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Sample records for advanced medical life

  1. Effect of ionizing radiation on advanced life support medications

    Energy Technology Data Exchange (ETDEWEB)

    Sullivan, D.J.; Hubbard, L.B.; Broadbent, M.V.; Stewart, P.; Jaeger, M.

    1987-06-01

    Advanced life support medications stored in emergency department stretcher areas, diagnostic radiology rooms, and radiotherapy suites are exposed to ionizing radiation. We hypothesized that radiation may decrease the potency and thus the shelf life of medications stored in these areas. Atropine, dopamine, epinephrine, and isoproterenol were exposed to a wide range of ionizing radiation. The potency of the four drugs was unaffected by levels of radiation found in ED stretcher areas and high-volume diagnostic radiograph rooms (eg, chest radiograph, computed tomography, fluoroscopy). The potency of atropine may be reduced by gamma radiation in high-use radiotherapy suites. However, dopamine, epinephrine, and isoproterenol were unaffected by high doses of gamma radiation. Atropine, dopamine, epinephrine, and isoproterenol may be safely kept in ED stretcher areas and diagnostic radiology rooms without loss of potency over the shelf life of the drugs.

  2. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service.

    NARCIS (Netherlands)

    Gerritse, B.M.; Schalkwijk, A.; Pelzer, B.J.; Scheffer, G.J.; Draaisma, J.M.T.

    2010-01-01

    BACKGROUND: To determine the advanced life support procedures provided by an Emergency Medical Service (EMS) and a Helicopter Emergency Medical Service (HEMS) for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures r

  3. Improving advanced cardiovascular life support skills in medical students: simulation-based education approach

    Directory of Open Access Journals (Sweden)

    Hamidreza Reihani

    2015-01-01

    Full Text Available Objective: In this trial, we intend to assess the effect of simulation-based education approach on advanced cardiovascular life support skills among medical students. Methods: Through convenient sampling method, 40 interns of Mashhad University of Medical Sciences in their emergency medicine rotation (from September to December 2012 participated in this study. Advanced Cardiovascular Life Support (ACLS workshops with pretest and post-test exams were performed. Workshops and checklists for pretest and post-test exams were designed according to the latest American Heart Association (AHA guidelines. Results: The total score of the students increased significantly after workshops (24.6 out of 100 to 78.6 out of 100. This demonstrates 53.9% improvement in the skills after the simulation-based education (P< 0.001. Also the mean score of each station had a significant improvement (P< 0.001. Conclusion: Pretests showed that interns had poor performance in practical clinical matters while their scientific knowledge, such as ECG interpretation was acceptable. The overall results of the study highlights that Simulation based-education approach is highly effective in Improving ACLS skills among medical students.

  4. Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management

    Directory of Open Access Journals (Sweden)

    Ahmadi Koorosh

    2013-06-01

    Full Text Available 【Abstract】Objective: Since appropriate and time-table methods in trauma care have an important impact on patients’ outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS program on medical interns' performance in simulated trauma patient management. Methods: A descriptive and analytical study before and after the training was conducted on 24 randomly se-lected undergraduate medical interns from Imam Reza Hos-pital in Mashhad, Iran. On the first day, we assessed in-terns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre-and post- ATLS periods, were compared through SPSS ver-sion 15.0 software. P values less than 0.05 were considered statistically significant. Results: Our findings showed that interns’ ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P<0.001, P=0.016 and P=0.01 respectively. Conclusion: ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns. Key words: Advanced Trauma Life Support Care; Knowledge; Inservice training; Wounds and injuries

  5. Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management

    Institute of Scientific and Technical Information of China (English)

    Koorosh Ahmadi; Mohammad Sedaghat; Mahdi Safdarian; Amir Masoud Hashemian; Zahra Nezamdoust; Mohammad Vaseie; Vafa Rahimi-Movaghar

    2013-01-01

    Since appropriate and timetable methods in trauma care have an important impact on patients' outcome,we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns'performance in simulated trauma patient management.Methods:A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad,Iran.On the first day,we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients.After 2 days of ATLS training,we performed the same study and evaluated their score again on the fourth day.The two findings,preand post-ATLS periods,were compared through SPSS version 15.0 software.P values less than 0.05 were considered statistically significant.Results:Our findings showed that interns' ability in all the three tasks improved after the training course.On the fourth day after training,there was a statistically significant increase in interns' clinical knowledge of ATLS procedures,the sequence of procedures and skill performance in trauma situations (P<0.001,P=0.016 and P=0.01 respectively).Conclusion:ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

  6. End-of-life costs of medical care for advanced stage cancer patients

    Directory of Open Access Journals (Sweden)

    Kovačević Aleksandra

    2015-01-01

    Full Text Available Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care, hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25% had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR and the lowest (4.00 EUR ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs, followed by oncology medical care (21%, radiation therapy and interventional radiology (11%, surgery (9%, imaging diagnostics (9% and laboratory costs (8%. Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients’ quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency. [Projekat Ministarstva nauke

  7. [Advance Care Planning and Decisions to limit treatment at the end of life - the view from medical ethics and psychooncology].

    Science.gov (United States)

    Winkler, Eva C; Heußner, Pia

    2016-03-01

    Decisions to limit treatment are important in order to avoid overtreatment at the end of life. They proceed more than half of expected deaths in Europe and the US, but are not always communicated with the patient in advance. One reason for non-involvement is that conversations that prepare patients for end-of-life decisions and work out their preferences do not take place on a regular basis. At the same time there is growing evidence that such communication improves patients' quality of life, reduces anxiety and depression and allows patients to develop a realistic understanding of their situation - which in turn is a prerequisite for shared decision making about limiting treatment. In this paper we define "treatment limitation" and explain the medical ethics perspective. The main focus, however, is on the causes that hinder advanced care planning and conversations about limiting treatment in the care of patients with advanced disease. Finally the evidence for approaches to improve the situation is presented with concrete suggestions for solutions.

  8. Effect of High-Fidelity Simulation on Medical Students' Knowledge about Advanced Life Support: A Randomized Study.

    Directory of Open Access Journals (Sweden)

    Andrea Cortegiani

    Full Text Available High-fidelity simulation (HFS is a learning method which has proven effective in medical education for technical and non-technical skills. However, its effectiveness for knowledge acquisition is less validated. We performed a randomized study with the primary aim of investigating whether HFS, in association with frontal lessons, would improve knowledge about advanced life support (ALS, in comparison to frontal lessons only among medical students. The secondary aims were to evaluate the effect of HFS on knowledge acquisition of different sections of ALS and personal knowledge perception. Participants answered a pre-test questionnaire consisting of a subjective (evaluating personal perception of knowledge and an objective section (measuring level of knowledge containing 100 questions about algorithms, technical skills, team working/early warning scores/communication strategies according to ALS guidelines. All students participated in 3 frontal lessons before being randomized in group S, undergoing a HFS session, and group C, receiving no further interventions. After 10 days from the end of each intervention, both groups answered a questionnaire (post-test with the same subjective section but a different objective one. The overall number of correct answers of the post-test was significantly higher in group S (mean 74.1, SD 11.2 than in group C (mean 65.5, SD 14.3, p = 0.0017, 95% C.I. 3.34 - 13.9. A significantly higher number of correct answers was reported in group S than in group C for questions investigating knowledge of algorithms (p = 0.0001; 95% C.I 2.22-5.99 and team working/early warning scores/communication strategies (p = 0.0060; 95% C.I 1.13-6.53. Students in group S showed a significantly higher score in the post-test subjective section (p = 0.0074. A lower proportion of students in group S confirmed their perception of knowledge compared to group C (p = 0.0079. HFS showed a beneficial effect on knowledge of ALS among medical students

  9. [Pediatric advanced life support].

    Science.gov (United States)

    Muguruma, Takashi

    2011-04-01

    Important changes or points of emphasis in the recommendations for pediatric advanced life support are as follows. In infants and children with no signs of life, healthcare providers should begin CPR unless they can definitely palpate a pulse within 10 seconds. New evidence documents the important role of ventilations in CPR for infants and children. Rescuers should provide conventional CPR for in-hospital and out-of-hospital pediatric cardiac arrests. The initial defibrillation energy dose of 2 to 4J/kg of either monophasic or biphasic waveform. Both cuffed and uncuffed tracheal tubes are acceptable for infants and children undergoing emergency intubation. Monitoring capnography/capnometry is recommended to confirm proper endotracheal tube position.

  10. Advanced Medication Dispenser

    OpenAIRE

    2013-01-01

    Medication dispensing is an important activity that can have major implications if done improperly. Dispensing must be done in the correct time interval, at the correct user, with the correct drug and dose. We propose a smart medication dispenser that can satisfy these needs and provide a mechanism for supervision. In order to ensure that the dispensing process is error free, the concept of a new smart medication container is used. A smart medication container is “smart” ...

  11. Advanced Medication Dispenser

    Directory of Open Access Journals (Sweden)

    A.I. Alexan

    2013-12-01

    Full Text Available Medication dispensing is an important activity that can have major implications if done improperly. Dispensing must be done in the correct time interval, at the correct user, with the correct drug and dose. We propose a smart medication dispenser that can satisfy these needs and provide a mechanism for supervision. In order to ensure that the dispensing process is error free, the concept of a new smart medication container is used. A smart medication container is “smart” as it holds the medication dispensing parameters for the drugs it contains: dispensing time and date and name. Based on this information, the actual dispensing is done.

  12. Advances in Medical Engineering

    CERN Document Server

    Buzug, Thorsten M

    2007-01-01

    Presents research and development trends of physics, engineering, mathematics and computer sciences in biomedical engineering. This work uses contributions from industry, clinics, universities and research labs with foci on medical imaging, computer-assisted surgery, and others to give insight to engineering, clinical and mathematical studies.

  13. [From freshmanship to the first "Staatsexamen"--increase of depression and decline in sense of coherence and mental quality of life in advanced medical students].

    Science.gov (United States)

    Burger, Pascal H M; Tektas, Ozan Y; Paulsen, Friedrich; Scholz, Michael

    2014-08-01

    Psychiatric disorders (Burnout, depression, anxiety disorders) are common among medical students with a distinctly higher prevalence compared to the general public. Although medi-cal students show a normal health status at the beginning of their university study period, a deterioration of these aspects in higher semesters is evident and continues when they become residents. In our study ESTRELLAS we examined 530 medical students in the preclinical semesters (1st-4th) before their first "Staatsexamen" with validated psychological questionnaires for depression, anxiety, quality of life and sense of coherence. Students in their 1st semester show normal values like the general public. During the 4 semesters a slow and continuous rise of depressive symptoms and anxiety was detected. Quality of life and sense of coherence constantly deteriorated. An increase of physical symptoms was not detected. In the 4th semester the number of depressive students had already doubled. The development of worsening psychological problems and resulting psychiatric disorders seems to be a continuous process, starting with the beginning of the medical studies and growing continuously during the preclinical semesters. Effect-ive strategies for coping with distress should be integrated in the medical curriculum at universities from the very first semester on. Relaxation techniques could thus be an opportunity.

  14. Flipping the advanced cardiac life support classroom with team-based learning: comparison of cognitive testing performance for medical students at the University of California, Irvine, United States

    Directory of Open Access Journals (Sweden)

    Megan Boysen-Osborn

    2016-02-01

    Full Text Available Purpose: It aimed to find if written test results improved for advanced cardiac life support (ACLS taught in flipped classroom/team-based Learning (FC/TBL vs. lecture-based (LB control in University of California-Irvine School of Medicine, USA. Methods: Medical students took 2010 ACLS with FC/TBL (2015, compared to 3 classes in LB (2012-14 format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours, and 20 (12 lecture, simulation 8 hours in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14 or podcast (2015 as was testing: 50 multiple-choice questions (MCQ, 20 rhythm matchings, and 7 fill-in clinical cases. Results: 354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015. Two of 3 tests (MCQ and fill-in improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4 to 95.1% (92.8, 96.7, P=0.0001. For the fill-in test: 94.1% for LB (89.6, 97.2 to 96.6% for FC/TBL (92.4, 99.20 P=0.0001. For MC: 88% for LB (84, 92 to 90% for FC/TBL (86, 94, P=0.0002. For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%, and 2 or 3 components (8.1% vs. 3.2%, P=0.006. Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%. Conclusion: A FC/TBL format for ACLS marginally improved written test results.

  15. Flipping the advanced cardiac life support classroom with team-based learning: comparison of cognitive testing performance for medical students at the University of California, Irvine, United State

    Science.gov (United States)

    2016-01-01

    Purpose: It aimed to find if written test results improved for advanced cardiac life support (ACLS) taught in flipped classroom/team-based Learning (FC/TBL) vs. lecture-based (LB) control in University of California-Irvine School of Medicine, USA. Methods: Medical students took 2010 ACLS with FC/TBL (2015), compared to 3 classes in LB (2012-14) format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours), and 20 (12 lecture, simulation 8 hours) in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14) or podcast (2015) as was testing: 50 multiple-choice questions (MCQ), 20 rhythm matchings, and 7 fill-in clinical cases. Results: 354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015). Two of 3 tests (MCQ and fill-in) improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4) to 95.1% (92.8, 96.7, P=0.0001). For the fill-in test: 94.1% for LB (89.6, 97.2) to 96.6% for FC/TBL (92.4, 99.20 P=0.0001). For MC: 88% for LB (84, 92) to 90% for FC/TBL (86, 94, P=0.0002). For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%), and 2 or 3 components (8.1% vs. 3.2%, P=0.006). Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%). Conclusion: A FC/TBL format for ACLS marginally improved written test results. PMID:26893399

  16. Desktop supercomputers. Advance medical imaging.

    Science.gov (United States)

    Frisiello, R S

    1991-02-01

    Medical imaging tools that radiologists as well as a wide range of clinicians and healthcare professionals have come to depend upon are emerging into the next phase of functionality. The strides being made in supercomputing technologies--including reduction of size and price--are pushing medical imaging to a new level of accuracy and functionality.

  17. Advance Care Planning: Medical Issues to Consider

    Science.gov (United States)

    ... Work Working Through Grief About Us Advance Care Planning: Medical Issues to Consider By Cheryl Arenella, MD, ... delirious, anxious, and agitated when taken out of familiar surroundings. Diagnostic tests What is involved? Diagnostic tests ...

  18. A randomised control trial to determine if use of the iResus© application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency.

    Science.gov (United States)

    Low, D; Clark, N; Soar, J; Padkin, A; Stoneham, A; Perkins, G D; Nolan, J

    2011-04-01

    This study sought to determine whether using the Resuscitation Council UK's iResus© application on a smart phone improves the performance of doctors trained in advanced life support in a simulated emergency. Thirty-one doctors (advanced life support-trained within the previous 48 months) were recruited. All received identical training using the smart phone and the iResus application. The participants were randomly assigned to a control group (no smart phone) and a test group (access to iResus on smart phone). Both groups were tested using a validated extended cardiac arrest simulation test (CASTest) scoring system. The primary outcome measure was the overall cardiac arrest simulation test score; these were significantly higher in the smart phone group (median (IQR [range]) 84.5 (75.5-92.5 [64-96])) compared with the control group (72 (62-87 [52-95]); p=0.02). Use of the iResus application significantly improves the performance of an advanced life support-certified doctor during a simulated medical emergency. Further studies are needed to determine if iResus can improve care in the clinical setting.

  19. Medical technology advances from space research

    Science.gov (United States)

    Pool, S. L.

    1972-01-01

    Details of medical research and development programs, particularly an integrated medical laboratory, as derived from space technology are given. The program covers digital biotelemetry systems, automatic visual field mapping equipment, sponge electrode caps for clinical electroencephalograms, and advanced respiratory analysis equipment. The possibility of using the medical laboratory in ground based remote areas and regional health care facilities, as well as long duration space missions is discussed.

  20. Advanced medical video services through context-aware medical networks.

    Science.gov (United States)

    Doukas, Charalampos N; Maglogiannis, Ilias; Pliakas, Thomas

    2007-01-01

    The aim of this paper is to present a framework for advanced medical video delivery services, through network and patient-state awareness. Under this scope a context-aware medical networking platform is described. The developed platform enables proper medical video data coding and transmission according to both a) network availability and/or quality and b) patient status, optimizing thus network performance and telediagnosis. An evaluation platform has been developed based on scalable H.264 coding of medical videos. Corresponding results of video transmission over a WiMax network have proved the effectiveness and efficiency of the platform providing proper video content delivery.

  1. Advances in Translational Medical Research

    Science.gov (United States)

    2011-01-25

    Chronic Myelogenous Leukemia Research Program Tuberous Sclerosis Complex Research Program National Prion Research Program Myeloproliferative Disorders...OEF/OIF Veterans  Randomized Controlled Trial of Galantamine, Methylphenidate , and Placebo for the Treatment of Cognitive Symptoms in Patients...Research Organization Network Guiding Studies on Trauma and Resilience External Advisory Board Genetics Core NeuroimagingCore CR Darnall Army Medical

  2. ['Advanced trauma life support' in Netherlands].

    Science.gov (United States)

    van Vugt, A B

    2000-10-28

    Introduction of the principles of advanced trauma life support (ATLS) in the management of accident victims has been in progress in the Netherlands since 1995. The main ATLS principles are that the aid giver treats the most dangerous disorder first and does no further damage. After assessment and, if necessary, treatment of the airways, the respiration, the circulation and any craniocerebral injury, an exploratory examination is carried out. Physicians receive theoretical and practical instructions in this form of management during an intensive two-day course, counselled by a coordinating organization in the USA. Most of those attending are interns in general surgery, traumatology and orthopaedics, gatekeeper doctors of emergency rooms and army medical officers. The standardized way of thinking improves the communication and understanding between the various disciplines involved in trauma care, in part because there exist comparable programmes for ambulance care and emergency care. Other measures improving the quality of trauma care are regionalization of the trauma care, medical helicopter teams and evaluation of the effects of ATLS as an operating procedure.

  3. Advances in medical diagnostic technology

    CERN Document Server

    Lai, Khin Wee; Mohamad Salim, Maheza Irna; Ong, Sang-Bing; Utama, Nugraha Priya; Myint, Yin Mon; Mohd Noor, Norliza; Supriyanto, Eko

    2014-01-01

    This book provides the most recent findings and knowledge in advanced diagnostics technology, covering a wide spectrum including brain activity analysis, breast and lung cancer detection, echocardiography, computer aided skeletal assessment to mitochondrial biology imaging at the cellular level. The authors explored magneto acoustic approaches and tissue elasticity imaging for the purpose of breast cancer detection. Perspectives in fetal echocardiography from an image processing angle are included. Diagnostic imaging in the field of mitochondrial diseases as well as the use of Computer-Aided System (CAD) are also discussed in the book. This book will be useful for students, lecturers or professional researchers in the field of biomedical sciences and image processing.

  4. New advances and prospects of medical ethics

    Directory of Open Access Journals (Sweden)

    Fang YANG

    2011-09-01

    Full Text Available Objective To review and summarize the latest advances and achievements in medical ethics research since "the Eleventh Five-Year Plan",and to infer the possible developmental prospects of medical ethics in "the Twelfth Five-Year Plan".Methods Bibliographical methods were employed to retrieve the academic achievements and dynamic developments in medical ethics since 2006 to obtain a brief overview and to conduct an in-depth study.Results Since "the Eleventh Five-Year Plan",a series of achievements in medical ethics,especially on the upgrade of the themes,the expansion of the scope,and the renovation of the methods,have been achieved.Research on medical ethics carried out in the army,such as the research on military medical ethics,bioethics,and disaster and epidemic ethics,also yielded several new achievements and played leading roles in the military and practical fields.Conclusions In the period of "the Twelfth Five-Year Plan",the localization of medical ethics research should be promoted,the level of original research should be improved,and the academic contingent and platform should be strenuously constructed.In terms of research direction,continuously strengthening basic and general research of bioethics,highlighting the characteristics and superiority of military medical ethics,enhancing non-combat and combat operation research,and strengthening ethics research for the application of advanced biotechnology in the military field are necessary.

  5. Advanced interaction techniques for medical models

    OpenAIRE

    Monclús, Eva

    2014-01-01

    Advances in Medical Visualization allows the analysis of anatomical structures with the use of 3D models reconstructed from a stack of intensity-based images acquired through different techniques, being Computerized Tomographic (CT) modality one of the most common. A general medical volume graphics application usually includes an exploration task which is sometimes preceded by an analysis process where the anatomical structures of interest are first identified. ...

  6. Modeling Advance Life Support Systems

    Science.gov (United States)

    Pitts, Marvin; Sager, John; Loader, Coleen; Drysdale, Alan

    1996-01-01

    Activities this summer consisted of two projects that involved computer simulation of bioregenerative life support systems for space habitats. Students in the Space Life Science Training Program (SLSTP) used the simulation, space station, to learn about relationships between humans, fish, plants, and microorganisms in a closed environment. One student complete a six week project to modify the simulation by converting the microbes from anaerobic to aerobic, and then balancing the simulation's life support system. A detailed computer simulation of a closed lunar station using bioregenerative life support was attempted, but there was not enough known about system restraints and constants in plant growth, bioreactor design for space habitats and food preparation to develop an integrated model with any confidence. Instead of a completed detailed model with broad assumptions concerning the unknown system parameters, a framework for an integrated model was outlined and work begun on plant and bioreactor simulations. The NASA sponsors and the summer Fell were satisfied with the progress made during the 10 weeks, and we have planned future cooperative work.

  7. Advanced cardiac life support training.

    Science.gov (United States)

    Despott, Edward J; Schreiber, Florian

    2010-01-01

    The OMED/ESGE consensus statements of the International Symposium on Sedation in Endoscopy, Athens, September 2009, in keeping with guidelines and position statements published by other societies, underline the need for sedation providers to be adequately trained in dealing with scenarios involving patients in respiratory and/or cardiovascular distress. This training should prepare the sedation provider with the necessary acumen to prevent, recognize and remedy sedation-related emergencies. Life support training that adheres to the International Liaison Committee on Resuscitation (ILCOR) guidelines should be a mandatory component of this instruction that should be governed by formal assessment and quality assurance reappraisal.

  8. IT for advanced Life Support in English

    DEFF Research Database (Denmark)

    Sejerø Pedersen, Birgitte; Jeberg, Kirsten Ann; Koerner, Christian

    2009-01-01

    In this study we analyzed how IT support can be established for the treatment and documentation of advanced life support (ALS) in a hospital. In close collaboration with clinical researchers, a running prototype of an IT solution to support the clinical decisions in ALS was developed and tried out...

  9. Advanced medical interventions in pleural disease

    Directory of Open Access Journals (Sweden)

    Rahul Bhatnagar

    2016-06-01

    Full Text Available The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease.

  10. Advances in Microelectronics for Implantable Medical Devices

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    Andreas Demosthenous

    2014-01-01

    Full Text Available Implantable medical devices provide therapy to treat numerous health conditions as well as monitoring and diagnosis. Over the years, the development of these devices has seen remarkable progress thanks to tremendous advances in microelectronics, electrode technology, packaging and signal processing techniques. Many of today’s implantable devices use wireless technology to supply power and provide communication. There are many challenges when creating an implantable device. Issues such as reliable and fast bidirectional data communication, efficient power delivery to the implantable circuits, low noise and low power for the recording part of the system, and delivery of safe stimulation to avoid tissue and electrode damage are some of the challenges faced by the microelectronics circuit designer. This paper provides a review of advances in microelectronics over the last decade or so for implantable medical devices and systems. The focus is on neural recording and stimulation circuits suitable for fabrication in modern silicon process technologies and biotelemetry methods for power and data transfer, with particular emphasis on methods employing radio frequency inductive coupling. The paper concludes by highlighting some of the issues that will drive future research in the field.

  11. End-of-Life Decisions and Advanced Old Age

    Directory of Open Access Journals (Sweden)

    Stoyles

    2014-07-01

    Full Text Available Despite the fact that most people die in advanced old age, little attention is given to cases involving older people in debates about the moral and legal dimensions of end-of-life decision making. The purpose of this paper is to establish some of the ways our discussions should change as we pay attention to important factors influencing end-of-life decisions for people in advanced old age. Focusing on the prevalence of comorbidities and the likelihood that people in advanced old age will experience an extended period of declining function before death, I argue that our debates should be expanded to include greater consideration of how we want to live in the final stages of life. With this, I am arguing against the tendency to think that “end-of-life” decision making concerns only making decisions about when and how it is appropriate to terminate a person’s life. I argue, further, that we should move away from the medicalization of dying.

  12. Nanomaterials for Advanced Life Support in Advanced Life Support in Space systems

    Science.gov (United States)

    Allada, Rama Kumar; Moloney, Padraig; Yowell, Leonard

    2006-01-01

    A viewgraph presentation describing nanomaterial research at NASA Johnson Space Center with a focus on advanced life support in space systems is shown. The topics include: 1) Introduction; 2) Research and accomplishments in Carbon Dioxide Removal; 3) Research and Accomplishments in Water Purification; and 4) Next Steps

  13. NASA Advanced Explorations Systems: Advancements in Life Support Systems

    Science.gov (United States)

    Shull, Sarah A.; Schneider, Walter F.

    2016-01-01

    The NASA Advanced Exploration Systems (AES) Life Support Systems (LSS) project strives to develop reliable, energy-efficient, and low-mass spacecraft systems to provide environmental control and life support systems (ECLSS) critical to enabling long duration human missions beyond low Earth orbit (LEO). Highly reliable, closed-loop life support systems are among the capabilities required for the longer duration human space exploration missions assessed by NASA's Habitability Architecture Team (HAT). The LSS project is focused on four areas: architecture and systems engineering for life support systems, environmental monitoring, air revitalization, and wastewater processing and water management. Starting with the international space station (ISS) LSS systems as a point of departure (where applicable), the mission of the LSS project is three-fold: 1. Address discrete LSS technology gaps 2. Improve the reliability of LSS systems 3. Advance LSS systems towards integrated testing on the ISS. This paper summarized the work being done in the four areas listed above to meet these objectives. Details will be given on the following focus areas: Systems Engineering and Architecture- With so many complex systems comprising life support in space, it is important to understand the overall system requirements to define life support system architectures for different space mission classes, ensure that all the components integrate well together and verify that testing is as representative of destination environments as possible. Environmental Monitoring- In an enclosed spacecraft that is constantly operating complex machinery for its own basic functionality as well as science experiments and technology demonstrations, it's possible for the environment to become compromised. While current environmental monitors aboard the ISS will alert crew members and mission control if there is an emergency, long-duration environmental monitoring cannot be done in-orbit as current methodologies

  14. Advanced Capabilities Medical Suction Device Project

    Data.gov (United States)

    National Aeronautics and Space Administration — A compact microgravity and hypogravity compatible vacuum device is proposed to provide medical suction and containment of extracted fluids. The proposed aspirator...

  15. Medical Advances in Child Sexual Abuse

    Science.gov (United States)

    Alexander, Randell A.

    2011-01-01

    This volume is the first of a two-part special issue detailing state of the art practice in medical issues around child sexual abuse. The six articles in this issue explore methods for medical history evaluation, the rationale for when sexual examinations should take place, specific hymenal findings that suggest a child has been sexually abused,…

  16. Life and Medical Ethics in Pediatric Neurosurgery

    Science.gov (United States)

    YAMASAKI, Mami

    2017-01-01

    Ethical issues in the field of pediatric neurosurgery, including prenatal diagnosis, palliative care for children with an intractable serious disease, and medical neglect, are discussed. An important role of medicine is to offer every possible treatment to a patient. However, it also is the responsibility of medicine to be conscious of its limitations, and to help parents love and respect a child who suffers from an incurable disease. When dealing with cases of medical neglect and palliative care for an incurable disease, it is critical to diagnose the child’s condition accurately and evaluate the outcome. However, to treat or not to treat also depends on the medical resources and social-economic status of the community, the parents’ religion and philosophy, the policies of the institutions involved, and the limits of medical science. Moral dilemmas will continue to be addressed as medical progress yields treatments for untreatable diseases in the future. PMID:28025426

  17. The Allied Health Care Professional's Role in Assisting Medical Decision Making at the End of Life

    Science.gov (United States)

    Lambert, Heather

    2012-01-01

    As a patient approaches the end of life, he or she faces a number of very difficult medical decisions. Allied health care professionals, including speech-language pathologists (SLPs) and occupational therapists (OTs), can be instrumental in assisting their patients to make advance care plans, although their traditional job descriptions do not…

  18. Medical humanities and medical alterity in fiction and in life.

    Science.gov (United States)

    Hurwitz, Brian

    2015-01-01

    A widely accepted component of any answer to the question 'What is it to do good medical ethics?' is the commitment to benefit people's health, in principlist terminology, 'beneficence'. This paper addresses deliberate maleficence and the cultural otherness with which it is associated, focusing on the activities of the serial killer Dr Harold Shipman. It finds an uncanny 'fit' between the normal operation of healthcare services and this sort of alterity which has attracted little attention from bioethicists but has been addressed by novelists. To the extent that the medical humanities offers useful insights into hard moral problems, its capacities rest on taking account of both the fictional and the real.

  19. Beyond advance directives: importance of communication skills at the end of life.

    Science.gov (United States)

    Tulsky, James A

    2005-07-20

    Patients and their families struggle with myriad choices concerning medical treatments that frequently precede death. Advance directives have been proposed as a tool to facilitate end-of-life decision making, yet frequently fail to achieve this goal. In the context of the case of a man with metastatic cancer for whom an advance directive was unable to prevent a traumatic death, I review the challenges in creating and implementing advance directives, discuss factors that can affect clear decision making; including trust, uncertainty, emotion, hope, and the presence of multiple medical providers; and offer practical suggestions for physicians. Advance care planning remains a useful tool for approaching conversations with patients about the end of life. However, such planning should occur within a framework that emphasizes responding to patient and family emotions and focuses more on goals for care and less on specific treatments.

  20. Clinical life: expectation and the double edge of medical promise.

    Science.gov (United States)

    Shim, Janet K; Russ, Ann J; Kaufman, Sharon R

    2007-04-01

    This article introduces the concept of clinical life to capture a form of life produced in the pursuit and wake of medically achieved longevity. Relying on the retrospective accounts of 28 individuals over age 70 who have undergone cardiac bypass surgery, angioplasty or a stent procedure, as well as interviews with their families and with clinicians, we examine three features of clinical life. First, patients do not distinguish between clinical possibility and clinical promise, and thus assume that life can and will be improved by medical intervention in late life. Rather than anticipating a range of potential treatment outcomes, patients therefore expect the best-case scenario: that medical procedures will reverse aging, disease and the march of time. Second, patients then assess the value of their post-procedure lives in accordance with that expectation. Norms regarding what life 'should be like' at particular ages are continually recalibrated to the horizon of what is clinically possible. And third, the price of living longer entails a double-edged relationship with the clinic--it generates opportunities for bodily restoration and increased self-worth but also creates ambivalence about the value of life. This latter feature of clinical life is rarely publicly acknowledged in an environment that emphasizes medical promise.

  1. Phases management for advanced life support processes

    NARCIS (Netherlands)

    Eckhard, F.; Brunink, J.A.J.; Tuinstra, B.; Assink, J.W.; Ten Asbroek, N.; Backx, V.; Klaassen, A.; Waters, G.; Stasiak, M.A.; Dixon, M.; Ordoñez-Inda, L.

    2005-01-01

    For a planetary base, a reliable life support system including food and water supply, gas generation and waste management is a condition sine qua non. While for a short-term period the life support system may be an open loop, i.e. water, gases and food provided from the Earth, for long-term missions

  2. Establishing advanced practice for medical imaging in New Zealand

    Energy Technology Data Exchange (ETDEWEB)

    Yielder, Jill, E-mail: j.yielder@auckland.ac.nz [University of Auckland, Auckland (New Zealand); Young, Adrienne; Park, Shelley; Coleman, Karen [University of Otago, Wellington (New Zealand); University of Auckland, Auckland (New Zealand)

    2014-02-15

    Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.

  3. A new data architecture for advancing life cycle assessment

    Science.gov (United States)

    IntroductionLife cycle assessment (LCA) has a technical architecture that limits data interoperability, transparency, and automated integration of external data. More advanced information technologies offer promise for increasing the ease with which information can be synthesized...

  4. [Audit: medical record documentation among advanced cancer patients].

    Science.gov (United States)

    Perceau, Elise; Chirac, Anne; Rhondali, Wadih; Ruer, Murielle; Chabloz, Claire; Filbet, Marilène

    2014-02-01

    Medical record documentation of cancer inpatients is a core component of continuity of care. The main goal of the study was an assessment of medical record documentation in a palliative care unit (PCU) using a targeted clinical audit based on deceased inpatients' charts. Stage 1 (2010): a clinical audit of medical record documentation assessed by a list of items (diagnosis, prognosis, treatment, power of attorney directive, advance directives). Stage 2 (2011): corrective measures. Stage 3 (2012): re-assessment with the same items' list after six month. Forty cases were investigated during stage 1 and 3. After the corrective measures, inpatient's medical record documentation was significantly improved, including for diagnosis (P = 0.01), diseases extension and treatment (P documentation for advanced directives (P = 0.145).

  5. Astronomy helps advance medical diagnosis techniques

    Science.gov (United States)

    2001-11-01

    Effective treatment of cancer relies on the early detection and removal of cancerous cells. Unfortunately, this is when they are hardest to spot. In the case of breast cancer, now the most prevalent form of cancer in the United Kingdom, cancer cells tend to congregate in the lymph nodes, from where they can rapidly spread throughout the rest of the body. Current medical equipment can give doctors only limited information on tissue health. A surgeon must then perform an exploratory operation to try to identify the diseased tissue. If that is possible, the diseased tissue will be removed. If identification is not possible, the doctor may be forced to take away the whole of the lymphatic system. Such drastic treatment can then cause side effects, such as excessive weight gain, because it throws the patient's hormones out of balance. Now, members of the Science Payloads Technology Division of the Research and Science Support Department, at ESA's science, technology and engineering research centre (ESTEC) in the Netherlands, have developed a new X-ray camera that could make on-the-spot diagnoses and pinpoint cancerous areas to guide surgeons. Importantly, it would be a small device that could be used continuously during operations. "There is no photography involved in the camera we envisage. It will be completely digital, so the surgeon will study the whole lymphatic system and the potentially cancerous parts on his monitor. He then decides which parts he removes," says Dr. Tone Peacock, Head of the Science Payloads Technology Division. The ESA team were trying to find a way to make images using high-energy X-rays because some celestial objects give out large quantities of X-rays but little visible light. To see these, astronomers need to use X-ray cameras. Traditionally, this has been a bit of a blind spot for astronomers. ESA's current X-ray telescope, XMM-Newton, is in orbit now, observing low energy, so-called 'soft' X-rays. European scientists have always wanted to

  6. 76 FR 71982 - Advancing Regulatory Science for Highly Multiplexed Microbiology/Medical Countermeasure Devices...

    Science.gov (United States)

    2011-11-21

    ... paper entitled ''Advancing Regulatory Science for Highly Multiplexed Microbiology/Medical Countermeasure... the ``Advancing Regulatory Science for Highly Multiplexed Microbiology/Medical Countermeasure Devices... HUMAN SERVICES Food and Drug Administration Advancing Regulatory Science for Highly...

  7. Lantus solostar in real life medical practice

    Directory of Open Access Journals (Sweden)

    Florenţiu Ariel

    2014-03-01

    Full Text Available Background and aims: The epidemic of diabetes mellitus has made the effective treatment of hyperglycemia a top priority. Maintaining near-normal glycemic levels has been demonstrated to have a beneficial effect on diabetes-specific complications. Insulin can decrease any level of elevated glycated hemoglobin. Insulin glargine (Lantus® is a long-acting insulin analog with a favorable 24-h time-action profile, once daily administration and low risk of hypoglycemia used in type 1 and 2 diabetes. In Romania, real-life data about glycaemic control is lacking. Material and methods: We present results from a retrospective, open-label, non-randomised, registry trial in 2946 Romanian diabetes patients. The objective of the study was to assess the proportion of patients with appropriate glycaemic control after 3 to 6 months of glargine treatment. Results and conclusions: A little over one third of the patients had reached target glycated hemoglobin after 3-6 months of glargine treatment in both types of diabetes. In type 2 diabetes patients the glargine dose used was not high (0.33 UI/kg. Inadequate insulin titration is a possible cause for not reaching glycemic targets.

  8. Early-life medical care and human capital accumulation

    DEFF Research Database (Denmark)

    Daysal, N. Meltem

    2015-01-01

    that both types of interventions may benefit not only child health but also long-term educational outcomes. In addition, early-life medical interventions may improve the educational outcomes of siblings. These findings can be used to design policies that improve long-term outcomes and reduce economic...

  9. End-of-life care in medical textbooks.

    Science.gov (United States)

    Carron, A T; Lynn, J; Keaney, P

    1999-01-05

    Improvement in end-of-life care has become a demand of the public and a priority for health care professionals. Medical textbooks could support this improvement by functioning as educational resources and as reference material. In this paper, four widely used general medical textbooks are assessed for their coverage of nine content domains for 12 illnesses that often cause death; each domain in each disease and in each text was graded for presence and helpfulness of advice. Helpful information was rare, and only prognostication and medical treatments to alter the course of the disease were usually mentioned. Harrison's Textbook of Medicine, The Merck Manual, and Scientific American Medicine often mentioned at least a few of the domains in each disease, although not often in a way that would guide a clinician. Manual of Medical Therapeutics (The Washington Manual) includes little information about end-of-life care. Improvement seems possible. Short additions of information on end-of-life care would probably be effective. Many chapters discussed at length certain topics that are clearly optional; other textbooks addressed these topics only briefly. When dealing with end-of-life care, physicians should seek guidance from other sources and textbook authors and editors should improve the utility and completeness of their texts.

  10. Students′ satisfaction to hybrid problem-based learning format for basic life support/advanced cardiac life support teaching

    Directory of Open Access Journals (Sweden)

    Geetanjali Chilkoti

    2016-01-01

    Full Text Available Background and Aims: Students are exposed to basic life support (BLS and advanced cardiac life support (ACLS training in the first semester in some medical colleges. The aim of this study was to compare students′ satisfaction between lecture-based traditional method and hybrid problem-based learning (PBL in BLS/ACLS teaching to undergraduate medical students. Methods: We conducted a questionnaire-based, cross-sectional survey among 118 1 st -year medical students from a university medical college in the city of New Delhi, India. We aimed to assess the students′ satisfaction between lecture-based and hybrid-PBL method in BLS/ACLS teaching. Likert 5-point scale was used to assess students′ satisfaction levels between the two teaching methods. Data were collected and scores regarding the students′ satisfaction levels between these two teaching methods were analysed using a two-sided paired t-test. Results: Most students preferred hybrid-PBL format over traditional lecture-based method in the following four aspects; learning and understanding, interest and motivation, training of personal abilities and being confident and satisfied with the teaching method (P < 0.05. Conclusion: Implementation of hybrid-PBL format along with the lecture-based method in BLS/ACLS teaching provided high satisfaction among undergraduate medical students.

  11. [Depression and stress management in medical students. A comparative study between freshman and advanced medical students].

    Science.gov (United States)

    Jurkat, H B; Richter, L; Cramer, M; Vetter, A; Bedau, S; Leweke, F; Milch, W

    2011-05-01

    International studies have indicated a high prevalence of depression and a lack of coping with stress in medical students. Freshman and advanced medical students were investigated using a specific questionnaire and the Beck Depression Inventory (BDI) with a response rate of 100%. Of the subjects studied 81.1% did not have any depression, 13.1% slight and 5.8% clinically relevant symptoms of depression. The severity of symptoms was highly associated with subjective appraisal of stressors. Coping skills of first year students significantly influenced the depression symptoms calling for preventative measures even in freshman medical students.

  12. MAXILLOFACIAL TRAUMA MANAGEMENT IN POLYTRAUMATIZED PATIENTS – THE USE OF ADVANCED TRAUMA LIFE SUPPORT (ATLS PRINCIPLES.

    Directory of Open Access Journals (Sweden)

    Elitsa G. Deliverska

    2013-03-01

    Full Text Available Management of the multiply injured patient requires a co-ordinated multi-disciplinary approach in order to optimise patients’ outcome. A working knowledge of the sort of problems these patients encounter is therefore vital to ensure that life-threatening injuries are recognised and treated in a timely pattern and that more minor associated injuries are not omitted. This article outlines the management of polytraumatized patients using the Advanced Trauma Life Support (ATLS principles and highlights the areas of specific involvement of the engaged medical team. Advanced Trauma Life Support is generally regarded as the gold standard and is founded on a number of well known principles, but strict adherence to protocols may have its drawbacks when facial trauma co-exists. These can arise in the presence of either major or minor facial injuries, and oral and maxillofacial surgeons need to be aware of the potential problems.

  13. Quality-of-life assessment in advanced cancer.

    LENUS (Irish Health Repository)

    Donnelly, S

    2000-07-01

    In the past 5 years, quality-of-life (QOL) assessment measures such as the McGill, McMaster, Global Visual Analogue Scale, Assessment of QOL at the End of Life, Life Evaluation Questionnaire, and Hospice QOL Index have been devised specifically for patients with advanced cancer. The developers of these instruments have tried to respond to the changing needs of this specific population, taking into account characteristics including poor performance status, difficulty with longitudinal study, rapidly deteriorating physical condition, and change in relevant issues. Emphasis has been placed on patient report, ease and speed of completion, and the existential domain or meaning of life. Novel techniques in QOL measurement have also been adapted for palliative care, such as judgment analysis in the Schedule for the Evaluation of Individual Quality of Life. It is generally agreed that a single tool will not cover all QOL assessment needs.

  14. [Recent advances in medical and surgical treatment of ulcerative colitis].

    Science.gov (United States)

    Sugita, Akira; Koganei, Kazutaka; Tatsumi, Kenji; Futatsuki, Ryo; Kuroki, Hirosuke; Yamada, Kyoko; Arai, Katsuhiko; Fukushima, Tsuneo

    2015-03-01

    Recent advances in both medical and surgical treatment of ulcerative colitis have been remarkable. Changes in medical treatment are mainly good results of therapy with the anti-TNF-α antibody, tacrolimus, and those in surgical treatment are an expansion of the surgical indications to include patients with intractable disease, such as treatment refractoriness and chronic corticosteroid dependence, by a better postoperative clinical course after pouch surgery, improred selection of surgical procedures and the timing of surgery in elderly patients. To offer the optimal treatment for patients with ulcerative colitis, new medical therapies should be analyzed from the standpoint of the efficacy and limitations of effect. Long postoperative clinical course of surgical patients including colitic cancer, prevention of postoperative complications should be also analyzed.

  15. Canadian advanced life support capacities and future directions

    Science.gov (United States)

    Bamsey, M.; Graham, T.; Stasiak, M.; Berinstain, A.; Scott, A.; Vuk, T. Rondeau; Dixon, M.

    2009-07-01

    Canada began research on space-relevant biological life support systems in the early 1990s. Since that time Canadian capabilities have grown tremendously, placing Canada among the emerging leaders in biological life support systems. The rapid growth of Canadian expertise has been the result of several factors including a large and technically sophisticated greenhouse sector which successfully operates under challenging climatic conditions, well planned technology transfer strategies between the academic and industrial sectors, and a strong emphasis on international research collaborations. Recent activities such as Canada's contribution of the Higher Plant Compartment of the European Space Agency's MELiSSA Pilot Plant and the remote operation of the Arthur Clarke Mars Greenhouse in the Canadian High Arctic continue to demonstrate Canadian capabilities with direct applicability to advanced life support systems. There is also a significant latent potential within Canadian institutions and organizations with respect to directly applicable advanced life support technologies. These directly applicable research interests include such areas as horticultural management strategies (for candidate crops), growth media, food processing, water management, atmosphere management, energy management, waste management, imaging, environment sensors, thermal control, lighting systems, robotics, command and data handling, communications systems, structures, in-situ resource utilization, space analogues and mission operations. With this background and in collaboration with the Canadian aerospace industry sector, a roadmap for future life support contributions is presented here. This roadmap targets an objective of at least 50% food closure by 2050 (providing greater closure in oxygen, water recycling and carbon dioxide uptake). The Canadian advanced life support community has chosen to focus on lunar surface infrastructure and not low Earth orbit or transit systems (i.e. microgravity

  16. Quality of Life in Medical Students With Internet Addiction

    Directory of Open Access Journals (Sweden)

    Farzad Fatehi

    2016-11-01

    Full Text Available The widespread use of internet has caused new psychological, social, and educational problems for the students. The aim of this study was to examine the quality of life in medical students who suffer from internet addiction. This cross-sectional survey was carried out in Tehran University of Medical Sciences, and a total of 174 fourth-to seventh-year undergraduate medical students were enrolled. The quality of life was assessed by WHOQOL-BREF questionnaire which covers four domains of physical health, psychological, social relationships, and the environment. For assessing internet addiction, we used Internet Addiction Test (IAT of Young. The students with IAT score higher than 50 were considered as addicted. For evaluating academic performance, the students were requested to report their grade point average (GPA. The mean IA score (±SD was 34.13±12.76. Twenty-eight students (16.90% had IAT score above 50. The mean quality of life score in internet addicted group was 54.97±11.38 versus 61.65±11.21 in normal group (P=0.005. Furthermore, there was a negative correlation between IA score and physical domain (r=-0.18, P=0.02; psychological domain (r=-0.35, P=0.000; and social relation domain (r=-0.26, P=0.001. Mean GPA was significantly lower in the addicted group. It seems that quality of life is lower in the internet addicted medical students; moreover, such students academically perform poorer in comparison with non-addicts. Since internet addiction is increasing at a rapid pace which may provoke considerable academic, psychological and social implications; as a result, it may require screening programs to the immediate finding of such problem to give consultations to prevent unwanted complications.

