbance. Conclusion Treatment of normal pressure hydrocephalus with adjustable shunt valve can alleviate symptoms of hydrocephalus. It is especially suitable for patients with short course and secondary normal hydrocephalus patients.
Deepa, Vanamala A. Alwar, Karuna Rameshkumar & Cecil Ross
Full Text Available Objectives: The study was undertaken to correlate the blood groups and clinical presentations in malaria patientsand to understand the differential host susceptibility in malaria.Methods: From October 2007 to September 2008, malaria positive patients’ samples were evaluated in thisstudy. Hemoglobin, total leukocyte count, and platelet count of each patient were done on an automated cellcounter. After determining the blood groups, malarial species and the severity of clinical course were correlated.Results: A total of 100 patients were included in the study, of which 63 cases were positive for Plasmodiumfalciparum and 37 cases were positive for P. vivax infection and 11 patients had mixed infection. The results ofthe blood groups showed 22 – ‘A’ group, 42 – ‘B’ group, 35 – ‘O’ group and 1 was ‘AB’ group. When the clinicalcourses between different groups were compared using the following parameters for severe infection—a parasiticload of >10/1000 RBCs, severe anemia with hemoglobin 101oF and other organ involvement, it wasobserved that ‘O’ group had an advantage over other the groups. The difference in rosetting ability between redblood cells of different ‘ABO’ blood groups with a diminished rosetting potential in blood group ‘O’ red bloodcells was due to the differential host susceptibility.Conclusion: ‘O’ group had an advantage over the other three blood groups. Based on literature and the results ofthis study, the diminished rosetting potential in blood group ‘O’ red blood cells is suggested as the basis for thedifferential host susceptibility.
Suldo, Shannon M; Shaunessy, Elizabeth; Thalji, Amanda; Michalowski, Jessica; Shaffer, Emily
Navigating puberty while developing independent living skills may render adolescents particularly vulnerable to stress, which may ultimately contribute to mental health problems (Compas, Orosan, & Grant, 1993; Elgar, Arlett, & Groves, 2003). The academic transition to high school presents additional challenges as youth are required to interact with a new and larger peer group and manage greater academic expectations. For students enrolled in academically rigorous college preparatory programs, such as the International Baccalaureate (IB) program, the amount of stress perceived may be greater than typical (Suldo, Shaunessy, & Hardesty, 2008). This study investigated the environmental stressors and psychological adjustment of 162 students participating in the IB program and a comparison sample of 157 students in general education. Factor analysis indicated students experience 7 primary categories of stressors, which were examined in relation to students' adjustment specific to academic and psychological functioning. The primary source of stress experienced by IB students was related to academic requirements. In contrast, students in the general education program indicated higher levels of stressors associated with parent-child relations, academic struggles, conflict within family, and peer relations, as well as role transitions and societal problems. Comparisons of correlations between categories of stressors and students' adjustment by curriculum group reveal that students in the IB program reported more symptoms of psychopathology and reduced academic functioning as they experienced higher levels of stress, particularly stressors associated with academic requirements, transitions and societal problems, academic struggles, and extra-curricular activities. Applied implications stem from findings suggesting that students in college preparatory programs are more likely to (a) experience elevated stress related to academic demands as opposed to more typical adolescent
Magi-Galluzzi, Cristina; Montironi, Rodolfo; Epstein, Jonathan I
The Gleason grading system provides important information for guiding prostate cancer patients' management and prognostication. The grading system underwent significant modifications over the past decade. In 2005 and more recently in 2014, the International Society of Urological Pathology (ISUP) held two consensus conferences to update prostate cancer grading. Recently, five prognostic grade groups have been proposed to be used in parallel to the Gleason grading system. The purpose of this review is to highlight the key changes in the Gleason grading system and the utility of the grade groups to better reflect biologic behavior for both patients and clinicians. At the 2014 ISUP consensus conference, prostate cancer Gleason grading was updated and a previously proposed concept of five prognostic grade groups, from 1 to 5 was supported. The Grade Groups, used in parallel to the modified Gleason grading system, translate Gleason scores in five distinct risk categories where Grade Group 1 is defined as Gleason score 6 or less, Grade Group 2 as Gleason score 3 + 4 = 7, Grade Group 3 as Gleason score 4 + 3 = 7, Grade Group 4 as Gleason score 4 + 4 = 8, and Grade Group 5 as Gleason score 9/10. This 5-tiered grade group system better reflects biologic behavior and guides clinical care. The Grade Groups have been endorsed by the ISUP and the World Health Organization. The performance of the Grade Groups has been examined in several recent studies. This review summarizes developments over the last year in the use of grade groups and outlines their value in clinical practice.
Full Text Available This paper summarizes findings and clinical implications of research on attachment disorganization in diverse clinical groups. Disorganized/unresolved attachment is overrepresented in these groups compared to healthy control participants, but disorder specific characteristics of this attachment pattern are still poorly understood. The focus of this study was to explore defensive processes in participants whose narratives were classified as disorganized/unresolved using the Adult Attachment Projective Picture System (AAP. Besides the predominance of disorganized attachment, clinical participants demonstrated more “segregated system material” especially in stories representing aloneness and more “Personal Experience material” compared to healthy individuals. Within the disorganized/ unresolved clinical individuals, BPD and PTSD patients showed the highest proportion of attachment disorganization and were less able to use other attachment-related defenses to maintain organized. Furthermore, PTSD patients were emotionally overwhelmed by the projective attachment scenes compared to the other clinical groups as indexed by an incapacity to complete sections of the AAP. BPD and addicted patients were characterized by a high degree of self-other boundary confusion. Depressive and schizophrenic patients showed a high overall defensive intensity to remain organized.
This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with bette
This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with
Wu, Linxin; Wang, Peng; Zhang, Chunyu; He, Jinghui; Chen, Dongyun; Jun, Jiang; Xu, Qingfeng; Lu, Jianmei
A polymer containing aldehyde active groups (PVB) was synthesized by atom transfer radical polymerization (ATRP), acting as a polymer precursor to graft a functional moiety via nucleophilic addition reaction. DHI (2-(1,5-dimethyl-hexyl)-6-hydrazino-benzo[de]isoquinoline-1,3-dione) and NPH (nitrophenyl hydrazine) groups, which contain naphthalimides that act as narrow traps and nitro groups that act as deep traps, were anchored onto the PVB at different ratios. A series of graft polymers were obtained and named PVB-DHI, PVB-DHI4 -NPH, PVB-DHI-NPH4 , and PVB-NPH. The chemical composition of the polymers was analyzed by (1) H-NMR spectroscopy and X-ray photoelectron spectroscopy (XPS). Memory devices were prepared from the polymers, and I-V characteristics were measured to determine the performance. By adjusting the ratio of different electron acceptors (DHI and NPH) to 4:1, ternary memory behavior was achieved. The relationship between memory behavior of PVB-DHIx NPHy and acceptor groups as well as their conduction mechanism were studied in detail.
Han, Baoguang; Zhan, Jia; John Zhong, Z; Liu, Dawei; Lindborg, Stacy
The borrowing of historical control data can be an efficient way to improve the treatment effect estimate of the current control group in a randomized clinical trial. When the historical and current control data are consistent, the borrowing of historical data can increase power and reduce Type I error rate. However, when these 2 sources of data are inconsistent, it may result in a combination of biased estimates, reduced power, and inflation of Type I error rate. In some situations, inconsistency between historical and current control data may be caused by a systematic variation in the measured baseline prognostic factors, which can be appropriately addressed through statistical modeling. In this paper, we propose a Bayesian hierarchical model that can incorporate patient-level baseline covariates to enhance the appropriateness of the exchangeability assumption between current and historical control data. The performance of the proposed method is shown through simulation studies, and its application to a clinical trial design for amyotrophic lateral sclerosis is described. The proposed method is developed for scenarios involving multiple imbalanced prognostic factors and thus has meaningful implications for clinical trials evaluating new treatments for heterogeneous diseases such as amyotrophic lateral sclerosis. Copyright © 2017 John Wiley & Sons, Ltd.
Hamasaki, Toshimitsu; Evans, Scott R; Ochiai, Toshimitsu
This book focuses on group sequential methods for clinical trials with co-primary endpoints based on the decision-making frameworks for: (1) rejecting the null hypothesis (stopping for efficacy), (2) rejecting the alternative hypothesis (stopping for futility), and (3) rejecting the null or alternative hypothesis (stopping for either futility or efficacy), where the trial is designed to evaluate whether the intervention is superior to the control on all endpoints. For assessing futility, there are two fundamental approaches, i.e., the decision to stop for futility based on the conditional probability of rejecting the null hypothesis, and the other based on stopping boundaries using group sequential methods. In this book, the latter approach is discussed. The book also briefly deals with the group sequential methods for clinical trials designed to evaluate whether the intervention is superior to the control on at least one endpoint. In addition, the book describes sample size recalculation and the resulting ef...
Paredes, T; Pereira, M; Simões, M R; Canavarro, M C
The present study examined change on emotional distress of sarcoma patients from the diagnostic to treatment phases, the distinct trajectories of adjustment and the influence of demographic, clinical and coping variables on anxiety and depression. Thirty-six sarcoma patients completed questionnaires on emotional distress (Hospital Anxiety and Depression Scale) and coping strategies (Brief Cope) at time of diagnosis, and again during treatment. No significant change in emotional distress levels was found from diagnostic to treatment phase, with mean anxiety and depression scores remaining below the clinical range. Over time, 52.8% and 66.7% of patients maintained non-clinical anxious and depressive symptoms respectively, and 25% and 11.1% remained with clinical anxiety and depression. Living with partner, less use of humour and more denial were associated with high emotional distress at time of diagnosis and during treatments, and high levels of distress at baseline were predictive of poorer emotional adjustment during treatments. Although sarcoma patients, in general, seem to exhibit good psychological adjustment, there is a significant minority that requires mental health services in order to help decrease their emotional distress following the diagnosis, and prevent psychological difficulties during treatments. Our findings are an important contribution to understanding the psychological adjustment of patients with a specific and rare type of cancer.
Adaptive designs have been proposed for clinical trials in which the nuisance parameters or alternative of interest are unknown or likely to be misspecified before the trial. Whereas most previous works on adaptive designs and mid-course sample size re-estimation have focused on two-stage or group sequential designs in the normal case, we consider here a new approach that involves at most three stages and is developed in the general framework of multiparameter exponential families. Not only does this approach maintain the prescribed type I error probability, but it also provides a simple but asymptotically efficient sequential test whose finite-sample performance, measured in terms of the expected sample size and power functions, is shown to be comparable to the optimal sequential design, determined by dynamic programming, in the simplified normal mean case with known variance and prespecified alternative, and superior to the existing two-stage designs and also to adaptive group sequential designs when the al...
Dworkin, Robert H; Turk, Dennis C; McDermott, Michael P; Peirce-Sandner, Sarah; Burke, Laurie B; Cowan, Penney; Farrar, John T; Hertz, Sharon; Raja, Srinivasa N; Rappaport, Bob A; Rauschkolb, Christine; Sampaio, Cristina
An essential component of the interpretation of results of randomized clinical trials of treatments for chronic pain involves the determination of their clinical importance or meaningfulness. This involves two distinct processes--interpreting the clinical importance of individual patient improvements and the clinical importance of group differences--which are frequently misunderstood. In this article, we first describe the essential differences between the interpretation of the clinical importance of patient improvements and of group differences. We then discuss the factors to consider when evaluating the clinical importance of group differences, which include the results of responder analyses of the primary outcome measure, the treatment effect size compared to available therapies, analyses of secondary efficacy endpoints, the safety and tolerability of treatment, the rapidity of onset and durability of the treatment benefit, convenience, cost, limitations of existing treatments, and other factors. The clinical importance of individual patient improvements can be determined by assessing what patients themselves consider meaningful improvement using well-described methods. In contrast, the clinical meaningfulness of group differences must be determined by a multi-factorial evaluation of the benefits and risks of the treatment and of other available treatments for the condition in light of the primary goals of therapy. Such determinations must be conducted on a case-by-case basis, and are ideally informed by patients and their significant others, clinicians, researchers, statisticians, and representatives of society at large.
Lee, Byoung Sook; Eo, Yong Sook; Lee, Mi Aie
The purpose of this study was to understand and describe the leadership experience of clinical nurses. During 2014, data were collected using focus group interviews. Three focus group interviews were held with a total of 20 clinical nurses participating. All interviews were recorded as they were spoken and transcribed and data were analyzed using qualitative content analysis. Fifteen categories emerged from the five main themes. 1) Thoughts on the leadership category: to lead others, to cope with problem situations adequately and to serve as a shield against difficulties. 2) Situations requiring leadership: situation that requires correct judgement, coping and situations that need coordination and cooperation. 3-1) Leadership behaviors: other-oriented approach and self-oriented approach. 3-2) Leadership behavior consequences: relevant compensation and unfair termination. 4-1) Facilitators of leadership: confidence and passion for nursing and external support and resources. 4-2) Barriers to leadership: non-supportive organization culture and deficiency in own leadership competencies. 5) Strategies of leadership development: strengthen leadership through self-development and organizational leadership development. In conclusion, the results indicate that it is necessary to enhance clinical nurses' leadership role in healthcare. Enhancement can be achieved through leadership programs focused on enlarging leadership experience, constant self-development, leadership training, and development of leadership competencies suited to the nursing environment.
Fleming, Pete; King, Lorraine; Royle, Jane
A service evaluation was performed exploring nurses' perceptions of a clinical psychology facilitated peer support group in a spinal injury rehabilitation setting. To determine whether staff found the meetings useful while, more broadly, to highlight the need to support and supervise nursing staff in psychological care appropriately. A questionnaire was developed and distributed to the 30 members of staff who worked on the ward. Seventeen questionnaires were returned (57%). Data was analysed using thematic analysis. The meetings were viewed as a place to discuss issues, and a safe protected space to share stresses. Staff felt the meetings aided team cohesion and helped them share ideas and draw up clinical strategies. Meetings aided stress management and confidence building. Staff considered the meetings to increase their psychological awareness and understanding. Staff involved in the acute care and rehabilitation of spinal injured patients are consistently exposed to highly demanding and stressful clinical environments. Support meetings where staff can discuss patient and ward issues are invaluable. Other clinical nursing areas would benefit from similar support systems.
Plaugher, Gregory; Long, Cynthia R; Alcantara, Joel; Silveus, Alyssa D; Wood, Herbert; Lotun, Kapildeo; Menke, J Michael; Meeker, William C; Rowe, Stephen H
To determine the feasibility of conducting a randomized clinical trial in the private practice setting examining short- and long-term effects of chiropractic adjustments for subjects with essential hypertension compared with a brief soft tissue massage, as well as a nontreatment control group. Randomized controlled-comparison trial with 3 parallel groups. Private practice outpatient chiropractic clinic. Twenty-three subjects, aged 24 to 50 years with systolic or diastolic essential hypertension. Two months of full-spine chiropractic care (ie, Gonstead) consisting primarily of specific-contact, short-lever-arm adjustments delivered at motion segments exhibiting signs of subluxation. The massage group had a brief effleurage procedure delivered at localized regions of the spine believed to be exhibiting signs of subluxation. The nontreatment control group rested alone for a period of approximately 5 minutes in an adjustment room. Cost per enrolled subject, as well as systolic and diastolic blood pressure (BP) measured with a random-0 sphygmomanometer and patient reported health status (SF-36). Pilot study outcome measures also included an assessment of cooperation of subjects to randomization procedures and drop-out rates, recruitment effectiveness, analysis of temporal stability of BPs at the beginning of care, and the effects of inclusion/exclusion criteria on the subject pool. Thirty subjects enrolled, yielding a cost of $161 per enrolled subject. One subject was later determined to be ineligible, and 6 others dropped out. In both the chiropractic and massage therapy groups, all subjects were classified as either overweight or obese; in the control group there were only 2 classified as such. SF-36 profiles for the groups were similar to that of a normal population. The mean change in diastolic BP was -4 (95% confidence interval [CI]: -8.6, 0.5) in the chiropractic care group, 0.5 (95% CI: -3.5, 4.5) in the brief massage treatment group, and -4.9 (95% CI: -9.7, -0
Davila-Seijo, P; Batalla, A; Garcia-Doval, I
Systematic reviews are one of the most important sources of information for evidence-based medicine. However, there is a general impression that these reviews rarely report results that provide sufficient evidence to change clinical practice. The aim of this study was to determine the percentage of Cochrane Skin Group reviews reporting results with the potential to guide clinical decision-making. We performed a bibliometric analysis of all the systematic reviews published by the Cochrane Skin Group up to 16 August, 2012. We retrieved 55 reviews, which were analyzed and graded independently by 2 investigators into 3 categories: 0 (insufficient evidence to support or reject the use of an intervention), 1 (insufficient evidence to support or reject the use of an intervention but sufficient evidence to support recommendations or suggestions), and 2 (sufficient evidence to support or reject the use of an intervention). Our analysis showed that 25.5% (14/55) of the studies did not provide sufficient evidence to support or reject the use of the interventions studied, 45.5% (25/25) provided sufficient but not strong evidence to support recommendations or suggestions, and 29.1% (16/55) provided strong evidence to support or reject the use of 1 or more of the interventions studied. Most of the systematic reviews published by the Cochrane Skin Group provide useful information to improve clinical practice. Clinicians should read these reviews and reconsider their current practice. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.
Chen, Zhi-Wei; Yao, Sheng-Yu; Zhang, Tie-Ning; Zhu, Zhen-Hua; Hu, Zhe-Kai; Lu, Xun
A new type of water phantom which would be specialised for the absorbed dose measurement in total body irradiation (TBI) treatment is developed. Ten millimetres of thick Plexiglas plates were arranged to form a square cube with 300 mm of edge length. An appropriate sleeve-type piston was installed on the side wall, and a tabular Plexiglas piston was positioned inside the sleeve. By pushing and pulling the piston, the length of the self-made water phantom could be varied to meet the required patients' physical sizes. To compare the international standard water phantom with the length-adjustable and the Plexiglas phantoms, absorbed dose for 6-MV X ray was measured by an ionisation chamber at different depths in three kinds of phantoms. In 70 cases with TBI, midplane doses were metered using the length-adjustable and the Plexiglas phantoms for simulating human dimensions, and dose validation was synchronously carried out. There were no significant statistical differences, p > 0.05, through statistical processing of data from the international standard water phantom and the self-designed one. There were significant statistical differences, p body width. Obviously, the difference had a positive correlation with the body width. The results proved that the new length-adjustable water phantom is more accurate for simulating human dimensions than Plexiglas phantom.
Drakulić, Aleksandra Mindoljević
Modern history of short-term group psychotherapy dates back to the late 1950-ies. From then to present day, this psychotherapeutic method has been used in various forms, from dynamic-oriented to cognitive behavioural psychotherapies. Although it has always been considered rather controversial, due its cost-effectiveness, it has been capturing more and more popularity. This paper presents the specificities of first session short-term psychotherapy psychodrama group through session work with two examined groups: a group of 20 adult women who suffer from mild or moderate forms of unipolar depression and a group of 20 students of the School of Medicine in Zagreb without any psychiatric symptomatology. The results indicate the high importance of having structure in first psychodrama session, of relating it with the previously thoroughly conducted, initial, clinical, interviews, and of the clarity and focus in terms of determining the goals of therapy, especially in a clinical context. This study also confirmed assumptions regarding the need for different approaches of warming-up in psychodrama, both in the clinical and in non-clinical samples. A psychodrama psychotherapist should have good time managing skills and capability to convert the time available into an opportunity for directly boosting the group energy and work on therapeutic alliance.
Ding, Su-Ann; Simonson, Donald C.; Wewalka, Marlene; Halperin, Florencia; Foster, Kathleen; Goebel-Fabbri, Ann; Hamdy, Osama; Clancy, Kerri; Lautz, David; Vernon, Ashley
Context: Recommendations for surgical, compared with lifestyle and pharmacologically based, approaches for type 2 diabetes (T2D) management remain controversial. Objective: The objective was to compare laparoscopic adjustable gastric band (LAGB) to an intensive medical diabetes and weight management (IMWM) program for T2D. Design: This was designed as a prospective, randomized clinical trial. Setting: The setting was two Harvard Medical School-affiliated academic institutions. Interventions and Participants: A 12-month randomized trial comparing LAGB (n = 23) vs IMWM (n = 22) in persons aged 21–65 years with body mass index of 30–45 kg/m2, T2D diagnosed more than 1 year earlier, and glycated hemoglobin (HbA1c) ≥ 6.5% on antihyperglycemic medication(s). Main Outcome Measure: The proportion meeting the prespecified primary glycemic endpoint, defined as HbA1c < 6.5% and fasting glucose < 7.0 mmol/L at 12 months, on or off medication. Results: After randomization, five participants did not undergo the surgical intervention. Of the 40 initiating intervention (22 males/18 females; age, 51 ± 10 y; body mass index, 36.5 ± 3.7 kg/m2; diabetes duration, 9 ± 5 y; HbA1c, 8.2 ± 1.2%; 40% on insulin), the proportion meeting the primary glycemic endpoint was achieved in 33% of the LAGB patients and 23% of the IMWM patients (P = .457). HbA1c reduction was similar between groups at both 3 and 12 months (−1.2 ± 0.3 vs −1.0 ± 0.3%; P = .496). Weight loss was similar at 3 months but greater 12 months after LAGB (−13.5 ± 1.7 vs −8.5 ± 1.6 kg; P = .027). Systolic blood pressure reduction was greater after IMWM than LAGB, whereas changes in diastolic blood pressure, lipids, fitness, and cardiovascular risk scores were similar between groups. Patient-reported health status, assessed using the Short Form-36, Impact of Weight on Quality of Life, and Problem Areas in Diabetes, all improved similarly between groups. Conclusions: LAGB and a multidisciplinary IMWM program
Fujiwara, Takeo; Kato, Noriko; Sanders, Matthew R.
The purpose of this study is to investigate the effectiveness of a group-based family intervention program known as the Group Positive Parenting Program (Triple P), with families in Japan. Reductions in children's behavioral problems, changes in dysfunctional parenting practices, and affects on parenting adjustment were examined. Participants of…
Fujiwara, Takeo; Kato, Noriko; Sanders, Matthew R.
The purpose of this study is to investigate the effectiveness of a group-based family intervention program known as the Group Positive Parenting Program (Triple P), with families in Japan. Reductions in children's behavioral problems, changes in dysfunctional parenting practices, and affects on parenting adjustment were examined. Participants of…
Kanellopoulos, Anastasios John
To evaluate the safety, efficacy, and contralateral eye comparison of topography-guided myopic LASIK with two different refraction treatment strategies. Private clinical ophthalmology practice. A total of 100 eyes (50 patients) in consecutive cases of myopic topography-guided LASIK procedures with the same refractive platform (FS200 femtosecond and EX500 excimer lasers) were randomized for treatment as follows: one eye with the standard clinical refraction (group A) and the contralateral eye with the topographic astigmatic power and axis (topography-modified treatment refraction; group B). All cases were evaluated pre- and post-operatively for the following parameters: refractive error, best corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), topography (Placido-disk based) and tomography (Scheimpflug-image based), wavefront analysis, pupillometry, and contrast sensitivity. Follow-up visits were conducted for at least 12 months. Mean refractive error was -5.5 D of myopia and -1.75 D of astigmatism. In group A versus group B, respectively, the average UDVA improved from 20/200 to 20/20 versus 20/16; post-operative CDVA was 20/20 and 20/13.5; 1 line of vision gained was 27.8% and 55.6%; and 2 lines of vision gained was 5.6% and 11.1%. In group A, 27.8% of eyes had over -0.50 diopters of residual refractive astigmatism, in comparison to 11.7% in group B (Prefractive astigmatism of more than -0.5 diopters. Topography-modified refraction (TMR): topographic adjustment of the amount and axis of astigmatism treated, when different from the clinical refraction, may offer superior outcomes in topography-guided myopic LASIK. These findings may change the current clinical paradigm of the optimal subjective refraction utilized in laser vision correction.
Newsum, Elize C; van der Helm-van Mil, Annette H M; Kaptein, Adrian A
The rheumatology field is moving towards identifying individuals with an increased risk for rheumatoid arthritis (RA) at a stage when arthritis is still absent but persons having clinically suspect arthralgia (CSA). Incorporating patients' views in rheumatologic care is pivotal; however, the views of persons with CSA on their condition are unknown. We aimed to help fill this gap by exploring illness perceptions of persons with CSA and their views on hypothetical prognoses for developing RA. Persons with CSA were invited to participate in a semi-structured focus group discussion. Illness perceptions according to the Common Sense Model (CSM) and four a priori formulated themes were explored in detail during the group discussion. The discussion was audio-taped and transcribed verbatim. Transcripts were analysed in an interpretative phenomenological approach manner, on the basis of the dimensions of the CSM by three researchers independently. The views of four participants with CSA were explored during one focus group discussion. Four dimensions of the CSM were mainly observed: Identity, Consequences, Personal Control and Concern. None of the patients identified themselves as being a patient. They did experience pain and impairments in daily functioning and were concerned that their symptoms would progress. In the absence of physician-initiated treatment, some patients changed lifestyle in order to reduce pain and to promote health. Patients unanimously said that they could not interpret prognostic information on RA development expressed in hypothetical chances. Persons with CSA do not consider themselves patients. Prognostic information related to the development of RA based on risk percentages was considered as not useful by persons with CSA. Understanding of the illness perceptions of persons with CSA by health care professionals might improve medical management and facilitate shared decision-making.
Sanders, Jim; Lacey, Marcus; Guse, Clare E
Savings garnered through the provision of preventive services is a form of profit for health systems. Free clinics have been using this logic to demonstrate their cost-savings. The Community-Based Chronic Disease Management (CCDM) clinic treats hypertension using nurse-led teams, clinical protocols, and community-based settings. We calculated CCDM's cost-effectiveness from 2007 to 2013 using 2 metrics: Quality-adjusted life years (QALYs) saved and return on investment (ROI). QALYs were calculated using the Clinical Preventive Burden (CPB) score for hypertension care. ROI was calculated by tallying the savings from prevented heart attacks, strokes, and emergency department visits against the total operating costs. Using conservative assumptions for cost estimates, hypertension care resulted in a value of QALYs saved of $711,000 to $2,133,000 and an ROI ratio range of 0.35 to 1.20. Our study shows that when using conservative assumptions to calculate cost-savings, our free clinic did not save money. Cost-savings did occur, but the amount was modest, was less than that of cost-inputs, and was not likely captured by any single health entity. Although free clinics remain a vital health care access point for many Americans, it has yet to be demonstrated that they generate a net savings. © Copyright 2017 by the American Board of Family Medicine.
A new approach to adaptive design of clinical trials is proposed in a general multiparameter exponential family setting, based on generalized likelihood ratio statistics and optimal sequential testing theory. These designs are easy to implement, maintain the prescribed Type I error probability, and are asymptotically efficient. Practical issues involved in clinical trials allowing mid-course adaptation and the large literature on this subject are discussed, and comparisons between the proposed and existing designs are presented in extensive simulation studies of their finite-sample performance, measured in terms of the expected sample size and power functions.
Stuive, Ilse; Kiers, Henk A.L.; Timmerman, Marieke E.
A common question in test evaluation is whether an a priori assignment of items to subtests is supported by empirical data. If the analysis results indicate the assignment of items to subtests under study is not supported by data, the assignment is often adjusted. In this study the authors compare t
van den Oord, Edwin J. C. G.; Van Rossem, Ronan
Examined differences among classes in academic and psychosocial aspects of school adjustment. Multilevel analyses showed that 83.5% of the variance was at the child level, 10.3% at the class level, and 6.2% at the school level. Social structure indices yielded significant correlation indicators of social interaction and intellectual competence and…
Chen, Xinyin; Chang, Lei; He, Yunfeng; Liu, Hongyun
This 2-year longitudinal study examined, in a sample of Chinese children (initial M age=11 years), the moderating effects of the peer group on relations between maternal supportive parenting and social and school adjustment. Data were collected from multiple sources including peer assessments, teacher ratings, school records, and maternal reports.…
Engels, Martin; Heijboer, A.C.; Blankenstein, M.A.; Vugt, J.M.G. van
OBJECTIVE: To evaluate the performance of the first-trimester combined test (FCT) in different maternal age groups and to discuss whether adjustments in screening policies should be made. METHODS: In this retrospective study data (n = 26 274) from a fetal medicine center on FCT (maternal age, fetal
Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol
Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Full Text Available BACKGROUND: When rates of uptake of other drugs differ between treatment arms in long-term trials, the true benefit or harm of the treatment may be underestimated. Methods to allow for such contamination have often been limited by failing to preserve the randomization comparisons. In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD study, patients were randomized to fenofibrate or placebo, but during the trial many started additional drugs, particularly statins, more so in the placebo group. The effects of fenofibrate estimated by intention-to-treat were likely to have been attenuated. We aimed to quantify this effect and to develop a method for use in other long-term trials. METHODOLOGY/PRINCIPAL FINDINGS: We applied efficacies of statins and other cardiovascular drugs from meta-analyses of randomized trials to adjust the effect of fenofibrate in a penalized Cox model. We assumed that future cardiovascular disease events were reduced by an average of 24% by statins, and 20% by a first other major cardiovascular drug. We applied these estimates to each patient who took these drugs for the period they were on them. We also adjusted the analysis by the rate of discontinuing fenofibrate. Among 4,900 placebo patients, average statin use was 16% over five years. Among 4,895 assigned fenofibrate, statin use was 8% and nonuse of fenofibrate was 10%. In placebo patients, use of cardiovascular drugs was 1% to 3% higher. Before adjustment, fenofibrate was associated with an 11% reduction in coronary events (coronary heart disease death or myocardial infarction (P = 0.16 and an 11% reduction in cardiovascular disease events (P = 0.04. After adjustment, the effects of fenofibrate on coronary events and cardiovascular disease events were 16% (P = 0.06 and 15% (P = 0.008, respectively. CONCLUSIONS/SIGNIFICANCE: This novel application of a penalized Cox model for adjustment of a trial estimate of treatment efficacy incorporates evidence
Stormshak, E A; Bierman, K L
Based upon developmental models of disruptive behavior problems, this study examined the hypothesis that the nature of a child's externalizing problems at home may be important in predicting the probability of and nature of school adjustment problems at school entry. Parent ratings were collected for a sample of 631 behaviorally disruptive children using the Child Behavior Checklist. Confirmatory factor analyses revealed differentiated ratings of oppositional, aggressive, and hyperactive/inattentive behaviors at home. Teacher and peer nominations assessed school adjustment at the end of first grade. As expected from a developmental perspective, aggressive behaviors indicated more severe dysfunction and were more likely to generalize to the school setting than were oppositional behaviors. Hyperactive/inattentive behaviors at home led to more classroom disruption than did aggressive or oppositional behaviors. Co-occurring patterns of oppositional/aggressive and hyperactive/inattentive behaviors were more common than were single-problem patterns, and were associated with broad dysfunction in the social and classroom contexts. The results were interpreted within a developmental framework, in which oppositional, aggressive, and hyperactive/inattentive behaviors may reflect distinct (as well as shared) developmental processes that have implications for the home-to-school generalization of behavior problems and subsequent school adjustment.
Full Text Available Anastasios John Kanellopoulos1,2 1LaserVision Clinical and Research Institute, Athens, Greece; 2Department of Ophthalmology, NYU Medical School, New York, NY, USA Purpose: To evaluate the safety, efficacy, and contralateral eye comparison of topography-guided myopic LASIK with two different refraction treatment strategies. Setting: Private clinical ophthalmology practice. Patients and methods: A total of 100 eyes (50 patients in consecutive cases of myopic topography-guided LASIK procedures with the same refractive platform (FS200 femtosecond and EX500 excimer lasers were randomized for treatment as follows: one eye with the standard clinical refraction (group A and the contralateral eye with the topographic astigmatic power and axis (topography-modified treatment refraction; group B. All cases were evaluated pre- and post-operatively for the following parameters: refractive error, best corrected distance visual acuity (CDVA, uncorrected distance visual acuity (UDVA, topography (Placido-disk based and tomography (Scheimpflug-image based, wavefront analysis, pupillometry, and contrast sensitivity. Follow-up visits were conducted for at least 12 months. Results: Mean refractive error was -5.5 D of myopia and -1.75 D of astigmatism. In group A versus group B, respectively, the average UDVA improved from 20/200 to 20/20 versus 20/16; post-operative CDVA was 20/20 and 20/13.5; 1 line of vision gained was 27.8% and 55.6%; and 2 lines of vision gained was 5.6% and 11.1%. In group A, 27.8% of eyes had over -0.50 diopters of residual refractive astigmatism, in comparison to 11.7% in group B (P<0.01. The residual percentages in both groups were measured with refractive astigmatism of more than –0.5 diopters. Conclusion: Topography-modified refraction (TMR: topographic adjustment of the amount and axis of astigmatism treated, when different from the clinical refraction, may offer superior outcomes in topography-guided myopic LASIK. These findings
Johnson, Ronald C.; Nagoshi, Craig T.
Results indicated offspring of within-group versus across-racial/ethnic marriages did not differ in personality test scores. As compared with offspring of within-group marriages, male offspring of across-group marriages scored higher on a factor measuring socially desirable traits and lower on a factor measuring intraception, while female…
Mahesh J. Patel; Cris A. Slentz; William E. Kraus
Randomized clinical trials of exercise training regimens in sedentary individuals have provided a mechanistic understanding of the long-term health benefits and consequences of physical activity and inactivity...
Okazaki, Tsubasa; Kato, Satoshi
The purpose of this study was to describe the clinical characteristics of patients with workplace-associated mood disorder. We conducted a clinical survey involving 84 clinical cases (regular employees suffering from mood disorder) who were hospitalized in the Psychiatry Department of Jichi Medical University Hospital, for a period over 8 years and 4 months between April 1st, 2000 and July 31st, 2008. The size of the workplace-associated group as a percentage of those patients in whom the onset of the symptom was occasioned by an evident issue at their workplace was 65%. This rate accounted for 74% of the total patients if clinical cases in which an evident issue at the workplace served as a significant trigger for the symptom were added to these patients in the case of an initial episode in the "non-workplace associated group". In the workplace-associated group, cases in which the premorbid character was a "depression-related personality" comprised only 42%, and was noticeably characterized by a perfection-oriented habit, enthusiastic character, conformity with other people, etc. Furthermore, the percentage of patients who were diagnosed with a "depression-related personality" comprised only 59% of the "overworked group", in which a heavy workload was evident in the workplace-associated group. In the workplace-associated group, the percentage of cases involving managerial workers was significantly high; their rate as initial cases was significantly high, as well the proportion of favorable outcomes. In the workplace-associated group, the percentage of patients who showed unambiguous depression at the initial stage was significantly low. Likewise, a similar result was obtained in the overworked group. Workplace-associated mood disorder today tends to have a stress-related aspect, or aspect of adjustment disorder. There was a period in many cases during which the main symptoms were insomnia, headache, panic attack, etc., prior to the onset of unambiguous depression
This study compared the effectiveness of short-term developmental group counseling applying Gestalt-play versus cognitive-verbal approaches with Taiwanese adolescents. On a measure of behavioral and emotional strengths, teachers reported significant changes in students' overall behavioral and emotional strengths measured via total scores. Specific…
L.M. Lamers (Leida)
textabstractOBJECTIVE: To evaluate the predictive accuracy of the Diagnostic Cost Group (DCG) model using health survey information. DATA SOURCES/STUDY SETTING: Longitudinal data collected for a sample of members of a Dutch sickness fund. In the Netherlands the sickness
This study compared the effectiveness of short-term developmental group counseling applying Gestalt-play versus cognitive-verbal approaches with Taiwanese adolescents. On a measure of behavioral and emotional strengths, teachers reported significant changes in students' overall behavioral and emotional strengths measured via total scores. Specific…
LeRoy, Michelle; Mahoney, Annette; Boxer, Paul; Gullan, Rebecca Lakin; Fang, Qijuan
The goals of this study were first, to delineate the co-occurrence of parental severe physical aggression and verbal aggression toward clinic-referred adolescents, and second, to examine the interactive effects of parental severe physical aggression and verbal aggression on adolescent externalizing and internalizing behavior problems. This research involved 239 referrals of 11- to 18-year-old youth and their dual-parent families to a non-profit, private community mental health center in a semi-rural Midwest community. Multiple informants (i.e., adolescents and mothers) were used to assess parental aggression and adolescent behavior problems. More than half of clinic-referred adolescents (51%) experienced severe physical aggression and/or high verbal aggression from one or both parents. A pattern of interactive effects of mother-to-adolescent severe physical aggression and verbal aggression on adolescent behavior problems emerged, indicating that when severe physical aggression was present, mother-to-adolescent verbal aggression was positively associated with greater adolescent behavior problems whereas when severe physical aggression was not present, the links between verbal aggression and behavior problems was no longer significant. No interactive effects were found for father-to-adolescent severe physical aggression and verbal aggression on adolescent adjustment; however, higher father-to-adolescent verbal aggression was consistently linked to behavior problems above and beyond the influence of severe physical aggression. The results of this study should promote the practice of routinely assessing clinic-referred adolescents and their parents about their experiences of verbal aggression in addition to severe physical aggression and other forms of abuse.
Traupe, H; Happle, R
Combined application of clinical, genetic and histological criteria in general allows a definite diagnosis of autosomal dominant ichthyosis vulgaris and of X-linked recessive ichthyosis. For differential diagnosis, the following rare syndromes should be considered: ichthyosis bullosa: Refsum syndrome; Jung-Vogel syndrome; ichthyosis with corneal opacity, pili torti and alopecia; ichthyosis with deafness, pili torti and dental anomalies; and ichthyosis with hepatosplenomegaly and cerebellar degeneration.
A Comparison of Clinical and Non-Clinical Samples Using the Concepts of: Individual Personality, Family Structure, Family of Origin Perception, Sexuality, and Adjustment/Adaptability To Determine Family Risk for Father Daughter Incest.
Utesch, William E.
Father-daughter incest is more traumatic than any other type of child-sexual molestation. This study examines some of the factors which may lead to father-daughter incest. The author divided 40 Caucasian couples into three groups: (1) clinical incest group; (2) clinical non-incest group (to control for clinical status); and (3) non-clinical group.…
Evidence suggests that group clinical supervision of counsellors and trainees is an effective mode of service delivery. However, clinical supervision is often understood to be concerned with teaching a generic set of skills. Without specifically labeling them as such, clinical supervision groups are implicitly identified as psycho-educational…
cerebrovascular accident , myocardial infarction, unstable angina, or coronary artery stenting within 6 months of enrollment, or a history of venous thrombosis...concept and accruing to six DOD-PCCTC trials including two that stem from major contributions by our group. c11-089 is a randomized, gene fusion...status in the CTCs is associated with response to therapy. To evaluate changes in circulating tumor cells (CTCs) at baseline and during therapy in all
In this paper, adjustment factors J and R put forward by professor Zhou Jiangwen are introduced and the nature of the adjustment factors and their role in evaluating adjustment structure is discussed and proved.
Halvarsson, Alexandra; Oddsson, Lars; Olsson, Elisabeth; Farén, Elin; Pettersson, Anna; Ståhle, Agneta
To evaluate the effects of a new, individually adjusted, progressive and specific balance group training programme on fear of falling, step execution, and gait in healthy elderly people with fear of falling and tend to fall. Randomized controlled trial. The study was conducted in Stockholm County, Sweden. Fifty-nine community dwelling elderly people were recruited by advertisement, and allocated at random to an intervention group (n = 38) or a control group (n = 21). Individually adjusted, progressive and specific balance group training was given three times a week for three months. The training incorporated elements included in, and required for, independent activities of daily living, and for reactions to loss of balance during dual or multiple tasks. Fear of falling was assessed with Falls Efficacy Scale International (FES-I). The reaction time of step execution was measured with the step-execution test, and gait was measured with GAITRite®. After three months the intervention group showed significant positive changes in the FES-I (P = 0.008), in the step-execution phase of dual-task performance (P = 0.012), and in gait at preferred speed during single-task performance; in cadence (P = 0.030) and, at fast speed, in velocity (P = 0.004) and cadence (P = 0.001). Significant decreases were also found for the likelihood of depression after participating in the training programme. This new balance training programme is feasible and leads to decreased fear of falling, decreased time for step execution during dual-task performance and increased velocity during fast walking.
Fisher, Paul; Hemanth, P
This article presents an evaluation of a Mindfulness group facilitate for trainee and qualified psychologists working in a university psychology clinic. the group was shown to have both personal and professional benefits for participants, but further evaluation is required.
M. Gaspar, Raquel; Murgoci, Agatha
of particular importance to practitioners: yield convexity adjustments, forward versus futures convexity adjustments, timing and quanto convexity adjustments. We claim that the appropriate way to look into any of these adjustments is as a side effect of a measure change, as proposed by Pelsser (2003...
Luo, Jake; Eldredge, Christina; Cho, Chi C; Cisler, Ron A
Understanding adverse event patterns in clinical studies across populations is important for patient safety and protection in clinical trials as well as for developing appropriate drug therapies, procedures, and treatment plans. The objective of our study was to conduct a data-driven population-based analysis to estimate the incidence, diversity, and association patterns of adverse events by age of the clinical trials patients and participants. Two aspects of adverse event patterns were measured: (1) the adverse event incidence rate in each of the patient age groups and (2) the diversity of adverse events defined as distinct types of adverse events categorized by organ system. Statistical analysis was done on the summarized clinical trial data. The incident rate and diversity level in each of the age groups were compared with the lowest group (reference group) using t tests. Cohort data was obtained from ClinicalTrials.gov, and 186,339 clinical studies were analyzed; data were extracted from the 17,853 clinical trials that reported clinical outcomes. The total number of clinical trial participants was 6,808,619, and total number of participants affected by adverse events in these trials was 1,840,432. The trial participants were divided into eight different age groups to support cross-age group comparison. In general, children and older patients are more susceptible to adverse events in clinical trial studies. Using the lowest incidence age group as the reference group (20-29 years), the incidence rate of the 0-9 years-old group was 31.41%, approximately 1.51 times higher (P=.04) than the young adult group (20-29 years) at 20.76%. The second-highest group is the 50-59 years-old group with an incidence rate of 30.09%, significantly higher (Pdata suggest that age-associated adverse events should be considered in planning, monitoring, and regulating clinical trials.
Objective To observe the clinical efficacy on cervical spondylotic radiculopathy treated with vertebral micro-adjustment manipulation.Methods 140 cases were randomly divided into control group and treatment group,70 cases in each one.In control group,nabumetone capsule was administered.In treatment group,vertebral micro-adjustment manipulation was adopted.The clinical efficacy was observed after treatment in two groups.Results The total effective rate was 97.14% in treatment group and 88.57% in control group,demonstrating significant difference in group comparison(P＜0.05).Conclusion Vertebral micro-adjustment manipulation presents apparently superior efficacy on cervical spondylotic radiculopathy compared with medicinal therapy.It removes nerve root stimulation and compression radically and cures the disease.%目的 观察逐椎微调手法治疗神经根型颈椎病的临床疗效.方法 将140例患者按完全随机原则分为对照组与治疗组,每组70例.对照组患者采用萘丁美酮胶囊治疗,治疗组采用逐椎微调手法治疗.观察两组患者治疗后的临床疗效.结果 治疗组总有效率为97.14 %,对照组为88.57%,两组比较有显著性差异(P＜0.05).结论 逐椎微调手法对神经根型颈椎病的治疗效果明显优于药物治疗,可从根本上解除神经根的刺激和压迫,达到治愈疾病的目的 .
This book provides an up-to-date review of the general principles of and techniques for confirmatory adaptive designs. Confirmatory adaptive designs are a generalization of group sequential designs. With these designs, interim analyses are performed in order to stop the trial prematurely under control of the Type I error rate. In adaptive designs, it is also permissible to perform a data-driven change of relevant aspects of the study design at interim stages. This includes, for example, a sample-size reassessment, a treatment-arm selection or a selection of a pre-specified sub-population. Essentially, this adaptive methodology was introduced in the 1990s. Since then, it has become popular and the object of intense discussion and still represents a rapidly growing field of statistical research. This book describes adaptive design methodology at an elementary level, while also considering designing and planning issues as well as methods for analyzing an adaptively planned trial. This includes estimation methods...
Grineva, I M; Khokholeva, A A; Obora, V V; Karagodina, E G; Lazarenko, A N
Socio-psychological and clinical factors and their significance for group psychotherapy were investigated in 62 patients with neuroses. The obtained statistically valid differences of some characteristic aspects between groups of patients with positive and negative directives. This indicates the necessity of differential approach to group psychotherapy and active individual and group work on the creation of positive motivation to this type of treatment.
Kivlighan, Dennis M
I describe three clinical processes: (a) bringing the discussion into the here-and-now; (b) making impact disclosures; and (c) creating a corrective emotional experience, derived from interpersonal theory, that occurs in most of my individual and group therapy sessions. For each of these clinical processes, I provide: (a) the theoretical principals that support the clinical process, (b) clinical descriptions and dialogue that demonstrate the process, and (c) a review of some of the research examining the clinical process. Finally, I propose a task model of interpersonal therapy, which illustrates how the three clinical processes come together in interpersonal therapy.
Ziaaddini, Hassan; Ebrahim-Nejad, Batoul; Nakhaee, Nouzar
A significant number of opioid-dependent patients in Iran are now being treated by methadone maintenance therapy (MMT). One of the social complications of substance dependency is family disorganization and a decrease in marital satisfaction. This study aimed to determine the effect of group therapy based on the transtheoretical model of change on family functioning of the patients under MMT. In this open clinical trial, 48 married people who were between the ages of 19 and 40, and under methadone maintenance therapy had been assigned to two random groups of test and control. In the intervention group, group therapy was held based on the transtheoretical model of behavior change, for 29 sessions (two times a week). To assess the overall health and pathology of the family, the two questionnaires Family Assessment Device (FAD) and Marital Conflict Questionnaire (MCQ), both with approved reliability and validity, were used. A total of 24 patients in the control group and 23 patients in the intervention group (one person withdrew from the study in the early meetings) were evaluated. The mean ± SD of age of the control and intervention groups, respectively, were 33.9 ± 4.8 and 32.8 ± 4.3 (P = 0.40). Before the intervention began the average score of FAD and MCQ questionnaires between the two groups was comparable. After the intervention was over the score of each of the two questionnaires, with the adjustment of the baseline score, was lower in the treatment group than the control group, the difference was marginally significant (P family functioning of the MMT treated patients showed improvement. Therefore, with the use of stage-of-change and group therapy, steps can be taken for improving family functioning of these patients. Due to the relatively long duration and frequency of treatment sessions the feasibility of this intervention needs further research.
Luquetti, Daniela V; Saltzman, Babette S; Heike, Carrie L; Sie, Kathleen C; Birgfeld, Craig B; Evans, Kelly N; Leroux, Brian G
The clinical presentation of microtia varies widely from minimal morphological abnormalities to complete absence of the ear. In this study we sought to identify and characterize sub-groups of microtia using a statistical and a clinical approach. Photographs of 86 ears were classified in relation to all the external ear components. We used cluster analysis and rater's clinical opinion to identify groups with similar phenotypes in two separate analyses. We used Cramer's Phi coefficient of association to assess the similarity among the clinician's groupings as well as among the statistical sub-phenotypic groups and each of the clinician's groupings. The cluster analysis initially divided the 86 ears into a more and a less severe group. The less severe group included two sub-groups that included ears classified as normal and a group that had very few anomalous components. The group of 48 more affected ears all had abnormalities of the helix crus; antihelix-stem, -superior crus and -inferior crus; and antitragus. These were further divided into 4 sub-phenotypes. There was a moderate degree of association among the raters' groupings (Cramer's Phi: 0.64 to 0.73). The statistical and clinical groupings had a lower degree of association (Cramer's Phi: 0.49 to 0.58). Using standardized characterization of structural abnormalities of the ear we identified six distinct phenotypic groups; correlations with clinicians' groupings were moderate. These clusters may represent groups of ear malformations associated with the same etiology, similar time of insult or target cell population during embryonic development. The results will help inform investigations on etiology.
Nilson, B; Olaison, L; Rasmussen, M
Streptococci are common causes of infective endocarditis (IE) and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has provided a practical tool for their species determination. We aimed to investigate if particular groups of non-beta heamolytic streptococci were associated with IE or to specific presentations thereof. The Swedish Registry of Infective Endocarditis was used to identify cases of IE caused by streptococci and a local database to identify cases of streptococcal bacteremia. The bacteria were grouped using MALDI-TOF MS and the clinical characteristics of IE caused by different groups were compared. We identified a group of 201 streptococcal IE isolates: 18 isolates belonged to the anginosus, 19 to the bovis, 140 to the mitis, 17 to the mutans, and seven to the salivarius groups. The mitis and mutans groups were significantly more common and the anginosus group less common among IE cases as compared to all cause bacteremia. Patients infected with the bovis group isolates were older, had more cardiac devices, and had more commonly prosthetic valve IE compared to IE caused by streptococci of the other groups. Twenty-one percent of patients needed surgery, and in-hospital mortality was 8% with no significant differences between the groups. Grouping of non-beta haemolytic streptococci using MALDI-TOF MS can provide a basis for decision-making in streptococcal bacteremia. IE caused by bovis group isolates have clinical characteristics distinguishing them from IE caused by other groups of Streptococcus.
Saxe, Brenda J.; Johnson, Susan M.
Empirically assesses the effectiveness of a group treatment program on intrapersonal symptomatology and interpersonal difficulties in a clinical population of women with a history of incest. Results indicate that a time-limited group, which focuses on the original trauma, is effective in reducing intrapersonal symptomatology for women with a…
目的 探讨透析低血压的相关症状和米多君联合低温可调钠对透析相关性低血压的治疗作用. 方法 整群选取2013年3月-2014年6月在该院治疗的120例反复发生透析相关性低血压的患者,采用自身分组对照的方法随机分为常温普通钠透析组(对照组),普通钠常温+米多君组(米多君透析组),低温可调钠组(低温可调钠透析组),低温可调钠+米多君组(联合治疗透析组),每组30例,每种治疗方法应用5次透析,比较四组方法透析中平均动脉压和低血压的发生次数. 结果 米多君透析组、低温可调钠透析组、联合治疗透析组平均动脉压分别为13.3%、15.3%、6.7%显著高于对照组21.3%(P<0.05). 结论 使用低温可调钠透析联合米多君对透析相关性低血压临床疗效显著.%Objective To discuss the complication of dialysis hypotension and the clinical curative effect of midodrine com-bined low temperature adjustable sodium for dialysis hypotension. Methods 120 patients experiencing repeated occurrence of dialysis hypotension and treated in our department from March 2013 and June 2014 were randomized to undergoing nor-mal-temperature sodium dialysis (the control group, n=30), dialysis using normal-temperature sodium combined with mido-drine (midodrine dialysis group, n=30), dialysis using low temperature adjustable sodium (dialysis using low temperature ad-justable sodium group, n=30), and dialysis using midodrine combined low temperature adjustable sodium (combined dialysis group, n=30), according to self-grouping and controlled method. Each dialysis regimen was performed five times for the pa-tients. The mean arterial blood pressure and the frequency of low blood pressure were compared between the patients in the four groups. Results The mean arterial blood pressure of the midodrine dialysis group, dialysis using low temperature ad-justable sodium group, and combined dialysis group was 13.3%, 15.3%, 6.7% respectively
Austin, S.F.; Sumbundu, A.D.; Lykke, J.
, anxiety and depressive symptoms and marked improvement in mobility. These improvements were maintained at 12-month follow-up. Outcomes supported the feasibility of a brief group cognitive-behavioural intervention for GP-referred patients. Implications of these results are discussed in terms...... implemented in everyday clinical settings. The aim of the following pilot study was to examine the feasibility of a brief group cognitive-behavioural intervention carried out in a clinical setting. Salient issues in determining feasibility include: representativeness of patient group treated, amount...
Ikeya, Kosuke; Watanabe, Akira
The composition of carbon (C) functional groups in natural organic matter (NOM), such as dissolved organic matter, soil organic matter, and humic substances, is frequently estimated using solid-state (13)C NMR techniques. A problem associated with quantitative analysis using general cross polarization/magic angle spinning (CPMAS) spectra is the appearance of spinning side bands (SSBs) split from the original center peaks of sp (2) hybridized C species (i.e., aromatic and carbonyl C). Ramp CP/phase-adjusted side band suppressing (PASS) is a pulse sequence that integrates SSBs separately and quantitatively recovers them into their inherent center peaks. In the present study, the applicability of ramp CP/PASS to NOM analysis was compared with direct polarization (DPMAS), another quantitative method but one that requires a long operation time, and/or a ramp CP/total suppression side band (ramp CP/TOSS) technique, a popular but non-quantitative method for deleting SSBs. The test materials were six soil humic acid samples with various known degrees of aromaticity and two fulvic acids. There were no significant differences in the relative abundance of alkyl C, O-alkyl C, and aromatic C between the ramp CP/PASS and DPMAS methods, while the signal intensities corresponding to aromatic C in the ramp CP/TOSS spectra were consistently less than the values obtained in the ramp CP/PASS spectra. These results indicate that ramp CP/PASS can be used to accurately estimate the C composition of NOM samples.
Full Text Available The objective of this research was to estimate the relative magnitude of effects included in contemporary groups (CG and their interactions with adjusted and actual 120 d and 210 d weights in 72, 731 male and female Nelore calves born from 1985 to 2005 in 40 herds from PMGRN (Genetic Improvement Program of Nelore. Ten models with different CG structures were compared. The analyses were done using the general linear models (GLM procedure run in SAS software. All of the effects included in the CG for each model were significant (p < 0.001 for the four traits analyzed. Inclusion of semester or trimester of birth as part of a CG was more appropriate than its use as an independent effect in the model because it accounted for interactions with the other effects in the CG. Calf sex (CS and dam age at calving (DAC had similar effects across the models, which suggested independence from other effects in these models. The corresponding age deviation effect had a larger impact on actual weight at 120 d than any other effect in all of the models tested. The use of actual weights in models with no CS effect in CG provides an alternative that would allow better genetic connectedness among CGs and greater accuracy in genetic evaluations.