  17. Quality of Life in Medical Students With Internet Addiction.

    Science.gov (United States)

    Fatehi, Farzad; Monajemi, Alireza; Sadeghi, Anahita; Mojtahedzadeh, Rita; Mirzazadeh, Azim

    2016-10-01

    The widespread use of internet has caused new psychological, social, and educational problems for the students. The aim of this study was to examine the quality of life in medical students who suffer from internet addiction. This cross-sectional survey was carried out in Tehran University of Medical Sciences, and a total of 174 fourth-to seventh-year undergraduate medical students were enrolled. The quality of life was assessed by WHOQOL-BREF questionnaire which covers four domains of physical health, psychological, social relationships, and the environment. For assessing internet addiction, we used Internet Addiction Test (IAT) of Young. The students with IAT score higher than 50 were considered as addicted. For evaluating academic performance, the students were requested to report their grade point average (GPA). The mean IA score (±SD) was 34.13±12.76. Twenty-eight students (16.90%) had IAT score above 50. The mean quality of life score in internet addicted group was 54.97±11.38 versus 61.65±11.21 in normal group (P=0.005). Furthermore, there was a negative correlation between IA score and physical domain (r=-0.18, P=0.02); psychological domain (r=-0.35, P=0.000); and social relation domain (r=-0.26, P=0.001). Mean GPA was significantly lower in the addicted group. It seems that quality of life is lower in the internet addicted medical students; moreover, such students academically perform poorer in comparison with non-addicts. Since internet addiction is increasing at a rapid pace which may provoke considerable academic, psychological and social implications; as a result, it may require screening programs to the immediate finding of such problem to give consultations to prevent unwanted complications.

  18. Revolutionary advances in medical waste management. The Sanitec system.

    Science.gov (United States)

    Edlich, Richard F; Borel, Lise; Jensen, H Gordon; Winters, Kathryne L; Long, William B; Gubler, K Dean; Buschbacher, Ralph M; Becker, Daniel G; Chang, Dillon E; Korngold, Jonathan; Chitwood, W Randolph; Lin, Kant Y; Nichter, Larry S; Berenson, Susan; Britt, L D; Tafel, John A

    2006-01-01

    It is the purpose of this collective review to provide a detailed outline of a revolutionary medical waste disposal system that should be used in all medical centers in the world to prevent pollution of our planet from medical waste. The Sanitec medical waste disposal system consists of the following seven components: (1) an all-weather steel enclosure of the waste management system, allowing it to be used inside or outside of the hospital center; (2) an automatic mechanical lift-and-load system that protects the workers from devastating back injuries; (3) a sophisticated shredding system designed for medical waste; (4) a series of air filters including the High Efficiency Particulate Air (HEPA) filter; (5) microwave disinfection of the medical waste material; (6) a waste compactor or dumpster; and (7) an onboard microprocessor. It must be emphasized that this waste management system can be used either inside or outside the hospital. From start to finish, the Sanitec Microwave Disinfection system is designed to provide process and engineering controls that assure complete disinfection and destruction, while minimizing the operator's exposure to risk. There are numerous technologic benefits to the Sanitec systems, including environmental, operational, physical, and disinfection efficiency as well as waste residue disinfection. Wastes treated through the Sanitec system are thoroughly disinfected, unrecognizable, and reduced in volume by approximately 80% (saving valuable landfill space and reducing hauling requirements and costs). They are acceptable in any municipal solid waste program. Sanitec's Zero Pollution Advantage is augmented by a complete range of services, including installation, startup, testing, training, maintenance, and repair, over the life of this system. The Sanitec waste management system has essentially been designed to provide the best overall solution to the customer, when that customer actually looks at the total cost of dealing with the

  19. Medical student debt and major life choices other than specialty

    Directory of Open Access Journals (Sweden)

    James Rohlfing

    2014-11-01

    Full Text Available Background: Median indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face. Methods: Medical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students. No incentives were offered for survey completion. Results: Responses were recorded from 102 US Allopathic medical schools (n=3,032, with 22 institutions (11 public, 11 private meeting inclusion criteria of 10% student body response proportion (n=1,846. Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice. Conclusions: Medical student debt and particularly debt

  20. Globular Clusters as Cradles of Life and Advanced Civilizations

    Science.gov (United States)

    Di Stefano, Rosanne; Ray, Alak

    2016-01-01

    Globular clusters are bound groups of about a million stars and stellar remnants. They are old, largely isolated, and very dense. We consider what each of these special features can mean for the development of life, the evolution of intelligent life, and the long-term survival of technological civilizations. We find that, if they house planets, globular clusters provide ideal environments for advanced civilizations that can survive over long times. We therefore propose methods to search for planets in globular clusters. If planets are found and if our arguments are correct, searches for intelligent life are most likely to succeed when directed toward globular clusters. Globular clusters may be the first places in which distant life is identified in our own or in external galaxies.

  1. Medical treatment of advanced non-small cell lung cancer: progress in 2014

    Directory of Open Access Journals (Sweden)

    Yong SONG

    2015-04-01

    Full Text Available Non-small cell lung cancer is the most common pathological type of lung cancer. Along with the rising incidence in recent years, lung cancer has been the leading cause of death due to malignancies both in our country and worldwide. Due to simplistic therapeutic approach for lung cancer decades ago, those patients suffering from advanced lung cancer had short lifetime, and it was difficult to ensure their life quality. In recent years, many molecular targeted drugs, such as Gefitinib, Erlotinib and Crizotinib etc., have been successively applied in clinical use, and they bring about a substantial prolongation of survival life and improvement in life quality of those patients with advanced lung cancer. In 2014, there was a number of important reports concerning the diagnosis and treatment of non-small cell lung cancer in the annual meetings of either American Society of Clinical Oncology or European Society for Medical Oncology. On the basis of the relevant reports delivered in the conferences, it is our attempt to summarize the recent advances in regard to chemotherapy, molecular targeted therapy, measures to treat TKI therapy resistant cases, and immune therapy, followed by a comment regarding recent advances in the treatment of non-small cell lung cancer in 2014. DOI: 10.11855/j.issn.0577-7402.2015.01.03

  2. Awareness of basic life support among medical, dental, nursing students and doctors

    Directory of Open Access Journals (Sweden)

    Shanta Chandrasekaran

    2010-01-01

    Full Text Available To study the awareness of Basic Life Support (BLS among students, doctors and nurses of medical, dental, homeopathy and nursing colleges. A cross-sectional study was conducted by assessing responses to 20 selected basic questions regarding BLS among students, doctors and nurses of medical, dental, homeopathy and nursing colleges. After excluding the incomplete response forms the data was analysed on 1,054 responders. The results were analysed using an answer key prepared with the use of the Advanced Cardiac Life Support manual. Out of 1,054 responders 345 were medical students, 75 were medical interns, 19 were dental students, 59 were dental interns, 105 were homeopathy interns, 319 were nursing students, 72 were doctors, 29 were dentists, 25 were nursing faculty and six were homeopathy doctors. No one among them had complete knowledge of BLS. Only two out of 1054 (0.19% had secured 80 - 89% marks, 10 out of 1054 (0.95% had secured 70 - 79% marks, 40 of 1054 (4.08% had secured 60 - 69% marks and 105 of 1054 (9.96% had secured 50 - 59% marks. A majority of them, that is, 894 (84.82% had secured less than 50% marks. Awareness of BLS among students, doctors and nurses of medical, dental, homeopathy and nursing colleges is very poor.

  3. 76 FR 48169 - Advancing Regulatory Science for Highly Multiplexed Microbiology/Medical Countermeasure Devices...

    Science.gov (United States)

    2011-08-08

    ... following public meeting: ``Advancing Regulatory Science for Highly Multiplexed Microbiology/Medical... microbiology/MCM devices. The ultimate goal is to advance regulatory science for highly multiplexed devices... HUMAN SERVICES Food and Drug Administration Advancing Regulatory Science for Highly...

  4. 1st International Conference on Advancements of Medical Electronics

    CERN Document Server

    Bag, Sandip; Ganguly, Karabi; Sarkar, Indranath; Biswas, Papun

    2015-01-01

    The book is a collection of peer-reviewed scientific papers submitted by active researchers in the 1st International Conference on Advancements of Medical Electronics (ICAME2015). The conference is organized jointly by the Department of Biomedical Engineering and Electronics and Communication Engineering, JIS College of Engineering, West Bengal, India. The primary objective of the conference is to strengthen interdisciplinary research and its applications for the welfare of humanity. A galaxy of academicians, professionals, scientists, statesman and researchers from different parts of the country and abroad got together and shared their knowledge. The book presents research articles of medical image processing & analysis, biomedical instrumentation & measurements, DSP & clinical applications, embedded systems & its applications in healthcare. The book can be referred as a tool for further research.

  5. Barcode of life: Advancing species identification and discovery

    Digital Repository Service at National Institute of Oceanography (India)

    Chandramohan, D.

    approach overlooks morphologically cryptic taxa, which are seen very commonly in many groups. 3. Since morphological keys are often effective only for a particular life stage or gender, many individuals in their early stages of development can... environment and subject them to test the efficacy of antifouling compounds under laboratory conditions. As the cost of sequencing is dropping rapidly due to technical advances and the existence of high throughput systems, processing of large number...

  6. Advances in Vitiligo: An Update on Medical and Surgical Treatments

    Science.gov (United States)

    Dillon, Alexander B.; Sideris, Andrew; Hadi, Ali

    2017-01-01

    Vitiligo is one of the most common cutaneous disorders of depigmentation. Although its underlying causes are still being studied and no definitive cure currently exists, recent research has provided insight into pathogenic mechanisms and new treatment options. Objective: The aim of this paper is to provide a comprehensive overview of the medical and surgical therapies for vitiligo with emphasis on the most recent treatment modalities. Design: This review was conducted through a literature search using PubMed and the National institutes of Health’s clinicalTrials.gov databases from January 2010 to July 2015. This yielded 86 studies, 12 of which were excluded, and 74 of which were reviewed. Results: Recent studies and ongoing clinical trials indicate that there are many promising new medical and surgical treatment modalities for this chronic condition. Conclusion: A combination of traditional and newer treatments may work synergistically to provide additional improvement in patients’ disease state and quality of life.

  7. Spillover Effects of Early-Life Medical Interventions

    DEFF Research Database (Denmark)

    Breining, Sanni Nørgaard; Daysal, N. Meltem; Simonsen, Marianne;

    2015-01-01

    substantial positive spillovers on all our measures of academic achievement. Our estimates suggest that siblings of focal children who were slightly below the VLBW cutoff have higher 9th grade language and math test scores, as well as higher probability of enrolling in a high school by age 19. Our results......We investigate the spillover effects of early-life medical treatments on the siblings of treated children. We use a regression discontinuity design that exploits changes in medical treatments across the very low birth weight (VLBW) cutoff. Using administrative data from Denmark, we first confirm...... the findings in the previous literature that children who are slightly below the VLBW cutoff have better short- and long-term health, and higher math test scores in 9th grade. We next investigate spillover effects on siblings and find no evidence of an impact on their health outcomes. However, we find...

  8. [Niccolo Paganini: medical aspects of his life and work].

    Science.gov (United States)

    Miranda C, Marcelo; Navarrete T, Luz; Zúñiga N, Gonzalo

    2008-07-01

    Niccolo Paganini is the most virtuous violinist of the history of music. He even received the nick name of "the violinist of the evil" for his outstanding skills on stage performance. It has been suggested that he had syphilis and tuberculosis, the commonest diseases of that time, but this hypothesis remains speculative. There are suggestions that he was the victim of iatrogenic mercurial poisoning. Furthermore, his body build suggests the presence of Ehlers-Danlos syndrome which could give him special anatomical conditions allowing him to achieve an amazing level of vírtuousness in his art. We herein review the medical aspects of this brilliant musician's life.

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

    Science.gov (United States)

    Sommerville, A.

    1995-01-01

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

  10. Medical futility in children's nursing: making end-of-life decisions.

    LENUS (Irish Health Repository)

    Brien, Irene O

    2012-02-01

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts\\' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of \\'parental autonomy\\' and \\'the child\\'s best interests\\' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents\\' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children\\'s nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children\\'s nursing.

  11. Tool for Sizing Analysis of the Advanced Life Support System

    Science.gov (United States)

    Yeh, Hue-Hsie Jannivine; Brown, Cheryl B.; Jeng, Frank J.

    2005-01-01

    Advanced Life Support Sizing Analysis Tool (ALSSAT) is a computer model for sizing and analyzing designs of environmental-control and life support systems (ECLSS) for spacecraft and surface habitats involved in the exploration of Mars and Moon. It performs conceptual designs of advanced life support (ALS) subsystems that utilize physicochemical and biological processes to recycle air and water, and process wastes in order to reduce the need of resource resupply. By assuming steady-state operations, ALSSAT is a means of investigating combinations of such subsystems technologies and thereby assisting in determining the most cost-effective technology combination available. In fact, ALSSAT can perform sizing analysis of the ALS subsystems that are operated dynamically or steady in nature. Using the Microsoft Excel spreadsheet software with Visual Basic programming language, ALSSAT has been developed to perform multiple-case trade studies based on the calculated ECLSS mass, volume, power, and Equivalent System Mass, as well as parametric studies by varying the input parameters. ALSSAT s modular format is specifically designed for the ease of future maintenance and upgrades.

  12. Work/Life Satisfaction Policy in ADVANCE Universities: Assessing Levels of Flexibility

    Science.gov (United States)

    Tower, Leslie E.; Dilks, Lisa M.

    2015-01-01

    Work/life satisfaction policies are seen as key to recruiting, retaining, and advancing high quality faculty. This article explores the work/life policies prevalent at NSF ADVANCE institutions (PAID, Catalyst, and IT). We systematically review ADVANCE university websites (N = 124) and rank 9 categories of work/life policy including dual career…

  13. Which Form of Medical Training is the Best in Improving Interns’ knowledge Related to Advanced Cardiac Life Support Drugs Pharmacology? An Educational Analytical Intervention Study Between Electronic Learning and Lecture-Based Education

    Science.gov (United States)

    Khoshbaten, Manouchehr; Soleimanpour, Hassan; Ala, Alireza; Shams Vahdati, Samad; Ebrahimian, Kimia; Safari, Saeid; Golzari, Samad EJ; Salek Ranjbarzadeh, Fariba; Mehdizadeh Esfanjani, Robab

    2014-01-01

    Background: Conventional educational systems seem to be improper throughout the cardiopulmonary resuscitation (CPR) teaching process. The most common causes of failed resuscitation are unfamiliarity with cardiopulmonary resuscitation algorithms, poor performance of leader of the CPR team and lack of skilled personnel, coordination among members during resuscitation, and responsibility of staff. Objectives: Electronic learning, as a new educational method is controversial issue in medical education for improving physicians’ practical knowledge and it is inevitable that further research on its effectiveness should be done. Materials and Methods: The present study is a prospective, pre- and post-educational, cross-sectional research, in which 84 interns were randomly divided into two groups. pre- and post- educational interventions that took place in the Department of Emergency Medicine, interns were evaluated by 21 multiple choice questions related to American Heart Association guidelineson cardiopulmonary resuscitation drugs. Questions were assessed in terms of routes for CPR drugs administration, CPR drug dosage forms, clinical judgment and appropriate CPR drug administration, and the alternative drugs in emergency situations. Data were analyzed by generalized estimating equations regression models and P < 0.05 was considered statistically significant. Results: Evaluating the effectiveness of both educational methods revealed that the mean answering score for 21 questions before education was 7.5 ± 2.6 and no significant difference was observed in groups (P = 0.55). However, after education, the average scores significantly increased to 11.0 ± 3.9 (P < 0.001). Electronic learning method was not associated with considerable increase in the knowledge of interns in this group compared with the lecture-based group (P = 0.49). Conclusions: No significant differences were observed between electronic learning and lecture-based education in improving interns

  14. The effects of human interest framing in television news coverage of medical advances.

    Science.gov (United States)

    Hong, Hyehyun

    2013-01-01

    The last few decades have witnessed the increasing dissemination of information on medical advances such as new medical treatments and prevention/diagnosis technologies through television news. To engage lay audiences with complex information, medical journalists often personalize news stories about medical advances by exemplifying individual patients and their personal experiences. This study investigates the effects of this journalistic technique, which is referred to as human interest framing, on audiences. The results of an experiment provide empirical evidence that the human interest framing of medical news stories can increase audiences' involvement in those stories and facilitate their positive perception of medical advances.

  15. Key role of social work in effective communication and conflict resolution process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and shared medical decision making at the end of life.

    Science.gov (United States)

    Bomba, Patricia A; Morrissey, Mary Beth; Leven, David C

    2011-01-01

    In this article, the authors review the development of the Medical Orders for Life-Sustaining Treatment (MOLST) Program and recent landmark legislation in New York State in the context of advance care planning and shared medical decision making at the end of life. Social workers are central health care professionals in working with patients, families, practitioners, health care agents, and surrogates in the health systems and in the communication and conflict resolution process that is integral to health care decision making. The critical importance of ethics and end-of-life training and education for social workers is also addressed. Data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making are reported. Recommendations are made for research on education and training of social workers, and investigation of the role and influence of systems in shaping social work involvement in end-of-life and palliative care.

  16. Materials Advances for Next-Generation Ingestible Electronic Medical Devices.

    Science.gov (United States)

    Bettinger, Christopher J

    2015-10-01

    Electronic medical implants have collectively transformed the diagnosis and treatment of many diseases, but have many inherent limitations. Electronic implants require invasive surgeries, operate in challenging microenvironments, and are susceptible to bacterial infection and persistent inflammation. Novel materials and nonconventional device fabrication strategies may revolutionize the way electronic devices are integrated with the body. Ingestible electronic devices offer many advantages compared with implantable counterparts that may improve the diagnosis and treatment of pathologies ranging from gastrointestinal infections to diabetes. This review summarizes current technologies and highlights recent materials advances. Specific focus is dedicated to next-generation materials for packaging, circuit design, and on-board power supplies that are benign, nontoxic, and even biodegradable. Future challenges and opportunities are also highlighted.

  17. Life-cycle cost analysis of advanced design mixer pump

    Energy Technology Data Exchange (ETDEWEB)

    Hall, M.N., Westinghouse Hanford

    1996-07-23

    This analysis provides cost justification for the Advanced Design Mixer Pump program based on the cost benefit to the Hanford Site of 4 mixer pump systems defined in terms of the life-cycle cost.A computer model is used to estimate the total number of service hours necessary for each mixer pump to operate over the 20-year retrieval sequence period for single-shell tank waste. This study also considered the double-shell tank waste retrieved prior to the single-shell tank waste which is considered the initial retrieval.

  18. End-of-Life Decisions and Palliative Care in Advanced Heart Failure.

    Science.gov (United States)

    Meyers, Deborah E; Goodlin, Sarah J

    2016-09-01

    Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan. Use of defined triggers for FCP can stimulate important patient-caregiver conversations. Guidelines advocate an annual review of HF status and future care preferences. Advance directives are important for any individual with a chronic, life-limiting illness and should be integrated into FCP. Nevertheless, use of advance directives by HF patients is extremely low. Consideration of illness trajectories and risk-scoring tools might facilitate prognostication and delivery of appropriate HF care. Decisions about heart transplantation or left ventricular assist device implantation should include planning for potential complications associated with these therapies. Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions.

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

    Science.gov (United States)

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

    2015-10-01

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

  20. Advanced robotics for medical rehabilitation current state of the art and recent advances

    CERN Document Server

    Xie, Shane

    2016-01-01

    Focussing on the key technologies in developing robots for a wide range of medical rehabilitation activities – which will include robotics basics, modelling and control, biomechanics modelling, rehabilitation strategies, robot assistance, clinical setup/implementation as well as neural and muscular interfaces for rehabilitation robot control – this book is split into two parts; a review of the current state of the art, and recent advances in robotics for medical rehabilitation. Both parts will include five sections for the five key areas in rehabilitation robotics: (i) the upper limb; (ii) lower limb for gait rehabilitation (iii) hand, finger and wrist; (iv) ankle for strains and sprains; and (v) the use of EEG and EMG to create interfaces between the neurological and muscular functions of the patients and the rehabilitation robots. Each chapter provides a description of the design of the device, the control system used, and the implementation and testing to show how it fulfils the needs of that specific ...

  1. Advanced Technologies to Improve Closure of Life Support Systems

    Science.gov (United States)

    Barta, Daniel J.

    2016-01-01

    As NASA looks beyond the International Space Station toward long-duration, deep space missions away from Earth, the current practice of supplying consumables and spares will not be practical nor affordable. New approaches are sought for life support and habitation systems that will reduce dependency on Earth and increase mission sustainability. To reduce launch mass, further closure of Environmental Control and Life Support Systems (ECLSS) beyond the current capability of the ISS will be required. Areas of particular interest include achieving higher degrees of recycling within Atmosphere Revitalization, Water Recovery and Waste Management Systems. NASA is currently investigating advanced carbon dioxide reduction processes that surpass the level of oxygen recovery available from the Sabatier Carbon Dioxide Reduction Assembly (CRA) on the ISS. Candidate technologies will potentially improve the recovery of oxygen from about 50% (for the CRA) to as much as 100% for technologies who's end product is solid carbon. Improving the efficiency of water recycling and recovery can be achieved by the addition of advanced technologies to recover water from brines and solid wastes. Bioregenerative technologies may be utilized for water reclaimation and also for the production of food. Use of higher plants will simultaneously benefit atmosphere revitalization and water recovery through photosynthesis and transpiration. The level at which bioregenerative technologies are utilized will depend on their comparative requirements for spacecraft resources including mass, power, volume, heat rejection, crew time and reliability. Planetary protection requirements will need to be considered for missions to other solar system bodies.

  2. Geographic Medical History: Advances in Geospatial Technology Present New Potentials in Medical Practice

    Science.gov (United States)

    Faruque, F. S.; Finley, R. W.

    2016-06-01

    Genes, behaviour, and the environment are known to be the major risk factors for common diseases. When the patient visits a physician, typical questions include family history (genes) and lifestyle of the patient (behaviour), but questions concerning environmental risk factors often remain unasked. It is ironic that 25 centuries ago Hippocrates, known as the father of medicine, noted the importance of environmental exposure in medical investigation as documented in his classic work, "Airs, Waters, Places", yet the practice of routinely incorporating environmental risk factors is still not in place. Modern epigenetic studies have found that unhealthy lifestyle and environmental factors can cause changes to our genes that can increase disease risk factors. Therefore, attempting to solve the puzzle of diseases using heredity and lifestyle alone will be incomplete without accounting for the environmental exposures. The primary reason why environmental exposure has not yet been a routine part of the patient's medical history is mostly due to our inability to provide clinicians useful measures of environmental exposures suitable for their clinical practices. This presentation will discuss advances in geospatial technology that show the potential to catalyse a paradigm shift in medical practice and health research by allowing environmental risk factors to be documented as the patient's "Geographic Medical History". In order to accomplish this we need information on: a) relevant spatiotemporal environmental variables, and b) location of the individual in that person's dynamic environment. Common environmental agents that are known to interact with genetic make-up include air pollutants, mold spores, pesticides, etc. Until recently, the other component, location of an individual was limited to a static representation such as residential or workplace location. Now, with the development of mobile technology, changes in an individual's location can be tracked in real time if

  3. GEOGRAPHIC MEDICAL HISTORY: ADVANCES IN GEOSPATIAL TECHNOLOGY PRESENT NEW POTENTIALS IN MEDICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    F. S. Faruque

    2016-06-01

    Full Text Available Genes, behaviour, and the environment are known to be the major risk factors for common diseases. When the patient visits a physician, typical questions include family history (genes and lifestyle of the patient (behaviour, but questions concerning environmental risk factors often remain unasked. It is ironic that 25 centuries ago Hippocrates, known as the father of medicine, noted the importance of environmental exposure in medical investigation as documented in his classic work, “Airs, Waters, Places”, yet the practice of routinely incorporating environmental risk factors is still not in place. Modern epigenetic studies have found that unhealthy lifestyle and environmental factors can cause changes to our genes that can increase disease risk factors. Therefore, attempting to solve the puzzle of diseases using heredity and lifestyle alone will be incomplete without accounting for the environmental exposures. The primary reason why environmental exposure has not yet been a routine part of the patient’s medical history is mostly due to our inability to provide clinicians useful measures of environmental exposures suitable for their clinical practices. This presentation will discuss advances in geospatial technology that show the potential to catalyse a paradigm shift in medical practice and health research by allowing environmental risk factors to be documented as the patient’s “Geographic Medical History”. In order to accomplish this we need information on: a relevant spatiotemporal environmental variables, and b location of the individual in that person’s dynamic environment. Common environmental agents that are known to interact with genetic make-up include air pollutants, mold spores, pesticides, etc. Until recently, the other component, location of an individual was limited to a static representation such as residential or workplace location. Now, with the development of mobile technology, changes in an individual’s location

  4. A Workshop to Teach Medical Students Communication Skills and Clinical Knowledge About End-of-Life Care

    OpenAIRE

    Torke, Alexia M.; Quest, Tammie E.; Kinlaw, Kathy; Eley, J. William; Branch, William T

    2004-01-01

    We describe a half-day workshop to teach third-year medical students three focused end-of-life care skills: breaking bad news, discussing advance directives, and assessing and managing pain. Our workshop included a readers’ theater exercise and three role-play exercises. In two of the workshops, faculty members played the role of patients. We used readers’ theater to engage the students on an emotional level and set a reflective tone for the workshop. Evaluations reflected that most responden...

  5. Advanced Cardiac Life Support (ACLS) utilizing Man-Tended Capability (MTC) hardware onboard Space Station Freedom

    Science.gov (United States)

    Smith, M.; Barratt, M.; Lloyd, C.

    1992-01-01

    Because of the time and distance involved in returning a patient from space to a definitive medical care facility, the capability for Advanced Cardiac Life Support (ACLS) exists onboard Space Station Freedom. Methods: In order to evaluate the effectiveness of terrestrial ACLS protocols in microgravity, a medical team conducted simulations during parabolic flights onboard the KC-135 aircraft. The hardware planned for use during the MTC phase of the space station was utilized to increase the fidelity of the scenario and to evaluate the prototype equipment. Based on initial KC-135 testing of CPR and ACLS, changes were made to the ventricular fibrillation algorithm in order to accommodate the space environment. Other constraints to delivery of ACLS onboard the space station include crew size, minimum training, crew deconditioning, and limited supplies and equipment. Results: The delivery of ACLS in microgravity is hindered by the environment, but should be adequate. Factors specific to microgravity were identified for inclusion in the protocol including immediate restraint of the patient and early intubation to insure airway. External cardiac compressions of adequate force and frequency were administered using various methods. The more significant limiting factors appear to be crew training, crew size, and limited supplies. Conclusions: Although ACLS is possible in the microgravity environment, future evaluations are necessary to further refine the protocols. Proper patient and medical officer restraint is crucial prior to advanced procedures. Also emphasis should be placed on early intubation for airway management and drug administration. Preliminary results and further testing will be utilized in the design of medical hardware, determination of crew training, and medical operations for space station and beyond.

  6. Recent advances in medical imaging: anatomical and clinical applications.

    Science.gov (United States)

    Grignon, Bruno; Mainard, Laurence; Delion, Matthieu; Hodez, Claude; Oldrini, Guillaume

    2012-10-01

    The aim of this paper was to present an overview of the most important recent advances in medical imaging and their potential clinical and anatomical applications. Dramatic changes have been particularly observed in the field of computed tomography (CT) and magnetic resonance imaging (MRI). Computed tomography (CT) has been completely overturned by the successive development of helical acquisition, multidetector and large area-detector acquisition. Visualising brain function has become a new challenge for MRI, which is called functional MRI, currently based principally on blood oxygenation level-dependent sequences, which could be completed or replaced by other techniques such as diffusion MRI (DWI). Based on molecular diffusion due to the thermal energy of free water, DWI offers a spectrum of anatomical and clinical applications, ranging from brain ischemia to visualisation of large fibrous structures of the human body such as the anatomical bundles of white matter with diffusion tensor imaging and tractography. In the field of X-ray projection imaging, a new low-dose device called EOS has been developed through new highly sensitive detectors of X-rays, allowing for acquiring frontal and lateral images simultaneously. Other improvements have been briefly mentioned. Technical principles have been considered in order to understand what is most useful in clinical practice as well as in the field of anatomical applications. Nuclear medicine has not been included.

  7. Advances in Medical Revascularisation Treatments in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    H. Asadi

    2014-01-01

    Full Text Available Urgent reperfusion of the ischaemic brain is the aim of stroke treatment and there has been ongoing research to find a drug that can promote vessel recanalisation more completely and with less side effects. In this review article, the major studies which have validated the use and safety of tPA are discussed. The safety and efficacy of other thrombolytic and anticoagulative agents such as tenecteplase, desmoteplase, ancrod, tirofiban, abciximab, eptifibatide, and argatroban are also reviewed. Tenecteplase and desmoteplase are both plasminogen activators with higher fibrin affinity and longer half-life compared to alteplase. They have shown greater reperfusion rates and improved functional outcomes in preliminary studies. Argatroban is a direct thrombin inhibitor used as an adjunct to intravenous tPA and showed higher rates of complete recanalisation in the ARTTS study with further studies which are now ongoing. Adjuvant thrombolysis techniques using transcranial ultrasound are also being investigated and have shown higher rates of complete recanalisation, for example, in the CLOTBUST study. Overall, development in medical therapies for stroke is important due to the ease of administration compared to endovascular treatments, and the new treatments such as tenecteplase, desmoteplase, and adjuvant sonothrombolysis are showing promising results and await further large-scale clinical trials.

  8. Clinical trials update: Medical management of advanced breast cancer.

    Science.gov (United States)

    Major, Maureen A

    2003-12-01

    Selection of treatment for metastatic breast cancer depends on several factors: the status of estrogen receptors or progesterone receptors on breast cancer cells and the expression levels of human epidermal growth factor receptor-2. The presence of estrogen or progesterone receptors typically indicates slower-growing tumors that may be amenable to hormonal manipulation, which provides significant disease control while offering a better toxicity profile than conventional chemotherapy. The understanding of hormonal therapies in patients with postmenopausal metastatic breast cancer has advanced greatly in the past several decades. Aromatase inhibitors, although used initially as second-line therapy, recently have proved to be as effective as tamoxifen, if not superior to it, as first-line therapy for metastatic breast cancer. New data also suggest that letrozole provides significantly better objective responses than anastrozole as second-line therapy. Exemestane, a steroidal aromatase inhibitor, is an effective third-line therapy. Fulvestrant, an estrogen receptor antagonist with no known agonist effect, provides a new option for hormonal therapy. For patients with metastatic breast cancer and overexpression of human epidermal growth factor receptor-2 on tumor cells, the monoclonal antibody trastuzumab is the preferred option, either in combination with paclitaxel as first-line treatment, or as a single agent for second-line therapy. By extending the sequence of hormonal therapy, disease progression and the need for chemotherapy may be significantly delayed, potentially extending patient survival rates and improving quality of life.

  9. What do medical students think about their quality of life? A qualitative study

    Directory of Open Access Journals (Sweden)

    Tempski Patricia

    2012-11-01

    Full Text Available Abstract Background Medical education can affect medical students’ physical and mental health as well as their quality of life. The aim of this study was to assess medical students’ perceptions of their quality of life and its relationship with medical education. Methods First- to sixth-year students from six Brazilian medical schools were interviewed using focus groups to explore what medical student’s lives are like, factors related to increases and decreases of their quality of life during medical school, and how they deal with the difficulties in their training. Results Students reported a variety of difficulties and crises during medical school. Factors that were reported to decrease their quality of life included competition, unprepared teachers, excessive activities, and medical school schedules that demanded exclusive dedication. Contact with pain, death and suffering and harsh social realities influence their quality of life, as well as frustrations with the program and insecurity regarding their professional future. The scarcity of time for studying, leisure activities, relationships, and rest was considered the main factor of influence. Among factors that increase quality of life are good teachers, classes with good didactic approaches, active learning methodologies, contact with patients, and efficient time management. Students also reported that meaningful relationships with family members, friends, or teachers increase their quality of life. Conclusion Quality of teachers, curricula, healthy lifestyles related to eating habits, sleep, and physical activity modify medical students’ quality of life. Lack of time due to medical school obligations was a major impact factor. Students affirm their quality of life is influenced by their medical school experiences, but they also reframe their difficulties, herein represented by their poor quality of life, understood as necessary and inherent to the process of becoming doctors.

  10. Impact of Volunteer Service Provided by Medical Students on Emotions and Quality of Life of Patients with Advanced Cancer%医学生义工服务对晚期癌症患者情绪及生活质量的影响研究

    Institute of Scientific and Technical Information of China (English)

    陈国荣; 段嘉; 李君艳; 张晓利; 郭康; 张永喜; 闫春萍

    2013-01-01

    Objective To investigate the impact of volunteer service provided by medical students on emotions and quality of life ( QOL) of patients with advanced cancer. Methods Sixty - two patients with advanced cancer were randomly divided into the treatment group ( n = 32 ) and the control group ( n = 30 ) using envelope - picking method. Patients in the treatment group received conventional care and volunteer household service, and patients in the control group only received conventional care. QOL scale, Hamilton anxiety ( HAMA ) scale, and Hamilton depression ( HAMD ) scale were used to assess the QOL, anxiety, and depression of the patients in the two groups before and after the study. Results Before the intervention, QOL, anxiety, and depression was not significantly different between the two groups ( P > 0. 05 ). After the intervention, patients in the treatment group had higher QOL ( 35 ±6 ) vs. ( 32 ±7 ), and lower scores of anxiety ( 16 ±5 ) vs. ( 20 ±4 ) and depression ( 22 ±5 ) vs. ( 29 ±9 ) than those in the control group ( P <0. 05 ). Conclusion The volunteer service provided by medical students can improve QOL and relieve or mitigate depression and anxiety of patients with advanced cancer.%目的 探讨医学生义工在晚期癌症患者服务中对患者情绪及生活质量的影响.方法 62例晚期癌症患者采用抽信封法随机分为试验组(n=32)和对照组(n=30),试验组接受常规护理和义工家居服务,对照组仅接受常规护理.在研究的前、后采用癌症患者生活质量评估量表(QOL)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评定分析两组患者生活质量、焦虑情绪、抑郁情绪的变化.结果 干预前,两组患者生活质量、焦虑情绪、抑郁情绪得分间差异无统计学意义(P>0.05);干预后,试验组患者生活质量得分高于对照组患者,QOL评分[(35±6)分比 (32±7)分]差异有统计学意义(P<0.05),焦虑得分[(16±5)分比 (20±4)

  11. Medical therapy of advanced malignant epithelial tumours of the ovary.

    Science.gov (United States)

    Colombo, N; Parma, G; Bocciolone, L; Franchi, D; Sideri, M; Maggioni, A

    2000-01-01

    quality of life and symptoms; ii. tumour load reduction and survival advantage; iii. evaluation of potentially active new drugs to be included in first-line. Since the goal is palliation in most cases, monotherapy is generally indicated. However, the chances of response are directly related to the treatment-free interval, with a response rate nearly equivalent to that of primary chemotherapy when the treatment-free interval exceeds 24 months. Extension of the platinum-free interval before re-treatment with platinum or taxanes may allow partial reversal of resistance to these agents which can therefore still show significant activity in relapsing patients. Unfortunately, durable response to salvage chemotherapy is rare and cure is almost impossible. The sequential use of the agents currently available for salvage treatment in monotherapy may transform ovarian cancer into a chronic disease and confers long survival to the patients. Perhaps, the most interesting role of second-line chemotherapy is to identify new potentially active drugs, which can be moved up-front. Most of the compounds used in second line (gemcitabine, topotecan, liposomal doxorubicin) are in fact under investigation to develop alternative schedules and sequences of drug administration. A new phase III multi-national randomised study for patients with advanced stage epithelial ovarian or primary periperitoneal carcinoma will evaluate the impact of incorporating a new drug within either a platinum-based triplet (new drug + platinum + PTX) or a sequential-doublet (new drug + platinum followed by platinum + PTX) in order to identify one or more experimental regimens able to improve long-term survival with acceptable toxicity.

  12. Goals of care in advanced dementia: quality of life, dignity and comfort.

    Science.gov (United States)

    Volicer, L

    2007-01-01

    Prolongation of human lifespan is increasing the number of individuals suffering from Alzheimer's disease and other progressive dementia worldwide. There are about 5 million of these individuals in both United States and European Union and many more in other countries of the world (1). Because there is no curative treatment for these diseases, most individuals with dementia survive to an advanced stage of dementia at which time many of them require institutional care. Home care for individuals with advanced dementia and especially institutional care are very expensive and are becoming major public health problems. The cost of care for advanced dementia is often increased by the use of aggressive medical interventions that may not be in the best interest of the patient. Because advanced dementia is currently incurable, it should be considered a terminal illness, similar to terminal cancer. Therefore, palliative care may be the most appropriate strategy for management of advanced dementia (2). The goals of palliative care are maintenance of quality of life, dignity and comfort and the four articles in this special issue are addressing these goals. Enhancement of quality of life in dementia requires attention to three main domains: provision of meaningful activities, appropriate medical care, and treatment of behavioral symptoms (3). Individuals with advanced dementia may not be able to participate in many activity programs but they still may maintain some quality of life if they are provided care in a pleasant environment with constant presence of a caregiver. Simard describes a program, Namaste Care, which is specifically tailored for individuals with advanced dementia. This program requires neither major expenditure nor increased staffing and should be instituted in all facilities that care for individuals with advanced dementia. Maintaining functional status of individuals with advanced dementia is important because it improves their self esteem and facilitates

  13. Radio Searches for Signatures of Advanced Extraterrestrial Life

    Science.gov (United States)

    Siemion, Andrew

    Over the last several decades, observational astronomy has produced a flood of discoveries that suggest that the building blocks and circumstances that gave rise to life on Earth may be the rule rather than the exception. It has now been conclusively shown that planets are common and that some 5-15% of FGKM stars host planets existing in their host star's habitable zone. Further, terrestrial biology has demonstrated that life on our own planet can thrive in extraordinarily extreme environments, dramatically extending our notion of what constitutes habitability. The deeper question, yet unanswered, is whether or not life in any form has ever existed in an environment outside of the Earth. As humans, we are drawn to an even more profound question, that of whether or not extraterrestrial life may have evolved a curiosity about the universe similar to our own and the technology with which to explore it. Radio astronomy has long played a prominent role in searches for extraterrestrial intelligence (SETI), beginning with the first suggestions by Cocconi and Morrison (1959) that narrow-band radio signals near 1420 MHz might be effective tracers of advanced technology and early experiments along these lines by Frank Drake in 1961, continuing through to more recent investigations searching for several types of coherent radio signals indicative of technology at a wider range of frequencies. The motivations for radio searches for extraterrestrial intelligence have been throughly discussed in the literature, but the salient arguments are the following: 1. coherent radio emission is commonly produced by advanced technology (judging by Earth’s technological development), 2. electromagnetic radiation can convey information at the maximum velocity currently known to be possible, 3. radio photons are energetically cheap to produce, 4. certain types of coherent radio emissions are easily distinguished from astrophysical background sources, especially within the so

  14. Microbial astronauts: assembling microbial communities for advanced life support systems

    Science.gov (United States)

    Roberts, M. S.; Garland, J. L.; Mills, A. L.

    2004-01-01

    Extension of human habitation into space requires that humans carry with them many of the microorganisms with which they coexist on Earth. The ubiquity of microorganisms in close association with all living things and biogeochemical processes on Earth predicates that they must also play a critical role in maintaining the viability of human life in space. Even though bacterial populations exist as locally adapted ecotypes, the abundance of individuals in microbial species is so large that dispersal is unlikely to be limited by geographical barriers on Earth (i.e., for most environments "everything is everywhere" given enough time). This will not be true for microbial communities in space where local species richness will be relatively low because of sterilization protocols prior to launch and physical barriers between Earth and spacecraft after launch. Although community diversity will be sufficient to sustain ecosystem function at the onset, richness and evenness may decline over time such that biological systems either lose functional potential (e.g., bioreactors may fail to reduce BOD or nitrogen load) or become susceptible to invasion by human-associated microorganisms (pathogens) over time. Research at the John F. Kennedy Space Center has evaluated fundamental properties of microbial diversity and community assembly in prototype bioregenerative systems for NASA Advanced Life Support. Successional trends related to increased niche specialization, including an apparent increase in the proportion of nonculturable types of organisms, have been consistently observed. In addition, the stability of the microbial communities, as defined by their resistance to invasion by human-associated microorganisms, has been correlated to their diversity. Overall, these results reflect the significant challenges ahead for the assembly of stable, functional communities using gnotobiotic approaches, and the need to better define the basic biological principles that define ecosystem

  15. Microbial astronauts: assembling microbial communities for advanced life support systems.

    Science.gov (United States)

    Roberts, M S; Garland, J L; Mills, A L

    2004-02-01

    Extension of human habitation into space requires that humans carry with them many of the microorganisms with which they coexist on Earth. The ubiquity of microorganisms in close association with all living things and biogeochemical processes on Earth predicates that they must also play a critical role in maintaining the viability of human life in space. Even though bacterial populations exist as locally adapted ecotypes, the abundance of individuals in microbial species is so large that dispersal is unlikely to be limited by geographical barriers on Earth (i.e., for most environments "everything is everywhere" given enough time). This will not be true for microbial communities in space where local species richness will be relatively low because of sterilization protocols prior to launch and physical barriers between Earth and spacecraft after launch. Although community diversity will be sufficient to sustain ecosystem function at the onset, richness and evenness may decline over time such that biological systems either lose functional potential (e.g., bioreactors may fail to reduce BOD or nitrogen load) or become susceptible to invasion by human-associated microorganisms (pathogens) over time. Research at the John F. Kennedy Space Center has evaluated fundamental properties of microbial diversity and community assembly in prototype bioregenerative systems for NASA Advanced Life Support. Successional trends related to increased niche specialization, including an apparent increase in the proportion of nonculturable types of organisms, have been consistently observed. In addition, the stability of the microbial communities, as defined by their resistance to invasion by human-associated microorganisms, has been correlated to their diversity. Overall, these results reflect the significant challenges ahead for the assembly of stable, functional communities using gnotobiotic approaches, and the need to better define the basic biological principles that define ecosystem

  16. Computing support for advanced medical data analysis and imaging

    CERN Document Server

    Wiślicki, W; Białas, P; Czerwiński, E; Kapłon, Ł; Kochanowski, A; Korcyl, G; Kowal, J; Kowalski, P; Kozik, T; Krzemień, W; Molenda, M; Moskal, P; Niedźwiecki, S; Pałka, M; Pawlik, M; Raczyński, L; Rudy, Z; Salabura, P; Sharma, N G; Silarski, M; Słomski, A; Smyrski, J; Strzelecki, A; Wieczorek, A; Zieliński, M; Zoń, N

    2014-01-01

    We discuss computing issues for data analysis and image reconstruction of PET-TOF medical scanner or other medical scanning devices producing large volumes of data. Service architecture based on the grid and cloud concepts for distributed processing is proposed and critically discussed.

  17. Current Advances in the Medical Application of Nanotechnology

    CERN Document Server

    Slevin, Mark

    2012-01-01

    Nanotechnology promises new medical therapies, more rapid and sensitive diagnostic and investigative tools for normal and diseased tissues, and new materials for tissue engineering. This e-book highlights the major current uses, new technologies and future perspectives of nanotechnology in relation to medical applications. Sections in this e-book include nanobiological approaches to imaging, diagnosis and treatment of disease using targeted monoclonal antibodies and siRNA, the medical use of nanomaterials, to nanoelectronic biosensors, and possible future applications of molecular nanotechnolo

  18. 75 FR 48356 - Advancing the Development of Medical Products Used In the Prevention, Diagnosis, and Treatment of...