Mohammad Taghi Beigmohammadi
Full Text Available Critically ill patient transfer is potentially risky and may be lead to morbidity and mortality. Physicians' skill is very important for safe transport. We want to evaluate the effect of clinical course teaching on the promotion of physicians' abilities in the transport of critically ill patients. In an interventional study, 320 interns, male and female, were taught about patient transfer in two groups include in one day clinical course as the small group system (n=160 and other group the lecture base learning (n=160. In the clinical course, each participant under observation of an anesthesiologist in the operation room and ICU was acquainted with mask ventilation, intubation and learned to work with a defibrillator, infusion pump, portable ventilator and pulse oximeter. In lecture group, the anesthesiologist explained the topics by video and dummy. At the end of education course, the interns’ abilities were evaluated based on checklist method and scored by the project colleague in all educational items. Three hundred twenty interns, 122 males, and 198 females; were enrolled, two groups. The clinical course training caused improvements in the interns’ knowledge and abilities in intubation and use of the defibrillator and portable ventilator vs.lecture group significantly (P<0.005. The males were better than females in laryngoscopy, but the progress of the females was significantly better than males (P=0.003. The rate of adverse events was reduced significantly after clinical course teaching (P=0.041 Clinical course teaching could promote interns' clinical competencies in the transport of critically ill patients.
Full Text Available Objective: To evaluate the clinical and immunological features of the hemorrhagic fever with renal syndrome in women of different age groups. Materials and methods: Clinical and laboratory characteristics of hemorrhagic fever with renal syndrome in 148 women aged 17 to 65 years old have been investigated. Patients have been divided into two groups: group I included 101 patients with normal menstrual rhythm, group II included 47 female patients with menopause. In 57 women (36 from group I, 21 — from group II the content of CD3+, CD4+, CD8+, CD16+, CD19+ — sub-populations of peripheral blood lymphocytes has been determined. Results: In compared groups significant differences in structure and frequency of complications of the disease have been revealed. Unidirectional tendency to increase significantly reduced absolute rates of investigated lymphocyte subpopulations in dynamics of the disease has been identified. It also has been stated that by the time of early convalescence in case of severe form of HFRS the indices did not reach the standard level. In an older group of women deeper damage and long-term recovery of immune system have been marked. Conclusion: According to the results of clinical and immunological studies the research work has revealed that in young women the response of the immune system to HFRS has developed faster and stronger than that in patients during the menopause period.
... syndrome) A certain type of stroke (vertebral artery dissection) after neck manipulation Don't seek chiropractic adjustment ... Chiropractic treatment. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015. Shekelle P, et al. Spinal ...
Full Text Available Introduction: People with epilepsy (PWE face physical and mental illness, and social stigma, which affect their self-esteem and quality of life. The purpose of this study was to examine the effects of a support group on the self-esteem of PWE. Methods: A Quasi-experimental study was performed on 120 PWE in the Epilepsy Clinic at Srinagarind Hospital. The experimental group (N=60 attended the support group before receiving regular health care services. The control group (N=60 received only regular healthcare services. Data was collected by using the Rosenberg self-esteem scale scoring before and after the experiment. The score was analyzed by using a paired t-test and an independent t-test. Results: The study showed that before the experiment, the self–esteem score of the control group was significantly higher than the experimental group. After the experiment, the scores of the control group and the experimental group showed a significant statistical difference. The score in the control group was significantly lower than the experimental group, while the score in the experimental group was significantly higher than before the experiment. Conclusion: The support group improves the self-esteem of PWE. Medical personnel should set up a support group for PWE to enhance their self-esteem.
The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "E10 Choice of Control Group and Related Issues in Clinical Trials." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The guidance sets forth general principles that are relevant to all controlled trials and are especially pertinent to the major clinical trials intended to demonstrate drug (including biological drug) efficacy. The guidance describes the principal types of control groups and discusses their appropriateness in particular situations. The guidance is intended to assist sponsors and investigators in the choice of control groups for clinical trials.
Arbus, C; Hergueta, T; Duburcq, A; Saleh, A; Le Guern, M-E; Robert, P; Camus, V
Adjustment disorder with anxiety (AjD-A) is a common cause of severe anxiety symptoms, but little is known about its prevalence in old age. This cross-sectional study examined the prevalence of AjD-A in outpatients over the age of 60 who consecutively consulted 34 general practitioners and 22 psychiatrists during a 2-week period. The diagnosis of AjD-A was obtained using the optional module for diagnostic of adjustment disorder of the Mini International Neuropsychiatric Interview (MINI). The study procedure also explored comorbid psychiatric conditions and documented recent past stressful life events, as well as social disability and current pharmacological and non-pharmacological management. Overall, 3651 consecutive subjects were screened (2937 in primary care and 714 in mental health care). The prevalence rate of AjD-A was 3.7% (n=136). Up to 39% (n=53) of AjD-A subjects had a comorbid psychiatric condition, mostly of the anxious type. The most frequently stressful life event reported to be associated with the onset of AjD-A was personal illness or health problem (29%). More than 50% of the AjD-A patients were markedly to extremely disabled by their symptoms. Compared to patients who consulted psychiatrists, patients who were seen by primary care physicians were older, had obtained lower scores at the Hamilton Anxiety Rating Scale, benefited less frequently from non-pharmacological management and received benzodiazepines more frequently. AjD-A appears to be a significantly disabling cause of anxiety symptoms in community dwelling elderly persons, in particular those presenting personal health related problems. Improvement of early diagnosis and non-pharmacological management of AjD-A would contribute to limit risks of benzodiazepine overuse, particularly in primary care settings. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Full Text Available Background A number of studies have shown that susceptibility to several infectious diseases is related to the patient’s blood group. Although the relationship between blood group and susceptibility to malaria has been studied by several researchers, the results have been contradictory. Since malaria has re-emerged as a major problem in India during the past few years, it would be useful to know whether there is any relationship between blood group and infection. Objectives The study will be undertaken to correlate the blood groups and clinical presentations in malaria patients and to understand the differential host susceptibility in malaria. Method Over a period of 4 years malaria positive samples identified by peripheral smear (thin and thick smears will be evaluated in this study. Haemoglobin, total leucocyte count, differential leucocyte count and platelet count of each patient done on an automated cell counter will be retrieved from the data. Blood group was determined by forward and reverse method. The demographic details of the patients and clinical details were obtained from case records of the patients. Malarial species and the severity of clinical course were correlated with blood groups Results A total of 205 patients were included in the study, of which 123 cases were positive for plasmodium falciparum and 78 cases were positive for P. vivax infection and 4 patients had mixed infection. The results of blood groups showed 33 -‘A’ group, 84 -‘B’ group, 70 -‘O’ group and 18 were ‘AB’ group. When the clinical courses between different groups were compared using the following parameters for severe infection- a parasitic load of > 10/1000 RBCs, severe anemia with haemoglobin 101o F and the other organ involvement, it was observed that there was no significant relationship between ABO blood group and malaria in our population, this could be due to various demographic reasons. Conclusions The present study indicate that
Dawson, S; McArdle, F; Bennett, M; Carter, M; Milton, I P; Turner, P; Meanger, J; Gaskell, R M
One hundred and thirteen isolates of feline calicivirus originating from seven different clinical groups were typed by virus neutralisation tests using eight different cat antisera. The clinical groups comprised 'healthy' cats, cases of acute oral/respiratory disease, chronic stomatitis, acute febrile lameness syndrome, vaccine reactions (clinical disease seen within 21 days of vaccination) and vaccine breakdowns (clinical disease seen more than 21 days after but within one year of vaccination). Isolates from the vaccine reaction cases were grouped into those associated with acute oral/respiratory disease alone and those associated with the lameness syndrome, and the latter group was further subdivided according to the vaccine used. Two groups appeared significantly different from others with some of the antisera. Thus the lameness vaccine reaction isolates associated with vaccine B were significantly different from the isolates from all the other clinical groups, including other lameness isolates, with a number of the antisera. In addition, the chronic stomatitis isolates were significantly different from those from the 'healthy' and the acute oral/respiratory disease groups with one or two of the antisera. Eighty-five to 88 per cent of the isolates were neutralised by antisera raised against F9 or F9-like vaccine strains at a dilution of 1 in 2. Twenty antibody units of such antisera neutralised 42 to 80 per cent of the isolates. A bivalent antiserum raised against a vaccine F9 strain and field strain LS015 neutralised 96 per cent of the isolates at a dilution of 1 in 2, and 20 antibody units neutralised 68 per cent of isolates. Antisera to field strain F65 neutralised all the remaining isolates at a dilution of 1 in 2 and 44 per cent of the remaining isolates at a dilution of 20 antibody units. Therefore, strains LS015 and F65 may be of use in the production of a polyvalent feline calicivirus vaccine, together with the widely used strain F9.
Minutes of the Hampstead Clinic's Diagnostic Profile Research Group during a fifteen-month period (1964-1965) are reviewed and discussed. A wide range of topics were considered and discussed, with a special focus on the affective life, object relations, and ego function of atypical children in comparison to the early ego functions and differentiation of normal and neurotic children. These lively clinical and theoretical discussions and their implications for therapeutic work with a wide range of children, demonstrate the multifaceted leadership and contributions of Anna Freud as teacher, clinician, and thinker, and of the Hampstead Clinic as a major center for psychoanalytic studies.
Bakermans-Kranenburg, Marian J; van IJzendoorn, Marinus H
More than 200 adult attachment representation studies, presenting more than 10,500 Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985) classifications, have been conducted in the past 25 years. In a series of analyses on the distributions of the AAI classifications in various cultural and age groups, fathers, and high-risk and clinical samples, we used the distribution of the combined samples of North American non-clinical mothers (23% dismissing, 58% secure, 19% preoccupied attachment representations, and 18% additionally coded for unresolved loss or other trauma) to examine deviations from this normative pattern, through multinomial tests and analyses of correspondence. The analyses were restricted to AAI classifications coded according to the Main, Goldwyn, and Hesse (2003) system. We did not find gender differences in the use of dismissing versus preoccupied attachment strategies, and the AAI distributions were largely independent of language and country of origin. Clinical subjects showed more insecure and unresolved attachment representations than the norm groups. Disorders with an internalizing dimension (e.g., borderline personality disorders) were associated with more preoccupied and unresolved attachments, whereas disorders with an externalizing dimension (e.g., antisocial personality disorders) displayed more dismissing as well as preoccupied attachments. Depressive symptomatology was associated with insecurity but not with unresolved loss or trauma, whereas adults with abuse experiences or PTSD were mostly unresolved. In order to find more reliable associations with clinical symptoms and disorders, future AAI studies may make more fruitful use of continuous AAI scales in addition to the conventionally used categorical classifications.
王培民; 黄国淳; 丁亮; 马勇
This study was aimed to evaluate clinic effect of the layers adjusting external application therapy on knee osteoarthritis (OA). A total of 240 knee OA cases were randomly divided into the treatment group and the control group, with 120 cases in each group. The layers adjusting external application therapy was used in the treatment group. And analgesic plaster of compound of rhizoma arisaematis was used in the control group. The treatment was continued for 21 days. Then, 14-day follow-up was given after the treatment course. There were a total of 35 days. Observations were made on indexes of pain, swelling and joint dysfunction with quantitative scoring. The results showed that the total effective rate was 98.2%in the treatment group, and 83.9%in the control group. The indexes of pain, swelling and joint dysfunction were markedly improved in the treatment group as compared with the control group (P<0.01). It was concluded that the layers adjusting external application therapy was effective on the treat-ment of knee OA.%目的：观察评价“易层”贴敷疗法治疗膝骨性关节炎的临床疗效研究。方法：将240例患者随机分为治疗组和对照组，每组各120例。治疗组使用“易层”贴敷疗法治疗，对照组使用复方南星止痛膏治疗，治疗21天，治疗结束后再随访14天，共35天。观察两组疼痛、肿胀、关节功能障碍的改善情况，进行量化评分。结果：治疗组总有效率98.2%，对照组83.9%；治疗组在疼痛、肿胀及关节功能障碍的指标积分改善显著优于对照组（P<0.01）。结论：研究结果表明，“易层”贴敷疗法治疗膝骨性关节炎有良好的疗效。
Marcucci, Maura; Sinclair, John C
Randomised controlled trials report group-level treatment effects. However, an individual patient confronting a treatment decision needs to know whether that person's expected treatment benefit will exceed the expected treatment harm. We describe a flexible model for individualising a treatment decision. It individualises group-level results from randomised trials using clinical prediction guides. We constructed models that estimate the size of individualised absolute risk reduction (ARR) for the target outcome that is required to offset individualised absolute risk increase (ARI) for the treatment harm. Inputs to the model include estimates for the individualised predicted absolute treatment benefit and harm, and the relative value assigned by the patient to harm/benefit. A decision rule recommends treatment when the predicted benefit exceeds the predicted harm, value-adjusted. We also derived expressions for the maximum treatment harm, or the maximum relative value for harm/benefit, above which treatment would not be recommended. For the simpler model, including one kind of benefit and one kind of harm, the individualised ARR required to justify treatment was expressed as required ARRtarget(i)=ARIharm(i) × RVharm/target(i). A complex model was also developed, applicable to treatments causing multiple kinds of benefits and/or harms. We demonstrated the applicability of the models to treatments tested in superiority trials (either placebo or active control, either fixed harm or variable harm) and non-inferiority trials. Individualised treatment recommendations can be derived using a model that applies clinical prediction guides to the results of randomised trials in order to identify which individual patients are likely to derive a clinically important benefit from the treatment. The resulting individualised prediction-based recommendations require validation by comparison with strategies of treat all or treat none.
王志力; 吴云松; 张俊辉; 陈松; 李明
目的:通过调整造影剂在腰椎间盘和突出物内分布,探讨提高胶原酶溶解术治疗椎间盘突出症临床疗效的方法.方法:将83例经腰椎CT或MRI确诊为腰椎间盘突出症的患者随机分成对照组和造影组,两组均在CT直视下经椎板间孔入路穿刺成功,针尖(靶点)位于突出椎间盘突出物内.对照组直接注射胶原酶；造影组注射碘海醇0.5ml,突出物显影完整后注射胶原酶；术后1周、3月、6月对两组患者进行随访.结果:造影组术后3个月、6个月有效率达90.48％、97.62％,造影组术后6月疗效优于对照组,有统计学意义.结论:胶原酶溶解术中调整造影剂分布可提高远期临床疗效.%Objective: Chemonucleolysis by adjusting the contrast agent omnipaque in an attempt to improve the long term clinical effect. Methods: 83 patients of lumbar disc herniation were divided randomly into two groups. The operations were carried out under CT guidance, and the target point was the disc prominence. The control group were not injected with contrast agent. In the contrast group, 0.5ml Omnipaque contrast were injected in order to observe the contrast agent distribution in prominence. Adjusting the needle position until a full prominence is developed. After 1 week, 3 months, 6 months, patients is developed followed-up. Results: The efficacy rate in the angiography group after three and six months were 90.5% and 97.6%, respectively. The effects of angiography group were significantly better than the control group after six months. Conclusion: chemonucleolysis with adjustment of the distribution of contrast agents can improve clinical efficacy.
Lindgren, Barbro; Athlin, Elsy
The extensive amount of studies on clinical supervision during the nursing students' clinical programmes has shown that supervision most often is given on a one-to-one basis, and that many challenges are embedded in this kind of supervision. In some studies group supervision has been used, with mostly successful effects according to the nursing students. At a university in Sweden, a model of group supervision was included in the baccalaureate nursing programme, conducted by nurse lecturers. The purpose of this study was to describe the value of clinical group supervision to nursing students, as perceived by the nurse lecturers. Data consisted of field notes written by the nurse lecturers after 60 supervision sessions, and qualitative content analysis was performed. The findings showed how reflection in a group of equals was considered to give the nursing students opportunities to increase their understanding of themselves and others, prepare them for coming events, increase their personal and professional strengths, and inspire them for further development. On the basis of the findings and previous studies the value of using nurse lecturers as group supervisors was discussed. The impact of a contract to achieve a good learning environment in group supervision was also stressed.
Ethnic minorities are generally at higher risk for experiencing a stroke and dying from a stroke than non-Hispanic Whites, but are less likely to have optimal stroke risk factor control. Part of this ethnic disparity in stroke outcomes can be attributed to sociocultural factors. As such, there is a need to use culturally sensitive qualitative analysis to explore various strategies for enhancing vascular risk reduction in minority stroke patients encountered in under-resourced health systems. One potential strategy could be the use of nurse-led group clinics. Group clinics might be a relatively straightforward way of supplementing physician-centered efforts to improve outcomes in under-resourced settings by improving efficiency and encouraging patient self-management. However, research is limited on the implementation of group clinics among low-income, ethnic minority populations. This study aimed to obtain information about the feasibility of successfully implementing group clinics to boost treatment adherence among elderly Spanish-speaking only stroke patients within an under-resourced urban health system. A total of 13 Spanish-only speaking participants aged >or=60 years discharged from a local government hospital in Los Angeles within 18 months of an index ischemic stroke, and 6 caregivers, engaged in focus groups and interviews. Structured interviews were conducted with 11 care providers and 9 administrators at the hospital. Framework analysis examined the data and elicited themes necessary for successful execution of nurse-led group clinics for promoting vascular risk reduction treatment adherence among Elderly Spanish-only speaking stroke patients encountered within an urban health care system.
Nielsen, Geir Høstmark; Skjerve, Jan; Jacobsen, Claus Haugaard;
In the two preceding papers of this issue of Nordic Psychology the authors report findings from a study of nondisclosure among student therapists and clinical supervisors. The findings were reported separately for each group. In this article, the two sets of findings are held together and compared......, so as to draw a picture of mutual assumptions and facts about nondisclosure among students and supervisors....
Campmans-Kuijpers, Marjo J.; Baan, Caroline A.; Lemmens, Lidwien C.; Rutten, Guy E.
OBJECTIVE: To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. RESEARCH DESIGN AND METHODS: This before-and-after study with a 1-year follow-up surveyed qualitymanagers on six domains of quality management. Q
Begovac, Branka; Begovac, Ivan
This article presents, in the form of a clinical illustration, a therapeutic group of bereaved mothers with special reference to their dreams about their deceased children. The article presents descriptions of the emotions of these mothers and countertransference feelings, a topic that, to our knowledge, has not been frequently studied. The group…
Campmans-Kuijpers, Marjo J.; Baan, Caroline A.; Lemmens, Lidwien C.; Rutten, Guy E.
OBJECTIVE: To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. RESEARCH DESIGN AND METHODS: This before-and-after study with a 1-year follow-up surveyed qualitymanagers on six domains of quality management.
Perlman, Lawrence M.; Arnedt, J. Todd; Earnheart, Kristie L.; Gorman, Ashley A.; Shirley, Katherine G.
Effective cognitive-behavioral therapies for insomnia have been developed over the past 2 decades, but they have not been systematically evaluated in some clinical settings. While insomnia is common among veterans with mental health problems, the availability of effective treatments is limited. We report on the group application of a…
Full Text Available The study is based on clinical evaluation of a psychotherapy group for children, employing Sicilian puppets, objects as mediators, to reflect on significant moments and the dynamic processes of change during the therapy. TCM (Therapeutic Cycle Model, 1996, designed by Mergenthaler, is used to identify whether and how the assessment corresponds to the changes detected by observation of each subject and the group. During the 8 sessions of therapy, verbal productions of children and therapists were analyzed and compared. Keywords:Evaluation; Group therapy; Mediating object; Children
Full Text Available Background: The ABO blood group antigens are present on the surface of red blood cells and various epithelial cells. As the majority of human cancers are derived from epithelial cells, changes in blood group antigens constitute an important aspect of human cancers. The aim of the study was to establish clinical usefulness of ABO blood group as a predisposing factor in early diagnosis and management of patients with oral precancerous lesions/conditions. Materials and Methods: The study sample consisted of 50 control and 50 oral precancer (25 leukoplakia and 25 Oral Submucous Fibrosis confirmed by histopathologic examination. All samples were subjected to blood group testing and their prevalence was compared by Z-test using STATA version 8. Results: The "A" blood group was prevalent among the precancerous group. Significant differences on prevalences of blood groups were found (P < 0.05 between control versus leukoplakia and OSMF. Interestingly, 24% gutka chewers who had higher number of grades of dysplasia were falling in "A" blood group. Conclusion: Blood group type should be considered along with other risk factors to understand the individual patient′s risk and further studies in larger samples with inclusion of Rh factor is needed to elucidate the relationship with ABO blood group types.
Bhateja, S; Arora, G
Background: The ABO blood group antigens are present on the surface of red blood cells and various epithelial cells. As the majority of human cancers are derived from epithelial cells, changes in blood group antigens constitute an important aspect of human cancers. The aim of the study was to establish clinical usefulness of ABO blood group as a predisposing factor in early diagnosis and management of patients with oral precancerous lesions/conditions. Materials and Methods: The study sample consisted of 50 control and 50 oral precancer (25 leukoplakia and 25 Oral Submucous Fibrosis) confirmed by histopathologic examination. All samples were subjected to blood group testing and their prevalence was compared by Z-test using STATA version 8. Results: The "A" blood group was prevalent among the precancerous group. Significant differences on prevalences of blood groups were found (P blood group. Conclusion: Blood group type should be considered along with other risk factors to understand the individual patient's risk and further studies in larger samples with inclusion of Rh factor is needed to elucidate the relationship with ABO blood group types.
Since most of the patients who attend for psychiatric consultation at a clinic are little motivated for psychotherapy, analytic group therapy was attempted, with basis on studies on psychological genetics, on groups management, and on the theories of Freud, Klein and Bion. Several open groups were handled, with the following achievements: 1. A decrease in anxiety, and increase in the objective vision of reality and in increase in the ability to see past and present conflicts. 2. A greater tolerance to agressive and sexual instincts and to frustration. 3. A greater personal acceptance, ability to sublimate productively and elimination of clinical symptoms. Varying degrees of improvement, and lesser need for psychiatric medication and hospitalization were obtained. Several problems were encountered: a) Desertion of 30% of patients from the sessions, due to the disapearance of symptoms buth with no character changes (resistances). b) Temporary absence or habit of arriving late to the sessions (resistances). c) Overwhelming passivity. The groups were handled in cotherapy and the work was supervised with experienced therapists. To attempt solving the above mentioned problems a better selection of patients was made, complete clinical histories were elaborated, a battery of psychological tests was made, and diagnosis, dynamics and prognosis of each case were outlined; this allowed the evaluation of middle and long term treatment. It was suggested to change the technique to that of operative groups.
Forbes, Bo; Volpe Horii, Cassandra; Earls, Bethany; Mashek, Stephanie; Akhtar, Fiona
Clinical supervision is an integral component of therapist training and professional development because of its capacity for fostering knowledge, self-awareness, and clinical acumen. Individual supervision is part of many yoga therapy training programs and is referenced in the IAYT Standards as "mentoring." Group supervision is not typically used in the training of yoga therapists. We propose that group supervision effectively supports the growth and development of yoga therapists-in-training. We present a model of group supervision for yoga therapist trainees developed by the New England School of Integrative Yoga Therapeutics™ (The NESIYT Model) that includes the background, structure, format, and development of our inaugural 18-month supervision group. Pre-and post-supervision surveys and analyzed case notes, which captured key didactic and process themes, are discussed. Clinical issues, such as boundaries, performance anxiety, sense of self efficacy, the therapeutic alliance, transference and counter transference, pacing of yoga therapy sessions, evaluation of client progress, and adjunct therapist interaction are reviewed. The timing and sequence of didactic and process themes and benefits for yoga therapist trainees' professional development, are discussed. The NESIYT group supervision model is offered as an effective blueprint for yoga therapy training programs.
Trejos, Ana María; Reyes, Lizeth; Bahamon, Marly Johana; Alarcón, Yolima; Gaviria, Gladys
A study in five Colombian cities in 2006, confirms the findings of other international studies: the majority of HIV-positive children not know their diagnosis, caregivers are reluctant to give this information because they believe that the news will cause emotional distress to the child becoming primary purpose of this study to validate a model of revelation. We implemented a clinical model, referred to as: "DIRE" that hypothetically had normalizing effects on psychological adjustment and adherence to antiretroviral treatment of HIV seropositive children, using a quasi-experimental design. Test were administered (questionnaire to assess patterns of disclosure and non-disclosure of the diagnosis of VIH/SIDA on children in health professionals and participants caregivers, Family Apgar, EuroQol EQ- 5D, MOS Social Support Survey Questionnaire Information treatment for VIH/SIDA and child Symptom Checklist CBCL/6-18 adapted to Latinos) before and after implementation of the model to 31 children (n: 31), 30 caregivers (n: 30) and 41 health professionals. Data processing was performed using the Statistical Package for the Social Science version 21 by applying parametric tests (Friedman) and nonparametric (t Student). No significant differences in adherence to treatment (p=0.392), in the psychological adjustment were found positive significant differences at follow-ups compared to baseline 2 weeks (p: 0.001), 3 months (p: 0.000) and 6 months (p: 0.000). The clinical model demonstrated effectiveness in normalizing of psychological adjustment and maintaining treatment compliance. The process also generated confidence in caregivers and health professionals in this difficult task.
HRV, Rajkumar; Devaki, Ramakrishna
Among the various pathogenic determinants shown by microorganisms hemagglutination and hemolysin production assume greater significance in terms of laboratory identification. This study evaluated the hemagglutination and hemolytic activity of various bacterial isolates against different blood groups. One hundred and fifty bacterial strains, isolated from clinical specimens like urine, pus, blood, and other body fluids were tested for their hemagglutinating and hemolytic activity against human A, B, AB, and O group red blood cells. Among the 150 isolates 81 were Escherichia coli, 18 were Klebsiella pneumoniae, 19 were Pseudomonas aeruginosa, 10 were Pseudomonas spp, six were Proteus mirabilis, and the rest 16 were Staphylococcus aureus. Nearly 85% of the isolates agglutinated A group cells followed by B and AB group (59.3% and 60.6% respectively). Least number of isolates agglutinated O group cells (38.0%). When the hemolytic activity was tested, out of these 150 isolates 79 (52.6%) hemolyzed A group cells, 61 (40.6%) hemolyzed AB group cells, 46 (30.6%) hemolyzed B group cells, and 57 (38.6%) isolates hemolyzed O group cells. Forty-six percent of the isolates exhibited both hemagglutinating and hemolytic property against A group cells, followed by B and AB group cells (28.6% and 21.3% respectively). Least number of isolates i.e., 32 (21.3%) showed both the properties against O group cells. The isolates showed wide variation in their hemagglutination and hemolytic properties against different combinations of human blood group cells. The study highlights the importance of selection of the type of cells especially when human RBCs are used for studying the hemagglutination and hemolytic activity of bacterial isolates because these two properties are considered as characteristic of pathogenic strains. PMID:27014523
Leyland-Jones, Brian R; Ambrosone, Christine B; Bartlett, John; Ellis, Matthew J C; Enos, Rebecca A; Raji, Adekunle; Pins, Michael R; Zujewski, Jo Anne; Hewitt, Stephen M; Forbes, John F; Abramovitz, Mark; Braga, Sofia; Cardoso, Fatima; Harbeck, Nadia; Denkert, Carsten; Jewell, Scott D
Recommendations for specimen collection and handling have been developed for adoption across breast cancer clinical trials conducted by the Breast International Group (BIG)-sponsored Groups and the National Cancer Institute (NCI)-sponsored North American Cooperative Groups. These recommendations are meant to promote identifiable standards for specimen collection and handling within and across breast cancer trials, such that the variability in collection/handling practices that currently exists is minimized and specimen condition and quality are enhanced, thereby maximizing results from specimen-based diagnostic testing and research. Three working groups were formed from the Cooperative Group Banking Committee, BIG groups, and North American breast cancer cooperative groups to identify standards for collection and handling of (1) formalin-fixed, paraffin-embedded (FFPE) tissue; (2) blood and its components; and (3) fresh/frozen tissue from breast cancer trials. The working groups collected standard operating procedures from multiple group specimen banks, administered a survey on banking practices to those banks, and engaged in a series of discussions from 2005 to 2007. Their contributions were synthesized into this document, which focuses primarily on collection and handling of specimens to the point of shipment to the central bank, although also offers some guidance to central banks. Major recommendations include submission of an FFPE block, whole blood, and serial serum or plasma from breast cancer clinical trials, and use of one fixative and buffer type (10% neutral phosphate-buffered formalin, pH 7) for FFPE tissue across trials. Recommendations for proper handling and shipping were developed for blood, serum, plasma, FFPE, and fresh/frozen tissue.
Harrison, Sean; Tilling, Kate; Turner, Emma L; Lane, J Athene; Simpkin, Andrew; Davis, Michael; Donovan, Jenny; Hamdy, Freddie C; Neal, David E; Martin, Richard M
Previous studies indicate a possible inverse relationship between prostate-specific antigen (PSA) and body mass index (BMI), and a positive relationship between PSA and age. We investigated the associations between age, BMI, PSA, and screen-detected prostate cancer to determine whether an age-BMI-adjusted PSA model would be clinically useful for detecting prostate cancer. Cross-sectional analysis nested within the UK ProtecT trial of treatments for localized cancer. Of 18,238 men aged 50-69 years, 9,457 men without screen-detected prostate cancer (controls) and 1,836 men with prostate cancer (cases) met inclusion criteria: no history of prostate cancer or diabetes; PSA BMI between 15 and 50 kg/m(2). Multivariable linear regression models were used to investigate the relationship between log-PSA, age, and BMI in all men, controlling for prostate cancer status. In the 11,293 included men, the median PSA was 1.2 ng/ml (IQR: 0.7-2.6); mean age 61.7 years (SD 4.9); and mean BMI 26.8 kg/m(2) (SD 3.7). There were a 5.1% decrease in PSA per 5 kg/m(2) increase in BMI (95% CI 3.4-6.8) and a 13.6% increase in PSA per 5-year increase in age (95% CI 12.0-15.1). Interaction tests showed no evidence for different associations between age, BMI, and PSA in men above and below 3.0 ng/ml (all p for interaction >0.2). The age-BMI-adjusted PSA model performed as well as an age-adjusted model based on National Institute for Health and Care Excellence (NICE) guidelines at detecting prostate cancer. Age and BMI were associated with small changes in PSA. An age-BMI-adjusted PSA model is no more clinically useful for detecting prostate cancer than current NICE guidelines. Future studies looking at the effect of different variables on PSA, independent of their effect on prostate cancer, may improve the discrimination of PSA for prostate cancer.
Djaldetti, R; Hassin-Baer, S; Farrer, M J; Vilariño-Güell, C; Ross, O A; Kolianov, V; Yust-Katz, S; Treves, T A; Barhum, Y; Hulihan, M; Melamed, E
Yemenite Jews in Israel are a distinctive ethnic division of the Jewish diaspora. Clinical findings, disease course and genetic tests for the LRRK2 6055G > A (G2019S) mutation were compared between Ashkenazi and Yemenite Israeli patients with Parkinson's disease (PD). Age of onset was significantly younger in the Yemenites (P Jewish ethnic groups in the severity and progression of PD, but not in clinical symptoms. The high frequency of Lrrk2 G2019S in the Ashkenazi and its absence in the Yemenite Jews suggests a specific ancestral pattern of inheritance in Ashkenazi Jews.
Mangoni, Monica; Gobitti, Carlo; Autorino, Rosa; Cerizza, Lorenzo; Furlan, Carlo; Mazzarotto, Renzo; Monari, Fabio; Simontacchi, Gabriele; Vianello, Federica; Basso, Michela; Zanirato Rambaldi, Giuseppe; Russi, Elvio; Tagliaferri, Luca
The therapeutic approach to thyroid carcinoma usually involves surgery as initial treatment. The use of external beam radiotherapy (EBRT) is limited to high-risk patients and depends on clinical stage and histologic type. Different behavior patterns and degrees of aggressiveness of thyroid carcinomas require different management for differentiated, medullary, and anaplastic carcinoma. However, the role of EBRT is an issue of debate. Most clinical studies are retrospective and based on single-institution experiences. In this article, we review the main literature and give recommendations for the use of EBRT in thyroid carcinoma on behalf of the "Radioterapia Metabolica" Group of the Italian Radiation Oncology Association.
Buus, Niels; Angel, Sanne; Traynor, Michael
Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses' experiences of participating in groupbased supervision and identifying psychosocial...... reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense...... of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses....
Full Text Available Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB, Italy, to develop general practitioners’ (GPs care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i clinical pathways can result in GPs working in a more efficient and effective fashion; ii they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.
In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, the following elements do not increase: a)\tFamily Allowance, Child Allowance and Infant Allowance (Annex R A 3); b)\tReimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be applied, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and rounding effects. Human Resources Department Tel. 73566
In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, following elements do not increase: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3). b) Reimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be implemented, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and the rounding effects. Human Resources Department Tel. 73566
张欣; 韩永和; 刘明军
OBJECTIVE To discuss the clinical effects and mechanism of insomnia by massage therapy of Grasping sha and Adjusting shen. METHODS 66 cases of insomnia were randomly divided into treatment group of 36 patients treated with the massage therapy of Grasping sha and Adjusting shen, and control group of 30 patients treated by herbs. RESULTS The total effective rate of one group was 86.11％, the other was 70 ％, with a significant difference between the two groups (P＜0.05). The Index PSQI had a significant difference either within the group and between the groups. CONCLUSION The massage therapy of Grasping sha and Adjusting shen has better effect on insomnia than that of herbs.%目的 探讨以抓痧调神法推拿治疗失眠症的疗效与机理.方法 将66例患者随机分为治疗组36例,对照组30例.治疗组采用抓痧调神法推拿施术于背部的督脉与足太阳膀胱经,对照组内服中药解郁安神颗粒,治疗21d.结果 失眠症的临床疗效比较,治疗组总有效率为86.11%,对照组总有效率为70%.2组疗效对比存在显著性差异(P<0.05).匹兹堡睡眠质量指数比较,组内治疗前后匹兹堡睡眠指数积分有显著性变化(P＜0.01),组间治疗后的匹兹堡睡眠指数积分存在显著性差异(P<0.05).结论 抓痧调神法推拿治疗失眠症的临床疗效较好,优于口服中药解郁安神颗粒.
Ferriere, Michael; Van Ness, Brian
The National Cancer Institute (NCI)-funded cooperative group cancer clinical trial system develops experimental therapies and often collects samples from patients for correlative research. The cooperative group bank (CGB) system maintains biobanks with a current policy not to return research results to individuals. An online survey was created, and 10 directors of CGBs completed the surveys asking about understanding and attitudes in changing policies to consider return of incidental findings (IFs) and individual research results (IRRs) of health significance. The potential impact of the 10 consensus recommendations of Wolf et al. presented in this issue are examined. Reidentification of samples is often not problematic; however, changes to the current banking and clinical trial systems would require significant effort to fulfill an obligation of recontact of subjects. Additional resources, as well as a national advisory board would be required to standardize implementation.
Bilić, Vedran; Nemčić-Moro, Iva; Karšić, Vana; Grgić, Vesna; Stojanović-Špehar, Stanislava; Marčinko, Darko
PTSD is a complex psychobiological disorder that couses disfunctionality in many areas. In treating PTSD different models have been applied, however, no general consensus on the method of treatment has yet been achieved. At the Clinic for Psychol.ogical Medicine we have developed the model of combined treatment for PTSD patients that involves outpatient individual psychoterapy, psychopharmacotherapy and group psyhoterapeutic techniques introduced within repeated day-hospital treatments. In th...
Peetoom, Kirsten K B; Ploum, Luc J L; Smits, Jacqueline J M; Halbach, Nicky S J; Dinant, Geert-Jan; Cals, Jochen W L
Fever is common in children aged 0-4 years old and often leads to parental worries and in turn, high use of healthcare services. Educating parents may have beneficial effects on their sense of coping and fever management. Most parents receive information when their child is ill but it might be more desirable to educate parents in the setting of well-child clinics prior to their child becoming ill, in order to prepare parents for future illness management. This study aims to explore experiences of well-child clinic professionals when dealing with childhood fever and current practices of fever information provision to identify starting points for future interventions. We held four focus group discussions based on naturalistic enquiry among 22 well-child clinic professionals. Data was analysed using the constant comparative technique. Well-child clinic professionals regularly received questions from parents about childhood fever and felt that parental worries were the major driving factor behind these contacts. These worries were assumed to be driven by: (1) lack of knowledge (2) experiences with fever (3) educational level and size social network (4) inconsistencies in paracetamol administration advice among healthcare professionals. Well-child clinic professionals perceive current information provision as limited and stated a need for improvement. For example, information should be consistent, easy to find and understand. Fever-related questions are common in well-child care and professionals perceive that most of the workload is driven by parental worries. The focus group discussions revealed a desire to optimise the current limited information provision for childhood fever. Future interventions aimed at improving information provision for fever in well-child clinics should consider parental level of knowledge, experience, educational level and social network and inconsistencies among healthcare providers. Future fever information provision should focus on
Fujikura, Yuji; Yuki, Atsushi; Hamamoto, Takaaki; Kawana, Akihiko; Ohkusu, Kiyofumi; Matsumoto, Tetsuya
Acinetobacter calcoaceticus-Acinetobacter baumannii complex, especially A. baumannii, Acinetobacter pittii and Acinetobacter nosocomialis, constitutes an important group of nosocomial pathogens; however, epidemiological or clinical characteristics and prognosis is limited in Japan. From 2009 to 2013, 47 blood stream infection cases resulting from A. baumannii group were reviewed at the National Defense Medical College, an 800-bed tertiary hospital. To determine the genospecies, further comparative nucleotide sequence analyses of the RNA polymerase b-subunit (rpoB) gene were performed. Sequence analysis of rpoB gene showed that 25 (49.0%), 17 (33.3%) and 5 (9.8%) cases were caused by A. baumannii, A. pittii and A. nosocomialis, respectively. The 30-day and in-hospital mortality rates of A. baumannii were 8.5% and 25.5%, respectively, and there were no significant differences between Acinetobacter species. Clinical characteristics were statistically insignificant. Multidrug-resistant Acinetobacter species were detected in 3 cases (5.9%) with same pulsed-field gel electrophoresis (PFGE) pattern and A. baumannii was less susceptible to amikacin and levofloxacin. In this study, the mortality and clinical characteristics were similar among A. baumannii group isolate cases despite some showing drug resistance. However, identification of Acinetobacter species helps to initiate appropriate antibiotic therapy in earlier treatment phase, because A. baumannii shows some drug resistance.
L.H. Visser (Leendert); F.G.A. van der Meché (Frans); J. Meulstee (Jan); P.A. van Doorn (Pieter)
textabstractThe risk factors for treatment related clinical fluctuations, relapses occurring after initial therapeutic induced stabilisation or improvement, were evaluated in a group of 172 patients with Guillain-Barre syndrome. Clinical, laboratory, and electrodiagnostic features
Pawar, Ajinkya M; Pawar, Mansing G; Kokate, Sharad R
The vital steps in any endodontic treatment are thorough mechanical shaping and chemical cleaning followed by obtaining a fluid tight impervious seal by an inert obturating material. For the past two decades, introduction and use of rotary nickel-titanium (Ni-Ti) files have changed our concepts of endodontic treatment from conventional to contemporary. They have reported good success rates, but still have many drawbacks. The Self-Adjusting File (SAF) introduces a new era in endodontics by performing the vital steps of shaping and cleaning simultaneously. The SAF is a hollow file in design that adapts itself three-dimensionally to the root canal and is a single file system, made up of Ni-Ti lattice. The case series presented in the paper report the clinical experience, while treating primary endodontic cases with the SAF system in India.
Ajinkya M Pawar
Full Text Available The vital steps in any endodontic treatment are thorough mechanical shaping and chemical cleaning followed by obtaining a fluid tight impervious seal by an inert obturating material. For the past two decades, introduction and use of rotary nickel-titanium (Ni-Ti files have changed our concepts of endodontic treatment from conventional to contemporary. They have reported good success rates, but still have many drawbacks. The Self-Adjusting File (SAF introduces a new era in endodontics by performing the vital steps of shaping and cleaning simultaneously. The SAF is a hollow file in design that adapts itself three-dimensionally to the root canal and is a single file system, made up of Ni-Ti lattice. The case series presented in the paper report the clinical experience, while treating primary endodontic cases with the SAF system in India.
Ørnbjerg, Lykke Midtbøll; Østergaard, Mikkel; Jensen, Trine
start), of which 135 patients had three x-rays (~2 years prior to TNFI, at start of TNFI, and ~2 years after TNFI start). Individual HBL/year prior to and during TNFI was calculated and compared to reference values. RESULTS: Estimated HBL/year varied strongly with age and sex. Compared to the reference...... remission (0.0032 vs. 0.0058 g/cm(2)/year; p sex-specific reference values for DXR-BMD in a large cohort without arthritis. HBL was increased in the majority of rheumatoid arthritis patients initiating TNFI in clinical practice, and only......BACKGROUND: Rheumatoid arthritis is characterised by progressive joint destruction and loss of periarticular bone mass. Hand bone loss (HBL) has therefore been proposed as an outcome measure for treatment efficacy. A definition of increased HBL adjusted for age- and sex-related bone loss is lacking...
Behrend, C; Felder, S; Busse, R
A report commissioned by the German Ministry of Health recommends to the existing scheme for calculating risk-adjusted transfers to sickness funds supplement with the IPHCC+RxGroups method. The method is based on inpatient diagnoses and prescribed drugs as health status measures deduced from prior use. The present study investigates the sickness fund's expected net return from gaming based on the drug component of the risk adjuster. The study explores three possible strategies using the RxGroups method. For the stimulations, insurees are assigned to additional indications or to higher valued RxGroups within the same indication. Then, costs and financial benefits attributable to the altered drug use are estimated and compared with the status quo. The study uses 2000 and 2001 sample data of more than 370,000 insurees of Germany's company-based sickness funds system (BKK). While upgrading increases overall costs, it can be beneficial for the individual sickness funds. Their net return crucially depends on the number of sickness funds gaming the system: the more participating in the game, the smaller is the average net return. Moreover, not participating often is even worse, which in turn points to a prisoner's dilemma. When extending the risk adjustment scheme in social health insurance, the German legislator should take into account the perverse incentives of risk adjusters such as the described prescription drug model.
Stone, Teresa; Levett-Jones, Tracy; Harris, Margaret; Sinclair, Peter M
This paper profiles the establishment and evaluation of the Neophyte Writers' Group, run by nurse academics in collaboration with clinical nurses. The growing demand for nurses to write, publish and present their work had inspired the introduction of a series of workshops designed to develop and improve writing and presentation skills, which eventuated in formation of the Neophytes. The group was founded on the basis of Bandura's theory of self-efficacy (1997), a concept which has been discussed extensively in social psychology literature to explain motivation and learning theory. People with high assurance in their capabilities regard difficult tasks as challenges to be mastered rather than as threats to be avoided (Bandura, 1994). The Neophytes' group employs a collaborative approach intended to increase and reinforce members' self-confidence; the underlying philosophy is to promote and enhance writers' motivation, capacity and self-efficacy in order to achieve future publication goals confidently and independently. Support which engenders these strengths through a program relevant to participants' needs is likely, as this group found, to increase publication productivity. Additional unexpected outcomes resulted, such as engagement by clinical nurses' in academic work, and an increase in research higher degree enrolments.
Campmans-Kuijpers, Marjo J; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E
To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P teamwork improved (P = 0.001). Measuring quality management and providing feedback and a benchmark improves the level of quality management in care groups but not in outpatient clinics. The questionnaires might also be a useful asset for other diabetes care groups, such as Accountable Care Organizations. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
Petry, Nancy M; Martin, Bonnie; Simcic, Francis
In this study, the authors evaluated a low-cost contingency management (CM) procedure for reducing cocaine use and enhancing group therapy attendance in 77 cocaine-dependent methadone patients. Patients were randomly assigned to 12 weeks of standard treatment or standard treatment with CM, in which patients earned the opportunity to win prizes ranging from $1 to $100 for submitting cocainenegative samples and attending therapy. Patients in the CM condition submitted more cocaine-negative samples and attended more groups than patients in standard treatment. The best predictor of cocaine abstinence at follow-up was duration of abstinence during treatment. On average, patients in the CM condition earned $117 in prizes. Data from this study suggest that some aspects of reinforcement can be implemented in group therapy in community-based clinics.
Crum, Matthew F.; White, Paul J.; Larson, Ian; Malone, Daniel T.; Manallack, David T.; Nicolazzo, Joseph A.; McDowell, Jennifer; Lim, Angelina S.; Kirkpatrick, Carl M.
Objective. To use the nominal group technique to develop a framework to improve existing and develop new objective structured clinical examinations (OSCEs) within a four-year bachelor of pharmacy course. Design. Using the nominal group technique, a unique method of group interview that combines qualitative and quantitative data collection, focus groups were conducted with faculty members, practicing pharmacists, and undergraduate pharmacy students. Five draft OSCEs frameworks were suggested and participants were asked to generate new framework ideas. Assessment. Two focus groups (n=9 and n=7) generated nine extra frameworks. Two of these frameworks, one from each focus group, ranked highest (mean scores of 4.4 and 4.1 on a 5-point scale) and were similar in nature. The project team used these two frameworks to produce the final framework, which includes an OSCE in every year of the course, earlier implementation of teaching OSCEs, and the use of independent simulated patients who are not examiners. Conclusions. The new OSCE framework provides a consistent structure from course entry to exit and ensures graduates meet internship requirements. PMID:28090107
Full Text Available Group C orthobunyaviruses (family Bunyaviridae, genus Orthobunyavirus, discovered in the 1950s, are vector-borne human pathogens in the Americas. Currently there is a gap in genomic information for group C viruses. In this study, we obtained complete coding region sequences of reference strains of Caraparu (CARV, Oriboca (ORIV, Marituba (MTBV and Madrid (MADV viruses, and five clinical isolates from Peru and Bolivia, using an unbiased de novo approach consisting of random reverse transcription, random anchored PCR amplification, and high throughput pyrosequencing. The small, medium, and large segments encode for a 235 amino acid nucleocapsid protein, an approximately 1430 amino acid surface glycoprotein polyprotein precursor, and a 2248 amino acid RNA-dependent RNA polymerase, respectively. Additionally, the S segment encodes for an 83 amino acid non-structural protein, although this protein is truncated or silenced in some isolates. Phylogenetically, three clinical isolates clustered with CARV, one clustered with MTBV, and one isolate appeared to be a reassortant or a genetic drift resulted from the high variability of the medium segment which was also seen in a few other orthobunyaviruses. These data represent the first complete coding region sequences for this serocomplex of pathogenic orthobunyaviruses. The genome-wide phylogeny of reference strains is consistent with the antigenic properties of the viruses reported in the original serological studies conducted in the 1960s. Comparative analysis of conserved protein regions across group C virus strains and the other orthobunyavirus groups revealed that these group C viruses contain characteristic domains of potential structural and functional significance. Our results provide the basis for the developments of diagnostics, further genetic analyses, and future epidemiologic studies of group C viruses.
Devine, Emily Beth; Hoang, Susan; Fisk, Albert W; Wilson-Norton, Jennifer L; Lawless, Nathan M; Louie, Clifton
To (1) describe the role of clinical pharmacists in providing population-based pharmaceutical care as employees of a physician group practice, (2) describe the strategies used by pharmacists to optimize medication use, (3) quantify improvements in care, and (4) illustrate the calculations used to quantify cost savings. Community-based, multispecialty, physician group practice located in the north Puget Sound area between 2003 and 2007. Using four cornerstones (evidence-based medicine, therapeutic interchange, academic detailing, and a local pharmacy and therapeutics committee), the pharmacists provided population-based pharmaceutical care, leading generic switches, target drug programs, and prescription to over-the-counter medication switches. They also led disease management programs, managed drug recalls, implemented electronic health records, negotiated budgets with health plans, and led patient assistance programs and prior authorization programs to improve patient satisfaction. Implementing these strategies from the vantage point of a physician group presents a seldom-realized employment opportunity for pharmacists. The impact of these strategies is measured by process, use, and clinical outcomes metrics. These, in turn, are linked to incentive payments in the pay-for-performance environment or to a lowered per member, per month cost in the capitated environment. In 2006-2007, 71% of our hypertensive patients received generic agents compared with a network average for receiving generic agents of 43%, while the proportion of patients with controlled blood pressure increased from 45% to 60%. We saved $450,000 in inpatient costs for deep venous thrombosis. Clinical pharmacists employed in a physician group practice can optimize medication use, improve care, and reduce costs.
邓旭阳; 郭晋林; 王小玲; 何壮湘; 李卉; 李辉; 姜婷娜
of group psychotherapy on adjustment disorder in mass sample is still very few.OBJECTIVE: To explore the efficacy of group psychotherapy for eliminating adjustment disorder symptoms of college freshmen.DESIGN: A retrospective control study.SETTING, PARTICIPANTS and INTERVENTIONS: Symptom Check(SGL-90) and psychological clinic interview were used in the study. Totally 1 126 freshmen from either 1999 or 2000 grades of Nanjing Medical College were adopted for screening adjustment disorder, which were randomly divided into two groups with 30 patients in each group. Basic techniques of group therapy, such as group discussion, psychodrama and relaxation were applied, and selfassessing scale and SCL-90 were combined for self-comparison after treatment.MAIN OUTCOME MEASURES: Ghanges of mental health and self-worth of freshman were identified after treatment.served in participant(7.10 ± 1.40, 7.23 ± 1.48), self-confidence(5.87 ±2.14,7.48±1.70) andothers (t=2.01, P ＜0.05, t=3.37, P ＜0.01);While 2000 grade freshmen showed obvious improvements in sharing experience with others after treatment( t = 2.41, P ＜ 0.05), particularly in participation with higher significance(t = 3.05, P ＜ 0.01), as well as in caring Post-treatment sonatization, interpersonal communication, depression, obsessive-compulsion, anxiety, phobia and psychoticism were significantly higher than those of pretreatment in 1999 grade freshmen( t = 2.26-2.50, P ＜0.05; t = 2.88-3.15, P ＜ 0.01), the same as somatization, phobia and depression of 2000 grade freshmen( t = 2.67, 2.10, P ＜ 0.05; t = 2. 94, P ＜groups, revealing higher significant difference in caring about others, responsibility and understanding others before treatment( t = 2.09, P ＜ 0.05; t =2.80, P ＜ 0.01; t = 3.82, P ＜ 0. 001), and obviously difference in four items including caring about others, self-confidence and so on( t = 2.47,2.17, P ＜ 0.01); post-treatment mental health was compared with that of pretreatment in both
Oei, Tian P S; Boschen, Mark J
Previous research has established efficacy of cognitive behavioral therapy (CBT) for anxiety disorders, yet it has not been widely assessed in routine community clinic practices. Efficacy research sacrifices external validity to achieve maximum internal validity. Recently, effectiveness research has been advocated as more ecologically valid for assessing routine clinical work in community clinics. Furthermore, there is a lack of effectiveness research in group CBT. This study aims to extend existing research on the effectiveness of CBT from individual therapy into group therapy delivery. It aimed also to examine outcome using not only symptom measures, but also measures of related symptoms, cognitions, and life quality and satisfaction. Results from a cohort of patients with various anxiety disorders demonstrated that treatment was effective in reducing anxiety symptoms to an extent comparable with other effectiveness studies. Despite this, only 43% of individuals showed reliable change, and 17% were 'recovered' from their anxiety symptoms, and the post-treatment measures were still significantly different from the level of anxiety symptoms observed in the general population.
Ribaudo, Heather J.; Smith, Kimberly Y.; Robbins, Gregory K.; Flexner, Charles; Haubrich, Richard; Chen, Yun; Fischl, Margaret A.; Schackman, Bruce R.; Riddler, Sharon A.; Gulick, Roy M.
Background. In the United States, black individuals infected with human immunodeficiency virus (HIV) have higher rates of virologic failure on antiretroviral therapy (ART) and of death compared to white individuals. The cause for these disparities is uncertain. We sought to examine differences in virologic outcomes among antiretroviral-naive clinical trial participants starting randomized ART and to investigate factors to explain the differences. Methods. Individual-level data from participants initiating ART in 5 AIDS Clinical Trials Group studies were analyzed. Included studies were those conducted during 1998–2006 with a primary outcome of virologic failure. The primary outcome measure was time to virologic failure, regardless of ART changes. Results. A total of 2495 individuals (1151 black; 1344 white) were included with a median follow-up of 129 weeks. Compared to whites, blacks had an increased hazard of virologic failure (hazard ratio [HR]; 1.7; 95% confidence interval [CI], 1.4–1.9; P < .001), with no evidence of heterogeneity across regimens (P = .97); the association remained after adjustment for measured confounders (HR, 1.4; 95% CI, 1.2–1.6; P < .001). Increased hazard of virologic failure was associated with younger age, higher pretreatment HIV type 1 RNA level, lower pretreatment CD4 cell count, hepatitis C antibody, less education, and recent nonadherence to treatment. Sensitivity analyses with different endpoint definitions demonstrated similar results. Conclusions. In this analysis, blacks had a 40% higher virologic failure risk than whites that was not explained by measured confounders. The observation was consistent over a range of regimens, suggesting that the difference may be driven by social factors; however, biological factors cannot be ruled out. Further research should identify the sources of racial disparities and develop strategies to reduce them. PMID:24046302
Burgess, Annette; Goulston, Kerry; Oates, Kim
Role modelling by clinicians assists in development of medical students' professional competencies, values and attitudes. Three core characteristics of a positive role model include 1) clinical attributes, 2) teaching skills, and 3) personal qualities. This study was designed to explore medical students' perceptions of their bedside clinical tutors as role models during the first year of a medical program. The study was conducted with one cohort (n = 301) of students who had completed Year 1 of the Sydney Medical Program in 2013. A total of nine focus groups (n = 59) were conducted with medical students following completion of Year 1. Data were transcribed verbatim. Thematic analysis was used to code and categorise data into themes. Students identified both positive and negative characteristics and behaviour displayed by their clinical tutors. Characteristics and behaviour that students would like to emulate as medical practitioners in the future included: 1) Clinical attributes: a good knowledge base; articulate history taking skills; the ability to explain and demonstrate skills at the appropriate level for students; and empathy, respect and genuine compassion for patients. 2) Teaching skills: development of a rapport with students; provision of time towards the growth of students academically and professionally; provision of a positive learning environment; an understanding of the student curriculum and assessment requirements; immediate and useful feedback; and provision of patient interaction. 3) Personal qualities: respectful interprofessional staff interactions; preparedness for tutorials; demonstration of a passion for teaching; and demonstration of a passion for their career choice. Excellence in role modelling entails demonstration of excellent clinical care, teaching skills and personal characteristics. Our findings reinforce the important function of clinical bedside tutors as role models, which has implications for faculty development and
Campbell, S; Sheaff, R; Sibbald, B; Marshall, M; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M
Objectives: To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Design: Qualitative case studies using semi-structured interviews and documentation review. Setting: Twelve purposively sampled PCG/Ts in England. Participants: Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Main outcome measures: Participants' perceptions of the role of clinical governance in PCG/Ts. Results: PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). Conclusion: PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance. PMID:12078380
Schumm, Jeremiah A; Walter, Kristen H; Bartone, Anne S; Chard, Kathleen M
To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs (VA) has widely disseminated cognitive processing therapy (CPT) and prolonged exposure (PE) therapy to VA clinicians. However, there is a lack of research on veteran preferences when presented with a range of psychotherapy and medication options. This study uses a mixed-method approach to explore veteran satisfaction with a VA PTSD specialty clinic pre-treatment orientation group, which provides education about available PTSD treatment options. This study also tested differences in treatment preference in response to the group. Participants were 183 US veterans. Most were White, male, and referred to the clinic by a VA provider. Results indicated high satisfaction with the group in providing an overview of services and helping to inform treatment choice. Most preferred psychotherapy plus medications (63.4%) or psychotherapy only (30.1%). Participants endorsed a significantly stronger preference for CPT versus other psychotherapies. PE was significantly preferred over nightmare resolution therapy and present-centered therapy, and both PE and cognitive-behavioral conjoint therapy were preferred over virtual reality exposure therapy. Results suggest that by informing consumers about evidence-based treatments for PTSD, pre-treatment educational approaches may increase consumer demand for these treatment options.