    Science.gov (United States)

    2010-08-10

    ... HUMAN SERVICES Food and Drug Administration Advancing the Development of Medical Products Used In the... ``Advancing the Development of Medical Products Used in the Prevention, Diagnosis, and Treatment of Neglected... the development of medical products (drugs, biological products, and medical devices) used in...

  19. U.S. Medical Experts Issue Warning on Yellow Fever's Advance

    Science.gov (United States)

    ... 164012.html U.S. Medical Experts Issue Warning on Yellow Fever's Advance Brazil outbreak has officials worried, and transmission ... another potential mosquito-borne health threat to Americans -- yellow fever. In an essay published Wednesday in the New ...

  20. Forensic issues in medical evaluation: competency and end-of-life issues.

    Science.gov (United States)

    Soliman, Sherif; Hall, Ryan C W

    2015-01-01

    Decision-making capacity is a common reason for psychiatric consultation that is likely to become more common as the population ages. Capacity assessments are frequently compromised by misconceptions, such as the belief that incapacity is permanent or that patients with dementia categorically lack capacity. This chapter will review the conceptual framework of decision-making capacity and discuss its application to medical decision-making. We will review selected developments in capacity assessment and recommend an approach to assessing decision-making capacity. We will discuss the unique challenges posed by end-of-life care, including determining capacity, identifying surrogate decision-makers, and working with surrogate decision-makers. We will discuss clinical and legal approaches to incapacity, including advance directives, surrogate decision-makers, and guardians. We will discuss the legal standards based on which surrogates make medical decisions and outline options for resolving disagreements between clinical staff and surrogate decision-makers. We will offer recommendations for approaching decision-making capacity assessments.

  1. MODERN HEMOPHILIA TREATMENT - MEDICAL IMPROVEMENTS AND QUALITY-OF-LIFE

    NARCIS (Netherlands)

    ROSENDAAL, FR; SMIT, C; VAREKAMP, [No Value; BROCKERVRIENDS, AHJT; VANDIJCK, H; SUURMEIJER, TPBM; VANDENBROUCKE, JP; BRIET, E

    1990-01-01

    Adequate replacement therapy in haemophilia has been available for two decades. This has led to considerable improvements in the life expectancy and physical status of haemophilia patients. A study was conducted to investigate whether this has also led to improvements in quality of life. With this a

  2. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    Science.gov (United States)

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  3. Advanced Medical Technology Capacity Building and the Medical Mentoring Event: A Unique Application of SOF Counterinsurgency Medical Engagement Strategies.

    Science.gov (United States)

    Irizarry, Dan; Tate, Charmaine; Wey, Pierre-Francois; Batjom, Emmanuel; Nicholas, Thomas A; Boedeker, Ben H

    2012-01-01

    Background The Medical Civic Assistance Program (MEDCAP) is a military commander?s tool developed during the Vietnam War to gain access to and positively influence an indigenous population through the provision of direct medical care provided by military medical personnel, particularly in Counter Insurgency Operations (COIN). An alternative to MEDCAPs is the medical seminar (MEDSEM). The MEDSEM uses a Commander?s military medical assets to share culturally appropriate medical information with a defined indigenous population in order to create a sustainable training resource for the local population?s health system. At the heart of the MEDSEM is the ?train the trainer? concept whereby medical information is passed to indigenous trainers who then pass that information to an indigenous population. The MEDSEM achieves the Commander?s objectives of increasing access and influence with the population through a medical training venue rather than direct patient care. Previous MEDSEMS conducted in Afghanistan by military forces focused on improvement of rural healthcare through creation of Village Health Care Workers. This model can also be used to engage host nation (HN) medical personnel and improve medical treatment capabilities in population centers. The authors describe a modification of the MEDSEM, a Medical Mentorship (MM), conducted in November 2010 in Kabul, Afghanistan, at the Afghan National Army (ANA) National Medical Hospital. This training was designed to improve intubation skills in Afghan National Army Hospitals by ANA medical providers, leave residual training capability, and build relationships within the institution that not only assist the institution, but can also be leveraged to foster Commanders? objectives, such as health and reconstruction initiatives and medical partnering for indigenous corps and medical forces described below. Methods We, the authors, developed a culturally appropriate endotracheal intubation training package including a Dari and

  4. [Application of advanced engineering technologies to medical and rehabilitation fields].

    Science.gov (United States)

    Fujie, Masakatsu

    2012-07-01

    The words "Japan syndrome" can now be heard increasingly through the media. Facing the approach of an elderly-dominated society, Robot Technology(RT)is expected to play an important role in Japan's medical, rehabilitation, and daily support fields. The industrial robot, which has already spread through the world with a great success in certain isolated environments by doing the work which is specialized for the thing with the hard known characteristic. By comparison, in the medical and rehabilitation fields, environments always change intricately, and individual characteristics differ from person to person. Furthermore, there are many times when a robot will be asked to directly interact with people. Moreover, the relation between a robot and a person turns into a relation which should involve contact flexibly according to a situation, and also turns into a relation which should avoid contact. In our group, we have so far developed practical rehabilitation and medical robots which can respond to difficulties such as environmental change and individual specificity. In developing rehabilitation robots, it is especially important to consider intuitive operability and individual differences. In addition, in developing medical robots, it is important to replace the experimental knowledge of surgeons to the mechanical quantitative properties. In this article, we introduce some practical examples of rehabilitation and medical robots interweaving several detailed technologies we have so far developed.

  5. Evaluation of the Effectiveness of an Advance Organizer in a Medical Microbiology Course.

    Science.gov (United States)

    Slock, James A.; And Others

    1980-01-01

    An advance organizer is a set of conceptual statements about the unifying ideas of a topic in terms already familiar to the learner. A study is reported that sought to determine whether two presentations of an advance organizer for a unit on pathogenic bacteria would result in increasing medical students' knowledge and ability to solve problems in…

  6. Associations of desire for change in sexual life amongst female medical students in North America

    OpenAIRE

    Shindel, AW; Breyer, BN; Smith, JF

    2013-01-01

    We analyzed associations of dissatisfaction with sexual life and desire for change in female medical students. Students enrolled in medical schools in North America between February and July 2008 were invited to participate in an internet-based survey of sexual function. The principle outcome measure was a single item question on sexual life satisfaction and desire for change. Women who reported dissatisfaction and desire for change were classified as 'sexually bothered'. The survey also asse...

  7. Learning by Living: Life-Altering Medical Education through Nursing Home-Based Experiential Learning

    Science.gov (United States)

    Gugliucci, Marilyn R.; Weiner, Audrey

    2013-01-01

    The University of New England College of Osteopathic Medicine Learning by Living Project (referred to as Learning by Living) was piloted in 2006 as an experiential medical education learning model. Since its inception, medical and other health professions students have been "admitted" into nursing homes to live the life of an older adult nursing…

  8. Life-Metaphors among Colombian Medical Students: Uncovering Core Values and Educational Implications

    Science.gov (United States)

    Hoffman, Edward; Acosta-Orozco, Catalina; Compton, William C.

    2015-01-01

    The present study utilized metaphor analysis to examine the core values of Colombian medical students. The entire 9th semester medical class of 60 students was invited to respond to a structured questionnaire. It asked participants to state their preferred life-metaphor, whether they had always preferred this metaphor since childhood or…

  9. Gaining Autonomy & [corrected] Medication Management (GAM): new perspectives on well-being, quality of life and psychiatric medication.

    Science.gov (United States)

    del Barrio, Lourdes Rodriguez; Cyr, Céline; Benisty, Lisa; Richard, Pierrette

    2013-10-01

    Autonomous Medication Management (GAM) is an innovative approach developed in partnership with medication users. It takes their subjective experience into account and strives to place the individual at the center of pharmacological treatment in psychiatry with a view to improving well-being and quality of life. It creates spaces of open dialogue on the issue of medication amongst users, physicians and their family and friends. This article is derived from a research study and presents the principles, practices and main impacts of GAM on how people relate to their medications and the physicians who prescribe them. The major positive effects were the users' clearer understanding of their experience of taking psychiatric medication and their rights, the reduction or elimination of sudden and unsupervised treatment interruptions and the users' sense of having more control over their treatment. It includes inner experience and life, an improved relationship with professionals and space for negotiation with the physician and, lastly, changes to prescriptions that significantly improved well-being and recovery. The distinguishing features of GAM are described and compared with other approaches, giving a voice to people who take medication.

  10. Impact of medical intervention on stress and quality of life in patients with cancer

    Directory of Open Access Journals (Sweden)

    Vijay Prasad Barre

    2015-01-01

    Full Text Available Context: Many studies have explored stress and quality of life in (QOL patients with cancer, under several phases of disease and treatment. However, the impact of medical intervention on psychological parameters, such as stress and quality of life focusing on psychological intervention has been sparsely studied. Aims: The main aim of the study was to examine the impact of medical intervention on the level of stress and quality of life of patients with lung, breast, and head and neck cancers. Settings and Design: The study was carried out in hospital settings by following a one-group pre-test-post-test pre-experimental design. Statistical analysis used: The quantitative data were analysed by means of descriptive statistics, paired t-tests, Cohen′s d, and bar graphs accordingly. Results: The effect of medical intervention was medium in case of reduction of overall stress in participants. So far as the components are concerned, the effect was high in case of psychosomatic complaints, medium in case of fear and information deficit, and low in case of everyday life restrictions. The effect of medical intervention in respect of the quality of life was found to be high in case of symptom scale (pain and additional symptoms (constipation; medium in case of functional scale (emotional functioning, cognitive functioning and symptoms scale (nausea, vomiting. In additional symptoms scale the effect of medical intervention was found to be medium in dyspnoea and appetite loss. Conclusions: The findings revealed that though the medical intervention reduced stress and improved the quality of life, it was not instrumental in bringing down the stress to minimal level and enhancing the quality of life to optimum level. Therefore, the findings point to the need of inclusion of psychological intervention along with the medical intervention for minimizing stress and optimizing the quality of life of patients with cancer.

  11. Advanced techniques in medical image segmentation of the liver

    OpenAIRE

    López Mir, Fernando

    2016-01-01

    [EN] Image segmentation is, along with multimodal and monomodal registration, the operation with the greatest applicability in medical image processing. There are many operations and filters, as much as applications and cases, where the segmentation of an organic tissue is the first step. The case of liver segmentation in radiological images is, after the brain, that on which the highest number of scientific publications can be found. This is due, on the one hand, to the need to continue inno...

  12. [Research advances on medical genetics in China in 2015].

    Science.gov (United States)

    Li, Yuanfeng; Han, Yubo; Cao, Pengbo; Meng, Jinfeng; Li, Haibei; Qin, Geng; Zhang, Feng; Jin, Guangfu; Yang, Yong; Wu, Lingqian; Ping, Jie; Zhou, Gangqiao

    2016-05-01

    Steady progress has been achieved in the medical genetics in China in 2015, as numerous original researches were published in the world's leading journals. Chinese scientists have made significant contributions to various fields of medical genetics, such as pathogenicity of rare diseases, predisposition of common diseases, somatic mutations of cancer, new technologies and methods, disease-related microRNAs (miRNAs), disease-related long non-coding RNAs (lncRNAs), disease-related competing endogenous RNAs (ceRNAs), disease-related RNA splicing and molecular evolution. In these fields, Chinese scientists have gradually formed the tendency, from common variants to rare variants, from single omic analyses to multipleomics integration analyses, from genetic discovery to functional confirmation, from basic research to clinical application. Meanwhile, the findings of Chinese scientists have been drawn great attentions of international peers. This review aims to provide an overall picture of the front in Chinese medical genetics, and highlights the important findings and their research strategy.

  13. A Study on Quality of Work Life among Nurses in a Medical College Hospital in Bangalore

    OpenAIRE

    Naveen Ramesh, Catherine Nisha, Andre Mary Josephine, Seena Thomas, Bobby Joseph

    2013-01-01

    Introduction: Quality of Work Life (QWL) is defined as the extent to which an employee is satisfied with personal and working needs through participating in the workplace while achieving the goals of the organization. Objectives: To assess the quality of life of nurses working in a medical college hospital in Bangalore and the factors associated with it. Methods: Ethical approval from the institution and informed consent from the study participants was obtained and quality of life que...

  14. Advanced SiC-Matrix Composites with Improved Oxidation Resistance and Life Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The objective of this proposed effort is to demonstrate the promise of advanced C/SiC and SiC/SiC composites having improved environmental durability and longer life...

  15. 75 FR 42103 - Advancing the Development of Medical Products Used In the Prevention, Diagnosis, and Treatment of...

    Science.gov (United States)

    2010-07-20

    ... HUMAN SERVICES Food and Drug Administration Advancing the Development of Medical Products Used In the... persons on issues related to advancing the development of medical products (drugs, biological products... challenges. To encourage the development of these much needed medical products, section 740 of...

  16. Medical advances in the treatment of postpartum hemorrhage.

    Science.gov (United States)

    Ducloy-Bouthors, Anne-Sophie; Susen, Sophie; Wong, Cynthia A; Butwick, Alex; Vallet, Benoit; Lockhart, Evelyn

    2014-11-01

    Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Recent advances in the management of severe bleeding for trauma patients may provide insight into PPH management, but must be applied with caution considering the significant differences between trauma and obstetric patients. In this review, we summarized evidence for current management strategies for patients with major obstetric hemorrhage, including (1) rapid laboratory assessment of coagulopathy, (2) early transfusion of plasma and high plasma-to-red blood cell transfusion ratios in massive PPH, and (3) use of tranexamic acid and fibrinogen concentrates in the setting of PPH complicated by coagulopathy.

  17. The new holism: P4 systems medicine and the medicalization of health and life itself.

    Science.gov (United States)

    Vogt, Henrik; Hofmann, Bjørn; Getz, Linn

    2016-06-01

    The emerging concept of systems medicine (or 'P4 medicine'-predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards 'precision medicine'. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call 'holistic medicalization': Each person's whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call 'the medicalization of health and life itself'. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention).

  18. Women and advancement in neuropsychology: real-life lessons learned.

    Science.gov (United States)

    Hilsabeck, Robin C; Martin, Eileen M

    2010-04-01

    The number of women in neuropsychology has been increasing over the past 20 years while the number of women in senior and leadership positions within neuropsychology has not. The field of neuropsychology has much to gain by facilitating the advancement of women into leadership roles, including access to some of the brightest and creative minds in the field. The purpose of this article is to offer practical advice about how to overcome barriers and advance within neuropsychology. Suggestions for professional organizations, women, and mentors of women are provided that will likely benefit trainees and junior colleagues regardless of their gender.

  19. Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

    Directory of Open Access Journals (Sweden)

    Sarah M. Westberg, Pharm.D.

    2010-01-01

    Full Text Available Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic.Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation.Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting.

  20. Advances in intelligent analysis of medical data and decision support systems

    CERN Document Server

    Iantovics, Barna

    2013-01-01

    This volume is a result of the fruitful and vivid discussions during the MedDecSup'2012 International Workshop bringing together a relevant body of knowledge, and new developments in the increasingly important field of medical informatics. This carefully edited book presents new ideas aimed at the development of intelligent processing of various kinds of medical information and the perfection of the contemporary computer systems for medical decision support. The book presents advances of the medical information systems for intelligent archiving, processing, analysis and search-by-content which will improve the quality of the medical services for every patient and of the global healthcare system. The book combines in a synergistic way theoretical developments with the practicability of the approaches developed and presents the last developments and achievements in  medical informatics to a broad range of readers: engineers, mathematicians, physicians, and PhD students.

  1. In-Service Aircraft Engine System Life Monitor Using Advanced Life-Estimating Technique Project

    Data.gov (United States)

    National Aeronautics and Space Administration — It is proposed to develop an accurate in-service aircraft engine life monitor system for the prediction of remaining component and system life for aircraft engines....

  2. Advanced physical-chemical life support systems research

    Science.gov (United States)

    Evanich, Peggy L.

    1988-01-01

    A proposed NASA space research and technology development program will provide adequate data for designing closed loop life support systems for long-duration manned space missions. This program, referred to as the Pathfinder Physical-Chemical Closed Loop Life Support Program, is to identify and develop critical chemical engineering technologies for the closure of air and water loops within the spacecraft, surface habitats or mobility devices. Computerized simulation can be used both as a research and management tool. Validated models will guide the selection of the best known applicable processes and in the development of new processes. For the integration of the habitat system, a biological subsystem would be introduced to provide food production and to enhance the physical-chemical life support functions on an ever-increasing basis.

  3. Recent advances in chemical evolution and the origins of life

    Science.gov (United States)

    Oro, John; Lazcano, Antonio

    1992-01-01

    Consideration is given to the ideas of Oparin and Haldane who independently suggested more than 60 years ago that the first forms of life were anaerobic, heterotrophic bacteria that emerged as the result of a long period of chemical abiotic synthesis of organic compounds. It is suggested that at least some requirements for life are met in the Galaxy due to the cosmic abundance of carbon, nitrogen, oxygen, and other biogenic elements; the existence of extraterrestrial organic compounds; and the processes of stellar and interstellar planetary formation.

  4. CURRENT SCENARIO: KNOWLEDGE OF BASIC LIFE SUPPORT IN MEDICAL COLLEGE

    Directory of Open Access Journals (Sweden)

    Asmita Chaudhary

    2011-04-01

    Full Text Available A workshop has been conducted on basic skill of Cardio-Pulmonary Resuscitation (CPR among doctors and nursing staff in medical college. Theoretical aspect was explained through power point presentation whereas practical aspect was demonstrated through skill station. The results were analyzed by using an answer key prepared from BLS manual of American Heart Association (AHA. Out of 117 participants only three participants secured 80-90% marks in pretest whereas rest of secured less than 50% marks .Post workshop assessment was done with same question papers showed 70% candidates securing more than 80%. Hence BLS workshop is essential to improve knowledge and skill of CPR. [National J of Med Res 2011; 1(2.000: 80-82

  5. Recent advances in medical device triage technologies for chemical, biological, radiological, and nuclear events.

    Science.gov (United States)

    Lansdowne, Krystal; Scully, Christopher G; Galeotti, Loriano; Schwartz, Suzanne; Marcozzi, David; Strauss, David G

    2015-06-01

    In 2010, the US Food and Drug Administration (Silver Spring, Maryland USA) created the Medical Countermeasures Initiative with the mission of development and promoting medical countermeasures that would be needed to protect the nation from identified, high-priority chemical, biological, radiological, or nuclear (CBRN) threats and emerging infectious diseases. The aim of this review was to promote regulatory science research of medical devices and to analyze how the devices can be employed in different CBRN scenarios. Triage in CBRN scenarios presents unique challenges for first responders because the effects of CBRN agents and the clinical presentations of casualties at each triage stage can vary. The uniqueness of a CBRN event can render standard patient monitoring medical device and conventional triage algorithms ineffective. Despite the challenges, there have been recent advances in CBRN triage technology that include: novel technologies; mobile medical applications ("medical apps") for CBRN disasters; electronic triage tags, such as eTriage; diagnostic field devices, such as the Joint Biological Agent Identification System; and decision support systems, such as the Chemical Hazards Emergency Medical Management Intelligent Syndromes Tool (CHEMM-IST). Further research and medical device validation can help to advance prehospital triage technology for CBRN events.

  6. The current format and ongoing advances of medical education in the United States.

    Science.gov (United States)

    Gishen, Kriya; Ovadia, Steven; Arzillo, Samantha; Avashia, Yash; Thaller, Seth R

    2014-01-01

    The objective of this study was to examine the current system of medical education along with the advances that are being made to support the demands of a changing health care system. American medical education must reform to anticipate the future needs of a changing health care system. Since the dramatic transformations to medical education that followed the publication of the Flexner report in 1910, medical education in the United States has largely remained unaltered. Today, the education of future physicians is undergoing modifications at all levels: premedical education, medical school, and residency training. Advances are being made with respect to curriculum design and content, standardized testing, and accreditation milestones. Fields such as plastic surgery are taking strides toward improving resident training as the next accreditation system is established. To promote more efficacious medical education, the American Medical Association has provided grants for innovations in education. Likewise, the Accreditation Council for Graduate Medical Education outlined 6 core competencies to standardize the educational goals of residency training. Such efforts are likely to improve the education of future physicians so that they are able to meet the future needs of American health care.

  7. Advancing life cycle economics in the Nordic countries

    DEFF Research Database (Denmark)

    Haugbølle, Kim; Hansen, Ernst Jan de Place

    2005-01-01

    that the configuration of the roles as client, owner and user is indicative of a client's interest in life cycle economics. Second, a proposal for a common Nordic cost classification was put forward. Third, it was argued that there is a strong need to develop tools and methodologies to depict the cost/value ratio...

  8. Life prediction of advanced materials for gas turbine application

    Energy Technology Data Exchange (ETDEWEB)

    Zamrik, S.Y.; Ray, A.; Koss, D.A.

    1995-12-31

    Emphasis is placed on life characterization based on low cycle fatigue under isothermal conditions and thermomechanical fatigue. Microstructure of failed coated and uncoated specimens is being analyzed. IN 738 LC is the material; the coating is either overlay (NiCoCrAly) or NiAl-based aluminide.

  9. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

    Science.gov (United States)

    Coffey, Alice; McCarthy, Geraldine; Weathers, Elizabeth; Friedman, M Isabel; Gallo, Katherine; Ehrenfeld, Mally; Chan, Sophia; Li, William H C; Poletti, Piera; Zanotti, Renzo; Molloy, D William; McGlade, Ciara; Fitzpatrick, Joyce J; Itzhaki, Michal

    2016-06-01

    Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

  10. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

    LENUS (Irish Health Repository)

    Coffey, Alice

    2016-01-28

    Nurses\\' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses\\' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients\\' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

  11. The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians

    Directory of Open Access Journals (Sweden)

    Schopper Andrea

    2010-10-01

    Full Text Available Abstract Background Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation. In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008. Methods Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. Results There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. Conclusion A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

  12. Advancing Primary Care Use of Electronic Medical Records in Canada

    Directory of Open Access Journals (Sweden)

    Jennifer Zelmer

    2014-10-01

    Full Text Available In 2010, the federal government's Economic Action Plan funded Canada Health Infoway to co-invest with provinces, territories, and health care providers in electronic medical records (EMRs in primary care. The goal is to help improve access to care, quality of health services, and productivity of the health system, as well as to deliver economic benefits. The decision to fund EMRs was consistent with a long-term framework for digital health established in consultation with stakeholders across the country, spurred by analysis demonstrating the economic impact of such investments and data on Canada's low rate of EMR use in primary care compared with other countries. The decision reflected widespread public and stakeholder consensus regarding the importance of such investments. EMR adoption has more than doubled since 2006, with evaluations identifying efficiency and patient care benefits (e.g., reduced time managing laboratory test results and fewer adverse drug events in community-based practices. These benefits are expected to rise further as EMR adoption continues to grow and practices gain more experience with their use.

  13. Student-Life Stress Level and its Related Factors among Medical Students of Hamadan University of Medical Sciences in 2015

    Directory of Open Access Journals (Sweden)

    Roya Nikanjam

    2016-03-01

    Full Text Available Background and Objectives: Student-life stress can lead to various negative consequences such as physical illness, mental disorders or exhaustion. The present study was conducted to evaluate the level of student life stress and its related factors among medical students of Hamadan University of Medical Sciences. Materials and Methods: This cross-sectional study applied multistage random sampling to select 500university students at Hamadan University of Medical Sciences during 2015. The data collection tool used in this study was a self-report questionnaire containing two parts: a section on subjects' demographic details and another section for Student-Life Stress Inventory (SLSI. Data were analyzed in SPSS20-using descriptive and inferential statistics, such as independent t-test, Pearson’s correlation test and one-way ANOVA. Results: This study revealed that %57of the students had moderate levels of stress. The most important stressors included self-impose and pressure, and also the most important reactions to stressors included cognitive appraisal and emotional reactions, respectively. There was a significant association between exam stressors and branch, educational level, and mother's and father's education level (P< 0.05. Conclusions: According to the high level of stress in students and the recognition of demographic factors, effective educational interventions can be conducted to reduce stress.

  14. Advances in wearable technology and its medical applications.

    Science.gov (United States)

    Bonato, Paolo

    2010-01-01

    The concept of monitoring individuals in the home and community settings was introduced more than 50 years ago, when Holter monitoring was proposed (in the late 1940s) and later adopted (in the 1960s) as a clinical tool. However, technologies to fully enable such vision were lacking and only sporadic and rather obtrusive monitoring techniques were available for several decades. Over the past decade, we have witnessed a great deal of progress in the field of wearable sensors and systems. Advances in this field have finally provided the tools to implement and deploy technology with the capabilities required by researchers in the field of patients' home monitoring. These technologies provide the tools to achieve early diagnosis of diseases such as congestive heart failure, prevention of chronic conditions such as diabetes, improved clinical management of neurodegenerative conditions such as Parkinson's disease, and the ability to promptly respond to emergency situations such as seizures in patients with epilepsy and cardiac arrest in subjects undergoing cardiovascular monitoring. Current research efforts are focused on the development of systems enabling clinical applications. The current focus on developing and deploying wearable systems targeting specific clinical applications has the potential of leading to clinical adoption within the next five to ten years.

  15. Advanced illumination control algorithm for medical endoscopy applications

    Science.gov (United States)

    Sousa, Ricardo M.; Wäny, Martin; Santos, Pedro; Morgado-Dias, F.

    2015-05-01

    CMOS image sensor manufacturer, AWAIBA, is providing the world's smallest digital camera modules to the world market for minimally invasive surgery and one time use endoscopic equipment. Based on the world's smallest digital camera head and the evaluation board provided to it, the aim of this paper is to demonstrate an advanced fast response dynamic control algorithm of the illumination LED source coupled to the camera head, over the LED drivers embedded on the evaluation board. Cost efficient and small size endoscopic camera modules nowadays embed minimal size image sensors capable of not only adjusting gain and exposure time but also LED illumination with adjustable illumination power. The LED illumination power has to be dynamically adjusted while navigating the endoscope over changing illumination conditions of several orders of magnitude within fractions of the second to guarantee a smooth viewing experience. The algorithm is centered on the pixel analysis of selected ROIs enabling it to dynamically adjust the illumination intensity based on the measured pixel saturation level. The control core was developed in VHDL and tested in a laboratory environment over changing light conditions. The obtained results show that it is capable of achieving correction speeds under 1 s while maintaining a static error below 3% relative to the total number of pixels on the image. The result of this work will allow the integration of millimeter sized high brightness LED sources on minimal form factor cameras enabling its use in endoscopic surgical robotic or micro invasive surgery.

  16. Metaphors and medication: understanding medication use by seniors in everyday life.

    Science.gov (United States)

    Beuthin, Rosanne E; Holroyd, Ann; Stephenson, Peter H; Vegsund, Britt

    2012-09-01

    The purpose of this study was to explore the use of metaphor by independent seniors taking medication for chronic health conditions. Narratives from a larger study using grounded theory were analyzed using constant comparative analysis and induction. A secondary analysis of the narratives of 21 participants was undertaken. Transcripts were read line-by-line and all relevant language was highlighted and reviewed with the aim of identifying relationships and themes. The narratives revealed a diverse range of metaphoric language. Four categories were identified: being shackled, hope, external authority, and communication fears. Three additional themes were interwoven into the narratives: aging and death, medication personified, and the body as object. The authors conclude that metaphor reveals the tension and unresolved dilemmas faced by seniors with regard to medication use.

  17. Life prediction of advanced materials for gas turbine application

    Energy Technology Data Exchange (ETDEWEB)

    Zamrik, S.Y.; Ray, A.; Koss, D.A. [Pennsylvania State Univ., University Park, PA (United States)

    1995-10-01

    Most of the studies on the low cycle fatigue life prediction have been reported under isothermal conditions where the deformation of the material is strain dependent. In the development of gas turbines, components such as blades and vanes are exposed to temperature variations in addition to strain cycling. As a result, the deformation process becomes temperature and strain dependent. Therefore, the life of the component becomes sensitive to temperature-strain cycling which produces a process known as {open_quotes}thermomechanical fatigue, or TMF{close_quotes}. The TMF fatigue failure phenomenon has been modeled using conventional fatigue life prediction methods, which are not sufficiently accurate to quantitatively establish an allowable design procedure. To add to the complexity of TMF life prediction, blade and vane substrates are normally coated with aluminide, overlay or thermal barrier type coatings (TBC) where the durability of the component is dominated by the coating/substrate constitutive response and by the fatigue behavior of the coating. A number of issues arise from TMF depending on the type of temperature/strain phase cycle: (1) time-dependent inelastic behavior can significantly affect the stress response. For example, creep relaxation during a tensile or compressive loading at elevated temperatures leads to a progressive increase in the mean stress level under cyclic loading. (2) the mismatch in elastic and thermal expansion properties between the coating and the substrate can lead to significant deviations in the coating stress levels due to changes in the elastic modulii. (3) the {open_quotes}dry{close_quotes} corrosion resistance coatings applied to the substrate may act as primary crack initiation sites. Crack initiation in the coating is a function of the coating composition, its mechanical properties, creep relaxation behavior, thermal strain range and the strain/temperature phase relationship.

  18. Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Tony [University of Newcastle Department of Rural Health, Taree, New South Wales (Australia); Harris, Jillian [Crown Princess Mary Cancer Centre, Westmead, Sydney, New South Wales (Australia); Woznitza, Nick [Homerton University Hospital and School of Allied Health Professions, Canterbury Christ Church University, Canterbury (Australia); Maresse, Sharon [Department of Imaging and Applied Physics, Curtin University, Perth, Western Australia (Australia); Sale, Charlotte [School of Medical Science, RMIT University, Melbourne, Victoria (Australia); University of Newcastle Department of Rural Health, Taree, New South Wales (Australia)

    2015-09-15

    Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.

  19. Advance in Etiopathogenesis of Narcolepsy%Medical Recapitulate

    Institute of Scientific and Technical Information of China (English)

    郝茂林; 郝苗清(综述); 杜怡峰(审校)

    2016-01-01

    Narcolepsy is a chronic lifelong sleep disorder and it often leaves a debilitating effect on the quality of life of the sufferer.This disorder is characterized by a tetrad of excessive daytime sleepiness ,cata-plexy,hypnogogic hallucinations and sleep paralysis.For over 100 years,clinicians have recognized narcolepsy, but only in the last few decades have scientists been able to shed light on the true cause and pathogenesis of narcolepsy.In the majority of subjects,typeⅠnarcolepsy is caused by autoimmune-mediated loss of hypocre-tin-secreting neurons in genetically predisposed individuals.The basic neural mechanisms behind sleepiness and cataplexy,the two defining symptoms of narcolepsy have started to become clearer .The pathophysiology of type Ⅱ narcolepsy is less well understood.%发作性睡病是一种慢性睡眠障碍性疾病,严重影响患者的生活质量。其临床症状包括日间过度睡眠、猝倒发作、睡前幻觉和睡眠瘫痪等。自该病发现至今已有100多年,但近年科学家才阐明其发病机制。Ⅰ型发作性睡病是由易患个体经免疫介导下视丘分泌素神经元丢失造成的;猝倒发作和过度睡眠的神经机制也越来越清晰,而Ⅱ型发作性睡病的发病机制尚不清楚。

  20. Globular Clusters as Cradles of Life and Advanced Civilizations

    Science.gov (United States)

    Di Stefano, R.; Ray, A.

    2016-08-01

    Globular clusters are ancient stellar populations in compact dense ellipsoids. There is no star formation and there are no core-collapse supernovae, but several lines of evidence suggest that globular clusters are rich in planets. If so, and if advanced civilizations can develop there, then the distances between these civilizations and other stars would be far smaller than typical distances between stars in the Galactic disk, facilitating interstellar communication and travel. The potent combination of long-term stability and high stellar densities provides a globular cluster opportunity. Yet the very proximity that promotes interstellar travel also brings danger, as stellar interactions can destroy planetary systems. We find, however, that large portions of many globular clusters are “sweet spots,” where habitable-zone planetary orbits are stable for long times. Globular clusters in our own and other galaxies are, therefore, among the best targets for searches for extraterrestrial intelligence (SETI). We use the Drake equation to compare the likelihood of advanced civilizations in globular clusters to that in the Galactic disk. We also consider free-floating planets, since wide-orbit planets can be ejected to travel through the cluster. Civilizations spawned in globular clusters may be able to establish self-sustaining outposts, reducing the probability that a single catastrophic event will destroy the civilization. Although individual civilizations may follow different evolutionary paths, or even be destroyed, the cluster may continue to host advanced civilizations once a small number have jumped across interstellar space. Civilizations residing in globular clusters could therefore, in a sense, be immortal.

  1. Life cycle assessment of advanced waste water treatment

    DEFF Research Database (Denmark)

    Larsen, Henrik Fred; Hansen, Peter Augusto

    The EU FP6 NEPTUNE project is related to the EU Water Framework Directive and the main goal is to develop new and optimize existing waste water treatment technologies (WWTT) and sludge handling methods for municipal waste water. Besides nutrients, a special focus area is micropollutants (e....... In total more that 20 different waste water and sludge treatment technologies are to be assessed. This paper will present the preliminary LCA results from running the induced versus avoided impact approach (mainly based on existing LCIA methodology) on one of the advanced treatment technologies, i...

  2. Medical advances in the treatment of congestive heart failure.

    Science.gov (United States)

    Armstrong, P W; Moe, G W

    1993-12-01

    The increased incidence and prevalence of congestive heart failure place a high priority on novel treatment strategies. Left ventricular ejection fraction remains the single most valuable measurement providing both diagnostic and prognostic insights. The most systematic approach to heart failure involves an objective assessment of functional disability, to include exercise tests such as a 6-minute walk under standardized conditions. Left ventricular dysfunction incites a host of neurohumoral compensations that are of fundamental importance in the heart failure syndrome expression. Both vasoconstrictor and vasodilator neurohormones are stimulated and provide new therapeutic opportunities. The therapeutic approach to heart failure begins with a strong emphasis on prevention, patient education, and self-participation in therapy with respect to both its monitoring and adjustment. Diuretics remain a mainstay of therapy but, in the face of severe heart failure, may become ineffectual, requiring constant infusion of loop-active diuretics, combination diuretics, or diuretics in association with concomitant low-dose dopamine infusion. Vasodilator therapy has been an important advance: combination hydralazine and nitrate therapy was initially shown to be efficacious in improving survival, and more recently, angiotensin-converting enzyme (ACE) inhibitors, in the form of enalapril, have shown incremental benefit on survival over this combination. Interestingly, there is now evidence from both SOLVD and SAVE to demonstrate an unexpected and, as yet, unexplained reduction in the frequency of both unstable angina and myocardial infarction. Although, on balance, the weight of evidence concerning the long-term efficacy of inotropic agents has been disappointing, especially as it relates to their unfavorable effects on survival, recent information on vesnarinone, an agent with a complex and diversified mechanism of action, suggests that with appropriate doses, improved symptoms and

  3. [G. W. Leibniz: medicine and the sciences of life. Ist part: Leibniz as a "medical practioner].

    Science.gov (United States)

    Chazaud, J

    1995-01-01

    A universal thinker, Leibniz always expressed a marked interest for matters of life. A reader and a correspondent of the most famous physicians of his time, he exhorted them - with some results - to found their theories on the ground of detailed comparative observations and of verified experiments, firmly distinguishing scientific and metaphysic points of view. He worked out a primal organismic theory, but devoted himself mostly to set up a coherent medical training programme and a requiring health policy. Nevertheless, beyond anecdote, Leibniz never pretended to be a medical practioner, but thought he was a "medically-minded" philosopher.

  4. Aspects of communication in medical life. Doctor-patient communication: differentiation and customization

    Science.gov (United States)

    Borţun, D; Matei, CS

    2017-01-01

    One of the weaknesses of the Romanian medical system is the absence of the communicational culture. This absence is felt at all levels of the healthcare system: doctor-patient relationship, doctor-patient’s relatives relationship, labor relations within the medical teams and units, the management of the large hospitals and of the medical institutions from the public administration system and last, but not least, the relationships of these units and institutions with the public opinion and, particularly, with the stakeholders. This paper tackled with some of the principles and values that underlie an efficient communication, the default of which was felt in various domains of the Romanian medical life. They were analyzed from the perspective of the Romanian and international literature and the conclusions drawn might inspire proposals for the improvement of the medical education as well as for the professional development of the Romanian doctors.

  5. Globular Clusters as Cradles of Life and Advanced Civilizations

    CERN Document Server

    Di Stefano, R

    2016-01-01

    Globular clusters are ancient stellar populations with no star formation or core-collapse supernovae. Several lines of evidence suggest that globular clusters are rich in planets. If so, and if advanced civilizations can develop there, then the distances between these civilizations and other stars would be far smaller than typical distances between stars in the Galactic disk. The relative proximity would facilitate interstellar communication and travel. However, the very proximity that promotes interstellar travel also brings danger, since stellar interactions can destroy planetary systems. However, by modeling globular clusters and their stellar populations, we find that large regions of many globular clusters can be thought of as "sweet spots" where habitable-zone planetary orbits can be stable for long times. We also compute the ambient densities and fluxes in the regions within which habitable-zone planets can survive. Globular clusters are among the best targets for searches for extraterrestrial intellig...

  6. Radiation Protection in Medical Physics : Proceedings of the NATO Advanced Study Institute on Radiation Protection in Medical Physics Activities

    CERN Document Server

    Lemoigne, Yves

    2011-01-01

    This book introduces the fundamental aspects of Radiation Protection in Medical Physics and covers three main themes: General Radiation Protection Principles; Radiobiology Principles; Radiation Protection in Hospital Medical Physics. Each of these topics is developed by analysing the underlying physics principles and their implementation, quality and safety aspects, clinical performance and recent advances in the field. Some issues specific to the individual techniques are also treated, e.g. calculation of patient dose as well as that of workers in hospital, optimisation of equipment used, shielding design of radiation facilities, radiation in oncology such as use of brachytherapy in gynecology or interventional procedures. All topics are presented with didactical language and style, making this book an appropriate reference for students and professionals seeking a comprehensive introduction to the field as well as a reliable overview of the most recent developments.

  7. Effects of Socio-Demographic, Personality and Medical Factors on Quality of Life of Postmenopausal Women

    Science.gov (United States)

    Wieder-Huszla, Sylwia; Szkup, Małgorzata; Jurczak, Anna; Samochowiec, Agnieszka; Samochowiec, Jerzy; Stanisławska, Marzanna; Rotter, Iwona; Karakiewicz, Beata; Grochans, Elżbieta

    2014-01-01

    Numerous studies show that changes occurring in a woman’s organism during menopause may lower her quality of life. This study involved 630 healthy postmenopausal women from Poland. Its purpose was to assess their quality of life in relation to socio-demographic variables, medical data and personality profiles. The authors used the Short Form Health Survey (SF-36) to assess quality of life, the NEO-Five Factor Inventory to measure personality traits, and the Blatt-Kupperman Menopausal Index to estimate severity of climacteric symptoms. The study demonstrated significant relationships between quality of life and variables such as: age, education, employment status, and the use of menopausal hormone therapy. An analysis of personality traits revealed correlations between the openness to experience scores and the quality of life within physical functioning, vitality, and mental health. Neuroticism, agreeableness and extroversion significantly correlated with all quality of life domains. Conclusions: (1) Age, education and employment status have significant effects on the selected quality of life domains after menopause. (2) Quality of life within the general health domain was assessed lower by MHT-users (Menopausal hormone theraphy (MHT)). (3) Health-related quality of life is also influenced by personality traits, which are relatively stable throughout life. PMID:24972032

  8. Effects of Socio-Demographic, Personality and Medical Factors on Quality of Life of Postmenopausal Women

    Directory of Open Access Journals (Sweden)

    Sylwia Wieder-Huszla

    2014-06-01

    Full Text Available Numerous studies show that changes occurring in a woman’s organism during menopause may lower her quality of life. This study involved 630 healthy postmenopausal women from Poland. Its purpose was to assess their quality of life in relation to socio-demographic variables, medical data and personality profiles. The authors used the Short Form Health Survey (SF-36 to assess quality of life, the NEO-Five Factor Inventory to measure personality traits, and the Blatt-Kupperman Menopausal Index to estimate severity of climacteric symptoms. The study demonstrated significant relationships between quality of life and variables such as: age, education, employment status, and the use of menopausal hormone therapy. An analysis of personality traits revealed correlations between the openness to experience scores and the quality of life within physical functioning, vitality, and mental health. Neuroticism, agreeableness and extroversion significantly correlated with all quality of life domains. Conclusions: (1 Age, education and employment status have significant effects on the selected quality of life domains after menopause. (2 Quality of life within the general health domain was assessed lower by MHT-users (Menopausal hormone theraphy (MHT. (3 Health-related quality of life is also influenced by personality traits, which are relatively stable throughout life.

  9. Care at the End of Life: A Novel Curriculum Module Implemented by Medical Students.

    Science.gov (United States)

    Magnani, Jared W.; Minor, Melissa A.; Aldrich, Jon Matthew

    2002-01-01

    Describes the development, implementation, and evaluation of a curriculum module on end-of-life care developed by medical students and implemented at Stanford University School of Medicine. The curriculum teaches students a protocol for communicating with patients when breaking bad news and discussing treatment options. (EV)

  10. Quality of Work-Life Programs in U.S. Medical Schools: Review and Case Studies

    Science.gov (United States)

    Otto, Ann; Bourguet, Claire

    2006-01-01

    Quality of work life is being recognized more and more as a driving factor in the recruitment and retention of highly qualified employees. Before Northeastern Ohio Universities College of Medicine began development of its QWL initiative, it surveyed other medical schools across the U.S. to determine benchmarks of best practices in these programs.…

  11. [Development and Hosting of a Perioperative Advanced Life Support Training Course for Anesthesiologists].

    Science.gov (United States)

    Komasawa, Nobuyasu; Fujiwara, Shunsuke; Haba, Masanori; Ueshima, Hironobu; Okada, Daisuke; Minami, Toshiaki

    2015-05-01

    Participation in the American Heart Association advanced cardiac life support provider course is a prerequisite for taking the anesthesiology specialist examination in Japan. The course teaches fundamental resuscitation methods for different types of cardiac arrest. However, crisis in the perioperative period can result from airway trouble, central venous catheter displacement, or massive hemorrhage. We report our experience of holding a problem- and learning-based perioperative advanced life support training course, Advanced Life Support for Operation (ALS-OP). Main contents of the course included circulation management, airway management central venous catheters, and pain clinic-related complications. ALS-OP simulation training may be beneficial for educating anesthesiologist and promoting perioperative patient safety.

  12. Advancing Integrated Systems Modelling Framework for Life Cycle Sustainability Assessment

    Directory of Open Access Journals (Sweden)

    Anthony Halog

    2011-02-01

    Full Text Available The need for integrated methodological framework for sustainability assessment has been widely discussed and is urgent due to increasingly complex environmental system problems. These problems have impacts on ecosystems and human well-being which represent a threat to economic performance of countries and corporations. Integrated assessment crosses issues; spans spatial and temporal scales; looks forward and backward; and incorporates multi-stakeholder inputs. This study aims to develop an integrated methodology by capitalizing the complementary strengths of different methods used by industrial ecologists and biophysical economists. The computational methodology proposed here is systems perspective, integrative, and holistic approach for sustainability assessment which attempts to link basic science and technology to policy formulation. The framework adopts life cycle thinking methods—LCA, LCC, and SLCA; stakeholders analysis supported by multi-criteria decision analysis (MCDA; and dynamic system modelling. Following Pareto principle, the critical sustainability criteria, indicators and metrics (i.e., hotspots can be identified and further modelled using system dynamics or agent based modelling and improved by data envelopment analysis (DEA and sustainability network theory (SNT. The framework is being applied to development of biofuel supply chain networks. The framework can provide new ways of integrating knowledge across the divides between social and natural sciences as well as between critical and problem-solving research.

  13. [Medicalization of life at the GP level: Where are we headed to?].

    Science.gov (United States)

    Cerecedo Pérez, M Jesús; Tovar Bobo, Margarita; Rozadilla Arias, Aurora

    2013-12-01

    The power of medicine has lately enhanced the idea of medicalizing any aspects of life that can be perceived as medical problems. Medicine sometimes creates false needs and there is nowadays an increasing number of situations are medicalized with the pretext of treating fake diseases such as spring fatigue, shyness o natural biological processes like menopause. Despite the better life conditions, we now attend more people that complain about discomfort that may have more to do with «feeling sick» than with authentic disease. There is an endless list: sadness, hyperactive children, anorexia, bulimia, vigorexia or problematic teenagers, amongst others. In this article we revise some interventions that, contribute to promote these situations also from the own doctor's office. Everyday adversity acquires today the status of disease, hence the remarkable increase in these consultations in the diverse sanitary services.