Granat, Tina; Nordgren, Ingrid; Rein, George; Sonnander, Karin
To study the effectiveness of a group intervention in a clinical setting designed to increase knowledge of disability and improve sibling relationship among siblings of children with disabilities. A self-selected sample of 54 younger and older siblings with typical development (ages 8-12 years) of children with attention deficit hyperactivity disorder (ADHD) (9), Asperger syndrome (7), autistic disorder (13), physical disability (8) and intellectual disability (17) participated in collateral sibling groups. The Sibling Knowledge Interview (SKI) and Sibling Relationship Questionnaire (SRQ) were administered pre- and post-intervention. SKI scores increased (p < 0.001) from pre- to post-intervention when merged diagnostic groups were compared. Comparisons of SRQ pre- and post-intervention scores across diagnostic sibling groups showed significantly different (p < 0.05) score patterns. The results were encouraging and contribute to further development of interventions meeting the needs of siblings of children with disabilities. In view of the limited empirical research on group interventions for siblings of children with disabilities future work is needed to investigate the effectiveness of such interventions. Particular attention should be given to siblings of children with autism and siblings of children with intellectual disability.
Gonzalez, Marianne Thorsen; Hartig, Terry; Patil, Grete Grindal; Martinsen, Egil W; Kirkevold, Marit
This study aimed to assess changes in psychological distress and social participation in adults diagnosed with clinical depression during and after participating in a therapeutic horticulture programme, and to investigate if the changes covaried with levels of group cohesiveness during the intervention. An intervention with a single-group design was repeated with different samples in successive years (pooled n = 46). In each year, five groups of 3-7 participants went through the intervention. Data were collected before, twice during, and immediately after a 12-week therapeutic horticulture programme, as well as at 3-months' follow up. Mental health assessments included the Beck Depression Inventory, the State Subscale of Spielberger State-Trait Anxiety Inventory, the Positive Affect Scale from the Positive and Negative Affect Scale, the Perceived Stress Scale, and the Therapeutic Factors Inventory-Cohesiveness Scale. The analysis of the pooled data confirmed significant beneficial change in all mental health variables during the intervention. Change from baseline in depression severity persisted at 3-months' follow up. Increased social activity after the intervention was reported for 38% of the participants. The groups quickly established strong cohesiveness, and this continued to increase during the intervention. The average level of group cohesiveness correlated positively, but not significantly, with change in all mental health outcome variables.
Alexander, Brian M; Galanis, Evanthia; Yung, W K Alfred; Ballman, Karla V; Boyett, James M; Cloughesy, Timothy F; Degroot, John F; Huse, Jason T; Mann, Bhupinder; Mason, Warren; Mellinghoff, Ingo K; Mikkelsen, Tom; Mischel, Paul S; O'Neill, Brian P; Prados, Michael D; Sarkaria, Jann N; Tawab-Amiri, Abdul; Trippa, Lorenzo; Ye, Xiaobu; Ligon, Keith L; Berry, Donald A; Wen, Patrick Y
Glioblastoma is the most common primary brain malignancy and is associated with poor prognosis despite aggressive local and systemic therapy, which is related to a paucity of viable treatment options in both the newly diagnosed and recurrent settings. Even so, the rapidly increasing number of targeted therapies being evaluated in oncology clinical trials offers hope for the future. Given the broad range of possibilities for future trials, the Brain Malignancy Steering Committee convened a clinical trials planning meeting that was held at the Udvar-Hazy Center in Chantilly, Virginia, on September 19 and 20, 2013. This manuscript reports the deliberations leading up to the event from the Targeted Therapies Working Group and the results of the meeting.
Otten, N D; Toft, N; Houe, H; Thomsen, P T; Sørensen, J T
The elimination of misclassification bias introduced by multiple observers was evaluated and discussed based on an illustrative example using lameness prevalence in 80 Danish dairy herds. Data from 5073 cows from loose-housed cubicle herds larger than 100 cows were included in the analysis. Four trained observers performed clinical scoring on cow level and undertook a calibration test with 39 video sequences. The calibration test served both the purpose of estimating inter-observer agreement (PABAK=0.69) in accordance with previous results and to estimate the sensitivity (Se) and specificity (Sp) for each observer. In the absence of a gold standard for the clinical observations, a latent class analysis (LCA) evaluating the true within-herd lameness prevalence was used. Sensitivity amongst observers was fairly low (0.24-0.81) inducing a general underestimation of the true prevalence. Comparative analyses were made to assess the effect of grazing on the lameness prevalence in order to demonstrate the consequences of using unadjusted apparent prevalences (AP) compared to the true prevalences (TP). Lameness prevalence was higher in grazing herds using AP estimates (19.0% zero-grazing, 20.2% grazing); while the TP estimates showed the expected higher lameness prevalence in zero-grazing herds (42.3% vs. 35.9%). Hence, this study emphasizes the importance of adjusting for observer Se and Sp to obtain true prevalence and avoid false interpretation.
Lozano-Vidal, Ruth; López-Pisa, Rosa M; Boyero-Granados, Ana; Recio-Ramos, Sandra; Padín-Minaya, Cristina; Garzón-Quiñones, Marina; Rodríguez-Latre, Luisa M
To analyze the characteristics of the population over 65 years served in a Basic Health Area, according to the Clinical Risk Group (CRG) classification and geriatric assessment test performed by the nurse in relation to their complexity. A descriptive, cross-sectional and observational prevalence study was conducted on the population over 65 years served in a Basic Health Area. The variables collected were: socio-demographic, CRG classification, diseases (ICD-10), healthcare activity, geriatric assessment, and preventive activities. The CRG classification was used as a measurement tool. Data was collected from the Primary Care computerized clinical history (e-CAP). Population over 65 years: 3,219 people; served at home, 130 (4%), and in residential institutions, 92 (2.85%). The population was grouped into: CRG 1-2: 83 (2.5%); CRG 3: 62 (2%); CRG 4: 99 (3%); CRG 5: 537 (17%); CRG 6: 2,077 (64.5%); CRG 7: 276 (8.6%); CRG 8: 61 (2%); CRG 9: 14 (0.4%). Most frequent chronic diseases: 69.12% AHT; 24.94% DM; 19.51% depression; 11.09% kidney failure. The groups 6-7-8 that were analyzed included 2,414 people (75%). Of those within CRG 6-7-8, only 570 (24%) had tests carried out by the geriatric nurse. The mean number of individuals assigned by a nurse for CRG 6-7-8 was 302. The introduction of classification systems in clinical practice, such as the CRG, along with the use of the new information and communication technologies, helps to incorporate predictive models of health needs. It also promotes proactive actions by nurses and the team to prevent complications of diseases, as well as improving efficiency in the use of services and in care of the complex patients. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Pergola, Giulio; Bellebaum, Christian; Gehlhaar, Britta; Koch, Benno; Schwarz, Michael; Daum, Irene; Suchan, Boris
There is increasing attention about the role of the thalamus in high cognitive functions, including memory. Although the bulk of the evidence refers to episodic memory, it was recently proposed that the mediodorsal (MD) and the centromedian-parafascicular (CM-Pf) nuclei of the thalamus may process general operations supporting memory performance, not only episodic memory. This perspective agrees with other recent fMRI findings on semantic retrieval in healthy participants. It can therefore be hypothesized that lesions to the MD and the CM-Pf impair semantic retrieval. In this study, 10 patients with focal ischemic lesions in the medial thalamus and 10 healthy controls matched for age, education, and verbal IQ performed a verbal semantic retrieval task. Patients were assigned to a target clinical group and a control clinical group based on lesion localization. Patients did not suffer from aphasia and performed in the range of controls in a categorization and a semantic association task. However, target patients performed poorer than healthy controls on semantic retrieval. The deficit was not because of higher distractibility but of an increased rate of false recall and, in some patients, of a considerably increased rate of misses. The latter deficit yielded a striking difference between the target and the control clinical groups and is consistent with anomia. Follow-up high-resolution structural scanning session in a subsample of patients revealed that lesions in the CM-Pf and MD were primarily associated with semantic retrieval deficits. We conclude that integrity of the MD and the CM-Pf is required for semantic retrieval, possibly because of their role in the activation of phonological representations.
Philipsen, Alexandra; Jans, Thomas; Graf, Erika; Matthies, Swantje; Borel, Patricia; Colla, Michael; Gentschow, Laura; Langner, Daina; Jacob, Christian; Groß-Lesch, Silke; Sobanski, Esther; Alm, Barbara; Schumacher-Stien, Martina; Roesler, Michael; Retz, Wolfgang; Retz-Junginger, Petra; Kis, Bernhard; Abdel-Hamid, Mona; Heinrich, Viola; Huss, Michael; Kornmann, Catherine; Bürger, Arne; Perlov, Evgeniy; Ihorst, Gabriele; Schlander, Michael; Berger, Mathias; Tebartz van Elst, Ludger
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with high prevalence in adulthood. There is a recognized need to assess the efficacy of psychotherapy in adult ADHD. To evaluate the efficacy of cognitive behavioral group psychotherapy (GPT) compared with individual clinical management (CM) and that of methylphenidate hydrochloride compared with placebo. Prospective, multicenter, randomized clinical trial of 18- to 58-year-old outpatients with ADHD from 7 German study centers. Patients were recruited between January 2007 and August 2010, treatment was finalized in August 2011, and final follow-up assessments occurred in March 2013. Sessions of GPT and CM were held weekly for the first 12 weeks and monthly thereafter (9 months). Patients received either methylphenidate or placebo for 1 year. The primary outcome was the change in the ADHD Index of the Conners Adult ADHD Rating Scale from baseline to the end of the 3-month intensive treatment (blinded observer ratings). Secondary outcomes included ADHD ratings after 1 year, blinded observer ratings using the Clinical Global Impression Scale, and self-ratings of depression. Among 1480 prescreened patients, 518 were assessed for eligibility, 433 were centrally randomized, and 419 were analyzed as randomized. After 3 months, the ADHD Index all-group baseline mean of 20.6 improved to adjusted means of 17.6 for GPT and 16.5 for CM, with no significant difference between groups. Methylphenidate (adjusted mean, 16.2) was superior to placebo (adjusted mean, 17.9) (difference, -1.7; 97.5% CI, -3.0 to -0.4; P = .003). After 1 year, treatment effects remained essentially stable. Descriptive analyses showed that methylphenidate was superior to placebo in patients assigned to GPT (difference, -1.7; 95% CI, -3.2 to -0.1; P = .04) or CM (difference, -1.7; 95% CI, -3.3 to -0.2; P = .03). Regarding depression, no significant differences were found. In contrast, GPT was superior to CM for all
Clausen, Frederik Banch
of the fetus and newborn to fetuses of immunized women. Prediction of the fetal RhD type has been very successful and is now integrated into clinical practice to assist in the management of the pregnancies of RhD immunized women. In addition, noninvasive prediction of the fetal RhD type can be applied to guide......Incompatibility of red blood cell blood group antigens between a pregnant woman and her fetus can cause maternal immunization and, consequently, hemolytic disease of the fetus and newborn. Noninvasive prenatal testing of cell-free fetal DNA can be used to assess the risk of hemolytic disease...
PEIXOTO JÚNIOR Arnaldo Aires
Full Text Available A total of 40 strains of the B. fragilis group was isolated from clinical specimens in two hospital centers in Fortaleza from 1993 to 1997. The most frequently isolated species was Bacteroides fragilis (19 strains and most isolates came from intra-abdominal and wound infections. The susceptibility profile was traced for cefoxitin, cefoperazone and ticarcillin-clavulanate by using the agar dilution reference method. All isolates were susceptible to ticarcillin-clavulanate (128/2mug/ml. Resistance rates of 15 and 70% were detected to cefoxitin (64mug/ml and cefoperazone (64mug/ml, respectively. Such regional results permit a better orientation in choosing this group of antibiotics for prophylaxis and therapy especially in relation to cefoxitin, which is frequently used in the hospital centers studied.
Ell, Kathleen; Katon, Wayne; Lee, Pey-Jiuan; Guterman, Jeffrey; Wu, Shinyi
Identify biopsychosocial factors associated with depression for patients with Type 2 diabetes. A quasi-experimental clinical trial of 1293 patients was predominantly Hispanic (91%) female (62%), mean age 53 and average diabetes duration 10 years; 373 (29%) patients were depressed and assessed by Patient Health Questionnaire-9. Demographic, baseline clinical and psychosocial variables were compared between depressed and nondepressed patients. Bivariate analyses found depression significantly associated (pidentified six key risk factors: greater disability, diabetes symptoms and regimen distress, female gender, less diabetes self-care and lack of A1C. In addition, after controlling for identified six factors, the number of psychosocial stressors significantly associated with increased risk of depression (adjusted odds ratio=1.37, 95% confidence intervals: 1.18-1.58, pidentify a high-risk group of patients needing depression screening. Copyright © 2015 Elsevier Inc. All rights reserved.
Campo Osaba Maria-Antonia
Full Text Available Abstract Background The promotion of health and the interventions in community health continue to be one of the pending subjects of our health system. The most prevalent health problems (cardiovascular diseases, cancer, diabetes... are for the most part related to life habits. We propose a holistic and integral approach as the best option for tackling behavior and its determinants. The research team has elaborated the necessary educational material to realize group teaching, which we call "Health Workshops". The goal of the present study is to evaluate the effectiveness of these Health Workshops in the following terms: Health Related Quality of Life (HRQOL, incorporate and maintain a balanced diet, do physical activity regularly, maintain risk factors such as tension, weight, cholesterol within normal limits and diminish cardiovascular risk. Methods/Design Controlled and random clinical testing, comparing a group of persons who have participated in the Health Workshops with a control group of similar characteristics who have not participated in the Health Workshops. Field of study: the research is being done in Health Centers of the city of Barcelona, Spain. Population studied: The group is composed of 108 persons that are actually doing the Health Workshops, and 108 that are not and form the control group. They are assigned at random to one group or the other. Data Analysis: With Student's t-distribution test to compare the differences between numerical variables or their non parametric equivalent if the variable does not comply with the criteria of normality. (Kolmogorov-Smirnof test. Chi-square test to compare the differences between categorical variables and the Logistic Regression Model to analyze different meaningful variables by dichotomous analysis related to the intervention. Discussion The Health Workshop proposed in the present study constitutes an innovative approach in health promotion, placing the emphasis on the person's self
World Health Organization, Copenhagen (Denmark). Regional Office for Europe.
The 1978 report of the Working Group of Postgraduate Training in Clinical Oncology, convened by the World Health Organization (WHO) Regional Office for Europe in collaboration with the government of The Netherlands, is presented. The groups analyzed models of postgraduate training in clinical oncology and evaluated their suitability in relation to…
Klingenberg, Sarah Louise; Nikolova, Dimitrinka; Alexakis, Nicholas
The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews wi...
Full Text Available In Italy, according to recent data, the over 65 are about 20% of the population, while those over 80 are as many as 3 million (Istat, 2011. Over 600 thousand people are affected by Alzheimer's disease, the most common of the dementias. This pandemic is concerned, more or less directly, the majority of Italian families. A territorial service which wants to approach to families in difficulty must be organized on professional performances of experts and operators, whose diversity of competence is warranty for taking charge and for overcoming of the detected uneasiness. In this sense, the elaboration group for family members (caregivers that we present, offers the chance to receive and give sense to the effort due to the emotional implications that the disease of the elderly person involves. The work, presented here, has been designed and built by a perspective groupanalityc subjectual (Lo Verso, Di Blasi, 2011. It has set itself the goal of helping families to cope with the implications emotional / affective related to the topics of death and loss. The group device well it is combined with these clinical needs because it provided support and processing of emotional and cognitive experiences, has put in network information, has enabled the sharing of specific experiences. Through rigorous qualitative methodology, are therefore presented the outcomes of the group experience. Keywords:dementia, caregivers, group
Craswell, Alison; Kearney, Lauren; Reed, Rachel
Establishment of a service to increase clinical placement opportunities for midwifery students in a regional area of Queensland, Australia with unknown impact on all service stakeholders. Group antenatal care (known as Expecting and Connecting) was provided at the university campus, instigated collaboratively between the health service and university in response to population growth and student needs in a health service jurisdiction not otherwise serviced for public pregnancy care. This study evaluated the 'Expecting and Connecting' Group Pregnancy Care service from the perspective of attending women, midwifery students and midwives. Qualitative findings were obtained from mothers, midwives and midwifery students. The study was guided by Donabedian's conceptual framework to assess quality within a health service. Thematic analysis was used to identify themes and concepts from the data within the areas of structure, process and outcome. Expecting and Connecting provided benefits to participants including an environment for students and pregnant women to build relationships to meet Continuity of Care requirements for students. Mothers reported high levels of satisfaction with antenatal care including the ability to develop peer support. The collaborative facilitation of group antenatal care by university and health service midwives provided a catalyst to the development of peer support networks within the local community and enhance opportunity for midwifery student requirements. The 'Expecting and Connecting' group antenatal care service was highly regarded by participant mothers, midwives and midwifery students and provided an additional source of midwifery student placement. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.
Cordioli Aristides V
Full Text Available Objective: To develop a cognitive-behavioral group therapy protocol and to verify its efficacy to reduce obsessive-compulsive symptoms. Methods: An open clinical trial with 32 obsessive-compulsive patients was performed, in which a cognitive-behavioral group therapy protocol of 12 weekly sessions of two hours, in 5 consecutive groups, was applied. The severity of symptoms was rated with the Yale-Brown Obsessive-Compulsive (Y-BOCS, Hamilton Anxiety (HAM A and Hamilton Depression (HAM D scales. The patients were followed up for 3 months after the end of the treatment. Results: There was a significant reduction in the scores of Y-BOCS, HAM A and HAM D scales with the treatment regardless the use of anti-obsessive medications. The rate of improved patients (decrease of > or = 35% in Y-BOCS was 78.1%. Two patients (6.25% dropped out from the study. The effect size calculated for the Y-BOCS scale was 1.75. Conclusions: This study suggests that cognitive-behavioral group therapy reduces obsessive-compulsive symptoms. In addition, patients presented good compliance.
Goldfield, Norbert; Averill, Richard; Eisenhandler, Jon; Hughes, John S.; Muldoon, John; Steinbeck, Barbara; Bagadia, Farah
Summarizes the development of a new risk adjustment methodology, the Clinical Risk Grouping System, a prospective capitation risk adjuster, that should be useful for payment and monitoring of episodes of clinical conditions that involve rehabilitation. (SLD)
Bilić, Vedran; Nemcić-Moro, Iva; Karsić, Vana; Grgić, Vesna; Stojanović-Spehar, Stanislava; Marcinko, Darko
PTSD is a complex psychobiological disorder that causes disfunctionality in many areas. In treating PTSD different models have been applied, however, no general consensus on the method of treatment has yet been achieved. At the Clinic for Psychological Medicine we have developed the model of combined treatment for PTSD patients that involves outpatient individual psychotherapy, psychopharmacotherapy and group psychotherapeutic techniques introduced within repeated day-hospital treatments. In this paper the efficiency of the above mentioned model has been explored. Three PTSD patients have been presented. We assessed changes in psychological functioning of our subjects on the basis of clinical observation and analysis of the session protocols. The model of combined and long-term treatment of PTSD in which the approach to traumatized patients has been mostly supportive, including supportive psychotherapeutic interventions and psychopharmacotherapy, has proved to be efficient in achieving integration of traumatic experiences and consolidation of the traumatised Self. Combination of individual and group approach facilitates the analysis of traumatic transference, whereas more mature defence patterns become stronger and integration of traumatic experiences improved. Consolidation of the Self leads to better socialization.
Farmer, Cristan; Butter, Eric; Mazurek, Micah O; Cowan, Charles; Lainhart, Janet; Cook, Edwin H; DeWitt, Mary Beth; Aman, Michael
A gap exists in the literature regarding aggression in autism spectrum disorders and how this behavior compares to other groups. In this multisite study, the Children's Scale for Hostility and Aggression: Reactive/Proactive and the Aggression subscale of the Child Behavior Checklist were rated for 414 children with autism spectrum disorder (autistic disorder, 69%; pervasive developmental disorder not otherwise specified, 24%; Asperger's disorder, 7%) and 243 clinic-referred children without autism spectrum disorder, aged 1-21 years (mean age about 7 years). Participants were not selected for aggressive behavior. Relative to the comparison group, children with autism spectrum disorder were reported to have less aggression and were more likely to be rated as reactive rather than proactive. Among all subjects, sex was not associated with aggression; higher IQ/adaptive behavior and older age were associated with more sophisticated types of aggression, while lower scores on IQ, adaptive behavior, and communication measures were associated with more physical aggression. The interaction between demographic variables and diagnosis was significant only for age: younger but not older children with autism spectrum disorder showed less aggression than clinic-referred controls.
Mattaloni, Stella Maris; Arnoni, Carine; Céspedes, Rosario; Nonaka, Claudia; Trucco Boggione, Carolina; Luján Brajovich, Melina Eliana; Trejo, Andrea; Zani, Néstor; Biondi, Claudia Silvia; Castilho, Lilian; Cotorruelo, Carlos Miquel
Background Kell null (K0) individuals can produce anti-Ku, an antibody against many epitopes in the Kell glycoprotein, after transfusion and/or pregnancy. Since sensitized K0 patients are rare, little is known about anti-Ku clinical relevance and in particular about its association to hemolytic disease of the fetus and newborn. Case Report This work describes a case of neonatal hyperbilirubinemia due to immune-mediated erythrocyte destruction by an alloantibody directed against the Kell glycoprotein. Serologic and molecular approaches identified an anti-Ku alloantibody in maternal serum. A homozygous IVS3 + 1g>a point mutation (KEL*02N.06 allele) was found to be responsible for the lack of Kell antigen expression in the mother's red blood cell and subsequent alloimmunization after a previous pregnancy. Even though in most cases Kell antibodies are clinically severe and may cause suppression of erythropoiesis, in our case the newborn had a moderate anemia and hyperbilirubinemia that was successfully treated with phototherapy without requiring exchange transfusion. Serological and molecular studies performed in the proband's family members allowed us to provide them with proper counseling regarding alloimmunization after transfusion and/or pregnancy. Conclusions This case enlarges the understanding of the clinical significance of alloantibodies against Kell blood group antigens.
Machado, Luciana Pimenta e Silva; Nery, Cláudio de Góis; Leles, Cláudio Rodrigues; Nery, Marianita Batista de Macedo; Okeson, Jeffrey P
The aim of this study was to observe the prevalence of diagnostic groups of temporomandibular disorders (TMD) in patients who were referred or sought treatment for TMD and/or orofacial pain in a private clinic. The clinical records of 357 patients were evaluated and selected based on inclusion/exclusion criteria; the mean age was 32 years. A clinical examination was performed and the diagnosis was based on the American Academy of Orofacial Pain criteria. Results showed that 86.8% of patients were women and 93.3% of the patients presented more than one diagnosis. The most frequent chief complaint (n = 216, chi2 = 30.68, p = 0.001) and total diagnosis realized (n = 748, chi2 = 14.14, p = 0.001) were muscle related. We concluded that women seek treatment for dysfunction/disorders of orofacial structures more than men do; patients seeking specialized treatment have more than one diagnosis and muscle dysfunction is more prevalent than intra-articular disorders.
Sauro, Khara M; Wiebe, Samuel; Perucca, Emilio; French, Jacqueline; Dunkley, Colin; de Marinis, Alejandro; Kirkpatrick, Martin; Jetté, Nathalie
Clinical practice guidelines (CPGs) contain evidence-based recommendations to guide clinical care, policy development, and quality of care improvement. A recent systematic review of epilepsy guidelines identified considerable variability in the quality of available guidelines. Although excellent frameworks for CPG development exist, processes are not followed uniformly internationally, and resources to develop CPGs may be limited in certain settings. An International League Against Epilepsy (ILAE) working group was charged with proposing methodology to guide the development of future epilepsy-specific CPGs. A comprehensive literature search (1985-2014) identified articles related to CPG development and handbooks. Guideline handbooks were included if they were publicly available, and if their methodology had been used to develop CPGs. The working group's expertise also informed the creation of methodologies and processes to develop future CPGs for the ILAE. Five handbooks from North America (American Academy of Neurology), Europe (Scottish Intercollegiate Guidelines Network & National Institute for Health and Care Excellence), Australia (National Health and Medical Research Council), World Health Organization (WHO), and additional references were identified to produce evidence-based, consensus-driven methodology for development of epilepsy-specific CPGs. Key components of CPG development include the following: identifying the topic and defining the scope; establishing a working group; identifying and evaluating the evidence; formulating recommendations and determining strength of recommendations; obtaining peer reviews; dissemination, implementation, and auditing; and updating and retiring the CPG. A practical handbook and toolkit was developed. The resulting CPG development toolkit should facilitate the development of high-quality ILAE CPGs to improve the care of persons with epilepsy.
Faddoul, Diala; Sposto, Richard; Batoon, Kristine; Polanco, Claudia M.; Dien Bard, Jennifer
Group A Streptococcus (GAS) pharyngitis is a very common condition causing significant morbidity in children. Accurate diagnosis followed by appropriate antimicrobial therapy is recommended to prevent postinfectious sequelae. Diagnosis of GAS pharyngitis by a rapid antigen detection test (RADT) or culture in the absence of discriminating clinical findings remains challenging. Validation of new sensitive rapid diagnostic tests is therefore a priority. The performance of a loop-mediated isothermal amplification (LAMP) assay (illumigene assay) for the diagnosis of GAS pharyngitis was compared with that of a RADT and standard culture in 361 pediatric throat swab samples. Discrepant results were resolved using an alternate molecular assay. Test results were correlated with clinical presentations in patients positive by either method. The closest estimate of the true prevalence of GAS pharyngitis was 19.7% (71/361 samples). The illumigene assay alone detected 70/71 GAS-positive samples; RADT and culture detected 35/71 and 55/71 samples, respectively. RADT followed by culture confirmation of RADT-negative specimens detected 58/71 cases. The illumigene assay increased identification among children eligible for testing by American College of Physicians (ACP)/American Academy of Family Physicians (AAFP) criteria from 31 to 39 positive cases, five of which were false positives. Analysis of clinical data in GAS-positive patients indicated that a significantly greater proportion of children with McIsaac scores of ≥4 tested positive by the illumigene assay versus RADT and culture. Overall, the illumigene assay was much more sensitive and was similarly specific for GAS detection, compared to culture alone, RADT alone, or the ACP/AAFP RADT/culture algorithm. Combining high sensitivity with rapidly available results, the illumigene GAS assay is an appropriate alternative to culture for the laboratory diagnosis of GAS pharyngitis in patients for whom testing is clinically
Zhang, Shuo; Maidenberg, Yanir; Luo, Kai; Koberstein, Jeffrey T
Azide-alkyne click chemistry has emerged as an important and versatile means for tethering a wide variety of guest molecules to virtually any substrate. In many of these applications, it is important to exercise control over the areal density of surface functional groups to achieve a desired areal density of the tethered guest molecule of interest. We demonstrate herein that the areal density of surface azide groups on flat germanium surfaces and nanoparticle substrates (silica and iron oxide) can be controlled kinetically by appropriately timed quenching of the S(N)2 substitution reaction of bromo-alkane-silane monolayers induced by the addition of sodium azide. The kinetics of the azide substitution reaction on monolayers formed on flat Ge substrates, determined by attenuated total reflection infrared spectroscopy (ATR-IR), are found to be identical to those for monolayers formed on both silica and iron oxide nanoparticles, the latter determined by transmission infrared spectroscopy. To validate the method, the percentages of surface bromine groups converted to azide groups after various reaction times were measured by quenching the S(N)2 reaction followed by analysis with ATR-IR (for Ge) and thermogravimetric analysis (after a subsequent click reaction with an alkyne-terminal polymer) for the nanoparticle substrates. The conversions found after quenching agree well with those expected from the standard kinetic curves. The latter result suggests that the kinetic method for the control of azide group areal density is a versatile means for functionalizing substrates with a prescribed areal density of azide groups for subsequent click reactions, and that the method is universal for any substrate, flat or nanoparticle, that can be modified with bromo-alkane-silane monolayers. Regardless of the surface geometry, we find that the azide substitution reaction is complete within 2-3 h, in sharp contrast to previous reports that indicate times of 48-60 h required for
chromosome sequences were found in only one patient, who subsequently underwent gonadectomy.Conclusion: The importance of this study resides, to the best of our knowledge, in the fact that the largest group of patients in Romania was analyzed and assessed. To draw firm conclusions on the most valuable clinical indicators for Turner syndrome diagnosis in clinical practice, studies on large groups of patients should be conducted. Keywords: Turner syndrome, diagnosis, phenotype, karyotype, GH treatment, Y chromosome sequences
Li, Huiyang; Fang, Manman; Hou, Yingqin; Tang, Runli; Yang, Yizhou; Zhong, Cheng; Li, Qianqian; Li, Zhen
Four organic sensitizers (LI-68-LI-71) bearing various conjugated bridges were designed and synthesized, in which the only difference between LI-68 and LI-69 (or LI-70 and LI-71) was the absence/presence of the CN group as the auxiliary electron acceptor. Interestingly, compared to the reference dye of LI-68, LI-69 bearing the additional CN group exhibited the bad performance with the decreased Jsc and Voc values. However, once one thiophene moiety near the anchor group was replaced by pyrrole with the electron-rich property, the resultant LI-71 exhibited a photoelectric conversion efficiency increase by about 3 folds from 2.75% (LI-69) to 7.95% (LI-71), displaying the synergistic effect of the two moieties (CN and pyrrole). Computational analysis disclosed that pyrrole as the auxiliary electron donor (D') in the conjugated bridge can compensate for the lower negative charge in the electron acceptor, which was caused by the CN group as the electron trap, leading to the more efficient electron injection and better photovoltaic performance.
This book applies the author's easy but effective differentiation strategies to the data analysis and probability content standard. Taking the foundational elements of differentiation in this book, it helps you: (1) assess students' math abilities quickly and efficiently; (2) group children by need; (3) target instruction to meet every student's…
This book applies the author's easy but effective differentiation strategies to the data analysis and probability content standard. Taking the foundational elements of differentiation in this book, it helps you: (1) assess students' math abilities quickly and efficiently; (2) group children by need; (3) target instruction to meet every student's…
Muenzner, Julienne K.; Rehm, Tobias; Biersack, Bernhard; Casini, Angela; de Graaf, Inge A. M.; Worawutputtapong, Pawida; Noor, Awal; Kempe, Rhett; Brabec, Viktor; Kasparkova, Jana; Schobert, Rainer
Five platinum(LI) complexes bearing a (1,3-dibenzyl)imidazol-2-ylidene ligand but different leaving groups trans to it were examined for cytotomicity, DNA and cell cycle interference, vascular disrupting properties, and nephrotoxicity. The cytotoxicity of complexes 3a-c increased with the steric shi
Trudelle-Jackson, Elaine; Ferro, Emerenciana; Morrow, James R.
Background Reduction in muscle strength is strongly associated with functional decline in women, and women with lower quadriceps strength adjusted for body weight are more likely to develop knee osteoarthritis. Objective To compare body weight--adjusted strength among women of different age/racial groups. Study Design Cross-sectional study of muscle strength in 918 women aged 20--83 (M ± SD = 52 ± 13). Methods An orthopedic examination was conducted including measurement of handgrip and lower extremity strength (hip abductors/external rotators, knee flexors/extensors). Data were grouped into young (20--39 years, n = 139), middle (40--54 years, n = 300), and older (55+ years, n = 424) ages for white (n = 699) and African American (AA) (n = 164) women. Means and standard deviations for strength adjusted for body weight were calculated for each age and racial group and compared using 2-way multivariate analysis of variance and post hoc tests. Results No significant age-by-race interaction (P = .092) but significant main effects for age and race (P < .001). Pairwise comparisons revealed significant differences in knee extensor and flexor strength between all age groups. For grip and hip external rotator strength, significant differences were found between the middle and older groups. Differences in hip abductor strength were found between the young and middle-aged groups. AA women had lower strength than white women in all muscle groups (P < .05) except hip external rotators. Conclusions Strength decreased with age in all muscle groups but magnitude of decrease varied by muscle. Strengthening programs should target different muscles, depending on a woman's age and race. PMID:21666779
Gerbi, Bruce J; Antolak, John A; Deibel, F Christopher; Followill, David S; Herman, Michael G; Higgins, Patrick D; Huq, M Saiful; Mihailidis, Dimitris N; Yorke, Ellen D; Hogstrom, Kenneth R; Khan, Faiz M
The goal of Task Group 25 (TG-25) of the Radiation Therapy Committee of the American Association of.Physicists in Medicine (AAPM) was to provide a methodology and set of procedures for a medical physicist performing clinical electron beam dosimetry in the nominal energy range of 5-25 MeV. Specifically, the task group recommended procedures for acquiring basic information required for acceptance testing and treatment planning of new accelerators with therapeutic electron beams. Since the publication of the TG-25 report, significant advances have taken place in the field of electron beam dosimetry, the most significant being that primary standards laboratories around the world have shifted from calibration standards based on exposure or air kerma to standards based on absorbed dose to water. The AAPM has published a new calibration protocol, TG-51, for the calibration of high-energy photon and electron beams. The formalism and dosimetry procedures recommended in this protocol are based on the absorbed dose to water calibration coefficient of an ionization chamber at 60Co energy, N60Co(D,w), together with the theoretical beam quality conversion coefficient k(Q) for the determination of absorbed dose to water in high-energy photon and electron beams. Task Group 70 was charged to reassess and update the recommendations in TG-25 to bring them into alignment with report TG-51 and to recommend new methodologies and procedures that would allow the practicing medical physicist to initiate and continue a high quality program in clinical electron beam dosimetry. This TG-70 report is a supplement to the TG-25 report and enhances the TG-25 report by including new topics and topics that were not covered in depth in the TG-25 report. These topics include procedures for obtaining data to commission a treatment planning computer, determining dose in irregularly shaped electron fields, and commissioning of sophisticated special procedures using high-energy electron beams. The use of
Farley, Gary L.
Local characteristics of fabrics varied to suit special applications. Adjustable reed machinery proposed for use in weaving fabrics in various net shapes, widths, yarn spacings, and yarn angles. Locations of edges of fabric and configuration of warp and filling yarns varied along fabric to obtain specified properties. In machinery, reed wires mounted in groups on sliders, mounted on lengthwise rails in reed frame. Mechanisms incorporated to move sliders lengthwise, parallel to warp yarns, by sliding them along rails; move sliders crosswise by translating reed frame rails perpendicular to warp yarns; and crosswise by spreading reed rails within group. Profile of reed wires in group on each slider changed.
Alberto Rubio-Tapia; Jorge Hernéndez-Calleros; Sagrario Trinidad-Hernández; Luis Uscanga
AIM: To describe the clinical and histological characteristics of a group of adults with small-bowel nodular lymphoid hyperplasia (NLH).METHODS: Patients were searched for five years in pathology records of our institution. The biopsy material was reassessed using strict histopathological criteria.Clinical data were obtained from medical records.RESULTS: Small-bowel NLH was diagnosed in 18 cases.The female: male ratio was 2: 1. The most frequent symptoms were diarrhea (72%), involuntary weight loss (72%) and abdominal pain (61%). Nine patients (50%)had immunodeficiency. Small-bowel bacterial overgrowth was found in three (17%) cases. At small-bowel NLH diagnosis, three (17%) had associated lymphoma: two intestinal and one extra-intestinal lymphomas. In two patients with villous atrophy and anti-endomysial antibodies the diagnosis of celiac disease was established.Giardia lamblia infection was found in only one patientwith hypogammaglobulinemia (Herman's syndrome).CONCLUSIONS; NLH is uncommon in adult patients.Associated diseases are immunodeficiency and lymphoid tissue malignancies.
Yu, Jihnhee; Hutson, Alan D; Siddiqui, Adnan H; Kedron, Mary A
In some small clinical trials, toxicity is not a primary endpoint; however, it often has dire effects on patients' quality of life and is even life-threatening. For such clinical trials, rigorous control of the overall incidence of adverse events is desirable, while simultaneously collecting safety information. In this article, we propose group sequential toxicity monitoring strategies to control overall toxicity incidents below a certain level as opposed to performing hypothesis testing, which can be incorporated into an existing study design based on the primary endpoint. We consider two sequential methods: a non-Bayesian approach in which stopping rules are obtained based on the 'future' probability of an excessive toxicity rate; and a Bayesian adaptation modifying the proposed non-Bayesian approach, which can use the information obtained at interim analyses. Through an extensive Monte Carlo study, we show that the Bayesian approach often provides better control of the overall toxicity rate than the non-Bayesian approach. We also investigate adequate toxicity estimation after the studies. We demonstrate the applicability of our proposed methods in controlling the symptomatic intracranial hemorrhage rate for treating acute ischemic stroke patients.
Changes in health-related quality of life across three post-heart transplantation stages: preoperative extracorporeal membrane versus non-extracorporeal membrane group/clinical trial plan group versus non-clinical trial plan group in Taiwan.
Tseng, P-H; Wang, S-S; Shih, F-J
The aims of this research were to compare changes in overall health-related quality of life (HRQoL), working competence (WC), physical functions (PF), and quality of sleep across 3 crucial post-heart transplantation (HT) stages (1 month, 6 months, and 1 year post-HT) between the following: (1) preoperative extracorporeal membrane (preop-ECMO) versus non-ECMO group and (2) postoperative Clinical Trial Plan (CTP) group versus non-CTP group in Taiwan. A between-method triangulation design was used. Subjects who had undergone HT in the last 1-4 years were recruited from a leading medical center in Taipei. Quantitative data were collected using Visual Analog scale (VAS) and Taiwan's version of the World Health Organization Quality of Life (WHOQOL) questionnaire. Semistructured qualitative questions were added to explore the factors influencing the changes in social domains of HRQoL. A total of 62 heart transplant recipients (HTRs) participated in this study. Their ages ranged from 20 to 70 (mean, 47.16 ± 12.09) years; 80.6% were male. Compared with the subjects with preop-ECMO, HRQoL, WC, and PF of the subjects without preop-ECMO were less at 1 month post-HT; the difference reached statistical significance for HRQoL and PF for 1 month post-HT, but they recovered at the 6 months post-HT stage. HTRs who had participated in the CTP had higher HRQoL and perceived WC in the period of 1 month post-HT, 6 months post-HT, and 1 year post-HT as compared with the group not in CTP; meanwhile, the difference was statistically significant for HRQoL at 1 month post-HT and 6 months post-HT and for PF at 1 month post-HT. The efficacy of postop-CTP including HRQoL, WC, and PF was promising across the 3 post-HT stages. Postop-CTP was suggested both clinically and was shown to be statistically significant to HTR's recovery of their health status. Copyright © 2012 Elsevier Inc. All rights reserved.
Despite a growing interest in auditory verbal hallucinations (AVHs) in different clinical and nonclinical groups, the phenomenological characteristics of such experiences have not yet been reviewed and contrasted, limiting our understanding of these phenomena on multiple empirical, theoretical, and clinical levels. We look at some of the most prominent descriptive features of AVHs in schizophrenia (SZ). These are then examined in clinical conditions including substance abuse, Parkinson’s dise...
Pavlovic Nada J
Full Text Available Abstract Background To identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices. Methods Within-groups analysis of responses to semi-structured interviews. Interviews consisted of using prototypes in response to task-based scenarios. The prototypes were implemented on two different form factors: a tablet style PC and a pocketPC. Participants were from three user groups: general internists, family physicians and medicine residents, and from two different settings: urban and semi-urban. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts of the testing sessions. Statistical relationships were investigated between staff physicians' and residents' background variables, self-reported experiences with the interfaces, and verbal code frequencies. Results 47 physicians were recruited from general internal medicine, family practice clinics and a residency training program. The mean age of participants was 42.6 years. Physician specialty had a greater effect on device and information-presentation preferences than gender, age, setting or previous technical experience. Family physicians preferred the screen size of the tablet computer and were less concerned about its portability. Residents liked the screen size of the tablet, but preferred the portability of the pocketPC. Internists liked the portability of the pocketPC, but saw less advantage to the large screen of the tablet computer (F[2,44] = 4.94, p = .012. Conclusion Different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization.
Balleza, Marco; Anton, Daniel; Casan, Pere; Riu, Pere
Equations used to estimate ventilation out of EIT images, validated on healthy volunteers show a significant bias and a larger variance when were applied on a COPD patients group. The differences in estimation values were found to be highly correlated with anthropometric parameters. Two groups of 13 and 4 COPD male patients (FEV1/FVC= 80%) were used in this study. We have measured different anthropometric parameters like age, weight, height and skinfolds. The EIT system (TIE4sys) and a pneumotach were simultaneously connected to monitor tidal volume. The main anthropometric parameters values of 13 COPD patients were: age: 67±9 years, height: 1.65±0.05 m, weight: 72±11 kg, BMI: 26.4±3.3 and the subscapular skinfold thickness was 23±9mm. The mean tidal volume estimated with TIE4sys and the pneumotach were: 0.580±0.212 L and 0.774±0.173 L r = 0.861 (pskinfold.
Proposes and experimentally tests mood adjustment approach, complementing mood management theory. Discusses how results regarding self-exposure across time show that patterns of popular music listening among a group of undergraduate students differ with initial mood and anticipation, lending support to mood adjustment hypotheses. Describes how…
Klingenberg, Sarah Louise; Nikolova, Dimitrinka; Alexakis, Nicholas
The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews...... with meta-analyses of the trials. In this overview, we present the growth of The CHBG Controlled Trials Register, as well as the systematic reviews that have been produced since March 1996....
Bellani, Giacomo; Coppadoro, Andrea; Patroniti, Nicolò; Turella, Marta; Arrigoni Marocco, Stefano; Grasselli, Giacomo; Mauri, Tommaso; Pesenti, Antonio
Auto-positive end-expiratory pressure (auto-PEEP) may substantially increase the inspiratory effort during assisted mechanical ventilation. Purpose of this study was to assess whether the electrical activity of the diaphragm (EAdi) signal can be reliably used to estimate auto-PEEP in patients undergoing pressure support ventilation and neurally adjusted ventilatory assist (NAVA) and whether NAVA was beneficial in comparison with pressure support ventilation in patients affected by auto-PEEP. In 10 patients with a clinical suspicion of auto-PEEP, the authors simultaneously recorded EAdi, airway, esophageal pressure, and flow during pressure support and NAVA, whereas external PEEP was increased from 2 to 14 cm H2O. Tracings were analyzed to measure apparent "dynamic" auto-PEEP (decrease in esophageal pressure to generate inspiratory flow), auto-EAdi (EAdi value at the onset of inspiratory flow), and IDEAdi (inspiratory delay between the onset of EAdi and the inspiratory flow). The pressure necessary to overcome auto-PEEP, auto-EAdi, and IDEAdi was significantly lower in NAVA as compared with pressure support ventilation, decreased with increase in external PEEP, although the effect of external PEEP was less pronounced in NAVA. Both auto-EAdi and IDEAdi were tightly correlated with auto-PEEP (r = 0.94 and r = 0.75, respectively). In the presence of auto-PEEP at lower external PEEP levels, NAVA was characterized by a characteristic shape of the airway pressure. In patients with auto-PEEP, NAVA, compared with pressure support ventilation, led to a decrease in the pressure necessary to overcome auto-PEEP, which could be reliably monitored by the electrical activity of the diaphragm before inspiratory flow onset (auto-EAdi).
Full Text Available Influenza H7N9 and H1N1pdm can cause severe human infections. It is important to investigate the distinguishing clinical features between these two diseases. Several studies have compared the differences in general, however, age and gender adjusted comparisons may be more useful and informative to the health professionals.A total of 184 severe H1N1pdm patients and 37 severe H7N9 patients from Jiangsu Province were included in this analysis to perform age and gender adjusted comparison of clinical features.After adjusting age and gender, no significant differences in chronic medical conditions or treatment were found between severely ill patients with H7N9 and H1N1pdm. Severely ill patients with H7N9 had significantly longer interval from onset of illness to neuraminidase inhibitor treatment and to death. They were more likely to have complications such as acute respiratory distress syndrome (ARDS, liver and renal dysfunctions, and had a significantly higher risk of death.Our results suggests that age and gender should be adjusted as important confounding factors when comparing the clinical features between severe H7N9 and H1N1pdm patients to avoid any misunderstanding regarding the differences between these two diseases particularly in terms of clinical severity and prognosis.
Scott, Dee; Jelsma, Jennifer
The study aimed to investigate whether learning from peers, learning from a clinical educator, or being the peer teacher during clinical group sessions was more effective at enhancing student learning outcomes for different health conditions. A secondary aim was to determine which method students found more satisfactory. Physiotherapy students at…
The present study compared a clinical and a control sample of Turkish children on the Bender Gestalt and Draw A Person tests. 44 of the children from a clinic sample were compared to 44 children from a matched nonclinical school sample The tests were scored according to the Koppitz criteria. ANOVA comparisons showed differences on the Bender Gestalt test, and the HFD. The two groups did not differ on the number of Emotional Indicators. Correct classification of the children in the clinical gr...
Jónsson, Hjalti; Arendt, Kristian Bech; Jørgensen, Lisbeth
Background: The efficacy of a group cognitive behavioural therapy program (Cool Kids) of childhood anxiety has been demonstrated in a university-clinic setting in Australia (Hudson et al., 2009) and findings from a randomized controlled trial (RCT) at a University-clinic supports its efficacy...... Service in Denmark. Method: Psychologists and psychiatrists from three Child and Adolescent Psychiatry clinics and four community bases School Counselling Services are trained and supervised in a manualized group CBT treatment program (Cool Kids) for Childhood anxiety. Ninety-six children with anxiety...... disorders aged between 7 - 14 are expected to be included, equally divided between Psychiatric clinics (n = 48) and School Counselling services (n =48). The treatment consists of 10 2-hour group sessions with 5-6 children and their parents. Results are measured by independent diagnostic interviews...
Mac Neil, Brad A; Leung, Pauline; Nadkarni, Pallavi; Stubbs, Laura; Singh, Manya
Eating disorder clinics across Canada place heavy reliance on group-based programming. However, little work has examined whether this modality of treatment is well-received by patients and results in clinical improvements. The purpose of this pilot study was to evaluate patient satisfaction and outcomes for group-based programming offered through an adult eating disorders clinic. Participants were 81 adults who met DSM-5 criteria for an eating disorder and participated in the study as part of the clinic's program evaluation. Participants received medical monitoring, psychiatric follow-up, adjunct nutrition and pre-psychological treatment, and participated in the clinic's core cognitive behavioural therapy (CBT) group. Demographic information and weight were collected at intake. Participants also completed pre- and post-group programming measures of life satisfaction, depressive and anxiety symptoms, psychological symptoms of the eating disorder, and satisfaction with the programming. Participants' experienced a significant increase in satisfaction with life, and decreases in depressive symptoms and psychological symptoms of the eating disorder post-group. Adults endorsed feeling fairly satisfied with the group-based services provided. Results draw attention to the importance of program evaluation as an integral component of an adult outpatient eating disorder clinic by providing a voice for patients' views of the services received and program outcomes.
Full Text Available Abstract Background Empirical support for cognitive behavioral therapy (CBT for treating Japanese patients with major depression is lacking, therefore, a feasibility study of CBT for depression in Japanese clinical settings is urgently required. Findings A culturally adapted, 16-week manualized individual CBT program for Japanese patients with major depressive disorder was developed. A total of 27 patients with major depression were enrolled in a single-group study with the purpose of testing the feasibility of the program. Twenty six patients (96% completed the study. The mean total score on the Beck Depression Inventory-II (BDI-II for all patients (Intention-to-treat sample improved from 32.6 to 11.7, with a mean change of 20.8 (95% confidence interval: 17.0 to 24.8. Within-group effect size at the endpoint assessment was 2.64 (Cohen's d. Twenty-one patients (77.7% showed treatment response and 17 patients (63.0% achieved remission at the end of the program. Significant improvement was observed in measurement of subjective and objective depression severity (assessed by BDI-II, Quick Inventory of Depressive Symptomatology-Self Rated, and Hamilton Depression Rating Scale, dysfunctional attitude (assessed by Dysfunctional Attitude Scale, global functioning (assessed by Global Assessment of Functioning of DSM-IV and subjective well-being (assessed by WHO Subjective Well-being Inventory (all p values Conclusions Our manualized treatment comprised of a 16-week individual CBT program for major depression appears feasible and may achieve favorable treatment outcomes among Japanese patients with major depression. Further research involving a larger sample in a randomized, controlled trial design is warranted. Trial registration UMIN-CTR UMIN000002542.
Park, Chan Ho; Han, Jong Kyu; Kim, Young Tong; Shin, Hyeong Cheol; Kim, Hyung Hwan; Jou, Sung Shick [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of)
To evaluate differences anatomical location and age groups on CT and clinical data in deep neck abscess. This study included 200 patients who underwent CT and were diagnosed with a deep neck abscess, from December 2005 to July 2010. Patients were divided into four groups by age (children, adolescent, adult, elderly). Next, the anatomic location, location multiplicity and clinical data regarding the deep neck abscesses were analyzed retrospectively. The deep neck abscesses observed were defined as superficial or deep and partitioned into sub-groups, with further analysis of their clinical data. The incidence of the parapharyngeal abscess was more frequent in children and elderly groups (p < 0.05). The masticator abscess was only observed among patients in the elderly group (p < 0.05). Multiple locations were observed with increased frequency in children and elderly groups (p < 0.05). Swelling in the neck was more frequently observed in children and elderly groups (p < 0.05), cervical lymphadenitis was frequently seen in children and adolescent groups (p < 0.05), and the incidence of symptoms including sore throat were significantly increased in adolescent and adult groups (p < 0.05). Location multiplicity was significantly higher in parapharyngeal, retropharyngeal, submandibular, danger, visceral and masticator spaces than other spaces (p < 0.05). With regards to anatomic location, neck swelling was more frequent in superficial group and sore throat was more frequent in deep group (p < 0.05). Deep neck abscess would show significant differences with regards to the abscess location, location multiplicity, and clinical symptoms according to age. The clinical symptoms observed are dependent on the anatomic location as defined by a superficial or deep abscess.
Chimura, T; Hirayama, T; Oda, T; Saito, N; Sato, S; Numazaki, M
Chorioamnionitis as a complication of threatened abortion and preterm labor and preterm PROM were treated with ceftazidime (CAZ) and aspoxicillin (ASPC) as a primary therapy. The following results were obtained. 1. Cases of threatened abortion and preterm labor (n = 25) and preterm PROM (n = 5) were treated with 2-4 g CAZ/day alone (n = 14) or in combination with 4 g ASPC/day (n = 16) along with a uterine contraction inhibitor (ritodrine hydrochloride etc. n = 28) and clinical evaluation was made. 2. In the cases of threatened abortion and preterm labor the efficacy ratio was 24/25 (96%). In the cases of preterm PROM, the latent period-delaying effect was observed in five out of the five patients. Upon analysis of the tocolysis index in the group of threatened abortion and preterm labor, the index values > or = 5 were observed in 12 out of 25 (60%), and the delivery incidence before the 35th week of gestation was 4/25 (16%). In all patients, the incidence of delivery after the 36th week of gestation was 24/30 (80%). 3. Bacteriological examinations showed a high detection rate for Gram-positive bacteria, and the combination effect between ASPC and CAZ was demonstrated against all 9 isolates examined. The above results indicated a high efficacy as well as safety of the combination of CAZ and ASPC as a primary therapeutic means against chorioamnionitis.
程琪辉; 张喜平; 曾小澜
Objective: To evaluate the clinical value of serum tumor supplied group of factor (TSGF) in diagnosis of epithelial ovarian cancer. Methods: The serum TSGF was tested in 69 patients with epithelial ovarian cancer, 28 patients with benign ovarian lesion and 61 healthy women. The serum levels of vascular endothelial growth factor (VEGF) and CA125 were determined in patients with epithelial ovarian cancer and in those with benign ovarian lesion. The correlations of TSGF with VEGF and CA125 were investigated. Results: The serum level of TSGF in patients with epithelial ovarian cancer was obviously higher than in patients with benign ovarian lesion and in healthy women (P0.05). The serum level of TSGF and VEGF and CA125 in patients with epithelial ovarian cancer showed positive correlation (P<0.01, P<0.05, respectively). Conclusion: There is no marked difference in diagnostic value among TSGF, VEGF and CA125. TSGF has a certain value in diagnosis of epithelial ovarian cancer, and is helpful to distinguish epithelial ovarian cancer from benign ovarian lesion.
Full Text Available Aim of the current study was to evaluate the clinical/health status of veal calves in 3 farms that adopt large group housing and automatic feeding stations in Italy. Visits were scheduled in three phases of the rearing cycle (early, middle, and end. Results showed a high incidence of coughing, skin infection and bloated rumen particularly in the middle phase while cross-sucking signs were present at the early stage when calves’ nibbling proclivity is still high. Throughout the rearing cycle, the frequency of bursitis increased reaching 53% of calves at the end. The percentage of calves with a poorer body condition than the mid-range of the batch raised gradually as well, likely due to the non-proportioned teat/calves ratio that increases competition for feed and reduces milk intake of the low ranking animals. The remarked growth differences among pen-mates and the mortality rate close to 7% showed by the use of automatic feeding devices for milk delivery seem not compensating the lower labour demand, therefore its sustainability at the present status is doubtful both for the veal calves’ welfare and the farm incomes.
Fan, Jiemin; Dong, Lin; Chen, Zhaoxing; Bei, Dandan
Group A β-hemolytic streptococcus (GAS) or Streptococcus pyogenes may be encountered in diverse clinical situations in children. A rising incidence of invasive group A streptococcus (IGAS) infections has been noted in children in the past three decades. The aim of this study was to summarize the clinical characteristics and antimicrobial resistance of IGAS in children, and to raise the level of diagnosis and treatment of this infection. The clinical data from 19 cases of IGAS younger than 14 years old seen from January 2004 to December 2011 treated in the authors' hospital were analyzed. IGAS infections are defined as the isolation of GAS from a normally sterile site in patients. The 19 cases were identified as IGAS infections, among whom 15 were male and 4 were female, and the ratio of them was 3.75. The age ranged from 1 day to 14 years, with a median age of 4 years. The course of disease was 4 h-10 days. The average length of stay was 12.2 days. In 13 cases the episodes of the infection occurred in winter and spring. In 18 cases the infection was community-acquired. Overall, 10 cases had neck or foot dorsum abscess, four cases had purulent peritonitis, and 3 cases were diagnosed as streptococcal toxic shock syndrome (STSS) complicated with empyema, pyopneumothorax occurred in 1 case and neonatal septicemia in another. Three cases had an underlying disease, including 2 cases wounded in a car accident and 1 case of congenital esophageal atresia and tracheoesophageal fistula. Before the isolation of GAS, 5 cases had stayed in ICUs, the length of ICU stay was 1-32 days, 4 cases had received intubation and mechanical ventilation, the ventilation time was 8 h-24 days, 2 cases had received major surgery; 5 cases had other pathogen coinfection, including 4 cases of abdominal pus at the same time and Escherichia coli was isolated, and 1 case had parainfluenza virus type I coinfection. Peripheral blood leucocyte increased in 18 cases, one case dropped off. The C
Watson, H R; Schroeder, T V; Simms, M H;
To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures.......To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures....
Sophia K Smith
Full Text Available Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed.Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions.Survey respondents (n = 179 valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p < .001. Patient group respondents placed higher value in open communications, clear expectations, and detailed contract execution than did non-patient group respondents (all p < .05. Industry and academic respondents more often cited internal bureaucratic processes and reluctance to share information as engagement barriers than did patient group respondents (all p < .01. Patient groups reported that a lack of transparency and understanding of the benefits of collaboration on the part of industry and academia were greater barriers than did non-patient group respondents (all p< .01.Despite reported similarities among approaches to engagement by the three stakeholder groups, key differences exist in perceived barriers and benefits to partnering with patient groups among the
Shorey, Ryan C.; Stuart, Gregory L.; Anderson, Scott
Early maladaptive schemas are rigidly held cognitive and behavioral patterns that guide how individuals encode and respond to stimuli in their environments (Young, 1994). Research has examined the early maladaptive schemas of substance abusers, as schemas are believed to underlie, perpetuate, and maintain problematic substance use. To date, research has not examined whether young adult male substance abuse treatment seekers (ages 18 to 25) report greater early maladaptive schema endorsement than a non-clinical comparison group. The current study extended the research on substance use and schemas by comparing the early maladaptive schemas of young adult male residential substance abuse patients (n = 101) and a group of non-clinical male college students (n = 175). Results demonstrated that the substance abuse group scored higher than the non-clinical comparison group on 9 of the 18 early maladaptive schemas. Implications of these findings for future research and substance use treatment programs are discussed. PMID:23312769
Darvishpoor Kakhki H.
Full Text Available atement of Problem: Lichen planus (LP is a chronic disease that affects skin and mucous membranes. Lesions of oral lichen planus (OLP can persist for a long time. Varying prevalence rates of oral lichen planus have been reported in different parts of the world, while information regarding the epidemiology of this disease in Iran is incomplete.Purpose: This study was designed to evaluate the characteristics of oral lichen planus in a group of Iranian patients and compare the results with similar conducted studies in other populations. Materials and Method: In this descriptive study data were collected from charts of 158 patients In Kerman, Iran (1997-2005 over 8 consecutive years. For each patient, age at presentation, gender, chief complaint, duration of chief compliant, previous treatment, current medications, skin involvement and a complete medical history has been recorded. A number of possible etiologic factors and possible presence of diabetes or liver disease also analyzed. Laboratory evaluations consisted of glucose tolerance test (GTT and liver function tests (LFT. This data were analyzed by SPSS version 12 statistical software. Results: The mean age of study population was 41.16 years. Subjects were predominantly female (65.1%. Liver function tests (LFT were abnormal in 19.6% of cases. Disturbance of glucose metabolism and fasting blood sugar was also higher than normal limit in10.8% and 2.9 % of cases respectively. Atrophic-erosive lesions were found in 17 of the cases. In 50 patients the lesions were exclusively keratotic and in 91 the lesions were atrophic-erosive and keratotic. Most oral lesions were multifocal (88.6%, with the buccal mucosa being the most common location in each clinical form (87.3%. Duration of oral lesions ranged from 0.4 to 20 years with a mean of 1.54 year. Conclusion: This study showed that epidemiological and clinical features of the disease in Kerman are similar to those mentioned in literature. Also, in
Fuller, Richard L; Hughes, John S; Goldfield, Norbert I
Risk adjustment accounts for differences in population mix by reducing the likelihood of enrollee selection by managed care plans and providing a correction to otherwise biased reporting of provider or plan performance. Functional health status is not routinely included within risk-adjustment methods, but is believed by many to be a significant enhancement to risk adjustment for complex enrollees and patients. In this analysis a standardized measure of functional health was created using 3 different source functional assessment instruments submitted to the Medicare program on condition of payment. The authors use a 5% development sample of Medicare claims from 2006 and 2007, including functional health assessments, and develop a model of functional health classification comprising 9 groups defined by the interaction of self-care, mobility, incontinence, and cognitive impairment. The 9 functional groups were used to augment Clinical Risk Groups, a diagnosis-based patient classification system, and when using a validation set of 100% of Medicare data for 2010 and 2011, this study found the use of the functional health module to improve the fit of observed enrollee cost, measured by the R(2) statistic, by 5% across all Medicare enrollees. The authors observed complex nonlinear interactions across functional health domains when constructing the model and caution that functional health status needs careful handling when used for risk adjustment. The addition of functional health status within existing risk-adjustment models has the potential to improve equitable resource allocation in the financing of care costs for more complex enrollees if handled appropriately. (Population Health Management 2016;19:136-144).
Vivian E A Eta
Full Text Available BACKGROUND: Clinical teaching is an important component of clinical education. In nursing, clinical teaching is ensured by clinical nurse educators (CNEs. This study aimed at describing the major challenges faced by CNEs in Cameroon. METHODS: In a qualitative study, supplemented with quantitative methods, CNEs were enrolled from three health districts to represent their frequency in Cameroon’s health delivery system. RESULTS: A total of 56 CNEs participated in the study, of whom, as many as 58.9% acknowledged always facing challenges in clinical teaching and supervision. The major challenges identified were the lack of opportunities to update knowledge and skills, students’ lack of preparedness and the CNEs not being prepared for clinical teaching. CNEs attributed these challenges in major part to the lack of incentives and poor health policies. CONCLUSION: CNEs in Cameroon do indeed face major challenges which are of diverse origins and could adversely affect teaching in clinical settings
Initially, Gastrointestinal Study Group in Japan Clinical Oncology Group (GIOSG/JCOG) focused on gastric cancer. In 1980s, fluoropyrimidine, cisplatin and mitomycin C were key drugs. A randomized Phase II trial (JCOG8501) comparing futrafur plus mitomycin C and uracil plus futrafur and mitomycin C showed a higher response rate of uracil plus futrafur and mitomycin C than futrafur plus mitomycin C. From the results of two Phase II trials of etoposide, adriamycin and cisplatin, and cisplatin plus 5-fluorouracil, uracil plus futrafur and mitomycin C and cisplatin plus 5-fluorouracil were adopted for the test arms of the Phase III trial (JCOG9205) comparing with continuous infusion of 5-fluorouracil as a control arm. Neither cisplatin plus 5-fluorouracil nor uracil plus futrafur and mitomycin C showed a survival benefit over continuous infusion of 5-fluorouracil. In late 1990s, new agents, irinotecan and S-1, were developed for gastric cancer in Japan. GIOSG conducted a Phase III trial (JCOG9912) investigating superiority of irinotecan plus cisplatin and non-inferiority of monotherapy with S-1 compared with continuous infusion of 5-fluorouracil, and S-1 succeeded in showing non-inferiority. Then, SPIRITS trial showed a survival benefit of S-1 plus cisplatin over S-1, resulting in the establishment of a standard care for advanced gastric cancer in Japan. GIOSG have merged with Gastric Cancer Study Group as the Stomach Cancer Study Group (SCSG) from 2011. Recent progress in the development of new drugs has been remarkable. From the point of the roles shared with many other study groups for clinical trials, including registration trials of new drugs conducted by pharmaceutical companies, SCSG should recognize its role and conduct clinical trials with high quality for establishing new standard treatment.
Stronks, Karien; Wieringa, Nicolien F.; Hardon, Anita
There is increasing evidence that outcomes of health care differ by patient characteristics, such as gender and ethnicity. If evidence-based medicine is to improve quality of care for all patients, it is essential to take this diversity into account when designing clinical studies. So far, this noti
Full Text Available Group B Streptococcus (GBS is increasingly causing invasive infections in nonpregnant adults. Elderly patients and those with comorbidities are at increased risk. On the basis of previous studies focusing on neonatal infections, penicillin plus gentamicin is recommended for infective endocarditis (IE and periprosthetic joint infections (PJI in adults. The purpose of this study was to investigate whether a synergism with penicillin and gentamicin is present in GBS isolates that caused IE and PJI. We used 5 GBS isolates, two clinical strains and three control strains, including one displaying high-level gentamicin resistance (HLGR. The results from the checkerboard and time-kill assays (TKAs were compared. For TKAs, antibiotic concentrations for penicillin were 0.048 and 0.2 mg/L, and for gentamicin 4 mg/L or 12.5 mg/L. In the checkerboard assay, the median fractional inhibitory concentration indices (FICIs of all isolates indicated indifference. TKAs for all isolates failed to demonstrate synergism with penicillin 0.048 or 0.2 mg/L, irrespective of gentamicin concentrations used. Rapid killing was seen with penicillin 0.048 mg/L plus either 4 mg/L or 12.5 mg/L gentamicin, from 2 h up to 8 h hours after antibiotic exposure. TKAs with penicillin 0.2 mg/L decreased the starting inoculum below the limit of quantification within 4 h to 6 h, irrespective of the addition of gentamicin. Fast killing was seen with penicillin 0.2 mg/L plus 12.5 mg/L gentamicin within the first 2 h. Our in vitro results indicate that the addition of gentamicin to penicillin contributes to faster killing at low penicillin concentrations, but only within the first few hours. Twenty-four hours after antibiotic exposure, PEN alone was bactericidal and synergism was not seen.
Ruppen, Corinne; Lupo, Agnese; Decosterd, Laurent; Sendi, Parham
Group B Streptococcus (GBS) is increasingly causing invasive infections in non-pregnant adults. Elderly patients and those with comorbidities are at increased risk. On the basis of previous studies focusing on neonatal infections, penicillin plus gentamicin is recommended for infective endocarditis (IE) and periprosthetic joint infections (PJI) in adults. The purpose of this study was to investigate whether a synergism with penicillin and gentamicin is present in GBS isolates that caused IE and PJI. We used 5 GBS isolates, two clinical strains and three control strains, including one displaying high-level gentamicin resistance (HLGR). The results from the checkerboard and time-kill assays (TKAs) were compared. For TKAs, antibiotic concentrations for penicillin were 0.048 and 0.2 mg/L, and for gentamicin 4 mg/L or 12.5 mg/L. In the checkerboard assay, the median fractional inhibitory concentration indices (FICIs) of all isolates indicated indifference. TKAs for all isolates failed to demonstrate synergism with penicillin 0.048 or 0.2 mg/L, irrespective of gentamicin concentrations used. Rapid killing was seen with penicillin 0.048 mg/L plus either 4 mg/L or 12.5 mg/L gentamicin, from 2 h up to 8 h hours after antibiotic exposure. TKAs with penicillin 0.2 mg/L decreased the starting inoculum below the limit of quantification within 4-6 h, irrespective of the addition of gentamicin. Fast killing was seen with penicillin 0.2 mg/L plus 12.5 mg/L gentamicin within the first 2 h. Our in vitro results indicate that the addition of gentamicin to penicillin contributes to faster killing at low penicillin concentrations, but only within the first few hours. Twenty-four hours after antibiotic exposure, PEN alone was bactericidal and synergism was not seen.
The Freedom of Access to Clinic Entrances Act (FACE) is a federal statute which was signed into law May 1994 prohibiting the use of force, threat of force, or physical obstruction to intentionally injure, intimidate, or interfere with anyone providing reproductive health services. Since FACE was enacted, seven federal district courts and one federal appellate court have found the measure constitutional, although one federal district court in Wisconsin did rule against FACE. Anti-choice activists have argued that neither the Commerce Clause nor the Fourteenth Amendment to the US Constitution empower Congress to enact FACE. Congress relied upon both constitutional provisions when it enacted the statute, recognizing that illegal, violent acts against abortion providers and their patients threaten to disrupt medical care nationwide and eliminate the right to choose abortion. The US Court of Appeals for the Fourth Circuit on February 13, 1995, however, unanimously upheld a lower court's dismissal of the case, finding that FACE does not violate the US Constitution. Relying upon an April 26 Supreme Court decision in United States vs. Lopez, which held that Congress did not have the power under the Commerce Clause to enact a federal statute prohibiting the possession of a firearm within 100 feet of a school zone, an anti-choice group and several individuals petitioned the US Supreme Court in a May 12 filing to review the appellate court ruling in American Life League vs. Reno. The petitioners also challenge the broad powers of Congress under the Fourteenth Amendment to remedy infringements upon constitutional rights and assert FACE violates the First Amendment and the Religious Freedom Restoration Act.
Kuhlmann, F Matthew; Santhanam, Srikanth; Kumar, Pardeep; Luo, Qingwei; Ciorba, Matthew A; Fleckenstein, James M
Because O blood group has been associated with more severe cholera infections, it has been hypothesized that cholera toxin (CT) may bind non-O blood group antigens of the intestinal mucosae, thereby preventing efficient interaction with target GM1 gangliosides required for uptake of the toxin and activation of cyclic adenosine monophosphate (cAMP) signaling in target epithelia. Herein, we show that after exposure to CT, human enteroids expressing O blood group exhibited marked increase in cAMP relative to cells derived from blood group A individuals. Likewise, using CRISPR/Cas9 engineering, a functional group O line (HT-29-A(-/-)) was generated from a parent group A HT-29 line. CT stimulated robust cAMP responses in HT-29-A(-/-) cells relative to HT-29 cells. These findings provide a direct molecular link between blood group O expression and differential cellular responses to CT, recapitulating clinical and epidemiologic observations.
Mattner, F; Sohr, D; Heim, A; Gastmeier, P; Vennema, H; Koopmans, M
Norovirus infections have been described as self-limiting diseases of short duration. An investigation of a norovirus outbreak in a university hospital provided evidence for severe clinical features in patients with several underlying diseases. Clinical outcomes of norovirus infection were defined.
Witteman, C.L.M.; Spaanjaars, N.L.; Aarts, A.A.
Clinical intuition in mental health care has been written off as a mysterious kind of ability to ‘see through’ clients, something that clinicians who favour evidence-based practice should have nothing to do with. We propose another understanding of clinical intuition. Similar to other types of profe
Buus, Niels; Angel, Sanne; Traynor, Michael
This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision...... in psychiatric settings have been reported to be relatively low. Qualitative research indicates that staff members appreciate clinical supervision, but paradoxically, do not prioritize participation and find participation emotionally challenging. Little is known about these contradictory experiences and how...... they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very...
Full Text Available The question whether parents’ reports on their children’s development provide reliable information is a subject of controversial debate. While parental rating scales and parental interviews are widely used in clinical practice, empirical findings have shown that parents cannot assess their children well. Previous research has illustrated that most parents tend to overestimate the developmental status and cognitive performance of their children. If the child displays behavior problems, the accuracy of mothers’ appraisals decreases substantially. The aim of this study was (1 to examine whether mothers who are concerned about their children’s development still overestimate the developmental status and (2 whether maternal beliefs about developmental norms influence the accuracy of evaluation. The sample consisted of 14 mother-child-dyads who were clients of two outpatient clinics in Vienna and had concerns about the child’s development, 16 mother-child-dyads without concerns who sought advice because of their children’s potential high abilities, and 30 mother-child-dyads without concerns and no clinic referral. While the children were tested using the Wiener Entwicklungstest (Viennese Developmental Test, WET, Kastner-Koller & Deimann, 2002, a developmental test for children 3 to 6 years old, mothers were asked to estimate which items of the WET (1 their own child and (2 a normal peer would be able to solve. Mothers with concerns had limited knowledge of what a child of a certain age can achieve and they expected too much. Though they realized that their own developmentally delayed child did not fulfill these high expectations, they were not able to appraise his/her performance accurately. Mothers whose children were normally developed or even above average were able to evaluate their own children much more precisely. Moreover, these mothers estimated developmental norms more accurately. Both mothers of gifted children and of
Frazer, Kate; Connolly, Michael; Naughton, Corina; Kow, Veronica
Facilitating and supporting clinical learning for student nurses and midwives are essential within their practice environments. Clinical placements provide unique opportunities in preparation for future roles. Understanding the experiences of first year student nurses and midwives following clinical exposures and examining the clinical facilitators and barriers can assist in maintaining and developing clinical supports. The study used a structured group feedback approach with a convenience sample of 223 first year nursing and midwifery students in one Irish university in April 2011 to ascertain feedback on the clinical aspects of their degree programme. Approximately 200 students participated in the process. Two key clinical issues were identified by students: facilitating clinical learning and learning experiences and needs. Positive learning environments, supportive staff and increased opportunities for reflection were important issues for first year students. The role of supportive mentoring staff in clinical practice is essential to enhance student learning. Students value reflection in practice and require more opportunities to engage during placements. More collaborative approaches are required to ensure evolving and adapting practice environments can accommodate student learning. Copyright © 2014 Elsevier Ltd. All rights reserved.
Bahamondes, Luis; Bottura, Bruna F; Bahamondes, M Valeria; Gonçalves, Mayara P; Correia, Vinicius M; Espejo-Arce, Ximena; Sousa, Maria H; Monteiro, Ilza; Fernandes, Arlete
What is the contribution of the provision, at no cost for users, of long acting reversible contraceptive methods (LARC; copper intrauterine device [IUD], the levonorgestrel-releasing intrauterine system [LNG-IUS], contraceptive implants and depot-medroxyprogesterone [DMPA] injection) towards the disability-adjusted life years (DALY) averted through a Brazilian university-based clinic established over 30 years ago. Over the last 10 years of evaluation, provision of LARC methods and DMPA by the clinic are estimated to have contributed to DALY averted by between 37 and 60 maternal deaths, 315-424 child mortalities, 634-853 combined maternal morbidity and mortality and child mortality, and 1056-1412 unsafe abortions averted. LARC methods are associated with a high contraceptive effectiveness when compared with contraceptive methods which need frequent attention; perhaps because LARC methods are independent of individual or couple compliance. However, in general previous studies have evaluated contraceptive methods during clinical studies over a short period of time, or not more than 10 years. Furthermore, information regarding the estimation of the DALY averted is scarce. We reviewed 50 004 medical charts from women who consulted for the first time looking for a contraceptive method over the period from 2 January 1980 through 31 December 2012. Women who consulted at the Department of Obstetrics and Gynaecology, University of Campinas, Brazil were new users and users switching contraceptive, including the copper IUD (n = 13 826), the LNG-IUS (n = 1525), implants (n = 277) and DMPA (n = 9387). Estimation of the DALY averted included maternal morbidity and mortality, child mortality and unsafe abortions averted. We obtained 29 416 contraceptive segments of use including 25 009 contraceptive segments of use from 20 821 new users or switchers to any LARC method or DMPA with at least 1 year of follow-up. The mean (± SD) age of the women at first consultation ranged from 25
Chahine, Saad; Cristancho, Sayra; Padgett, Jessica; Lingard, Lorelei
In the competency-based medical education (CBME) approach, clinical competency committees are responsible for making decisions about trainees' competence. However, we currently lack a theoretical model for group decision-making to inform this emerging assessment phenomenon. This paper proposes an organizing framework to study and guide the decision-making processes of clinical competency committees.This is an explanatory, non-exhaustive review, tailored to identify relevant theoretical and evidence-based papers related to small group decision-making. The search was conducted using Google Scholar, Web of Science, MEDLINE, ERIC, and PsycINFO for relevant literature. Using a thematic analysis, two researchers (SC & JP) met four times between April-June 2016 to consolidate the literature included in this review.Three theoretical orientations towards group decision-making emerged from the review: schema, constructivist, and social influence. Schema orientations focus on how groups use algorithms for decision-making. Constructivist orientations focus on how groups construct their shared understanding. Social influence orientations focus on how individual members influence the group's perspective on a decision. Moderators of decision-making relevant to all orientations include: guidelines, stressors, authority, and leadership.Clinical competency committees are the mechanisms by which groups of clinicians will be in charge of interpreting multiple assessment data points and coming to a shared decision about trainee competence. The way in which these committees make decisions can have huge implications for trainee progression and, ultimately, patient care. Therefore, there is a pressing need to build the science of how such group decision-making works in practice. This synthesis suggests a preliminary organizing framework that can be used in the implementation and study of clinical competency committees.
Fifteen minutes after injection there was a fall in mean heart rate (18%, p less than 0.001), systolic blood pressure (10%, p less than 0.001) and rate-pressure product (27%, p less than 0.0001) in the metoprolol group of patients in the MIAMI trial. Hypotension and bradycardia not necessarily associated with withdrawal of drug were more common in the metoprolol group (p less than 0.001). Atrioventricular block I was more common in the metoprolol group (p less than 0.03), whereas no such difference was observed for atrioventricular block II and III, asystole or pacemaker implantations. Left ventricular failure was observed no more often in the metoprolol group. The occurrence of cardiogenic shock also did not differ between the groups. Cardiac glycosides were used more in the placebo group, but diuretic and furosemide usage did not differ. For all patients mean furosemide doses and number of diuretic injections were similar in both treatment groups. Atropine (4.1 vs 6.4%) and sympathomimetic (3.2 vs 4.6%) agents were used more often in the metoprolol group during days 0 to 5 (p less than 0.05). The trial medication was withdrawn temporarily more often in the metoprolol than in the placebo group (p less than 0.001). However, permanent withdrawal of trial medication occurred with a similar frequency overall in both groups. More patients were withdrawn from the study because of cardiovascular reasons in the metoprolol group (9%) than in the placebo group (5%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Imakyure, Osamu; Shuto, Hideki; Nishikawa, Fumi; Hagiwara, Yoshifuka; Inoue, Sachiko; Koyanagi, Taeko; Hirakawa, Masaaki; Kataoka, Yasufumi
The acquirement of basic knowledge of clinical trials and professional attitude in their practices is a general instructional objective in the Model Core Curriculum for Pharmaceutical Education. Unfortunately, the previous program of clinical trial education was not effective in the acquirement of a professional attitude in their practices. Then, we developed the new clinical trial education program using protocol through small group discussion (SGD) and roll-playing. Our program consists of 7 steps of practical training. In step 1, the students find some problems after presentation of the protocol including case and prescription. In step 2, they analyse the extracted problems and share the information obtained in SGD. In steps 3 and 5, five clinical case scenarios are presented to the students and they discuss which case is suitable for entry to the clinical trial or which case corresponds to the discontinuance criteria in the present designed protocol. In steps 4 and 6, the roll-playing is performed by teachers and students as doctors and clinical research coordinators (CRC) respectively. Further, we conducted a trial practice based on this program for the students. In the student's self-evaluation into five grades, the average score of the skill acquisition level in each step was 3.8-4.7 grade. Our clinical trial education program could be effective in educating the candidates for CRC or clinical pharmacists.
Frère, Julie; Bidet, Philippe; Tapiéro, Bruce; Rallu, Fabien; Minodier, Philippe; Bonacorsi, Stephane; Bingen, Edouard; Ovetchkine, Philippe
Since the introduction of the varicella vaccine to the routine immunization schedule, we have observed a 70% reduction in the rate of varicella-associated invasive group A streptococcal infections (IGASI). In the mean time, the clinical presentation of IGASI and microbiological characteristics of GAS strains have changed significantly.
Davidsen, Annika Helgadóttir
disorders in group therapy. We conducted a randomized clinical trial and included 159 adult participants, 156 females and 3 males, diagnosed with bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified according to DSM-IV. Eighty participants were allocated to the experimental...
... 0332 260.517 fax email@example.com ITALY–Support Groups Associazione Nazionale Polio e Sindrome Postpolio Louise Read, ... Allen San Rafael FrancineAllen@comcast.net Post-Polio Group/California North ... PT Advanced Spine Physical Therapy Drake Professional Park 343 W Drake Rd Ste ...
Christophersen, J; Menné, T; Tanghøj, P;
patch tested with the standard series of the International Contact Dermatitis Research Group (ICDRG) by members of the Danish Contact Dermatitis Group (DCDG) over a period of 6 months. For the 8 test allergens most often found positive (nickel, fragrance-mix, cobalt, chromate, balsam of Peru, carba...
Arnowitz, Edward; And Others
Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)
Warnakulasuriya, K A; Samaranayake, L P; Peiris, J S
The relative importance of various factors in the pathogenesis of angular cheilitis in a population of Sri Lankan adults was studied. Forty-nine patients with cheilitis were examined clinically and microbiologically. Only 5 of 49 patients were full denture wearers. The clinical presentation of the lesions could be categorized as mild (Type I), moderate (Type II) or severe (Type III) and the duration of the lesions ranged from 1 month to more than 4 yr. Hematologic investigations revealed 18 patients with low hemoglobin 8 of whom had hypochromic, microcytic anaemia. Pathogenic organisms were isolated from 59% of the lesions; Candida spp. in 24 patients and Staph. aureus in 11 patients. A significant positive relationship between commissural leukoplakia and an infective etiology of angles was noted. This study confirms the multifactorial etiology of angular cheilitis while highlighting the varied clinical presentation of the lesions in an Asian population.
Smith, Sophia K; Selig, Wendy; Harker, Matthew; Roberts, Jamie N; Hesterlee, Sharon; Leventhal, David; Klein, Richard; Patrick-Lake, Bray; Abernethy, Amy P
Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed. Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions. Survey respondents (n = 179) valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p research is needed to define and optimize key success factors.
Allen, Kelli D; Bongiorni, Dennis; Bosworth, Hayden B; Coffman, Cynthia J; Datta, Santanu K; Edelman, David; Hall, Katherine S; Lindquist, Jennifer H; Oddone, Eugene Z; Hoenig, Helen
Efficient approaches are needed for delivering nonpharmacological interventions for management of knee osteoarthritis (OA). This trial compared group-based versus individual physical therapy interventions for management of knee OA. Three hundred twenty patients with knee OA at the VA Medical Center in Durham, North Carolina, (mean age=60 years, 88% male, 58% nonwhite) were randomly assigned to receive either the group intervention (group physical therapy; six 1-hour sessions, typically 8 participants per group) or the individual intervention (individual physical therapy; two 1-hour sessions). Both programs included instruction in home exercise, joint protection techniques, and individual physical therapist evaluation. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range=0-96, higher scores indicate worse symptoms), measured at baseline, 12 weeks, and 24 weeks. The secondary outcome measure was the Short Physical Performance Battery (SPPB; range=0-12, higher scores indicate better performance), measured at baseline and 12 weeks. Linear mixed models assessed the difference in WOMAC scores between arms. At 12 weeks, WOMAC scores were 2.7 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% confidence interval [CI]=-5.9, 0.5; P=.10), indicating no between-group difference. At 24 weeks, WOMAC scores were 1.3 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% CI=-4.6, 2.0; P=.44), indicating no significant between-group difference. At 12 weeks, SPPB scores were 0.1 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% CI=-0.5, 0.2; P=.53), indicating no difference between groups. This study was conducted in one VA medical center. Outcome assessors were blinded, but participants and physical therapists were not blinded. Group physical therapy was not more effective
Valinsky, Liora; Mishali, Moshe; Endevelt, Ronit; Preiss, Rachel; Dopelt, Keren; Heymann, Anthony D
.... The Objective of this study was to examine the effectiveness of diabetes groups in reducing resistance to treatment and the association between reduced resistance and better management of the disease...
Koole, Sebastiaan; Christiaens, Véronique; Cosyn, Jan; De Bruyn, Hugo
Despite the consensus on the importance of reflection for dental professionals, a lack of understanding remains about how students and clinicians should develop their ability to reflect. The aim of this study was to investigate dental students’ and mentors’ perceptions of mentor groups as an instructional method to facilitate students’ reflection in terms of the strategy’s learning potential, role of the mentor, group dynamics, and feasibility. At Ghent University in Belgium, third- and fourt...
Two systematic reviews have evaluated the quality of research and reporting of observational studies investigating the prevalence of, the incidence of and the risk factors for peri-implant diseases and of experimental clinical studies evaluating the efficacy of preventive and therapeutic interventions.
Compared MMPIs of 80 male and 80 female drug abusers with MMPIs of 550 male and 695 female medical patients. Male drug abusers obtained significantly higher scores than male medical patients on all clinical scales. Female drug abusers obtained significantly higher scores than female medical patients on seven scales. (Author)
Fleming, M; MacGowan, B; Costos, D
Dyadic adjustment, sexual activities, and marital stability in the relationships of female-to-male transsexuals and their spouses were examined. Participants were 22 female-to-male transsexuals who had undergone some form of surgery to alter their anatomical sex, their spouses, and a control group of married or cohabitating nontranssexual men and women. Participants were administered the Dyadic Adjustment Scale and additional items to assess quantitatively their marital relationships. The transsexuals and their spouses were also asked open-ended interview questions concerning marital and life adjustments. Generally, the transsexuals and their spouses reported good and mutually satisfying interpersonal relationships that are in many ways comparable to those of the matched control group. These findings lend support to the previous clinical interview studies that have reported that female-to-male transsexuals form stable and enduring intimate relationships.
Kjellman, Görel; Oberg, Birgitta
Seventy-seven patients with neck pain in the primary health care were included in a prospective, randomized clinical trial and randomly assigned to general exercise, McKenzie treatment, or a control group. Seventy patients completed the treatment; response rate 93% at 12-month follow-up. All three groups showed significant improvement regarding the main outcomes, pain intensity and Neck Disability Index, even at 12-month follow-up, but there was no significant difference between the groups. In all, 79% reported that they were better or completely restored after treatment, although 51% reported constant/daily pain. In the McKenzie group compared with the control group, a tendency toward greater improvement was noted for pain intensity at 3 weeks and at 6-month follow-up, and for post-treatment Neck Disability Index. Significant improvement in Distress and Risk Assessment Method scores was shown in the McKenzie group only. The three groups had similar recurrence rates, although after 12 months the McKenzie group showed a tendency toward fewer visits for additional health care. The study did not provide a definite evidence of treatment efficacy in patients with neck pain, however, there was a tendency toward a better outcome with the two active alternatives compared with the control group.
Bourin, Michel; Deplanque, Dominique; Zins-Ritter, Marcel
In spite of considerable progress over the past decade, training investigators for inter-rater reliability for clinical trials remains a major problem. The aim of the present study was to promote a new tool to increase data homogeneity by introducing conformity into groups of clinical investigators. The investigators scoring grid we are proposing-the Mean Deviation of Inter-rater Scoring (MDIS)-involves the calculation of the score deviation for each investigator relative to the median score of an expert group who had evaluated the same videotape-recorded clinical case. Whatever the scale, the score deviation is calculated as the absolute deviation value from the median score obtained by the experts for each item. The MDIS value is then evaluated from all the scores given by an investigator by dividing the total sum of the previously defined values by the number of items of the scale. Some examples from practice are given using several rating scales: (i) Hamilton Anxiety Rating Scale; (ii) Hamilton Depression Rating Scale; (iii) Montgomery Asberg Depression Rating Scale; and (iv) Positive And Negative Symptoms Scale. Finally, such a method could also be employed by experts to evaluate the quality of videotape-recorded clinical cases used in clinical trials, as well as by teachers to evaluate initial or continuous medical training.
Chao, Maria T; Tippens, Kimberly M; Connelly, Erin
Acupuncture utilization in the United States has increased in recent years, but is less common among racial/ethnic minorities and those of low socioeconomic status. Group-based, community acupuncture is a delivery model gaining in popularity around the United States, due in part to low-cost treatments provided on a sliding-fee scale. Affordable, community-based acupuncture may increase access to health care at a time when increasing numbers of people are uninsured. To assess the population using local community acupuncture clinics, sociodemographic factors, health status, and utilization patterns compared to national acupuncture users were examined. Data were employed from (1) a cross-sectional survey of 478 clients of two community acupuncture clinics in Portland, Oregon and (2) a nationally representative sample of acupuncture users from the 2007 National Health Interview Survey. Portland community acupuncture clients were more homogeneous racially, had higher educational attainment, lower household income, and were more likely to receive 10 or more treatments in the past 12 months (odds ratio=5.39, 95% confidence interval=3.54, 8.22), compared to a nationally representative sample of U.S. acupuncture users. Self-reported health status and medical reasons for seeking acupuncture treatment were similar in both groups. Back pain (21%), joint pain (17%), and depression (13%) were the most common conditions for seeking treatment at community acupuncture clinics. Study findings suggest that local community acupuncture clinics reach individuals of a broad socioeconomic spectrum and may allow for increased frequency of treatment. Limited racial diversity among community acupuncture clients may reflect local demographics of Portland. In addition, exposure to and knowledge about acupuncture is likely to vary by race and ethnicity. Future studies should examine access, patient satisfaction, frequency of treatment, and clinical outcomes of group-based models of community
Lin, Nancy U; Prowell, Tatiana; Tan, Antoinette R; Kozak, Marina; Rosen, Oliver; Amiri-Kordestani, Laleh; White, Julia; Sul, Joohee; Perkins, Louise; Beal, Katherine; Gaynor, Richard; Kim, Edward S
Purpose Broadening trial eligibility to improve accrual and access and to better reflect intended-to-treat populations has been recognized as a priority. Historically, patients with brain metastases have been understudied, because of restrictive eligibility across all phases of clinical trials. Methods In 2016, after a literature search and series of teleconferences, a multistakeholder workshop was convened. Our working group focused on developing consensus recommendations regarding the inclusion of patients with brain metastases in clinical trials, as part of a broader effort that encompassed minimum age, HIV status, and organ dysfunction. The working group attempted to balance the needs of protecting patient safety, facilitating access to investigational therapies, and ensuring trial integrity. On the basis of input at the workshop, guidelines were further refined and finalized. Results The working group identified three key populations: those with treated/stable brain metastases, defined as patients who have received prior therapy for their brain metastases and whose CNS disease is radiographically stable at study entry; those with active brain metastases, defined as new and/or progressive brain metastases at the time of study entry; and those with leptomeningeal disease. In most circumstances, the working group encourages the inclusion of patients with treated/stable brain metastases in clinical trials. A framework of key considerations for patients with active brain metastases was developed. For patients with leptomeningeal disease, inclusion of a separate cohort in both early-phase and later-phase trials is recommended, if CNS activity is anticipated and when relevant to the specific disease type. Conclusion Expanding eligibility to be more inclusive of patients with brain metastasis is justified in many cases and may speed the development of effective therapies in this area of high clinical need.
Kangaba, Achille Aime; Saglam, Filiz Yarimcam; Tokman, Hrisi Bahar; Torun, Mert; Torun, Muzeyyen Mamal
This study was conducted to measure the antibiotic susceptibilities, corresponding gene contents, and the enterotoxin gene bft, in 50 Bacteroides fragilis group isolates, 25 of which were clinical and 25 intestinal. The resistance rates to amoxicillin/clavulanic acid, imipenem and metronidazole were low; ampicillin and tetracyclin resistance was high; clindamycin resistance and ermF gene presence was also high. Regarding phenotypical bacterial resistance and the presence of resistance genes, there was not statistically significant difference between clinical and intestinal isolates and bft positive and negative isolates. Copyright © 2015 Elsevier Ltd. All rights reserved.
Modernizing Clinical Trial Eligibility Criteria: Recommendations of the American Society of Clinical Oncology-Friends of Cancer Research Organ Dysfunction, Prior or Concurrent Malignancy, and Comorbidities Working Group.
Lichtman, Stuart M; Harvey, R Donald; Damiette Smit, Marie-Anne; Rahman, Atiqur; Thompson, Michael A; Roach, Nancy; Schenkel, Caroline; Bruinooge, Suanna S; Cortazar, Patricia; Walker, Dana; Fehrenbacher, Louis
Purpose Patients with organ dysfunction, prior or concurrent malignancies, and comorbidities are often excluded from clinical trials. Excluding patients on the basis of these factors results in clinical trial participants who are healthier and younger than the overall population of patients with cancer. Methods ASCO and Friends of Cancer Research established a multidisciplinary working group that included experts in trial design and conduct to examine how eligibility criteria could be more inclusive. The group analyzed current eligibility criteria; conducted original data analysis; considered safety concerns, potential benefits, research, and potential hurdles of this approach through discussion; and reached consensus on recommendations regarding updated eligibility criteria that prioritize inclusiveness without compromising patient safety. Results If renal toxicity and clearance are not of direct treatment-related concern, then patients with lower creatinine clearance values of > 30 mL/min should be included in trials. Inclusion of patients with mild to moderate hepatic dysfunction may be possible when the totality of the available nonclinical and clinical data indicates that inclusion is safe. Ejection fraction values should be used with investigator assessment of a patient's risk for heart failure to determine eligibility. Patients with laboratory parameters out of normal range as a result of hematologic disease should be included in trials. Measures of patient functional status should be included in trials to better assess fit versus frail patients. Conclusion Expanding inclusion of these patients will increase the number and diversity of patients in clinical trials and result in a more appropriate population of patients.
Full Text Available Viridans Group Streptococci (VGS species-level identification is fundamental for patients management. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS has been used for VGS identification but discrimination within the Mitis group resulted difficult. In this study, VGS identifications with two MALDI-TOF instruments, the Biotyper (Bruker and the VITEK MS (bioMérieux have been compared to those derived from tuf, soda and rpoB genes sequencing. VGS isolates were clustered and a dendrogram constructed using the Biotyper 3.0 software (Bruker. RpoB gene sequencing resulted the most sensitive and specific molecular method for S. pneumonia identification and was used as reference method. The sensitivity and the specificity of the VITEK MS in S. pneumonia identification were 100%, while the Biotyper resulted less specific (92.4%. In non pneumococcal VGS strains, the group-level correlation between rpoB and the Biotyper was 100%, while the species-level correlation was 61% after database upgrading (than 37% before upgrading. The group-level correlation between rpoB and the VITEK MS was 100%, while the species-level correlation was 36% and increases at 69% if isolates identified as S. mitis/S. oralis are included. The less accurate performance of the VITEK MS in VGS identification within the Mitis group was due to the inability to discriminate between S. mitis and S. oralis. Conversely, the Biotyper, after the release of the upgraded database, was able to discriminate between the two species. In the dendrogram, VGS strains from the same group were grouped into the same cluster and had a good correspondence with the gene-based clustering reported by other authors, thus confirming the validity of the upgraded version of the database. Data from this study demonstrated that MALDI-TOF technique can represent a rapid and cost saving method for VGS identification even within the Mitis group but improvements of spectra
Reaman, Gregory H. [The George Washington University, School of Medicine and Health Sciences, Division of Hematology Oncology, Children' s National Medical Center, Washington, DC (United States)
Success in improving treatment outcomes in childhood cancer has been achieved almost exclusively through multicenter and multidisciplinary clinical and applied research over several decades. While biologically rational as well as empirical approaches have led to combination chemotherapy and multimodality approaches to therapy, which have given rise to evidence-based practice standards, similar scientific rigor has not always been as evidently applied to modalities utilized to assess initial disease burden and, more important, response to investigational approaches to therapy. As the empirical approach to therapeutic advances has likely maximized its benefit, future progress will require translation of biologic discovery most notably from the areas of genomics and proteomics. Hence, attempts to improve efficacy of therapy will require a parallel effort to minimize collateral damage of future therapeutic approaches, and such a parallel approach will mandate the continued dependence on advances in diagnostic imaging for improvements in staging methodologies to best define risk groups for risk-adjusted therapy. In addition, anatomic and functional assessment of response and surveillance for disease recurrence will require improved understanding of the biology as well as natural history of individual diseases, which one hopes will better inform investigators in designing trials. Clinical and research expertise is urgently needed in the selection of specific imaging studies and frequencies that best assess a response as well as to define disease-free intervals. Despite limited resources to develop sufficient infrastructure, emphasis on enabling early assessment of new technology to minimize risks associated with treatment advances and with those critical diagnostic and staging procedures must continue to be a focus of pediatric cancer clinical research. (orig.)
Ford, Julian D; Chang, Rocío; Levine, Joan; Zhang, Wanli
Traumatic victimization and associated problems with posttraumatic stress disorder (PTSD) and affect dysregulation are prevalent among incarcerated women, but there is limited evidence to support psychotherapeutic interventions for these problems in this underserved population. A group psychotherapy designed to enhance affect regulation without trauma memory processing-Trauma Affect Regulation: Guide for Education and Therapy (TARGET)-was compared to a supportive group therapy (SGT) in a randomized clinical trial with 72 incarcerated women with full or partial PTSD. Both interventions achieved statistically significant reductions in PTSD and associated symptom severity and increased self-efficacy. Dropout rates for both interventions were low (PTSD and associated symptoms. Experiential-focused supportive group therapy also may reduce victimization-related PTSD and associated symptoms. Both group therapy approaches warrant further study with this vulnerable population.
Full Text Available The purpose of this study is to examine the possible benefits of participation in group singing for people with eating disorders in a non-clinical context. The creation of a group singing workshop for women that exhibited disordered eating provided the opportunity to explore the participants’ experiences as perceived by them. A qualitative approach utilizing a semi-structured interview was employed to explore in depth the women’s perceptions regarding the group singing workshop. A thematic analysis of the data identified four main categories concerning the benefits of group singing for the population under study. The theoretical model of Sears (1968 of the processes in music therapy and its application on anorexic clients (Parente 1989 informed the discussion of the empirical findings.
Farmer, Cristan; Butter, Eric; Mazurek, Micah O.; Cowan, Charles; Lainhart, Janet; Cook, Edwin H.; DeWitt, Mary Beth; Aman, Michael
A gap exists in the literature regarding aggression in autism spectrum disorders and how this behavior compares to other groups. In this multisite study, the "Children's Scale for Hostility and Aggression: Reactive/Proactive" and the Aggression subscale of the "Child Behavior Checklist" were rated for 414 children with autism…
Lockard, Allison J.; Hayes, Jeffrey A.; Neff, Kristin; Locke, Benjamin D.
There has been growing interest in the mental health benefits of self-compassion. This study was designed to establish norms on the Self-Compassion Scale-Short Form, a popular measure of self-compassion for individuals seeking counseling, and to examine group differences in self-compassion based on gender, race/ethnicity, sexual orientation,…
Söder, B; Jin, L J; Söder, P O; Wikner, S
An initial screening investigation of 1681 Swedish urban adults aged 31-40 years with untreated periodontitis showed that 17.2% (289) had at least one site with probing depth > or = 5 mm. The 289 subjects were offered a complete clinical examination and treatment. 144 subjects, 85 men and 59 women, agreed to participate and 145 were non-responding subjects and used as a drop out sample. The results from the screening data showed that the attendants had poorer oral hygiene status and more severe periodontitis than the drop out subjects. The present report describes clinical data of this representative sample with adult periodontitis. Clinical indices were recorded and bone height (BH%) for all teeth was measured with a computer digitizing system. In the 144 attendants, Plaque Index was > 1 in 56.2%, Calculus Index was > 1 in 57.0%, Gingival Index was > 1 in 97.2% and bleeding on probing was found in 89.1% of the sites. 11.1% of the subjects had 1-3 teeth with probing depth > or = 5 mm, 59.0% 4-10 teeth, 25.7% 11-20 teeth and 4.2% > 20 teeth. 47.9% of the subjects had mean BH% less than 80. 45.1% of the subjects had at least one site with an intrabony defect, of which 20% had 3-4 sites and 27.7% > or = 5 sites. It is concluded that advanced generalized periodontitis exists in a limited number of 31-40 year-olds in Sweden. Specific risk factors may be involved in the pathogenesis of the disease.
Maria Caterina Branca
Full Text Available This research was driven by the fundamental idea that one of the main methodological competencies of a psychologist is to be able to think one’s emotions (especially those formed within a relationship and to use them to build theories on the relationship itself. In this context, the project aims to explore the role identity of the trainee psychologist, that is to say the mental representations (fantasies, subconscious associations, myths of those who have just finished their university journey and are about to embark upon the world of work in the field of applied clinical psychology.
Eccles Martin P
Full Text Available Abstract Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence. It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.
Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven
Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.
Recently formed Clinical Commissioning Groups in the English National Health Service have important responsibility for commissioning local health and care services. Women are under-represented on the governing bodies of these significant primary care based organizations despite the fact that they constitute almost half of the general practitioner workforce in England. This essay examines some of the reasons for this under-representation including the predominance of women in the salaried and part-time sector of general practice and gendered management styles within the National Health Service. It is argued that the under-representation of women on Clinical Commissioning Group governing bodies matters in terms of social justice, representation of the broader community and role models. © The Author(s) 2015.
Bristowe, Katherine; Siassakos, Dimitrios; Hambly, Helen; Angouri, Jo; Yelland, Andrew; Draycott, Timothy J; Fox, Robert
Our purpose was to investigate health care professionals' beliefs about effective teamwork in medical emergencies based on their experiences. We used framework analysis of interprofessional focus groups in four secondary and tertiary maternity units. The participants were randomly selected senior and junior doctors, senior and junior midwives, and health care assistants, in five groups of 5 to 7 participants each. We found that optimal teamwork was perceived to be dependent on good leadership and availability of experienced staff. The participants described a good leader as one who verbally declares being the leader, communicates clear objectives, and allocates critical tasks, including communication with patients or their family, to suitable individual members. We triangulated the results with evidence from simulation to identify convergent findings and issues requiring further research. The findings will inform the development of teaching programs for medical teams who manage emergencies to improve patient safety and experience.
Dosea, Aline S; Brito, Giselle C; Santos, Lincoln M C; Marques, Tatiane C; Balisa-Rocha, Blície; Pimentel, Deborah; Bueno, Denise; Lyra, Divaldo P
When pharmacists incorporate clinical practice into their routine, barriers and facilitators influence the implementation of patient care services. Three focus groups were conducted with 11 pharmacists who were working for the Farmácia Popular do Brasil program on the establishment, implementation, and consolidation of clinical pharmacy services. The perception of the pharmacists in Brazil about the program was that it facilitated access to health care and medication. The distance between neighboring cities made it difficult for patients to return for services. Lack of staff training created a lack of communication skills and knowledge. The pharmacists wanted to have increased technical support, skill development opportunities, and monitoring of researchers who assessed progress of the service. Pharmacists overcame many of their insecurities and felt more proactive and committed to quality service. Positive experiences in service implementations have shown that it is possible to develop a model of clinical services in community pharmacies.
Jensen, Tina Birk; Bonde, Marianne; Kongsted, Anne Grete
Sows suffering from clinical signs of disease (e.g. lameness, wounds and shoulder ulcers) are often involuntarily culled, affecting the farmer's economy and the welfare of the animals. In order to investigate the interrelationships between clinical signs of individual pregnant group-housed sows, we...... the explanatory factor analysis, we identified three factors describing the underlying structure of the 16 clinical variables. We interpreted the factors as ‘pressure marks', ‘wounds' and ‘lameness' Logistic analyses were performed to investigate the effect of the three factors and the parity number of each sow...... of disease (P = 0.026). Lameness is generally considered to be an important welfare problem in sows, which could explain the increased risk seen in this study. By contrast, ‘pressure marks' and ‘wounds' did not have any significant effect on the four outcomes (P > 0.05). Udgivelsesdato: June 2010...
Escorihuela-García, Vicente; Llópez-Carratalá, Ignacio; Orts-Alborch, Miguel; Marco-Algarra, Jaime
The acoustic neuroma is a benign tumour that originates in the vestibular branch of the eighth cranial nerve. The main treatment is surgery, but many authors suggest that with elderly patients or in small neuromas we can opt for watchful waiting. This was a retrospective study from 2007 to 2013 that included 27 patients diagnosed of acoustic neuroma that had not been treated due to the size of the tumour, age and comorbidities, or by patient choice. We evaluated overall condition, hearing thresholds, degree of canal paresis and central disorders. After 6 years of follow up, clinical manifestations of 18 patients remained unchanged, 5 patients underwent hearing loss and developed tinnitus, 2 cases had more intense tinnitus and 2 cases had dizziness. The radiological controls by magnetic resonance imaging showed that the initial maximum diameters (5-16mm) increased by 1.7mm on average, with annual growth rates below 0.5mm. In selected cases, such as for small neuromas and in elderly patients, the conservative option of close monitoring with magnetic resonance imaging is an important alternative given that, in our cases, clinical features and radiological image did not suffer major changes. If there were any such changes, therapeutic options could be proposed. Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.
Mihalache, Cornelia; Oprea, Veronica; Constantin, Brânduşa; Pintilie, Wanda; Teslariu, Elena; Pal, Cristina
The objective of this article is to present a series of 12 cases with the chronic lead poisoning produced after a short but intensive professional exposure (in average 12-14 hours per day, 41.6 days) at mineral dust and oxides containing lead (technical revision of a oven and of a furnace network by mechanical and welding operation). After the first case with saturnine colic, all the workers of the same team (n=12) were hospitalised (average time was of 14 days) with clinical examination and by specific toxicological indicators. Particularly, for clinical picture were uncharacteristic and oligosymptomatic complaints. Occupational exposure was augmented by the level of Pb-blood (46.8-286 mg/100 ml are ranges), Pb-urine (221-637 mg/l are ranges), d-aminolevulinic urinary acid (22.9-99.1 mg/l are ranges) and increased urinary coproporphyrins (+ +, + + +) exceeding biological limits and high urinary discharge of lead induced by CaNa2-EDTA treatment. The biological effects of lead intoxication consist in the occurrence of stippled basophilic erythrocytes (2 cases with 46,000/1 mil erythrocytes), the anemia (only 4 cases with haematocrit L 40%) and the liver cytolytic syndrome (the increase of GPT, GOT and of g-GT). These changes and the polyneuropathic syndrome (the decrease of motor and sensitive speed velocity) were judged by toxic combination between ethanol and lead.
Jeerisuda Khumsikiew; Sisira Donsamak; Manit Saeteaw
Problem-based Learning (PBL) is an alternate method of instruction that incorporates basic elements of cognitive learning theory. Colleges of pharmacy use PBL to aid anticipated learning outcomes and practice competencies for pharmacy student. The purpose of this study were to implement and evaluate a model of small group PBL for 5th year pharmacy students in the clinical environment that facilitated by pharmacy instructors. A PBL model was implemented in 1-day periods each wee...
Objective To detect the levels of high mobility group box 1 protein(HMGB1),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)in order to explore the clinical significance of HMGB1 in patients with severely traumatic brain injury.Methods A total of 75 patients composed of 40 male and35 female with severely traumatic brain
Sato, Hiroe; Woodhead, Felix A.; Ahmad, Tariq; Grutters, Jan C.; Spagnolo, Paolo; van den Bosch, Jules M.M.; Maier, Lisa A.; Newman, Lee S.; Nagai, Sonoko; Izumi, Takateru; Wells, Athol U.; du Bois, Roland M.; Welsh, Kenneth I.
The HLA class II (DRB1 and DQB1) associations with sarcoidosis have been studied by several groups but often without consistent results. In this paper, we consider the hypothesis that observed inconsistencies relate to distinct, genetically encoded disease phenotypes which differ in prevalence between centres. We therefore typed HLA-DRB1 and DQB1 in 340 UK, 139 Dutch and 163 Japanese sarcoidosis patients and, respectively, 354, 218 and 168 healthy controls from these populations. We applied consistent phenotyping and genotyping and investigated associations between HLA class II alleles and distinct disease phenotypes within and between ethnic groups. DRB1*01 and DQB1*0501 are protective against all manifestations of sarcoidosis. Lung-predominant sarcoidosis is associated with DRB1*12 and *14. Löfgren's syndrome is a common sarcoidosis phenotype in the Dutch and is strongly associated with the DRB1*0301 allele. This phenotype is not seen among the Japanese in whom DRB1*0301 is absent. The same allele is protective for UK uveitis. Sarcoid uveitis is common in Japan. The DRB1*04–DQB1*0301 haplotype is a risk factor for this disease manifestation in Japanese and UK subjects but protective for sarcoidosis overall. We show that distinct sarcoidosis phenotypes have similar genetic associations across ethnic groups. The disease case mix differs between centres and may be explained by different ethnic allelic frequencies. PMID:20685690
Koppes, Dorothea Maria; Vriends, Antonius Arnoldus Cornelis Maria; van Rijn, Michiel; van Heesewijk, Antonine Dimphne
To reduce the intrapartum use of antibiotics in women with prolonged rupture of the membranes (PROM) by restriction of antibiotics to women who are colonized with group B streptococci (GBS), as identified with the Cepheid Gene Xpert polymerase chain reaction (PCR) for detecting GBS. We conducted a randomized controlled trial among full-term delivering women with PROM. Fifty-four women were enrolled, based on a power calculation with a significance level of 5% and a power of 95%. Twenty-seven women received the standard treatment (rectovaginal swab [RVS] for bacterial culture and antibiotics). For another 27 women PCR was performed on the RVS and antibiotics were used only when the PCR was positive. The primary outcome was reduction in antibiotic use, defined as the percentage of women who received antibiotics during labor. 54 Women were enrolled in the study between 1 May and 18 November 2014. There were no significant differences in baseline characteristics. In total, 10 of the 54 women were GBS positive (18.5%). Of those 10 women, three were identified on bacterial culture and seven on PCR. In the bacterial culture group all the women received antibiotics. In the PCR group 10 women (37%) received antibiotics (P = 0.002). Two false-positive PCR tests were identified. There were no false-negative PCR tests. Real-time identification of GBS on PCR reduces the intrapartum use of antibiotics in women with PROM. © 2017 Japan Society of Obstetrics and Gynecology.