  14. [Risk factor calculator for medical underwriting of life insurers based on the PROCAM study].

    Science.gov (United States)

    Geritse, A; Müller, G; Trompetter, T; Schulte, H; Assmann, G

    2008-06-01

    For its electronic manual GEM, used to perform medical risk assessment in life insurance, SCOR Global Life Germany has developed an innovative and evidence-based calculator of the mortality risk depending on cardiovascular risk factors. The calculator contains several new findings regarding medical underwriting, which were gained from the analysis of the PROCAM (Prospective Cardiovascular Münster) study. For instance, in the overall consideration of all risk factors of a medically examined applicant, BMI is not an independent risk factor. Further, given sufficient information, the total extra mortality of a person no longer results from adding up the ratings for the single risk factors. In fact, this new approach of risk assessment considers the interdependencies between the different risk factors. The new calculator is expected to improve risk selection and standard acceptances will probably increase.

  15. Quality of life of medical students in China: a study using the WHOQOL-BREF.

    Directory of Open Access Journals (Sweden)

    Yang Zhang

    Full Text Available OBJECTIVE: The aim of this study was to assess the quality of life (QOL of medical students during their medical education and explore the influencing factors of the QOL of students. METHODS: A cross-sectional study was conducted in June 2011. The study population was composed of 1686 medical students in years 1 to 5 at China Medical University. The Chinese version of WHOQOL-BREF instrument was used to assess the QOL of medical students. The reliability and validity of the questionnaire were assessed by Cronbach's α coefficient and factor analysis respectively. The relationships between QOL and the factors including gender, academic year level, and specialty were examined using t-test or one-way ANOVA followed by Student-Newman-Keuls test. Statistic analysis was performed by SPSS 13.0. RESULTS: The overall Cronbach's α coefficient of the WHOQOL-BREF questionnaire was 0.731. The confirmatory factor analysis provided an acceptable fit to a four-factor model in the medical student sample. The scores of different academic years were significantly different in the psychological health and social relations domains (p<0.05. Third year students had the lowest scores in psychological health and social relations domains. The scores of different specialties had significant differences in psychological health and social relations domains (p<0.05. Students from clinical medicine had the highest scores. Gender, interest in the area of study, confidence in career development, hometown location, and physical exercise were significantly associated with the quality of life of students in some domains (p<0.05. CONCLUSIONS: The WHOQOL-BREF was reliable and valid in the assessment of the QOL of Chinese medical students. In order to cope with the influencing factors of the QOL, medical schools should carry out curriculum innovation and give the necessary support for medical students, especially for 3(rd year students.

  16. DAWN (Design Assistant Workstation) for advanced physical-chemical life support systems

    Science.gov (United States)

    Rudokas, Mary R.; Cantwell, Elizabeth R.; Robinson, Peter I.; Shenk, Timothy W.

    1989-01-01

    This paper reports the results of a project supported by the National Aeronautics and Space Administration, Office of Aeronautics and Space Technology (NASA-OAST) under the Advanced Life Support Development Program. It is an initial attempt to integrate artificial intelligence techniques (via expert systems) with conventional quantitative modeling tools for advanced physical-chemical life support systems. The addition of artificial intelligence techniques will assist the designer in the definition and simulation of loosely/well-defined life support processes/problems as well as assist in the capture of design knowledge, both quantitative and qualitative. Expert system and conventional modeling tools are integrated to provide a design workstation that assists the engineer/scientist in creating, evaluating, documenting and optimizing physical-chemical life support systems for short-term and extended duration missions.

  17. Characteristics of Prison Hospice Patients: Medical History, Hospice Care, and End-of-Life Symptom Prevalence.

    Science.gov (United States)

    Cloyes, Kristin G; Berry, Patricia H; Martz, Kim; Supiano, Katherine

    2015-07-01

    Increasing numbers of prisoners in the United States are dying from age-related and chronic illnesses while incarcerated. This study is among the first to document characteristics of a population of prison hospice patients. Retrospective review of medical records for all patients admitted to the Louisiana State Penitentiary prison hospice program between January 1, 2004, and May 31, 2012 (N = 79) examined demographics, medical history, hospice diagnosis, length of stay, and end-of-life symptom prevalence on admission and during final 72 hours before death. Resulting data were contrasted with community-based end-of-life care study data, demonstrating a unique clinical profile of this group. As prisons consider adopting programs to meet the growing need for inmate end-of-life care, more research concerning the particular characteristics and unique needs of prison hospice patients will inform these efforts.

  18. Advances in Medical Management of Early Stage and Advanced Breast Cancer: 2015.

    Science.gov (United States)

    Witherby, Sabrina; Rizack, Tina; Sakr, Bachir J; Legare, Robert D; Sikov, William M

    2016-01-01

    Standard management of early stage and advanced breast cancer has been improved over the past few years by knowledge gained about the biology of the disease, results from a number of eagerly anticipated clinical trials and the development of novel agents that offer our patients options for improved outcomes or reduced toxicity or both. This review highlights recent major developments affecting the systemic therapy of breast cancer, broken down by clinically relevant patient subgroups and disease stage, and briefly discusses some of the ongoing controversies in the treatment of breast cancer and promising therapies on the horizon.

  19. Attributes of advanced practice registered nurse care coordination for children with medical complexity.

    Science.gov (United States)

    Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M; Looman, Wendy S; Garwick, Ann W

    2014-01-01

    Care coordination is an essential component of the pediatric health care home. This study investigated the attributes of relationship-based advanced practice registered nurse care coordination for children with medical complexity enrolled in a tertiary hospital-based health care home. Retrospective review of 2,628 care coordination episodes conducted by telehealth over a consecutive 3-year time period for 27 children indicated that parents initiated the majority of episodes and the most frequent reason was acute and chronic condition management. During this period, care coordination episodes tripled, with a significant increase (p care coordination model has potential for changing the health management processes for children with medical complexity.

  20. Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

    Science.gov (United States)

    Mazutti, Sandra Regina Gonzaga; Nascimento, Andréia de Fátima; Fumis, Renata Rego Lins

    2016-01-01

    Objective To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. Methods This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. Results A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. Conclusion The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means. PMID:27626949

  1. 41 CFR 102-36.460 - Do we report excess medical shelf-life items held for national emergency purposes?

    Science.gov (United States)

    2010-07-01

    ... items held for national emergency purposes? When the remaining shelf life of any medical materials or supplies held for national emergency purposes is of too short a period to justify their continued retention... medical shelf-life items held for national emergency purposes? 102-36.460 Section 102-36.460...

  2. A workshop to teach medical students communication skills and clinical knowledge about end-of-life care.

    Science.gov (United States)

    Torke, Alexia M; Quest, Tammie E; Kinlaw, Kathy; Eley, J William; Branch, William T

    2004-05-01

    We describe a half-day workshop to teach third-year medical students three focused end-of-life care skills: breaking bad news, discussing advance directives, and assessing and managing pain. Our workshop included a readers' theater exercise and three role-play exercises. In two of the workshops, faculty members played the role of patients. We used readers' theater to engage the students on an emotional level and set a reflective tone for the workshop. Evaluations reflected that most respondents felt that the workshop enhanced their understanding and ability to address these skills with patients. By 6 months, many students reported applying these skills to patient care in a way they thought was effective.

  3. Comparison of severe trauma care effect before and after advanced trauma life support training

    Institute of Scientific and Technical Information of China (English)

    WANG Peng; LI Neng-ping; GU Yong-feng; LU Xiao-bing; CONG Jian-nong; YANG Xin; LING Yun

    2010-01-01

    Objective: To study the emergency care effect of in-hospital severe trauma patients with the injury severity score (ISS)≥ 16 after medical staff received advanced trauma life support (ATLS) training.Methods: ATLS training was implemented by lectures,scenarios, field practices, and examinations. The clinical effect of in-hospital severe trauma care was compared 2 years before and after ATLS training.Results: During 2 years (from January 1, 2004, to December 31, 2005) before ATLS training, 438 cases of severe trauma were admitted and treated emergently in our department. Among them, ISS score was 28.6±7.8 on average, and 87 cases died with the mortality of 19.9%. The duration in emergency department and from admission to operation were 69.5 min±l 1.5 min and 89.6 min±9.3 min respectively. Two years (from January 1,2007, to December 31, 2008) after ATLS training, 382 cases of severe trauma were admitted and treated. The ISS was 25.3 ±6.1 on average and 62 cases died with the mortality of 15.1%. The duration in emergency department and from admission to operation were 47.8 min±10.7 min and 61.5 min±9.9 min respectively. The ISS score showed no significant difference between the two groups (P>0.05), but the mortality, the duration in emergency department and from admission to operation were markedly decreased after ATLS training and showed significant difference between the two groups (P<0.05).Conclusion: ATLS course training can improve the emergency care effect of in-hospital severe trauma patients,and should be put into practice as soon as possible in China.

  4. Transition to life--a sendoff to the real world for graduating medical students.

    Science.gov (United States)

    Coates, Wendy C; Spector, Tahlia S; Uijtdehaage, Sebastian

    2012-01-01

    Graduating medical students will enter the workforce, often for the first time. Many have spent the past 20 years as students, receiving financial support from parents, and have not managed real-life issues such as financial planning, real estate, balancing well-being with employment, and integrating into a new community with stressful working conditions. To address a perceived need, we designed an intervention to introduce graduating medical students to financial planning, real estate choices, physician wellness during relocation/internship, and traits of efficient interns. The objectives of this study are to (a) assess baseline experience, knowledge, and comfort of seniors about "real-life" experiences, and (b) assess the efficacy of a 4-hr educational intervention on perceptions of understanding financial planning, real estate choices, intern preparedness, and physician wellness. Acute Care College seniors (classes of 2009 and 2010) attended the intervention after match day and completed a survey to gather demographic data and assess preexisting knowledge and a postintervention survey (1-7 Likert scale). Forty-nine students (45% male; M age = 25.5 years) participated. Prior experiences: 43% no break in education, 51% no full-time job, 38% never signed a rental lease and 94% had not purchased real estate, 90% did not have (or were not aware of having) disability insurance, and 82% had educational debt exceeding $50,000. Following the workshop, students felt more confident in their understanding of life skills topics (real estate, 83%; financial planning, 94%; well-being, 86%). Our workshop assisted in preparing for life after medical school for 98% of the participants. Graduating medical students can gain knowledge about real-life responsibilities and confidence during an educational session prior to starting residency.

  5. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

    Directory of Open Access Journals (Sweden)

    Leppert W

    2014-05-01

    Full Text Available Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL in cancer patients treated at home, at an in-patient palliative care unit (PCU, and at a day care center (DCC. Patients and methods: QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL, the Edmonton Symptom Assessment System (ESAS, and the Karnofsky Performance Status (KPS scale. Results: A total of 129 patients completed the study, with 51 patients treated at home, 51 patients treated at the PCU, and 27 patients at DCC. In the EORTC QLQ-C15-PAL, improvement in functional and symptom scales was observed except in physical functioning and fatigue levels; patients at DCC had a better physical functioning, global QoL, appetite, and fatigue levels. In the ESAS, improvement in all items was found except for drowsiness levels, which was stable in patients treated at DCC and deteriorated in home and PCU patients. Higher activity, better appetite and well-being, and less drowsiness were observed in patients treated at DCC. KPS was better in DCC patients compared to those treated at home and at the PCU; the latter group deteriorated. Conclusions: QoL improved in all patient groups, with better results in DCC patients and similar scores in those staying at home and at the PCU. Along with clinical assessment, baseline age, KPS, physical and emotional functioning may be considered when assigning patients to care at a DCC, PCU, or at home. Keywords: oncology, patient care

  6. Advanced Trauma Life Support. ABCDE from a radiological point of view.

    NARCIS (Netherlands)

    Kool, D.R.; Blickman, J.G.

    2007-01-01

    Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support(R) (ATLS) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS, and we will discuss discrepancies with

  7. Microbial detection and monitoring in advanced life support systems like the international space station

    NARCIS (Netherlands)

    van Tongeren, Sandra P.; Krooneman, Janneke; Raangs, Gerwin C.; Welling, Gjalt W.; Harmsen, Hermie J. M.

    2007-01-01

    Potentially pathogenic microbes and so-called technophiles may form a serious threat in advanced life support systems, such as the International Space Station (ISS). They not only pose a threat to the health of the crew, but also to the technical equipment and materials of the space station. The dev

  8. Microbial detection and monitoring in advanced life support systems like the International Space Station

    NARCIS (Netherlands)

    van Tongeren, Sandra P.; Krooneman, Janneke; Raangs, Gerwin C.; Welling, Gjalt W.; Harmsen, Hermie J. M.

    2006-01-01

    Potentially pathogenic microbes and so-called technophiles may form a serious threat in advanced life support systems, such as the International Space Station (ISS). They not only pose a threat to the health of the crew, but also to the technical equipment and materials of the space station. The dev

  9. Life satisfaction and resilience in medical school – a six-year longitudinal, nationwide and comparative study

    Directory of Open Access Journals (Sweden)

    Gronvold Nina T

    2006-09-01

    Full Text Available Abstract Background This study examined the relationship between life satisfaction among medical students and a basic model of personality, stress and coping. Previous studies have shown relatively high levels of distress, such as symptoms of depression and suicidal thoughts in medical undergraduates. However despite the increased focus on positive psychological health and well-being during the past decades, only a few studies have focused on life satisfaction and coping in medical students. This is the first longitudinal study which has identified predictors of sustained high levels of life satisfaction among medical students. Methods This longitudinal, nationwide questionnaire study examined the course of life satisfaction during medical school, compared the level of satisfaction of medical students with that of other university students, and identified resilience factors. T-tests were used to compare means of life satisfaction between and within the population groups. K-means cluster analyses were applied to identify subgroups among the medical students. Analysis of Variance (ANOVA and logistic regression analyses were used to compare the subgroups. Results Life satisfaction decreased during medical school. Medical students were as satisfied as other students in the first year of study, but reported less satisfaction in their graduation year. Medical students who sustained high levels of life satisfaction perceived medical school as interfering less with their social and personal life, and were less likely to use emotion focused coping, such as wishful thinking, than their peers. Conclusion Medical schools should encourage students to spend adequate time on their social and personal lives and emphasise the importance of health-promoting coping strategies.

  10. Living with an adult family member using advanced medical technology at home.

    Science.gov (United States)

    Fex, Angelika; Flensner, Gullvi; Ek, Anna-Christina; Söderhamn, Olle

    2011-12-01

    Living with an adult family member using advanced medical technology at home An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context.

  11. Activity and meaning-making in everyday life of people with advanced cancer

    DEFF Research Database (Denmark)

    la Cour, Karen; Johannessen, Helle; Josephsson, Staffan

    2009-01-01

    Objective: This study aims to explore and understand how people with advanced cancer create meaning and handle everyday life through activity. Methods: A purposive sample of seven participants was recruited from a larger study. Data were collected through qualitative interviews and participant....... A narrative of “being healthy although ill” provided an arena for exploring the contrast between simultaneously feeling well and severely ill. Further emplotment of activities in “routines and continuity” was identified as a means to provide a safe, familiar framework stimulating participants’ everyday agency....... “My little Mecca” was identified as a narrative reflecting the activity of life-confirming experiences and taking time out. Significance of results: The identified narratives performed and told in daily life may guide the development of palliative care services to support people with advanced cancer...

  12. The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

    Directory of Open Access Journals (Sweden)

    Monique Venter

    2016-11-01

    Full Text Available Background. Critical care transfers (CCT refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft of patients who are of high acuity. In South Africa (SA, advanced life support (ALS paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7, consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81 of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.

  13. The art of perception: from the life world to the medical gaze and back again.

    Science.gov (United States)

    Hick, C

    1999-01-01

    Perceptions are often merely regarded as the basic elements of knowledge. They have, however, a complex structure of their own and are far from being elementary. My paper will analyze two basic patterns of perception and some of the resulting medical implications. Most basically, all object perception is characterized by a mixture of knowledge and ignorance (Husserl). Perception essentially perceives with inner and outer horizons, brought about by the kinesthetic activity of the perceiving subject (Sartre). This first layer of perceptual reality, the world of "open" perceptions, is the inescapable background for "every rationality, every value, every existence" (Merleau-Ponty). On an epistemological level a characteristic change of perceptual patterns in medicine was introduced by pathological anatomy (Foucault). The reference of medical perception to the dead body created the new possibility of "absolute" perception, allowing for more precise medical interventions, but at the same time coming into conflict with the open structures of "ordinary," non-scientific perception patterns in everyday life. On the basis of these distinctions, an analysis of the different perceptual patterns in medicine becomes possible. Such an analysis would be the task of a sub-field in medical philosophy that could be called "medical aesthetics" having as its goal an "art of perception" understood as a technique of adequately applying different perceptual patterns in medical practice.

  14. Development of advanced techniques for life management and inspection of advanced heavy water reactor (AWHR) coolant channel components

    Energy Technology Data Exchange (ETDEWEB)

    Madhusoodanan, K.; Sinha, S.K.; Kumar, K.; Shyam, T.V.; Panwar, S.; Sharma, B.S.V.G. [Bhabha Atomic Research Centre, Reactor Engineering Div., Trombay, Mumbai (India); Sinha, R. K. [Bhabha Atomic Research Centre, Reactor Design and Development Group., Trombay, Mumbai (India)

    2011-07-01

    Operating life of pressure tubes of Pressurized Heavy Water Reactor (PHWR) is limited due to the presence of various issues associated with the material like hydrogen pick up, delayed hydride cracking, axial elongation and increase in diameter due to irradiation creep and growth. Periodic monitoring of the health of the pressure tube under in-situ conditions is essential to ensure the safe operation of the reactor. New designs of reactor call for innovative design philosophy, modification in fabrication route of pressure tube, development of reactor specific tools, both analytical and hardware for assessing the fitness for service of the pressure tube. Feedback from existing reactors has enhanced the understanding about life limiting parameters. This paper gives an insight into the life limiting issues associated with pressure tube and the efforts pursued for development of life management techniques for coolant channel of Advanced Heavy Water Reactor (AHWR) designed in India. The tools and techniques for in-situ property/hydrogen measurement, pulsed eddy current technique for zirconium alloy in-homogeneity characterization, horizontal shear wave EMAT system for dissimilar metal weld inspection, sliver sampling of vertical channel etc. are elaborated in the paper. (author)

  15. End-of-Life Care for Undocumented Immigrants With Advanced Cancer: Documenting the Undocumented.

    Science.gov (United States)

    Jaramillo, Sylvia; Hui, David

    2016-04-01

    There are approximately 11.1 million undocumented immigrants in the United States, with a majority being Latino. Cancer is now the leading cause of death in Latinos. There is little research guiding providers on how to deliver optimal end-of-life care in this population. We describe a case of an undocumented Latino patient with advanced cancer, and provide a review of the literature on end-of-life care in undocumented immigrants. Our patient encountered many challenges as he navigated through the healthcare system in the last months of life. These included delayed diagnosis, limited social support, financial issues, fear of deportation, and language and cultural barriers, which resulted in significant physical and psychological distress. Within the undocumented patient population, there is often a lack of advance care planning, prognostic understanding, mistrust, religious practices, and cultural beliefs that may affect decision making. Given the growing number of undocumented immigrants in the United States, it is important for clinicians and policy makers to have a better understanding of the issues surrounding end-of-life care for undocumented immigrants, and work together to improve the quality of life and quality of end-of-life care for these disadvantaged individuals.

  16. Empathy among medical students: is there a relation with quality of life and burnout?

    Directory of Open Access Journals (Sweden)

    Helena B M S Paro

    Full Text Available BACKGROUND: We aimed to assess medical students' empathy and its associations with gender, stage of medical school, quality of life and burnout. METHOD: A cross-sectional, multi-centric (22 medical schools study that employed online, validated, self-reported questionnaires on empathy (Interpersonal Reactivity Index, quality of life (The World Health Organization Quality of Life Assessment and burnout (the Maslach Burnout Inventory in a random sample of medical students. RESULTS: Out of a total of 1,650 randomly selected students, 1,350 (81.8% completed all of the questionnaires. Female students exhibited higher dispositional empathic concern and experienced more personal distress than their male counterparts (p<0.05; d ≥ 0.5. There were minor differences in the empathic dispositions of students in different stages of their medical training (p<0.05; f<0.25. Female students had slightly lower scores for physical and psychological quality of life than male students (p<0.05; d<0.5. Female students scored higher on emotional exhaustion and lower on depersonalization than male students (p<0.001; d<0.5. Students in their final stage of medical school had slightly higher scores for emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25. Gender (β = 0.27; p<0.001 and perspective taking (β = 0.30; p<0.001 were significant predictors of empathic concern scores. Depersonalization was associated with lower empathic concern (β =  -0.18 and perspective taking (β =  -0.14 (p<0.001. Personal accomplishment was associated with higher perspective taking (β = 0.21; p<0.001 and lower personal distress (β =  -0.26; p<0.001 scores. CONCLUSIONS: Female students had higher empathic concern and personal distress dispositions. The differences in the empathy scores of students in different stages of medical school were small. Among all of the studied variables, personal accomplishment held the most important association with

  17. Quality of life, treatment adherence, and locus of control: multiple family groups for chronic medical illnesses.

    Science.gov (United States)

    López-Larrosa, Silvia

    2013-12-01

    The Multiple Family Groups (MFGs) approach for patients with a chronic medical illness and their families is a structured psychoeducational program that unfolds in six weekly 90-minute sessions. In the MFGs, patients and family members explore new ways to balance illness and nonillness priorities in family life (Steinglass, 1998; Steinglass, 2000 Cuadernos de Terapia Familiar, 44-45, 11; Steinglass, Ostroff, & Steinglass, 2011 Family Process, 50, 393).

  18. Quality of life of glaucoma patients under medical therapy with different prostaglandins

    Directory of Open Access Journals (Sweden)

    Paletta Guedes RA

    2012-10-01

    Full Text Available Ricardo Augusto Paletta Guedes,1–3 Vanessa Maria Paletta Guedes,1–3, Sirley Maria Freitas,2 Alfredo Chaoubah11Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; 2Paletta Guedes Ophthalmological Center, Juiz de Fora, MG, Brazil; 3Santa Casa de Misericórdia Hospital, Juiz de Fora, Minas Gerais, BrazilPurpose: To assess the quality of life of glaucoma patients under medical therapy with different prostaglandin analogs.Methods: A cross-sectional study of consecutive glaucoma patients was designed. We assessed the patients' quality of life through the Brazilian 25-question version of the National Eye Institute Visual Functioning Questionnaire, comprising 12 subscales (general health, general vision, ocular pain, near vision, distance vision, social function, mental health, role limitations, dependency, driving, color vision, and peripheral vision and a total composite score. Clinical features, including current medical treatment, were obtained from each patient's medical record. Three groups of patients were identified according to the prostaglandin in use: bimatoprost, latanoprost, or travoprost. The main outcome measures were: mean score in each subscale and mean total composite score.Results: The mean total composite score for the whole group was 70.60. The bimatoprost, latanoprost, and travoprost groups had the following mean composite scores, respectively: 56.56, 77.36, and 71.08 (P = 0.001, analysis of variance [ANOVA]. Latanoprost and travoprost results were similar, and both were superior to bimatoprost. Most subscales had similar results. The subscale with the lowest score for all groups was general health. Groups were homogenous and comparable.Conclusion: There is a difference in the quality of life between glaucoma patients using prostaglandin analogs. It seems that bimatoprost users have lower QoL when compared to latanoprost and travoprost users.Keywords: glaucoma, medical treatment, prostaglandin analogs

  19. Doctors’ Support – An important part of medical therapy and quality of life

    Directory of Open Access Journals (Sweden)

    Mariusz Jaworski

    2015-07-01

    Full Text Available Introduction: The correct patient – doctor relationship is important in shaping the whole process of treatment. The scientific studies highlight the various irregularities in this relationship and its negative impact on the effectiveness of medical treatment. The purpose of this study was to assess the relationship between levels of doctors’ support and attitude to certain aspects of the treatment process and quality of life among patients with psoriasis. Material and Methods: The study was conducted on 50 patients with psoriasis aged from 21 to 78 who are treated in dermatological clinics. The Psoriasis Area and Severity Index (PASI was used to assess the severity of psoriatic skin changes. The patients completed a questionnaire for the assessment of receive doctors’ support, and its relationship with the attitude towards the disease. The research tool was developed based on literature review. Results: The level of doctors’ support had a direct impact on the patients’ attitude the disease, including attitudes towards the treatment and medical personnel, as well as adherence to medical recommendations; and indirectly on satisfaction with the treatment and the quality of life. Conclusions: Results of this study have shown clear evidence the importance of the level of doctors’ support in psoriasis which could help to improve the overall functioning of these patients. The level of doctors’ support indirectly affects the quality of life in patients with psoriasis.

  20. Relationship among Medical Student Resilience, Educational Environment and Quality of Life.

    Directory of Open Access Journals (Sweden)

    Patricia Tempski

    Full Text Available Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL and educational environment perceptions in medical students.We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young's resilience scale (RS-14, the Dundee Ready Educational Environment Measure (DREEM, the World Health Organization Quality of Life questionnaire - short form (WHOQOL-BREF, the Beck Depression Inventory (BDI and the State-Trait Anxiety Inventory (STAI.Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score ≥ 14 and STAI state or anxiety scores ≥ 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (β=-0.89; 95% confidence interval =-1.21 to -0.56 and medical-school related (β=-0.85; 95%CI=-1.25 to -0.45 QoL scores, environment (β=-6.48; 95%CI=-10.01 to -2.95, psychological (β=-22.89; 95%CI=-25.70 to -20.07, social relationships (β=-14.28; 95%CI=-19.07 to -9.49, and physical health (β=-10.74; 95%CI=-14.07 to -7.42 WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (β=-31.42; 95%CI=-37.86 to -24.98, learning (β=-7.32; 95%CI=-9.23 to -5.41, teachers (β=-5.37; 95%CI=-7.16 to -3.58, academic self-perception (β=-7.33; 95%CI=-8.53 to -6.12, atmosphere (β=-8.29; 95%CI=-10.13 to -6.44 and social self-perception (β=-3.12; 95%CI=-4.11 to -2.12 DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements.Medical students with higher resilience levels

  1. Withholding and withdrawing life-sustaining treatment: criminal responsibility for established medical practice?

    Science.gov (United States)

    White, Ben; Willmott, Lindy; Allen, John

    2010-05-01

    The law recognises the right of a competent adult to refuse medical treatment even if this will lead to death. Guardianship and other legislation also facilitates the making of decisions to withhold or withdraw life-sustaining treatment in certain circumstances. Despite this apparent endorsement that such decisions can be lawful, doubts have been raised in Queensland about whether decisions to withhold or withdraw life-sustaining treatment would contravene the criminal law, and particularly the duty imposed by the Criminal Code (Qld) to provide the "necessaries of life". This article considers this tension in the law and examines various arguments that might allow for such decisions to be made lawfully. It ultimately concludes, however, that criminal responsibility may still arise and so reform is needed.

  2. Changes in medical end-of-life practices during the legalization process of euthanasia in Belgium.

    Science.gov (United States)

    Bilsen, Johan; Vander Stichele, Robert; Broeckaert, Bert; Mortier, Freddy; Deliens, Luc

    2007-08-01

    Changes in medical practices during transitions in regulating healthcare are rarely investigated. In this study, we investigated changes in medical end-of-life decisions with a possible or certain life-shortening effect (ELDs) that occurred during the legalization process of euthanasia in Belgium. We took representative random samples from deaths reported to registries in Flanders, Belgium in 1998 (n=3999) at the beginning of the process and in 2001 (N=5005), at the end of the process. The reporting physicians received an anonymous mail questionnaire about possible ELDs preceding the death involved. We found no significant shifts in the epidemiology of diseases between 1998 and 2001. The overall incidence of ELDs did not change. The incidence decreased for euthanasia, administering life-ending drugs without patient's explicit request, and alleviation of pain and symptoms with life-shortening co-intention. Incidence increased for alleviation of pain and symptom without life-shortening intention, and remained stable for non-treatment decisions. All decisions in 2001 were more often discussed with patients, their relatives and nurses. In 2001, continuous deep sedation was reported in 8.3% of deaths. We can conclude that physicians' end-of-life practices have substantially changed during the short but tumultuous legalization process of euthanasia in Belgium. Although follow-up research is needed to investigate the continuance of these changes, it is important for policy makers to keep in mind that social factors related to transitions in healthcare regulation may play an important role in the physicians' actual behaviour.

  3. [Life and medical missionary activities of Esther K. Pak (1877-1910)].

    Science.gov (United States)

    Lee, Bang Weon

    2007-12-01

    Esther K. Pak (1876-1910) is believed as the first medical doctor in Korea. Esther's life can be largely reviewed in three parts: school-hood at EwhaHaktang (currently Ewha Womans University), Education in the United States, and medical missionary work after coming back to Korea from the United States. The foreign Methodist missionaries was able to enter Korea after opening of its ports and establishing its diplomatic relationship with the United States. Esther met modern sciences and Christianity at EwhaHaktang, which was founded by those missionaries. She could dream of being an American-style medical doctor in the future, while she assisted medical missionaries at PoKuNyoKwan in EwhaHaktang. She could get substantial academic help from those missionaries. With the support of Dr. Rosetta Sherwood Hall, who first introduced the world of medial science to Esther in a real sense, Esther went to the United States to study the field in 1894. While learning it, she suffered from academic frustration, economic difficulty, her husband's death and so on, but she eventually got over those adversities and completed the four years of academic courses to become a medical doctor. Her religious faith and will to help Koreans as a doctor encouraged her to finish what she had originally planned. Esther came back to Korea in 1900 and began to work earnestly as a medical missionary delegated from Woman's Foreign Missionary Society. At PoKuNyoKwan in Seoul and Woman's Hospital in Pyongyang, She performed medical work and enlightenment campaign against the superstitious healing conduct. Esther also took part in the circuit missionary performances. She devoted herself for evangelical work at Bible Institute as well. Esther's activity made people understand the effectiveness of education. She helped people to recognize education for woman, occidental medical treatment and Christianity in a positive way. On April 28, 1909, based on these excellent performances for the social development

  4. Comparison of the Perceived Quality of Life between Medical and Veterinary Students in Tehran.

    Science.gov (United States)

    Labbafinejad, Yasser; Danesh, Hossein; Imanizade, Zahra

    2016-01-01

    Medical and veterinary professional programs are demanding and may have an impact on a student's quality of life (QOL). The aim of this study was to compare the perceived QOL of these two groups. In this study, we used the SF-36 questionnaire in which higher scores mean a better perceived QOL. Only the students in the internship phase of their program were selected so that we could compare the two groups in a similar way. In total, 308 valid questionnaires were gathered. Apart from age and body mass index (BMI), the two groups were demographically similar. The scores of five domains (physical activity limitation due to health problems, usual role limitation due to emotional problems, vitality, general mental health, and general health perception) and also the total score were statistically higher in medical students. Only the score of one domain (social activity limitation due to physical or emotional problems) was statistically higher in veterinary students. BMI, physical activity limitation due to health problems, and vitality lost their significance after binomial logistic regression. We found that, in general, veterinary students have lower scores for the perceived QOL with social function being the only exception. It can be assumed that in medical students, interaction with human patients may have a negative impact in the score of this domain. Even though medical students have shown lower perceived QOL than the general population in previous studies, veterinary students appear to have slightly lower perceived QOL than medical students.

  5. Ethics teaching on 'Beginning of Life' issues in UK medical schools.

    Science.gov (United States)

    Oldroyd, Christopher; Fialova, Lydie

    2014-12-01

    Medical ethics forms an essential component of an undergraduate medical programme. In the UK the Institute of Medical Ethics has released a consensus statement detailing its recommendations for a minimum curriculum for ethics. One important issue it highlights for inclusion is 'Beginning of Life', which includes a wide range of themes. This paper presents an evaluation of the current teaching and assessment of these important issues in UK medical schools, complemented by a specific analysis of students' reaction to the teaching they received at the University of Edinburgh as part of their Obstetrics and Gynaecology rotation. Schools which responded to the survey reported a wide range of teaching and assessment methods. While there was a good overall coverage of topics, only one of them was covered by every institution and the religious/cultural elements of those topics were often neglected. The medical schools viewed better clinical integration of ethics teaching as the best route to improvement, but the students reported a desire for more ethics teaching in the form of specific tutorials, lectures or discussions. It is likely that a combination of these approaches will lead to significant improvements in the delivery of ethics teaching in this area and in others.

  6. [Truth telling and advance care planning at the end of life].

    Science.gov (United States)

    Hu, Wen-Yu; Yang, Chia-Ling

    2009-02-01

    One of the core values in terminal care the respect of patient 'autonomy'. This essay begins with a discussion of medical ethics principles and the Natural Death Act in Taiwan and then summarizes two medical ethical dilemmas, truth telling and advance care planning (ACP), faced in the development of hospice and palliative care in Taiwan. The terminal truth telling process incorporates the four basic principles of Assessment and preparation, Communication with family, Truth-telling process, and Support and follow up (the so-called "ACTs"). Many experts suggest practicing ACP by abiding by the following five steps: (1) presenting and illustrating topics; (2) facilitating a structured discussion; (3) completing documents with advanced directives (ADs); (4) reviewing and updating ADs; and (5) applying ADs in clinical circumstances. Finally, the myths and challenges in truth telling and ADs include the influence of healthcare system procedures and priorities, inadequate communication skills, and the psychological barriers of medical staffs. Good communication skills are critical to truth telling and ACP. Significant discussion about ACP should help engender mutual trust between patients and the medical staffs who take the time to establish such relationships. Promoting patient autonomy by providing the opportunity of a good death is an important goal of truth telling and ACP in which patients have opportunities to choose their terminal treatment.

  7. Advanced biosensing methodologies developed for evaluating performance quality and safety of emerging biophotonics technologies and medical devices (Conference Presentation)

    Science.gov (United States)

    Ilev, Ilko K.; Walker, Bennett; Calhoun, William; Hassan, Moinuddin

    2016-03-01

    Biophotonics is an emerging field in modern biomedical technology that has opened up new horizons for transfer of state-of-the-art techniques from the areas of lasers, fiber optics and biomedical optics to the life sciences and medicine. This field continues to vastly expand with advanced developments across the entire spectrum of biomedical applications ranging from fundamental "bench" laboratory studies to clinical patient "bedside" diagnostics and therapeutics. However, in order to translate these technologies to clinical device applications, the scientific and industrial community, and FDA are facing the requirement for a thorough evaluation and review of laser radiation safety and efficacy concerns. In many cases, however, the review process is complicated due the lack of effective means and standard test methods to precisely analyze safety and effectiveness of some of the newly developed biophotonics techniques and devices. There is, therefore, an immediate public health need for new test protocols, guidance documents and standard test methods to precisely evaluate fundamental characteristics, performance quality and safety of these technologies and devices. Here, we will overview our recent developments of novel test methodologies for safety and efficacy evaluation of some emerging biophotonics technologies and medical devices. These methodologies are based on integrating the advanced features of state-of-the-art optical sensor technologies and approaches such as high-resolution fiber-optic sensing, confocal and optical coherence tomography imaging, and infrared spectroscopy. The presentation will also illustrate some methodologies developed and implemented for testing intraocular lens implants, biochemical contaminations of medical devices, ultrahigh-resolution nanoscopy, and femtosecond laser therapeutics.

  8. Improving quality of life in patients with advanced cancer: Targeting metastatic bone pain

    OpenAIRE

    von Moos, Roger; Costa, Luis; Ripamonti, Carla Ida; Niepel, Daniela; Santini, Daniele

    2017-01-01

    Metastatic bone disease in patients with advanced cancer is frequently associated with skeletal complications. These can be debilitating, causing pain, impaired functioning and decreased quality of life, as well as reduced survival. This review considers how the management of metastatic bone pain might be optimised, to limit the considerable burden it can impose on affected patients. Cancer-related pain is notoriously under-reported and under-treated, despite the availability of many therapeu...

  9. Professional identity formation in the transition from medical school to working life

    DEFF Research Database (Denmark)

    De Lasson, Lydia; Just, Eva; Stegeager, Nikolaj W.M.

    2016-01-01

    Background The transition from student to medical doctor is challenging and stressful to many junior doctors. To practice with confidence and professionalism the junior doctors have to develop a strong professional identity. Various suggestions on how to facilitate formation of professional ident...... and acting as a doctor), adoption to medical culture, career planning and managing a healthy work/life-balance. Further studies in different contexts are recommended as well as studies using other methods to test the results of this qualitative study.......: Adoption to medical culture, career planning, and work/life-balance. The junior doctors found the coaching intervention highly useful in order to cope with these challenges. Furthermore, the group was a forum where the junior doctors could share thoughts and feelings with colleagues without being afraid...... identity have been offered including the possible positive effect of group-coaching courses. The purpose of this study was to explore how group-coaching might facilitate professional identity formation among junior doctors in the transition period. Methods Group-coaching courses comprising three whole...

  10. Job-related burnout and the relationship to quality of life among Chinese medical college staff.

    Science.gov (United States)

    Yao, Shang-Man; Yu, Hong-Mei; Ai, Yong-Mei; Song, Ping-Ping; Meng, Su-Yan; Li, Wei

    2015-01-01

    Although staffs in medical colleges have traditionally been characterized as a stressed group of people, there are no specific studies assessing burnout and the relationship to quality of life (QOL). The purpose of this cross-sectional study was to evaluate job-related burnout and the relationship to QOL among medical college staff in mainland China. Some 360 medical college staffs from 15 schools and departments were enrolled in the study. The Chinese Teachers' Burnout Inventory (TBI) and the World Health Organization Quality of Life--brief Chinese version were used. Data on sociodemographic, work-related, and health-related factors were also collected. Multiple stepwise regression analysis was used to identify significant factors related to the 3 domain scores of the TBI. Structural equation modeling was performed to test the correlation between job-related burnout and QOL. The most significant and common predictors of burnout prevention were a love of the teaching profession and work acknowledgment from a direct supervisor. Job-related burnout had a direct negative effect on QOL. Corresponding health policies and suggestions could be developed to prevent job-related burnout and improve QOL.

  11. Survey of the incidence and effect of major life events on graduate medical education trainees

    Directory of Open Access Journals (Sweden)

    Lars J. Grimm

    2015-06-01

    Full Text Available Purpose: This study aims to assess the incidence of major life events during graduate medical education (GME training and to establish any associations with modifiable activities and career planning. Methods: The authors surveyed graduating GME trainees from their parent institution in June 2013. Demographic information (clinical department, gender, training duration and major life events (marriage, children, death/illness, home purchase, legal troubles, property loss were surveyed. Respondents were queried about the relationship between life events and career planning. A multivariable logistic regression model tested for associations. Results: A total of 53.2% (166/312 of graduates responded to the survey. 50% (83/166 of respondents were female. Major life events occurred in 96.4% (160/166 of respondents. Male trainees were more likely (56.1% [46/82] vs. 30.1% [25/83] to have a child during training (p=0.01. A total of 41.6% (69/166 of responders consciously engaged or avoided activities during GME training, while 31.9% (53/166 of responders reported that life events influenced their career plans. Trainees in lifestyle residencies (p=0.02, those who experienced the death or illness of a close associate (p=0.01, and those with legal troubles (p=0.04 were significantly more likely to consciously control life events. Conclusion: Major life events are very common and changed career plans in nearly a third of GME trainees. Furthermore, many trainees consciously avoided activities due to their responsibilities during training. GME training programs should closely assess the institutional support systems available to trainees during this difficult time.

  12. [Life-style of medical personnel dwelling and working in agroindustrial area].

    Science.gov (United States)

    Sorokina, M G; Kamaev, I A

    2005-01-01

    Results of sociological survey of medical personnel of typical agroindustrial area of Novgorod Oblast are presented. Data of self-registration of acute and chronic diseases and self-appraisal of one's health testify higher morbidity and health deterioration during last 3 years. Analysis of demographic characteristics, life-styles and labor conditions revealed complex of major factors impacting individual health and flow-out of professional medical personnel. Both amount of average monthly wage of physicians and paramedics, levels of their family income and welfare and as well degree of their inconsistence with cost of living of able-bodied population are established. Conditions of living and social maintenance, labor and off-labor activity, attitude to one's own health and spread of risk factors were analyzed. Management weaknesses of district and rural patient care institutions were established, including considerable exceeding of hygienic regulations established for medical personnel working load and higher spread of physical, chemical and biological risk factors of working environment harmful for health. Need in further enhancement of management of working process, occupational safety, labor remuneration and in increasing social safety, hygienic and curative activity of medical personnel is justified.

  13. Systematic Education of Self-Medication at Tokyo University of Pharmacy and Life Sciences.

    Science.gov (United States)

    Narui, Koji; Samizo, Kazuo; Inoue, Michiko; Watanabe, Kinzo

    2016-01-01

    The promotion of self-medication by pharmacies, with the aim of encouraging a patient's self-selection of proper OTC drug, is written about in the national action plan "Japan is Back". The subject of self-medication has been improved in the 2013 revised edition of "Model Core Curriculum for Pharmaceutical Education". At Tokyo University of Pharmacy and Life Sciences, the systematic education of self-medication was started from the onset of the six-year course in the third, fourth and fifth grade. We introduce here a new approach in our systematic education of self-medication. In the practice of the fourth grade, groups of around 5-6 students are formed. The pharmacy students assume various roles-of pharmacist, rater, observer, and chairman-and perform role-playing. We prepared a standardized patient (SP) showing various symptoms. The student of the role of pharmacist asks about the SP's symptoms, chooses an OTC drug suitable for the SP, and explains the OTC drug to the SP. After the role-playing, those in the roles of rater, observer, SP, and faculty give feedback to the student who played the role of pharmacist. Because we conduct this role-playing using SPs with a variety of symptoms, we can create a situation similar to a real drugstore.

  14. Medical deontology, meetings, journals, candidacy for higher posts and how to better enjoy life.

    Science.gov (United States)

    Grammaticos, Philip C

    2014-01-01

    Unfortunately, today few physicians care about medical deontology and medical ethics, that is how to behave and respect others when exercising our medical profession. Some of us may not show the care and kindness we should show towards our students or the due respect to our senior colleagues. Occasionally, when examining our patients we may not pay the proper attention to their problems, being tired from work overload. Another issue of deontology is medical meetings. Do they offer us enough knowledge or mainly pleasure? Is our curriculum vitae comprised by useful to society and to medicine original or confirmatory research work? Few examples to illustrate what the situation is at present are included in this paper. Our financial success in practice should not compete with the "old" Hippocratic oath and ideals. The pursuit of happiness in our life is not achieved through untruthfulness, dishonesty or only high financial status. "The Lancet"mentioned long ago (1969; September 27; 681-4) a phrase by John Keats: "Truth is beauty‥this only exists on Earth and this is what we need to know".

  15. Attitudes of Japanese Medical Students towards Disclosure of a Diagnosis of Life-threatening Illness

    Directory of Open Access Journals (Sweden)

    Ohtsu,Tadahiro

    2009-02-01

    Full Text Available

    In this study we investigated the attitudes of Japanese medical students toward being informed of a diagnosis of life-threatening illness. Fourth-year medical students from 20 randomly sampled universities were administered questionnaires that examined their opinion about whether they would welcome disclosure of medical information if they were diagnosed as having an ultimately fatal disease. Data from 1,619 students (male 1,074, female 545, effective collection rate 90.6% were analyzed. With regard to attitudes about disclosure of a diagnosis of life-threatening illness, 87.7% of the students stated that they would wish to be informed even if there was little chance of recovery, and 11.6% expressed a wish to be informed of their condition only if there was a chance of recovery. Students who did not wish to be informed even if there was a chance of recovery accounted for 0.7% of those surveyed. Our study reveals that medical students are more positive than are members of the general population with regard to being informed of the truth. The proportion of those who wished to be informed even if there was little chance of recovery was higher among students from national and public universities than among those from private universities, and the inter-group difference was statistically significant. Among male students, answers to the survey were significantly correlated with 12-item General Health Questionnaire scores and mental health status, suggesting that mental health status may have affected how this study population viewed being informed of their diagnosis.