This paper presents a quantitative analysis of adjustment programmes. This is done by charting changes in various performance indicators following the receipt of the first adjustment loan, and by further contrasting the results with those for the comparator group of countries that did not receive adjustment loans. It is found that the average decline in the GDP growth rate in the loan-recipient countries was less than in the comparator groups. Similar results were obtained in regard to per ca...
Gray, Stacy W; Martins, Yolanda; Feuerman, Lindsay Z; Bernhardt, Barbara A; Biesecker, Barbara B; Christensen, Kurt D; Joffe, Steven; Rini, Christine; Veenstra, David; McGuire, Amy L
The routine use of genomic sequencing in clinical medicine has the potential to dramatically alter patient care and medical outcomes. To fully understand the psychosocial and behavioral impact of sequencing integration into clinical practice, it is imperative that we identify the factors that influence sequencing-related decision making and patient outcomes. In an effort to develop a collaborative and conceptually grounded approach to studying sequencing adoption, members of the National Human Genome Research Institute's Clinical Sequencing Exploratory Research Consortium formed the Outcomes and Measures Working Group. Here we highlight the priority areas of investigation and psychosocial and behavioral outcomes identified by the Working Group. We also review some of the anticipated challenges to measurement in social and behavioral research related to genomic sequencing; opportunities for instrument development; and the importance of qualitative, quantitative, and mixed-method approaches. This work represents the early, shared efforts of multiple research teams as we strive to understand individuals' experiences with genomic sequencing. The resulting body of knowledge will guide recommendations for the optimal use of sequencing in clinical practice.
Full Text Available Introduction: Suicide is a great economical, social and public health problem. It is prevalent worldwide and has a lot of negative effects on individuals, families and society. Depression is often prelude to Suicide. An important part of the treatment of the mentally ill patients is spiritual-religious psychotherapy which should be done after physical treatment. The aim of this study was to determine the effect of spiritual and religious group psychotherapy on suicidal ideation in depressed patients. Methods: 51 depressed patients with suicidal ideation from Razi hospital (Tabriz, Iran participated in this clinical trial. To collect Data questionnaire was used which included demographic and Beck Suicide Scale Ideation. Experimental group participated in 10 sessions of group psychotherapy. Each section lasted 1 hour. Two weeks after the last section post test was done. Statistical software SPSS ver 13 was used for data analysis. Results: Results of independent t-test revealed no difference between two groups in terms of suicidal ideation before intervention but after study there is a statistical difference. Also the results of ANCOVA test showed a significant relationship between spiritual group therapy and decrease in suicidal ideation, so that this intervention can make 57% of variance in suicidal ideation of experimental group.Conclusion: Regarding positive effect of spiritual and religious group psychotherapy on decreasing suicidal ideation of depressed patients, we suggest this intervention to be held in Psychiatric Wards and also more study on depression and other psychiatric patients with greater sample size would be helpful.
Ørnbjerg, Lykke Midtbøll; Østergaard, Mikkel; Jensen, Trine
BACKGROUND: Rheumatoid arthritis is characterised by progressive joint destruction and loss of periarticular bone mass. Hand bone loss (HBL) has therefore been proposed as an outcome measure for treatment efficacy. A definition of increased HBL adjusted for age- and sex-related bone loss is lacking....... In this study, we aimed to: 1) establish reference values for normal hand bone mass (bone mineral density measured by digital x-ray radiogrammetry (DXR-BMD)); and 2) examine whether HBL is normalised in rheumatoid arthritis patients during treatment with tumour necrosis factor alpha inhibitors (TNFI). METHODS......: DXR-BMD was measured from hand x-rays in a reference cohort (1485 men/2541 women) without arthritis randomly selected from an urban Danish population. Sex- and age-related HBL/year was estimated. DXR-BMD was measured in rheumatoid arthritis patients (n = 350: at start of TNFI, and ~2 years after TNFI...
Department of Housing and Urban Development — The Department of Housing and Urban Development establishes the rent adjustment factors - called Annual Adjustment Factors (AAFs) - on the basis of Consumer Price...
Full Text Available Purpose: Structured narrative reflective writing combined with guided feedback is an efficient teaching method for enhancing medical students’ reflective capacity. However, what kinds of feedback offered and reflection presented in a reflective group remain unclear. The aim of this study was to investigate the characteristics of feedback in a reflective dialogue group. Methods: Fifth-year medical students on a monthly interval rotation at the pediatric department of a medical center in eastern Taiwan during the 2012 academic year completed their reflective writing regarding patient and family psychosocial issues, and were subsequently debriefed in a 2-h group discussion session to receive feedback from a clinical tutor and peers. Content analysis was conducted to explore the characteristics of feedback and reflection presented in the reflective dialogue. The evaluative questionnaire regarding the benefits of reflection with others was administrated following the group session. Results: Forty students participated in five reflective groups and 108 psychosocial issues were discussed and identified. The tutor played an initiating role in the group discussion by providing six equal feedback types involving exploring new knowledge, initiating advanced discussion, highlighting the issues, and encouraging the students. The students provided eight types of feedback that involved a substantial deep discussion on psychosocial issues and action plans based on the complex interactive ecological network of clinical encounters. Each student attained 1.25 times the depth or breadth of reflection after receiving feedback and experienced the benefits of reflection with others. Conclusion: Through structured narrative reflective writing combined with pluralistic group discussion with a tutor and peers, the medical students had time to think deeply and broadly about psychosocial issues among patients and their family members. Facilitative feedback providing new
Wen, Chin-Chen; Lin, Meei-Ju; Lin, Chi-Wei; Chu, Shao-Yin
Purpose Structured narrative reflective writing combined with guided feedback is an efficient teaching method for enhancing medical students’ reflective capacity. However, what kinds of feedback offered and reflection presented in a reflective group remain unclear. The aim of this study was to investigate the characteristics of feedback in a reflective dialogue group. Methods Fifth-year medical students on a monthly interval rotation at the pediatric department of a medical center in eastern Taiwan during the 2012 academic year completed their reflective writing regarding patient and family psychosocial issues, and were subsequently debriefed in a 2-h group discussion session to receive feedback from a clinical tutor and peers. Content analysis was conducted to explore the characteristics of feedback and reflection presented in the reflective dialogue. The evaluative questionnaire regarding the benefits of reflection with others was administrated following the group session. Results Forty students participated in five reflective groups and 108 psychosocial issues were discussed and identified. The tutor played an initiating role in the group discussion by providing six equal feedback types involving exploring new knowledge, initiating advanced discussion, highlighting the issues, and encouraging the students. The students provided eight types of feedback that involved a substantial deep discussion on psychosocial issues and action plans based on the complex interactive ecological network of clinical encounters. Each student attained 1.25 times the depth or breadth of reflection after receiving feedback and experienced the benefits of reflection with others. Conclusion Through structured narrative reflective writing combined with pluralistic group discussion with a tutor and peers, the medical students had time to think deeply and broadly about psychosocial issues among patients and their family members. Facilitative feedback providing new knowledge, deeper
Wang Jianming; Zeng Xiaoyun
Objection: The trend of brain hemorrhage cases of young adults have increased recently. In this article, We studied brain hemorrhage clinical feature and pathogenic causes of 72 young adults, Whose ages are all beneath 45Y. We found That the major pathogen reasons of young adult brain hemorrhage are blood system diseases、 arteriovenous malformation of cerebral blood vessel、 hypertension arteriosclerosis、 arteritis and rheumatic heart disease et. We also found that the trend can be related to hard work、 tense life、 drinking too much alcohol and eating high lipid food, and cercbral vascular disease family history. So in order to reduce the incidence of young adult brain hemorrhage, Young adults should not drink and smoke heavily, should not eat too much high lipid food. Young adults who have hypertension and brain vessel disease family history should be regularly measured blood pressure and blood lipid. If they had hypertension, should be treated regularly.
Full Text Available The number of people with normal hearing thresholds seeking medical help for tinnitus and other hearing problems is increasing. For diagnostic purposes, existence/nonexistence of lesions or combinations of lesions in the inner ear not reflected in the audiogram was evaluated with advanced hearing tests applied to tinnitus patients with certain backgrounds, including noise exposure. For forty-six patients with pronounced tinnitus, and other symptoms, tentative diagnoses were established, including judgments of the influence of four causative factors: (1 acoustic trauma, (2 music, (3 suspected hereditary, and (4 nonauditory, for example, stress or muscular tension. They were analyzed with a test battery sensitive to lesions involving the outer hair cells, damage from impulse noise, and dysfunction of the efferent system. There were significant differences in test results between groups with individuals with the same most likely causative factor. Most patients claiming acoustic trauma had a specific type of result, ′hyper-PMTF′ (psychoacoustical modulation transfer function, and abnormal test results of the efferent system. Everyone in the hereditary group had dysfunction of the efferent system. All patients working with music, except one, had some abnormality, but without specific pattern. The nonauditory group mostly had normal test results. The investigation shows that it is possible to diagnose minor cochlear lesions as well as dysfunction of the efferent system, which might be causing the tinnitus. Those abnormalities could not be detected with routine audiological tests. Malfunctioning caused by impulse noise is an obvious example of this. These findings facilitate choice of treatment, rehabilitation programs, and medicolegal decisions.
Alleyne, Jo; Jumaa, Mansour Olawale
The general aims of this article were to facilitate primary care nurses (District Nurse Team Leaders) to link management and leadership theories with clinical practice and to improve the quality of the service provided to their patients. The specific aim was to identify, create and evaluate effective processes for collaborative working so that the nurses' capacity for clinical decision-making could be improved. This article, part of a doctoral study on Clinical Leadership in Nursing, has wider application in the workplace of the future where professional standards based on collaboration will be more critical in a world of work that will be increasingly complex and uncertain. This article heralds the type of research and development activities that the nursing and midwifery professions should give premier attention to, particularly given the recent developments within the National Health Service in the United Kingdom. The implications of: Agenda for Change, the Knowledge and Skills Framework, 'Our Health, Our Care, Our Say' and the recent proposals from the article 'Modernising Nursing Career', to name but a few, are the key influences impacting on and demanding new ways of clinical supervision for nurses and midwives to improve the quality of patient management and services. The overall approach was based on an action research using a collaborative enquiry within a case study. This was facilitated by a process of executive co-coaching for focused group clinical supervision sessions involving six district nurses as co-researchers and two professional doctoral candidates as the main researchers. The enquiry conducted over a period of two and a half years used evidence-based management and leadership interventions to assist the participants to develop 'actionable knowledge'. Group clinical supervision was not practised in this study as a form of 'therapy' but as a focus for the development of actionable knowledge, knowledge needed for effective clinical management and
Rimm, David L; Nielsen, Torsten O; Jewell, Scott D; Rohrer, Daniel C; Broadwater, Gloria; Waldman, Frederic; Mitchell, Kisha A; Singh, Baljit; Tsongalis, Gregory J; Frankel, Wendy L; Magliocco, Anthony M; Lara, Jonathan F; Hsi, Eric D; Bleiweiss, Ira J; Badve, Sunil S; Chen, Beiyun; Ravdin, Peter M; Schilsky, Richard L; Thor, Ann; Berry, Donald A
Practice-changing evidence requires confirmation, preferably in multi-institutional clinical trials. The collection of tissue within such trials has enabled biomarker studies and evaluation of companion diagnostic tests. Tissue microarrays (TMAs) have become a standard approach in many cooperative oncology groups. A principal goal is to maximize the number of assays with this precious tissue. However, production strategies for these arrays have not been standardized, possibly decreasing the value of the study. In this article, members of the Cancer and Leukemia Group B Pathology Committee relay our experiences as array facility directors and propose guidelines regarding the production of high-quality TMAs for cooperative group studies. We also discuss statistical issues arising from having a proportion of patients available for TMAs and the possibility that patients with TMAs fail to represent the greater study population.
Kastner, Monika; Li, Jamy; Lottridge, Danielle; Marquez, Christine; Newton, David; Straus, Sharon E
Osteoporosis affects over 200 million people worldwide, and represents a significant cost burden. Although guidelines are available for best practice in osteoporosis, evidence indicates that patients are not receiving appropriate diagnostic testing or treatment according to guidelines. The use of clinical decision support systems (CDSSs) may be one solution because they can facilitate knowledge translation by providing high-quality evidence at the point of care. Findings from a systematic review of osteoporosis interventions and consultation with clinical and human factors engineering experts were used to develop a conceptual model of an osteoporosis tool. We conducted a qualitative study of focus groups to better understand physicians' perceptions of CDSSs and to transform the conceptual osteoporosis tool into a functional prototype that can support clinical decision making in osteoporosis disease management at the point of care. The conceptual design of the osteoporosis tool was tested in 4 progressive focus groups with family physicians and general internists. An iterative strategy was used to qualitatively explore the experiences of physicians with CDSSs; and to find out what features, functions, and evidence should be included in a working prototype. Focus groups were conducted using a semi-structured interview guide using an iterative process where results of the first focus group informed changes to the questions for subsequent focus groups and to the conceptual tool design. Transcripts were transcribed verbatim and analyzed using grounded theory methodology. Of the 3 broad categories of themes that were identified, major barriers related to the accuracy and feasibility of extracting bone mineral density test results and medications from the risk assessment questionnaire; using an electronic input device such as a Tablet PC in the waiting room; and the importance of including well-balanced information in the patient education component of the osteoporosis
Vogler, Carrie N; Sattovia, Stacy; Salazar, Laura Y; Leung, Tiffany I; Botchway, Albert
This study evaluates the impact of pain education group visits on patients with chronic non-cancer pain (CNCP). The primary outcome of the study was to evaluate patients' functional status and secondary outcomes included knowledge, behavior, and satisfaction, before and after participation in the pain education group visits. Locally produced patient educational videos on chronic non-cancer pain were delivered during patient group visits led by a healthcare provider. Study participants included patients with CNCP pain in an academic general medicine practice. The primary outcome was functional status, measured by the Pain Intensity, Enjoyment of life, and General Activity (PEG) score and the Oswestry Disability Index. Secondary outcomes were evaluated through a pre- and post-intervention knowledge assessment and chart review of opioid use and utilization of emergency and urgent care services. A satisfaction survey was administered after each group visit. Thirty-five patient-group visits were analyzed and 14 patient charts reviewed. A moderately positive correlation was observed between PEG and Oswestry Disability Index (r = 0.47, p high. Group visits providing patient education about CNCP may benefit patients' knowledge about this clinical condition, and was received with high patient satisfaction. Further investigation is needed to evaluate longer-term knowledge retention, sustainability of improvements resulting from the intervention, and longer-term effects of the intervention on functional status.
赵定麟; 陈德玉; 沈强; 王新伟; 赵杰; 严力生; 吴德胜; 郭岱琦; 赵宏
目的自行研制可调式中空人工椎体,并将其应用于治疗脊椎肿瘤和椎体爆裂性骨折患者.方法采用无磁性的医用钛金属加工制成可调式中空人工椎体,其长度可调节,中空部分可植骨,周壁上孔隙可使植骨与周围骨组织融合,上下端带刺,可插至断端骨质内固定.椎体切除减压后置入人工椎体,撑开固定治疗椎体肿瘤和爆裂性骨折23例.术后定期进行X线检查,观察手术椎节的稳定性和融合情况.结果随访6个月～4年,平均1.2年.脊髓功能障碍按Frankel分级评价,术后平均提高1.2级,神经根引起的疼痛迅速缓解.X线平片定期观察,结果显示人工椎体稳定、椎间高度恢复良好.结论可调式中空人工椎体可撑开施术椎节,恢复前柱高度,并提供即刻稳定,适用于脊柱椎节广泛切除的病例.%Objective To evaluate the efficacy of an adjustable hollow artificial vertebral body for the treatment of the tumor and burst fracture of vertebral body. Methods The hollow artificial vertebral body was made with medical titanium. It is adjustable in length. The bone graft can be place into the hollow space. The holes on the wall of the artificial device facilitated fusion of the bone graft, and the pegs on the top and bottom can sink into the adjacent vertebral bodies. 23 patients with tumor and burst fracture of vertebral body were treated by implanting this artificial device after resection of the diseased vertebral body. X-ray films were taken after operation to observe the stability and fusion of the segments. Results The patients were followed-up from 6 months to 4 years, with an average of 1.2 year. The neurological functions were improved 1.2 degrees based on Frankel classification. The pain was relieved immediately after operation. The implants were stable and the reconstruction of the segment height was maintained on the X-ray films. Conclusion The adjustable hollow artificial vertebral body can be used to
Objective To study the effect of adjustable suture trabeculectomy with mitomycin combination therapy in patients with glaucoma.Methods 76 patients with glaucoma (76 eyes) were divided into treatment group and control group, respectively received traditional trabeculectomy with adjustable suture trabeculectomy and mitomycin combination therapy.Results In the treatment group, shallow anterior chamber intraocular pressure levelⅠgrade proportion and postoperative complications were better than control group (P<0.05).Conclusion The glaucoma patients receiving adjustable suture trabeculectomy with mitomycin combination therapy have distinct curative effect.%目的：研究可调整缝线小梁切除术与丝裂霉素联合治疗青光眼患者的疗效。方法随机将76例青光眼患者（76眼）分成治疗组与对照组，分别行传统小梁切除术与可调整缝线小梁切除术与丝裂霉素联合治疗。结果治疗组平均眼压水平、浅前房Ⅰ级比例以及术后并发症等均优于对照组（P＜0.05）。结论治疗青光眼患者应用可调整缝线小梁切除术与丝裂霉素联合疗法，疗效显著。
Rasmussen, L H; Dargis, R; Højholt, K; Christensen, J J; Skovgaard, O; Justesen, U S; Rosenvinge, F S; Moser, C; Lukjancenko, O; Rasmussen, S; Nielsen, X C
Identification of Mitis group streptococci (MGS) to the species level is challenging for routine microbiology laboratories. Correct identification is crucial for the diagnosis of infective endocarditis, identification of treatment failure, and/or infection relapse. Eighty MGS from Danish patients with infective endocarditis were whole genome sequenced. We compared the phylogenetic analyses based on single genes (recA, sodA, gdh), multigene (MLSA), SNPs, and core-genome sequences. The six phylogenetic analyses generally showed a similar pattern of six monophyletic clusters, though a few differences were observed in single gene analyses. Species identification based on single gene analysis showed their limitations when more strains were included. In contrast, analyses incorporating more sequence data, like MLSA, SNPs and core-genome analyses, provided more distinct clustering. The core-genome tree showed the most distinct clustering.
Kaneda, Mitsunori; Nagasaki, Hiromi; Tasaki, Megumi; Kamiyama, Kiyoshi
Group B Streptococcus (GBS) are normal flora of the vagina and intestinal, but if the pregnant woman was infected with GBS in the vagina, miscarriage or premature would occur or the newborn would be developed to severe GBS infection. It is recommended that the inspection of GBS on all pregnant women by Japan Society of Obstetrics and Gynecology (JSOG) and Center for Disease Control and Prevention (CDC). We examined the comparison of detection rate between Pourmedia GBS agar (Eiken Chemical Co., Ltd.) and Nissui Separated Plate Sheep Blood Agar/BTB Lactose Agar medium (Nissui Pharmaceutical Co., Ltd.) on 112 sample. The positive rate of Pourmedia GBS agar was 21.4% (24/112 samples), Whereas Nissui Separated Plate Sheep Blood Agar/BTB Lactose Agar medium was 17.8% (20/112 samples). It was found that the detection rate was improved by using Pourmedia GBS agar on GBS screening test of vaginal swab.
Hironaka, Masatoshi (Hiroshima Univ. (Japan). School of Medicine)
Magnetic resonance imaging (MRI) study was performed in 32 patients with recent lacunar stroke. T2-weighted images showed ischemic lesions more clearly than T1-weighted images. Sixty-six percent of 32 patients had periventricular lesions. Eighty-four percent had subcortical white matter lesions. Sixty-nine percent had lesions in basal ganglia. Twenty-eight percent had lesions in brainstem. Periventricular lesions were revealed symmetrically. On the other hand, lesions in other areas were not detected symmetrically. Severe periventricular lesions on MRI were similar to those of Binswanger's disease. Patients with severe periventricular lesions had often hypertension. Moreover, two of them had dementia. Twenty-three patients with transient ischemic attack had less remarkable lesions than patients with lacunar stroke. Thirty-seven patients with a history of cerebrovascular risk factors (hypertension, diabetes mellitus) had severer lesions compared with normal controls. Sixty-one percent of controls, who had no cerebrovascular symptoms and signs, had MRI lesions. These results suggest that MRI is useful for detection of cerebral ischemic lesions with no associated clinical symptoms or signs. (author).
Walter, S D; Cook, D J; Guyatt, G H; King, D; Troyan, S
Considerable effort is often expended to adjudicate outcomes in clinical trials, but little has been written on the administration of the adjudication process and its possible impact on study results. As a case study, we describe the function and performance of an adjudication committee in a large randomized trial of two diagnostic approaches to potentially operable lung cancer. Up to five independent adjudicators independently determined two primary outcomes: tumor status at death or at final follow-up and the cause of death. Patients for whom there was any disagreement were discussed in committee until a consensus was achieved. We describe the pattern of agreement among the adjudicators and with the final consensus result. Additionally, we model the adjudication process and predict the results if a smaller committee had been used. We found that reducing the number of adjudicators from five to two or three would probably have changed the consensus outcome in less than 10% of cases. Correspondingly, the effect on the final study results (comparing primary outcomes in both randomized arms) would have been altered very little. Even using a single adjudicator would not have affected the results substantially. About 90 minutes of person-time per patient was required for activities directly related to the adjudication process, or approximately 6 months of full time work for the entire study. This level of effort could be substantially reduced by using fewer adjudicators with little impact on the results. Thus, we suggest that when high observer agreement is demonstrated or anticipated, adjudication committees should consist of no more than three members. Further work is needed to evaluate if smaller committees are adequate to detect small but important treatment effects or if they compromise validity when the level of adjudicator agreement is lower.
Sahin, Nilay; Karataş, Omer; Ozkaya, Murat; Cakmak, Ayşegül; Berker, Ender
Subjects with myofascial pain of muscles of the neck region may present with various clinical symptoms. The aim of this study was to explore the demographics features, clinical findings and functional status in a group of patients presenting with myofascial pain of the cervical muscles. 94 cervical myofascial pain syndrome patients were recruited from the out-patient clinic. Evaluated of patient short form health survey (SF-36), pain, depression, patient demographics and physical examinations. Outcome measures; SF-36 Health Survey, visual analog scale, Beck Depression Inventory, history, physical examination. A total of 82 patients with a diagnosis of cervical myofascial syndrome were included in the study. All patients were in the young age group 37.4+/-9, and 87.8% were females. 53.1% had trigger points in the trapezius muscle with high percentage of autonomic phenomena like skin reddening, lacrimation, tinnitus and vertigo. 58.5% of the series had suffered from former cervical trauma and 40.2% also had fibromyalgia syndrome and 18.5% had benign Joint hypermobility syndrome. Younger female patients presenting with autonomic phenomena and early onset cervical injury should be examined for cervical myofascial pain syndrome and also for fibromyalgia syndrome since this study demonstrated a high percentage of fibromyalgia syndrome in these patients.
Wardle, Jonathan Lee; Sarris, Jerome
Complementary medicine is forming an increasingly large part of health care in developed countries and is increasingly being formally taught in tertiary academic settings. An exploratory study of naturopathic student perceptions of, use of and attitudes towards teaching resources in naturopathic clinical training and education. Focus groups were conducted with current and recent students of 4-year naturopathic degree programmes in Brisbane and Sydney to ascertain how they interact with clinical teaching materials, and their perceptions and attitudes towards teaching materials in naturopathic education. Naturopathic students have a complex and critical relationship with their learning materials. Although naturopathic practice is often defined by traditional evidence, students want information that both supports and is critical of traditional naturopathic practices, and focuses heavily on evidence-based medicine. Students remain largely ambivalent about new teaching technologies and would prefer that these develop organically as an evolution from printed materials, rather than depart from dramatically and radically from these previously established materials. Findings from this study will assist publishers, librarians and academics develop clinical information sources that appropriately meet student expectations and support their learning requirements. © 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group.
Hertz, D G
This paper focuses on patterns of integration in migrant individuals and families. The level of adjustment in traditional and Westernized families has been examined. Different factors affecting adjustment are pointed out. Migration process is interpreted as a transient and necessary crisis situation. Risk factors in the acculturation crisis are reported and predictive and preventive measures are suggested. Characteristics of migrant and remigrant groups are compared. The role of "homesickness" in clinical symptom formation is discussed.
De Hertogh, Willem J; Vaes, Peter H; Vijverman, Veerle; De Cordt, Ann; Duquet, William
We evaluated whether a blinded observer could identify the neck pain patients in a sample of 42 subjects consisting of neck pain patients and asymptomatic controls.The allocation of subjects to either the control or patient group was based on the scoring of a VAS scale for pain intensity, a Bournemouth Questionnaire (BQ), a manual examination of the rotation of C0-2-7 (rated for Range Of Motion, end feel, onset of pain), an adapted Spurling test and Cervical Range Of Motion (CROM) measurements.The VAS and BQ resulted in a high % of correct allocations (>/= 77.5%) and a high specificity (90.9%). The Manual Examination Procedures (MEPs) have similar results especially when clustered. The combination of the VAS score, BQ and MEPs resulted in a sensitivity and specificity of 100% and 86.4%, respectively. Except for the flexion movement all CROM allocation percentages are around 50%, indicating a lesser diagnostic value.Our findings reinforce the validity of MEPs. Clustering pain measurements, BQ and MEPs provides the highest diagnostic value to identify neck pain patients or necks in need of treatment.
Lord, S R; Delbaere, K; Gandevia, S C
Ageing decreases exercise performance and is frequently accompanied by reductions in cognitive performance. Deterioration in the physiological capacity to stand, locomote and exercise can manifest itself as falling over and represents a significant deterioration in sensorimotor control. In the elderly, falling leads to serious morbidity and mortality with major societal costs. Measurement of a suite of physiological capacities that are required for successful motor performance (including vision, muscle strength, proprioception and balance) has been used to produce a physiological profile assessment (PPA) which has been tracked over the age spectrum and in different diseases (e.g. multiple sclerosis, Parkinson's disease). As well as measures of specific physiological capacities, the PPA generates an overall 'score' which quantitatively measures an individual's cumulative risk of falling. The present review collates data from the PPA (and the physiological capacities it measures) as well as its use in strategies to reduce falls in the elderly and those with different diseases. We emphasise that (i) motor impairment arises via reductions in a wide range of sensorimotor abilities; (ii) the PPA approach not only gives a snapshot of the physiological capacity of an individual, but it also gives insight into the deficits among groups of individuals with particular diseases; and (iii) deficits in seemingly restricted and disparate physiological domains (e.g. vision, strength, cognition) are funnelled into impairments in tasks requiring upright balance. Motor impairments become more prevalent with ageing but careful physiological measurement and appropriate interventions offer a way to maximise health across the lifespan.
Barbier, Paolo; Alimento, Marina; Berna, Giovanni; Cavoretto, Dario; Celeste, Fabrizio; Muratori, Manuela; Guazzi, Maurizio D
Tele-echocardiography is not widely used because of lengthy transmission times when using standard Motion Pictures Expert Groups (MPEG)-2 lossy compression algorythms, unless expensive high bandwidth lines are used. We sought to validate the newer MPEG-4 algorythms to allow further reduction in echocardiographic motion video file size. Four cardiologists expert in echocardiography read blindly 165 randomized uncompressed and compressed 2D and color Doppler normal and pathologic motion images. One Digital Video and 3 MPEG-4 compression algorythms were tested, the latter at 3 decreasing compression quality levels (100%, 65% and 40%). Mean diagnostic and image quality scores were computed for each file and compared across the 3 compression levels using uncompressed files as controls. File dimensions decreased from a range of uncompressed 12-83 MB to MPEG-4 0.03-2.3 MB. All algorythms showed mean scores that were not significantly different from uncompressed source, except the MPEG-4 DivX algorythm at the highest selected compression (40%, p=.002). These data support the use of MPEG-4 compression to reduce echocardiographic motion image size for transmission purposes, allowing cost reduction through use of low bandwidth lines.
Jónsson, Hjalti; Arendt, Kristian Bech; Jørgensen, Lisbeth
Service in Denmark. Method: Psychologists and psychiatrists from three Child and Adolescent Psychiatry clinics and four community bases School Counselling Services are trained and supervised in a manualized group CBT treatment program (Cool Kids) for Childhood anxiety. Ninety-six children with anxiety...... with the children and their parents at pre- and post-treatment and at 3-month follow-up (ADIS-C/P: Silverman & Nelles, 1988), as well as by self-report child and parent scales pre- and post-treatment, and at 3- and 12 month follow-ups. Parents’ symptoms of anxiety and depression are also measured. Results...... in Denmark (Arendt & Thastum, 2013). Objective: To evaluate the outcomes of evidence based, manualized group cognitive-behavioural treatment (CBT) for children and adolescent with anxiety disorders, when delivered in an outpatient Child and Adolescent Psychiatry or in a community based School Counselling...
Baillie, Sarah; Pierce, Stephanie E; May, Stephen A
Teaching and learning in a clinical setting is important in veterinary and medical training but presents many challenges, including providing enough hands-on experience while not putting patients (animal or human) at risk. Some of the issues have been addressed with the introduction of clinical skills laboratories and communication skills training using role play. However, in both instances skills are learned in isolation, whereas the real task requires the integration of many skills including technical competencies, effective communication, decision making, and professionalism. In our study, we trialed "contextualized simulation" by combining role play with a simulator, the haptic cow, in a small-group tutorial, the Simulated Fertility Visit. Students took turns as the veterinarian; they had to establish the cow's history from the farmer (a role player), palpate the simulation, make a diagnosis, and decide on treatment, if appropriate. We included scenarios varying from common cases to challenging situations. The tutorial was introduced in the farm-animal clinical rotation, and feedback was gathered from students by means of a questionnaire. The tutorial was attended by 178 students (98% of that year's students), and 151 questionnaires were returned (85% response rate). Students reported that the tutorial was a positive learning experience and recognized that it presented an opportunity to integrate the skills needed for clinical work. Student feedback suggests that contextualized simulation provides a valuable complement to clinical cases, and we recommend extending this teaching method to other clinical scenarios and species, particularly because it provides a safe environment in which to experience, and learn from, mistakes.
Jan Sebastian Novotný
Full Text Available Problem: Residential care environment represents a specific social space that is associated with a number of negative consequences, covering most aspects of children and youth functioning. The paper analyzes of the presence of adjustment problems among adolescents from institutional care environment and compares this results with a population of adolescents who grew up in a family. Methods: The sample consisted of two groups of adolescents. The first group included 285 adolescents currently growing up in an residential care environment, aged 13 to 21 (M = 16.23, SD = 1.643. The second group consisted of 214 adolescents growing up in a family, aged 15 to 20 (M = 17.07, SD = 1.070. We used a questionnaire Youth Self Report. Data were analyzed using descriptive statistics and MANOVA. Results: Results showed that adolescents in residential care exhibit higher average values in all adjustment problems. Also, in the context of diagnostic categories are the residential care adolescents more frequently in non-normal range (borderline and clinical, primarily in the border range. The greatest differences were reflected in the Thought problems and Rule-breaking behavior. MANOVA showed a significant multivariate effect between groups of adolescents, Hotelling's T = .803, F(8, 490 = 49.202, p <.001, d = .445 (large effect. Univariate analysis further showed a significant effect for Withdrawn/depressed (p = .044, d = .089, small effect, Somatic complaints (p = .002, d = .139, medium effect, Social problems (p = 004, d = .127, a small effect, Thought problems (p <.001, d = .633, strong effect, Attention problems (p <.001, d = .320,strong effect, Rule-breaking behavior (p <.001 , d = .383, strong effect, and Aggressive behavior (p = 015, d = .110, small effect. Results for the dimension of Anxious/depressed were not significant (p = .159. Discussion: The results didn’t confirmed the assumption that more than 30% of residential care adolescents have adjustment
Acosta, Oscar; Solano, Luis; Escobar, Jorge; Fernandez, Miguel; Solano, Carlos; Fujita, Ricardo
Carrion's disease (CD), is a human bartonellosis, that is, endemic in the Andes of Peru, Ecuador, and Colombia. Bartonella bacilliformis, a native hemotrophic bacteria, is the causative agent of CD, and the interaction with the host could have produced changes in the gene frequencies of erythrocyte antigens. The goal here is to investigate the relationship between allele frequencies of blood group systems MNS, Diego, and Duffy and the clinical phases of CD, within a genetic context. In this associative and analytical study, 76 individuals from Bagua Grande, the province of Utcubamba, and the department of Amazonas in Peru, were enrolled. Forty of them resided in Tomocho-Collicate-Vista Hermosa area (high prevalence of cases in chronic phase, verrucous, or eruptive phase, without previous acute phase). Thirty-six individuals were from the area of Miraflores (high prevalence of cases in acute phase only) and were evaluated for blood group systems MNS, Diego, and Duffy. This study constitutes one of the first attempts at evaluating the genetic factors and clinical phases of CD. No significant statistical differences (P > 0.05) between allele frequencies of blood groups MNS, Diego, and Duffy and the prevalence of chronic and acute phases were detected in the two areas of Amazonas, Peru.
Oei, Tian Po; McAlinden, Niamh May
The present study examined the relationship between quality of life and symptom change following group CBT treatment for anxiety or depression in a psychiatric hospital outpatient setting. One hundred seventy seven outpatients undergoing eight sessions of group CBT for anxiety (n=124) or mood disorders (n=53) participated. The Beck Anxiety Inventory (BAI), Zung Self-Rating Depression Scale (Zung-SRDS), Quality of Life Inventory (QOLI), and Satisfaction with Life Scale (SWLS) were administered at baseline and post-treatment. Additionally, the QOLI and SWLS scores of those who achieved reliable improvement or clinically significant symptom change were compared to those who experienced no reliable symptom improvement. There were significant changes across the QOLI, SWLS, BAI and Zung-SRDS outcome measures between baseline and post-treatment, with moderate to very large effect sizes observed. Patients with reliable or clinically significant change in their symptoms experienced significant increases in QOLI and SWLS scores when compared to those whose symptoms did not change reliably. Overall, in a psychiatric hospital outpatient setting, group CBT appeared to be successful in increasing quality of life and satisfaction with life in addition to reducing anxiety and depression symptoms.
West, Stephen G; Cham, Heining; Thoemmes, Felix; Renneberg, Babette; Schulze, Julian; Weiler, Matthias
A propensity score is the probability that a participant is assigned to the treatment group based on a set of baseline covariates. Propensity scores provide an excellent basis for equating treatment groups on a large set of covariates when randomization is not possible. This article provides a nontechnical introduction to propensity scores for clinical researchers. If all important covariates are measured, then methods that equate on propensity scores can achieve balance on a large set of covariates that mimics that achieved by a randomized experiment. We present an illustration of the steps in the construction and checking of propensity scores in a study of the effectiveness of a health coach versus treatment as usual on the well-being of seriously ill individuals. We then consider alternative methods of equating groups on propensity scores and estimating treatment effects including matching, stratification, weighting, and analysis of covariance. We illustrate a sensitivity analysis that can probe for the potential effects of omitted covariates on the estimate of the causal effect. Finally, we briefly consider several practical and theoretical issues in the use of propensity scores in applied settings. Propensity score methods have advantages over alternative approaches to equating groups particularly when the treatment and control groups do not fully overlap, and there are nonlinear relationships between covariates and the outcome.
Bernhardt, Olaf; Biffar, Reiner; Kocher, Thomas; Meyer, Georg
The aim of this study is to investigate associations between degenerative bony changes of the temporomandibular joint (TMJ) evaluated by magnetic resonance imaging (MRI) and signs and symptoms of temporomandibular disorders (TMD) in a non-patient group. A total of 307 subjects (140 males and 167 females) were selected from the cross-sectional epidemiological study "Study of Health in Pomerania" (SHIP) for this evaluation. A clinical functional examination of the masticatory muscles and the TMJs was performed as well as an MRI examination of the TMJs. Another 77 subjects (25%) exhibited degenerative changes of one or both TMJs in the MRI. Clinical analysis revealed pain on palpation of the masticatory muscles in 113 subjects. Some 39 subjects had pain during palpation of the TMJs. There were significant associations between the MRI confirmed diagnosis of osteoarthrosis and some clinical signs (joint noises, joint palpation pain, reduced mouth opening) and symptoms (reported pain in the jaw and masticatory muscles) of TMD as well as further MRI diagnoses (disc displacement with and without reduction, fibrosis of the posterior ligament). Although there were some associations, clinical examination alone is not sufficient for diagnosing degenerative joint diseases. MRI is a necessary diagnostic adjunct for estimating the prevalence of TMD subgroups in non-patient populations.
Full Text Available Over past decade, the Iowa gambling task (IGT has been utilized to test various decision deficits induced by neurological damage or psychiatric disorders. The IGT has recently been standardized for identifying 13 different neuropsychological disorders. Neuropsychological patients choose bad decks frequently, and normal subjects prefer good EV decks. However, the IGT has several validity and reliability problems. Some research groups have pointed out that the validity of IGT is influenced by the personality and emotional state of subjects. Additionally, several other studies have proposed that the prominent deck B phenomenon (PDB phenomenon – that is, normal subjects preferring bad deck B – may be the most serious problem confronting IGT validity. Specifically, deck B offers a high frequency of gains but negative EV. In the standard IGT administration, choice behavior can be understood with reference to gain-loss frequency (GLF rather than inferred future consequences (EV, the basic assumption of IGT. Furthermore, using two different criteria (basic assumption vs. professional norm results in significantly different classification results. Therefore, we recruited 72 normal subjects to test the validity and reliability of IGT. Each subject performed three runs of the computer-based clinical IGT version. The PDB phenomenon has been observed to a significant degree in the first and second stages of the clinical IGT version. Obviously, validity, reliability and the practice effect were unstable between two given stages. The present form of the clinical IGT version has only one stage, so its use should be reconsidered for examining normal decision makers; results from patient groups must also be interpreted with great care. GLF could be the main factor to be considered in establishing the constructional validity and reliability of the clinical IGT version.
徐德才; 张少军; 姜之全; 韩易
Objective: To explore the clinical effects of the adjustable ventriculo-peritoneal shunt valve in treating adult hydrocephalus. Methods:Twenty cases with hydrocephalus were treated with the adjustable ventriculo-peritoneal shunt valve. The valve pressure was adjusted according to the intracranial pressure of patients during the operation and the ventricular size in CT and the clinical symptoms after operation. The valve increased or decreased 1 level every month according to the brain CT. Results:All patients were followed up for 3 to 19 months. The high-pressure hydrocephalus symptoms were improved in 5 cases,the valve in 1 case with less ventricle was adjusted to high 1 level. Among 15 cases with normal-pressure hydrocephalus,the improvement in 8 cases and no obvious improvement in 7 cases were found. Among 8 cases treated with adjustment,the improvement of symptom and imaging in 7 cases and no obvious improvement in 1 case were found. Conclusions:The clinical effects of the adjustable ventriculo-peritoneal shunt valve are good,which can prevent complications.%目的：探讨可调压式分流管行脑室-腹腔分流术治疗成年人脑积水的临床效果。方法：采用可调压式分流管行脑室-腹腔分流术治疗成年人脑积水20例。术中测量颅内压并根据所测压力调整阀门压力。术后根据头颅CT显示的脑室大小和临床症状的改善调节分流泵的压力。每月复查头颅CT 1次,每次调低或调高1个档次,每月调节1次。结果：出院后随访3~19个月,5例高压性脑积水术后症状均有不同程度的改善,1例出现脑室过小,调高1个档次,共调节1次；15例正常压力脑积水术后1个月内8例症状改善,7例症状改善不明显,进行压力调节；共8例调节,7例症状和影像学改善,1例无改善。结论：使用可调压式分流管行脑室-腹腔分流术,可在术后调整阀门压力,防止并发症,分流效果显著。
Full Text Available Many clinics still use monitor unit (MU calculations for electron treatment planning and/or quality assurance (QA. This work (1 investigates the clinical implementation of a dosimetry system including a modified American Association of Physicists in Medicine-task group-71 (TG-71-based electron MU calculation protocol (modified TG-71 electron [mTG-71E] and an independent commercial calculation program and (2 provides the practice recommendations for clinical usage. Following the recently published TG-71 guidance, an organized mTG-71E databook was developed to facilitate data access and subsequent MU computation according to our clinical need. A recently released commercial secondary calculation program - Mobius3D (version 1.5.1 Electron Quick Calc (EQC (Mobius Medical System, LP, Houston, TX, USA, with inherent pencil beam algorithm and independent beam data, was used to corroborate the calculation results. For various setups, the calculation consistency and accuracy of mTG-71E and EQC were validated by their cross-comparison and the ion chamber measurements in a solid water phantom. Our results show good agreement between mTG-71E and EQC calculations, with average 2% difference. Both mTG-71E and EQC calculations match with measurements within 3%. In general, these differences increase with decreased cutout size, increased extended source to surface distance, and lower energy. It is feasible to use TG71 and Mobius3D clinically as primary and secondary electron MU calculations or vice versa. We recommend a practice that only requires patient-specific measurements in rare cases when mTG-71E and EQC calculations differ by 5% or more.
Full Text Available Problem-based Learning (PBL is an alternate method of instruction that incorporates basic elements of cognitive learning theory. Colleges of pharmacy use PBL to aid anticipated learning outcomes and practice competencies for pharmacy student. The purpose of this study were to implement and evaluate a model of small group PBL for 5th year pharmacy students in the clinical environment that facilitated by pharmacy instructors. A PBL model was implemented in 1-day periods each week in total of 15 weeks at clinical practice sites. PBL activities consisted of providing pharmaceutical care service, collecting patients based clinical data, evaluation therapeutic regimens, developing SOAP note, peer feedback and case wrap-up sessions. In data collection, 36 students who had participated model completed a 17-items questionnaire using 5- point Likert scale (Cronbach's Alpha is 0.96 about their pharmacy student competencies at before and after finished course. They also completed 11-items questionnaire using 5-point Likert scale (Cronbach's Alpha is 0.87 about their satisfaction. Data of pharmacy student competencies and satisfaction were analyzed by paired sample t-test and descriptive statistics in respectively. From the result of this study indicated that pharmacy student's competencies have been increased through PBL course and also statistical significant (P < 0.05 have found in every items mainly in clinical skills regarding apply didactic knowledge to direct patients care activities such as identifying, prioritization, solving therapy-drug related problem as well as clinical communication with patients or other members of interdisciplinary team. Moreover, in the part of satisfaction found that all of questions were scored range from high to highest level of mean score and most of modes were 4. Overall concluded that the PBL model enhances pharmacy student competencies and students were satisfied with PBL course.
Galton C. Vasconcelos
Full Text Available ABSTRACT Purpose: To compare the surgical results of adjustable and non-adjustable horizontal strabismus surgery for concomitant horizontal strabismus. Methods: The charts of 231 patients, who underwent horizontal strabismus surgery, selected using probabilistic sampling, were retrospectively reviewed. Patients were divided into two groups according to the surgical technique used and strabismus type. The adjustable suture technique was used for 107 patients (Group 1, and non-adjustable or conventional surgery was performed in the remaining 124 patients (Group 2. Patients with esotropia (ET or exotropia (XT of 5 PD, syndromes, restrictive or paretic strabismus, reoperations, botulinum toxin injection, and patients postoperatively followed up for 50% was present in all subgroups. Significant differences between strabismus groups submitted to adjustable technique and non-adjustable on postoperative day 1 were observed (p=0.00 for ET and p=0.01 for XT and at the last visit for the XT group with a follow-up of at least 1 year (p=0.05. Conclusion: The adjustable suture technique produced a higher success rate than non-adjustable strabismus surgery for both ET and XT groups on postoperative day 1. For XT patients, the adjustable suture technique appears to produce better surgical results than non-adjustable surgery, when the surgical goal is long-lasting maintenance of a small hypercorrection.
González-Rodríguez, Alexandre; Molina-Andreu, Oriol; Imaz Gurrutxaga, María Luisa; Catalán Campos, Rosa; Arroyo, Miquel Bernardo
Gender differences in attendance rates for appointments in delusional disorder have been poorly studied. Furthermore, delusional disorder is traditionally considered a treatment-resistant disorder. We conducted a longitudinal retrospective study with a one-year follow-up, including 78 delusional disorder patients (DSM-IV-TR), consecutively admitted over a period of 10 years. We performed a follow-up for one year in order to describe demographic and clinical variables, and to compare the therapeutic effectiveness. In this study, due to the non-interventional nature of this study, indirect measures were used to measure treatment effectiveness. The sample was divided into three groups according to the antipsychotic received at the first admission. Twenty-three patients received Risperidone Long-Acting Injection (RILD), 30 oral risperidone, and 25 patients received other oral atypical antipsychotics. Delusional disorder women had a later age at onset and needed a longer duration of hospitalization. No statistically significant differences were found between the three treatment groups as regards demographic data, social and personal functioning, and psychopathology at admission. The RILD group showed higher maintenance rates at the end of the follow-up period. Furthermore, the RILD group required treatment with antidepressants and benzodiazepines less often. We concluded that treatment with RLAI may increase maintenance rates at follow-up in DD patients when compared with other oral atypical antipsychotics. Copyright © 2012 SEP y SEPB. Published by Elsevier España. All rights reserved.
Päivi Maria Pylvänäinen
Full Text Available AbstractWe were interested in investigating the effects of dance movement therapy (DMT in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms.All adult patients (n = 33 included in the study received treatment as usual (TAU. 21 patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES were medium in favor for the DMT group (d= 0.60-0.79. In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15 – 0.37. The results indicated that DMT is beneficial in the treatment of depressed patients.
Pylvänäinen, Päivi M; Muotka, Joona S; Lappalainen, Raimo
We were interested in investigating the effects of dance movement therapy (DMT) in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms. All adult patients (n = 33) included in the study received treatment as usual (TAU). Twenty-one patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES) were medium in favor for the DMT group (d = 0.60-0.79). In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15-0.37. The results indicated that DMT is beneficial in the treatment of depressed patients.
Full Text Available The aim of the study was to compare the clinical and anthropometric characteristics of patients with COPD, which differ in the degree of airways obstruction and belong to groups A, B, C, D in accordance with GOLD, 2011 classification. A total of 112 ambulatory COPD patients in remission made the study sample. Anthropometric data, body mass index, medical history, dyspnea by mMRC scale, and spirometry was performed for all patients. There was confirmed that outpatients with COPD is a heterogeneous group, in which the majority are those with moderate (48.22 % and severe (30.36 %, airway obstruction. Despite the vast majority of men among outpatients, the percentage of women among patients with mild to moderate obstruction (22.58±5.31 % was significantly higher (p=0.002 as compared with those with severe or very severe limitation of airflow (6.00±3.36 %. Patients with severe and very severe obstruction were of significantly older age (p = 0.024. At the same time, the distribution of patients according to the GOLD, 2011 classification, demonstrate that all groups did not differ on any of the anthropometric indicators, including gender and age (p > 0.050. Distribution of patients by groups with different risk for future exacerbations is not a mirror image of gradation in accordance with the degree of airway obstruction. Every second (50.00±4.43 % of cases patient is included in group C and every tenth (10.20±4.32 % belongs to the group D not due to degree of bronchial obstruction, but due to the number of exacerbations in the past year. Therefore, in future studies it is advisable to use both principles of patients’ classification.
Antibiotic susceptibilities, streptococcal pyrogenic exotoxin gene profiles among clinical isolates of group C or G Streptococcus dysgalactiae subsp. equisimilis & of group G S. anginosus group at a tertiary care centre
Full Text Available Background & objectives: Group C and group G streptococci (together GCGS are often regarded as commensal bacteria and their role in streptococcal disease burden is under-recognized. While reports of recovery of GCGS from normally sterile body sites are increasing, their resistance to macrolides, fluoroquinolone further warrants all invasive β haemolytic streptococci to be identified to the species level and accurately tested for antimicrobial susceptibility. This study was aimed to determine the prevalence, clinical profile, antimicrobial susceptibility and streptococcal pyrogenic exotoxin gene profile (speA, speB, speC, speF, smeZ, speI, speM, speG, speH and ssa of GCGS obtained over a period of two years at a tertiary care centre from north India. Methods: The clinical samples were processed as per standard microbiological techniques. β-haemolytic streptococci (BHS were characterized and grouped. Antimicrobial susceptibility of GCGS was performed using disk diffusion method. All GCGS were characterized for the presence of streptococcal pyrogenic exotoxins (spe and spe genes were amplified by PCR method. Results: GCGS (23 GGS, 2GCS comprised 16 per cent of β haemolytic streptococci (25/142 βHS, 16% isolated over the study period. Of the 25 GCGS, 22 (88% were recovered from pus, two (8% from respiratory tract, whereas one isolate was recovered from blood of a fatal case of septicaemia. Of the total 23 GGS isolates, 18 (78% were identified as Streptococcus dysgalactiae subsp equisimilis (SDSE, large-colony phenotype, five (21% were Streptococcus anginosus group (SAG, small-colony phenotype. The two GCS were identified as SDSE. All GCGS isolates were susceptible to penicillin, vancomycin, and linezolid. Tetracycline resistance was noted in 50 per cent of SDSE isolates. The rates of macrolide and fluoroquinolone resistance in SDSE were low. Twelve of the 20 SDSE isolates were positive for one or more spe genes, with five of the SDSE isolates
Kelly, J B
This article summarizes current research on children's adjustment after separation and divorce, and then focuses on the contributions of marital conflict, marital violence, and hostile family environments to children's adjustment during marriage and after divorce. Children living in marriages with frequent and intense conflict are significantly more likely to have substantial adjustment problems before parental divorce and compromised parent-child relationships. These findings suggest that the deleterious effects of divorce per se have been overstated, with insufficient attention paid in the clinical and research literature to the damaging effects of highly troubled marriages on children's adjustment.
Karlowsky, James A; Walkty, Andrew J; Adam, Heather J; Baxter, Melanie R; Hoban, Daryl J; Zhanel, George G
Clinical isolates of the Bacteroides fragilis group (n = 387) were collected from patients attending nine Canadian hospitals in 2010-2011 and tested for susceptibility to 10 antimicrobial agents using the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method. B. fragilis (59.9%), Bacteroides ovatus (16.3%), and Bacteroides thetaiotaomicron (12.7%) accounted for ~90% of isolates collected. Overall rates of percent susceptibility were as follows: 99.7%, metronidazole; 99.5%, piperacillin-tazobactam; 99.2%, imipenem; 97.7%, ertapenem; 92.0%, doripenem; 87.3%, amoxicillin-clavulanate; 80.9%, tigecycline; 65.9%, cefoxitin; 55.6%, moxifloxacin; and 52.2%, clindamycin. Percent susceptibility to cefoxitin, clindamycin, and moxifloxacin was lowest for B. thetaiotaomicron (n = 49, 24.5%), Parabacteroides distasonis/P. merdae (n = 11, 9.1%), and B. ovatus (n = 63, 31.8%), respectively. One isolate (B. thetaiotaomicron) was resistant to metronidazole, and two isolates (both B. fragilis) were resistant to both piperacillin-tazobactam and imipenem. Since the last published surveillance study describing Canadian isolates of B. fragilis group almost 20 years ago (A.-M. Bourgault et al., Antimicrob. Agents Chemother. 36:343-347, 1992), rates of resistance have increased for amoxicillin-clavulanate, from 0.8% (1992) to 6.2% (2010-2011), and for clindamycin, from 9% (1992) to 34.1% (2010-2011).
Full Text Available CONTEXT : Infections of the respiratory tract are perhaps the most common human ailments. Acute Respiratory Infections (ARI has quite a high morbidity and mortality in children in developing countries 1 ARI is responsible for about 30 - 50 percent of visits to health facilities and for about 20 - 40 percent of hospital admissions. Pneumonia is a leading cause of mortality in children worldwide. Because mortality due to pneumonia in developing countries is attributable mainly to bacterial etiology , IM NCI strategy recommends the use of antibiotics when a child presented with tachypnea as defined previously . AIMS : To re - define or refine tachypnea as a specific indicator of bacterial pneumonia. To identify other clinical predictors for identifying bacteri al pneumonia. DESIGNS : The study was designed to be done in two phases . In the first phase it is to be carried out as a descriptive study of children presenting with fever and respiratory distress in the OPD to identify the specific markers for bacterial p neumonia. In the second phase presenting clinical features in children with radiological pneumonia will be analysed to validate the findings from Phase I. MATERIALS AND METHODS : This was a hospital based study and was conducted in Sri Manakula V inayagar Me dical College and Hospital , Puducherry . The study included 100 Children in the age group 6 months to 5 years presenting in the out patients department with fever and respiratory distress Children attending the out - patient department on a fixed day of the w eek (Monday and who come under this study population during the study period were admitted and recruited in the study and informed verbal consent for participation was taken from the parents. Their clinical profiles were recorded as in phase I. All childr en coming under this study population were given antibiotics and supportive treatment. The cases were monitored for any worsening or improvement every 6 th hourly on day 1 and
Eapen, Valsamma; Crnčec, Rudi; Walter, Amelia
Available evidence indicates that early intervention programs, such as the Early Start Denver Model (ESDM), can positively affect key outcomes for children with Autism Spectrum Disorder (ASD). However, programs involving resource intensive one-to-one clinical intervention are not readily available or deliverable in the community, resulting in many children with ASD missing out on evidence-based intervention during their early and most critical preschool years. This study evaluated the effectiveness of the ESDM for preschool-aged children with ASD using a predominantly group-based intervention in a community child care setting. Participants were 26 children (21 male) with ASD with a mean age of 49.6 months. The ESDM, a comprehensive early intervention program that integrates applied behaviour analysis with developmental and relationship-based approaches, was delivered by trained therapists during the child's attendance at a child care centre for preschool-aged children with ASD. Children received 15-20 hours of group-based, and one hour of one-to-one, ESDM intervention per week. The average intervention period was ten months. Outcome measures were administered pre- and post-intervention, and comprised a developmental assessment - the Mullen Scales of Early Learning (MSEL); and two parent-report questionnaires - the Social Communication Questionnaire (SCQ) and Vineland Adaptive Behaviours Scales-Second Edition (VABS-II). Statistically significant post-intervention improvements were found in children's performance on the visual reception, receptive language and expressive language domains of the MSEL in addition to their overall intellectual functioning, as assessed by standardised developmental quotients. Parents reported significant increases in their child's receptive communication and motor skills on the VABS-II, and a significant decrease in autism-specific features on the SCQ. These effects were of around medium size, and appeared to be in excess of what may
An adjustable microchip holder for holding a microchip is provided having a plurality of displaceable interconnection pads for connecting the connection holes of a microchip with one or more external devices or equipment. The adjustable microchip holder can fit different sizes of microchips with ...