  16. Medical care utilization and costs on end-of-life cancer patients: The role of hospice care.

    Science.gov (United States)

    Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Chen, Tzeng-Ji; Tsai, Shu-Lin; Cheng, Shao-Yi; Chiu, Tai-Yuan; Tsai, Shih-Tzu; Hwang, Shinn-Jang

    2016-11-01

    Although there are 3 hospice care programs for terminal cancer patients in Taiwan, the medical utilization and expenses for these patients by programs have not been well-explored. The aim of this study was to examine the medical utilization and expenses of terminal cancer patients under different programs of hospice care in the last 90, 30, and 14 days of life.This was a retrospective observational study by secondary data analysis. By using the National Health Insurance claim database and Hospice Shared Care Databases. We identified cancer descents from these databases and classified them into nonhospice care and hospice care groups based on different combination of hospice care received. We then analyzed medical utilization including inpatient care, outpatient care, emergency room visits, and medical expenses by patient groups in the last 90, 30, and 14 days of life.Among 118,376 cancer descents, 46.9% ever received hospice care. Patients had ever received hospice care had significantly lower average medical utilization and expenses in their last 90, 30, and 14 days of life (all P hospice care group had significantly less medical utilization and expenses in the last 90, 30, and 14 days of life (all P hospice care program have different effects on medical care utilization reduction and cost-saving at different stage of the end of life of terminal cancer patients.

  17. Advancing Competency-Based Medical Education: A Charter for Clinician-Educators.

    Science.gov (United States)

    Carraccio, Carol; Englander, Robert; Van Melle, Elaine; Ten Cate, Olle; Lockyer, Jocelyn; Chan, Ming-Ka; Frank, Jason R; Snell, Linda S

    2016-05-01

    The International Competency-Based Medical Education (ICBME) Collaborators have been working since 2009 to promote understanding of competency-based medical education (CBME) and accelerate its uptake worldwide. This article presents a charter, supported by a literature-based rationale, which is meant to provide a shared mental model of CBME that will serve as a path forward in its widespread implementation.At a 2013 summit, the ICBME Collaborators laid the groundwork for this charter. Here, the fundamental principles of CBME and professional responsibilities of medical educators in its implementation process are described. The authors outline three fundamental principles: (1) Medical education must be based on the health needs of the populations served; (2) the primary focus of education and training should be the desired outcomes for learners rather than the structure and process of the educational system; and (3) the formation of a physician should be seamless across the continuum of education, training, and practice.Building on these principles, medical educators must demonstrate commitment to teaching, assessing, and role modeling the range of identified competencies. In the clinical setting, they must provide supervision that balances patient safety with the professional development of learners, being transparent with stakeholders about level of supervision needed. They must use effective and efficient assessment strategies and tools for basing transition decisions on competence rather than time in training, empowering learners to be active participants in their learning and assessment. Finally, advancing CBME requires program evaluation and research, faculty development, and a collaborative approach to realize its full potential.

  18. Audience responses to television news coverage of medical advances: The mediating role of audience emotions and identification.

    Science.gov (United States)

    Hong, Hyehyun

    2015-08-01

    Exemplifying a real person in news stories has become a popular journalistic technique to describe an event or issue. With the frequent appearance of medical news reports in local television in recent years, this news presentation style is widely believed to help audiences better engage in and understand complex medical information and to influence their perceptions and judgments. In terms of television news coverage of medical advances, this study investigates how audiences respond to embedded human examples (mainly patients who experience benefits from the advances) and to overall news stories, and how such responses are related to their perception of portrayed medical advances. The experimental results indicate that news stories with a human example were more likely to intensify the audience's positive emotions than those without, which in turn influenced favorable perceptions of the described medical advance. In addition, the extent to which the audience identified with a human example (in particular, sympathy) mediated the relationship between the audience's involvement in the news story and its perception of the portrayed medical advance.

  19. End-of-Life and Palliative Care Issues in Medical and Nursing Schools in the United States

    Science.gov (United States)

    Dickinson, George E.

    2007-01-01

    Medical and nursing schools in the United States have traditionally had a limited emphasis on end-of-life care. The present study is a comparison of these 2 professional programs' current offerings on death education. Data were gathered via a mailed survey from the 122 medical schools in 2005 and the 580 baccalaureate nursing programs in 2006.…

  20. Associations of desire for change in sexual life amongst female medical students in North America

    Science.gov (United States)

    Shindel, Alan W.; Breyer, Benjamin N.; Smith, James F.

    2012-01-01

    We analyzed associations of dissatisfaction with sexual life and desire for change in female medical students. Students enrolled in medical schools in North America between February and July 2008 were invited to participate in an internet based survey of sexual function. The principle outcome measure was a single item question on sexual life satisfaction and desire for change. Women who reported dissatisfaction and desire for change were classified as “sexually bothered”. The survey also assessed ethnodemographic factors, student status, sexual history, and depressive symptoms. Respondents completed the Female Sexual Function Index (FSFI) and the Index of Sex Life (ISL). Descriptive statistics, ANOVA, and multivariable logistic regression were utilized to analyze responses. There were 661 non-virgin female subjects with data adequate for analysis. Whereas 281 (43%) of these met criteria for High Risk of Female Sexual Dysfunction (HRFSD) based on FSFI scoring, just 173 (26%) reported sexual bother. Among women with HRFSD, 126 (45%) reported sexual bother; in women without HRFSD, 362 (95%) were not sexually bothered. Interference in sexual life from tiredness and stress were associated with sexual bother. Progressively better scores on the FSFI-desire, orgasm, and satisfaction domains were significantly associated with lower odds of sexual bother. Few women in this cohort with FSFI score >26.55 reported sexual bother. Women with FSFI less than 26.55 had greater odds of sexual bother but this criterion alone was not pathognomonic for sexual concerns. Issues of sexual desire and orgasm appear to play a more important role than lubrication, arousal, and sexual pain issues in this population. PMID:22971616

  1. The Effect of Life Skills Training on Emotional Intelligence of the Medical Sciences Students in Iran

    Directory of Open Access Journals (Sweden)

    Hamideh A Lolaty

    2012-01-01

    Full Text Available Background: Emotional intelligence has a major role in mental health and life skills training, and could be viewed as a bridge relating to emotional intelligence and mental health. Aim: The present study is aimed at determining the effect of life skills training on the emotional intelligence among the first year students of Mazandaran University of Medical Sciences. Materials and Methods: In this experimental study, the subjects were selected by random sampling and allocated into two groups: Case group (n=20 and control group (n=19; they matched for gender, experience of stressful life events in the past six months, level of interest in the field of study, and level of emotional intelligence. The two groups responded to Bar-on Emotional Quotient Inventory before starting the experiment. Subsequently, the case group underwent life skills training. After the training, Bar-on Emotional Quotient Inventory was responded by the case and control groups again. The data was analyzed using descriptive statistics including Chi-square test, paired and independent t-tests, using SPSS software version 15. Results and Conclusion: In the case group, the scores of emotional intelligence after life skills training were significantly improved (t=11.703 df=19 P=0.001, while no significant difference was observed in the control group (t=0.683 df =18 P=0.503. By performing programs such as life skills training, the levels of emotional intelligence of the students could be increased, which itself could lead to academic success, reduced substance abuse, and increased stress tolerance in the students.

  2. [The quality of life after chemotherapy in advanced non-small cell lung cancer patients].

    Science.gov (United States)

    Słowik-Gabryelska, A; Szczepanik, A; Kalicka, A

    1999-01-01

    The intensity of complains, short survival and great number of patients makes many oncologists to apply chemotherapy in advanced non-small cell lung cancer/NSCLC/. The achieved median duration of life after chemotherapy was 6 to 12 month. From the other hand non small cell lung cancer chemotherapy is a big burden even to healthy persons. It can worsen the quality of life. That was the reason we evaluated the quality of life after chemotherapy in advanced non small cell lung cancer patients. Taking into account, that the evaluation of quality of life, used in most diseases is useless in advanced NSCLC patients, for appreciation the quality of life in these cases the lung cancer symptoms scale/LCSS/was adopted. In 110 non small cell lung cancer patients in stage IIIB and IV, who received combined chemotherapy by Le Chevalier/Vindesine, Cisplatin, Cyclophosphamide, Lomustin/or by Rosell/Mitomycin, Cyclophosphamide, Cisplatin/the quality of life was evaluated. In 20-persons control group all patients received the symptomatic treatment. In observed group of 110 patients, tumor regressions after 4 courses of chemotherapy allowed to resect cancer in 14 cases, to apply radiotherapy in 42 and to continue chemiotherapy in 23 persons. In every person from above mentioned group the quality of life was evaluated on the basis of intensity of cancer symptoms, accordingly to LCSS. The intensity of cancer symptoms was compared before and after treatment. There were compared; the innensity of complains, weakness, appetite, malnutrition, and hematological, neurological, performans state as well as respiratory sufficiency, infections, cardiac disorders and pain. Apart it, the side effects of applied therapy were assessed in 5 degree scale. The level of hemoglobin, the number of leucocytes, thrombocytes, bilirubine and transaminases in peripheral blood, hematurie, proteinurie, bleedings, appetite, nausea, vomitings, diarrhea, mucosal lesions, infections, skin lesions, cardiac lesions

  3. Exploring the relationship between the engineering and physical sciences and the health and life sciences by advanced bibliometric methods.

    Science.gov (United States)

    Waltman, Ludo; van Raan, Anthony F J; Smart, Sue

    2014-01-01

    We investigate the extent to which advances in the health and life sciences (HLS) are dependent on research in the engineering and physical sciences (EPS), particularly physics, chemistry, mathematics, and engineering. The analysis combines two different bibliometric approaches. The first approach to analyze the 'EPS-HLS interface' is based on term map visualizations of HLS research fields. We consider 16 clinical fields and five life science fields. On the basis of expert judgment, EPS research in these fields is studied by identifying EPS-related terms in the term maps. In the second approach, a large-scale citation-based network analysis is applied to publications from all fields of science. We work with about 22,000 clusters of publications, each representing a topic in the scientific literature. Citation relations are used to identify topics at the EPS-HLS interface. The two approaches complement each other. The advantages of working with textual data compensate for the limitations of working with citation relations and the other way around. An important advantage of working with textual data is in the in-depth qualitative insights it provides. Working with citation relations, on the other hand, yields many relevant quantitative statistics. We find that EPS research contributes to HLS developments mainly in the following five ways: new materials and their properties; chemical methods for analysis and molecular synthesis; imaging of parts of the body as well as of biomaterial surfaces; medical engineering mainly related to imaging, radiation therapy, signal processing technology, and other medical instrumentation; mathematical and statistical methods for data analysis. In our analysis, about 10% of all EPS and HLS publications are classified as being at the EPS-HLS interface. This percentage has remained more or less constant during the past decade.

  4. Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness

    Science.gov (United States)

    Kutner, Jean S.; Blatchford, Patrick J.; Taylor, Don H.; Ritchie, Christine S.; Bull, Janet H.; Fairclough, Diane L.; Hanson, Laura C.; LeBlanc, Thomas W.; Samsa, Greg P.; Wolf, Steven; Aziz, Noreen M.; Currow, David C.; Ferrell, Betty; Wagner-Johnston, Nina; Zafar, S. Yousuf; Cleary, James F.; Dev, Sandesh; Goode, Patricia S.; Kamal, Arif H.; Kassner, Cordt; Kvale, Elizabeth A.; McCallum, Janelle G.; Ogunseitan, Adeboye B.; Pantilat, Steven Z.; Portenoy, Russell K.; Prince-Paul, Maryjo; Sloan, Jeff A.; Swetz, Keith M.; Von Gunten, Charles F.; Abernethy, Amy P.

    2015-01-01

    IMPORTANCE For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy. OBJECTIVE To evaluate the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting. DESIGN, SETTING, AND PARTICIPANTS This was a multicenter, parallel-group, unblinded, pragmatic clinical trial. Eligibility included adults with an estimated life expectancy of between 1 month and 1 year, statin therapy for 3 months or more for primary or secondary prevention of cardiovascular disease, recent deterioration in functional status, and no recent active cardiovascular disease. Participants were randomized to either discontinue or continue statin therapy and were monitored monthly for up to 1 year. The study was conducted from June 3, 2011, to May 2, 2013. All analyses were performed using an intent-to-treat approach. INTERVENTIONS Statin therapy was withdrawn from eligible patients who were randomized to the discontinuation group. Patients in the continuation group continued to receive statins. MAIN OUTCOMES AND MEASURES Outcomes included death within 60 days (primary outcome), survival, cardiovascular events, performance status, quality of life (QOL), symptoms, number of nonstatin medications, and cost savings. RESULTS A total of 381 patients were enrolled; 189 of these were randomized to discontinue statins, and 192 were randomized to continue therapy. Mean (SD) age was 74.1 (11.6) years, 22.0% of the participants were cognitively impaired, and 48.8% had cancer. The proportion of participants in the discontinuation vs continuation groups who died within 60 days was not significantly different (23.8% vs 20.3%; 90% CI, −3.5% to 10.5%; P = .36) and did not meet the noninferiority end point. Total QOL was better for the group

  5. The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study

    Science.gov (United States)

    Zambas, Shelaine I.; Smythe, Elizabeth A.; Koziol-Mclain, Jane

    2016-01-01

    Aims and objectives The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. Background Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of “advanced” physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations. Design This qualitative study used a hermeneutic pragmatic approach. Method Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills. Results The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill. Conclusion Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations. Relevance to clinical practice The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting. PMID:27607193

  6. Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer

    Science.gov (United States)

    Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney M.; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A.

    2015-01-01

    Abstract Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care. PMID:26186553

  7. Calendar Life Studies of Advanced Technology Development Program Gen 1 Lithium Ion Batteries

    Energy Technology Data Exchange (ETDEWEB)

    Wright, Randy Ben; Motloch, Chester George

    2001-03-01

    This report presents the test results of a special calendar-life test conducted on 18650-size, prototype, lithium-ion battery cells developed to establish a baseline chemistry and performance for the Advanced Technology Development Program. As part of electrical performance testing, a new calendar-life test protocol was used. The test consisted of a once-per-day discharge and charge pulse designed to have minimal impact on the cell yet establish the performance of the cell over a period of time such that the calendar life of the cell could be determined. The calendar life test matrix included two states of charge (i.e., 60 and 80%) and four temperatures (40, 50, 60, and 70°C). Discharge and regen resistances were calculated from the test data. Results indicate that both discharge and regen resistance increased nonlinearly as a function of the test time. The magnitude of the discharge and regen resistance depended on the temperature and state of charge at which the test was conducted. The calculated discharge and regen resistances were then used to develop empirical models that may be useful to predict the calendar life or the cells.

  8. Cycle Life Studies of Advanced Technology Development Program Gen 1 Lithium Ion Batteries

    Energy Technology Data Exchange (ETDEWEB)

    Wright, Randy Ben; Motloch, Chester George

    2001-03-01

    This report presents the test results of a special calendar-life test conducted on 18650-size, prototype, lithium-ion battery cells developed to establish a baseline chemistry and performance for the Advanced Technology Development Program. As part of electrical performance testing, a new calendar-life test protocol was used. The test consisted of a once-per-day discharge and charge pulse designed to have minimal impact on the cell yet establish the performance of the cell over a period of time such that the calendar life of the cell could be determined. The calendar life test matrix included two states of charge (i.e., 60 and 80%) and four temperatures (40, 50, 60, and 70°C). Discharge and regen resistances were calculated from the test data. Results indicate that both discharge and regen resistance increased nonlinearly as a function of the test time. The magnitude of the discharge and regen resistance depended on the temperature and state of charge at which the test was conducted. The calculated discharge and regen resistances were then used to develop empirical models that may be useful to predict the calendar life or the cells.

  9. Gastrostomy tube placement in patients with advanced dementia or near end of life.

    Science.gov (United States)

    Schwartz, Denise Baird; Barrocas, Albert; Wesley, John R; Kliger, Gustavo; Pontes-Arruda, Alessandro; Márquez, Humberto Arenas; James, Rosemarie Lembo; Monturo, Cheryl; Lysen, Lucinda K; DiTucci, Angela

    2014-12-01

    Based on current scientific literature, gastrostomy tube (G-tube) placement or other long-term enteral access devices should be withheld in patients with advanced dementia or other near end-of-life conditions. In many instances healthcare providers are not optimally equipped to implement this recommendation at the bedside. Autonomy of the patient or surrogate decision maker should be respected, as should the patient's cultural, religious, social, and emotional value system. Clinical practice needs to address risks, burdens, benefits, and expected short-term and long-term outcomes in order to clarify practice changes. This paper recommends a change in clinical practice and care strategy based on the results of a thorough literature review and provides tools for healthcare clinicians, particularly in the hospital setting, including an algorithm for decision making and a checklist to use prior to the placement of G-tubes or other long-term enteral access devices. Integrating concepts of patient-centered care, shared decision making, health literacy, and the teach-back method of education enhances the desired outcome of ethical dilemma prevention. The goal is advance care planning and a timely consensus among health team members, family members, and significant others regarding end-of-life care for patients who do not have an advance directive and lack the capacity to advocate for themselves. Achieving this goal requires interdisciplinary collaboration and proactive planning within a supportive healthcare institution environment.

  10. Correlation of Simulation Examination to Written Test Scores for Advanced Cardiac Life Support Testing: Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Suzanne L. Strom

    2015-11-01

    Full Text Available Introduction: Traditional Advanced Cardiac Life Support (ACLS courses are evaluated using written multiple-choice tests. High-fidelity simulation is a widely used adjunct to didactic content, and has been used in many specialties as a training resource as well as an evaluative tool. There are no data to our knowledge that compare simulation examination scores with written test scores for ACLS courses. Objective: To compare and correlate a novel high-fidelity simulation-based evaluation with traditional written testing for senior medical students in an ACLS course. Methods: We performed a prospective cohort study to determine the correlation between simulationbased evaluation and traditional written testing in a medical school simulation center. Students were tested on a standard acute coronary syndrome/ventricular fibrillation cardiac arrest scenario. Our primary outcome measure was correlation of exam results for 19 volunteer fourth-year medical students after a 32-hour ACLS-based Resuscitation Boot Camp course. Our secondary outcome was comparison of simulation-based vs. written outcome scores. Results: The composite average score on the written evaluation was substantially higher (93.6% than the simulation performance score (81.3%, absolute difference 12.3%, 95% CI [10.6-14.0%], p<0.00005. We found a statistically significant moderate correlation between simulation scenario test performance and traditional written testing (Pearson r=0.48, p=0.04, validating the new evaluation method. Conclusion: Simulation-based ACLS evaluation methods correlate with traditional written testing and demonstrate resuscitation knowledge and skills. Simulation may be a more discriminating and challenging testing method, as students scored higher on written evaluation methods compared to simulation.

  11. Antidepression medication improves quality of life in elderly patients with benign prostatic hyperplasia and depression.

    Science.gov (United States)

    Ma, Lina; Zhao, Xiaoling; Liu, Huizhen; Zhu, Hong; Yang, Wei; Qian, Yuying; Wang, Jieyu; Feng, Ming; Li, Yun

    2015-01-01

    We aim to explore the influence of an antidepression medication on symptom scores and quality of life in elderly patients with benign prostatic hyperplasia accompanied by depression. We conducted a randomized controlled clinical trial which included 94 elderly patients with benign prostatic hyperplasia accompanied by depression in Xuan Wu Hospital and Beijing Boai Hospital during August 2008 to May 2012. The study was designed to compare outcomes related to patient quality of life (QoL). The patients were randomly assigned to one of two groups, consisting of a control group (n = 47) and a therapy group (n = 47), and were followed up for 3 months. The pre-treatment and post-treatment changes among patients in the two groups were compared using their respective IPSS symptom scores, HAM-D scores, and scores on the Short Form 36 Health Survey. Following treatment, the patient IPSS symptom scores in the therapy group were significantly lower than those in the control group (10.74 ± 4.72 vs. 16.42 ± 8.09, respectively; t = 4.157, P benign prostatic hyperplasia accompanied by depression. Our findings suggest that an antidepression medication should be included when treating elderly patients with benign prostatic hyperplasia.

  12. Effect of end of life education on medical students' and health care workers' death attitude.

    Science.gov (United States)

    Hegedus, K; Zana, A; Szabó, G

    2008-04-01

    One of the goals of education in end of life care is to make communication more open by exploring critical issues related to fear of dying and death in order to reduce anxiety and improve an individual's attitude to dying patients. The aim of our research was to evaluate the effects of courses for health care workers and medical students in care at the end of life. One hundred and twenty-seven health care professionals and 41 undergraduate medical students completed the Multidimensional Fear of Death Scale (MFODS) on the first and last day of the course. The most significant factors of fear of death are: Fear for Significant Others, Fear of the Dying Process and Fear of the Unknown. Overall fear of death scores were reduced as an effect of the courses. Changes in the components and level of fear of death are influenced by the participants' gender, age and profession. Improvement was evident in the attitudes to dying patients in both groups, which was related to an increase in knowledge of high-quality care of dying patients.

  13. Abandoning the common law: medical negligence, genetic tests and wrongful life in the Australian High Court.

    Science.gov (United States)

    Faunce, Thomas; Jefferys, Susannah

    2007-05-01

    The Australian High Court recently found that the common law could allow parents to claim tortious damages when medical negligence was proven to have led to the birth of an unplanned, but healthy, baby (Cattanach v Melchior (2003) 215 CLR 1). In Harriton v Stephens (2006) 80 ALJR 791; [2006] HCA 15 and Waller v James; Waller v Hoolahan (2006) 80 ALJR 846; [2006] HCA 16 the High Court in a six-to-one decision (Kirby J dissenting) decided that no such claim could be made by a child when medical negligence in failing to order an in utero genetic test caused the child severe disability. In an era when almost all pregnancies will soon require patented fetal genetic tests as part of the professional standard of care, the High Court, by barring so-called "wrongful life" (better termed "wrongful suffering") claims, may have created a partial immunity from suit for their corporate manufacturers and the doctors who administer them. What lessons can be learnt from this case about how the Australian High Court is, or should be, approaching medical negligence cases and its role as guardian of the Australian common law?

  14. Life Cycle Assessment as a tool for green Chemistry: Application to different advanced oxidation processes for wastewater treatment

    Energy Technology Data Exchange (ETDEWEB)

    Munoz Ortiz, I.; Domenech Antunez, X.; Malato Rodriguez, S.

    2006-07-01

    The development of chemistry during the twentieth century has changed our lives. In fact, chemistry and chemicals surrounds US in our daily activities, due to the huge supply of products aimed at improving our quality of life. Chemistry has resulted in the medical revolution of the past century, in which drugs as antibiotics have been used to cure diseases that affected mankind for centuries. These advances have led to the rise in the average life expectancy from 47 in 1900, to 75 years in the 1990s (Breslow 1997). On the other hand, the world's food supply has seen an explosive expansion because of the development of pesticides as well as fertilisers that protect crops and improve their productivity. Other common chemicals are those related to hygiene, such as soaps, detergents, disinfectants, toothpaste, etc. Therefore, there is practically no facet in material life-transportation communication, clothing, shelter, office- in which chemistry does not play an important role, either to supply consumer products or to improve services addressed to society in general (Domenech 2005). In spite of all these clear benefits, the chemical industry is often viewed by the general public as causing more harm than good (Lancaster 2002). A major reason for this is that the industry is perceived as being polluting and causing significant environmental damage. Indeed, the manufacture, use and disposal of chemicals consume large amounts of resources, and originates emissions of pollutants to all environmental compartments, not to mention the numerous accidents and disasters in which the chemical industry has been involved in the recent past. (Author)

  15. Physical sciences and engineering advances in life sciences and oncology a WTEC global assessment

    CERN Document Server

    Fletcher, Daniel; Gerecht, Sharon; Levine, Ross; Mallick, Parag; McCarty, Owen; Munn, Lance; Reinhart-King, Cynthia

    2016-01-01

    This book presents an Assessment of Physical Sciences and Engineering Advances in Life Sciences and Oncology (APHELION) by a panel of experts. It covers the status and trends of applying physical sciences and engineering principles to oncology research in leading laboratories and organizations in Europe and Asia. The book elaborates on the six topics identified by the panel that have the greatest potential to advance understanding and treatment of cancer, each covered by a chapter in the book. The study was sponsored by the National Cancer Institute (NCI) at the National Institute of Health (NIH), the National Science Foundation (NSF) and the National Institute of Biomedical Imaging and Bioengineering at the NIH in the US under a cooperative agreement with the World Technology Evaluation Center (WTEC).

  16. Considerations in miniaturizing simplified agro-ecosystems for advanced life support

    Science.gov (United States)

    Volk, T.

    1996-01-01

    Miniaturizing the Earth's biogeochemical cycles to support human life during future space missions is the goal of the NASA research and engineering program in advanced life support. Mission requirements to reduce mass, volume, and power have focused efforts on (1) a maximally simplified agro-ecosystem of humans, food crops, and microbes; and, (2) a design for optimized productivity of food crops with high light levels over long days, with hydroponics, with elevated carbon dioxide and other controlled environmental factors, as well as with genetic selection for desirable crop properties. Mathematical modeling contributes to the goals by establishing trade-offs, by analyzing the growth and development of experimental crops, and by pointing to the possibilities of directed phasic control using modified field crop models to increase the harvest index.

  17. Advanced Trauma Life Support. ABCDE from a radiological point of view.

    Science.gov (United States)

    Kool, Digna R; Blickman, Johan G

    2007-07-01

    Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support(R) (ATLS) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS, and we will discuss discrepancies with day to day practice and the radiological literature. Because the ATLS is neither thorough nor up-to-date concerning several parts of radiology in trauma, it should not be adopted without serious attention to defining the indications and limitations pertaining to diagnostic imaging.

  18. Advanced Trauma Life Support®. ABCDE from a radiological point of view

    OpenAIRE

    2007-01-01

    Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support® (ATLS®) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS®, and we will discuss discrepancies with day to day practice and the radiological literature. Because the ATLS® is neither thorough nor up-to-date concerning several parts of radiology in trauma, it should not be adopted without serious a...

  19. Adult patients with pulmonary arterial hypertension due to congenital heart disease: a review on advanced medical treatment with bosentan

    Directory of Open Access Journals (Sweden)

    Mark J Schuuring

    2010-08-01

    Full Text Available Mark J Schuuring1,2, Jeroen C Vis1,2, Marielle G Duffels1, Berto J Bouma1, Barbara JM Mulder1,21Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands; 2Interuniversity Cardiology Institute of The Netherlands, Utrecht, The NetherlandsAbstract: Pulmonary arterial hypertension (PAH is a progressive disease with poor survival outcome. PAH is classified by the 2009 updated clinical classification of pulmonary hypertension and a major subgroup is PAH due to congenital heart disease (CHD with systemic-to-pulmonary shunt. CHD-PAH is a result of systemic-to-pulmonary shunting and chronic increased flow that ultimately results in adaptations of pulmonary vasculature and endothelial dysfunction. The advanced stage is called Eisenmenger syndrome which forms a small percentage (1% of all CHD patients. Therapies targeted on PAH symptoms are called primary therapy for PAH, but most CHD-PAH patients progress to advanced therapy which is directed at the PAH itself. In CHD-PAH, advanced therapies are extensively investigated for all three major pathways: endothelin-1 receptor antagonists such as bosentan, prostanoids such as epoprostenol and phosphodiesterase 5 inhibitors such as sildenafil. Endpoints in most trials were catheterization hemodynamics, World Health Organization functional class, six-minute walking distance and patient-focused outcomes, based on quality of life questionnaires and Borg dyspnea index. The BREATHE-5 and EARLY study were two important randomized controlled trials showing efficacy of bosentan at short follow-up. Moreover in patients with Eisenmenger syndrome, one recent survival retrospective study with majority of patients on bosentan showed strong survival benefit over conservative therapy. A diversity of prospective cohort and retrospective studies were performed but all with limited data, due to small numbers and heterogeneity of underlying CHD diagnoses. Further larger studies are needed to determine optimal

  20. Review of recent advances in medical treatment for neuroendocrine neoplasms:somatostatin analogs and chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Francesca Spada; Monica Valente

    2016-01-01

    Neuroendocrine neoplasms (NENs) are a heterogeneous group of rare tumours often producing high levels of hormones and causing symptoms. There are a number of different types of NENs. They usually arise as advanced and low/intermediate grade only in a minority of cases, as high grade. Treatment depends on which type and may include surgery, interventional radiology, and systemic treatment, including chemotherapy, somatostatin analogs, interferon α2b, peptide receptor radionuclide therapy, and only for pancreatic neuroendocrine tumors, molecular targeted agents, including everolimus and sunitinib. The aim of the article is to review the medical approaches with somatostatin analogs and chemotherapy. The treatment of NENs is mainly based on their biological characteristics of aggressiveness and functional features, such as symptoms and endocrine markers.

  1. Targeted medical therapy of biliary tract cancer: Recent advances and future perspectives

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    The limited efficacy of cytotoxic therapy for advanced biliary tract and gallbladder cancers emphasizes the need for novel and more effective medical treatment options. A better understanding of the specific biological features of these neoplasms led to the development of new targeted therapies, which take the abundant expression of several growth factors and cognate tyrosine kinase receptors into account. This review will briefly summarize the status and future perspectives of antiangiogenic and growth factor receptor-based pharmacological approaches for the treatment of biliary tract and gallbladder cancers. In view of multiple novel targeted approaches, the rationale for innovative therapies, such as combinations of growth factor (receptor)-targeting agents with cytotoxic drugs or with other novel anticancer drugs will be highlighted.

  2. Impact of individualized learning plans on United States senior medical students advanced clinical rotations

    Directory of Open Access Journals (Sweden)

    Amalia Guardiola

    2016-11-01

    Full Text Available The individualized learning plan (ILP is a tool that promotes self-directed learning. The aim of this pilot study was to look at the perception of the ILPs in United States senior medical school students as a way to improve their learning experience during their advanced practice clerkship. We conducted a survey of graduating medical students that contained both quantitative and open-ended questions regarding the students’ experiences with the ILP during their advanced practice clerkship from July 2014 to March 2016. We systematically identified and compiled themes among the qualitative responses. Responses from 294 out of 460 subjects were included for analysis (63.9%. Ninety students (30.6% reported that the ILP was definitely reviewed at the midpoint and 88 (29.9% at the final evaluation. One hundred sixty one students (54.8% felt the ILP provided a framework for learning. One hundred sixty one students (61.6% felt it was a useful tool in helping open a discussion between the student and faculty. The qualitative data was grouped by areas most mentioned and these areas of concern centered on lack of faculty knowledge about ILP, time to complete ILP, and uncertainty of appropriate goal setting. The majority of students perceive the ILP to be helpful. Our results suggest that active intervention is needed by dedicated and trained faculty to improve ILP utilization. It is recommended that faculty gives students examples of learning goals to create their own learning framework and encourages them to discuss and review the ILP.

  3. Emergency Medical Service

    Science.gov (United States)

    1980-01-01

    Lewis Research Center helped design the complex EMS Communication System, originating from space operated telemetry, including the telemetry link between ambulances and hospitals for advanced life support services. In emergency medical use telemetry links ambulances and hospitals for advanced life support services and allows transmission of physiological data -- an electrocardiogram from an ambulance to a hospital emergency room where a physician reads the telemetered message and prescribes emergency procedures to ambulance attendants.

  4. Osteoporosis Medication and Quality of Life in Older Women - Original Investigation

    Directory of Open Access Journals (Sweden)

    Ayşe Dicle Turhanoğlu

    2008-04-01

    Full Text Available Aim: We aimed to investigate the effect of drug therapy on quality of life in older women with osteoporosis. Material and Methods: One hundred seventy seven women over 65 years were enrolled in this study. Quality of life was evaluated by Short-Form-36 (SF-36. Participants’ quality of life was compared according to their medication use for osteoporosis by comparing Physical Component Summary (PCS and Mental Component Summary (MCS score of SF-36 between groups. Results: While one hundred twenty two(68.9% of the participants had not used any drug, 20 (11.3% women had used only vitamin D-calcium and, 35 (19.8% women had used antiresorptive agents plus vitamin D-calcium. There were no statistically difference between groups in respect to age and bone mineral density (p>0.05. The mean values of PCS were 34.80±11.24, 30.33±9.49, and 31.56±7.28 respectively in the groups 1, 2 and 3. The mean values of MCS were 44.91±9, 44.15±11.93, and 44.42±12.09 respectively in the groups 1, 2 and 3. There were no significant differences between the PCS and MCS values (p>0.05, p>0.05. Conclusion: The findings of this study were considered that vitamin D plus calcium and antiresorptive agents were not sufficient to improve the quality of life in the older women with osteoporosis. (From the World of Osteoporosis 2008;14:7-11

  5. Technology assessment for the advanced life detector. Final technical report, May 1987-January 1988

    Energy Technology Data Exchange (ETDEWEB)

    Burrows, W.D.; George, D.T.

    1988-01-29

    This report summarizes an assessment of technology available to develop a noninvasive life detector for use on the battlefield. The detectors determine if casualties wearing chemical protective overgarments are alive or dead without further exposing either the casualties or the aidmen to the contaminated environment. Seven technology approaches sponsored by the Department of Defense (comprising 11 devices), four technologies identified in a market survey, and one device described in a Broad Agency Announcement proposal were examined as candidate Advanced Life Detectors. The technologies and instruments surveyed included three transmitter-receiver technologies, an electrocardiogram (ECG) technology, pacemaker-transmitter/receiver, dry electrode heart rate monitor, five microwave technologies, flash reflectance oximetry, an ultrasound technology, a streaming potential technology, a dry electrode ECG monitor coupled to a microphone, a statometric technique for determining heart rate and blood pressure, and a vital-signs monitor that determines heart rate and blood pressure using blood pressure cuff and microphones incorporated into the cuff. Analysis of the state-of-the-art of each device indicates that none of them are advanced enough to fulfill all the requirements of the draft Joint Services Operational Requirement. Three of the devices identified are recommended for further evaluation.

  6. Other than healing: medical practitioners and the business of life assurance during the nineteenth and early twentieth centuries.

    Science.gov (United States)

    Dupree, M W

    1997-04-01

    The purpose of this paper is to explore briefly the nature, development and implications of the relationship between medical practitioners and life assurance companies. The aim is to elucidate the development both of the medical profession and the life insurance business--two important aspects of economic and social change in the nineteenth and early twentieth centuries which are usually treated separately. The focus is primarily, though not exclusively, on Scottish companies as they carried out a disproportionately large amount of the UK life assurance business by the mid-nineteenth century. The insurance industry's increasing, and increasingly systematic, tapping of medical expertise enabled it to raise profits by reducing losses on standard policies and by venturing out into types of business previously thought too risky. While nineteenth-century medical therapeutics may have left much to be desired, medical involvement in insurance suggests that medical practitioners were by no means ineffective. At the same time, a substantial proportion of the medical profession gained valuable part-time appointments which helped to alter the diagnostic techniques of the profession more generally. Thus insurance turns out to be an especially important element in the 'non-healing' aspects of medicine, with spin-offs for the healing side as well.

  7. Building Irish families through surrogacy: medical and judicial issues for the advanced reproductive technologies.

    LENUS (Irish Health Repository)

    Sills, Eric Scott

    2008-01-01

    Surrogacy involves one woman (surrogate mother) carrying a child for another person\\/s (commissioning person\\/couple), based on a mutual agreement requiring the child to be handed over to the commissioning person\\/couple following birth. Reasons for seeking surrogacy include situations where a woman has non-functional or absent reproductive organs, or as a remedy for recurrent pregnancy loss. Additionally, surrogacy may find application in any medical context where pregnancy is contraindicated, or where a couple consisting of two males seek to become parents through oocyte donation. Gestational surrogacy is one of the main issues at the forefront of bioethics and the advanced reproductive technologies, representing an important challenge to medical law. This analysis reviews the history of surrogacy and clinical and legal issues pertaining to this branch of reproductive medicine. Interestingly, the Medical Council of Ireland does not acknowledge surrogacy in its current practice guidelines, nor is there specific legislation addressing surrogacy in Ireland at present. We therefore have developed a contract-based model for surrogacy in which, courts in Ireland may consider when confronted with a surrogacy dispute, and formulated a system to resolve any potential dispute arising from a surrogacy arrangement. While the 2005 report by the Commission on Assisted Human Reproduction (CAHR) is an expert opinion guiding the Oireachtas\\' development of specific legislation governing assisted human reproduction and surrogacy, our report represents independent scholarship on the contractual elements of surrogacy with particular focus on how Irish courts might decide on surrogacy matters in a modern day Ireland. This joint medico-legal collaborative also reviews the contract for services arrangement between the commissioning person\\/s and the surrogate, and the extent to which the contract may be enforced.

  8. [Physician-assisted suicide and advance care planning--ethical considerations on the autonomy of dementia patients at their end of life].

    Science.gov (United States)

    Gather, Jakov; Vollmann, Jochen

    2014-10-01

    Physician-assisted suicide (PAS), which is currently the subject of intense and controversial discussion in medical ethics, is barely discussed in psychiatry, albeit there are already dementia patients in Germany and other European countries who end their own lives with the assistance of physicians. Based on the finding that patients who ask for medical assistance in suicide often have in mind the loss of their mental capacity, we submit PAS to an ethical analysis and put it into a broader context of patient autonomy at the end of life. In doing so, we point to advance care planning, through which the patient autonomy of the person concerned can be supported as well as respected in later stages of the disease. If patients adhere to their autonomous wish for PAS, physicians find themselves in an ethical dilemma. A further tabooing of the topic, however, does not provide a solution; rather, an open societal and professional ethical discussion and regulation are essential.

  9. The Life of Medical Historian(醫史學者 Miki Sakae, and the

    Directory of Open Access Journals (Sweden)

    KIM Ho

    2005-12-01

    Full Text Available Miki Sakae was a Medical historian, who is well known for his studies of Korean medicine. He authored the renowned trilogy which dealt with subjects of Korean medicine and diseases, namely the , , and , during the Japanese Occupation period. He was born in 1903 in Osaka, Japan, and graduated from the Kyushu(九州 College of Medicine. In 1928 he was assigned to the Gyeongseong Imperial University's College of Medicine as a professor, and also served as Chief of the Suweon Provincial Hospital while he was staying in Korea. During the 18-year period of his stay, he widely collected medical books of Korea and also thoroughly studied them. He returned to Japan in 1944 due to the illness of his father, but continued his studies of Korean medicine, and in 1955 published the for the first time. Following such accomplishment, was published in 1956, the next year, and finally was published a few decades later, in 1985. Since the 1950s, aside of continuing to study and author the history of Korean medicine, he had also engaged himself in a joint effort associated with the members of the Medical History Association of Japan in a group study of Huseya Soteki 伏屋素狄 the first Japanese Experimental Physiologist. He also attempted at establishing an academic branch which could be referred to as Experimental Historical Studies of Medicine, by recreating the experiments of Huseya Sotek 伏屋素狄 with his own son 三木謙. Later he also expanded his interest and studies to the medical history of the world and also the area of Medical Ethics. But his ultimate interest and passion were always targeted at the Medicine of Korea, and the one consistent position he maintained during his entire life regarding the Korean medicine, was that 'One can only talk about the medicine of China and Japan when he or she is well versed in the medicine of Korea'. And his lifetime achievement, was authored upon the basis established by such conviction and philosophy. First

  10. Health-related quality of life among patients with advanced cancer: an integrative review

    Directory of Open Access Journals (Sweden)

    Maria Eliane Moreira Freire

    2014-04-01

    Full Text Available This integrative literature review aimed to characterize scientific articles on health-related quality of life – HRQoL – among patients with advanced cancer from national and international literature, and summarize those factors evidenced in the literature that contributed to the improvement or worsening of HRQoL among patients with advanced cancer. The search for materials was conducted in the following databases: CINAHL, EMBASE, PubMed, SciELO and LILACS. Among the 21 articles in the sample, 13 showed an improvement of HRQoL among patients with advanced cancer related to the development of physical, emotional and spiritual interventions. In eight studies, we identified predictive symptoms of low HRQoL, such as pain, fatigue, sleep disorders, depression, nutritional changes, and others. The results showed that clinical manifestations, which many times were inherent in cancer, such as factors that can lower patients’ HRQoL, while physical, psychological and spiritual benefits resulting from therapeutic interventions may promote its improvement.

  11. "To me, it's my life": medical communication, trust, and activism in cyberspace.

    Science.gov (United States)

    Radin, Patricia

    2006-02-01

    This paper studies the conversations and activities of an online support group for breast cancer sufferers and survivors and their supporters. Using communications medium theory and social capital theory, it examines the mundane and profound exchanges, the poignant self-disclosures, the creative expressions of solidarity, and the minor but not-insignificant political actions of people--initially strangers--who come together as a 'virtuous circle,' not only to assist with medical issues but also to meet emotional and even material needs. Sponsored by the Canadian nonprofit organization Breast Cancer Action Nova Scotia (BCANS), this virtual community has logged over a half million messages since 1996. Not every BCANS participant is an activist--many are just trying to grapple with their disease--but some find ways to shatter the professional "information monopoly," and to press for healthcare improvements. The study illustrates the scope, passion, and complexity of peer-to-peer medical communication in a virtual environment that promotes "thick trust". BCANS participants discuss with candor, warmth and even humor such painful topics as death and dying and the crises in intimate relationships brought about by a terminal illness. The sharing of confidences and fears enables participants to pool their 'collective intelligence' about many things, from how to cope with swelling, to how to think about end-of-life issues, to how to improve social policy.

  12. Caregivers experiences of managing medications for palliative care patients at the end of life: a qualitative study.

    Science.gov (United States)

    Sheehy-Skeffington, Barbara; McLean, Sarah; Bramwell, Michael; O'Leary, Norma; O'Gorman, Aisling

    2014-03-01

    Informal caregivers are important in enabling palliative care patients to die at home, including their role in managing medications. Often these patients are taking multiple medications, imposing an unnecessary burden on those who are already struggling with oral intake. A literature review revealed that, while there are a number of qualitative studies published examining the experience of caregivers looking after patients at the end of life, there is a dearth of published studies specifically examining the impact of managing medications on caregivers. This study explores the experience of caregivers managing medications for patients dying at home, focusing on the impact of polypharmacy, the use of syringe drivers and the use of "as needed" medications for symptom control. Three focus groups were performed, involving bereaved caregivers of patients that had died at home, and were analysed using content thematic analysis. Themes that emerged include: the significant burden of polypharmacy; the positive impact of subcutaneous infusions; the value of being able to give medications as needed for symptom control; the importance of clear guidance to assist with medication management. Strategies are suggested that might ease the burden of medications at the end of life.

  13. Influence of comorbidity on survival, toxicity and health-related quality of life in patients with advanced non-small-cell lung cancer receiving platinum-doublet chemotherapy

    DEFF Research Database (Denmark)

    Grønberg, Bjørn H; Sundstrøm, Stein; Kaasa, Stein;

    2010-01-01

    AIM OF THE STUDY: To investigate whether patients with severe comorbidity receiving platinum-based chemotherapy for advanced non-small-cell lung cancer (NSCLC) have a shorter overall survival, experience more toxicity or more deterioration of health-related quality of life (HRQoL) than other....... Comorbidity was assessed from hospital medical records using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Toxicity was graded using the CTCAE v3.0 and the patients reported HRQoL on the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30...... neutropenic fevers (12% versus 5%; p=.012) and deaths from neutropenic infections (3% versus 0%; p=.027). They had more thrombocytopenia (46% versus 36%; p=.03), but not more thrombocytopenic bleedings (3% versus 4%; p=.65). In general, the patients with severe comorbidity reported poorer HRQoL...

  14. Teaching paediatric resuscitation skills in a developing country: introduction of the Advanced Paediatric Life Support course into Vietnam.

    Science.gov (United States)

    Young, Simon; Hutchinson, Adrian; Nguyen, Van Tu; Le, Thanh Hai; Nguyen, Dich Van; Vo, Thi Kim Hue

    2008-06-01

    In 2001, a nationwide study revealed deficiencies in the emergency care of seriously ill and injured children in Vietnam. In response, a project was initiated to conduct the Advanced Paediatric Life Support course in Vietnam and ascertain whether this course would provide a practical and sustainable method of improving the knowledge and skills of medical and nursing staff in this area. After approval to use the course was secured and funding obtained, the project commenced in 2003. Key Vietnamese personnel travelled to Australia to complete the course, undertake instructor training and gain organizational experience. Teaching materials were translated, reviewed and modified to account for local diseases and clinical practices while maintaining the fundamental principles of the parent course. Commencing in March 2004, 10 courses were conducted by Australian and Vietnamese instructors, training 239 doctors and nurses from a wide variety of clinical backgrounds. Additionally, three instructor courses were conducted, training 52 new instructors. As the skill and confidence of the Vietnamese instructors grew, the number and responsibilities of the international faculty reduced. The infrastructure now exists for the course to operate in a sustainable fashion within Vietnam. We believe that this project demonstrates that the course can be successfully modified to provide teaching in paediatric emergency care in a developing country.

  15. Negative life events and mental health of Chinese medical students: the effect of resilience, personality and social support.