Ph.H.B.F. Franses (Philip Hans); L.P. de Bruijn (Bert)
textabstractMany publicly available macroeconomic forecasts are judgmentally adjusted model-based forecasts. In practice, usually only a single final forecast is available, and not the underlying econometric model, nor are the size and reason for adjustment known. Hence, the relative weights given
Ph.H.B.F. Franses (Philip Hans); L.P. de Bruijn (Bert)
markdownabstractMany publicly available macroeconomic forecasts are judgmentally-adjusted model-based forecasts. In practice usually only a single final forecast is available, and not the underlying econometric model, nor are the size and reason for adjustment known. Hence, the relative weights
Ph.H.B.F. Franses (Philip Hans); L.P. de Bruijn (Bert)
markdownabstractMany publicly available macroeconomic forecasts are judgmentally-adjusted model-based forecasts. In practice usually only a single final forecast is available, and not the underlying econometric model, nor are the size and reason for adjustment known. Hence, the relative weights give
Full Text Available Abstract Background Chronic neck pain is highly prevalent in Western societies, with about 15% of females and 10% of males suffering with it at any time. The course of untreated chronic neck pain patients in clinical trials has not been well-defined and the placebo effect has not been clarified. Methods A systematic review of RCT's of conservative treatments for chronic mechanical neck pain was conducted. Studies were excluded if they did not include a control group, if they involved subjects with whiplash injuries, a predominance of headache or arm pain associated with chronic neck pain and if only one treatment was reported. Only studies scoring 3–5 out of 5 on the Jadad Scale for quality were included in the final analysis. Data on change in pain scores of subjects in both placebo (PL as well as no-treatment (NT control groups were analyzed. Mean changes in pain scores as well as effect sizes were calculated, summarized and compared between these groups. Results Twenty (20 studies, 5 in the NT group and 15 in the PL group, with outcome intervals ranging from 1–52 weeks were included in the final analysis. The mean [95% CI] effect size of change in pain ratings in the no-treatment control studies at outcome points up to 10 weeks was 0.18 [-0.05, 0.41] and for outcomes from 12–52 weeks it was 0.4 [0.12, 0.68]. In the placebo control groups it was 0.50 [0.10, 0.90] at up to 10 weeks and 0.33. [-1.97, 2.66] at 12–24 weeks. None of the comparisons between the no-treatment and placebo groups were statistically significant. Conclusion It appears that the changes in pain scores in subjects with chronic neck pain not due to whiplash who are enrolled in no-treatment and placebo control groups were similarly small and not significantly different. As well, they do not appear to increase over longer-term follow-up.
Clough, Anthony D; Moore, Patrick M
Gastric banding surgery can fail if the patient develops frequent vomiting, intolerance of common food types or reflux. These patients can be divided into those with a well-defined anatomical problem such as slippage and those without. Intermittent gastric prolapse (IGP) is a possible explanation for some patients who do not achieve adequate early satiety without excessive food intolerance but have normal imaging. A series of eight patients was identified over a 2-year period with findings consistent with IGP. Cases were identified in the process of normal clinical practice and details reviewed retrospectively. Specific diagnostic methods included measures to increase pouch pressure above the band by either stress barium or endoscopy with pressure challenge. The median time until diagnosis of IGP was 48.0 months (16-124), and weight loss over that time was 26.4 kg, or 69.6 % excess weight loss (EWL) (5.8-101.8). This fell to 43.7 % EWL after IGP was diagnosed and managed. The mean fill volume when the patients experienced IGP was 6.8 ml (4.5-9.0). Most patients were diagnosed by radiological investigation. Four patients underwent revisional surgery with the remainder treated conservatively. Intermittent gastric prolapse may explain excessive food and fluid intolerance in gastric band patients who have normal initial imaging. These patients typically experience gross food intolerance with a relatively small increment in fluid volume with relief when the increment is removed. The diagnosis is best made with either modified stress barium or endoscopy with pressure challenge. Management entails establishment of a safe fill volume, modification of weight loss expectations and earlier discussion of revisional surgery.
Naranjo, Antonio; Cáceres, Laura; Hernández-Beriaín, José Ángel; Francisco, Félix; Ojeda, Soledad; Talaverano, Sigrid; Nóvoa-Medina, Javier; Martín, José Adán; Delgado, Esmeralda; Trujillo, Elisa; Álvarez, Fátima; Magdalena, Laura; Rodríguez-Lozano, Carlos
To analyze compliance with t2t clinical practice guidelines. Cross-sectional observational study in consecutive patients with rheumatoid arthritis (RA) in 5 hospitals in the Canary Islands. Patients filled out activity scales, HAQ and answered the question of whether the doctor had explained the treatment target. The rheumatologist also collected: visits in the past year, use of activity indices and HAQ, DAS28 of current visit and date of the next visit. The percentage of compliance to indicators based on the t2t recommendations (R) 1, 3, 5-7 and 10 was analyzed. A total of 343 patients were recruited, 77% female, mean age 57, RA duration of 10 years. Median visits in the last year were 3 and mean time between last and current visit was 5.6 months. A total of 93% of the patients were treated with DMARDs and 44% were in remission by DAS (R1). In the previous visit, documented joint count was present in 85%, a HAQ in 19%, patient VAS in 41%, and a DAS28 in 35% of the patients (R6). The next visit was scheduled at an average of 4.3 months (R5). In 64% of patients with DAS28> 3.2 a visit between one and 3 months was scheduled (R5). A total of 96% of patients said they had been informed of the treatment target (R10). Variability between centers existed but was moderate. The only factor determining the performance of a DAS28 in the last visit was the patient's center of origin. The Canary Island centers studied achieved high levels of remission and low activity in their patients. The performance of composite indices and follow-up frequency recommended by the t2t are met, although there is room for improvement. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Merakou, K.; Knithaki, A.; Karageorgos, G.; Theodoridis, D.; Barbouni, A.
This study aims to assess the impact of a brief patient group education intervention in people with type 2 diabetes mellitus. The sample, 193 people with type 2 diabetes mellitus who were patients at the diabetic clinic of a primary health care setting in Attica, was assigned to two groups, intervention (138 individuals) and control group (55…
Full Text Available Xing-Hui Shao,1 Yan-Min Yang,1 Jun Zhu,1 Han Zhang,1 Yao Liu,1 Xin Gao,1 Li-Tian Yu,1 Li-Sheng Liu,1 Li Zhao,2 Peng-Fei Yu,3 Hua Zhang,4 Qing He,5 Xiao-Dan Gu6 1Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 2Department of Emergency, Fu Xing Hospital, Capital Medical University, Beijing, 3Department of Cardiology, Pingdu People’s Hospital, Pingdu, 4Department of Emergency, Qingdao Municipal Hospital, Qingdao, 5Department of Emergency, West China Hospital, Sichuan University, Chengdu, 6Department of Emergency, Sixth People’s Hospital of Chengdu, Chengdu, People’s Republic of China Background: Atrial fibrillation (AF disproportionately affects older adults. However, direct comparison of clinical features, medical therapy, and outcomes in AF patients aged 65–74 and ≥75 years is rare. The objective of the present study was to evaluate the differences in clinical characteristics and prognosis in these two age-groups of geriatric patients with AF.Materials and methods: A total of 1,336 individuals aged ≥65 years from a Chinese AF registry were assessed in the present study: 570 were in the 65- to 74-year group, and 766 were in the ≥75-year group. Multivariable Cox hazards regression was performed to analyze the major adverse cardiac events (MACEs between groups.Results: In our population, the older group were more likely to have coronary artery disease, hypertension, previous stroke, cognitive disorder, or chronic obstructive pulmonary disease, and the 65- to 74-year group were more likely to have valvular heart disease, left ventricular systolic dysfunction, or sleep apnea. The older patients had 1.2-fold higher mean CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke scores, but less probability of being prescribed drugs. Compared with those aged 65–74 years, the older group had a higher risk of death (hazard ratio 2
Tremaine, Larry; Brian, William; DelMonte, Terrye; Francke, Stephan; Groenen, Peter; Johnson, Keith; Li, Lei; Pearson, Kimberly; Marshall, Jean-Claude
Genetic polymorphisms in metabolizing enzymes and drug transporters have been shown to significantly impact the exposure of drugs having a high dependence on a single mechanism for their absorption, distribution or clearance, such that genotyping can lead to actionable steps in disease treatment. Recently, global regulatory agencies have provided guidance for assessment of pharmacogenomics during early stages of drug development, both in the form of formal guidance and perspectives published in scientific journals. The Industry Pharmacogenomics Working Group (I-PWG), conducted a survey among member companies to assess the practices relating to absorption, distribution, metabolism, excretion pharmacogenomics) during early stages of clinical development, to assess the impact of the recent Regulatory Guidance issued by the US FDA and EMA on Industry practices.
Schumacher, Andrew; Sikov, William M.; Quesenberry, Matthew I.; Safran, Howard; Khurshid, Humera; Mitchell, Kristen M.
Background Informed consent forms (ICFs) for oncology clinical trials have grown increasingly longer and more complex. We evaluated objective understanding of critical components of informed consent among patients enrolling in contemporary trials of conventional or novel biologic/targeted therapies. Methods We evaluated ICFs for cancer clinical trials for length and readability, and patients registered on those studies were asked to complete a validated 14-question survey assessing their understanding of key characteristics of the trial. Mean scores were compared in groups defined by trial and patient characteristics. Results Fifty patients, of whom half participated in trials of immunotherapy or biologic/targeted agents and half in trials of conventional therapy, completed the survey. On average, ICFs for industry-originated trials (N = 9 trials) were significantly longer (P < .0001) and had lower Flesch ease-of-reading scores (P = .003) than investigator-initiated trials (N = 11). At least 80% of patients incorrectly responded to three key questions which addressed the experimental nature of their trial therapy, its purported efficacy and potential risks relative to alternative treatments. The mean objective understanding score was 76.9±8.8, but it was statistically significantly lower for patients who had not completed high school (P = .011). The scores did not differ significantly by type of cancer therapy (P = .12) or trial sponsor (P = .38). Conclusions Many participants enrolled on cancer trials had poor understanding of essential elements of their trial. In order to ensure true informed consent, innovative approaches, such as expanded in-person counseling adapted to the patient’s education level or cultural characteristics should be evaluated across socio-demographic groups. Trial registration Clinicaltrials.gov NCT01772511 PMID:28235011
Geist, Kamile; Hitchcock, John H
The profession would benefit from greater and routine generation of causal evidence pertaining to the impact of music therapy interventions on client outcomes. One way to meet this goal is to revisit the use of Single Case Designs (SCDs) in clinical practice and research endeavors in music therapy. Given the appropriate setting and goals, this design can be accomplished with small sample sizes and it is often appropriate for studying music therapy interventions. In this article, we promote and discuss implementation of SCD studies in music therapy settings, review the meaning of internal study validity and by extension the notion of causality, and describe two of the most commonly used SCDs to demonstrate how they can help generate causal evidence to inform the field. In closing, we describe the need for replication and future meta-analysis of SCD studies completed in music therapy settings. SCD studies are both feasible and appropriate for use in music therapy clinical practice settings, particularly for testing effectiveness of interventions for individuals or small groups. © the American Music Therapy Association 2014. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Beever, L; Bond, R; Graham, P A; Jackson, B; Lloyd, D H; Loeffler, A
Frequencies of antimicrobial resistance were determined amongst 14,555 clinical Staphylococcus intermedius group (SIG) isolates from UK dogs and cats to estimate resistance trends and quantify the occurrence of meticillin-resistant Staphylococcus pseudintermedius (MRSP). Reports from two diagnostic laboratories (13,313 general submissions, 1242 referral centre only submissions) were analysed retrospectively (2003/2006-2012). MRSP were defined by phenotypic resistance to meticillin and concurrent broad β-lactam resistance; a subset was confirmed genetically (SIG-specific nuc and mecA). Trends were analysed by Cochran-Armitage test. Resistance remained below 10 per cent for cefalexin, amoxicillin-clavulanic acid and the fluoroquinolones. Increasing resistance trends were seen in both laboratories for ampicillin/amoxicillin (both PResistance to cefalexin increased over time in referral hospital isolates (Presistance to important antimicrobials was identified overtime and the emergence of MRSP from UK clinical cases was confirmed. Attention to responsible use of antibacterial therapy in small animal practice is urgently needed. British Veterinary Association.
Hicks, Lisa K; Cheung, Matthew C; Ding, Keyue; Hasan, Baktiar; Seymour, Lesley; Le Maître, Aurélie; Leighl, Natasha B; Shepherd, Frances A
Advanced nonsmall cell lung cancer (NSCLC) is associated with venous thromboembolism (VTE). However, to the authors' knowledge, the incidence of VTE in early NSCLC, predictors of VTE, and the prognostic significance of VTE in NSCLC have not been explored. Individual patient data from 3 National Cancer Institute of Canada Clinical Trials Group trials were analyzed (n = 1987 patients). Clinical Trial BR.10 was a randomized study of postoperative vinorelbine and cisplatin versus observation in patients with stage IB/II NSCLC (grading determined according to the TNM staging system). Clinical Trial BR.18 was a randomized study of paclitaxel and carboplatin with or without the metalloproteinase inhibitor BMS-275291 in patients with advanced NSCLC. BR.21 was a randomized study of erlotinib versus placebo in patients with previously treated NSCLC. The relations between VTE, treatment, concomitant medications, and patient characteristics were explored in univariate and multivariate analyses. Survival analysis was completed using Cox regression. The incidence of VTE ranged from 0% in patients with early stage NSCLC on the observation arm of BR.10 to 7.9% in patients with advanced NSCLC who received chemotherapy (BR.18). Patients with early stage NSCLC who received chemotherapy (BR.10) and patients with previously treated NSCLC who received erlotinib or placebo (BR.21) had a VTE incidence of approximately 3%. Factors that were found to be predictive of VTE included previous VTE (BR.18; P = .001) and obesity (BR.10; P = .03). In patients with advanced NSCLC, VTE was associated with shorter survival (BR.18: hazard ratio [HR], 1.61; 95% confidence interval [95% CI], 1.26-2.07 [P = .0002]; BR.21: HR, 2.18; 95% CI, 1.57-3.04 [P obesity and a history of VTE. VTE was found to be prognostic in patients with advanced stage NSCLC. (c) 2009 American Cancer Society.
Full Text Available Abstract Background Flexed posture commonly increases with age and is related to musculoskeletal impairment and reduced physical performance. The purpose of this clinical study was to systematically compare the effects of a physical activity program that specifically address the flexed posture that marks a certain percentage of elderly individuals with a non specific exercise program for 3 months. Methods Participants were randomly divided into two groups: one followed an Adapted Physical Activity program for flexed posture and the other one completed a non-specific physical activity protocol for the elderly. A multidimensional clinical assessment was performed at baseline and at 3 months including anthropometric data, clinical profile, measures of musculoskeletal impairment and disability. The instrumental assessment of posture was realized using a stereophotogrammetric system and a specific biomechanical model designed to describe the reciprocal position of the body segments on the sagittal plane in a upright posture. Results The Adapted Physical Activity program determined a significant improvement in several key parameters of the multidimensional assessment in comparison to the non-specific protocol: decreased occiput-to-wall distance, greater lower limb range of motion, better flexibility of pectoralis, hamstrings and hip flexor muscles, increased spine extensor muscles strength. Stereophotogrammetric analysis confirmed a reduced protrusion of the head and revealed a reduction in compensative postural adaptations to flexed posture characterized by knee flexion and ankle dorsiflexion in the participants of the specific program. Conclusion The Adapted Physical Activity program for flexed posture significantly improved postural alignment and musculoskeletal impairment of the elderly. The stereophotogrammetric evaluation of posture was useful to measure the global postural alignment and especially to analyse the possible compensatory strategies
Stern, Robin L; Heaton, Robert; Fraser, Martin W; Goddu, S Murty; Kirby, Thomas H; Lam, Kwok Leung; Molineu, Andrea; Zhu, Timothy C
The requirement of an independent verification of the monitor units (MU) or time calculated to deliver the prescribed dose to a patient has been a mainstay of radiation oncology quality assurance. The need for and value of such a verification was obvious when calculations were performed by hand using look-up tables, and the verification was achieved by a second person independently repeating the calculation. However, in a modern clinic using CT/MR/PET simulation, computerized 3D treatment planning, heterogeneity corrections, and complex calculation algorithms such as convolution/superposition and Monte Carlo, the purpose of and methodology for the MU verification have come into question. In addition, since the verification is often performed using a simpler geometrical model and calculation algorithm than the primary calculation, exact or almost exact agreement between the two can no longer be expected. Guidelines are needed to help the physicist set clinically reasonable action levels for agreement. This report addresses the following charges of the task group: (1) To re-evaluate the purpose and methods of the "independent second check" for monitor unit calculations for non-IMRT radiation treatment in light of the complexities of modern-day treatment planning. (2) To present recommendations on how to perform verification of monitor unit calculations in a modern clinic. (3) To provide recommendations on establishing action levels for agreement between primary calculations and verification, and to provide guidance in addressing discrepancies outside the action levels. These recommendations are to be used as guidelines only and shall not be interpreted as requirements.
... Public / Speech, Language and Swallowing / Disorders and Diseases Family Adjustment to Aphasia Richard S. was a senior manager ... It also presents a great challenge to the family. There may be tension among family members and ...
Kouns, H. H.; Gardner, L. D.
Outlet pressure adjusted to match varying loads. Electrohydraulic servo has positioned sleeve in leftmost position, adjusting outlet pressure to maximum value. Sleeve in equilibrium position, with control land covering control port. For lowest pressure setting, sleeve shifted toward right by increased pressure on sleeve shoulder from servovalve. Pump used in aircraft and robots, where hydraulic actuators repeatedly turned on and off, changing pump load frequently and over wide range.
Karpiuk, Izabela; Tyski, Stefan
There is an essential need for searching for the new compounds effective in the treatment of infections caused by multidrug-resistant bacteria. This paper is the third part of a series associated with the exploration of new antibacterial agents and it discusses the compounds belonging to the group of quinolones and substances possessing a hybrid structure composed of the quinolone molecule and other compounds. Eleven new substances at the stage of clinical trials are presented. Three of them belong to the group of non-fluorinated quinolone (nemonoxacin, ozenoxacin and KRP-AM 1977X), while six are the quinolones containing fluorine atom at 6 position of the carbon atom in the quinoline ring (zabofloxacin, finafloxacin, delafloxacin, JNJ-Q2, WCK771 and KPI-10). The remaining two compounds possess a hybrid construction composed of the quinolone structure and other molecules (cadazolid and CBR-2092). There is a chance in the near future, that the presented compounds can extend the range of existing antibacterial drugs and provide an alternative to currently available medicinal products.
Neonato, M G; Guilloud-Bataille, M; Beauvais, P; Bégué, P; Belloy, M; Benkerrou, M; Ducrocq, R; Maier-Redelsperger, M; de Montalembert, M; Quinet, B; Elion, J; Feingold, J; Girot, R
A subset of 299 patients with homozygous sickle cell anaemia, enrolled in the cohort of the French Study Group on sickle cell disease (SCD), was investigated in this study. The majority of patients were children (mean age 10.1 +/- 5.8 yr) of first generation immigrants from Western and Central Africa, the others originated from the French West Indies (20.2%). We report the frequency of the main clinical events (mean follow-up 4.2 +/- 2.2 yr). The prevalence of meningitis-septicaemia and osteomyelitis was, respectively, 11.4% and 12% acute chest syndrome was observed in 134 patients (44.8%). Twenty patients (6.7%) developed stroke with peak prevalence at 10-15 yr of age. One hundred and seventy-two patients (58%) suffered from one or more painful sickle cell crises, while the others (42.5%) never suffered from pain. The overall frequency of acute anaemic episodes was 50.5%, (acute aplastic anaemia 46%; acute splenic sequestration 26%). A group of 27 patients were asymptomatic (follow-up > 3 yr). Epistatic mechanisms influencing SCD were studied. Coinherited alpha-thalassemia strongly reduced the risk of stroke (p haplotype strongly reflects the geographic origin and identifies subgroups with a homogenous genetic background. Thus the observed effects might result more from differences in as yet unidentified determinants in the genetic background than from the direct linkage with differences in the beta-globin gene locus.
Anderson, Walter L.
The variation of coordinates method is employed to perform a weighted least squares adjustment of horizontal survey networks. Geodetic coordinates are required for each fixed and adjustable station. A preliminary inverse geodetic position computation is made for each observed line. Weights associated with each observed equation for direction, azimuth, and distance are applied in the formation of the normal equations in-the least squares adjustment. The number of normal equations that may be solved is twice the number of new stations and less than 150. When the normal equations are solved, shifts are produced at adjustable stations. Previously computed correction factors are applied to the shifts and a most probable geodetic position is found for each adjustable station. Pinal azimuths and distances are computed. These may be written onto magnetic tape for subsequent computation of state plane or grid coordinates. Input consists of punch cards containing project identification, program options, and position and observation information. Results listed include preliminary and final positions, residuals, observation equations, solution of the normal equations showing magnitudes of shifts, and a plot of each adjusted and fixed station. During processing, data sets containing irrecoverable errors are rejected and the type of error is listed. The computer resumes processing of additional data sets.. Other conditions cause warning-errors to be issued, and processing continues with the current data set.
Anderson, Walter L.
The variation of coordinates method is employed to perform a weighted least squares adjustment of horizontal survey networks. Geodetic coordinates are required for each fixed and adjustable station. A preliminary inverse geodetic position computation is made for each observed line. Weights associated with each observed equation for direction, azimuth, and distance are applied in the formation of the normal equations in-the least squares adjustment. The number of normal equations that may be solved is twice the number of new stations and less than 150. When the normal equations are solved, shifts are produced at adjustable stations. Previously computed correction factors are applied to the shifts and a most probable geodetic position is found for each adjustable station. Pinal azimuths and distances are computed. These may be written onto magnetic tape for subsequent computation of state plane or grid coordinates. Input consists of punch cards containing project identification, program options, and position and observation information. Results listed include preliminary and final positions, residuals, observation equations, solution of the normal equations showing magnitudes of shifts, and a plot of each adjusted and fixed station. During processing, data sets containing irrecoverable errors are rejected and the type of error is listed. The computer resumes processing of additional data sets.. Other conditions cause warning-errors to be issued, and processing continues with the current data set.
Li, M; Zhang, W; Leng, X; Li, Z; Ye, Z; Li, C; Li, X; Zhu, P; Wang, Z; Zheng, Y; Li, X; Zhang, M; Zhang, F; Zhao, Y; Zeng, X
The Chinese systemic lupus erythematosus (SLE) treatment and research group (CSTAR) provides major clinical characteristics of SLE in China and establishes a platform to provide resources for future basic and clinical studies. CSTAR originated as a multicentre, consecutive, and prospective design. The data were collected online from 104 rheumatology centers, which covered 30 provinces in China. The registered patients were required to meet four or more of the American College of Rheumatology (ACR) criteria for the classification of SLE. All CSTAR centers use the same protocol-directed methods to provide uniform evaluations, which included demographic data, clinical features, laboratory examinations, and disease activity evaluations. The patient samples, including DNA samples and sera, were also collected for further quality controls and additional studies. Preliminary analysis from 2104 baseline evaluations was available for this analysis. Of 1914 female and 190 male patients (F:M=10.1), the mean age at onset was 29.2 y with confirmed diagnosis one year later at the age of 30.3 y. Eighty four (4.2%) of 2002 patients had a family history of rheumatic diseases, including 34 (1.7%) cases with SLE. In addition, one hundred and seven (5.2%) abnormal pregnancies were recorded among 2026 experiences. The characteristics of the CSTAR cohort were compared to similarly sized cohorts from other studies. We found that 56.1% of patients presented with concurrent hematological disorders compared to only 18.2% of European patients. Moreover, 47.4% of patients presented with nephropathy compared to 27.9% of European patients. Conversely, neurological manifestations were only seen in 4.8% of Chinese SLE patients compared to 19.4% of European patients, 12.1% of U.S. patients, 22.8% of Malaysian patients and 26.4% of Latin Americans. Pulmonary arterial hypertension and interstitial lung diseases were complications identified in 3.8% and 4.2% of Chinese lupus patients, respectively
Alsop, David C; Detre, John A; Golay, Xavier; Günther, Matthias; Hendrikse, Jeroen; Hernandez‐Garcia, Luis; Lu, Hanzhang; MacIntosh, Bradley J; Parkes, Laura M; Smits, Marion; Osch, Matthias J. P; Wang, Danny J. J; Wong, Eric C; Zaharchuk, Greg
...) for clinical applications. It is a consensus of the ISMRM Perfusion Study Group and the European ASL in Dementia consortium, both of whom met to reach this consensus in October 2012 in Amsterdam...
Laroi, Frank; Sommer, Iris E.; Blom, Jan Dirk; Fernyhough, Charles; Ffytche, Dominic H.; Hugdahl, Kenneth; Johns, Louise C.; McCarthy-Jones, Simon; Preti, Antonio; Raballo, Andrea; Slotema, Christina W.; Stephane, Massoud; Waters, Flavie
Despite a growing interest in auditory verbal hallucinations (AVHs) in different clinical and nonclinical groups, the phenomenological characteristics of such experiences have not yet been reviewed and contrasted, limiting our understanding of these phenomena on multiple empirical, theoretical, and
Brok, Jesper; Greisen, Gorm; Jacobsen, Robert Thorkild
To assess the agreement between Cochrane Neonatal Group reviews and clinical guidelines of a University Neonatology Department, to evaluate the reasons for potential disagreements and to ascertain whether Cochrane reviews were considered for the guidelines development.......To assess the agreement between Cochrane Neonatal Group reviews and clinical guidelines of a University Neonatology Department, to evaluate the reasons for potential disagreements and to ascertain whether Cochrane reviews were considered for the guidelines development....
Vasilescu, L; Ciochină, D A
In time, well water, as a source of drinking and coking water, with physical-chemical, bacteriological, and biological indicators suggestive of alteration in water potability, determines complex, sometimes irreversible, metabolic disorders. Sixty individuals residing in a rural community were divided into 2 groups: study group -30 subjects using well water, and control group--30 subjects using safe water. For the study group the selection criteria were: age, sex, use of well water as drinking and cooking water, history suggestive of chronic poisoning (pregnancy course, birth weight, susceptibility to infectious agents, and current chronic diseases). In the study group, gestosis, prematurity, and altered body mass index are more frequent as compared to the subjects in the control group. The identified laboratory changes indicate moderate anemia, hepatic cytolysis, dyslipidemia, presence of nitrites in urine, and positive urine cultures. Long-term use of water with mineral constituents in excess, absent, or inadequate, the direct biological and chemical water pollution, or most frequently the indirect pollution through the soil determine, in time, complex, sometimes irreversible, metabolic disorders.
... COUNTERVAILING DUTIES Calculation of Export Price, Constructed Export Price, Fair Value, and Normal Value § 351..., constructed export price, or normal value, as the case may be. Groups of adjustments are adjustments for...
Güleç, Gülcan; Hassa, Hikmet; Yalçın, Elif Güneş; Yenilmez, Cınar
The aim of this study was to determine the effects of infertility on sexual functions and dyadic adjustment in infertile couples that seek infertility treatment. The Beck Depression Inventory (BDI), Golombok-Rust Inventory of Sexual Satisfaction (GRISS), and Dyadic Adjustment Scale (DAS) were administered to the infertility group (n = 220) and control group (n = 110). None of the study participants had an Axis I psychiatric disorder. There wasn't a significant difference in BDI score between the 2 groups. None of the study participants had clinical depression. Men in both groups reported more problems according to GRISS total scale and subscale scores (except the avoidance subscale) than the women. Women in both groups reported more problems according to GRISS avoidance subscale score than did the men. Men in the control group reported more problems on the GRISS frequency subscale, as compared men in the infertile group. Women in the control group reported more problems based on GRISS total score, and GRISS frequency, satisfaction, touch, and avoidance subscale scores, as compared to the women in the infertile group. The men in the infertile group were more satisfied with dyadic adjustment than the women in the infertile group. The men and women in the control group had higher DAS total score, and DAS consensus and emotional expression subscale scores. The differences in sexual functions between the infertile and control groups were not significant. Both women and men in the infertility group reported more dyadic adjustment problems than those in the control group.
Sego, Landon H.; Reynolds, Marion R.; Woodall, William H.
We consider the monitoring of clinical outcomes, where each patient has a di®erent risk of death prior to undergoing a health care procedure.We propose a risk-adjusted survival time CUSUM chart (RAST CUSUM) for monitoring clinical outcomes where the primary endpoint is a continuous, time-to-event variable that may be right censored. Risk adjustment is accomplished using accelerated failure time regression models. We compare the average run length performance of the RAST CUSUM chart to the risk-adjusted Bernoulli CUSUM chart, using data from cardiac surgeries to motivate the details of the comparison. The comparisons show that the RAST CUSUM chart is more efficient at detecting a sudden decrease in the odds of death than the risk-adjusted Bernoulli CUSUM chart, especially when the fraction of censored observations is not too high. We also discuss the implementation of a prospective monitoring scheme using the RAST CUSUM chart.
Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I
In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria.
Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I
In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I
In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria. Copyright © 2015. Publicado por Elsevier España, S.L.U.
Cui Yunfeng [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Galvin, James M. [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Radiation Therapy Oncology Group, American College of Radiology, Philadelphia, Pennsylvania (United States); Parker, William [Department of Medical Physics, McGill University Health Center, Montreal, QC (Canada); Breen, Stephen [Department of Radiation Physics, Princess Margaret Hospital, Toronto, ON (Canada); Yin Fangfang; Cai Jing [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Papiez, Lech S. [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Li, X. Allen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Bednarz, Greg [Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Chen Wenzhou [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Xiao Ying, E-mail: email@example.com [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Radiation Therapy Oncology Group, American College of Radiology, Philadelphia, Pennsylvania (United States)
Purpose: To report the process and initial experience of remote credentialing of three-dimensional (3D) image guided radiation therapy (IGRT) as part of the quality assurance (QA) of submitted data for Radiation Therapy Oncology Group (RTOG) clinical trials; and to identify major issues resulting from this process and analyze the review results on patient positioning shifts. Methods and Materials: Image guided radiation therapy datasets including in-room positioning CT scans and daily shifts applied were submitted through the Image Guided Therapy QA Center from institutions for the IGRT credentialing process, as required by various RTOG trials. A centralized virtual environment is established at the RTOG Core Laboratory, containing analysis tools and database infrastructure for remote review by the Physics Principal Investigators of each protocol. The appropriateness of IGRT technique and volumetric image registration accuracy were evaluated. Registration accuracy was verified by repeat registration with a third-party registration software system. With the accumulated review results, registration differences between those obtained by the Physics Principal Investigators and from the institutions were analyzed for different imaging sites, shift directions, and imaging modalities. Results: The remote review process was successfully carried out for 87 3D cases (out of 137 total cases, including 2-dimensional and 3D) during 2010. Frequent errors in submitted IGRT data and challenges in the review of image registration for some special cases were identified. Workarounds for these issues were developed. The average differences of registration results between reviewers and institutions ranged between 2 mm and 3 mm. Large discrepancies in the superior-inferior direction were found for megavoltage CT cases, owing to low spatial resolution in this direction for most megavoltage CT cases. Conclusion: This first experience indicated that remote review for 3D IGRT as part of QA
Cui, Yunfeng; Galvin, James M; Parker, William; Breen, Stephen; Yin, Fang-Fang; Cai, Jing; Papiez, Lech S; Li, X Allen; Bednarz, Greg; Chen, Wenzhou; Xiao, Ying
To report the process and initial experience of remote credentialing of three-dimensional (3D) image guided radiation therapy (IGRT) as part of the quality assurance (QA) of submitted data for Radiation Therapy Oncology Group (RTOG) clinical trials; and to identify major issues resulting from this process and analyze the review results on patient positioning shifts. Image guided radiation therapy datasets including in-room positioning CT scans and daily shifts applied were submitted through the Image Guided Therapy QA Center from institutions for the IGRT credentialing process, as required by various RTOG trials. A centralized virtual environment is established at the RTOG Core Laboratory, containing analysis tools and database infrastructure for remote review by the Physics Principal Investigators of each protocol. The appropriateness of IGRT technique and volumetric image registration accuracy were evaluated. Registration accuracy was verified by repeat registration with a third-party registration software system. With the accumulated review results, registration differences between those obtained by the Physics Principal Investigators and from the institutions were analyzed for different imaging sites, shift directions, and imaging modalities. The remote review process was successfully carried out for 87 3D cases (out of 137 total cases, including 2-dimensional and 3D) during 2010. Frequent errors in submitted IGRT data and challenges in the review of image registration for some special cases were identified. Workarounds for these issues were developed. The average differences of registration results between reviewers and institutions ranged between 2 mm and 3 mm. Large discrepancies in the superior-inferior direction were found for megavoltage CT cases, owing to low spatial resolution in this direction for most megavoltage CT cases. This first experience indicated that remote review for 3D IGRT as part of QA for RTOG clinical trials is feasible and effective
Lewis, Roger J; Lipsky, Ari M; Berry, Donald A
The decision to terminate a controlled clinical trial at the time of an interim analysis is perhaps best made by weighing the value of the likely additional information to be gained if further subjects are enrolled against the various costs of that further enrollment. The most commonly used statistical plans for interim analysis (eg, O'Brien-Fleming), however, are based on a frequentist approach that makes no such comparison. A two-armed Bayesian decision-theoretic clinical trial design is developed for a disease with two possible outcomes, incorporating a quadratic decision loss function and using backward induction to quantify the cost of future enrollment. Monte Carlo simulation is used to compare frequentist error rates and mean required sample sizes for these Bayesian designs with the two-tailed frequentist group-sequential designs of, O'Brien-Fleming and Pocock. When the terminal decision loss function is chosen to yield typical frequentist error rates, the mean sample sizes required by the Bayesian designs are smaller than those of the corresponding O'Brien-Fleming frequentist designs, largely due to the more frequent interim analyses typically used with the Bayesian designs and the ability of the Bayesian designs to terminate early and conclude equivalence. Adding stochastic curtailment to the frequentist designs and using the same number of interim analyses results in largely equivalent trials. An example of a Bayesian design for the data safety monitoring of a clinical trial is given. Our design assumes independence of the probabilities of success in the two trial arms. Additionally, we have chosen non-informative priors and selected loss functions to produce trials with appealing frequentist error rates, rather than choosing priors that reflect realistic prior information and loss functions that reflect true costs. Our Bayesian designs allow interpretation of the final results along either Bayesian or frequentist lines. For the Bayesian, they minimize
Tubiana, M; Henry-Amar, M; Carde, P; Burgers, J M; Hayat, M; Van der Schueren, E; Noordijk, E M; Tanguy, A; Meerwaldt, J H; Thomas, J
From 1964 to 1987, the EORTC Lymphoma Group conducted four consecutive controlled clinical trials on clinical stages I and II Hodgkin's disease in which 1,579 patients were entered. From the onset the main aim of these trials was to identify the subsets of patients who could be treated safely by regional radiotherapy (RT). Therefore, several prognostic indicators were prospectively registered and progressively used in the trial protocols for the delineation of the favorable and unfavorable subgroups as soon as they were recognized of high predictive value. In the H2 trial (1972 to 1976), the histologic subtype was the only variable taken into account for the therapeutic strategy and the staging laparotomy findings were found to be of prognostic value only in patients with favorable prognostic indicators. In the H5 trial (1977 to 1982), patients were subdivided into two subgroups according to six prognostic indicators. Patients with favorable features were submitted to a staging laparotomy (lap); lap negative patients were randomized between mantle field RT and mantle field plus paraaortic RT. Disease free survival (DFS) and total survival (S) were similar in the two arms. Among patients with unfavorable features, DFS and S were significantly higher in the arm treated by combination of mechlorethamine, vincristine, procarbazine, prednisone (MOPP) chemotherapy (CT) and RT than in the arm treated by total nodal irradiation. Nevertheless, in patients below the age of 40, the overall survival rates were equivalent in the two arms. In the H6 trial, the delineation of the favorable subgroup was based on (a) absence of systemic symptoms and elevated ESR, (b) no more than one or two lymph node areas involved. The aim of the study was to assess the impact on survival of a therapeutic strategy including staging laparotomy. At a 4-year follow-up, no difference in survival was evidenced. In patients with unfavorable prognostic indicators, 3 MOPP-RT-3 MOPP were compared with 3
Kristiansen, Tine Mechlenborg; Primdahl, Jette; Antoft, Rasmus; Hørslev-Petersen, Kim
This study aimed to explore how everyday life is affected by rheumatoid arthritis (RA), in order to inform patient education and clinical practice and generate further research. Six focus group interviews were conducted with, in total, 32 participants. Interview data were analysed using content analysis methods. The study showed that RA affected almost every aspect of participants' everyday lives, particularly self-identity, social relationships, work and relationships with health and social care professionals. A small number of the participants did not have these experiences, due to receiving fast diagnosis and effective medical treatment. The findings point to a need to increase knowledge about RA, support symptom management and reduce the physical, social and psychological challenges posed by RA in everyday life. An individualized and engaged approach to patient education, taking the individual experiences as the point of departure, is suggested. The results indicate directions for further research. The general implications for patient education that emerge from this study might not address the support needs of those who did not experience significant changes in everyday life. A more detailed and in-depth understanding about living with RA in the first years after diagnosis would provide a valuable supplement to the many retrospective studies, and useful knowledge in the design of patient education tailored to those who are newly diagnosed with RA. Copyright © 2011 John Wiley & Sons, Ltd.
Full Text Available BACKGROUND: Caesarean delivery (CD rates have been frequently used as quality measures for maternity service comparisons. More recently, primary CD rates (CD in women without previous CD or CD rates within selected categories such as nulliparous, term, cephalic singleton deliveries (NTCS have been used. The objective of this study is to determine the extent to which risk adjustment for clinical and socio-demographic variables is needed for inter-hospital comparisons of CD rates in women without previous CD and in NTCS deliveries. METHODS: Hospital discharge records of women who delivered in Emilia-Romagna Region (Italy from January, 2007 to June 2009 and in Tuscany Region for year 2009 were linked with birth certificates. Adjusted RRs of CD in women without a previous Caesarean and NTCS were estimated using Poisson regression. Percentage differences in RR before and after adjustment were calculated and hospital rankings, based on crude and adjusted RRs, were examined. RESULTS: Adjusted RR differed substantially from crude RR in women without a previous Caesarean and only marginally in NTCS group. Hospital ranking was markedly affected by adjustment in women without a previous CD, but less in NTCS. CONCLUSION: Risk adjustment is warranted for inter-hospital comparisons of primary CD rates but not for NTCS CD rates. Crude NTCS CD rates are a reliable estimate of adjusted NTCS CD.
Choi, Y S; Lee, E J; Cho, Y
WHAT IS KNOWN ON THE SUBJECT?: Panic disorder patients display various panic-related physical symptoms and catastrophic misinterpretation of bodily sensations, which lower their quality of life by interfering with daily activities. Cognitive behavioural therapy (CBT) is a useful strategy for panic disorder patients to manage symptoms associated with inaccurate cognitive interpretation of situations resulting from the patient's cognitive vulnerability. In South Korea, however, despite the increasing prevalence of panic disorder, CBT is not a common element of nursing care plans for panic disorder patients. Moreover, few Korean researchers have attempted to assess the effects of CBT on such patients. WHAT THIS PAPER ADD TO EXISTING KNOWLEDGE?: In a strategy combining CBT and routine treatments, patients with panic disorder can experience greater positive effects in the acute treatment phase than those they experience when receiving only routine treatment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health professionals, especially psychiatric nurses in local clinics who operate most special mental health programmes for panic disorder patients, should apply a panic disorder management programme that integrates CBT and routine treatments. The integrated approach is more effective for reducing the number of panic attacks and cognitive misinterpretation in patients than providing routine treatment alone. For patients with panic disorder, the objective of CBT is to understand the relationship between psychological panic disorder sensations, emotions, thoughts and behaviours. Therefore, nurses can help patients address and improve biological, social and psychological aspects of physical health problems as well as help them improve their coping skills in general. Introduction In panic disorder, sensitivity to bodily sensations increases due to the patient's cognitive vulnerability. Cognitive behavioural therapy (CBT) can help to decrease sensitivity to bodily sensations
Selmer, Jan; Chiu, Randy K.; Shenkar, Oded
of the assignment. Design/methodology/approach - Using a two-flow sample of US expatriates in Germany and German expatriates in the USA, we examine and compare the psychological and socio-cultural adjustment of each group of executives. Findings - Controlling for the length of assignment, we find that German...... expatriates in the USA were better adjusted, both socio-culturally and psychologically, than American expatriates in Germany. These results support the asymmetry hypothesis and call into question previous findings attesting to the relationship between CD and expatriate adjustment. Originality......Purpose - The current literature implicitly assumes a symmetric impact of cultural distance (CD) on expatriate adjustment. By using distance as a predictor of adjustment, the literature has rendered the direction of the flow irrelevant: a US expatriate in Germany is presumed to face the same hurdle...
Rohit R. Ghalsasi
Full Text Available Astronomical telescope is powerful and basic tool for star or celestial observation. Here we proposed integrated system using Raspberry Pi for auto adjusting astronomical telescope. This integrated circuit helps to control stellar monitoring, stellar targeting, and tracking functions of telescope. Astro compass gives the direction of the celestial objects.
Gonsiorek, John C.
In this paper, the diverse literature bearing on the topic of homosexuality and psychological adjustment is critically reviewed and synthesized. The first chapter discusses the most crucial methodological issue in this area, the problem of sampling. The kinds of samples used to date are critically examined, and some suggestions for improved…
Balicer Ran D
Full Text Available Background The ability to accurately detect differential resource use between persons of different socioeconomic status relies on the accuracy of health-needs adjustment measures. This study tests different approaches to morbidity adjustment in explanation of health care utilization inequity. Methods A representative sample was selected of 10 percent (~270,000 adult enrolees of Clalit Health Services, Israel's largest health care organization. The Johns-Hopkins University Adjusted Clinical Groups® were used to assess each person's overall morbidity burden based on one year's (2009 diagnostic information. The odds of above average health care resource use (primary care visits, specialty visits, diagnostic tests, or hospitalizations were tested using multivariate logistic regression models, separately adjusting for levels of health-need using data on age and gender, comorbidity (using the Charlson Comorbidity Index, or morbidity burden (using the Adjusted Clinical Groups. Model fit was assessed using tests of the Area Under the Receiver Operating Characteristics Curve and the Akaike Information Criteria. Results Low socioeconomic status was associated with higher morbidity burden (1.5-fold difference. Adjusting for health needs using age and gender or the Charlson index, persons of low socioeconomic status had greater odds of above average resource use for all types of services examined (primary care and specialist visits, diagnostic tests, or hospitalizations. In contrast, after adjustment for overall morbidity burden (using Adjusted Clinical Groups, low socioeconomic status was no longer associated with greater odds of specialty care or diagnostic tests (OR: 0.95, CI: 0.94-0.99; and OR: 0.91, CI: 0.86-0.96, for specialty visits and diagnostic respectively. Tests of model fit showed that adjustment using the comprehensive morbidity burden measure provided a better fit than age and gender or the Charlson Index. Conclusions Identification of
Nguyen, Austin; Bhavsar, Sheila; Riley, Erinn; Caponetti, Gabriel; Agrawal, Devendra
Introduction High mobility group box 1 is a versatile protein involved in gene transcription, extracellular signaling, and response to inflammation. Extracellularly, high mobility group box 1 binds to several receptors, notably the receptor for advanced glycation end-products. Expression of high mobility group box 1 and the receptor for advanced glycation end-products has been described in many cancers. Objectives To systematically review the available literature using PubMed and Web of Science to evaluate the clinical value of high mobility group box 1 and the receptor for advanced glycation end-products in head and neck squamous cell carcinomas. Data synthesis A total of eleven studies were included in this review. High mobility group box 1 overexpression is associated with poor prognosis and many clinical and pathological characteristics of head and neck squamous cell carcinomas patients. Additionally, the receptor for advanced glycation end-products demonstrates potential value as a clinical indicator of tumor angiogenesis and advanced staging. In diagnosis, high mobility group box 1 demonstrates low sensitivity. Conclusion High mobility group box 1 and the receptor for advanced glycation end-products are associated with clinical and pathological characteristics of head and neck squamous cell carcinomas. Further investigation of the prognostic and diagnostic value of these molecules is warranted.
Full Text Available Introduction High mobility group box 1 is a versatile protein involved in gene transcription, extracellular signaling, and response to inflammation. Extracellularly, high mobility group box 1 binds to several receptors, notably the receptor for advanced glycation end-products. Expression of high mobility group box 1 and the receptor for advanced glycation end-products has been described in many cancers. Objectives To systematically review the available literature using PubMed and Web of Science to evaluate the clinical value of high mobility group box 1 and the receptor for advanced glycation end-products in head and neck squamous cell carcinomas. Data synthesis A total of eleven studies were included in this review. High mobility group box 1 overexpression is associated with poor prognosis and many clinical and pathological characteristics of head and neck squamous cell carcinomas patients. Additionally, the receptor for advanced glycation end-products demonstrates potential value as a clinical indicator of tumor angiogenesis and advanced staging. In diagnosis, high mobility group box 1 demonstrates low sensitivity. Conclusion High mobility group box 1 and the receptor for advanced glycation end-products are associated with clinical and pathological characteristics of head and neck squamous cell carcinomas. Further investigation of the prognostic and diagnostic value of these molecules is warranted.
In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
卢毓敏; 马胜生; 罗铭; 梁纳
目的：：观察中周部加光镜片联合调节训练治疗儿童近视的临床效果。方法：选取我院2014-01/2015-07门诊就诊的儿童近视患者80例160眼,随机分为治疗组和对照组,每组各40例80眼。治疗组采用中周部加光镜片联合调节训练治疗近视,对照组则采用配戴普通单光框架眼镜的常规方法治疗近视,两组患者戴镜后每3 mo复查,1 a后观察各组近视进展指标、调节功能指标,比较分析两组的治疗效果。结果：戴镜1a后治疗组病例裸眼视力、屈光度数、眼轴长度较戴镜前变化不大趋于稳定,与戴镜前比较差异无统计学意义(P>0.05)；对照组病例裸眼视力较戴镜前下降,屈光度数增加,眼轴增长,与戴镜前比较差异有统计学意义(P0.05)。两组间比较差异有统计学意义(P 0. 05 ). The visual acuity decreased, refraction and axial length increased in comparison group, the differences were statistically significant (P0. 05). The difference between the two groups was statistically significant ( P<0. 01).•CONCLUSlON:Midperipherv additional designed lenses and adjustment training treatment of juvenile myopia is effective, which can delay the diopters development of myopic children, improve the regulatory function, control the development of myopia, improve the adjustment function.
Mousavi, Seyed Masoud
Full Text Available Aim: The aims of the present study were to determine the antibiotic susceptibility profils with particular emphasis on susceptible or resistant strains to macrolides and lincosamids antibiotics and to determine possible antibiotic resistance mechanisms occurring in group B streptococci (GBS strains using PCR assay and disk diffusion method.Methods: A total of 62 clinical GBS strains were investigated. Antibacterial susceptibility testing was performed using the disk diffusion method and inducible resistance test for clindamycin by standard double disk diffusion or D-zone test for all isolates to differentiate macrolide resistance phenotype (M, constitutive macrolide-lincosamide-streptogramin B phenotype (cMLS and induced macrolide-lincosamide-streptogramin B phenotype (iMLS. In addition, minimum inhibitory concentrations (MIC of penicillin were determined for all isolates. Finally, possible existence of antibiotic resistance genes for erythromycin , and and for clindamycin were examined among isolates using PCR assay.Results: All 62 isolates were susceptible to penicillin, ampicillin, linezolid, cefazoline and vancomycin. However, 93.5% (n=58 of isolates showed an increased MIC to penicillin. The overall rate of erythromycin resistance was 35.5% (n=22. All erythromycin-resistant isolates displayed the M phenotype (100%, n=22. All three erythromycin resistance genes (i.e. , and were found in erythromycin-resistant isolates.Conclusion: It was concluded that prescribing antibiotic without antibacterial susceptibility tests should be prevented because of the high prevalence of erythromycin-resistant GBS strains and the fact that erythromycin-resistant GBS strains has shown an increased MIC to penicillin, as the drug of choice for treating GBS infections.
establish a connection between the geometrical formulation of quantum statistics as proposed by Chentsov and Morozova and measures of quantum information as introduced by Wigner and Yanase and extended in this article. We show that the set of normalized Morozova-Chentsov functions describing the possible...... quantum statistics is a Bauer simplex and determine its extreme points. We determine a particularly simple skew information, the "¿-skew information," parametrized by a ¿ ¿ (0, 1], and show that the convex cone this family generates coincides with the set of all metric adjusted skew informations.......We extend the concept of Wigner-Yanase-Dyson skew information to something we call "metric adjusted skew information" (of a state with respect to a conserved observable). This "skew information" is intended to be a non-negative quantity bounded by the variance (of an observable in a state...
Full Text Available Two questions are addressed in this paper. The first one is the determination of periods of fiscal consolidation and fiscal stimulus. The second one is the importance of the composition of fiscal adjustments for their success, defined as a declining debt to GDP ratio. We, characterize 1994 and 1999 as points of fiscal consolidation. The 1994 consolidation can not be considered successful since after that period the debt to GDP ratio has grown continuously. The adjustment can be characterized as a type 2 adjustment (Alesina and Perotti (1997 in the sense that cuts were made mainly in public investment, while government wages and transfers remained almost unchanged. This type of adjustment usually has a low likelihood of being a success.Duas questões são tratadas neste artigo. A primeira é a determinação dos períodos de consolidação fiscal e estímulo fiscal. A segunda questão é a importância da composição dos ajustamentos fiscais para o seu sucesso, definido como um declínio na razo dívida/PIB. Nós, caracterizamos 1994 e 1999 como pontos de consolidação fiscal. A consolidação de 1994 não pode ser considerada um sucesso pois nos anos seguintes a razão dívida/PIB cresceu continuamente. O ajustamento pode ser considerado como um ajustamento do tipo 2 (Alesina and Perotti, 1997 no sentido de que foram feitos cortes principalmente no investimento público, enquanto os salários e transferências permaneceram praticamente inalterados. Este tipo de ajustamento geralmente tem uma baixa probabilidade de sucesso.
张武; 张铁山; 贾建文; 吕国荣; 邹万忠; 霍信礼
研制成功一种新型组织学活检装置及改良的内槽式切割针,该装置可使活检针的射程在11.5～23mm范围内连续可调,以适应不同部位和大小病变的取材需要.改良针的盲区由通用针的5～6ram缩短至3mm,针槽由通用针的17mm延长至19ram,增加了有效取材长度的可调范围.经过体外实验取材和临床广泛应用,证明该装置性能稳定,使用方便,取材可靠,效果满意.临床162例174处病变取材总成功率100%(174/174),首次取材成功率95%(155/162).%A new type of tissue core biopsy apparatus--adjustable automated biopsy device (AABD) and itsmodified Tru-Cut type needle has been designed. A mechanism which allow the stroke length of the needle to be continuously adjusted was installed in the AABD. so the stroke length can be easily selected from 11. 5mm to 23mm according to the different size and position of the lesions or tumors in the body. The blind area of the modified Tru-Cut needle at the distal tip of the stylet has been reduced from 5~6mm to 3mm, So then the risk of hitting any normal sensitive structures beyond the target area could be reduced. Because the length of the slot on the stylet extends from conventional 17mm to 19mm. theoretically, the maximal length of the tissue core to be retrieved in the stylet varies from 7mm to 19mm. The results of our experimental studies and clinical applications show that AABD is a safe, accurate, sampling-reliable, valuable diagnostic tool. Biopsy specimens sufficient for histologic analysis are obtained in all of the lesions (174/174). For the first sampling, the success rate was acounted for 95%(155/162).
Full Text Available This study sought to determine the effect of participation in support groups on the depression, anxiety and stress level of caregivers of patients with Alzheimer. This study was a single blind randomized clinical controlled trial (RCT with 80 family caregivers of people with Alzheimer’s (per group=40. The intervention group participated in eight sessions 1.5- 2 hours in support groups. The tool used in this study was the DASS-21 questionnaire for measuring depression, anxiety and stress level of the caregivers, analysis of parametric data, using SPSS version 21. Findings showed, participation in support groups showed no significant difference on depression, anxiety and stress in family caregivers of Alzheimer patients in the control group and the intervention group. Given that caring for these patients by their family members are very sensitive and costly issues for policy makers and health service providers, community and families of these patients.
Full Text Available Background. Relationship between blood groups and dermatologic diseases remains controversial and was not yet fully elucidated nor explained clearly. The aim of this study was to examine if any relation exists between different types of pemphigoid diseases and ABO blood group. Methods. In this case-control study, 159 pemphigoid patients and 152 healthy matched-controls were evaluated. All blood group (including Rh status data for the study was obtained from the hospital medical records. Statistical comparisons were completed with chi-square test and logistic regression. Results. Blood group “O” was found in 32.9% of patients and 38.2% of control group. Blood group “A” was found among 30.8% of patients and 34.2% of control group, while group “B” was reported in 27.4% of cases and 21.1% of controls and “AB” was identified among 8.9% of patients and 6.6% of control group. 84.9% of patients were Rh positive, while in the control group 86.2% of patients were Rh positive. No significant differences were found regarding ABO blood groups (P=0.46 or Rh (P=0.76 between pemphigoid patients and control group. Also, older females had the higher risk of developing bullous pemphigoid. Conclusion. We found no relationship between ABO blood groups and pemphigoid disease.