    Science.gov (United States)

    Peng, Li; Zhang, Jiajia; Li, Min; Li, Peipei; Zhang, Yu; Zuo, Xin; Miao, Yi; Xu, Ying

    2012-03-30

    The present study was conducted on a large sample of Chinese medical students to test the moderating effect of resilience between negative life events and mental health problems, and investigate the factors that affect the mental health problems of the students. The Adolescent Self-Rating Life Events Check List, Eysenck Adult Personality Questionnaire-Revised, Social Support Rating Scale, Connor-Davidson Resilience Scale, and Symptom Check List were adopted for a survey with 1,998 Chinese medical students as respondents. Mental health problems had a positive correlation with negative life events and neuroticism. On the other hand, mental health problems had a negative correlation with social support, extraversion, and resilience. Regression analysis showed that resilience moderated negative life events and mental health problems. Promoting resilience may be helpful for the adjustment of college students.

  16. Next Generation Life Support Project: Development of Advanced Technologies for Human Exploration Missions

    Science.gov (United States)

    Barta, Daniel J.

    2012-01-01

    Next Generation Life Support (NGLS) is one of several technology development projects sponsored by the National Aeronautics and Space Administration s Game Changing Development Program. NGLS is developing life support technologies (including water recovery, and space suit life support technologies) needed for humans to live and work productively in space. NGLS has three project tasks: Variable Oxygen Regulator (VOR), Rapid Cycle Amine (RCA) swing bed, and Alternative Water Processing. The selected technologies within each of these areas are focused on increasing affordability, reliability, and vehicle self sufficiency while decreasing mass and enabling long duration exploration. The RCA and VOR tasks are directed at key technology needs for the Portable Life Support System (PLSS) for an Exploration Extravehicular Mobility Unit (EMU), with focus on prototyping and integrated testing. The focus of the Rapid Cycle Amine (RCA) swing-bed ventilation task is to provide integrated carbon dioxide removal and humidity control that can be regenerated in real time during an EVA. The Variable Oxygen Regulator technology will significantly increase the number of pressure settings available to the space suit. Current spacesuit pressure regulators are limited to only two settings while the adjustability of the advanced regulator will be nearly continuous. The Alternative Water Processor efforts will result in the development of a system capable of recycling wastewater from sources expected in future exploration missions, including hygiene and laundry water, based on natural biological processes and membrane-based post treatment. The technologies will support a capability-driven architecture for extending human presence beyond low Earth orbit to potential destinations such as the Moon, near Earth asteroids and Mars.

  17. Failure modes and effects criticality analysis and accelerated life testing of LEDs for medical applications

    Science.gov (United States)

    Sawant, M.; Christou, A.

    2012-12-01

    While use of LEDs in Fiber Optics and lighting applications is common, their use in medical diagnostic applications is not very extensive. Since the precise value of light intensity will be used to interpret patient results, understanding failure modes [1-4] is very important. We used the Failure Modes and Effects Criticality Analysis (FMECA) tool to identify the critical failure modes of the LEDs. FMECA involves identification of various failure modes, their effects on the system (LED optical output in this context), their frequency of occurrence, severity and the criticality of the failure modes. The competing failure modes/mechanisms were degradation of: active layer (where electron-hole recombination occurs to emit light), electrodes (provides electrical contact to the semiconductor chip), Indium Tin Oxide (ITO) surface layer (used to improve current spreading and light extraction), plastic encapsulation (protective polymer layer) and packaging failures (bond wires, heat sink separation). A FMECA table is constructed and the criticality is calculated by estimating the failure effect probability (β), failure mode ratio (α), failure rate (λ) and the operating time. Once the critical failure modes were identified, the next steps were generation of prior time to failure distribution and comparing with our accelerated life test data. To generate the prior distributions, data and results from previous investigations were utilized [5-33] where reliability test results of similar LEDs were reported. From the graphs or tabular data, we extracted the time required for the optical power output to reach 80% of its initial value. This is our failure criterion for the medical diagnostic application. Analysis of published data for different LED materials (AlGaInP, GaN, AlGaAs), the Semiconductor Structures (DH, MQW) and the mode of testing (DC, Pulsed) was carried out. The data was categorized according to the materials system and LED structure such as AlGaInP-DH-DC, Al

  18. Medical therapy for advanced gastro-entero-pancreatic and bronchopulmonary neuroendocrine tumors

    Institute of Scientific and Technical Information of China (English)

    Mariangela Torniai; Silvia Rinaldi; Francesca Morgese; Giulia Ricci; Azzurra Onofri; Christian Groh; Rossana Berardi

    2016-01-01

    Neuroendocrine tumors (NETs) represent a spectrum of rare neoplasms arising in different organism sites. Depending on the site of onset, they also can be distinguished using lab exams (secretingvs. nonsecreting), clinical symptoms (functioningvs. nonfunctioning), behavioral, morphological characteristics (tumor cells’ architectural growth patterns, mitotic and Ki-67 index, presence of necrosis), and grade of cellular differentiation. The aim of this review is to focus on the main signaling pathways targeted by medical treatments of advanced sporadic gastro-entero-pancreatic (GEP) and bronchopulmonary (BP) neuroendocrine neoplasms. The scientiifc literature regarding treatment of advanced GEP and BP-NETs has been extensively reviewed using MEDLINE and PubMed databases, selecting principal and more recent research articles, clinical trials, and updated guidelines. Somatostatin analogues represent a valid approach to control symptoms in functioning tumors and to inhibit tumor progression in certain categories on the basis of the typical somatostatin receptor expression observed in NETs. The pathogenesis of NETs has been the subject of increased interest in recent years. Many driver mutations pathway genes have been identiifed as important factors in the carcinogenesis process and, therefore, as potential targets for new anticancer therapies. Activating mutations have been shown in epidermal growth factor receptor, stem cell factor receptor, platelet-derived growth factor receptor, vascular endothelial growth factor, basic-ifbroblastic growth factor, transforming growth factor, insulin-like growth factor-1, and their receptors. Effective M-Tor inhibition pathway modulation has led to the approval of drugs in this ifeld such as everolimus. New drugs and several combination regimens with targeted and newer biological agents are being developed and tested in recently conducted and ongoing trials.

  19. Development of expanded extrusion food products for an Advanced Life Support system.

    Science.gov (United States)

    Zasypkin, D V; Lee, T C

    1999-01-01

    Extrusion processing was proposed to provide texture and to expand the variety of cereal food products in an isolated Advanced Life Support (ALS) system. Rice, wheat, and soy are the baseline crops selected for growing during long-term manned space missions. A Brabender single-screw laboratory extruder (model 2003, L/D 20:1), equipped with round nozzles of various lengths, was used as a prototype of a small-size extruder. Several concepts were tested to extend the variety and improve the quality of the products, to decrease environmental loads, and to promote processing stability. These concepts include: the blending of wheat and soybean flour, the extrusion of a coarser rice flour, separation of wheat bran, and optimization of the extruder nozzle design. An optimal nozzle length has been established for the extrusion of rice flour. Bran separating was necessary to improve the quality of wheat extrudates.

  20. Impact of an Advanced Cardiac Life Support Simulation Laboratory Experience on Pharmacy Student Confidence and Knowledge.

    Science.gov (United States)

    Maxwell, Whitney D; Mohorn, Phillip L; Haney, Jason S; Phillips, Cynthia M; Lu, Z Kevin; Clark, Kimberly; Corboy, Alex; Ragucci, Kelly R

    2016-10-25

    Objective. To assess the impact of an advanced cardiac life support (ACLS) simulation on pharmacy student confidence and knowledge. Design. Third-year pharmacy students participated in a simulation experience that consisted of team roles training, high-fidelity ACLS simulations, and debriefing. Students completed a pre/postsimulation confidence and knowledge assessment. Assessment. Overall, student knowledge assessment scores and student confidence scores improved significantly. Student confidence and knowledge changes from baseline were not significantly correlated. Conversely, a significant, weak positive correlation between presimulation studying and both presimulation confidence and presimulation knowledge was discovered. Conclusions. Overall, student confidence and knowledge assessment scores in ACLS significantly improved from baseline; however, student confidence and knowledge were not significantly correlated.

  1. Solid Waste Management Requirements Definition for Advanced Life Support Missions: Results

    Science.gov (United States)

    Alazraki, Michael P.; Hogan, John; Levri, Julie; Fisher, John; Drysdale, Alan

    2002-01-01

    Prior to determining what Solid Waste Management (SWM) technologies should be researched and developed by the Advanced Life Support (ALS) Project for future missions, there is a need to define SWM requirements. Because future waste streams will be highly mission-dependent, missions need to be defined prior to developing SWM requirements. The SWM Working Group has used the mission architecture outlined in the System Integration, Modeling and Analysis (SIMA) Element Reference Missions Document (RMD) as a starting point in the requirement development process. The missions examined include the International Space Station (ISS), a Mars Dual Lander mission, and a Mars Base. The SWM Element has also identified common SWM functionalities needed for future missions. These functionalities include: acceptance, transport, processing, storage, monitoring and control, and disposal. Requirements in each of these six areas are currently being developed for the selected missions. This paper reviews the results of this ongoing effort and identifies mission-dependent resource recovery requirements.

  2. Discussing advance preferences for end-of-life: The role of nurses and other health proffessionals

    Directory of Open Access Journals (Sweden)

    Apolo García Palomares

    2006-01-01

    Full Text Available Our society keeps on achieving goals regarding individual liberties. This fact has been reinforced since the law 41/2002 (basic law on patient rights, duties and autonomy regarding health information and documentation was approved on May 16th 2003. This law establishes the ethic boundaries not to be crossed regarding health attention. Additionally to the patient autonomy, this law includes the reference to the living wills, defined as an anticipated declaration about the desired care in case of loosing the capability to give an opinion about it when the end of life is coming.Literature makes clear that living wills are a phenomena in which not only the patients and the health professionals are involved, but the whole society.This article aims to revise the participation of the health and medical professionals in this process, as well as to think about the role of the health carer leading this process. The objective is not to reduce the caring process to a simple document signing, but to plan health decisions when the end of life is coming from a global conception of the caring process.

  3. SysBioMed report: advancing systems biology for medical applications.

    Science.gov (United States)

    Wolkenhauer, O; Fell, D; De Meyts, P; Blüthgen, N; Herzel, H; Le Novère, N; Höfer, T; Schürrle, K; van Leeuwen, I

    2009-05-01

    The following report selects and summarises some of the conclusions and recommendations generated throughout a series of workshops and discussions that have lead to the publication of the Science Policy Briefing (SPB) Nr. 35, published by the European Science Foundation. (Large parts of the present text are directly based on the ESF SPB. Detailed recommendations with regard to specific application areas are not given here but can be found in the SPB. Issues related to mathematical modelling, including training and the need for an infrastructure supporting modelling are discussed in greater detail in the present text.)The numerous reports and publications about the advances within the rapidly growing field of systems biology have led to a plethora of alternative definitions for key concepts. Here, with 'mathematical modelling' the authors refer to the modelling and simulation of subcellular, cellular and macro-scale phenomena, using primarily methods from dynamical systems theory. The aim of such models is encoding and testing hypotheses about mechanisms underlying the functioning of cells. Typical examples are models for molecular networks, where the behaviour of cells is expressed in terms of quantitative changes in the levels of transcripts and gene products. Bioinformatics provides essential complementary tools, including procedures for pattern recognition, machine learning, statistical modelling (testing for differences, searching for associations and correlations) and secondary data extracted from databases.Dynamical systems theory is the natural language to investigate complex biological systems demonstrating nonlinear spatio-temporal behaviour. However, the generation of experimental data suitable to parameterise, calibrate and validate such models is often time consuming and expensive or not even possible with the technology available today. In our report, we use the term 'computational model' when mathematical models are complemented with information

  4. Impact of Duodopa on Quality of Life in Advanced Parkinson's Disease: A UK Case Series

    Directory of Open Access Journals (Sweden)

    T. Foltynie

    2013-01-01

    Full Text Available Treatment options in advanced Parkinson’s disease (PD include subcutaneous apomorphine, pallidal or subthalamic nucleus Deep Brain Stimulation (DBS, or levodopa/carbidopa intestinal gel (LCIG/Duodopa. In this study, we describe the outcome of 12 PD patients with PD related complications started on LCIG, with respect to their quality of life measured by a disease specific validated scale—the PDQ39, together with diaries recording time spent “On,” “Off,” “Dyskinetic,” or “Asleep.” At the time of latest follow up, improvements were observed in both the PDQ39 Summary index as well as diary reports of PD symptom control following introduction of LCIG, supporting its use in well selected patients. The use of a trial period of LCIG via naso-jejunal administration allows objective evaluation of improvement in PD symptom control in advance of the placement of the more invasive percutaneous jejunostomy procedure. The decision to embark on LCIG, apomorphine or DBS should be supported by input from centres with experience of all 3 approaches. Since LCIG is an expensive option, development of the most appropriate future commissioning of this therapy in the absence of Class 1 evidence requires careful scrutiny of the outcomes of its use in a broad range of published series.

  5. Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience

    Science.gov (United States)

    Gilliam, Eric; Thompson, Megan; Griend, Joseph Vande

    2017-01-01

    Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students’ self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services. PMID:28381896

  6. Advancing science diplomacy: Indonesia and the US Naval Medical Research Unit.

    Science.gov (United States)

    Smith, Frank L

    2014-12-01

    Science diplomacy supposedly builds international cooperation through scientific and technical exchange. In practice, however, there are important but often overlooked instances where it might create conflict instead--as with accusations of espionage surrounding the US Naval Medical Research Unit 2 (NAMRU-2) in Indonesia. Did American science diplomacy backfire in Indonesia and, if so, why? Most literature fails to anticipate this possibility, let alone explain it, since science diplomacy is rarely subject to critical analysis. Rather than shun politics or, similarly, simply blame the demise of NAMRU-2 on the military or avian influenza, I consider both the successes and failures of this research unit in the context of Indonesia's transition to democracy and America's legacy from the Cold War. Based on this history, I propose that the effects of science diplomacy depend on strategic communication and exchange, as well as elite influence and material incentives. Therefore, by challenging the conventional wisdom about science diplomacy, NAMRU-2 can help advance the theory and practice of this potentially useful tool of statecraft.

  7. Hydroponics Database and Handbook for the Advanced Life Support Test Bed

    Science.gov (United States)

    Nash, Allen J.

    1999-01-01

    During the summer 1998, I did student assistance to Dr. Daniel J. Barta, chief plant growth expert at Johnson Space Center - NASA. We established the preliminary stages of a hydroponic crop growth database for the Advanced Life Support Systems Integration Test Bed, otherwise referred to as BIO-Plex (Biological Planetary Life Support Systems Test Complex). The database summarizes information from published technical papers by plant growth experts, and it includes bibliographical, environmental and harvest information based on plant growth under varying environmental conditions. I collected 84 lettuce entries, 14 soybean, 49 sweet potato, 16 wheat, 237 white potato, and 26 mix crop entries. The list will grow with the publication of new research. This database will be integrated with a search and systems analysis computer program that will cross-reference multiple parameters to determine optimum edible yield under varying parameters. Also, we have made preliminary effort to put together a crop handbook for BIO-Plex plant growth management. It will be a collection of information obtained from experts who provided recommendations on a particular crop's growing conditions. It includes bibliographic, environmental, nutrient solution, potential yield, harvest nutritional, and propagation procedure information. This handbook will stand as the baseline growth conditions for the first set of experiments in the BIO-Plex facility.

  8. Study for requirement of advanced long life small modular fast reactor

    Science.gov (United States)

    Tak, Taewoo; Choe, Jiwon; Jeong, Yongjin; Lee, Deokjung; Kim, T. K.

    2016-01-01

    To develop an advanced long-life SMR core concept, the feasibility of the long-life breed-and-burn core concept has been assessed and the preliminary selection on the reactor design requirement such as fuel form, coolant material has been performed. With the simplified cigar-type geometry of 8m-tall CANDLE reactor concept, it has demonstrated the strengths of breed-and-burn strategy. There is a saturation region in the graph for the multiplication factors, which means that a steady breeding is being proceeded along the axial direction. The propagation behavior of the CANDLE core can be also confirmed through the evolution of the axial power profile. Coolant material is expected to have low melting point, density, viscosity and absorption cross section and a high boiling point, specific heat, and thermal conductivity. In this respect, sodium is preferable material for a coolant of this nuclear power plant system. The metallic fuel has harder spectrum compared to the oxide and carbide fuel, which is favorable to increase the breeding and extend the cycle length.

  9. Study for requirement of advanced long life small modular fast reactor

    Energy Technology Data Exchange (ETDEWEB)

    Tak, Taewoo, E-mail: ttwispy@unist.ac.kr; Choe, Jiwon, E-mail: chi91023@unist.ac.kr; Jeong, Yongjin, E-mail: yjjeong09@unist.ac.kr; Lee, Deokjung, E-mail: deokjung@unist.ac.kr [Ulsan National Institute of Science and Technology, 50, UNIST-gil, Eonyang-eup, Ulju-gun, Ulsan, 689-798 (Korea, Republic of); Kim, T. K., E-mail: tkkim@anl.gov [Argonne National Laboratory, 9700 South Cass Avenue, Argonne, IL 60564 (United States)

    2016-01-22

    To develop an advanced long-life SMR core concept, the feasibility of the long-life breed-and-burn core concept has been assessed and the preliminary selection on the reactor design requirement such as fuel form, coolant material has been performed. With the simplified cigar-type geometry of 8m-tall CANDLE reactor concept, it has demonstrated the strengths of breed-and-burn strategy. There is a saturation region in the graph for the multiplication factors, which means that a steady breeding is being proceeded along the axial direction. The propagation behavior of the CANDLE core can be also confirmed through the evolution of the axial power profile. Coolant material is expected to have low melting point, density, viscosity and absorption cross section and a high boiling point, specific heat, and thermal conductivity. In this respect, sodium is preferable material for a coolant of this nuclear power plant system. The metallic fuel has harder spectrum compared to the oxide and carbide fuel, which is favorable to increase the breeding and extend the cycle length.

  10. Requirements Development Issues for Advanced Life Support Systems: Solid Waste Management

    Science.gov (United States)

    Levri, Julie A.; Fisher, John W.; Alazraki, Michael P.; Hogan, John A.

    2002-01-01

    Long duration missions pose substantial new challenges for solid waste management in Advanced Life Support (ALS) systems. These possibly include storing large volumes of waste material in a safe manner, rendering wastes stable or sterilized for extended periods of time, and/or processing wastes for recovery of vital resources. This is further complicated because future missions remain ill-defined with respect to waste stream quantity, composition and generation schedule. Without definitive knowledge of this information, development of requirements is hampered. Additionally, even if waste streams were well characterized, other operational and processing needs require clarification (e.g. resource recovery requirements, planetary protection constraints). Therefore, the development of solid waste management (SWM) subsystem requirements for long duration space missions is an inherently uncertain, complex and iterative process. The intent of this paper is to address some of the difficulties in writing requirements for missions that are not completely defined. This paper discusses an approach and motivation for ALS SWM requirements development, the characteristics of effective requirements, and the presence of those characteristics in requirements that are developed for uncertain missions. Associated drivers for life support system technological capability are also presented. A general means of requirements forecasting is discussed, including successive modification of requirements and the need to consider requirements integration among subsystems.

  11. Unrelated medical costs in life-years gained : should they be included in economic evaluations of healthcare interventions?

    NARCIS (Netherlands)

    Rappange, David R; van Baal, Pieter H M; van Exel, N Job A; Feenstra, Talitha L; Rutten, Frans F H; Brouwer, Werner B F

    2008-01-01

    Which costs and benefits to consider in economic evaluations of healthcare interventions remains an area of much controversy. Unrelated medical costs in life-years gained is an important cost category that is normally ignored in economic evaluations, irrespective of the perspective chosen for the an

  12. Paul Scherrer Institut annual report 1994. Annex II: PSI life sciences and institute for medical radiobiology newsletter 1994

    Energy Technology Data Exchange (ETDEWEB)

    Reist, H.W. [ed.] [Paul Scherrer Inst. (PSI), Villigen (Switzerland)

    1995-10-01

    This annex reports on the PSI life science division`s progress achieved during 1994 in the fields of radiation medicine, radiopharmacy, magnetic resonance imaging, radiation hygiene, positron emission tomography (PET) and medical radiology. A bibliography of the department`s publications is included. figs., tabs., refs.

  13. Some observations on the interdigitation of advances in medical science and mathematics.

    Science.gov (United States)

    Glamore, Michael James; West, James L; O'leary, James Patrick

    2013-12-01

    The immense advancement of our understanding of disease processes has not been a uniform progression related to the passage of time. Advances have been made in "lurches" and "catches" since the advent of the written word. There has been a remarkable interdependency between such advances in medicine and advances in mathematics that has proved beneficial to both. This work explores some of these critical relationships and documents how the individuals involved contributed to advances in each.

  14. HEALTH SURVEY AND LIFE HABITS OF NURSES WHO WORK AT THE MEDICAL FACULTY HOSPITAL AT AIBU

    Directory of Open Access Journals (Sweden)

    Fatih DENIZ

    2005-04-01

    Full Text Available Objectives: Nursing is an occupation needed renunciation, patience and physical endurance. Nurses have to prevent their physical and mental health, because they can be more beneficial to patients. A cross-sectional study was conducted on AIBU Duzce Medical School Nurses to determine health problems and nutritional habits. Materials and Methods: The questionnaires forms filled by 79 nurses(%86 and analysed the data using an statistical package programme. Results: Mean age of the study group was 23.5 ± 0.2(Standard Erroryears. The answer to ‘Do you satisfied in your life?’question was reported ‘fair’ in 39.7% of the group. 65.7% reported no physical activity. Skipped meals were 80.9%. The most frequent health problems were reported as low back pain (52.9%, back pain (48.5%, stomach pain (48.5%, shoulder pain (38.2% and neck pain (38.2%. Twenty-six and half percent of the group were not immunized against to Hepatitis B. Conclusion: Occupational health and safety unit must be established in workplace. Training about occupational risks and stress management must be given to nurses. [TAF Prev Med Bull 2005; 4(2.000: 55-65

  15. Effects of medical causes, role concepts and treatment stages on quality of life in involuntary childless men.

    Science.gov (United States)

    Schick, M; Rösner, S; Toth, B; Strowitzki, T; Jank, A; Kentenich, H; Thöne, C; Wischmann, T

    2016-11-01

    Goal of this study was to investigate differences in quality of life in men contingent upon various fertility treatment stages, infertility causes and adoption of roles. A quantitative study with n = 115 men in three German fertility centres was devised. Participants completed a standardised, fertility-specific questionnaire devised for men (TLMK), sociodemographic and role items. Men having experienced severe medical conditions, for example cancer, reported significant higher quality of life compared to men with other infertility reasons [F(1,56) = 12.77, P = 0.001]. Furthermore, allocating participants into distinctive groups by means of kind and duration of treatment revealed significant group differences [F(2,111) = 4.94, P = 0.009], with quality of life decreasing with the use of more invasive fertility methods. A higher satisfaction with life was also stated by men adopting many tasks in the treatment process. The high quality of life displayed by men having experienced severe medical conditions contains valuable and far-reaching information about possible resilience factors that need to be researched more in detail. The finding of decreasing quality of life in men with the use of more invasive methods in treatment applies for increased psychosocial services in fertility clinics.

  16. Effect of antipsychotic medication on overall life satisfaction among individuals with chronic schizophrenia: findings from the NIMH CATIE study.

    Science.gov (United States)

    Fervaha, Gagan; Agid, Ofer; Takeuchi, Hiroyoshi; Foussias, George; Remington, Gary

    2014-07-01

    The field of schizophrenia is redefining optimal outcome, moving beyond clinical remission to a more comprehensive model including functional recovery and improved subjective well-being. Although numerous studies have evaluated subjective outcomes within the domain of subjective quality of life in patients with schizophrenia, less is known about global evaluations of subjective well-being. This study examined the effects of antipsychotic medication on overall life satisfaction in patients with chronic schizophrenia. Data were drawn from the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) study, where participants with a DSM-IV diagnosis of schizophrenia were randomized to receive olanzapine, perphenazine, quetiapine, risperidone or ziprasidone under double-blind conditions (N=753). The primary outcome measure was prospective change in subjectively evaluated overall life satisfaction scores following 12 months of antipsychotic treatment. Psychopathology, medication side effects and functional status were also evaluated, among other variables. Patients experienced modest improvements in overall life satisfaction (d=0.22, p0.05). Change in severity of positive, negative, and depressive symptoms as well as functional status each demonstrated a small, albeit statistically significant, association with change in life satisfaction (r=0.10-0.21, p׳slife satisfaction scores (explained variance satisfaction with life. Clinicians should be aware that these two domains are not inextricably linked.

  17. The Quality-of-Life Effects of Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Herman, Joseph M., E-mail: jherma15@jhmi.edu [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Narang, Amol K. [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Griffith, Kent A. [Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Zalupski, Mark M. [Department of Hematology Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Reese, Jennifer B. [Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Gearhart, Susan L. [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Azad, Nolifer S. [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Chan, June; Olsen, Leah [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Efron, Jonathan E. [Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Lawrence, Theodore S.; Ben-Josef, Edgar [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)

    2013-01-01

    Purpose: Existing studies that examine the effect of neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer on patient quality of life (QOL) are limited. Our goals were to prospectively explore acute changes in patient-reported QOL endpoints during and after treatment and to establish a distribution of scores that could be used for comparison as new treatment modalities emerge. Methods and Materials: Fifty patients with locally advanced rectal cancer were prospectively enrolled at 2 institutions. Validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) and colorectal cancer-specific (EORTC QLQ-CR38 and EORTC QLQ-CR 29) QOL questionnaires were administered to patients 1 month before they began CRT, at week 4 of CRT, and 1 month after they had finished CRT. The questionnaires included multiple symptom scales, functional domains, and a composite global QOL score. Additionally, a toxicity scale was completed by providers 1 month before the beginning of CRT, weekly during treatment, and 1 month after the end of CRT. Results: Global QOL showed a statistically significant and borderline clinically significant decrease during CRT (-9.50, P=.0024) but returned to baseline 1 month after the end of treatment (-0.33, P=.9205). Symptoms during treatment were mostly gastrointestinal (nausea/vomiting +9.94, P<.0001; and diarrhea +16.67, P=.0022), urinary (dysuria +13.33, P<.0001; and frequency +11.82, P=.0006) or fatigue (+16.22, P<.0001). These symptoms returned to baseline after therapy. However, sexual enjoyment (P=.0236) and sexual function (P=.0047) remained persistently diminished after therapy. Conclusions: Rectal cancer patients undergoing neoadjuvant CRT may experience a reduction in global QOL along with significant gastrointestinal and genitourinary symptoms during treatment. Moreover, provider-rated toxicity scales may not fully capture this decrease in patient-reported QOL. Although most symptoms are transient

  18. Optical Breath Gas Extravehicular Activity Sensor for the Advanced Portable Life Support System

    Science.gov (United States)

    Wood, William R.; Casias, Miguel E.; Pilgrim, Jeffrey S.; Chullen, Cinda; Campbell, Colin

    2016-01-01

    The function of the infrared gas transducer used during extravehicular activity (EVA) in the current space suit is to measure and report the concentration of carbon dioxide (CO2) in the ventilation loop. The next generation portable life support system (PLSS) requires highly accurate CO2 sensing technology with performance beyond that presently in use on the International Space Station extravehicular mobility unit (EMU). Further, that accuracy needs to be provided over the full operating pressure range of the suit (3 to 25 psia). Accommodation within space suits demands that optical sensors meet stringent size, weight, and power requirements. A laser diode (LD) sensor based on infrared absorption spectroscopy is being developed for this purpose by Vista Photonics, Inc. Version 1.0 prototype devices were delivered to NASA Johnson Space Center (JSC) in September 2011. The prototypes were upgraded with more sophisticated communications and faster response times to version 2.0 and delivered to JSC in July 2012. The sensors incorporate a laser diode based CO2 channel that also includes an incidental water vapor (humidity) measurement. The prototypes are controlled digitally with an field-programmable gate array microcontroller architecture. Based on the results of the iterative instrument development, further prototype development and testing of instruments were performed leveraging the lessons learned where feasible. The present development extends and upgrades the earlier hardware for the advanced PLSS 2.5 prototypes for testing at JSC. The prototypes provide significantly enhanced accuracy for water vapor measurement and eliminate wavelength drift affecting the earlier versions. Various improvements to the electronics and gas sampling are currently being advanced including the companion development of engineering development units that will ultimately be capable of radiation tolerance. The combination of low power electronics with the performance of a long wavelength

  19. Clinical Impact of Education Provision on Determining Advance Care Planning Decisions among End Stage Renal Disease Patients Receiving Regular Hemodialysis in University Malaya Medical Centre

    Science.gov (United States)

    Hing (Wong), Albert; Chin, Loh Ee; Ping, Tan Li; Peng, Ng Kok; Kun, Lim Soo

    2016-01-01

    Introduction: Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States. Aim: To assess the clinical impact of education provision on determining ACP decisions among end-stage renal disease patients on regular hemodialysis at University Malaya Medical Centre (UMMC). To study the knowledge and attitude of patients toward ACP and end-of-life issues. Materials and Methods: Fifty-six patients were recruited from UMMC. About 43 questions pretest survey adapted from Lyon's ACP survey and Moss's cardiopulmonary resuscitation (CPR) attitude survey was given to patients to answer. An educational brochure is then introduced to these patients, and a posttest survey carried out after that. The results were analyzed using SPSS version 22.0. Results: Opinion on ACP, including CPR decisions, showed an upward trend on the importance percentage after the educational brochure exposure, but this was statistically not significant. Seventy-five percent of participants had never heard of ACP before, and only 3.6% had actually prepared a written advanced directive. Conclusion: The ACP educational brochure clinically impacts patients’ preferences and decisions toward end-of-life care; however, this is statistically not significant. Majority of patients have poor knowledge on ACP. This study lays the foundation for execution of future larger scale clinical trials, and ultimately, the incorporation of ACP into clinical practice in Malaysia.

  20. Effect of Intermittent Androgen Blockade on the Quality of Life of Patients with Advanced Prostate Carcinoma

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    OBJECTIVE To investigate the effect of intermittent androgen blockade (IAB) on the quality of life (QOL) of patients with advanced prostatic carcinoma (APC).METHODS Investigations on the QOL of 51 APC patients receiving IAB treatment, totaling 3 times, i.e. 6 months before and after, and 12 months after treatment, were perform using the EORTC QLQ-C30 measuring scale and QLQ-PR25 scale.RESULTS Although IAB became an economic burden for the families, it was lessened during the intermission (P<0.05). The overall health status significantly improved 6 months after IAB treatment (P<0.01), especially during the intermission (P<0.05), with a total or local easement of pain (P<0.01) and an improvement of urinary function (P<0.01). Although there was impairment,to various degrees, in many functions of the patients on the 6th month of treatment, such as the physical function (P<0.05), role function (P<0.05), the emotional (P<0.01) and the social functions (P<0.01), with an enhancement of fatigue (P<0.01), these functions gradually recovered by the 12th month as the intermission started. Treatment-related symptoms such as flushing and mammary swelling significantly emerged on the 6th treatment month (P<0.01), and lessened on the 12th (P<0.01). During the treatment period,therewas an notable drop in sexual interest (P<0.01), with a deprivation of sex life, but revived to various degrees during the intermission (P<0.01).CONCLUSION Although IAB treatment of APC patients did impair the physiologic and psychologic status of patients to varying degrees, these were improved and restored during the intermission.

  1. Weighing environmental advantages and disadvantages of advanced wastewater treatment of micro-pollutants using environmental life cycle assessment

    DEFF Research Database (Denmark)

    Wenzel, Henrik; Larsen, Henrik Fred; Clauson-Kaas, Jes;

    2007-01-01

    -off was investigated using Life Cycle Assessment (LCA) methodology and based on a literature review of advanced treatment performance. The LCA evaluation comprised sand filtration, ozonation and MBRs and assessed the effect of extending existing tertiary treatment with these technologies on a variety of micro...

  2. Assessment of voice, speech, and related quality of life in advanced head and neck cancer patients 10-years+ after chemoradiotherapy

    NARCIS (Netherlands)

    Kraaijenga, S.A.C.; Oskam, I.M.; van Son, R.J.J.H.; Hamming-Vrieze, O.; Hilgers, F.J.M.; van den Brekel, M.W.M.; van der Molen, L.

    2016-01-01

    Objectives: Assessment of long-term objective and subjective voice, speech, articulation, and quality of life in patients with head and neck cancer (HNC) treated with concurrent chemoradiotherapy (CRT) for advanced, stage IV disease. Materials and methods: Twenty-two disease-free survivors, treated

  3. The effect of the Advanced Paediatric Life Support course on perceived self-efficacy and use of resuscitation skills.

    NARCIS (Netherlands)

    Turner, N.M.; Dierselhuis, M.P.; Draaisma, J.M.T.; Cate, O.T. ten

    2007-01-01

    BACKGROUND: Perceived self-efficacy is a predictor of behaviour and therefore an important dimension of resuscitation training which may have consequences for patient care. The Advanced Paediatric Life Support (APLS) course makes use of techniques which would be expected to increase self-efficacy. W

  4. Impact of continuous glucose monitoring on quality of life, treatment satisfaction, and use of medical care resources

    DEFF Research Database (Denmark)

    Hommel, E; Olsen, B; Battelino, T

    2014-01-01

    To investigate the impact of continuous glucose monitoring (CGM) on health-related quality of life (HRQOL), treatment satisfaction (TS) medical resource use, and indirect costs in the SWITCH study. SWITCH was a multicentre, randomized, crossover study. Patients with type 1 diabetes (n = 153) using......, unscheduled visits, or diabetes-related hospitalizations did not differ significantly between the two arms. Adult patients made fewer telephone consultations during the sensor-On arm; children's caregivers made similar numbers of telephone consultations during both arms, and calls were on average only 3 min...... without imposing an additional burden on the patient or increased medical resource use, and offered the potential for cost offsets....

  5. The impact of Roman Catholic moral theology on end-of-life care under the Texas Advance Directives Act.

    Science.gov (United States)

    Zientek, David M

    2006-04-01

    This essay reviews the Roman Catholic moral tradition surrounding treatments at the end of life together with the challenges presented to that tradition by the Texas Advance Directives Act. The impact on Catholic health care facilities and physicians, and the way in which the moral tradition should be applied under this statute, particularly with reference to the provision dealing with conflicts over end-of-life treatments, will be critically assessed. I will argue, based on the traditional treatment of end-of-life issues, that Catholic physicians and institutions should appeal to the conflict resolution process of the Advance Directives Act only under a limited number of circumstances. The implications, under the Texas statute, of varied interpretations of Pope John Paul II's recent allocution on artificial feeding and hydration in the persistent vegetative state will also be considered.

  6. Health-Related Quality of Life after surgery for primary advanced rectal cancer and recurrent rectal cancer

    DEFF Research Database (Denmark)

    Thaysen, Henriette Vind; Jess, Per; Laurberg, Søren

    2012-01-01

    Aim: A review of the literature was undertaken to provide an overview of Health-related quality of life (HRQoL) after surgery for primary advanced or recurrent rectal cancer and to outline proposals for future HRQoL studies in this area. Method: A systematic literature search was undertaken. Only...... studies concerning surgery for primary advanced or recurrent rectal cancer and describing methods used for measuring HRQoL were considered. Results Seven studies were identified including two prospective longitudinal, three cross-sectional and two based on qualitative data. Global quality of life...... cancer. Larger prospective longitudinal studies are needed to improve information on the effects of this extensive surgery on quality of life....

  7. Helmet Exhalation Capture System (HECS) Sizing Evaluation for an Advanced Space Suit Portable Life Support System

    Science.gov (United States)

    Paul, Heather L.; Waguespack, Glenn M.; Paul, Thomas H.; Conger, Bruce C.

    2008-01-01

    As part of NASA s initiative to develop an advanced portable life support system (PLSS), a baseline schematic has been chosen that includes gaseous oxygen in a closed circuit ventilation configuration. Supply oxygen enters the suit at the back of the helmet and return gases pass over the astronaut s body to be extracted at the astronaut s wrists and ankles through the liquid cooling and ventilation garment (LCVG). The extracted gases are then treated using a rapid cycling amine (RCA) system for carbon dioxide and water removal and activated carbon for trace gas removal before being mixed with makeup oxygen and reintroduced into the helmet. Thermal control is provided by a suit water membrane evaporator (SWME). As an extension of the original schematic development, NASA evaluated several Helmet Exhalation Capture System (HECS) configurations as alternatives to the baseline. The HECS configurations incorporate the use of full contact masks or non-contact masks to reduce flow requirements within the PLSS ventilation subsystem. The primary scope of this study was to compare the alternatives based on mass and volume considerations; however other design issues were also briefly investigated. This paper summarizes the results of this sizing analysis task.

  8. Nile tilapia Oreochromis niloticus as a food source in advanced life support systems: Initial considerations

    Science.gov (United States)

    Gonzales, John M.; Brown, Paul B.

    2006-01-01

    Maintenance of crew health is of paramount importance for long duration space missions. Weight loss, bone and calcium loss, increased exposure to radiation and oxidative stress are critical concerns that need to be alleviated. Tilapia are currently under evaluation as a source of food and their contribution to reducing waste in advanced life support systems (ALSS). The nutritional composition of tilapia whole bodies, fillet, and carcass residues were quantitatively determined. Carbon and nitrogen free-extract percentages were similar among whole body (53.76% and 6.96%, respectively), fillets (47.06% and 6.75%, respectively), and carcass (56.36% and 7.04%, respectively) whereas percentages of N, S, and protein were highest in fillet (13.34, 1.34, and 83.37%, respectively) than whole body (9.27, 0.62, and 57.97%, respectively) and carcass (7.70, 0.39, and 48.15%, respectively). Whole body and fillet meet and/or exceeded current nutritional recommendations for protein, vitamin D, ascorbic acid, and selenium for international space station missions. Whole body appears to be a better source of lipids and n-3 fatty acids, calcium, and phosphorous than fillet. Consuming whole fish appears to optimize equivalent system mass compared to consumption of fillets. Additional research is needed to determine nutritional composition of tilapia whole body, fillet, and carcass when fed waste residues possibly encountered in an ALSS.

  9. Systems Engineering and Integration for Advanced Life Support System and HST

    Science.gov (United States)

    Kamarani, Ali K.

    2005-01-01

    Systems engineering (SE) discipline has revolutionized the way engineers and managers think about solving issues related to design of complex systems: With continued development of state-of-the-art technologies, systems are becoming more complex and therefore, a systematic approach is essential to control and manage their integrated design and development. This complexity is driven from integration issues. In this case, subsystems must interact with one another in order to achieve integration objectives, and also achieve the overall system's required performance. Systems engineering process addresses these issues at multiple levels. It is a technology and management process dedicated to controlling all aspects of system life cycle to assure integration at all levels. The Advanced Integration Matrix (AIM) project serves as the systems engineering and integration function for the Human Support Technology (HST) program. AIM provides means for integrated test facilities and personnel for performance trade studies, analyses, integrated models, test results, and validated requirements of the integration of HST. The goal of AIM is to address systems-level integration issues for exploration missions. It will use an incremental systems integration approach to yield technologies, baselines for further development, and possible breakthrough concepts in the areas of technological and organizational interfaces, total information flow, system wide controls, technical synergism, mission operations protocols and procedures, and human-machine interfaces.

  10. Relation between medical sociology and sociology of ageing or later life. A new challenges, social expectations and dilemmas

    Directory of Open Access Journals (Sweden)

    Tobiasz-Adamczyk Beata

    2015-12-01

    Full Text Available Medical sociology has not paid special attention to observed demographic changes associated with the “greying of societies”. Lack of interest in ageing has resulted in the necessity to develop a new subdiscipline - sociology of aging. The evolution of this subdiscipline has been described in relation to social gerontology. Theories of aging (healthy, successful have been presented in relation to new changes. Dilemmas and intractable problems focus on prejudices concerning the older persons, gender-related differences in the quality of life in older age, elderly abuse, and quality of life in mentally ill old people as well as other issues.

  11. Advancing medical-surgical nursing practice: improving management of the changing patient condition.

    Science.gov (United States)

    Monroe, Heidi; Plylar, Peggy; Krugman, Mary

    2014-01-01

    Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.

  12. Models of care for late-life depression of the medically ill: examples from chronic obstructive pulmonary disease and stroke.

    Science.gov (United States)

    Avari, Jimmy N; Alexopoulos, George S

    2015-05-01

    Depression worsens most treatment outcomes in medically ill older adults. Chronic medical illnesses weaken and demoralize patients and compromise their ability to adhere to treatments requiring consistency and effort. Acute medical illnesses create a psychosocial storm that finds patients and their ecosystem unprepared. We describe two intervention models that can be used to target and personalize treatment in depressed, chronically, or acutely medically ill older adults. The Personalized Adherence Intervention for Depression and COPD (PID-C) is a model intervention for depressed patients with chronic medical illnesses. It targets patient-specific barriers to treatment engagement and aims to shift the balance in favor of treatment participation. PID-C led to higher remission rates of depression, reduction in depressive symptoms, and reduction in dyspnea-related disability. The addition of problem-solving training enables patients to use resources available to them and hopefully improve their outcomes. Ecosystem-focused therapy (EFT) is a model intervention for depression developing in the context of an acute medical event. It was developed for patients with poststroke depression (PSD) and targets five areas, part of the "psychosocial storm" originating from the patient's sudden disability and the resulting change in the patient's needs and family's life. A preliminary study suggests that EFT is feasible and efficacious in reducing depressive symptoms and signs and disability in PSD.

  13. ADVANCEMENT IN MEDICAL TREATMENT OF PATIENTS WITH ACUTE RESPIRATORY VIRAL INFECTIONS

    Directory of Open Access Journals (Sweden)

    Kopcha V.S.

    2015-05-01

    Full Text Available Introduction. Acute respiratory viral infections are the special group of diseases, which in the structure of infectious pathology firmly occupies one of leading places. The problem of morbidity belongs to the number of leading medical problems not only in Ukraine but also in the whole world. In addition, there is a greater risk of epidemic flashes of acute respiratory infections in the conditions of megapolis with the expressed processes of migration and accumulation of people. Purpose of test – to promote efficiency of patients treatment with acute respiratory viral infections by complex application of preparation «Extralact» on a background traditional (base therapy without the use of other antiviral preparations, thoroughly to probe influence on clinical motion of the indicated illnesses, endogenous intoxication and immune status of organism. Patients & methods. Under a supervision was 60 patients (22 men and 38 women of young and middle age (hesitated from 18 to 58, which treated oneself concerning ARVI. Determined the indexes of Extralact efficiency: general duration of disease; frequency of development of complications; dynamics of clinical displays; dynamics of laboratory indexes, indexes of endogenous intoxication, and immunological indexes. Patients were randomised on 2 groups: a I group (30 persons – 50,0 % got treatment of base therapy preparations; the II group (30 patients – 50,0 % on a background base therapy got preparation «Extralact» for 2 capsules 3 times per days during 5 days. Results & discussion. Based on the examination of 60 patients with ARVI established following. Addition of base therapy of such patients of extralact in a dose 2 caps. 3 times daily during 5 days was accompanied by a significant advantage compared with only basic therapy on several grounds: the greater the number of patients advancing recovery up to 7 days, most regressed cough, relatively less there were complications. After 5 days of

  14. Axisymmetric whole pin life modelling of advanced gas-cooled reactor nuclear fuel

    Science.gov (United States)

    Mella, R.; Wenman, M. R.

    2013-06-01

    Thermo-mechanical contributions to pellet-clad interaction (PCI) in advanced gas-cooled reactors (AGRs) are modelled in the ABAQUS finite element (FE) code. User supplied sub-routines permit the modelling of the non-linear behaviour of AGR fuel through life. Through utilisation of ABAQUS's well-developed pre- and post-processing ability, the behaviour of the axially constrained steel clad fuel was modelled. The 2D axisymmetric model includes thermo-mechanical behaviour of the fuel with time and condition dependent material properties. Pellet cladding gap dynamics and thermal behaviour are also modelled. The model treats heat up as a fully coupled temperature-displacement study. Dwell time and direct power cycling was applied to model the impact of online refuelling, a key feature of the AGR. The model includes the visco-plastic behaviour of the fuel under the stress and irradiation conditions within an AGR core and a non-linear heat transfer model. A multiscale fission gas release model is applied to compute pin pressure; this model is coupled to the PCI gap model through an explicit fission gas inventory code. Whole pin, whole life, models are able to show the impact of the fuel on all segments of cladding including weld end caps and cladding pellet locking mechanisms (unique to AGR fuel). The development of this model in a commercial FE package shows that the development of a potentially verified and future-proof fuel performance code can be created and used. The usability of a FE based fuel performance code would be an enhancement over past codes. Pre- and post-processors have lowered the entry barrier for the development of a fuel performance model to permit the ability to model complicated systems. Typical runtimes for a 5 year axisymmetric model takes less than one hour on a single core workstation. The current model has implemented: Non-linear fuel thermal behaviour, including a complex description of heat flow in the fuel. Coupled with a variety of

  15. Advance Directives for End-of-Life Care and the Role of Health Education Specialists: Applying the Theory of Reasoned Action

    Science.gov (United States)

    Tremethick, Mary Jane; Johnson, Maureen K.; Carter, Mary R.