Morrow, Gary R.; And Others
Assessed the psychosocial adjustment of (N=107) parents whose children had cancer. Different patterns of association between 11 sources of social support and adjustment were found among groups of parents. Psychosocial adjustment of parents with a child in treatment was correlated more frequently with perceived social support. (Author)
Launay-Vacher, Vincent; Rey, Jean-Baptiste; Isnard-Bagnis, Corinne; Deray, Gilbert; Daouphars, Mikael
Antineoplastic drugs used in the treatment of cancers present with variable renal tolerance profiles. Among drugs with a potential for renal toxicity, platinum salts, and especially cisplatin is a well-known agent that may induce acute and chronic renal failure. The mechanisms of its renal toxicity and the means of its prevention are presented in this article which represent the Clinical Recommendation from the Special Interest Group on Cancer Care of the European Society of Clinical Pharmacy (ESCP).
Miloseva, Lence; Cuijeprs, Pim; Stojcev, Saso; Niklewski, Günter; Richter, Kneginja
Introduction: The main aim of this presentation is to introduce project supported by Goce Delcev University, Stip, R. Macedonia, which will be realize during 2015-2016 year. This research study is clinically prospective, cross-sequential, but also partly retrospective because it involves also variables from the past, such as patients’ history data (number of suicidal attempts, stressful life events, etc.). Research objective: This research clinical study is aimed at exploring the differen...
Miloseva, Lence; Cuijpers, Pim; Stojcev, Saso; Niklewski, Gunter; Richter, Kneginja; Jovevska, Svetlana; Arsova, Roza; Serafimov, Aleksandar
Introduction: In recent years, researchers and clinicians do not treat passive suicidal ideation as a clinically relevant risk factor for suicide, while underestimating the strength of this desire to die, compared with making a plan for suicide in individuals having active suicidal ideation. This research study is clinically prospective, cross-sequential, but also partly retrospective because it involves also variables from the past, such as patients’ history data (number of suicidal attempts...
Buus, Niels; Angel, Sanne; Traynor, Michael; Gonge, Henrik
This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision in psychiatric settings have been reported to be relatively low. Qualitative research indicates that staff members appreciate clinical supervision, but paradoxically, do not prioritize participation and find participation emotionally challenging. Little is known about these contradictory experiences and how they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very limited impact on their clinical practice. Neither management nor the staff effectively prioritized clinical supervision, which added to a downward spiral where low levels of participation undermined the potential benefits of clinical supervision. The respondents embraced and used alternative forums for getting emotional support among peers, but maintained that formalized supervision was the only forum for reflection that could solve the most difficult situations.
Byrne, Ciara; Bond, Lynne A.; London, Miv
This quasi-experimental study compared a group mindfulness-based intervention (MI) with an interpersonal process (IP) group intervention and a no-treatment (NT) control condition in reducing psychological distress among 112 students at 2 universities. At postintervention, IP and MI group participants exhibited significant reductions in anxiety,…
Freidlin, Boris; Korn, Edward L
Sample size adjustment designs, which allow increasing the study sample size based on interim analysis of outcome data from a randomized clinical trial, have been increasingly promoted in the biostatistical literature. Although it is recognized that group sequential designs can be at least as efficient as sample size adjustment designs, many authors argue that a key advantage of these designs is their flexibility; interim sample size adjustment decisions can incorporate information and business interests external to the trial. Recently, Chen et al. (Clinical Trials 2015) considered sample size adjustment applications in the time-to-event setting using a design (CDL) that limits adjustments to situations where the interim results are promising. The authors demonstrated that while CDL provides little gain in unconditional power (versus fixed-sample-size designs), there is a considerable increase in conditional power for trials in which the sample size is adjusted. In time-to-event settings, sample size adjustment allows an increase in the number of events required for the final analysis. This can be achieved by either (a) following the original study population until the additional events are observed thus focusing on the tail of the survival curves or (b) enrolling a potentially large number of additional patients thus focusing on the early differences in survival curves. We use the CDL approach to investigate performance of sample size adjustment designs in time-to-event trials. Through simulations, we demonstrate that when the magnitude of the true treatment effect changes over time, interim information on the shape of the survival curves can be used to enrich the final analysis with events from the time period with the strongest treatment effect. In particular, interested parties have the ability to make the end-of-trial treatment effect larger (on average) based on decisions using interim outcome data. Furthermore, in "clinical null" cases where there is no
Full Text Available Sergio Vázquez,1 Joaquín Casal,2 Francisco Javier Afonso Afonso,3 José Luis Fírvida,4 Lucía Santomé,5 Francisco Barón,6 Martín Lázaro,7 Carolina Pena,7 Margarita Amenedo,8 Ihab Abdulkader,9 Carmen González-Arenas,10 Laura Fachal,11 Ana Vega11 On behalf of the Galician Lung Cancer Group (GGCP1Medical Oncology Department, Lucus Augusti University Hospital, Lugo, 2Medical Oncology Department, University Hospital Complex of Vigo, Pontevedra, 3Medical Oncology Department, University Hospital Complex of Ferrol, Ferrol, 4Medical Oncology Department, University Hospital Complex of Ourense, Ourense, 5Medical Oncology Department Povisa Hospital, Vigo, 6Medical Oncology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, 7Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, 8Medical Oncology Department, Oncology Center of Galicia, A Coruña, 9Anatomical Pathology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, 10AstraZeneca, Madrid, 11Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain Purpose: This study aimed to assess the incidence of mutations in the epidermal growth factor receptor (EGFR gene in non-small-cell lung cancer (NSCLC patients in the Galician region of Spain and the clinical management and outcome of patients carrying EGFR mutations. Patients and methods: All newly diagnosed advanced or metastatic NSCLC patients were screened for EGFR mutations in matched tumor samples (tissue or cytology specimens and serum samples. Results: Of 198 patients screened for EGFR mutations in tumor samples, 184 had evaluable data and, of these, 25 (13.6% had EGFR mutations (84% sensitizing mutations. EGFR mutation was found in serum in 14 (8.1% patients (of 174 evaluable. Compared to matched tumor tissue, serum EGFR mutation testing specificity and sensitivity were 99% and 52
Xiao, Bing-bing; Zhang, Dai; Chen, Rui; Shi, Hui-rong; Xin, Xiao-ran; Wang, Hui-lan; Pang, Yi-cun; Zhu, Sai-nan; Yao, Chen; Liao, Qin-ping
To evaluate the cure effectiveness and safety of sucrose gel in the treatment of bacterial vaginosis through a multi-center, randomized, double-blind, parallel controlled clinical study. A clinical research method of multi-center, randomly double-blind, and dose group parallel comparison was adopted. In the study, 533 patients with bacterial vaginosis were randomly divided into two groups, which included 214 cases in the control group (5.0 g metronidazole gel) and 319 cases in the trial group (5.0 g sucrose gel ). The patients were treated with different medication according to the group where they were. All the cases in these two groups were treated with drugs vaginally twice in a day, morning and evening separately, for 5 days. The curative effect and safety evaluation were assessed from 7 to 10 days and 21 to 30 days after treatment respectively. The efficacy of the comprehensive clinical treatment showed that the cure rate of metronidazole gel group and sucrose gel group were 70.53% and 80.83% respectively 7 to 10 days after treatment. The recovery rate of Nugent score for vaginal smear were 71.50% and 81.15% respectively. The differences in the efficacy between these two groups were significant statistically (P0.05) could be found in the cure rates of the two groups. The clinical comprehensive efficacy and recovery of vaginal bacteria of sucrose gel group in the treatment of bacterial vaginosis were obviously superior to those of metronidazole gel 7 to 10 days after treatment. The susucrose gel could improve the clinical efficacy index and laboratory index of bacterial vaginosis. Other effects included the release of clinical symptoms, and the recovery of the normal micro-environment in the vagina according to the Nugent score. The curative efficacy of sucrose gel was equal to that of metronidazole gel 21 to 30 days after treatment. In the future, sucrose gel treatment can be a new strategy for the treatment of bacterial vaginosis. Various advantages can be
Full Text Available Abstract Background Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data. Methods The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed. Results A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p Conclusions The programme demonstrated that acceptable and accessible services with marginalised and often difficult–to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.
Tanaka, M; Kanamori, H; Matsumoto, K; Tachibana, T; Numata, A; Ohashi, K; Kobayashi, T; Nakaseko, C; Kanda, Y; Yamazaki, E; Fujisawa, S; Ooi, J; Sakura, T; Aotsuka, N; Onoda, M; Machida, S; Kato, J; Usuki, K; Watanabe, R; Taguchi, J; Yano, S; Saito, T; Takahashi, S; Sakamaki, H; Okamoto, S
This prospective study aimed to investigate the influence of pretransplant serum ferritin levels on the outcomes of allogeneic hematopoietic SCT (HSCT). In total, 190 patients with acute leukemia or myelodysplastic syndrome were consecutively enrolled. The patients were divided into two groups: low-ferritin group (ferritin group (⩾1000 ng/mL). The primary end point was the cumulative incidence of infection within 100 days after HSCT, which was similar between the two groups: bloodstream infection, 35 vs 38%, P=0.65; bacterial infection, 44 vs 41%, P=0.68; and fungal infection, 6 vs 8%, P=0.71. The 1-year adjusted probability of OS of the high-ferritin group was significantly lower than that of the low-ferritin group (76 vs 63%, P=0.017). Using receiver operating characteristic curve, the threshold of pretransplant serum ferritin levels for bloodstream infection was 1400 ng/mL; the threshold for OS, EFS and non-relapse mortality was 1349 ng/mL. In conclusion, pretransplant serum ferritin levels of ⩾1000 ng/mL did not influence the incidence of infection but adversely affected OS after HSCT. A higher threshold of pretransplant serum ferritin levels may predict HSCT outcomes.
Shorey, Ryan C; Stuart, Gregory L; Anderson, Scott
Early maladaptive schemas, defined as cognitive and behavioural patterns of viewing oneself and the world that cause considerable distress, are increasingly being recognized as an important underlying correlate of mental health problems. Recent research has begun to examine early maladaptive schemas among individuals seeking treatment for substance abuse. Unfortunately, there is limited research on whether substance abusers score higher on early maladaptive schemas than non-clinical controls. Thus, the current study examined whether a sample of young adult female substance abuse treatment seekers (n = 180) scored higher than a non-clinical group of female college students (n = 284) on early maladaptive schemas. Results demonstrated that the substance abuse group scored higher than the non-clinical group on 16 of the 18 early maladaptive schemas. In addition, a number of differences in early maladaptive schemas were large in effect size. Implications of these findings for future research and substance abuse treatment programmes are discussed. Young adult female substance users have a number of early maladaptive schemas that may be contributing to the onset and maintenance of substance use. Findings from the current study suggest that early maladaptive schemas are more prevalent among young adult female substance abusers than a non-clinical control group, even after controlling for demographic differences between groups. The treatment of substance abuse among young adults should consider targeting early maladaptive schemas. Copyright © 2012 John Wiley & Sons, Ltd.
Alicia Gonzalez Baeza
Full Text Available Introduction: The prevalence of risky alcohol consumption, associated factors and its impact on the brain is not well established in clinically stable HIV patients. Materials and Methods: Within the PIVOT neurocognitive sub-study, effectively suppressed HIV-infected adults on either standard cART or ritonavir-boosted PI monotherapy completed the Alcohol Use Disorders Identification Test (AUDIT designed to detect risky alcohol consumption. They also completed a brief neuropsychological assessment (NPZ 5 composed by five measures. For this cross-sectional analysis, we calculated rates of hazardous (AUDIT=8–15 or harmful (AUDIT=16–19 consumption and likely dependence (AUDIT>20. We explored the association between risky alcohol intakes (AUDIT>8 and clinical/demographical variables, conducting logistic regressions when significant association was found (p<.05. Also, the association between cognitive performance and alcohol consumption was calculated and adjusted by potential confounders. Results: Of the 146 included participants, the majority were male (86.3%, white (81.5% and educated (mean years on formal education=15, SD=3.9. Average age was 47.6 years (SD=8.7, and 36.3% had risky consumption (29.5% hazardous, 6.2% harmful, 0.7% likely dependence. White ethnicity and male sex were positively associated with risky consumption (Table 1. After adjustments, white ethnicity remained significantly associated with risky consumption (1.64 [95% CI 0.34–2.95]; p=0.013. Better cognitive performance was associated with risky alcohol consumption in the univariate analysis (p<.001. After adjustment by ethnicity, sex and years of education, cognitive performance and risky alcohol consumption maintained significant association (0.45 [95% CI 0.19–0.70] p=0.001. Conclusions: Despite the substantially high prevalence of risky alcohol consumption, it was not associated with worse adherence, immunological or quality of life measures in this cohort of
Markham, V; Turner, P
Clinical supervision is to become an integral part of mental health nursing, and the United Kingdom Central Council for Nursing, Midwifery & Health Visiting has recommended that it be incorporated in pre-registration education. This paper describes teachers' experiences of delivering a programme of clinical supervision education within the mental health branch of a diploma in nursing course. It outlines the implementation and evaluation of the programme, including discussion of the process and difficulties encountered. The programme appears to have provided a positive first experience for the students and to have given them the enthusiasm to adopt clinical supervision as part of their future roles as qualified practitioners.
Megbaru Alemu; Guesh Abrha; Gessessew Bugssa; Kiros Tedla
This study was aimed to determine the frequency of ABO and Rh blood group patterns and hemoglobin threshold among pregnant women screened at Family Guidance Association of Ethiopia, North Area Mekelle model clinic. Checklists were prepared to collect data from laboratory registration books of five years to undergo this retrospective study. Those registration books were reviewed for ABO blood group, Rh profiles and hemoglobin threshold of the pregnant women screened during the specified per...
Pagán-Collazo, Grace J; Oliva, Jazmin; Cuadrado, Lumarie; Rivas-Tumanyan, Sona; Elías-Boneta, Augusto R
To estimate the prevalence of hypodontia in a group of 10- to 14-year-olds from a group of orthodontic clinics in Puerto Rico. A cross-sectional study was conducted to estimate the prevalence of hypodontia in 10- to 14-year-olds from orthodontic clinics located in each of 9 regions (as determined by the government-run health insurance program, Reforma) in Puerto Rico. A total of 1,911 patients, ranging in age from 10 to 14 years, were evaluated using patient charts covering from May 2004 through June of that same year. A logistic regression model was done to evaluate the relation between the prevalence of hypodontia in the study group and clinic location, gender, and age; a 5% significance level was used. The overall weighted prevalence of hypodontia was 6.02%. Females showed a higher weighted prevalence of hypodontia than did males (7.02% vs. 4.72%, respectively: p = 0.06). The prevalence also varied by geographic region, ranging from 3.21% at the San Juan clinic to 10.68% at the Aibonito clinic (p = 0.01). The most prevalent missing teeth were the maxillary lateral incisors, followed by the lower second premolars (1.9%). The prevalence of hypodontia in Puerto Rico was 6.02%. Females presented a higher prevalence of hypodontia than did males. Each of the clinics in Fajardo, Bayamón, San Juan, and Guayama had a lower prevalence of hypodontia than the Aibonito clinic did. The tooth most frequently missing in the study group was the maxillary right lateral incisor.
Full Text Available Uncertainty often exists in the process of obtaining measurement data, which affects the reliability of parameter estimation. This paper establishes a new adjustment model in which uncertainty is incorporated into the function model as a parameter. A new adjustment criterion and its iterative algorithm are given based on uncertainty propagation law in the residual error, in which the maximum possible uncertainty is minimized. This paper also analyzes, with examples, the different adjustment criteria and features of optimal solutions about the least-squares adjustment, the uncertainty adjustment and total least-squares adjustment. Existing error theory is extended with new observational data processing method about uncertainty.
Quitzau, Maj-Britt; Jensen, Jens Stissing; Elle, Morten
The endogenous agency that urban governments increasingly portray by making conscious and planned efforts to adjust the regimes they operate within is currently not well captured in transition studies. There is a need to acknowledge the ambiguity of regime enactment at the urban scale. This directs...... attention to the transformative implications of conscious strategic maneuvering by incumbent regime actors, when confronting regime structurations. This article provides insight to processes of regime enactment performed by local governments by applying a flow-oriented perspective on regime dynamics...
Jordan Human Development Index (HDI) and Adjusted Human Development Index (IHDI) In 1990, the United Nations Development Programme designed a Human Development Index composed of life expectancy at birth, level of education and gross domestic product (GDP) per capita. In 2011, the UNDP ranked Jordan 95th out of 187 countries with a human development index of 0.698, up from 0.591 in 1990, making it the leading medium-range country for human development (fig. VIII.1). In 2010, the inequality adj...
of ‘adjusting to the emergent’. Newcomer innovation is portrayed as carrying a variety of possible significations, such as unintentional innovation effects of newcomer’s proactive self-socializing behavior; an inspirational basis for designing innovation-generating employee induction; ‘resonant instances...... in standardized induction programs where newcomers are cast in roles as insecure novices needing to be “taught the ropes” of the organizational culture. Linked with this, it is suggested that the prevailing dichotomy of ‘newcomer assimilation’ versus ‘organizational accommodation’ is replaced with a notion...
Borroni, B; Turrone, R; Galimberti, D; Nacmias, B; Alberici, A; Benussi, A; Caffarra, P; Caltagirone, C; Cappa, S F; Frisoni, G B; Ghidoni, R; Marra, C; Padovani, A; Rainero, I; Scarpini, E; Silani, V; Sorbi, S; Tagliavini, F; Tremolizzo, L; Bruni, A C
In the prospect of improved disease management and future clinical trials in Frontotemporal Dementia, it is desirable to share common diagnostic procedures. To this aim, the Italian FTD Network, under the aegis of the Italian Neurological Society for Dementia, has been established. Currently, 85 Italian Centers involved in dementia care are part of the network. Each Center completed a questionnaire on the local clinical procedures, focused on (1) clinical assessment, (2) use of neuroimaging and genetics; (3) support for patients and caregivers; (4) an opinion about the prevalence of FTD. The analyses of the results documented a comprehensive clinical and instrumental approach to FTD patients and their caregivers in Italy, with about 1,000 newly diagnosed cases per year and 2,500 patients currently followed by the participating Centers. In analogy to other European FTD consortia, future aims will be devoted to collect data on epidemiology of FTD and its subtypes and to provide harmonization of procedures among Centers.
Frerichs, Inéz; Amato, Marcelo B P; van Kaam, Anton H; Tingay, David G; Zhao, Zhanqi; Grychtol, Bartłomiej; Bodenstein, Marc; Gagnon, Hervé; Böhm, Stephan H; Teschner, Eckhard; Stenqvist, Ola; Mauri, Tommaso; Torsani, Vinicius; Camporota, Luigi; Schibler, Andreas; Wolf, Gerhard K; Gommers, Diederik; Leonhardt, Steffen; Adler, Andy
Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use. Recommendations of how EIT findings can be applied to generate diagnoses and impact clinical decision-making and therapy planning are required. This consensus paper was prepared by an international working group, collaborating on the clinical promotion of EIT called TRanslational EIT developmeNt stuDy group. It addresses the stated needs by providing (1) a new classification of core processes involved in chest EIT examinations and data analysis, (2) focus on clinical applications with structured reviews and outlooks (separately for adult and neonatal/paediatric patients), (3) a structured framework to categorise and understand the relationships among analysis approaches and their clinical roles, (4) consensus, unified terminology with clinical user-friendly definitions and explanations, (5) a review of all major work in thoracic EIT and (6) recommendations for future development (193 pages of online supplements systematically linked with the chief sections of the main document). We expect this information to be useful for clinicians and researchers working with EIT, as well as for industry producers of this technology. PMID:27596161
Frerichs, Inéz; Amato, Marcelo B P; van Kaam, Anton H; Tingay, David G; Zhao, Zhanqi; Grychtol, Bartłomiej; Bodenstein, Marc; Gagnon, Hervé; Böhm, Stephan H; Teschner, Eckhard; Stenqvist, Ola; Mauri, Tommaso; Torsani, Vinicius; Camporota, Luigi; Schibler, Andreas; Wolf, Gerhard K; Gommers, Diederik; Leonhardt, Steffen; Adler, Andy
Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use. Recommendations of how EIT findings can be applied to generate diagnoses and impact clinical decision-making and therapy planning are required. This consensus paper was prepared by an international working group, collaborating on the clinical promotion of EIT called TRanslational EIT developmeNt stuDy group. It addresses the stated needs by providing (1) a new classification of core processes involved in chest EIT examinations and data analysis, (2) focus on clinical applications with structured reviews and outlooks (separately for adult and neonatal/paediatric patients), (3) a structured framework to categorise and understand the relationships among analysis approaches and their clinical roles, (4) consensus, unified terminology with clinical user-friendly definitions and explanations, (5) a review of all major work in thoracic EIT and (6) recommendations for future development (193 pages of online supplements systematically linked with the chief sections of the main document). We expect this information to be useful for clinicians and researchers working with EIT, as well as for industry producers of this technology.
The efficacy, cycle control, subjective complaints, and safety of monophasic preparations of the oral contraceptives containing gestodene 75 mcg plus ethinyl estradiol 30 mcg versus desogestrel 150 mcg plus ethinyl estradiol 30 mcg were compared in a 6-cycle, open-label, parallel, randomized, multicenter phase IV clinical study in Latin America. Of a total of 176 women in each group, 163 in the gestodene group and 160 in the desogestrel group completed 6 cycles, providing data for 1,015 and 1,006 cycles, respectively. Subject compliance was excellent; pills were missed during only 6.9% of the cycles in each group. No woman became pregnant during the study. Gestodene group exhibited significantly better cycle control as evidenced by the lower incidence of breakthrough bleeding and spotting. Spotting in some cycles was reported by 11.9% of women taking the gestodene-combination compared with 21% of women taking the desogestrel-combination. Based on number of women, 86.4% of the gestodene group reported all cycles were normal (no BTB) compared with 76.7% of the desogestrel group. Also, the women in the gestodene group reported a significantly lower incidence of nuisance side effects during treatment cycles. No amenorrhea was observed for either group. There were no clinically significant differences between groups with respect to body weight, blood pressure, or laboratory evaluations. Seven women withdrew from the gestodene group and 8 women withdrew from the desogestrel group because of adverse reactions. The results of this study indicate that, although both OCs provided effective contraception, in comparison to the desogestrel-combination, the gestodene-containing OC is associated with better cycle control, less bleeding, and fewer subjective complaints.
Bakermans-Kranenburg, M J; van I Jzendoorn, M H
... (perceived threat of the 'out-group'), personality and childhood experiences. In individuals with untoward childhood experiences, positive behavioral or neurobiological effects seem lowered or absent...
Jacobs, Ken; Karpf, Ron
A number of Pulfrich 3-D movies and TV shows have been produced, but the standard implementation has inherent drawbacks. The movie and TV industries have correctly concluded that the standard Pulfrich 3-D implementation is not a useful 3-D technique. Continuously Adjustable Pulfrich Spectacles (CAPS) is a new implementation of the Pulfrich effect that allows any scene containing movement in a standard 2-D movie, which are most scenes, to be optionally viewed in 3-D using inexpensive viewing specs. Recent scientific results in the fields of human perception, optoelectronics, video compression and video format conversion are translated into a new implementation of Pulfrich 3- D. CAPS uses these results to continuously adjust to the movie so that the viewing spectacles always conform to the optical density that optimizes the Pulfrich stereoscopic illusion. CAPS instantly provides 3-D immersion to any moving scene in any 2-D movie. Without the glasses, the movie will appear as a normal 2-D image. CAPS work on any viewing device, and with any distribution medium. CAPS is appropriate for viewing Internet streamed movies in 3-D.
Berge, Jerica M; Law, David D; Johnson, Jennifer; Wells, M Gawain
Although integrated care for adults in primary care has steadily increased over the last several decades, there remains a paucity of research regarding integrated care for children in primary care. To report results of a pilot study testing initial feasibility of a parenting psychoeducational group targeting child behavioral problems within a primary care clinic. The participants (n = 35) were parents representing an underserved population from an inner-city primary care clinic. Participants attended a 12-week psychoeducational parenting group and reported pre- and post-measures of family functioning, child misbehavior and dyadic functioning. Paired t-tests and effects sizes are reported. Participants reported statistically significant improvement in family functioning, child misbehavior, and couple functioning after participating in the parenting psychoeducational group. Results suggest initial feasibility of a parenting psychoeducational group within a primary care clinic with an underserved population. This intervention may be useful for other primary care clinics seeking to offer more integrative care options for children and their families.
Allan, Helen Therese; Dixon, Roz; Lee, Gay; O'Driscoll, Michael; Savage, Jan; Tapson, Christine
In this study, we discuss the role of senior nurses who sit on clinical commissioning groups that now plan and procure most health services in England. These nurses are expected to bring a nursing view to all aspects of clinical commissioning group business. The role is a senior level appointment and requires experience of strategic commissioning. However, little is known about how nurses function in these roles. Following Barrientos' methodology, published policy and literature were analysed to investigate these roles and National Health Service England's claim that nursing can influence and advance a nursing perspective in clinical commissioning groups. Drawing on work by Berg, Barry and Chandler on 'new public management', we discuss how nurses on clinical commissioning groups work at the alignment of the interests of biomedicine and managerialism. We propose that the way this nursing role is being implemented might paradoxically offer further evidence of the devaluing of nursing rather than the emergence of a strong professional nursing voice at the level of strategic commissioning.
Cohen, Robert; Levy, Corinne; Bonacorsi, Stéphane; Wollner, Alain; Koskas, Marc; Jung, Camille; Béchet, Stéphane; Chalumeau, Martin; Cohen, Jérémie; Bidet, Philippe
From 2009 to 2014, we prospectively enrolled 132 children with perianal infections. The presentation of painful defecation, anal fissures, and macroscopic blood in stools was highly suggestive of group A streptococcal perianal infection (probability 83.3%). We found a high sensitivity of a group A streptococcal rapid diagnostic testing (98%) but relatively low specificity (72.8%).
Vasen, Hans F. A.; Blanco, Ignacio; Aktan-Collan, Katja; Gopie, Jessica P.; Alonso, Angel; Aretz, Stefan; Bernstein, Inge; Bertario, Lucio; Burn, John; Capella, Gabriel; Colas, Chrystelle; Engel, Christoph; Frayling, Ian M.; Genuardi, Maurizio; Heinimann, Karl; Hes, Frederik J.; Hodgson, Shirley V.; Karagiannis, John A.; Lalloo, Fiona; Lindblom, Annika; Mecklin, Jukka-Pekka; Moller, Pal; Myrhoj, Torben; Nagengast, Fokko M.; Parc, Yann; de Leon, Maurizio Ponz; Renkonen-Sinisalo, Laura; Sampson, Julian R.; Stormorken, Astrid; Sijmons, Rolf H.; Tejpar, Sabine; Thomas, Huw J. W.; Rahner, Nils; Wijnen, Juul T.; Jaervinen, Heikki Juhani; Moeslein, Gabriela; Jarvinen, H.J.; Moslein, G.
Lynch syndrome (LS) is characterised by the development of colorectal cancer, endometrial cancer and various other cancers, and is caused by a mutation in one of the mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. In 2007, a group of European experts (the Mallorca group) published guidelines for th
Velasco de Ongay, M E
The problems of an ISSSTE clinic were approached within the general systems theory and it was observed that within the group there existed forces to maintain the status-quo and forces towards change; to produce the latter the group was handled during 20 hours with a slightly directive technique. The goals were to improve interpersonal relationships, to increase communication, to make known to individuals their attitudes within a group and make them sensitive to problems they shared with others. The results were good, the status-quo was broken and change started occurring.
Uttley, Lesley; Stevenson, Matt; Scope, Alison; Rawdin, Andrew; Sutton, Anthea
The majority of mental health problems are non-psychotic (e.g., depression, anxiety, and phobias). For some people, art therapy may be a more acceptable alternative form of psychological therapy than standard forms of treatment, such as talking therapies. This study was part of a health technology assessment commissioned by the National Institute for Health Research, UK and aimed to systematically appraise the clinical and cost-effective evidence for art therapy for people with non-psychotic mental health disorders. Comprehensive literature searches for studies examining art therapy in populations with non-psychotic mental health disorders were performed in May 2013. A quantitative systematic review of clinical effectiveness and a systematic review of studies evaluating the cost-effectiveness of group art therapy were conducted. Eleven randomised controlled trials were included (533 patients). Meta-analysis was not possible due to clinical heterogeneity and insufficient comparable data on outcome measures across studies. The control groups varied between studies but included: no treatment/wait-list, attention placebo controls and psychological therapy comparators. Art therapy was associated with significant positive changes relative to the control group in mental health symptoms in 7 of the 11 studies. A de novo model was constructed and populated with data identified from the clinical review. Scenario analyses were conducted allowing comparisons of group art therapy with wait-list control and group art therapy with group verbal therapy. Group art-therapy appeared cost-effective compared with wait-list control with high certainty although generalisability to the target population was unclear; group verbal therapy appeared more cost-effective than art therapy but there was considerable uncertainty and a sizeable probability that art therapy was more cost effective. From the limited available evidence art therapy was associated with positive effects compared with
Lin, Nancy U; Lee, Eudocia Q; Aoyama, Hidefumi; Barani, Igor J; Baumert, Brigitta G; Brown, Paul D; Camidge, D Ross; Chang, Susan M; Dancey, Janet; Gaspar, Laurie E; Harris, Gordon J; Hodi, F Stephen; Kalkanis, Steven N; Lamborn, Kathleen R; Linskey, Mark E; Macdonald, David R; Margolin, Kim; Mehta, Minesh P; Schiff, David; Soffietti, Riccardo; Suh, John H; van den Bent, Martin J; Vogelbaum, Michael A; Wefel, Jeffrey S; Wen, Patrick Y
Therapeutic outcomes for patients with brain metastases need to improve. A critical review of trials specifically addressing brain metastases shows key issues that could prevent acceptance of results by regulatory agencies, including enrolment of heterogeneous groups of patients and varying definitions of clinical endpoints. Considerations specific to disease, modality, and treatment are not consistently addressed. Additionally, the schedule of CNS imaging and consequences of detection of new or progressive brain metastases in trials mainly exploring the extra-CNS activity of systemic drugs are highly variable. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, collaborative effort to improve the design of trials in patients with brain tumours. In this two-part series, we review the state of clinical trials of brain metastases and suggest a consensus recommendation for the development of criteria for future clinical trials.
张凯; 胡文星; 赵守城; 王忠; 苑小历
LSU sulodexide bid (the observed group,n =60) ;②10 mg ezetimibe qd +20 mg simvastatin qd. (the 1st control group,n =60) ;③20 mg simvastatin qd. (the 2nd control group,n =60). Serum total cholesterol (TC) , low density lipoprotein cholesterol (LDL-C) ,high density lipo-protein cholesterol (HDL-C) , tolal tnglyeride (TG) were determined before treatment, at 4 weeks and at 12 weeks; serum tumor necrosis factor- (TNF-α) and C- reactive protein (CRP) were also determined before treatment and at 12 weeks. Results ①TC and LDL-C in the 3 groups were significantly lower ( P < 0. 05) after treatment compared with the basic IeveL TC and LDL-C were significantly Sower in the 1 st conlroi group than the observed group ( P < 0. 05 ) , and lower in the observed group than the 2nd control group ( P < 0. 05 ) at 12 weeks. ②HDL-C was significantly higher in the observed group compared with the basic level at 12 weeks.③ TG was significantly lower in the observed group and the 1st control group compared with their respective baseline (P <0. O5) , and in the observed group than the I st control group at 4 weeks and at 12 weeks (P < 0. 05). ④Al 12 weeks,the compliance rates of TC,LDL-C,HDL-C and TG in the observed group were higher than in the 2nd control group respectively; the compliance rate of TG in the observed group was higher than in the 1st control group; the compliance rates of TC and LDL-C in the 1st control group were the highest (reached at 100% ) than the other 2 groups. ⑤TNF-ct and CRP were significantly lower in the 3 groups compared with their respective baseline (P <0.05) ,and there was no difference on the therapeutic effectiveness between in the 3 groups. Conclusion Ezetimibe co-administration with sulodexide in elderly patients with CHD and DM can not only show pleiotropic effects on overall lipid-adjusting,anti-inflammation,good safeness,but also can educes classical pharmacological actions of sulodexide, so it is a prospective clinical medication
Vukobrat-Bijedic, Zora; Husic-Selimovic, Azra; Bijedic, Nina; Bjelogrlic, Ivana; Djuran, Aleksandra
Ulcerative colitis (UC) is a common disease with a chronic and relapsing presentation requiring regular clinical follow up. Epidemiological and microbiologic studies suggest that enteropathogenic microorganisms play a substantial role in the clinical presentation and extent of inflammatory bowel disease. To evaluate the presence of intestinal infections by Entamoeba hystolitica in patients with ulcerative colitis, their impact on clinical outcome, and to identify associated risk factors. A total of 31 patients hospitalized on Gastroenterohepatology Department with patohystologically proved ulcerative colitis were studied. Fresh feces samples taken from 20 patients were examined immediately using Eosin and Lugol-staining methods and analyzing the presence of vegetative and MIFC (Meriolat and Iod staining). A total of 16 female and 15 male hospitalized UC patients were analysed in a period of two years (2010-2011). The mean age at diagnosis was 43 years. We analyzed relation of amoeba infection with localization of ulcerative colitis. Our results indicate that amoeba infection is related to extent of disease (they were mostly present in pancolitis). Presence of amoeba is not related to age nor gender. Furthermore, presence of amoeba was not associated with more severe clinical course of disease. Similarly, higher value of serum marker of inflammation was not associated with amoeba infection. Amoeba infections in UC patients treated at Gastroenterohepatology Department was not related to the grade of disease activity, and other clinical variables such as gender, age and parameters of inflammation. These microorganisms could be a contributing cause of extended localization of disease.
Morgan, R G
This paper discusses the importance of maintaining high quality clinical records. Evidence from studies carried out in the USA, Australia and Scandinavia shows that record keeping often falls well below accepted standards. Evidence of current standards in the UK, however, has tended to be anecdotal or circumstantial. An assessment was carried out on 47 general practitioners entering the quality assurance programme of a private capitation scheme. A sample of clinical records from each practitioner was analysed, and the presence or absence of key diagnostic and treatment planning entries were recorded. Overall, the quality of record keeping was poor, and in line with the findings of the other worldwide studies. Fundamental clinical entries that could impact on basic dental care provision were missing from many records. The frequency of recording for patients whose treatment was funded under NHS regulations was significantly worse than for patients whose treatment was privately funded.
In her doctoral thesis Line Revsbaek explores newcomer innovation related to organizational entry processes in a changing organization. She introduces process philosophy and complexity theory to research on organizational socialization and newcomer innovation. The study challenges assumptions...... in standardized induction programs where newcomers are cast in roles as insecure novices needing to be “taught the ropes” of the organizational culture. Linked with this, it is suggested that the prevailing dichotomy of ‘newcomer assimilation’ versus ‘organizational accommodation’ is replaced with a notion...... of ‘adjusting to the emergent’. Newcomer innovation is portrayed as carrying a variety of possible significations, such as unintentional innovation effects of newcomer’s proactive self-socializing behavior; an inspirational basis for designing innovation-generating employee induction; ‘resonant instances...
Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study.
Fitzmaurice, Christina; Allen, Christine; Barber, Ryan M; Barregard, Lars; Bhutta, Zulfiqar A; Brenner, Hermann; Dicker, Daniel J; Chimed-Orchir, Odgerel; Dandona, Rakhi; Dandona, Lalit; Fleming, Tom; Forouzanfar, Mohammad H; Hancock, Jamie; Hay, Roderick J; Hunter-Merrill, Rachel; Huynh, Chantal; Hosgood, H Dean; Johnson, Catherine O; Jonas, Jost B; Khubchandani, Jagdish; Kumar, G Anil; Kutz, Michael; Lan, Qing; Larson, Heidi J; Liang, Xiaofeng; Lim, Stephen S; Lopez, Alan D; MacIntyre, Michael F; Marczak, Laurie; Marquez, Neal; Mokdad, Ali H; Pinho, Christine; Pourmalek, Farshad; Salomon, Joshua A; Sanabria, Juan Ramon; Sandar, Logan; Sartorius, Benn; Schwartz, Stephen M; Shackelford, Katya A; Shibuya, Kenji; Stanaway, Jeff; Steiner, Caitlyn; Sun, Jiandong; Takahashi, Ken; Vollset, Stein Emil; Vos, Theo; Wagner, Joseph A; Wang, Haidong; Westerman, Ronny; Zeeb, Hajo; Zoeckler, Leo; Abd-Allah, Foad; Ahmed, Muktar Beshir; Alabed, Samer; Alam, Noore K; Aldhahri, Saleh Fahed; Alem, Girma; Alemayohu, Mulubirhan Assefa; Ali, Raghib; Al-Raddadi, Rajaa; Amare, Azmeraw; Amoako, Yaw; Artaman, Al; Asayesh, Hamid; Atnafu, Niguse; Awasthi, Ashish; Saleem, Huda Ba; Barac, Aleksandra; Bedi, Neeraj; Bensenor, Isabela; Berhane, Adugnaw; Bernabé, Eduardo; Betsu, Balem; Binagwaho, Agnes; Boneya, Dube; Campos-Nonato, Ismael; Castañeda-Orjuela, Carlos; Catalá-López, Ferrán; Chiang, Peggy; Chibueze, Chioma; Chitheer, Abdulaal; Choi, Jee-Young; Cowie, Benjamin; Damtew, Solomon; das Neves, José; Dey, Suhojit; Dharmaratne, Samath; Dhillon, Preet; Ding, Eric; Driscoll, Tim; Ekwueme, Donatus; Endries, Aman Yesuf; Farvid, Maryam; Farzadfar, Farshad; Fernandes, Joao; Fischer, Florian; G/Hiwot, Tsegaye Tewelde; Gebru, Alemseged; Gopalani, Sameer; Hailu, Alemayehu; Horino, Masako; Horita, Nobuyuki; Husseini, Abdullatif; Huybrechts, Inge; Inoue, Manami; Islami, Farhad; Jakovljevic, Mihajlo; James, Spencer; Javanbakht, Mehdi; Jee, Sun Ha; Kasaeian, Amir; Kedir, Muktar Sano; Khader, Yousef S; Khang, Young-Ho; Kim, Daniel; Leigh, James; Linn, Shai; Lunevicius, Raimundas; El Razek, Hassan Magdy Abd; Malekzadeh, Reza; Malta, Deborah Carvalho; Marcenes, Wagner; Markos, Desalegn; Melaku, Yohannes A; Meles, Kidanu G; Mendoza, Walter; Mengiste, Desalegn Tadese; Meretoja, Tuomo J; Miller, Ted R; Mohammad, Karzan Abdulmuhsin; Mohammadi, Alireza; Mohammed, Shafiu; Moradi-Lakeh, Maziar; Nagel, Gabriele; Nand, Devina; Le Nguyen, Quyen; Nolte, Sandra; Ogbo, Felix A; Oladimeji, Kelechi E; Oren, Eyal; Pa, Mahesh; Park, Eun-Kee; Pereira, David M; Plass, Dietrich; Qorbani, Mostafa; Radfar, Amir; Rafay, Anwar; Rahman, Mahfuzar; Rana, Saleem M; Søreide, Kjetil; Satpathy, Maheswar; Sawhney, Monika; Sepanlou, Sadaf G; Shaikh, Masood Ali; She, Jun; Shiue, Ivy; Shore, Hirbo Roba; Shrime, Mark G; So, Samuel; Soneji, Samir; Stathopoulou, Vasiliki; Stroumpoulis, Konstantinos; Sufiyan, Muawiyyah Babale; Sykes, Bryan L; Tabarés-Seisdedos, Rafael; Tadese, Fentaw; Tedla, Bemnet Amare; Tessema, Gizachew Assefa; Thakur, J S; Tran, Bach Xuan; Ukwaja, Kingsley Nnanna; Uzochukwu, Benjamin S Chudi; Vlassov, Vasiliy Victorovich; Weiderpass, Elisabete; Wubshet Terefe, Mamo; Yebyo, Henock Gebremedhin; Yimam, Hassen Hamid; Yonemoto, Naohiro; Younis, Mustafa Z; Yu, Chuanhua; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Zenebe, Zerihun Menlkalew; Murray, Christopher J L; Naghavi, Mohsen
Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. Countries were categorized by SDI quintiles to summarize results. In 2015, there were 17.5 million cancer cases worldwide and 8.7 million deaths. Between 2005 and 2015, cancer cases increased by 33%, with population aging contributing 16%, population growth 13%, and changes in age-specific rates contributing 4%. For men, the most common cancer globally was prostate cancer (1.6 million cases). Tracheal, bronchus, and lung cancer was the leading cause of cancer deaths and DALYs in men (1.2 million deaths and 25.9 million DALYs). For women, the most common cancer was breast cancer (2.4 million cases). Breast cancer was also the leading cause of cancer deaths and DALYs for women (523 000 deaths and 15.1 million DALYs). Overall, cancer caused 208.3 million DALYs worldwide in 2015 for both sexes combined. Between 2005 and 2015, age-standardized incidence rates for all cancers combined increased in
Branten, A.J.W.; Buf-Vereijken, P.W.G. du; Vervloet, M.; Wetzels, J.F.M.
BACKGROUND: Cyclophosphamide can decrease proteinuria and improve renal function in patients with idiopathic membranous nephropathy, but has a high risk of side effects. We studied whether mycophenolate mofetil (MMF) could be a reasonable alternative with fewer side effects. STUDY DESIGN: Clinical t
Vink, Sylvia; van Tartwijk, Jan; Verloop, Nico; Gosselink, Manon; Driessen, Erik; Bolk, Jan
To determine the content of integrated curricula, clinical concepts and the underlying basic science concepts need to be made explicit. Preconstructed concept maps are recommended for this purpose. They are mainly constructed by experts. However, concept maps constructed by residents are hypothesize
Full Text Available We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS, scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n=60 served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n=60 received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation. Patients in Group C (n=60 received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values <0.05. Moreover, patients in Group B had a significantly lower number of positive Phalen’s tests at 3 months compared with the other study groups (P<0.05. We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve.
熊国强; 余红梅; 史阿品; 刘西
通过分析群体性冲突中各利益主体之间的博弈行为，运用演化博弈的方法建立了非政府组织与冲突双方的三方博弈模型，并寻求博弈均衡点。通过分析均衡解，认为冲突双方是否选择和解取决于非政府组织调解成功的概率、协调成本和冲突双方不愿意和解时所产生的损失。%In the group conflict, the biggest contradiction often is to fight for the ownership of interest, and the focus is on how to make the interest maximization. When the two parties in the game can’t properly resolve the contradiction and the game is stalemated, we introduce the third party non-governmental organizations to mediate contradiction and even resolve the contradiction between the two parties. Through analysis of the game behavior between main stakeholders in group conflict, this paper uses the evolutionary game method to establish the tripartite game model with the non-governmental organizations and the two parties in conflict, and pursuits equilibrium points of the game. Through the analysis of the equilibrium, the paper concludes whether the two parties choose mediation depends on the non-governmental organizations’ probability of success to mediation, the costs of mediation, and the loss generated by that conflict in which the two parties don’t compromise.
Márquez, Samuel; Lawson, William; Mowbray, Kenneth; Delman, Bradley N; Laitman, Jeffrey T
The interaction of nasal morphology and climatic conditions has resulted in diverse hard- and soft-tissue configurations across human population groups. While the processes of skull pneumatization are not fully understood, the invasions of the paranasal sinuses [PNS] into the cranium have contributed to assorted morphologies. Human migratory patterns and the strong association with climatic variables through time and space may explain this diversity. This study examined four multiregional populations of which two are from Egypt but of widely divergent eras. Three Egyptian mummies [EG-M] from the middle kingdom were CT scanned providing a unique opportunity to investigate the status of PNS anatomy within a time frame from 1567 BCE to 600 CE and compare it to a contemporary Egyptian [EG] (n = 12) population. Dry skulls of Inuit [IT] (n = 10) and East African [EA] (n = 8) provide out-group comparisons, as one group represents an isolated geographic environment far different from that of Egypt and the other group inhabiting distinct environmental conditions albeit located within the same continent. Results showed EG-M and EG frontal sinus volumes were diminutive in size with no statistically significant difference between them. Maxillary sinus size values of EG-M and EG clustered together while IT and EA significantly differed from each other (P = 0.002). The multiregional groups exhibited population specific morphologies in their PNS anatomy. Ecogeographic localities revealed anatomical differences among IT and EA, while the potential time span of about 3,500 years produced only a negligible difference between the Egyptian groups. The small sample sizes incorporated into this research requires confirmation of the results by analyses of larger samples from each geographic region and with the integration of a larger group of Egyptian mummified remains.
Kanstrup, Marie; Wicksell, Rikard K; Kemani, Mike; Wiwe Lipsker, Camilla; Lekander, Mats; Holmström, Linda
Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT) have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions), including a parent support program (four sessions). Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12) or individual (n = 18) treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01) improvements (large effects) in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%-63% of the adolescents across the different outcome measures and in 54%-76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.
袁瑛; 叶俊; 郑树
Background Hereditary nonpolyposis colorectal cancer (HNPPC) is one of the most common genetic syndrome related with mutation of human mismatch repair genes. This study was to evaluate the clinical significance of suspected hereditary nonpolyposis colorectal cancer (sHNPCC) criteria I and the clinical and genetic features of International Collaborative Group-HNPCC (ICG-HNPCC) and sHNPCC families.Methods Twenty-nine ICG-HNPCC families fulfilling the Amsterdam criteria and 34 sHNPCC families fulfilling the sHNPCC criteria I were collected. PCR-SSCP and DNA sequencing analysis were employed to screen the germline mutations of the hMLH1 and hMSH2 genes in these families.Results The ICG group had more colorectal cancer (CRC) patients per family than did the suspected group (P0.05), mutation type, and mutation distribution. Comparison of the families with and without mutation showed no significant difference in CRC patients per family, Lynch classification, and tumor spectrum.Conclusions ICG-HNPCC and sHNPCC families that have similar clinical manifestations and genetic basis indicate a similar nature for cancer development. The application of sHNPCC criteria I will facilitate clinical diagnosis and treatment of small families.
Importance of diagnostic laboratory methods of beta hemolytic streptococcus group A in comparison with clinical findings in the diagnosis of streptococcal sore throat and unnecessary antibacterial therapy
Full Text Available Background: Streptococcus Pyogenes (group A streptococcus, GAS is the most important cause of bacterial pharyngitis in children and adolescents. Acute pharyngitis is one of the most common conditions in all ages but it is most common in children. Over diagnosis of acute pharyngitis represents one of the major causes of antibiotic abuse. The goal of this study is to make an estimate of the frequency of group A streptococcus in sore throat patients in Farshchian hospital emergency department and clinic in Hamadan. Methods: For estimation of the clinical features role in diagnosis of streptococcal sore throat, we took samples of 100 patients with average age of 32.96±29.86 years with sore throat. We took samples from pharynx and used standard methods of bacteriology in order to detect streptococcus. Results: Group A Streptococcus (GAS accounts for 3 percent of all cases of pharyngitis. Clinically, all of the patients had sore throat. The percent breakdowns are as follows: 30% had exudate, 78% had fever, 8% had lymphadenopathy and 7.7 percent of exudative pharyngitis was streptococcal. The cost for unnecessary antibiotic therapy for every single patient who had negative pharynx culture was approximately 32160 Rails. Conclusion: The low frequency of streptococcus pharyngitis in treated patients reveal that diagnosis based on clinical features is not reliable. We recommend use of other diagnostic methods such as Rapid Antigen Detection Tests (RATs. Only reliable and scientific protocols for antibiotic to therapy.
Full Text Available Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions, including a parent support program (four sessions. Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12 or individual (n = 18 treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p < 0.01 improvements (medium to large effects in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01 improvements (large effects in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%–63% of the adolescents across the different outcome measures and in 54%–76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.
Knight, Katherine; Sperlinger, David; Maltby, Michael
Given the importance of reflective practice within clinical psychology and a lack of empirical research, this study aimed to investigate the personal and professional impact of reflective practice groups (RPGs) for former trainees. This study followed an analytic survey design utilizing a convenience sample of qualified clinical psychologists from a UK training programme. A RPG questionnaire (RPGQ) was developed for the purposes of the study. Following initial pilot work, 297 qualified psychologists were invited to complete the RPGQ. One hundred and twenty-four psychologists (42%) completed the RPGQ. Factor analysis yielded two underlying constructs labelled 'value' and 'distress'. The RPGQ demonstrated significant internal and test-retest reliability. The majority rated the RPGs as valuable for personal and professional development and learning about group processes. Just under half however reported distress as a result of the groups. Whilst some trainees, who reported distress, were able to view the challenges positively, one-sixth were not. Potency of facilitation and group size significantly predicted levels of perceived value and distress. In view of the ethical issues raised by compulsory RPGs, recommendations were made to keep group sizes within an average of 10-13, utilize facilitators with sufficient training in group processes and ensure additional methods of reflective practice development are available. Further suggestions and recommendations for future research in relation to coping and personal learning style were also made. © 2009 John Wiley & Sons, Ltd.
Estevez, Estefania; Murgui, Sergio; Musitu, Gonzalo
The present study examined psychosocial adjustment in the following four groups of students: victims, bullies, bully/victims and a control group of adolescents not involved in bullying or victimization problems. Psychosocial adjustment was measured considering as indicators: level of self-esteem, depressive symptomatology, perceived stress,…
Estevez, Estefania; Murgui, Sergio; Musitu, Gonzalo
The present study examined psychosocial adjustment in the following four groups of students: victims, bullies, bully/victims and a control group of adolescents not involved in bullying or victimization problems. Psychosocial adjustment was measured considering as indicators: level of self-esteem, depressive symptomatology, perceived stress,…
Campbell, J R; Carpenter, P; Sneiderman, C; Cohn, S; Chute, C G; Warren, J
To compare three potential sources of controlled clinical terminology (READ codes version 3.1, SNOMED International, and Unified Medical Language System (UMLS) version 1.6) relative to attributes of completeness, clinical taxonomy, administrative mapping, term definitions and clarity (duplicate coding rate). The authors assembled 1929 source concept records from a variety of clinical information taken from four medical centers across the United States. The source data included medical as well as ample nursing terminology. The source records were coded in each scheme by an investigator and checked by the coding scheme owner. The codings were then scored by an independent panel of clinicians for acceptability. Codes were checked for definitions provided with the scheme. Codes for a random sample of source records were analyzed by an investigator for "parent" and "child" codes within the scheme. Parent and child pairs were scored by an independent panel of medical informatics specialists for clinical acceptability. Administrative and billing code mapping from the published scheme were reviewed for all coded records and analyzed by independent reviewers for accuracy. The investigator for each scheme exhaustively searched a sample of coded records for duplications. SNOMED was judged to be significantly more complete in coding the source material than the other schemes (SNOMED* 70%; READ 57%; UMLS 50%; *p < .00001). SNOMED also had a richer clinical taxonomy judged by the number of acceptable first-degree relatives per coded concept (SNOMED* 4.56, UMLS 3.17; READ 2.14, *p < .005). Only the UMLS provided any definitions; these were found for 49% of records which had a coding assignment. READ and UMLS had better administrative mappings (composite score: READ* 40.6%; UMLS* 36.1%; SNOMED 20.7%, *p < .00001), and SNOMED had substantially more duplications of coding assignments (duplication rate: READ 0%; UMLS 4.2%; SNOMED* 13.9%, *p < .004) associated with a loss of clarity
Samuels, Valerie Jarvis; And Others
Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…
Samuels, Valerie Jarvis; And Others
Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…
Kao, Chung-Lan; Hsieh, Wan-Ling; Chern, Chang-Ming; Chen, Liang-Kung; Lin, Ming-Hsien; Chan, Rai-Chi
BPPV is a common cause of vertigo. Several treatment procedures can facilitate recovery. In this study, we aimed to identify the demographic features, resolution and recurrence rates and impacts on daily activities in BPPV patient between young and senior age groups in Taiwan. This retrospective study recruited 218 patients of BPPV. Medical history, canal involvement, treatment required for complete resolution, symptom free period and recurrence rates were evaluated between the two age groups. Up to 80.7% of patients were successfully treated by a single treatment. For patients aged more than 65 years, the recurrence rate was 1.7 times higher than that in the younger age group (p = 0.07). The symptom-free period before recurrence was nearly 2.2 times longer in the senior age group (p = 0.03). Work-related activities were influenced more by BPPV in the younger age group (p = 0.03). We conclude that BPPV is prone to occur and recur in people of senior age. Clinicians should have the knowledge to diagnose different types of BPPV and treat it accordingly to prevent further complications.
Dahlberg, Suzanne E; Schiller, Joan H; Bonomi, Philip B; Sandler, Alan B; Brahmer, Julie R; Ramalingam, Suresh S; Johnson, David H
Obesity increases the risk of death from many adverse health outcomes and has also been linked with cancer outcomes. The impact of obesity on outcomes of advanced non-small-cell lung cancer patients is unclear. The authors evaluated the association of body mass index (BMI) and outcomes in 2585 eligible patients enrolled in three consecutive first-line trials conducted by the Eastern Cooperative Oncology Group. BMI was categorized as underweight (BMI obese (BMI ≥ 30 kg/m). In addition to analyzing overall and progression-free survival, reasons for treatment discontinuation were also assessed by BMI group. Of the patients enrolled, 4.6% were underweight, 44.1% were normal weight, 34.3% of patients were classified as overweight, and 16.9% were obese. Nonproportional hazards existed for obese patients relative to the other three groups of patients, with a change in overall survival hazard occurring at approximately 16 months. In multivariable Cox models, obese patients had superior outcomes earlier on study compared with normal/overweight patients 0.86 (HR=0.86, p=0.04; 95% CI: 0.75-0.99), but later experienced increased hazard (HR=1.54, p< 0.001; 95% CI: 1.22-1.94), indicating a time effect while undergoing treatment. Data from these three trials suggest differential outcomes associated with BMI, and additional studies of the mechanisms underlying this observation, as well as dietary and lifestyle interventions, are warranted to help optimize therapy.
Eapen, Valsamma; Črnčec, Rudi; Walter, Amelia
Background Available evidence indicates that early intervention programs, such as the Early Start Denver Model (ESDM), can positively affect key outcomes for children with Autism Spectrum Disorder (ASD). However, programs involving resource intensive one-to-one clinical intervention are not readily available or deliverable in the community, resulting in many children with ASD missing out on evidence-based intervention during their early and most critical preschool years. This study evaluated ...
OR Metabolic Syndrome presenting as a BMI ≥ 25 kg/m2, with at least 3 of the following risk factors for metabolic syndrome: waist circumference ...at least 3 of the following risk factors for metabolic syndrome: waist circumference (>40 inches men, >35 inches AMIGO Clinical Study...height, weight, waist circumferences , and BMI) Review of GLB CD-ROM, patient responsibilities, and curriculum Distribution of patient
Päivi Maria Pylvänäinen; Muotka, Joona S.; Raimo eLappalainen
We were interested in investigating the effects of dance movement therapy (DMT) in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms. All adult patients (n = 33) incl...