    2011-01-01

    Quality end-of-life care is subjective and based on individual values and beliefs. An advance directive provides a legal means of communicating these values and beliefs, as well as preferences in regards to end-of-life care when an individual is no longer able to make his or her desires known. In many nations, advance directives are underused…

  16. Advanced signal processing theory and implementation for sonar, radar, and non-invasive medical diagnostic systems

    CERN Document Server

    Stergiopoulos, Stergios

    2009-01-01

    Integrates topics of signal processing from sonar, radar, and medical system technologies by identifying their concept similarities. This book covers non-invasive medical diagnostic system applications, including intracranial ultrasound, a technology that attempts to address non-invasive detection on brain injuries and stroke.

  17. The CELSS Antarctic Analog Project: An Advanced Life Support Testbed at the Amundsen-Scott South Pole Station, Antarctica

    Science.gov (United States)

    Straight, Christian L.; Bubenheim, David L.; Bates, Maynard E.; Flynn, Michael T.

    1994-01-01

    CELSS Antarctic Analog Project (CAAP) represents a logical solution to the multiple objectives of both the NASA and the National Science Foundation (NSF). CAAP will result in direct transfer of proven technologies and systems, proven under the most rigorous of conditions, to the NSF and to society at large. This project goes beyond, as it must, the generally accepted scope of CELSS and life support systems including the issues of power generation, human dynamics, community systems, and training. CAAP provides a vivid and starkly realistic testbed of Controlled Ecological Life Support System (CELSS) and life support systems and methods. CAAP will also be critical in the development and validation of performance parameters for future advanced life support systems.

  18. A study of the Life Quality of Students at a University of Medical Sciences in the Northeast of Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Amiri

    2014-01-01

    Full Text Available Introduction: Quality of life is an important index in assessing the personal health, making decisions and passing judgments on the general health status of the society, and finding major problems people have in different arenas of life. This study aimed at determining the quality of life among students of Shahroud University of Medical Sciences. Methods: This applied cross-sectional research was carried out in 2011. The data collection instrument was the 26-item quality of life questionnaire by WHO. The collected data were analyzed through chi square test with SPSS. Results: The average age of the participants was 20.8±2.3. 79.2% of the participants were females. 22.7% of the participants were indigenous students. In studying the students’ quality of life in the four areas of health, physical health (14.2±2.4 showed the highest score, followed by social health (14.1±3.2, mental health (13.1±2.8 and environmental health (12.7±2.5. No significant relationships were observed between quality of life and gender, level of education, marital status, place of residence, economic activities, the size of family, birth order, and the life status (dead/alive of the parents (P>0.05. However the relationships between quality of life and being indigenous (P=0.049, family’s income (P=0.02 and main field of study (P=0.02 were significant. Conclusion: In addition to admitting indigenous students, setting up counseling clinics in campuses and dormitories and offering training and explanatory courses on living in university environments, improving the facilities and sports and recreational programs can promote the health level of students and enhance their life quality.

  19. Plant Growth Experiments in Zeoponic Substrates: Applications for Advanced Life Support Systems

    Science.gov (United States)

    Ming, Douglas W.; Gruener, J. E.; Henderson, K. E.; Steinberg, S. L.; Barta, D. J.; Galindo, C.; Henninger, D. L.

    2001-01-01

    A zeoponic plant-growth system is defined as the cultivation of plants in artificial soils, which have zeolites as a major component (Allen and Ming, 1995). Zeolites are crystalline, hydrated aluminosilicate minerals that have the ability to exchange constituent cations without major change of the mineral structure. Recently, zeoponic systems developed at the National Aeronautics and Space Administration (NASA) slowly release some (Allen et at., 1995) or all of the essential plant-growth nutrients (Ming et at., 1995). These systems have NH4- and K-exchanged clinoptilolite (a natural zeolite) and either natural or synthetic apatite (a calcium phosphate mineral). For the natural apatite system, Ca and P were made available to the plant by the dissolution of apatite. Potassium and NH4-N were made available by ion-exchange reactions involving Ca(2+) from apatite dissolution and K(+) and NH4(+) on zeolitic exchange sites. In addition to NH4-N, K, Ca, and P, the synthetic apatite system also supplied Mg, S, and other micronutrients during dissolution (Figure 1). The overall objective of this research task is to develop zeoponic substrates wherein all plant growth nutrients are supplied by the plant growth medium for several growth seasons with only the addition of water. The substrate is being developed for plant growth in Advanced Life Support (ALS) testbeds (i.e., BioPLEX) and microgravity plant growth experiments. Zeoponic substrates have been used for plant growth experiments on two Space Shuttle flight experiments (STS-60; STS-63; Morrow et aI., 1995). These substrates may be ideally suited for plant growth experiments on the International Space Station and applications in ALS testbeds. However, there are several issues that need to be resolved before zeoponics will be the choice substrate for plant growth experiments in space. The objective of this paper is to provide an overview on recent research directed toward the refinement of zeoponic plant growth substrates.

  20. Can course format influence the performance of students in an advanced cardiac life support (ACLS program?

    Directory of Open Access Journals (Sweden)

    F.D. Garrido

    2011-01-01

    Full Text Available Advanced cardiac life support (ACLS is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003 and Model 2 (N = 2085; 2003-2007. Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given. Compared to Model 1, Model 2 presented odds ratios (OR indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64, practical (OR = 1.19; 95%CI = 0.90-1.57, and combined (OR = 1.38; 95%CI = 1.13-1.68 outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students.

  1. Can course format influence the performance of students in an advanced cardiac life support (ACLS) program?

    Science.gov (United States)

    Garrido, F D; Romano, M M D; Schmidt, A; Pazin-Filho, A

    2011-01-01

    Advanced cardiac life support (ACLS) is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003) and Model 2 (N = 2085; 2003-2007). Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given). Compared to Model 1, Model 2 presented odds ratios (OR) indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64), practical (OR = 1.19; 95%CI = 0.90-1.57), and combined (OR = 1.38; 95%CI = 1.13-1.68) outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students.

  2. Advanced life events (ALEs) that impede aging-in-place among seniors.

    Science.gov (United States)

    Lindquist, Lee A; Ramirez-Zohfeld, Vanessa; Sunkara, Priya; Forcucci, Chris; Campbell, Dianne; Mitzen, Phyllis; Cameron, Kenzie A

    2016-01-01

    Despite the wishes of many seniors to age-in-place in their own homes, critical events occur that impede their ability to do so. A gap exists as to what these advanced life events (ALEs) entail and the planning that older adults perceive is necessary. The purpose of this study was to identify seniors' perceptions and planning toward ALEs that may impact their ability to remain in their own home. We conducted focus groups with 68 seniors, age ≥65 years (mean age 73.8 years), living in the community (rural, urban, and suburban), using open-ended questions about perceptions of future heath events, needs, and planning. Three investigators coded transcriptions using constant comparative analysis to identify emerging themes, with disagreements resolved via consensus. Subjects identified five ALEs that impacted their ability to remain at home: (1) Hospitalizations, (2) Falls, (3) Dementia, (4) Spousal Loss, and (5) Home Upkeep Issues. While recognizing that ALEs frequently occur, many subjects reported a lack of planning for ALEs and perceived that these ALEs would not happen to them. Themes for the rationale behind the lack of planning emerged as: uncertainty in future, being too healthy/too sick, offspring influences, denial/procrastination, pride, feeling overwhelmed, and financial concerns. Subjects expressed reliance on offspring for navigating future ALEs, although many had not communicated their needs with their offspring. Overcoming the reasons for not planning for ALEs is crucial, as being prepared for future home needs provides seniors a voice in their care while engaging key supporters (e.g., offspring).

  3. End-of-life experiences of mothers with advanced cancer: perspectives of widowed fathers

    Science.gov (United States)

    Park, Eliza M; Deal, Allison M; Yopp, Justin M; Edwards, Teresa; Wilson, Douglas J; Hanson, Laura C; Rosenstein, Donald L

    2017-01-01

    Objective Despite the importance of parenting-related responsibilities for adult patients with terminal illnesses who have dependent children, little is known about the psychological concerns of dying parents and their families at the end of life (EOL). The aim of this study was to elicit widowed fathers’ perspectives on how parental status may have influenced the EOL experiences of mothers with advanced cancer. Subjects Three hundred and forty-four men identified themselves through an open-access educational website as widowed fathers who had lost a spouse to cancer and were raising dependent children. Methods Participants completed a web-based survey about their wife’s EOL experience and cancer history, and their own depression (Center for Epidemiologic Studies Depression Scale, CES-D) and bereavement (Texas Revised Inventory of Grief, TRIG) symptoms. Descriptive statistics, Fisher’s exact tests, and linear regression modeling were used to evaluate relationships between variables. Results According to fathers, 38% of mothers had not said goodbye to their children before death and 26% were not at all “at peace with dying.” Ninety percent of widowed fathers reported that their spouse was worried about the strain on their children at the EOL. Fathers who reported clearer prognostic communication between wife and physician had lower CES-D and TRIG scores. Conclusions To improve EOL care for seriously ill patients and their families, we must understand the concerns of parents with dependent children. These data underscore the importance of parenting-related worries in this population and the need for additional clinical and research programs devoted to addressing these issues. PMID:26685117

  4. Practical Considerations of Waste Heat Reuse for a Mars Mission Advanced Life Support System

    Science.gov (United States)

    Levri, Julie; Finn, Cory; Luna, Bernadette (Technical Monitor)

    2000-01-01

    Energy conservation is a key issue in design optimization of Advanced Life Support Systems (ALSS) for long-term space missions. By considering designs for conservation at the system level, energy saving opportunities arise that would otherwise go unnoticed. This paper builds on a steady-state investigation of system-level waste heat reuse in an ALSS with a low degree of crop growth for a Mars mission. In past studies, such a system has been defined in terms of technology types, hot and cold stream identification and stream energy content. The maximum steady-state potential for power and cooling savings within the system was computed via the Pinch Method. In this paper, several practical issues are considered for achieving a pragmatic estimate of total system savings in terms of equivalent system mass (ESM), rather than savings solely in terms of power and cooling. In this paper, more realistic ESM savings are computed by considering heat transfer inefficiencies during material transfer. An estimate of the steady-state mass, volume and crewtime requirements associated with heat exchange equipment is made by considering heat exchange equipment material type and configuration, stream flow characteristics and associated energy losses during the heat exchange process. Also, previously estimated power and cooling savings are adjusted to reflect the impact of such energy losses. This paper goes one step further than the traditional Pinch Method of considering waste heat reuse in heat exchangers to include ESM savings that occur with direct reuse of a stream. For example, rather than exchanging heat between crop growth lamp cooling air and air going to a clothes dryer, air used to cool crop lamps might be reused directly for clothes drying purposes. When thermodynamically feasible, such an approach may increase ESM savings by minimizing the mass, volume and crewtime requirements associated with stream routing equipment.

  5. Level of Knowledge of specialist cardiologists and anesthesiologists in Basic and Advanced Life Support

    Directory of Open Access Journals (Sweden)

    Maria Vachla

    2013-01-01

    Full Text Available Health professionals often witness in-hospital episodes of cardiac arrest. The quality of the Cardiopulmonary Resuscitation (CPR depends on the level of theoretical background and practical skills. Purpose: The aim of the present study was to investigate the level of theoretical knowledge of skilled cardiologists and anesthesiologists in the Basic and Advanced Life Support (BLS/ ALS. Material - method: In this study, sample included 240 cardiologists and anesthesiologists, chosen randomly from employers of 17 General Public Hospitals of Athens. For data collection, a questionnaire with 16 theoretical questions was designed, based on the guidelines of the European Resuscitation Council (ERC 2005. Significance level was set at p=≤0,05. The analysis was performed with the Statistical Package IBM SPSS Statistics 19. Results: No statistically significant difference was observed between specialists cardiologists and anesthesiologists in overall performance in theoretical knowledge on the BLS and ALS. Additionally, no statistical significance was observed between the two separate groups of theoretical background. Statistically significant difference was observed among those who had participated in a training seminar in BLS and ALS and those who had not participated (p<0,001. Also, there was statistical significance between the follow-up seminar in BLS/ ALS and specialty for the right answer to the question "which is the right ratio of chest compressions and ventilation", (p<0,001. Conclusions: The level of background knowledge of specialist cardiologists and anesthesiologists in the algorithms of BLS and ALS seem to correlate to the attendance of a training course.

  6. Astrobiology Sample Analysis Program (ASAP) for Advanced Life Detection Instrumentation Development and Calibration

    Science.gov (United States)

    Glavin, Daniel; Brinkerhoff, Will; Dworkin, Jason; Eigenbrode, Jennifer; Franz, Heather; Mahaffy, Paul; Stern, Jen; Blake, Daid; Sandford, Scott; Fries, marc; Steele, Andrew; Amashukeli, Xenia; Fisher, Anita; Grunthaner, Frank; Aubrey, Andrew; Bada, Jeff; Chiesl, Tom; Stockton, Amanda; Mathies, Rich

    2008-01-01

    Scientific ground-truth measurements for near-term Mars missions, such as the 2009 Mars Science Laboratory (MSL) mission, are essential for validating current in situ flight instrumentation and for the development of advanced instrumentation technologies for life-detection missions over the next decade. The NASA Astrobiology Institute (NAI) has recently funded a consortium of researchers called the Astrobiology Sample Analysis Program (ASAP) to analyze an identical set of homogenized martian analog materials in a "round-robin" style using both state-of-the-art laboratory techniques as well as in-situ flight instrumentation including the SAM gas chromatograph mass spectrometer and CHEMIN X-ray diffraction/fluorescence instruments on MSL and the Urey and MOMA organic analyzer instruments under development for the 2013 ExoMars missions. The analog samples studied included an Atacama Desert soil from Chile, the Murchison meteorite, a gypsum sample from the 2007 AMASE Mars analog site, jarosite from Panoche Valley, CA, a hydrothermal sample from Rio Tinto, Spain, and a "blind" sample collected during the 2007 MSL slow-motion field test in New Mexico. Each sample was distributed to the team for analysis to: (1) determine the nature and inventory of organic compounds, (2) measure the bulk carbon and nitrogen isotopic composition, (3) investigate elemental abundances, mineralogy and matrix, and (4) search for biological activity. The experimental results obtained from the ASAP Mars analog research consortium will be used to build a framework for understanding the biogeochemistry of martian analogs, help calibrate current spaceflight instrumentation, and enhance the scientific return from upcoming missions.

  7. Advances in medical education and practice: student perceptions of the flipped classroom

    Science.gov (United States)

    Ramnanan, Christopher J; Pound, Lynley D

    2017-01-01

    The flipped classroom (FC) approach to teaching has been increasingly employed in undergraduate medical education in recent years. In FC applications, students are first exposed to content via online resources. Subsequent face-to-face class time can then be devoted to student-centered activities that promote active learning. Although the FC has been well received by students in other contexts, the perceptions of medical students regarding this innovation are unclear. This review serves as an early exploration into medical student perceptions of benefits and limitations of the FC. Medical students have generally expressed strong appreciation for the pre-class preparation activities (especially when facilitated by concise, readily accessed online tools) as well as for interactive, engaging small group classroom activities. Some students have expressed concerns with the FC and noted that suboptimal student preparation and insufficient direction and structure during active learning sessions may limit the student-centered benefits. Although students generally perceive that FC approaches can improve their learning and knowledge, this has not been conclusively shown via performances on assessment tools, which may be related to caveats with the assessment tools used. In any case, lifelong self-directed learning skills are perceived by medical students to be enhanced by the FC. In conclusion, medical students have generally expressed strong satisfaction with early applications of the FC to undergraduate medical education, and generally prefer this method to lecture-based instruction. PMID:28144171

  8. Advances in medical education and practice: student perceptions of the flipped classroom.

    Science.gov (United States)

    Ramnanan, Christopher J; Pound, Lynley D

    2017-01-01

    The flipped classroom (FC) approach to teaching has been increasingly employed in undergraduate medical education in recent years. In FC applications, students are first exposed to content via online resources. Subsequent face-to-face class time can then be devoted to student-centered activities that promote active learning. Although the FC has been well received by students in other contexts, the perceptions of medical students regarding this innovation are unclear. This review serves as an early exploration into medical student perceptions of benefits and limitations of the FC. Medical students have generally expressed strong appreciation for the pre-class preparation activities (especially when facilitated by concise, readily accessed online tools) as well as for interactive, engaging small group classroom activities. Some students have expressed concerns with the FC and noted that suboptimal student preparation and insufficient direction and structure during active learning sessions may limit the student-centered benefits. Although students generally perceive that FC approaches can improve their learning and knowledge, this has not been conclusively shown via performances on assessment tools, which may be related to caveats with the assessment tools used. In any case, lifelong self-directed learning skills are perceived by medical students to be enhanced by the FC. In conclusion, medical students have generally expressed strong satisfaction with early applications of the FC to undergraduate medical education, and generally prefer this method to lecture-based instruction.

  9. The Study of Life Change Unit as Stressor Agents among Tehran University of Medical Sciences Hospitals' Employees

    Directory of Open Access Journals (Sweden)

    Hossein Dargahi

    2010-08-01

    Full Text Available Life crises as stressor agents can disrupt the best stress management regime. Different life crises have different impacts. A standard scale to rate change and its related stress impact has been developed commonly referred to as LCU (Life Change Unit Rating. This allocates a number of Life Crisis Units or Life Change Units (LCUs to different event and then evaluates them and takes action accordingly. This idea behind this approach of is to rundown the LCU table, totaling the LCUs for life crisis that have occurred in the previous one year. A Cross - sectional, descriptive and analytical study was conducted among 900 Tehran University of Medical Sciences (TUMS Employees by a Holms and Rahe LCU questionnaire at 15 hospitals. The respondents were asked to determine their demographic information, list of stress symptoms which suffered from these diseases in the previous one year and finally, responded to 45 Life Change Unit as stressful life events and the value of each in "stress units" which occurred in the previous one year. The results showed that there is significant correlation between the employees LCU rating by sex, educational degree and size of hospital. Also we found that there are significant correlations between the employees stress symptoms with their LCU rating. Totally, 40% of the employees have less than 150 LCU rating (normal range and 60% of them have 150-300 or more than 300 LCU rating (abnormal range. In conclusion most of TUMS hospitals' employees who had stress symptoms have more LCU rating. One third of these employees are not in danger of suffering the illness effect, while two third of them are in danger.

  10. The study of life change unit as stressor agents among Tehran University of Medical Sciences Hospitals' employees.

    Science.gov (United States)

    Dargahi, Hossein; Sharifiy Yazdi, Mohammad Kazem

    2010-01-01

    Life crises as stressor agents can disrupt the best stress management regime. Different life crises have different impacts. A standard scale to rate change and its related stress impact has been developed commonly referred to as LCU (life change unit) rating. This allocates a number of life crisis units or life change units (LCUs) to different event and then evaluates them and takes action accordingly. This idea behind this approach of is to rundown the LCU table, totaling the LCUs for life crisis that have occurred in the previous one year. A cross-sectional, descriptive and analytical study was conducted among 900 Tehran University of Medical Sciences (TUMS) employees by a Holms and Rahe LCU questionnaire at 15 hospitals. The respondents were asked to determine their demographic information, list of stress symptoms which suffered from these diseases in the previous one year and finally, responded to 45 Life Change Unit as stressful life events and the value of each in "stress units" which occurred in the previous one year. The results showed that there is significant correlation between the employees LCU rating by sex, educational degree and size of hospital. Also we found that there are significant correlations between the employees stress symptoms with their LCU rating. Totally, 40% of the employees have less than 150 LCU rating (normal range) and 60% of them have 150-300 or more than 300 LCU rating (abnormal range). In conclusion most of TUMS hospitals' employees who had stress symptoms have more LCU rating. One third of these employees are not in danger of suffering the illness effect, while two third of them are in danger.

  11. Treatment adherence and quality of life in patients on antihypertensive medications in a Middle Eastern population: adherence

    Directory of Open Access Journals (Sweden)

    Alhaddad IA

    2016-10-01

    Full Text Available Imad A Alhaddad,1 Omar Hamoui,2 Ayman Hammoudeh,3 Samir Mallat4 1Cardiovascular Department, Jordan Hospital, Amman, Jordan; 2Cardiology Department, Clemenceau Medical Center, Beirut, Lebanon; 3Cardiology Department, Istishari Hospital, Amman, Jordan; 4Department of Internal Medicine, Nephrology Division, American University of Beirut Medical Center, Beirut, Lebanon Background: Poor adherence to antihypertensive treatment remains a clinical challenge worldwide. The objectives of this study were to assess the adherence level to antihypertensive treatment and to identify its associated factors in a sample of hypertensive patients in Lebanon and Jordan. Methods: We conducted an observational study between May 2011 and September 2012. A total of 1,470 eligible hypertensive patients were enrolled in our study and followed up for a period of 6 months. Data were collected regarding sociodemographic, health behavior, and hypertension-related characteristics. The adherence to treatment and the quality of life were self-reported using the Morisky, Green & Levine Scale and the Hypertension Quality of Life Questionnaire. Results: Our results revealed that 55.9 % of the patients were adherent to their antihypertensive medication. Older age was associated with better adherence, whereas being divorced or widowed, having a poorer quality of life, and being classified as having stage 1 or 2 hypertension at the end of the study were all associated with poorer adherence. Conclusion: Efforts should be exerted on all levels in order to increase the adherence to antihypertensive treatment through the implementation of educational campaigns. Keywords: adherence, NC 7 guidelines, Morisky, Green & Levine Scale, Hypertension Quality of Life Questionnaire, Lebanon, Jordan

  12. Quality of life of breast cancer patients medicated with anti-estrogens, 2 years after acupuncture treatment: a qualitative study

    Directory of Open Access Journals (Sweden)

    Jill Hervik

    2010-09-01

    Full Text Available Jill Hervik1, Odd Mjåland21Pain Clinic, Vestfold Hospital, Tønsberg, Norway; 2Department of Abdominal Surgery, Sørlandet Sykehus, Kristiansand, NorwayObjective: The aim of this study was to examine the quality of life of breast cancer patients medicated with estrogen antagonists, 2 years after having acupuncture treatment for hot flashes.Methods and materials: Our sample was taken from women who had recently participated in a randomized controlled trial investigating the effects of acupuncture on hot flashes, a side effect of estrogen-antagonist treatment. Forty-one women from the true acupuncture treatment group and 41 women from the control group (sham acupuncture, who had 2 years previously received a course of 15 acupuncture treatments over a period of 10 weeks, were asked to answer an open question. The question, “Would you like to share your thoughts and experiences related to your breast cancer diagnosis, treatments or anything else?” was by being open, broad, and nonspecific, intended to stimulate subjective information, which was not included in the original, or future quantitative studies. Qualitative data were analyzed using systematic text condensation.Results: Most women were troubled by two or more side effects due to anti-estrogen medication, negatively affecting their life quality. Symptoms included hot flashes, sleep problems, muscle and joint pain, arm edema, fatigue, weight gain, depression, and lack of sexual desire. Women previously treated with sham acupuncture complained that hot flashes were still problematic, whilst those previously treated with traditional Chinese acupuncture found them less of a problem and generally had a more positive outlook on life. These results compare favorably with the findings from our original study that measured quantitatively health related quality of life.Conclusion: Side effects due to anti-estrogen treatment seriously affect the quality of life of breast cancer operated patients

  13. Short report : Chronic medical conditions and life satisfaction in the elderly

    NARCIS (Netherlands)

    Jelicic, M; Kempen, GIJM

    1999-01-01

    The aim of this study was to examine the effect of chronic disease on life satisfaction in community dwelling elderly. A total of 5279 research participants, mean age 69.57 (SD = 8.04) yrs, were asked to judge their life satisfaction on the Seven Point Satisfaction Rating Scale. They were also admin

  14. Adapting the Advanced Cardiac Life Support for the Experienced Provider (ACLS-EP course for emergency care education in Rwanda

    Directory of Open Access Journals (Sweden)

    William E. Cayley Jr

    2011-02-01

    Full Text Available The Advanced Cardiac Life Support for the Experienced Provider (ACLS-EP course uses a case-based curriculum to teach emergency resuscitation principles to experienced health care professionals. This article describes the adaptation of the ACLS-EP curriculum to be used in a family medicine training programme in Rwanda, including lessons learned and recommendations for future use of this material for emergency care education in the African setting.

  15. Adapting the Advanced Cardiac Life Support for the Experienced Provider (ACLS-EP) course for emergency care education in Rwanda

    OpenAIRE

    Cayley Jr, William E

    2011-01-01

    The Advanced Cardiac Life Support for the Experienced Provider (ACLS-EP) course uses a case-based curriculum to teach emergency resuscitation principles to experienced health care professionals. This article describes the adaptation of the ACLS-EP curriculum to be used in a family medicine training programme in Rwanda, including lessons learned and recommendations for future use of this material for emergency care education in the African setting.

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

    Science.gov (United States)

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

    2015-04-01

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

  17. Medical Informatics For Medical Students And Medical Practitioners

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    Jai MOHAN

    2010-06-01

    Full Text Available The importance of incorporating medical (or healthinformatics into the education of medical students andmedical practitioners is being increasingly recognised.The advances in information and communicationtechnology and the pervasion of the Internet intoeveryday life have important implications forhealthcare services and medical education.Students and practitioners should learn to utilisebiomedical information for problem solving anddecision making based on evidence. The extensiveintroduction of electronic health information systemsinto hospitals and clinics and at the enterprise level inMalaysia and elsewhere is driving a demand for healthprofessionals who have at least basic skills in andappreciation of the use of these technologies.The essential clinical informatics skills have beenidentified and should be incorporated into theundergraduate medical curriculum. It is recommendedthat these be introduced in stages and integrated intoexisting programmes rather than taught as a separatemodule. At the same time, medical schools shouldsupport the integration of e-learning in the educationalprocess in view of the numerous potential benefits.

  18. End-of-life mental health assessments for older aged, medically ill persons with expressed desire to die.

    Science.gov (United States)

    Weinberger, Linda E; Sreenivasan, Shoba; Garrick, Thomas

    2014-01-01

    In recent years, assisted suicide has been legalized in four states for those who are terminally ill and wish to end their lives with the assistance of lethal doses of medications prescribed by a physician. The ethics-related and legal questions raised by end-of-life suicide and decisional capacity to refuse treatment assessments are complex. In treating patients with end-stage medical conditions or disorders that severely affect the future quality of their lives, clinicians tend to engage in suicide prevention at all costs. Overriding the patient's expressed desire to die conflicts with another value, however, that of the individual's right to autonomy. We provide a framework for understanding these difficult decisions, by providing a review of the epidemiology of suicide in later life; reviewing findings from a unique dataset of suicides among the elderly obtained from the Los Angeles County Coroner's Office, as well as data from states with legalized assisted suicide; presenting a discussion of the two frameworks of suicidal ideation as a pathological versus an existential reaction; and giving a case example that highlights the dilemmas faced by clinicians addressing decisional capacity to refuse treatment in an elderly, medically ill patient who has expressed the wish to die.

  19. Weighing environmental advantages and disadvantages of advanced wastewater treatment of micro-pollutants using environmental life cycle assessment

    DEFF Research Database (Denmark)

    Wenzel, Henrik; Larsen, Henrik Fred; Clauson-Kaas, Jes

    2008-01-01

    has the best balance between prevented and induced impacts, and sand filtration proved to have a net environmental benefit under the assumptions used in the study. But the outcome of the study suggests that this is not always the case for ozonation and MBR. Keywords: advanced wastewater treatment; LCA......Much research and development effort is directed towards advances in municipal wastewater treatment aiming at reducing the effluent content of micro-pollutants and pathogens. The objective is to further reduce the eco-toxicity, hormone effects and pathogenic effects of the effluent. Such further......-off was investigated using Life Cycle Assessment (LCA) methodology and based on a literature review of advanced treatment performance. The LCA evaluation comprised sand filtration, ozonation and MBRs and assessed the effect of extending existing tertiary treatment with these technologies on a variety of micro...

  20. Meeting the needs of children with medical complexity using a telehealth advanced practice registered nurse care coordination model.

    Science.gov (United States)

    Cady, Rhonda G; Erickson, Mary; Lunos, Scott; Finkelstein, Stanley M; Looman, Wendy; Celebreeze, Margaret; Garwick, Ann

    2015-07-01

    Effective care coordination is a key quality and safety strategy for populations with chronic conditions, including children with medical complexity (CMC). However, gaps remain in parent report of the need for care coordination help and receipt of care coordination help. New models must close this gap while maintaining family-centered focus. A three-armed randomized controlled trial conducted in an established medical home utilized an advanced practice registered nurse intervention based on Presler's model of clinic-based care coordination. The model supported families of CMC across settings using telephone only or telephone and video telehealth care coordination. Effectiveness was evaluated from many perspectives and this paper reports on a subset of outcomes that includes family-centered care (FCC), need for care coordination help and adequacy of care coordination help received. FCC at baseline and end of study showed no significant difference between groups. Median FCC scores of 18.0-20.0 across all groups indicated high FCC within the medical home. No significant differences were found in the need for care coordination help within or between groups and over time. No significant difference was found in the adequacy of help received between groups at baseline. However, this indicator increased significantly over time for both intervention groups. These findings suggest that in an established medical home with high levels of FCC, families of CMC have unmet needs for care coordination help that are addressed by the APRN telehealth care coordination model.

  1. An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU in Brazil

    Directory of Open Access Journals (Sweden)

    Fernando Sabia Tallo

    2014-09-01

    Full Text Available OBJECTIVE: To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU in Brazil and to evaluate their quality of life. METHODS: Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. RESULTS: Of a total of 902 physicians, including 644 (71.4% males, 533 (59.1% were between 30 and 45 years of age and 562 (62.4% worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%, airway surgical access (45.6%, pericardiocentesis (64.4% and thoracentesis (29.9%. Difficulties in using an artificial ventilator (43.3% and in transcutaneous pacing (42.2% were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p48 h per week (12.8 vs 8.6%; p<0.001, and were non-specialists with the shortest length of service (<1 year at SAMU (30.1 vs 18.2%; p<0.001 who were hired without having to pass public service exams* (i.e., for a temporary job (61.8 vs 46.2%; p<0.001. Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU. CONCLUSIONS: The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills

  2. Racial Differences in Processes of Care at End of Life in VA Medical Centers: Planned Secondary Analysis of Data from the BEACON Trial

    Science.gov (United States)

    Williams, Beverly R.; Dionne-Odom, J. Nicholas; Redden, David T.; Noh, Hyunjin; Goode, Patricia S.; Kvale, Elizabeth; Bakitas, Marie; Bailey, F. Amos

    2016-01-01

    Abstract Background: Racial differences exist for a number of health conditions, services, and outcomes, including end-of-life (EOL) care. Objective: The aim of the study was to examine differences in processes of care in the last 7 days of life between African American and white inpatients. Methods: Secondary analysis was conducted of data collected in the Best Practices for End-of-Life Care for Our Nation's Veterans (BEACON) trial (conducted 2005–2011). Subjects were 4891 inpatient decedents in six Veterans Administration Medical Centers. Data were abstracted from decedents' medical records. Multi-variable analyses were conducted to examine the relationship between race and each of 18 EOL processes of care controlling for patient characteristics, study site, year of death, and whether the observation was pre- or post-intervention. Results: The sample consisted of 1690 African American patients (34.6%) and 3201 white patients (65.4%). African Americans were less likely to have: do not resuscitate (DNR) orders (odds ratio [OR]: 0.67; p = 0.004), advance directives (OR: 0.71; p = 0.023), active opioid orders (OR: 0.64, p = 0.0008), opioid medications administered (OR: 0.61, p = 0.004), benzodiazepine orders (OR: 0.68, p < 0.0001), benzodiazepines administered (OR: 0.61, p < 0.0001), antipsychotics administered (OR: 0.73, p = 0.004), and steroids administered (OR: 0.76, p = 0.020). Racial differences were not found for other processes of care, including palliative care consultation, pastoral care, antipsychotic and steroid orders, and location of death. Conclusions: Racial differences exist in some but not all aspects of EOL care. Further study is needed to understand the extent to which racial differences reflect different patient needs and preferences and whether interventions are needed to reduce disparities in patient/family education or access to quality EOL care. PMID:26840851

  3. DOES URINARY DIVERSION IMPROVE THE QUALITY OF LIFE IN OBSTRUCTIVE UROPATHY SECONDARY TO ADVANCED PELVIC MALIGNANCY?

    Directory of Open Access Journals (Sweden)

    Shivashankarappa

    2016-02-01

    Full Text Available INTRODUCTION The incidence of patients presenting with advanced pelvic malignancy with obstructive uropathy is high in our country. Relentless progress of the malignancy will cause deterioration of renal function, aggravation of pain, infection, deterioration of Quality of Life (QOL, uremia and death. Decreased renal function is considered as a contraindication for palliative chemo and radiotherapy. However urinary diversion in these patients will lead to improvement in renal function and may help in administration of palliative therapy and thus, improve the quality of life of these patients. MATERIALS AND METHODS The present study includes the obstructive uropathy patients secondary to pelvic malignancy referred to our institution for urinary diversion between Jan 2010 to Dec 2014. Total 40 patients were included, of which, 25 patients underwent PCN, 9 patients retrograde DJ stenting, 4 patients refused the treatment, 2 patients were not fit for any intervention due to coagulopathy & comorbid conditions. Of 34 treated patients, 30 were female patients and 4 were male patients. All the patients were explained about the procedure and proper consent taken. Laboratory investigations like CBC, coagulation profile, LFT, routine urine analysis, urine C&S and serum electrolytes were carried out. Haemodialysis was done for 10 patients whose serum creatinine was >6mg% & potassium >6meq. USG guided PCN insertion was done in 8 patients, and in those who failed in this procedure, fluoroscopic C-ARM guided PCN insertion done in 17 patients. Post operatively RFT and serum electrolytes were assessed on 3, 7, 15, & 30th day. PCN catheter was changed once in 3 months. RESULTS 8 patients succeeded in USG guided PCN insertion and 17 patients who failed USG PCN insertion, was done under C–Arm guidance. 3 patients received blood transfusion. No deaths were seen during or post procedure in the hospital. Renal functions improved and normalised in most of the

  4. A CMMI-based approach for medical software project life cycle study.

    Science.gov (United States)

    Chen, Jui-Jen; Su, Wu-Chen; Wang, Pei-Wen; Yen, Hung-Chi

    2013-01-01

    In terms of medical techniques, Taiwan has gained international recognition in recent years. However, the medical information system industry in Taiwan is still at a developing stage compared with the software industries in other nations. In addition, systematic development processes are indispensable elements of software development. They can help developers increase their productivity and efficiency and also avoid unnecessary risks arising during the development process. Thus, this paper presents an application of Light-Weight Capability Maturity Model Integration (LW-CMMI) to Chang Gung Medical Research Project (CMRP) in the Nuclear medicine field. This application was intended to integrate user requirements, system design and testing of software development processes into three layers (Domain, Concept and Instance) model. Then, expressing in structural System Modeling Language (SysML) diagrams and converts part of the manual effort necessary for project management maintenance into computational effort, for example: (semi-) automatic delivery of traceability management. In this application, it supports establishing artifacts of "requirement specification document", "project execution plan document", "system design document" and "system test document", and can deliver a prototype of lightweight project management tool on the Nuclear Medicine software project. The results of this application can be a reference for other medical institutions in developing medical information systems and support of project management to achieve the aim of patient safety.

  5. User experience integrated life-style cloud-based medical application.

    Science.gov (United States)

    Serban, Alexandru; Lupşe, Oana Sorina; Stoicu-Tivadar, Lăcrămioara

    2015-01-01

    Having a modern application capable to automatically collect and process data from users, based on information and lifestyle answers is one of current challenges for researchers and medical science. The purpose of the current study is to integrate user experience design (UXD) in a cloud-based medical application to improve patient safety, quality of care and organizational efficiency. The process consists of collecting traditional and new data from patients and users using online questionnaires. A questionnaire dynamically asks questions about the user's current diet and lifestyle. After the user will introduce the data, the application will formulate a presumptive nutritional plan and will suggest different medical recommendations regarding a healthy lifestyle, and calculates a risk factor for diseases. This software application, by design and usability will be an efficient tool dedicated for fitness, nutrition and health professionals.

  6. Growing up Kennedy: the role of medical ailments in the life of JFK, 1920-1957.

    Science.gov (United States)

    Giglio, James N

    2006-10-01

    As a result of the opening of new materials at the John F Kennedy Library relating to John F Kennedy's medical problems, we have a better understanding of the specific nature of those ailments, how they were treated, and how he responded to them. Most important, this study focuses on how his medical problems affected his relationship with his parents, especially his father, in the context of an older sibling who personified what a Kennedy should be: bright, athletic, and healthy. John Kennedy's response to family expectations produced a sometimes rebellious and detached youth who learned to rely on his charm, wit, intellect, and inner toughness to overcome adversity. In the process of dealing with serious medical issues into adulthood, John Kennedy revealed both courage and fortitude-traits that would eventually carry him to the White House.

  7. Basic and Advanced Bayesian Structural Equation Modeling With Applications in the Medical and Behavioral Sciences

    CERN Document Server

    Lee, Sik-Yum

    2012-01-01

    This book provides clear instructions to researchers on how to apply Structural Equation Models (SEMs) for analyzing the inter relationships between observed and latent variables. Basic and Advanced Bayesian Structural Equation Modeling introduces basic and advanced SEMs for analyzing various kinds of complex data, such as ordered and unordered categorical data, multilevel data, mixture data, longitudinal data, highly non-normal data, as well as some of their combinations. In addition, Bayesian semiparametric SEMs to capture the true distribution of explanatory latent variables are introduce

  8. Data Mining and Domain Knowledge: An Exploration of Methods to Advance Medical Research

    Science.gov (United States)

    Engle, Kelley M.

    2013-01-01

    Researchers in the medical domain consider the double-blind placebo controlled clinical trial the gold standard. The data for these clinical trials are collected for a specifically defined hypothesis and there is very little in the realm of secondary data analyses conducted. The underlying purpose of this work is to demonstrate the value and…

  9. Advances in the medical imaging of multiple myeloma and related clinical significance.

    Science.gov (United States)

    Zhang, Hai-Bo; Xue, Hua-Dan; Li, Shuo

    2014-12-01

    Multiple myeloma is an incurable malignancy developed in the bone marrow plasma cell system. It usually consists of focal lesions of the bone,soft tissue lesions,and diffuse bone marrow infiltration. Currently,the diagnosis and follow-up of multiple myeloma are highly dependent on various medical imaging techniques.

  10. Advances in solid state laser technology for space and medical applications

    Science.gov (United States)

    Byvik, C. E.; Buoncristiani, A. M.

    1988-01-01

    Recent developments in laser technology and their potential for medical applications are discussed. Gas discharge lasers, dye lasers, excimer lasers, Nd:YAG lasers, HF and DF lasers, and other commonly used lasers are briefly addressed. Emerging laser technology is examined, including diode-pumped lasers and other solid state lasers.

  11. Competency-based Residency Training: The Next Advance in Graduate Medical Education.

    Science.gov (United States)

    Long, Donlin M.

    2000-01-01

    Proposes replacing the current approach to medical residents' education, which specifies a fixed time of training, with competency-based training. Reviews the basis of traditional residency training and its problems (both the fixed time and uncertainty of evaluation methods). Discusses the competency-based approach, probability that some residents…

  12. Determinants of quality of life in advanced kidney disease: time to screen?

    Science.gov (United States)

    Iyasere, Osasuyi; Brown, Edwina A

    2014-06-01

    The incidence of older patients with end stage renal disease is on the increase. This group of patients have multiple comorbidities and a high symptom burden. Dialysis can be life sustaining for such patients. But it is often at the expense of quality of life, which starts to decline early in the pathway of chronic kidney disease. Quality of life is also important to patients and is a major determinant in decisions regarding renal replacement. As a result, validated patient-reported outcome measures are increasingly used to assess quality of life in renal patients. Cognitive impairment, depression, malnutrition and function decline are non-renal determinants of quality of life and mortality. They are under-recognised in the renal population but are potentially treatable, if not preventable. This review article discusses aetio-pathogenesis, prevalence and impact of these four outcomes, advocating regular screening for early identification and management.

  13. Comorbidity, Use of Common Medications, and Risk of Early Death in Patients with Localized or Locally Advanced Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Carsten Nieder

    2011-01-01

    Full Text Available In this paper, we analyze predictive factors for early death from comorbidity (defined as death within 3 years from diagnosis and unrelated to prostate cancer in patients with localized or locally advanced prostate cancer. Such information may guide individually tailored treatment or observation strategies, and help to avoid overtreatment. We retrospectively analyzed baseline parameters including information on comorbidity and medication use among 177 patients (median age at diagnosis 70 years. Actuarial survival analyses were performed. During the first 3 years, two patients (1.1% died from progressive prostate cancer after they had developed distant metastases. The risk of dying from other causes (3.4% was numerically higher, although not to a statistically significant degree. Six patients who died from other causes had age-adjusted Charlson comorbidity index (CCI scores ≥5 (CCI is a sum score where each comorbid condition is assigned with a score depending on the risk of dying associated with this condition. The main comorbidity was cardiovascular disease. The two statistically significant predictive factors were medication use and age-adjusted CCI score ≥5 (univariate analysis. However, medication use was not an independent factor as all patients with age-adjusted CCI score ≥5 also used at least one class of medication. Median survival was 30 months in patients with age-adjusted CCI score ≥5. Prediction of non-prostate cancer death may be important to prevent overtreatment in patients who are more threatened by comorbidity. Our data suggest that simple parameters such as use of medications vs. none, or presence of serious cardiac disease vs. none, are not sufficient, and that age-adjusted CCI scores outperform the other factors included in our analysis.

  14. Beyond medical diagnosis: Factors contributing to life satisfaction of women with epilepsy in Israel.

    Science.gov (United States)

    Sulimani-Aidan, Yafit; Rimmerman, Arie

    2015-04-01

    This study was an exploratory study aimed to examine the contribution of both objective variables (such as education, occupational status, and leisure activity) and subjective variables (such as perceived disability, body image, and feminine self-image) to the life satisfaction of women with epilepsy in Israel. The study also sought to compare the findings with earlier studies of women with epilepsy or other disabilities in order to identify similar patterns in their life satisfaction. The study included 70 women, who had applied in the past to the Israel Epilepsy Association to obtain information and leisure activities. They were asked about their degree of life satisfaction in the context of their personal data including occupational status, leisure activity, perceived disability, body image, and feminine self-image. Findings indicated that higher education and perception of body image and femininity were positively correlated with higher life satisfaction. The regression model showed that perceived severity of disability and body image had the highest contribution to satisfaction with life, a fact that attests to the paramount importance of women's perception of their health disability in dealing with the disorder. These findings are discussed in relation to earlier comparative studies of those with/without epilepsy. The implications for practice suggest aspects that ought to be included in therapeutic interventions such as including contents related to feminine self-image and body image in the rehabilitation process as well as recommendations for future studies.