Leonardo Tammaro; Maria Carla Di Paolo; Angelo Zullo; Cesare Hassan; Sergio Morini; Sebastiano Caliendo; Lorella Pallotta
AIM: To investigate in a prospective study whether a simplified clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy.METHODS: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were stratified according to a simple clinical score (T-score),including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis.RESULTS: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2,and 175 (40%) T3. Overall, stigmata of recent haernorrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in Tt patients than in T2/T3 cases (85% vs 3.2%; x2 = 304.5309, P < 0.001). Older age (t = 3.311; P <0.01) and presence of comorbidities (x2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients.CONCLUSION: Our simplified clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further,randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients.
Ince Gunal, D; Agan, K; Afsar, N; Borucu, D; Us, O
Autosomal dominant cerebellar ataxias are clinically and genetically heterogeneous neurodegenerative disorders. There is no known treatment to prevent neuronal cell death in these disorders. Current treatment is purely symptomatic; ataxia is one of the most disabling symptoms and represents the main therapeutic challenge. A previous case report suggesting benefit from administration of high dose piracetam inspired the present study of the efficacy of this agent in patients with cerebellar ataxia. Piracetam is a low molecular weight derivative of gamma-aminobutyric acid. Although little is known of its mode of action, its efficacy has been documented in a wide range of clinical indications, such as cognitive disorders, dementia, vertigo and dyslexia, as well as cortical myoclonus. The present report investigated the role of high dose piracetam in patients with cerebellar ataxia. Eight patients with autosomal dominant cerebellar ataxia were given intravenous piracetam 60 g/day by a structured protocol for 14 days. The baseline and end-of-the study evaluations were based on the International Cooperative Ataxia Rating Scale. Statistical analysis demonstrated a significant improvement in the patients' total score (P = 0.018) and a subscale analysis showed statistical significance for only the posture and gait disturbances item (P = 0.018). This study is providing good clinical observation in favour of high dose piracetam infusion to reduce the disability of the patients by improving their gait ataxia.
Robertson, K; Jiang, H; Evans, S R; Marra, C M; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, T B; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S; Kumarasamy, N; la Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L; Amod, F; Walawander, A
Infrastructure for conducting neurological research in resource-limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment and normative data needed for clinical interpretation impedes research and clinical care. Here, we report on ACTG 5271, which provided neurological training of clinical site personnel and collected neurocognitive normative comparison data in diverse settings. At ten sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n = 240), India (n = 480), Malawi (n = 481), Peru (n = 239), South Africa (480), Thailand (n = 240), and Zimbabwe (n = 240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline and 770 at 6 months. Participants were enrolled in eight strata, gender (female and male), education (normative data needed to build infrastructure for future neurological and neurocognitive studies in diverse RLS. These normative data are a much-needed resource for both clinicians and researchers.
Weaver, Charlotte; O'Brien, Ann
In 2014, a group of diverse informatics leaders from practice, academia, and the software industry formed to address how best to transform electronic documentation to provide knowledge at the point of care and to deliver value to front line nurses and nurse leaders. This presentation reports the recommendations from this Working Group geared towards a 2020 framework. The recommendations propose redesign to optimize nurses' documentation efficiency while contributing to knowledge generation and attaining a balance that ensures the capture of nursing's impact on safety, quality, yet minimizes "death by data entry."
Furusho, Masahide; Kawazu, Minami; Takeda, Kazuhito; Kurachi, Emiko; Nakashima, Takafumi; Sagara, Rikako; Hara, Takashi; Mukai, Hideyuki; Miura, Shuhei; Sugawara, Koji
Several studies have suggested that pre-dialysis care is associated with clinical outcomes. However, little has been reported on the influence of pre-dialysis care on the psychological adjustment to dialysis. The purpose of this study was to evaluate the impact of pre-dialysis care on psychological adjustment to dialysis and clinical characteristics. In this cross-sectional study, we enrolled 52 patients who started hemodialysis at our hospital. They were divided into two groups according to the time of referral to our hospital: the early referral group (over 1 year prior to first dialysis: 19 patients, mean age 69.3 ± 11.1) and the late referral group (within 1 year prior to first dialysis: 33 patients, mean age 72.3 ± 8.9). We measured the clinical characteristics and evaluated the psychological adjustment to dialysis by Shontz's stage theory. Compared with the late referral group, the early referral group had a significantly better clinical characteristics concerning blood pressure (140.2 ± 23.7 vs. 156.9 ± 23.3 mmHg, P = 0.0150), hemoglobin (10.3 ± 1.5 vs. 9.4 ± 1.0 g/dL, P = 0.0078), and phosphorus (4.5 ± 1.5 vs. 5.5 ± 1.3 mg/dL, P = 0.0166). In addition, psychological adjustment to dialysis evaluated by Shontz's stage theory was significantly better in the early referral group (P = 0.017). Our results indicate that nephrology pre-dialysis care affects not only blood pressure, anemia, and phosphorus control but also the psychological adjustment to dialysis.
Marsden, Daniel; Giles, Rachel
Background People with learning disabilities experience significant inequalities in accessing healthcare. Legal frameworks, such as the Equality Act 2010, are intended to reduce such disparities in care, and require organisations to make 'reasonable adjustments' for people with disabilities, including learning disabilities. However, reasonable adjustments are often not clearly defined or adequately implemented in clinical practice. Aim To examine and synthesise the challenges in caring for people with learning disabilities to develop a framework for making reasonable adjustments for people with learning disabilities in hospital. This framework would assist ward staff in identifying and managing the challenges of delivering person-centred, safe and effective healthcare to people with learning disabilities in this setting. Method Fourth-generation evaluation, collaborative thematic analysis, reflection and a secondary analysis were used to develop a framework for making reasonable adjustments in the hospital setting. The authors attended ward manager and matron group meetings to collect their claims, concerns and issues, then conducted a collaborative thematic analysis with the group members to identify the main themes. Findings Four main themes were identified from the ward manager and matron group meetings: communication, choice-making, collaboration and coordination. These were used to develop the 4C framework for making reasonable adjustments for people with learning disabilities in hospital. Discussion The 4C framework has provided a basis for delivering person-centred care for people with learning disabilities. It has been used to inform training needs analyses, develop audit tools to review delivery of care that is adjusted appropriately to the individual patient; and to develop competencies for learning disability champions. The most significant benefit of the 4C framework has been in helping to evaluate and resolve practice-based scenarios. Conclusion Use of
Khumsikiew, Jeerisuda; Donsamak, Sisira; Saeteaw, Manit
Problem-based Learning (PBL) is an alternate method of instruction that incorporates basic elements of cognitive learning theory. Colleges of pharmacy use PBL to aid anticipated learning outcomes and practice competencies for pharmacy student. The purpose of this study were to implement and evaluate a model of small group PBL for 5th year pharmacy…
Nelson, Briana S.; Wampler, Karen S.
Study compared female childhood sexual abuse (CSA) survivors and their male partners with a group of couples reporting no CSA. Both female CSA survivors and their partners reported higher symptoms of stress, suggesting support for the theory of secondary traumatic stress. Relationship impairment results did not support the hypothesis that CSA…
Walker, U.; A. Tyndall; Czirják, L; Denton, C.; Farge-Bancel, D.; Kowal-Bielecka, O.; Müller-Ladner, U; Bocelli-Tyndall, C.; Matucci-Cerinic, M; Ribi, Camillo; Chizzolini, Carlo; EUSTAR Group
Systemic sclerosis (SSc) is a multisystem autoimmune disease, which is classified into a diffuse cutaneous (dcSSc) and a limited cutaneous (lcSSc) subset according to the skin involvement. In order to better understand the vascular, immunological and fibrotic processes of SSc and to guide its treatment, the EULAR Scleroderma Trials And Research (EUSTAR) group was formed in June 2004.
de Groot, Femke M.; Voogt-Bode, Annieke; Passchier, Jan; Berger, Marjolein Y.; Koes, Bart W.; Verhagen, Arianne P.
Objective: The purpose of this study is to describe the effects in the placebo and "no treatment" arms in trials with headache patients. Method: This is a secondary analysis of randomized controlled trials from 8 systematic reviews and selected trials with a "no treatment" or placebo control group.
Takizawa, Kohei; Takashima, Atsuo; Kimura, Aya; Mizusawa, Junki; Hasuike, Noriaki; Ono, Hiroyuki; Terashima, Masanori; Muto, Manabu; Boku, Narikazu; Sasako, Mitsuru; Fukuda, Haruhiko
A Phase II clinical trial has been initiated to evaluate the efficacy and safety of endoscopic submucosal dissection for intramucosal (cT1a) gastric cancer of undifferentiated type. Patients with cT1a gastric cancer with undifferentiated-type adenocarcinoma are eligible for the study. The tumor size should be 2 cm or less without ulceration. The study will enroll a total of 325 patients from 51 institutions over a 4-year period. The primary endpoint is proportion of 5-year overall survival (% 5-year overall survival) in patients with undifferentiated dominant type. The secondary endpoints are overall survival, relapse-free survival, distant metastasis-free survival, % 5-year overall survival without either recurrence or gastrectomy, % en-bloc resection with endoscopic submucosal dissection, % pathological curative resection with endoscopic submucosal dissection, % 5-year overall survival in patients with differentiated dominant type, % 5-year overall survival in patients with pathologically curative resection with endoscopic submucosal dissection and adverse events.
Levinson, Michele; Kelly, Diane; Zahariou, Krisoula; Johnson, Matthew; Jackman, Christine; Mackenzie, Sara
Contemporary education for medical students should be student-centred, integrated and contextualised. Small group learning promotes clinical reasoning and skills for lifelong learning. Simulation can provide experiential learning in a safe and controlled environment. We developed a weekly integrated problem-based learning and simulation programme (IPS) over two semesters in the first clinical year to augment clinical placement experience and contextualise theory into work-relevant practice. To evaluate the new programme at Kirkpatrick level 1. An anonymous survey of participating students. The programme was well liked. Students found the programme relevant and that they had a better understanding of patient safety and the assessment of the deteriorating patient. They felt it contributed to integration of theory and practice, clinical reasoning and the acquisition of non-technical skills, particularly affective and communication elements. This IPS programme in the first clinical year can deliver a student-centred curriculum to complement clinical placement that delivers the important requirements of contemporary medical student education. © 2016 Royal Australasian College of Physicians.
Artemiou, Elpida; Adams, Cindy L; Vallevand, Andrea; Violato, Claudio; Hecker, Kent G
Current teaching approaches in human and veterinary medicine across North America, Europe, and Australia include lectures, group discussions, feedback, role-play, and web-based training. Increasing class sizes, changing learning preferences, and economic and logistical challenges are influencing the design and delivery of communication skills in veterinary undergraduate education. The study's objectives were to (1) assess the effectiveness of small-group and web-based methods for teaching communication skills and (2) identify which training method is more effective in helping students to develop communication skills. At the Ross University School of Veterinary Medicine (RUSVM), 96 students were randomly assigned to one of three groups (control, web, or small-group training) in a pre-intervention and post-intervention group design. An Objective Structured Clinical Examination (OSCE) was used to measure communication competence within and across the intervention and control groups. Reliability of the OSCEs was determined by generalizability theory to be 0.65 (pre-intervention OSCE) and 0.70 (post-intervention OSCE). Study results showed that (1) small-group training was the most effective teaching approach in enhancing communication skills and resulted in students scoring significantly higher on the post-intervention OSCE compared to the web-based and control groups, (2) web-based training resulted in significant though considerably smaller improvement in skills than small-group training, and (3) the control group demonstrated the lowest mean difference between the pre-intervention/post-intervention OSCE scores, reinforcing the need to teach communication skills. Furthermore, small-group training had a significant effect in improving skills derived from the initial phase of the consultation and skills related to giving information and planning.
Heinemann, Trine; Matthews, Ben; Raudaskoski, Pirkko Liisa
Conversation analytic research on clinical encounters shows that interactional conduct can be consequential for diagnosis, treatment and compliance. Problems reported for doctor-patient interaction can also be identified in Danish audiological encounters. There are, however, also specific aspects...... in which the hearing aid user’s implicit and often unrealistic expectations are handled. This kind of research has potential application for developing a model of best practices.......Conversation analytic research on clinical encounters shows that interactional conduct can be consequential for diagnosis, treatment and compliance. Problems reported for doctor-patient interaction can also be identified in Danish audiological encounters. There are, however, also specific aspects...... to the interaction during hearing aid fitting. This report of a Danish pilot study describes two such problems. The first problem arises from the requirement that the audiologist needs to ‘translate’ the patient’s subjective hearing description for making technological decisions. The second problem is the way...
Lancellotti, Patrizio; Rosenhek, Raphael; Pibarot, Philippe; Iung, Bernard; Otto, Catherine M; Tornos, Pilar; Donal, Erwan; Prendergast, Bernard; Magne, Julien; La Canna, Giovanni; Piérard, Luc A; Maurer, Gerald
With an increasing prevalence of patients with valvular heart disease (VHD), a dedicated management approach is needed. The challenges encountered are manifold and include appropriate diagnosis and quantification of valve lesion, organization of adequate follow-up, and making the right management decisions, in particular with regard to the timing and choice of interventions. Data from the Euro Heart Survey have shown a substantial discrepancy between guidelines and clinical practice in the field of VHD and many patients are denied surgery despite having clear indications. The concept of heart valve clinics (HVCs) is increasingly recognized as the way to proceed. At the same time, very few centres have developed such expertise, indicating that specific recommendations for the initial development and subsequent operating requirements of an HVC are needed. The aim of this position paper is to provide insights into the rationale, organization, structure, and expertise needed to establish and operate an HVC. Although the main goal is to improve the clinical management of patients with VHD, the impact of HVCs on education is of particular importance: larger patient volumes foster the required expertise among more senior physicians but are also fundamental for training new cardiologists, medical students, and nurses. Additional benefits arise from research opportunities resulting from such an organized structure and the delivery of standardized care protocols. The growing volume of patients with VHD, their changing characteristics, and the growing technological opportunities of refined diagnosis and treatment in addition to the potential dismal prognosis if overlooked mandate specialized evaluation and care by dedicated physicians working in a specialized environment that is called the HVC.
Robertson, K; Jiang, H; Evans, SR; Marra, CM; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, TB; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S.; Kumarasamy, N; La Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L.; Amod, F; Walawander, A
Summary ACTG A5271 collected neurocognitive normative comparison test data in 2400 at-risk HIV seronegative participants from Brazil, India, Malawi, Peru, South Africa, Thailand and Zimbabwe. The participants were enrolled in strata by site (10 levels), age (2 levels), education (2 levels), and gender (2 levels). These data provide necessary normative data infrastructure for future clinical research and care in these diverse resource limited settings. Infrastructure for conducting neurological research in resource limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment, and normative data needed for clinical interpretation impede research and clinical care. Here we report on ACTG 5271, which provided neurological training of clinical site personnel, and collected neurocognitive normative comparison data in diverse settings. At 10 sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n=240), India (n=480), Malawi (n=481), Peru (n=239), South Africa (480), Thailand (n=240) and Zimbabwe (n=240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline, and 770 at six-months. Participants were enrolled in 8 strata, gender (female and male), education (<10 years and ≥ 10 years), and age (<35 years and ≥35 years). Of 2400 enrolled, 770 completed the six-month follow up. As expected, significant between-country differences were evident in all the neurocognitive test scores (p<.0001). There was variation between the age, gender and education strata on the neurocognitive tests. Age and education were important variables for all tests; older participants had poorer performance and those with higher education had better performance. Women had better performance on verbal learning/memory and speed of processing tests, while men performed better on motor tests. This study provides the
Karpiuk, Izabela; Tyski, Stefan
This paper is the fourth in a series on the search for new antibacterial therapies, and covers new compounds belonging to the aminoglycoside, macrolide and tetracycline groups of antibiotics. The article describes eight new substances at the clinical trial stage of development. One of them is an aminoglycoside (plazomicin), four are macrolides, collectively known as ketolides (cethromycin, solithromycin, EDP-420 and EDP-788), and the remaining three are members of the tetracycline group (omadacycline, eravacycline, sarecycline). Despite the long-term and very expensive process of collecting documentation proving the efficacy of antimicrobial drugs, there is a possibility, that particular compounds find use as active ingredients of medicinal products allowing for the triumph over the clinically relevant, dangerous bacteria.
Hiyama, Yoshinori; Kamitani, Tsukasa; Wada, Osamu; Mizuno, Kiyonori; Yamada, Minoru
Study Design Prospective observational study including a historical control group. Background The extent to which group-based exercise (G-EXE) improves knee range of motion (ROM), quadriceps strength, and gait ability is similar to that of individualized exercise (I-EXE) at 6 weeks and 8 months after total knee arthroplasty (TKA). However, the benefits of G-EXE for patients during the acute recovery phase after TKA remain unclear. Objective To determine the effects of G-EXE during the acute recovery phase after TKA on knee ROM, quadriceps strength, functional ability, and knee pain. Methods Two hundred thirty-one patients participated in G-EXE in addition to regular ambulation and activities-of-daily-living exercises twice daily during the hospital stay. Outcomes were compared to those of a retrospectively identified, historical control group (I-EXE group [n = 206]) that included patients who performed exercises identical to those performed by the G-EXE group. The outcomes included knee ROM, quadriceps strength, pain intensity, and timed up-and-go test score at 1 month before surgery and at discharge. Analyses were adjusted for age, body mass index, sex, length of hospital stay, and preoperative values. Results Changes in ROM of knee flexion and extension (Pexercises demonstrated greater changes in knee ROM, quadriceps strength, and knee pain than those performing I-EXE in addition to regular ambulation and activities-of-daily-living exercises. The nonrandomized, asynchronous design decreases certainty of these findings. Level of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2016;46(9):742-748. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6409.
Alexsandra Maria Silva Lima
Full Text Available Introduction The high prevalence of Klebsiella pneumoniae infections is related to the ability of K. pneumoniae to acquire and disseminate exogenous genes associated with mobile elements, such as R plasmids, transposons and integrons. This study investigated the presence of class 1 integrons in clinical and microbiota isolates of K. pneumoniae belonging to different phylogenetic groups and correlated these results with the antimicrobial resistance profiles of the studied isolates. Methods Of the 51 isolates of K. pneumoniae selected for this study, 29 were from multidrug-resistant clinical isolates, and 22 were from children's microbiota. The susceptibility profile was determined using the disk diffusion method, and class 1 integrons were detected through polymerase chain reaction (PCR. Results The results showed that none of the 22 microbiota isolates carried class 1 integrons. Among the 29 clinical isolates, 19 (65.5% contained class 1 integrons, and resistance to sulfamethoxazole/trimethoprim was identified in 18 of these isolates (94.7%. Among the K. pneumoniae isolates with class 1 integrons, 47% belonged to the KpI phylogenetic group, and one isolate (14.3% carrying these genetic elements belonged to the KpIII group. Conclusions The wide variety of detected class 1 integrons supports the presence of high rates of antimicrobial resistance, genetic variability, and rapid dissemination of beta-lactamase genes among K. pneumoniae clinical isolates in recent years in hospitals in Recife-PE, Brazil. The findings of this study indicate that the surveillance of K. pneumoniae integrons in clinical isolates could be useful for monitoring the spread of antibiotic resistance genes in the hospital environment.
Law, Emma; Starr, John M; Connelly, Peter John
Scotland's National Dementia Strategy calls for people with dementia and their carers to give voice to what they see as the priorities for dementia research. We sent questionnaires on dementia research priorities, locus and type of research, desired outcome measures and willingness to volunteer, to two groups of dementia research stakeholders: (1) people with dementia and their carers who may or may not be participating in research and (2) those who are directly participating in research. We also made the questionnaire available on a national dementia research website. Five hundred and fourteen responses were received. The top four topics rated by importance were identical across all three groups of respondents: early detection (38.1%), drug trials (14.2%), studies on people living at home (9.7%) and study of carers (6.0%). The data can help shape the dementia research agenda, but more information needs to be made available to the public about other potential research areas.
Segal, Brahm H; Herbrecht, Raoul; Stevens, David A; Ostrosky-Zeichner, Luis; Sobel, Jack; Viscoli, Claudio; Walsh, Thomas J; Maertens, Johan; Patterson, Thomas F; Perfect, John R; Dupont, Bertrand; Wingard, John R; Calandra, Thierry; Kauffman, Carol A; Graybill, John R; Baden, Lindsey R; Pappas, Peter G; Bennett, John E; Kontoyiannis, Dimitrios P; Cordonnier, Catherine; Viviani, Maria Anna; Bille, Jacques; Almyroudis, Nikolaos G; Wheat, L Joseph; Graninger, Wolfgang; Bow, Eric J; Holland, Steven M; Kullberg, Bart-Jan; Dismukes, William E; De Pauw, Ben E
Invasive fungal diseases (IFDs) have become major causes of morbidity and mortality among highly immunocompromised patients. Authoritative consensus criteria to diagnose IFD have been useful in establishing eligibility criteria for antifungal trials. There is an important need for generation of consensus definitions of outcomes of IFD that will form a standard for evaluating treatment success and failure in clinical trials. Therefore, an expert international panel consisting of the Mycoses Study Group and the European Organization for Research and Treatment of Cancer was convened to propose guidelines for assessing treatment responses in clinical trials of IFDs and for defining study outcomes. Major fungal diseases that are discussed include invasive disease due to Candida species, Aspergillus species and other molds, Cryptococcus neoformans, Histoplasma capsulatum, and Coccidioides immitis. We also discuss potential pitfalls in assessing outcome, such as conflicting clinical, radiological, and/or mycological data and gaps in knowledge.
Larøi, Frank; Sommer, Iris E; Blom, Jan Dirk; Fernyhough, Charles; Ffytche, Dominic H; Hugdahl, Kenneth; Johns, Louise C; McCarthy-Jones, Simon; Preti, Antonio; Raballo, Andrea; Slotema, Christina W; Stephane, Massoud; Waters, Flavie
Despite a growing interest in auditory verbal hallucinations (AVHs) in different clinical and nonclinical groups, the phenomenological characteristics of such experiences have not yet been reviewed and contrasted, limiting our understanding of these phenomena on multiple empirical, theoretical, and clinical levels. We look at some of the most prominent descriptive features of AVHs in schizophrenia (SZ). These are then examined in clinical conditions including substance abuse, Parkinson's disease, epilepsy, dementia, late-onset SZ, mood disorders, borderline personality disorder, hearing impairment, and dissociative disorders. The phenomenological changes linked to AVHs in prepsychotic stages are also outlined, together with a review of AVHs in healthy persons. A discussion of key issues and future research directions concludes the review.
[Purpose] This study compared respiratory function and differences in pneumonia history between Alzheimer’s disease and vascular dementia groups. [Subjects] Fifty-eight inpatients in the dementia treatment ward in a psychiatric facility were enrolled. [Methods] Patients underwent respiratory function testing twice using an 80-cm party horn. The Mini-Mental State Examination was also performed and motor functions were evaluated. Patient characteristics were obtained from medical records. [Resu...
Gomes Marília B
Full Text Available Abstract Background To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. Methods This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years ( Results Overall, 18.4% patients had HbA1c levels Conclusions A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.
Sauerwein, W; Moss, R; Rassow, J; Stecher-Rasmussen, F; Hideghéty, K; Wolbers, J G; Sack, H
Boron Neutron Capture Therapy is based on the ability of the isotope 10B to capture thermal neutrons and to disintegrate instantaneously producing high LET particles. The only neutron beam available in Europe for such a treatment is based at the European High Flux Reactor HFR at Petten (The Netherlands). The European Commission, owners of the reactor, decided that the potential benefit of the facility should be opened to all European citizens and therefore insisted on a multinational approach to perform the first clinical trial in Europe on BNCT. This precondition had to be respected as well as the national laws and regulations. Together with the Dutch authorities actions were undertaken to overcome the obvious legal problems. Furthermore, the clinical trial at Petten takes place in a nuclear research reactor, which apart from being conducted in a non-hospital environment, is per se known to be dangerous. It was therefore of the utmost importance that special attention is given to safety, beyond normal rules, and to the training of staff. In itself, the trial is an unusual Phase I study, introducing a new drug with a new irradiation modality, with really an unknown dose-effect relationship. This trial must follow optimal procedures, which underscore the quality and qualified manner of performance.
Kyung Mi Kim, RN, PhD, ICAPN
Conclusions: These focus groups revealed that many nursing students worked in vulnerable environments and risked pathogen exposure. Nursing students expressed the importance of SP but reported witnessing many instances of failure to comply with established measures. Several barriers were explored as reasons of SP noncompliance. By removing the barriers presented in this study, nursing students would be able to perform their duties in a safe clinical environment.
Snydman, David R; Jacobus, Nilda V; McDermott, Laura A
We evaluated the in vitro activity of imipenem-relebactam (imipenem-MK7655) against 451 recent clinical isolates within the Bacteroides group and related species. Relebactam did not enhance or inhibit the activity of imipenem against Bacteroides fragilis or other Bacteroides species. No synergistic or antagonistic effect was observed. The MICs of imipenem-relebactam were equal to or within one dilution of the MICs of these isolates to imipenem. Copyright © 2016, American Society for Microbiology. All Rights Reserved.
Holdnack, James A; Delis, Dean C
The WMS-III face memory subtest was developed as a quick, reliable, measure of non-verbal recognition memory. While the face memory subtest has demonstrated clinical sensitivity, the test has been criticized for low correlation with other WMS-III visual memory subtests and for failing to differentiate performance between clinical groups. One possible reason for these findings may be due to the impact of response bias associated with recognition memory tests. Four studies were conducted to evaluate the utility of applying signal detection measures to the face memory subtests. The first two studies used the WMS-III standardization data set to determine age and education effects and to present normative and reliability data for hits, false positives, discriminability and response bias. The third study tested the hypothesis that using response components and signal detection measures would enhance the correlation between face memory and the other WMS-III visual memory subtests. The fourth study compared performance of patients with Alzheimer's disease, Huntington's disease, Korsakoff's syndrome and demographically matched controls on the new face memory scores. The new measures did not have higher correlation with other WMS-III visual memory measures than the standard scoring of the test. Analysis of the clinical samples indicated that the discriminability index best differentiated patients from controls. The response components, particularly delayed false positives, differentiated performance among the clinical groups. Normative and reliability data are presented.
Eberhard, David A; Giaccone, Giuseppe; Johnson, Bruce E
The body of literature on the correlations between molecular assessments and patient outcomes after treatment with epidermal growth factor receptor (EGFR) inhibitors continues to grow. It will be important in the future to determine how to most effectively integrate molecular assays that assess the likelihood of therapeutic benefit into clinical practice. Although EGFR-targeted therapies such as erlotinib have been approved for use without molecular testing, immunohistochemistry, fluorescence in situ hybridization, and mutational analyses of the EGFR gene have all been proposed as candidates to help predict response or survival benefit from EGFR-targeted therapy in patients with non-small-cell lung cancer (NSCLC). Further prospective validation from ongoing randomized studies will be needed to fully determine which assays are best to help predict patient outcome. In addition, it will be critical for these assays to undergo standardization before widespread clinical use. The Molecular Assays in NSCLC Working Group, under the sponsorship of Genentech Inc, Roche Pharmaceuticals, and OSI Pharmaceuticals, Inc, was convened to evaluate the available molecular assays for use in the clinical trial setting and provide recommendations for application and interpretation of these tests for future clinical trials. Recommendations of the Molecular Assays in NSCLC Working Group for the use of EGFR molecular assays are presented and include guidelines for tissue storage, handling, and processing. Recommendations for the standardization of molecular assays are also discussed.
Nadine Correia Santos
Full Text Available It is relevant to unravel the factors that may mediate the cognitive decline observed during aging. Previous reports indicate that education has a positive influence on cognitive performance, while age, female gender and, especially, depressed mood were associated with poorer performances across multiple cognitive dimensions (memory and general executive function. Herein, the present study aimed to characterize the cognitive performance of community-dwelling individuals within distinct educational groups categorized by the number of completed formal school years: less than 4, 4, completed primary education, and more than 4. Participants (n = 1051 were randomly selected from local health registries and representative of the Portuguese population for age and gender. Neurocognitive and clinical assessments were conducted in local health care centers. Structural equation modeling was used to derive a cognitive score, and hierarchical linear regressions were conducted for each educational group. Education, age and depressed mood were significant variables in directly explaining the obtained cognitive score, while gender was found to be an indirect variable. In all educational groups, mood was the most significant factor with effect on cognitive performance. Specifically, a depressed mood led to lower cognitive performance. The clinical disease indices cardiac and stroke associated with a more negative mood, while moderate increases in BMI, alcohol consumption and physical activity associated positively with improved mood and thus benefitted cognitive performance. Results warrant further research on the cause-effect (longitudinal relationship between clinical indices of disease and risk factors and mood and cognition throughout aging.
de Almeida, Lara M; de Almeida, Mayra Zilta P R B; de Mendonça, Carla L; Mamizuka, Elsa M
Staphylococcus aureus is one of the most frequent mastitis causative agents in small ruminants. The expression of most virulence genes of S. aureus is controlled by an accessory gene regulator (agr) locus. This study aimed to ascertain the prevalence of the different agr groups and to evaluate the occurrence of encoding genes for cytotoxin, adhesins and toxins with superantigen activity in S. aureus isolates from milk of ewes with clinical and subclinical mastitis in sheep flocks raised for meat production The agr groups I and II were identified in both cases of clinical and subclinical mastitis. Neither the arg groups III and IV nor negative agr were found. The presence of cflA gene was identified in 100% of the isolates. The frequency of hla and lukE-D genes was high - 77.3 and 82.8%, respectively and all isolates from clinical mastitis presented these genes. The sec gene, either associated to tst gene or not, was identified only in isolates from subclinical mastitis. None of the following genes were identified: bbp, ebpS, cna, fnbB, icaA, icaD, bap, hlg, lukM-lukF-PV and se-a-b-d-e.
Heinemann, Trine; Matthews, Ben; Raudaskoski, Pirkko Liisa
to the interaction during hearing aid fitting. This report of a Danish pilot study describes two such problems. The first problem arises from the requirement that the audiologist needs to ‘translate’ the patient’s subjective hearing description for making technological decisions. The second problem is the way......Conversation analytic research on clinical encounters shows that interactional conduct can be consequential for diagnosis, treatment and compliance. Problems reported for doctor-patient interaction can also be identified in Danish audiological encounters. There are, however, also specific aspects...
Madsen, Matias Vested; Gøtzsche, Peter C; Hróbjartsson, Asbjørn
OBJECTIVES: To study the analgesic effect of acupuncture and placebo acupuncture and to explore whether the type of the placebo acupuncture is associated with the estimated effect of acupuncture. DESIGN: Systematic review and meta-analysis of three armed randomised clinical trials. DATA SOURCES......: Cochrane Library, Medline, Embase, Biological Abstracts, and PsycLIT. Data extraction and analysis Standardised mean differences from each trial were used to estimate the effect of acupuncture and placebo acupuncture. The different types of placebo acupuncture were ranked from 1 to 5 according...... to assessment of the possibility of a physiological effect, and this ranking was meta-regressed with the effect of acupuncture. DATA SYNTHESIS: Thirteen trials (3025 patients) involving a variety of pain conditions were eligible. The allocation of patients was adequately concealed in eight trials...
Madsen, Matias Vested; Gøtzsche, Peter C; Hróbjartsson, Asbjørn
OBJECTIVES: To study the analgesic effect of acupuncture and placebo acupuncture and to explore whether the type of the placebo acupuncture is associated with the estimated effect of acupuncture. DESIGN: Systematic review and meta-analysis of three armed randomised clinical trials. DATA SOURCES......: Cochrane Library, Medline, Embase, Biological Abstracts, and PsycLIT. Data extraction and analysis Standardised mean differences from each trial were used to estimate the effect of acupuncture and placebo acupuncture. The different types of placebo acupuncture were ranked from 1 to 5 according...... to assessment of the possibility of a physiological effect, and this ranking was meta-regressed with the effect of acupuncture. DATA SYNTHESIS: Thirteen trials (3025 patients) involving a variety of pain conditions were eligible. The allocation of patients was adequately concealed in eight trials...
Weaver, Michael F.; Eldridge, Gloria D.; Villalobos, Gabriela C.; Best, Al M.; Stitzer, Maxine L.
Introduction This study replicated prior observations of racial differences in smoking cessation in which Black smokers have demonstrated lower smoking cessation rates than White smokers. Methods The study used data from a smoking cessation intervention and compared White and Black female prisoners (N = 233) on a 10-week intervention of group psychotherapy and nicotine replacement (patch). Generalized estimating equations were used to model smoking cessation across the 12-month follow-up. Results Compared with an untreated control group, both Black and White smokers benefited from the cessation treatment. However, after controlling for potential confounds, White smokers had significantly higher overall smoking cessation rates across time compared with Black smokers (e.g., 30% vs. 24% abstinent at 6 weeks; 13% vs. 10% abstinent at 12 months). Smoking mentholated cigarettes was not associated with these differences in quit rates. Discussion Understanding differential treatment responses can lead to the development of more tailored and efficacious smoking cessation interventions that may reduce the morbidity and mortality associated with smoking in prison populations. PMID:19386816
Shang, Wei; Wang, Aiming; Lv, Libo; Zhang, Lei; Shu, Mingming; Zhao, Yong; Hui, Shang
Our goal was to develop a safe, efficient, and practical clinical plan for successful pregnancies for patients with recurrent spontaneous miscarriages by adjustment of their hormone levels after ovulation. We treated 61 patients with recurrent miscarriages and 110 patients with two miscarriages. All patients had miscarriages before or during the 12th week of pregnancy, and unsuccessfully underwent progesterone therapy. We measured their hormone levels and administered appropriate doses of estrogen, progesterone, and luteinizing hormones to attain normal levels (respectively, 150 pg/ml, 16 ng/ml, and 6 mIU/ml). The hormone doses were reduced upon detection of fetal heart beating, and the treatment continued until the 12th week of pregnancy. The patients were followed up by phone after the child birth. In patients with recurrent miscarriages, these were prevented in 57/61 (93.44 %). In patients with two miscarriages, successful pregnancies were in 106/110 (96.4 %) patients. The vast majority of patients in both groups gave birth to healthy babies. There was only one case per each group of induced labor due to trisomy 21 (patient with a history of recurrent miscarriages) or trisomy 17 (patient with two previous miscarriages). Individualized adjustment of hormone levels after ovulation prevents miscarriages and improves the pregnancy success rates.
Full Text Available PURPOSE: To describe an adjustable suture (AS experimental model that allows for tightening, loosening and retightening of the suture tension in trabeculectomy. METHODS: Standard trabeculectomy was performed in fifteen pig eyeballs. All pig eyes were tested twice: one test with conventional suture in both flap's corners (conventional suture group and another test with a conventional suture at one corner and an adjustable suture in the other corner (AS group. The order in which each test was performed was defined by randomization. Intraocular pressure was measured at three time points: T1 when the knots were tightened; T2 when the AS was loosened or the conventional knot was removed; and T3 when the AS was retightened in the AS group or five minutes after the knot removal in the conventional suture group. RESULTS: The mean Intraocular pressure was similar between the two groups at time point 1 (p=0.97. However, significant Intraocular pressure differences were found between eyes in the conventional and adjustable suture groups at time points 2 (12.6 ± 4.2 vs 16.3 ± 2.3 cmH2O, respectively, p=0.006 and 3 (12.2 ± 4.0 vs 26.4 ± 1.7cmH2O, respectively; p=0.001. While the conventional technique allowed only Intraocular pressure reduction (following the knot removal; T2 and T3, the AS technique allowed both Intraocular pressure reduction (T2 and elevation (T3 through the management (loosening and retightening of the suture. CONCLUSION: This experimental model provides an effective noninvasive postoperative mechanism of suture tension adjustment.
Marchand, André; Roberge, Pasquale; Primiano, Sandra; Germain, Vanessa
A randomized controlled clinical trial with a wait-list control group was conducted to examine the effectiveness of three modalities (brief, group, and standard) of cognitive-behavioral treatment (CBT) for panic disorder with agoraphobia. A total of 100 participants meeting DSM-IV criteria were randomly assigned to each treatment condition: a 14-session standard CBT (n=33), a 14-session group CBT (n=35) and a 7-session brief CBT (n=32). Participants received a self-study manual and were assigned weekly readings and exercises. The results indicate that regardless of the treatment condition, CBT for moderate to severe PDA is beneficial in medium and long term. To this effect, all three-treatment conditions significantly reduced the intensity of symptoms, increased participants' quality of life, offered high effect sizes, superior maintenance of gains over time, and lower rates of relapse, compared to the wait-list control.
Background A significant number of individuals suffer from plantar heel pain (PHP) and many go on to have chronic symptoms and continued disability. Persistence of symptoms adds to the economic burden of PHP and cost-effective solutions are needed. Currently, there is a wide variation in treatment, cost, and outcomes of care for PHP with limited information on the cost-effectiveness and comparisons of common treatment approaches. Two practice guidelines and recent evidence of effective physical therapy intervention are available to direct treatment but the timing and influence of physical therapy intervention in the multidisciplinary management of PHP is unclear. The purpose of this investigation is to compare the outcomes and costs associated with early physical therapy intervention (ePT) following initial presentation to podiatry versus usual podiatric care (uPOD) in individuals with PHP. Methods A parallel-group, block-randomized clinical trial will compare ePT and uPOD. Both groups will be seen initially by a podiatrist before allocation to a group that will receive physical therapy intervention consisting primarily of manual therapy, exercise, and modalities, or podiatric care consisting primarily of a stretching handout, medication, injections, and orthotics. Treatment in each group will be directed by practice guidelines and a procedural manual, yet the specific intervention for each participant will be selected by the treating provider. Between-group differences in the Foot and Ankle Ability Measure 6 months following the initial visit will be the primary outcome collected by an independent investigator. In addition, differences in the European Quality of Life – Five Dimensions, Numeric Pain Rating Scale, Global Rating of Change (GROC), health-related costs, and cost-effectiveness at 6 weeks, 6 months, and 1 year will be compared between groups. The association between successful outcomes based on GROC score and participant expectations of recovery
Hauer, Karen E; Cate, Olle Ten; Boscardin, Christy K; Iobst, William; Holmboe, Eric S; Chesluk, Benjamin; Baron, Robert B; O'Sullivan, Patricia S
Background The expectation for graduate medical education programs to ensure that trainees are progressing toward competence for unsupervised practice prompted requirements for a committee to make decisions regarding residents' progress, termed a clinical competency committee (CCC). The literature on the composition of these committees and how they share information and render decisions can inform the work of CCCs by highlighting vulnerabilities and best practices. Objective We conducted a narrative review of the literature on group decision making that can help characterize the work of CCCs, including how they are populated and how they use information. Methods English language studies of group decision making in medical education, psychology, and organizational behavior were used. Results The results highlighted 2 major themes. Group member composition showcased the value placed on the complementarity of members' experience and lessons they had learned about performance review through their teaching and committee work. Group processes revealed strengths and limitations in groups' understanding of their work, leader role, and information-sharing procedures. Time pressure was a threat to the quality of group work. Conclusions Implications of the findings include the risks for committees that arise with homogeneous membership, limitations to available resident performance information, and processes that arise through experience rather than deriving from a well-articulated purpose of their work. Recommendations are presented to maximize the effectiveness of CCC processes, including their membership and access to, and interpretation of, information to yield evidence-based, well-reasoned judgments.
Tornambe, P E; Hilton, G F
Pneumatic retinopexy was compared with scleral buckling in a multicenter (7 centers), randomized, controlled, clinical trial with 198 patients. Admission criteria included detachments with retinal break(s) no greater than 1 clock hour in size, within the superior two thirds of the fundus, without significant proliferative vitreoretinopathy (PVR). All patients were followed for at least 6 months. Scleral buckling was compared with pneumatic retinopexy with regard to single-operation reattachment (82 versus 73%), reattachment with one operation and postoperative laser/cryotherapy (84 versus 81%), overall reattachment with reoperations (98 versus 99%), final visual acuity of 20/50 or better in eye with preoperative detachment of the macula for 2 weeks or less (56 versus 80%), PVR (5 versus 3%), and new retinal breaks (13 versus 23%). Complications, including reoperations, as measured by the "score" system, were similar. The anatomic results of the two operations were not significantly different (P greater than 0.05), but pneumatic retinopexy had less morbidity and better postoperative visual acuity (P = 0.01). Pneumatic retinopexy is recommended for cases meeting the admission criteria.
Moustafa A El-Nakeeb
Full Text Available Antihistaminics are widely used for various indications during microbial infection. Hence, this paper investigates the antimicrobial activities of 10 antihistaminics belonging to both old and new generations using multiresistant Gram-positive and Gram-negative clinical isolates. The bacteriostatic activity of antihistaminics was investigated by determining their MIC both by broth and agar dilution techniques against 29 bacterial strains. Azelastine, cyproheptadine, mequitazine and promethazine were the most active among the tested drugs. Diphenhydramine and cetirizine possessed weaker activity whereas doxylamine, fexofenadine and loratadine were inactive even at the highest tested concentration (1 mg/ml. The MIC of meclozine could not be determined as it precipitated with the used culture media. The MBC values of antihistaminics were almost identical to the corresponding MIC values. The bactericidal activity of antihistaminics was also studied by the viable count technique in sterile saline solution. Evident killing effects were exerted by mequitazine, meclozine, azelastine and cyproheptadine. Moreover, the dynamics of bactericidal activity of azelastine were studied by the viable count technique in nutrient broth. This activity was found to be concentration-dependant. This effect was reduced on increasing the inoculum size while it was increased on raising the pH. The post-antimicrobial effect of 100 fg/ml azelastine was also determined and reached up to 3.36 h.
Blom, Thomas J; Mingione, Carolyn J; Guerdjikova, Anna I; Keck, Paul E; Welge, Jeffrey A; McElroy, Susan L
The aim of this study was to gain further understanding of placebo response in binge eating disorder. We pooled participant-level data from 10 double-blind, placebo-controlled, randomized trials of medications for binge eating disorder. The primary outcomes were response (75% reduction in binge eating episodes), cessation of binge eating episodes, change in mean weekly binge eating episodes and binge eating episodes per week. Of 234 participants receiving placebo, 89 (38%) were responders and 59 (26%) attained cessation. Placebo-treated participants significantly reduced their binge eating. The mean (SD) binge eating episodes per week at baseline was 5.2 (3.2) and at endpoint was 2.2 (2.6). Lower baseline binge eating episode frequency and longer study participation were significantly associated with response and cessation. Less severe eating pathology at baseline was associated with higher placebo response and cessation rates. Future clinical trials may want to stipulate that participants exceed a threshold of illness severity, which may lead to better placebo and drug separation. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
Armsden, G C; Lewis, F M
To describe children's psychosocial adjustment to their mother's breast cancer and to compare their level of adjustment with normative data and with the level of adjustment of children of women with fibrocystic breast disease or diabetes. Hypotheses tested were (a) children of women with breast cancer would be most negatively affected and (b) families of mothers with fibrocystic breast disease would require less family adaptation than families of women with breast cancer or diabetes. One component of a larger longitudinal survey. University-based physician clinic in a metropolitan area in the Northwestern United States. Mothers, predominantly Caucasian, with medically controlled diabetes mellitus (n = 18), nonmetastatic breast cancer (n = 13), or biopsy-proven fibrocystic breast disease (n = 17) and their children (N = 48), who ranged in age from 6 to 12. Five in-home interviews conducted at four-month intervals. Behavioral adjustment using the Louisville Behavior Checklist (maternal report) and the Zeitlin Coping Inventory (nurse-observer report) and self-esteem using the Personal Attribute Inventory for Children (children's self-report). Children of women with breast cancer scored better than average on behavioral adjustment (mothers' ratings) and were judged by nurse observers to be better behaviorally adjusted than children in the noncancer illness groups. Children of women with breast cancer and of women with diabetes tended to score significantly lower on self-esteem than the comparative sample. Measures of childhood adjustment to chronic medical illness in mothers need to distinguish between behavioral adjustment and self-esteem. Discrepancies between child ratings and mother and nurse-observer ratings suggest that differences exist. Findings are preliminary in nature, and other explanations for findings must be ruled out. However, if a child's self-appraisal is affected negatively by the mother's illness, it would be appropriate to identify ways to increase
Ghilani, Charles D
the complete guide to adjusting for measurement error-expanded and updated no measurement is ever exact. Adjustment Computations updates a classic, definitive text on surveying with the latest methodologies and tools for analyzing and adjusting errors with a focus on least squares adjustments, the most rigorous methodology available and the one on which accuracy standards for surveys are based. This extensively updated Fifth Edition shares new information on advances in modern software and GNSS-acquired data. Expanded sections offer a greater amount of computable problems and their worked solu
Liang, Cai; Hansen, Frank
We give a truly elementary proof of the convexity of metric-adjusted skew information following an idea of Effros. We extend earlier results of weak forms of superadditivity to general metric-adjusted skew information. Recently, Luo and Zhang introduced the notion of semi-quantum states on a bipa......We give a truly elementary proof of the convexity of metric-adjusted skew information following an idea of Effros. We extend earlier results of weak forms of superadditivity to general metric-adjusted skew information. Recently, Luo and Zhang introduced the notion of semi-quantum states...
Murgoci, Agatha; Gaspar, Raquel M.
Practitioners are used to value a broad class of exotic interest rate derivatives simply by preforming for what is known as convexity adjustments (or convexity corrections). We start by exploiting the relations between various interest rate models and their connections to measure changes. As a re......Practitioners are used to value a broad class of exotic interest rate derivatives simply by preforming for what is known as convexity adjustments (or convexity corrections). We start by exploiting the relations between various interest rate models and their connections to measure changes....... As a result we classify convexity adjustments into forward adjustments and swaps adjustments. We, then, focus on affine term structure (ATS) models and, in this context, conjecture convexity adjustments should be related of affine functionals. In the case of forward adjustments, we show how to obtain exact...... formulas. Concretely for LIBOR in arrears (LIA) contracts, we derive the system of Riccatti ODE-s one needs to compute to obtain the exact adjustment. Based upon the ideas of Schrager and Pelsser (2006) we are also able to derive general swap adjustments useful, in particular, when dealing with constant...
Clinical Information System Services and Capabilities Desired for Scalable, Standards-Based, Service-oriented Decision Support: Consensus Assessment of the Health Level 7 Clinical Decision Support Work Group
Kawamoto, Kensaku; Jacobs, Jason; Welch, Brandon M.; Huser, Vojtech; Paterno, Marilyn D.; Del Fiol, Guilherme; Shields, David; Strasberg, Howard R.; Haug, Peter J.; Liu, Zhijing; Jenders, Robert A.; Rowed, David W.; Chertcoff, Daryl; Fehre, Karsten; Adlassnig, Klaus-Peter; Curtis, A. Clayton
A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service. PMID:23304315
Clinical information system services and capabilities desired for scalable, standards-based, service-oriented decision support: consensus assessment of the Health Level 7 clinical decision support Work Group.
Kawamoto, Kensaku; Jacobs, Jason; Welch, Brandon M; Huser, Vojtech; Paterno, Marilyn D; Del Fiol, Guilherme; Shields, David; Strasberg, Howard R; Haug, Peter J; Liu, Zhijing; Jenders, Robert A; Rowed, David W; Chertcoff, Daryl; Fehre, Karsten; Adlassnig, Klaus-Peter; Curtis, A Clayton
A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service.
BACKGROUND AND METHODS: In February 1994, batches of anti-D immune globulin used in Ireland during 1977 and 1978 to prevent Rh isoimmunization were found to be contaminated with hepatitis C virus (HCV) from a single infected donor. In March 1994, a national screening program was initiated for all women who had received anti-D immune globulin between 1970 and 1994. Of the 62,667 women who had been screened when this study began, 704 (1.1 percent) had evidence of past or current HCV infection, and 390 of those 704 (55 percent) had positive tests for serum HCV RNA on reverse-transcription-polymerase-chain-reaction analysis. All 390 were offered a referral for clinical assessment and therapy. We evaluated 376 of these 390 women (96 percent); the other 14 were not seen at one of the designated treatment centers. RESULTS: The mean (+\\/-SD) age of the 376 women was 45+\\/-6 years at the time of screening. They had been infected with hepatitis C for about 17 years. A total of 304 women (81 percent) reported symptoms, most commonly fatigue (248 [66 percent]). Serum alanine aminotransferase concentrations were slightly elevated (40 to 99 U per liter) in 176 of 371 women (47 percent), and the concentrations were 100 U per liter or higher in 31 (8 percent). Liver biopsies showed inflammation in 356 of 363 women (98 percent); in most cases the inflammation was slight (41 percent) or moderate (52 percent). Although the biopsy samples from 186 of the 363 women (51 percent) showed evidence of fibrosis, only 7 women (2 percent) had probable or definite cirrhosis. Two of the seven reported excessive alcohol consumption. CONCLUSIONS: Most of the women with HCV infection 17 years after receiving HCV-contaminated anti-D immune globulin had evidence of slight or moderate hepatic inflammation on liver biopsy, about half had fibrosis, and 2 percent had probable or definite cirrhosis.
Berger, Rony; Gelkopf, Marc
Due to the terror and war-related situation in Israel, well baby clinic nurses dealing with a large number of traumatized and highly distressed infants, toddlers and their parents have become overwhelmed. (1) Assess the level of secondary traumatization, including lack of compassion satisfaction, burnout and compassion fatigue of well baby clinic nurses living under chronic threat of war and terror. (2) Assess the efficacy of an intervention aimed at providing well baby clinic nurses with psycho-educational knowledge pertaining to stress and trauma in infants, young children and parents. This intervention provides the nurses with screening tools for identifying children and parents at risk of developing stress-related problems and equips them with stress management techniques. Quasi-random control trial. The intervention took place in Israel, in war (North) and terror (South) affected areas. Ninety well baby clinic nurses from the most war and terror affected areas in Israel were approached, 42 were randomly assigned the experimental intervention and 38 served as a waiting list group. The intervention was comprised of 12 weekly 6-h sessions. Each session included theoretical knowledge, experiential exercises based on the nurses' work or personal life experience, and the learning of skills accompanied by homework assignments. Participants were assessed on self-report measures of secondary traumatization, professional self-efficacy, hope, sense of mastery and self-esteem before and after the intervention. (1) Well baby clinic nurses were found to have elevated secondary traumatization levels. (2) Compared to the waiting list group, the intervention group improved significantly on the professional self-efficacy measure as well as reducing the level of secondary traumatization. Furthermore, improvement on all secondary traumatization measures covaried with the improvement on the professional self-efficacy assessments. Based on additional informal reports, the
Antoaneta Andreea Muraru
Full Text Available The purpose of this study was to explore if there are differences between women and men in relationships among family-of-origin, romantic attachment, and marital adjustment. Two hundred and forty-nine participants filled out four self-reported measures: The Differentiation in the Family System Scale, Family Adaptability and Cohesion Evaluation Scale, Experiences in Close Relationship Scale, and Revised Dyadic Adjustment Scale. In order to analyze the data, multiple-group analysis with AMOS 16.0 was used. There was no difference between women and men in all observed variables. Regardless of gender, only the romantic attachment was a significant predictor of marital adjustment. Only in women, family-of-origin significantly predicted their romantic attachment. Across gender groups, the configural model fitted satisfactorily the observed data. When measurement and structural weights, as well as residuals were constrained to be equal across gender groups, the invariance of the model was also supported. The results suggest women and men could be similar when it comes to the relationships among constructions they both have regarding family-of-origin experiences, romantic attachment patterns, and marital adjustment. Some implications for research and clinical practice with marital couples are briefly discussed.
Rokosz, Alicja; Fiejka, Maria; Górska, Paulina; Aleksandrowicz, Janina; Meisel-Mikołajczyk, Felicja; Łuczak, MirosŁaw
The aim of this study was to determine and compare a biological activity of lipopolysaccharides (LPS) from reference and clinical strains of strictly anaerobic bacteria belonging to the Bacteroides fragilis group (BFG) by means of quantitative, photometric BET (LAL) method with Limulus polyphemus amoebocyte lysate and chromogenic substrate S-2423. Lipopolysaccharides of five BFG species were extracted by Westphal and Jann method (1965) from eight reference and two clinical strains of B. fragilis group. Crude LPS preparations were purified according to the procedure described by Gmeiner (1975) with ultracentrifugation and nuclease treatment. Biological activities of bacterial endotoxins were determined by quantitative BET method with chromogenic substrate S-2423 (ENDOCHROME kit, Charles River Endosafe Ltd., USA). Tests were performed according to the producer's recommendations. E. coli O55:B5 LPS was applied to compare its activity in reaction with LAL reagent with activities of LPS preparations from rods of the Bacteroides genus. Among examined bacterial compounds the most active in BET method was E. coli O55:B5 LPS. Activities of lipopolysaccharides from five species of BFG rods in reaction with Limulus amoebocyte lysate were differentiated. Greater ability to activate LAL proenzyme revealed lipopolysaccharides of these species of the Bacteroides genus, which are important from the clinical point of view--B. fragilis and B. thetaiotaomicron.
Nandurkar, H; Chong, B; Salem, H; Gallus, A; Ferro, V; McKinnon, R
A working group of clinicians and scientists was formed to review the clinical considerations for use of low-molecular-weight heparin (LMWH) biosimilars. LMWH are biological molecules of significant complexity; the full complexity of chemical structure is still to be elucidated. LMWH biosimilars are products that are biologically similar to their reference product and rely on clinical data from a reference product to establish safety and efficacy. The complex nature of LMWH molecules means that it is uncertain whether a LMWH biosimilar is chemically identical to its reference product; this introduces the possibility of differences in activity and immunogenicity. The challenge for regulators and clinicians is to evaluate the level of evidence required to demonstrate that a LMWH is sufficiently similar to the reference product. The consensus opinion of the working group is that prior to clinical use a LMWH biosimilar should have proven efficacy and safety, similar to the reference product with prospective studies, which should be confirmed with a proactive post-marketing pharmacovigilance programme.
Lown, R N; Philippe, J; Navarro, W; van Walraven, S M; Philips-Johnson, L; Fechter, M; Pawson, R; Bengtsson, M; Beksac, M; Field, S; Yang, H; Shaw, B E
The World Marrow Donor Association (WMDA) fosters collaboration between international registries to facilitate the ex