  15. United States Army Advanced Medic (91B30) Training: An Iterative Decision Method Application

    Science.gov (United States)

    1983-03-25

    be provided through subsequent boards. Croup casks, group Interaccion process and group performance effecciveness: A review and In...L. Berkowlcz (Ed.), Advances In Experimental Social Psychology (Vol 8). New York: Ac- Reference Noce I. Flnstuen, K...discussion upon the correctness of group decisions, when the factor of majority influ- ence is allowed for. Journal of Social

  16. Analysis of Life-Saving Interventions Performed by Out-of-Hospital Combat Medical Personnel

    Science.gov (United States)

    2011-07-01

    emergency medicine physician assistants who completed a formal 1-year fellowship in emergency medi- cine ). Combat medics certified as National...war on terror 2001–2004. Ann Surg. 2007;245:986–991. 3. Kelly JF, Ritenour AE, McLaughlin DF, et al. Injury severity and causes of death from

  17. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: A pilot trial

    Directory of Open Access Journals (Sweden)

    Strauss Ingrid

    2011-07-01

    Full Text Available Abstract Background Tumor patients exhibit an increased peripheral demand of fatty acids and protein. Contrarily, tumors utilize glucose as their main source of energy supply. Thus, a diet supplying the cancer patient with sufficient fat and protein for his demands while restricting the carbohydrates (CHO tumors thrive on, could be a helpful strategy in improving the patients' situation. A ketogenic diet (KD fulfills these requirements. Therefore, we performed a pilot study to investigate the feasibility of a KD and its influence on the quality of life of patients with advanced metastatic tumors. Methods Sixteen patients with advanced metastatic tumors and no conventional therapeutic options participated in the study. The patients were instructed to follow a KD (less than 70 g CHO per day with normal groceries and were provided with a supply of food additives to mix a protein/fat shake to simplify the 3-month intervention period. Quality of life [assessed by EORTC QLQ-C30 (version 2], serum and general health parameters were determined at baseline, after every two weeks of follow-up, or after drop out. The effect of dietary change on metabolism was monitored daily by measuring urinary ketone bodies. Results One patient did not tolerate the diet and dropped out within 3 days. Among those who tolerated the diet, two patients died early, one stopped after 2 weeks due to personal reasons, one felt unable to stick to the diet after 4 weeks, one stopped after 6 and two stopped after 7 and 8 weeks due to progress of the disease, one had to discontinue after 6 weeks to resume chemotherapy and five completed the 3 month intervention period. These five and the one who resumed chemotherapy after 6 weeks report an improved emotional functioning and less insomnia, while several other parameters of quality of life remained stable or worsened, reflecting their very advanced disease. Except for temporary constipation and fatigue, we found no severe adverse side

  18. Quality of life assessed with the medical outcomes study short form 36-item health survey of patients on renal replacement therapy: A systematic review and meta-analysis

    NARCIS (Netherlands)

    Y.S. Liem (Ylian Serina); J.L. Bosch (Johanna); L.R. Arends (Lidia); M.H. Heijenbrok-Kal (Majanka); M.G.M. Hunink (Myriam)

    2007-01-01

    textabstractObjectives: The Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) is the most widely used generic instrument to estimate quality of life of patients on renal replacement therapy. Purpose of this study was to summarize and compare the published literature on quality of life

  19. Artificial intelligence in medicine and cardiac imaging: harnessing big data and advanced computing to provide personalized medical diagnosis and treatment.

    Science.gov (United States)

    Dilsizian, Steven E; Siegel, Eliot L

    2014-01-01

    Although advances in information technology in the past decade have come in quantum leaps in nearly every aspect of our lives, they seem to be coming at a slower pace in the field of medicine. However, the implementation of electronic health records (EHR) in hospitals is increasing rapidly, accelerated by the meaningful use initiatives associated with the Center for Medicare & Medicaid Services EHR Incentive Programs. The transition to electronic medical records and availability of patient data has been associated with increases in the volume and complexity of patient information, as well as an increase in medical alerts, with resulting "alert fatigue" and increased expectations for rapid and accurate diagnosis and treatment. Unfortunately, these increased demands on health care providers create greater risk for diagnostic and therapeutic errors. In the near future, artificial intelligence (AI)/machine learning will likely assist physicians with differential diagnosis of disease, treatment options suggestions, and recommendations, and, in the case of medical imaging, with cues in image interpretation. Mining and advanced analysis of "big data" in health care provide the potential not only to perform "in silico" research but also to provide "real time" diagnostic and (potentially) therapeutic recommendations based on empirical data. "On demand" access to high-performance computing and large health care databases will support and sustain our ability to achieve personalized medicine. The IBM Jeopardy! Challenge, which pitted the best all-time human players against the Watson computer, captured the imagination of millions of people across the world and demonstrated the potential to apply AI approaches to a wide variety of subject matter, including medicine. The combination of AI, big data, and massively parallel computing offers the potential to create a revolutionary way of practicing evidence-based, personalized medicine.

  20. Medication use during end-of-life care in a palliative care centre

    NARCIS (Netherlands)

    A.D. Masman (Anniek); M. van Dijk (Monique); D. Tibboel (Dick); F.P.M. Baar (Frans); R.A. Mathot (Ron)

    2015-01-01

    textabstractBackground In end-of-life care, symptoms of discomfort are mainly managed by drug therapy, the guidelines for which are mainly based on expert opinions. A few papers have inventoried drug prescriptions in palliative care settings, but none has reported the frequency of use in combination

  1. Advanced, Long-Life Cryocooler Technology for Zero-Boil-Off Cryogen Storage Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Long-life, high-capacity cryocoolers are a critical need for future space systems utilizing stored cryogens. The cooling requirements for planetary and...

  2. Advanced Energy Storage Life and Health Prognostics (INL) FY 2012 Annual Progress Report

    Energy Technology Data Exchange (ETDEWEB)

    Jon P. Christophersen

    2012-10-01

    The objective of this work is to develop methodologies that will accurately estimate state-of-health (SOH) and remaining useful life (RUL) of electrochemical energy storage devices using both offline and online (i.e., in-situ) techniques through: · A statistically robust offline battery calendar life estimator tool based on both testing and simulation, and · Novel onboard sensor technology for improved online battery diagnostics and prognostics.

  3. Psychological consequences and quality of life among medical rescuers who responded to the 2010 Yushu earthquake: A neglected problem.

    Science.gov (United States)

    Kang, Peng; Lv, Yipeng; Hao, Lu; Tang, Bihan; Liu, Zhipeng; Liu, Xu; Liu, Yuan; Zhang, Lulu

    2015-12-15

    A comprehensive study was conducted 8 months after the 2010 Yushu earthquake to assess the prevalence of posttraumatic stress disorder (PTSD) among medical rescuers and the rescuers' quality of life. Additionally, the study examines differences between local and supporting forces, as well as the relationship between PTSD and lower quality of life (QoL), and the risk factors for both. A total of 338 rescuers (including 123 local rescuers and 215 supporting ones) were randomly selected from Yushu County (the epicenter) and Xining City using multistage systematic sampling. Two standardized instruments, the PTSD Checklist-Civilian Version (PCL-C) and the Chinese version of the WHOQOL-BREF, were used to evaluate the prevalence of PTSD and obtain the rescuers' QoL. Being between 40 and 50 years old, a nurse, Tibetan, having been in serious danger or having received mental health training before this earthquake were significantly and independently associated with PTSD symptoms. Compared with supporting rescuers, local rescuers were more likely to develop PTSD and to report a lower QoL. Additional mental health services and training should be available to at-risk medical rescuers and groups to ensure they are adequately prepared for relief efforts and to maintain their mental health after assistance in disaster relief.

  4. The law and its interaction with medical ethics in end-of-life decision making.

    Science.gov (United States)

    Cerminara, Kathy L

    2011-09-01

    The previous two articles in this series explored the historical and theoretical development of medical decision making from initial reliance on medical beneficence to a more recent emphasis on patient autonomy. The law of withholding and withdrawal of treatment has much in common with medical ethics. It is based on concerns about patient autonomy expressed by courts, legislatures, and the executive branch of the government. Legally, the patient's right of self-determination has been based on a variety of sources ranging from state and federal constitutions to the common law of torts and from cases to statutes and regulations. Understanding the various sources of the law, the distinctions among those sources, and the interaction of the branches of government in this context assists in understanding the law itself. In our federalist system of government, significant legal variations can exist among the states, but although technically valid, excessive concern about compliance with the precise contours of each state's statute when surrogate decision makers are engaging in bedside deliberations is unnecessary. Regardless of source or precise legal contours, the overall goal, which neither the physician nor the patient's surrogate or proxy decision makers should forget, is to honor what the patient would want to have done. Physicians and attorneys will agree on that as a matter of both ethics and the law.

  5. End-of-life care in advanced kidney disease: ethical and legal issues and key challenges for black and minority ethnic groups.

    Science.gov (United States)

    Cronin, Antonia J

    2014-09-01

    Advances in modern medical technology have gone so far that it is now possible for machinery to keep people alive. To some extent this has led to a misperception in society that death can almost always be postponed because life-sustaining extracorporeal machinery of some sort or another, for example a dialysis machine, can prevent it. However, for some, being kept alive connected to a dialysis machine for four hours three times a week does not represent or even come close to an existence or quality of life they consider valuable. It may even cause unnecessary distress. This may be because they have reached a point at the end of their lives where they would like the focus of their treatment or care to become that which enables them to live as well as possible until they die. In these circumstances treatment and care should properly be that which enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. Identifying and acknowledging the importance of such a paradigm shift in the delivery of healthcare, and above all facilitating it, includes taking on the responsibility, incumbent upon us all, to address the ethical issues that are brought into focus. In this paper, I examine some of these issues. I consider the ways in which underlying theoretical ethical principles have informed the development of professional guidance and highlight the dynamic relationship this guidance has with the law. Finally, I demonstrate the ways in which it can be usefully applied to inform and assist clinical decision-making. Key challenges for BAME groups are addressed.

  6. Belief in an afterlife, spiritual well-being and end-of-life despair in patients with advanced cancer.

    Science.gov (United States)

    McClain-Jacobson, Colleen; Rosenfeld, Barry; Kosinski, Anne; Pessin, Hayley; Cimino, James E; Breitbart, William

    2004-01-01

    Despite the plethora of research linking spirituality, religiosity and psychological well-being among people living with medical illnesses, the role of afterlife beliefs on psychological functioning has been virtually ignored. The present investigation assessed afterlife beliefs, spiritual well-being and psychological functioning at the end of life among 276 terminally ill cancer patients. Results indicated that belief in an afterlife was associated with lower levels of end-of-life despair (desire for death, hopelessness and suicidal ideation) but was not associated with levels of depression or anxiety. Further analyses indicated that when spirituality levels were controlled for, the effect of afterlife beliefs disappeared. The authors concluded that spirituality has a much more powerful effect on psychological functioning than beliefs held about an afterlife. Treatment implications are discussed.

  7. Medical students' perception of inpatients' anxiety, self-esteem, purpose-in-life and health locus of control as compared with nursing practitioners'.

    Directory of Open Access Journals (Sweden)

    Nagata H

    1999-06-01

    Full Text Available Medical students (fourth-year: n = 67; fifth-year: n = 63 estimated inpatients' feelings of anxiety, self-esteem, purpose-in-life, and multidimensional health locus of control. Their ratings were compared both with the ratings given by the 121 inpatients themselves and with those given by nursing practitioners (nurses and nursing students. Findings showed that the medical students overestimated inpatients' anxiety, while they underestimated the inpatients' purpose-in-life and internal health locus of control. Hence they underestimated, as did the nursing practitioners, the inpatients' positive emotional states and their positive attitude toward their own lives. Fifth-year medical students, with clinical experience, rated the inpatients' score of chance health locus of control higher than did the fourth-year medical students, who had no clinical experience. These findings indicate that medical students, like nursing practitioners, are inclined to pay more attention to inpatients' weaknesses than to their strengths.

  8. Advancing LGBT Health at an Academic Medical Center: A Case Study.

    Science.gov (United States)

    Yehia, Baligh R; Calder, Daniel; Flesch, Judd D; Hirsh, Rebecca L; Higginbotham, Eve; Tkacs, Nancy; Crawford, Beverley; Fishman, Neil

    2015-12-01

    Academic health centers are strategically positioned to impact the health of lesbian, gay, bisexual and transgender (LGBT) populations by advancing science, educating future generations of providers, and delivering integrated care that addresses the unique health needs of the LGBT community. This report describes the early experiences of the Penn Medicine Program for LGBT Health, highlighting the favorable environment that led to its creation, the mission and structure of the Program, strategic planning process used to set priorities and establish collaborations, and the reception and early successes of the Program.

  9. Using Advanced Prosthetics for Stress Inoculation Training and to Teach Life Saving Skills

    Science.gov (United States)

    2010-04-01

    Shoot House Virtual Reality Videogame (VRVG) MOUT training and testing for joint forces and for echelon one combat trauma care SIT training...both pre and post deployment TATRC Combat Medic using Virtual Reality Videogames (91W) Provide an inexpensive training tool that will allow

  10. Nurses and Psychologists Advancing the Patient-Centered Medical Home Model.

    Science.gov (United States)

    Corso, Kent A; Gage, Donna

    2016-01-01

    As America experiences the largest health care revolution of the past 50 years, clinicians and administrators are refocusing their attention on the goals of the Quadruple Aim. Motivation and capabilities among stakeholders vary as practical tools and an adequate workforce remain elusive. At the same time, the patient-centered medical home (PCMH) model is spreading rapidly but demonstrating variable results. Positive PCMH outcomes seem to reflect high-quality teamwork. A primary care physician shortage is looming, and increasing numbers of health professionals are being pushed into the PCMH, mandated to provide "integrated" care. Even now, the majority of our Graduate Medical Education programs do not train clinicians in team-based workflow models and interaction skills. Consequently, PCMH teams will only optimize and realize the model's true potential if they learn to coordinate, communicate, and collaborate effectively. This means all PCMH staff members achieve solid teamwork skills and work at the top of their license. The authors discuss resources for improving coordination, communication, and collaboration among members of PCMH teams, and strategies for including other professionals.

  11. Negative life events in medical students%医学生负性生活事件现况调查

    Institute of Scientific and Technical Information of China (English)

    王建平; 梁多宏; 史新竹; 张莹; 刘艳; 杨雪

    2011-01-01

    目的 了解医学生负性生活事件的发生情况,为采取干预措施提供参考依据.方法 采用分层整群抽样方法抽取辽宁省沈阳市某医学院大一至大三年级在校大学生进行问卷调查.结果 在1 026名有效应答的医学生中,各种负性生活事件发生率为2.9%~70.5%,发生率居于前5位的负性生活事件依次为考试失败或不理想、学习负担重、被人误会或错怪、长期远离家人不能团聚和生活习惯明显变化,发生率分别为70.5%、65.3%、64.9%、49.5%和43.8%;医学生负性生活事件中人际关系、学习压力、受惩罚、丧失和健康适应5个维度得分分别为(7.78±2.10)、(8.76±2.91)、(8.48±2.42)、(4.29±1.99)和(5.60±1.74)分;不同特征医学生负性生活事件5个维度比较,男生受惩罚得分高于女生(t=2.189,P=0.029);不同年级学生人际关系和丧失得分差异均有统计学意义(P<0.01);不同生源学生学习压力、丧失和健康适应得分差异均有统计学意义(P<0.05).结论 医学生负性生活事件普遍存在;不同特征医学生负性生活事件存在差异.%Objective To understand the occurrence of negative life events in medical students for implementing effective intervention. Methods Students at their 1st - 3rd year of study in Shenyang Medical College were selected with stratified cluster sampling and surveyed using Adolescent Self-Rating Life Events Check List. Results The prevalences of various negative life events were 2. 9% - 70. 5% among 1 026 respondents. The top five events for the respondents were the failure or unsatisfactory result of examination, the burden of study, to be misunderstood by others, significant change in living habit, and seperation with the family for a long lime. The score for interpersonal relationship, study pressure, having been punished,loss,and health adaption was 7.78 ±2. 10,8.76 ±2. 91,8. 48 ±2. 42,4. 29 ± 1.99,and 5.60 ± 1.74,respectively.The scores of

  12. Medication adherence and quality of life among the elderly with diabetic retinopathy

    Directory of Open Access Journals (Sweden)

    Fernanda Freire Jannuzzi

    2014-12-01

    Full Text Available METHOD: one hundred (n=100 elderly outpatients with diabetic retinopathy taking antihypertensives and/or oral antidiabetics/insulin were interviewed. Adherence was evaluated by the adherence proportion and its association with the care taken in administrating medications and by the Morisky Scale. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25 was used to evaluate HRQoL.RESULTS: most (58% reported the use of 80% or more of the prescribed dose and care in utilizing the medication. The item "stopping the drug when experiencing an adverse event", from the Morisky Scale, explained 12.8% and 13.5% of the variability of adherence proportion to antihypertensives and oral antidiabetics/insulin, respectively.CONCLUSION: there was better HRQoL in the Color Vision, Driving and Social Functioning domains of the NEI VFQ-25. Individuals with lower scores on the NEI VFQ-25 and higher scores on the Morisky Scale presented greater chance to be nonadherent to the pharmacological treatment of diabetes and hypertension.

  13. [The life of medical historian Miki Sakae, and the "history of Korean medicine and of diseases in Korea"].

    Science.gov (United States)

    Kim, Ho

    2005-12-01

    maintained during his entire life regarding the Korean medicine, was that 'One can only talk about the medicine of China and Japan when he or she is well versed in the medicine of Korea'. And his lifetime achievement, "History of Korean Medicine and of Diseases in Korea" was authored upon the basis established by such conviction and philosophy. First, in this book the perspective of Cultural Transmission, which considers the flow of cultural qualities and assets to be ordinarily flowing from highly developed regions to less developed ones, was firmly maintained. He argued that the medicine of China had to pass through the Korean peninsula to reach Japan. Second, he suggested that studies of medicine and diseases could only be fully and thoroughly understood when it is approached not only from the perspective devised by medical historical studies but also from perspectives devised for general and total historical examination of human life events. And third, he argued that all historical studies should be based upon proofs and evidences, and the 'development' factor of a particular type of studies or practices should be measured by whether that study or practice has reached or accomplished the level of Western modern science. Demonstrating such conviction, out of Korean traditional medical practices he particularly examined the medical procedures of treating tumors or regulations and procedures developed for forensic medicine, which he considered superior to or at least at the same level with Western medicine. In his final years he was forced to battle cancer, but he refused to be hospitalized. Instead, he exhibited his firm belief that medicine and medical practices which believe in the ultimate power of human body and soul are what the practitioners should pursue in order to acquire the very core of medicine. He died in 1992, at home, surrounded by his family. He is known to have always uttered that one of the most celebrated Medical books of Korea, the "Dongeui Bogam

  14. Quality of Life Assessment:an Outcome Estimation of Chinese Medical Treatment

    Institute of Scientific and Technical Information of China (English)

    赵利; 陈金泉

    2003-01-01

    @@ At present, quality of life (QOL) has become a relevant measure of efficacy in clinical trials. Its use is spreading, and its importance is growing as a valid indicator of effectiveness of a treatment(1). In 1985, QOL, recommended by Food and Drug Administration (FDA), is one of the primary efficacy parameters as a basis for approval of anticancer drugs. Some scholars in China are also interested in establishing a related parameter for measuring efficacy of new drugs in view of QOL(2). Without question, to improve QOL is one of the main goals in health care and social work.

  15. End of Life Care and the Chaplain's Role on the Medical Team.

    Science.gov (United States)

    Lahaj, Mary

    2011-12-01

    This article depicts a chaplain's role in various learning and teaching situations, including end-of-life care and cases requiring cultural competency and gender preferences. The cases exemplify and underscore the difference between the role of a chaplain and the imam, as well as the necessity to have imams and both male and female chaplains in the hospital. It also describes the training, education, pastoral formation, pastoral identity, and roots of pastoral care in the Islamic tradition. The article explores the challenges of this new profession and advocates having a Muslim chaplain available in the hospital to serve Muslim patients, families, and the non-Muslim staff.

  16. Evaluation of the effects of the Advanced Paediatric Life-Support course

    NARCIS (Netherlands)

    Turner, N.M.

    2008-01-01

    Doctors are generally unacceptably poor at resuscitation and this has been shown to lead to unnecessary mortality. This problem has led to the development of structured resuscitation training in the form of life-support courses, which have become very popular and are widely advocated, but which are

  17. Quality of life after hyperthermic isolated limb perfusion for locally advanced extremity soft tissue sarcoma

    NARCIS (Netherlands)

    Thijssens, KMJ; Hoekstra-Weebers, JEHM; van Ginkel, RJ; Hoekstra, HJ

    2006-01-01

    Background: Quality of life (QoL) and posttraumatic stress symptoms (PTSS) were studied in patients with soft tissue sarcoma (STS) of the extremities treated with isolated limb perfusion and delayed resection, with or without adjuvant irradiation. Methods: Forty-one patients received a questionnaire

  18. Alkali metal pool boiler life tests for a 25 kWe advanced Stirling conversion system

    Science.gov (United States)

    Anderson, W. G.; Rosenfeld, J. H.; Noble, J.

    The overall operating temperature and efficiency of solar-powered Stirling engines can be improved by adding an alkali metal pool boiler heat transport system to supply heat more uniformly to the heater head tubes. One issue with liquid metal pool boilers is unstable boiling. Stable boiling is obtained with an enhanced boiling surface containing nucleation sites that promote continuous boiling. Over longer time periods, it is possible that the boiling behavior of the system will change. An 800-h life test was conducted to verify that pool boiling with the chosen fluid/surface combination remains stable as the system ages. The apparatus uses NaK boiling on a - 100 + 140 stainless steel sintered porous layer, with the addition of a small amount of xenon. Pool boiling remained stable to the end of life test. The pool boiler life test included a total of 82 cold starts, to simulate startup each morning, and 60 warm restarts, to simulate cloud cover transients. The behavior of the cold and warm starts showed no significant changes during the life test. In the experiments, the fluid/surface combination provided stable, high-performance boiling at the operating temperature of 700 C. Based on these experiments, a pool boiler was designed for a full-scale 25-kWe Stirling system.

  19. Advance Care Planning.

    Science.gov (United States)

    Stallworthy, Elizabeth J

    2013-04-16

    Advance care planning should be available to all patients with chronic kidney disease, including end-stage kidney disease on renal replacement therapy. Advance care planning is a process of patient-centred discussion, ideally involving family/significant others, to assist the patient to understand how their illness might affect them, identify their goals and establish how medical treatment might help them to achieve these. An Advance Care Plan is only one useful outcome from the Advance Care Planning process, the education of patient and family around prognosis and treatment options is likely to be beneficial whether or not a plan is written or the individual loses decision making capacity at the end of life. Facilitating Advance Care Planning discussions requires an understanding of their purpose and communication skills which need to be taught. Advance Care Planning needs to be supported by effective systems to enable the discussions and any resulting Plans to be used to aid subsequent decision making.

  20. Organ function and quality of life after transoral laser microsurgery and adjuvant radiotherapy for locally advanced laryngeal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Olthoff, Arno; Hess, Clemens F. [Dept. of Phoniatrics and Pedaudiology, Univ. of Goettingen (Germany); Ewen, Andreas; Wolff, Hendrik Andreas; Hermann, Robert Michael; Vorwerk, Hilke; Hille, Andrea; Christiansen, Hans [Dept. of Radiotherapy, Univ. of Goettingen (Germany); Roedel, Ralph; Steiner, Wolfgang [Dept. of Otorhinolaryngology, Univ. of Goettingen (Germany); Pradier, Olivier [Dept. of Cancerology, CHU Morvan, Brest (France)

    2009-05-15

    Background and purpose: transoral laser microsurgery (TLM) and adjuvant radiotherapy are an established therapy regimen for locally advanced laryngeal cancer at our institution. Aim of the present study was to assess value of quality of life (QoL) data with special regard to organ function under consideration of treatment efficacy in patients with locally advanced laryngeal cancer treated with larynx-preserving TLM and adjuvant radiotherapy. Patients and methods: from 1994 to 2006, 39 patients (ten UICC stage III, 29 UICC stage IVA/B) with locally advanced laryngeal carcinomas were treated with TLM and adjuvant radiotherapy. Data concerning treatment efficacy, QoL (using the VHI [Voice Handicap Index], the EORTC QLQ-C30 and QLQ-H and N35 questionnaires) and organ function (respiration, deglutition, voice quality) were obtained for ten patients still alive after long-term follow-up. Correlations were determined using the Spearman rank test. Results: after a median follow-up of 80.8 months, the 5-year overall survival rate was 46.8% and the locoregional control rate 76.5%, respectively. The larynx preservation rate was 89.7% for all patients and 100% for patients still alive after follow-up. Despite some verifiable problems in respiration, speech and swallowing, patients showed a subjectively good QoL. Conclusion: TLM and adjuvant radiotherapy is a curative option for patients with locally advanced laryngeal cancer and an alternative to radical surgery. Even if functional deficits are unavoidable in the treatment of locally advanced laryngeal carcinomas, larynx preservation is associated with a subjectively good QoL. (orig.)

  1. [Six years of Advanced Trauma Life Support (ATLS) in Germany: the 100th provider course in Hamburg].

    Science.gov (United States)

    Münzberg, M; Mahlke, L; Bouillon, B; Paffrath, T; Matthes, G; Wölfl, C G

    2010-07-01

    With over 1 million certified physicians in more than 50 countries worldwide, the Advanced Trauma Life Support (ATLS) concept is one of the most successful international education programs. The concept is simple, priority-orientated (ABCDE scheme) and assesses the situation of the trauma patient on the basis of vital signs to treat the life-threatening injuries immediately. With over 100 ATLS provider courses and 10 instruction courses accomplished in less than 6 years, no other land in the world has successfully established this concept in such a short time as Germany. Meanwhile nearly 1,600 colleagues have been trained and certified. Evaluation of the first 100 ATLS courses in Germany supports this concept. The total evaluation of all courses is 1.36 (1.06-1.8, n=100). The individual parts of the course were marked as followed: presentations 1.6 (1.0-2.81, n=100), practical skills stations 1.46 (1.0-2.4, n=100) and surgical skills stations 1.38 (1.0-2.38, n=100). In 2009 a total of 47 ATLS courses were accomplished which will clearly increase in 2010. Other ATLS formats, such as ATCN (Advanced Trauma Care for Nurses) and refresher courses are planned for the beginning of 2010.

  2. Exploring the opinion of CKD patients on dialysis regarding end-of-life and Advance Care Planning.

    Science.gov (United States)

    Sánchez-Tomero, J A; Rodríguez-Jornet, A; Balda, S; Cigarrán, S; Herrero, J C; Maduell, F; Martín, J; Palomar, R

    2011-01-01

    Advance care planning (ACP) and the subsequent advance directive document (ADD), previously known as "living wills", have not been widely used in Spain. The Ethics Group from the Spanish Society of Nephrology has developed a survey in order to investigate the opinion of dialysis patients regarding the ADD and end-of-life care. Patients received documentation explaining ACP and filled out a survey about their familiarity with and approval of the ADD. Seven hospital dialysis centres participated in the study for a total of 416 active dialysis patients. Questionnaires were distributed to 263 patients, 154 of which answered (69.2% completed them without assistance). The rates for ADD implementation (7.9%) and designation of a representative person (6.6%) were very low. Most of the patients clearly expressed their wishes about irreversible coma, vegetative state, dementia and untreatable disease. More than 65% did not want mechanical ventilation, chronic dialysis, tube feeding or resuscitation if cardiorespiratory arrest occurred. They reported that an ADD could be done before starting dialysis but most thought that it should be offered only to those who requested it (65% vs 34%). In conclusion, patients have clear wishes about end-of-life care, although these desires had not been documented due to the very low implementation of the ADD.

  3. Application of NASA's Advanced Life Support Technologies for Waste Treatment, Water Purification and Recycle, and Food Production in Polar Regions

    Science.gov (United States)

    Bubenheim, David L.; Lewis, Carol E.; Covington, M. Alan (Technical Monitor)

    1995-01-01

    NASA's advanced life support technologies are being combined with Arctic science and engineering knowledge to address the unique needs of the remote communities of Alaska through the Advanced Life Systems for Extreme Environments (ALSEE) project. ALSEE is a collaborative effort involving NASA, the State of Alaska, the University of Alaska, the North Slope Borough of Alaska, and the National Science Foundation (NSF). The focus is a major issue in the state of Alaska and other areas of the Circumpolar North, the health and welfare of its people, their lives and the subsistence lifestyle in remote communities, economic opportunity, and care for the environment. The project primarily provides treatment and reduction of waste, purification and recycling of water. and production of food. A testbed is being established to demonstrate the technologies which will enable safe, healthy, and autonomous function of remote communities and to establish the base for commercial development of the resulting technology into new industries. The challenge is to implement the technological capabilities in a manner compatible with the social and economic structures of the native communities, the state, and the commercial sector. Additional information is contained in the original extended abstract.

  4. A new medical research model: ethically and responsibly advancing health for humans and animals.

    Science.gov (United States)

    Olson, Patricia N; Ganzert, Robin R

    2015-01-01

    With the increasing use of genomics, computational analytics, emerging technologies, and personalized medicine, the possibility of a new research model is emerging. Using the clues from thousands of species living on our planet, scientists from many disciplines (medicine, veterinary medicine, wildlife) must collaborate, prioritize, and strategize on how to address causes of health and disease. Such clues should guide disease prevention, as well as the development of innovative, efficacious, and gentler therapies. Geographic and language barriers must be broken down, and scientists--even within a single academic, corporate, or government research site--must be vigilant in seeking the help of nonmedical disciplines of colleagues from whence answers might come. The public will become more interested in and demanding of such a model, desiring that all family members (humans and animals) have an opportunity for a long and healthy life. Above all, such activities will be humanely conducted with outcomes having the greatest chance for success.

  5. Palliative Care Improves Survival, Quality of Life in Advanced Lung Cancer | Division of Cancer Prevention

    Science.gov (United States)

    Results from the first randomized clinical trial of its kind have revealed a surprising and welcome benefit of early palliative care for patients with advanced lung cancer—longer median survival. Although several researchers said that the finding needs to be confirmed in other trials of patients with other cancer types, they were cautiously optimistic that the trial results could influence oncologists’ perceptions and use of palliative care. |

  6. [Euthanasia and other decisions at the end of life (Proposal for a more transparent terminology and some thoughts on the legal framework of medical treatment)].

    Science.gov (United States)

    Vadász, Gábor

    2010-10-24

    Indication of euthanasia is only one of several medical decisions at the end of life. Precise definition of this topic related to the clinical events happening around the sick-bed is not complete in the legal and medical literature. The present review attempts to classify the different end of life events with the aim of clarifying which of these do not belong to the concept of passive euthanasia. Euthanasia is not a legal category. The everyday expressions of active and passive euthanasia are simplifications, which cover actions of different purposes. Use of these in medical and legal literature can be confusing and misleading. We differentiate decisions at the end of life on basis of their purpose. Based on the definition and category of the Hungarian Doctors' Chamber, euthanasia is the act or the lack of action in order to mercifully shorten or end the life of a suffering fellow-man to help him. Concepts of active, passive and forced euthanasia are defined. The terms of indirect and intermediate euthanasia are not used in order to avoid misunderstanding. Help and participation of non-professionals in the implementation cannot be completely excluded from the concept of euthanasia, and we believe euthanasia is not merely related to doctors. We outline those medical decisions at the end of life which do not belong to the category of passive euthanasia, namely: withdrawal of ineffective and life sustaining treatments, letting go of the patient, contra-indication of therapy escalation, use of palliative therapy, pain-relieving treatment, compromise medicine, consideration of reanimation and choosing cost-effective therapy. We touch upon the subject of the living will, why it cannot be applied, and its relation to active and passive euthanasia. With reference to the legal regulation of life saving and life sustaining treatment, we deal with the expected spirit of medical legislation.

  7. Recent developments of ion sources for life-science studies at the Heavy Ion Medical Accelerator in Chiba (invited)

    Energy Technology Data Exchange (ETDEWEB)

    Kitagawa, A.; Drentje, A. G.; Fujita, T.; Muramatsu, M. [National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba 263-8555 (Japan); Fukushima, K.; Shiraishi, N.; Suzuki, T.; Takahashi, K.; Takasugi, W. [Accelerator Engineering Corporation, Chiba (Japan); Biri, S.; Rácz, R. [Institute for Nuclear Research (Atomki), Hungarian Academy of Sciences, Bem tér 18/C, H-4026 Debrecen (Hungary); Kato, Y. [Graduate School of Engineering, Osaka University, Osaka (Japan); Uchida, T.; Yoshida, Y. [Bio-Nano Electronics Research Centre, Toyo University, Kawagoe (Japan)

    2016-02-15

    With about 1000-h of relativistic high-energy ion beams provided by Heavy Ion Medical Accelerator in Chiba, about 70 users are performing various biology experiments every year. A rich variety of ion species from hydrogen to xenon ions with a dose rate of several Gy/min is available. Carbon, iron, silicon, helium, neon, argon, hydrogen, and oxygen ions were utilized between 2012 and 2014. Presently, three electron cyclotron resonance ion sources (ECRISs) and one Penning ion source are available. Especially, the two frequency heating techniques have improved the performance of an 18 GHz ECRIS. The results have satisfied most requirements for life-science studies. In addition, this improved performance has realized a feasible solution for similar biology experiments with a hospital-specified accelerator complex.

  8. Getting past the accident: explosive devices, limb loss, and refashioning a life in a military medical center.

    Science.gov (United States)

    Messinger, Seth D

    2010-09-01

    I describe the refashioning of a sense of self and identity of a junior officer in the U.S. Army who was injured in Iraq. Ethnographic data for this article were collected between July 2006 and January 2008. The setting for this article is the U.S. Armed Forces Amputee Patient Care Program at Walter Reed Army Medical Center. Two models of rehabilitation are contrasted in the rehabilitation program. The first focuses on the refashioning of identity through a sports model of rehabilitation emphasizing physical functioning. The second approaches rehabilitation by emphasizing individual interests and the concern of a person who has a future life to develop. I conclude by arguing that understanding the process of rehabilitation from traumatic injury would benefit from a perspective that melds multiple dimensions, taking into account both the physical body and the social world that patients have inhabited and will inhabit.

  9. [Life style, family history and personal pathology in relation to arterial hypertension in students of the Medical Faculty of UNAM].

    Science.gov (United States)

    Güemez Sandoval, J C; Moreno Altamirano, L; Kuri Morales, P; Argote Roumagnere, A; Alba Leonel, A; Méndez Vargas, R; Ramos Velázquez, E

    1990-01-01

    Arterial hypertension (HA) is a public health problem, 15 to 30% of adults in our country suffer it. There are different facts that influence its outcome. Among young people the main factors are: alcoholism, smoking tobacco, overweight, diabetes, family history, sedentarism and psychological aspects. The main object of this study, was to detect the risk factor for the development of HA in the students of the University. For this search 489 sophomore students class at the Medical School of the University of Mexico (UNAM), between 17 and 24 years old, were studied. Our results showed that positive family history was more prevalent among females. Among males life-style factors were more significant, the main factor was sedentarism, whereas lesser factor was overweight. The prevalence of HA was higher for diastolic hypertension than for systolic. We concluded there are many risk factors that influence the development of HA, which are distributed in a different way according to gender preventive measures are recommended.

  10. The Utilization of Urine Processing for the Advancement of Life Support Technologies

    Science.gov (United States)

    Grossi-Soyster, Elysse; Hogan, John; Flynn, Michael

    2014-01-01

    The success of long-duration missions will depend on resource recovery and the self-sustainability of life support technologies. Current technologies used on the International Space Station (ISS) utilize chemical and mechanical processes, such as filtration, to recover potable water from urine produced by crewmembers. Such technologies have significantly reduced the need for water resupply through closed-loop resource recovery and recycling. Harvesting the important components of urine requires selectivity, whether through the use of membranes or other physical barriers, or by chemical or biological processes. Given the chemical composition of urine, the downstream benefits of urine processing for resource recovery will be critical for many aspects of life support, such as food production and the synthesis of biofuels. This paper discusses the beneficial components of urine and their potential applications, and the challenges associated with using urine for nutrient recycling for space application.

  11. Transitioning the young adult with congenital heart disease for life-long medical care.

    Science.gov (United States)

    Fernandes, Susan M; Landzberg, Michael J

    2004-12-01

    Guidelines for the successful orchestration of transitioning of the adolescent and young and older adult patient with congenital heart disease to a health care system appropriate for their long-term congenital heart disease care and counseling appear necessary to improve patient and family confidence, education, therapy, life quality, and survival outcomes. Schema for care organization and delivery for adult patients with congenital heart disease remain primitive and largely unimplemented. The presence of a strong central care oversight organization and the establishment of a multi-institutional database to assist in assessment of care outcomes and guidelines appears requisite to these needs and for the establishment of transitioning guidelines for these patients as they assume a greater and deeper shared control of their futures with their caregivers.

  12. Change in quality of life after medical and surgical treatment of graves′ ophthalmopathy

    Directory of Open Access Journals (Sweden)

    Mohsen Bahmani Kashkouli

    2011-01-01

    Full Text Available Purpose : To assess the changes in quality of life (QOL of patients after treatment of their Graves′ ophthalmopathy (GO. Materials and Methods : In this prospective, cross-sectional study, the GO-QOL questionnaire was completed by 67 subjects before and at least 6 months after steroid treatment (61 subjects, group 1 or optic neuropathy orbital decompression (6 subjects, group 2. Visual, psychosocial, education and counseling scores (higher score = better health, GO severity and clinical activity scores and minimal clinically important difference (MCID were recorded and analyzed for correlation and statistical significance. A P-value 0.05. There was no significant effect of duration of thyroid disease and GO and severity and activity of GO on QOL scores either before or after treatment (P > 0.05, all cases. Conclusion : Steroid treatment and orbital decompression significantly improve the QOL in GO. Duration, severity and activity of GO did not have a significant impact on the QOL.

  13. End‐of‐life decisions in medical practice: a survey of doctors in Victoria (Australia)

    Science.gov (United States)

    Neil, D A; Coady, C A J; Thompson, J; Kuhse, H

    2007-01-01

    Objectives To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end‐of‐life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies. Design and participants Cross‐sectional postal survey of doctors in Victoria. Results 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the definition of euthanasia. Conclusions Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised. PMID:18055904

  14. Breast cancer and quality of life: medical information extraction from health forums.

    Science.gov (United States)

    Opitz, Thomas; Aze, Jérome; Bringay, Sandra; Joutard, Cyrille; Lavergne, Christian; Mollevi, Caroline

    2014-01-01

    Internet health forums are a rich textual resource with content generated through free exchanges among patients and, in certain cases, health professionals. We tackle the problem of retrieving clinically relevant information from such forums, with relevant topics being defined from clinical auto-questionnaires. Texts in forums are largely unstructured and noisy, calling for adapted preprocessing and query methods. We minimize the number of false negatives in queries by using a synonym tool to achieve query expansion of initial topic keywords. To avoid false positives, we propose a new measure based on a statistical comparison of frequent co-occurrences in a large reference corpus (Web) to keep only relevant expansions. Our work is motivated by a study of breast cancer patients' health-related quality of life (QoL). We consider topics defined from a breast-cancer specific QoL-questionnaire. We quantify and structure occurrences in posts of a specialized French forum and outline important future developments.

  15. The influence of an advanced agriculture & life science course on students' views of the nature of science

    Science.gov (United States)

    Anderson, Megan N.

    One of the goals in today's society is to ensure that students exiting school have the ability to understand, develop, and comprehend scientific information. For students to be able to meet these goals, it is imperative that they become scientifically literate and understand the concept of the Nature of Science (NOS). The discipline of Agricultural Education has strong connections with science and today many students are earning science credit and developing science understanding through Agricultural Education courses. If students are continuing to gain science mastery through their Agricultural Education courses, they should also be gaining adequate conceptions of science and the NOS. Overall, many studies have indicated that students exiting the K-12 education system lack these vital skills and understanding. The purpose of this study was to explore the conceptions of the NOS of advanced agriculture students in Indiana. This study explored the conceptions of agricultural science students before and after taking a semester of an advanced life science course (N=48). Conceptions were explored through a qualitative case study utilizing the VNOS-C questionnaire. Responses were coded into one of three categories: Naive, Emerging, or Informed. Demographic data were also collected and analyzed. Overall, results of this study indicate that students in advanced agricultural science courses lack NOS understanding. The study's conclusions are discussed along with implications for theory, research and practice in addition to future directions for research.

  16. Advances in Modeling Concrete Service Life : Proceedings of 4th International RILEM PhD Workshop

    CERN Document Server

    Gulikers, Joost

    2012-01-01

    In this book, a critical analysis is made on service life models related to reinforcement corrosion. The contributors are on the frontier of knowledge in the field of durability of reinforced concrete. Topics covered in the book include: causes and mechanisms of deterioration, transport mechanisms in concrete, numerical modeling of concrete behavior, durability modeling and prediction, reliability approach to structural design for durability, structural behavior following degradation of concrete structures, deterioration and repair of concrete structures, and corrosion measurement techniques.

  17. Advances and critical aspects in the life-cycle assessment of battery electric cars

    OpenAIRE

    HELMERS Eckard; WEISS MARTIN

    2016-01-01

    Concerns over climate change, air pollution, and oil supply have stimulated the market for battery electric vehicles (BEVs). The environmental impacts of BEVs are typically evaluated through a standardized life-cycle assessment (LCA) methodology. Here, the LCA literature was surveyed with the objective to sketch the major trends and challenges in the impact assessment of BEVs. It was found that BEVs tend to be more energy efficient and less polluting than conventional cars. BEVs decrease expo...

  18. [Advances in psychosocial interventions on quality of life of cancer survivors].

    Science.gov (United States)

    Chen, Xuefen; Wang, Jiwei; Gong, Xiaohuan; Yu, Jinming

    2015-02-01

    In recent years, there has been increasing recognition of the importance of psychosocial interventions' studies on quality of life in cancer survivors because of improving cancer survival rate. This paper was an integrative literatures review of various psychosocial interventions including cognitive behavioral therapy, group-based supportive therapy, counseling or psychotherapy, education or psychoeducation and music therapy et al, and analyzing the complexity of psychosocial interventions' RCTs in oncology and the current characteristic of these studies in China.

  19. Effect of integrated Chinese medical treatment on the survival time of patients with advanced non-small-cell lung cancer: a clinical study

    Institute of Scientific and Technical Information of China (English)

    刘苓霜

    2014-01-01

    Objective To observe clinical effect of integrated Chinese medical(CM)treatment(as maintenance therapy)on the progression-free survival(PFS)and overall survival(OS)in patients with advanced non-small-cell lung cancer(NSCLC)after first-line chemotherapy.Methods The study was a prospective,randomized,controlled clinical trial.Totally 69 non-progressive advanced NSCLC patients treated with first-line chemotherapy were

  20. Recent advances of basic materials to obtain electrospun polymeric nanofibers for medical applications

    Science.gov (United States)

    Manea, L. R.; Hristian, L.; Leon, A. L.; Popa, A.

    2016-08-01

    The most important applications of electrospun polymeric nanofibers are by far those from biomedical field. From the biological point of view, almost all the human tissues and organs consist of nanofibroas structures. The examples include the bone, dentine, cartilage, tendons and skin. All these are characterized through different fibrous structures, hierarchically organized at nanometer scale. Electrospinning represents one of the nanotechnologies that permit to obtain such structures for cell cultures, besides other technologies, such as selfassembling and phase separation technologies. The basic materials used to produce electrospun nanofibers can be natural or synthetic, having polymeric, ceramic or composite nature. These materials are selected depending of the nature and structure of the tissue meant to be regenerated, namely: for the regeneration of smooth tissues regeneration one needs to process through electrospinning polymeric basic materials, while in order to obtain the supports for the regeneration of hard tissues one must mainly use ceramic materials or composite structures that permit imbedding the bioactive substances in distinctive zones of the matrix. This work presents recent studies concerning basic materials used to obtain electrospun polymeric nanofibers, and real possibilities to produce and implement these nanofibers in medical bioengineering applications.

  1. Recent Advances in Dendritic Macromonomers for Hydrogel Formation and Their Medical Applications.

    Science.gov (United States)

    Ghobril, Cynthia; Rodriguez, Edward K; Nazarian, Ara; Grinstaff, Mark W

    2016-04-11

    Hydrogels represent one of the most important classes of biomaterials and are of interest for various medical applications including wound repair, tissue engineering, and drug release. Hydrogels possess tunable mechanical properties, biocompatibility, nontoxicity, and similarity to natural soft tissues. The need for hydrogels with specific properties, based on the design requirements of the in vitro, in vivo, or clinical application, motivates researchers to develop new synthetic approaches and cross-linking methodologies to form novel hydrogels with unique properties. The use of dendritic macromonomers represents one elegant strategy for the formation of hydrogels with specific properties. Specifically, the uniformity of dendrimers combined with the control of their size, architecture, density, and surface groups make them promising cross-linkers for hydrogel formation. Over the last two decades, a large variety of dendritic-based hydrogels are reported for their potential use in the clinic. This review describes the state of the art with these different dendritic hydrogel formulations including their design requirements, the synthetic routes, the measurement and determination of their properties, the evaluation of their in vitro and in vivo performances, and future perspectives.

  2. New regulations for medical devices: Rationale, advances and impact on research and patient care.

    Science.gov (United States)

    Labek, Gerold; Schöffl, Harald; Stoica, Christian Ioan

    2016-03-18

    A series of events relating to inferior medical devices has brought about changes in the legal requirements regarding quality control on the part of regulators. Apart from clinical studies, register and routine data will play an essential role in this context. To ensure adequate use of these data, adapted methodologies are required as register data in fact represent a new scientific entity. For the interpretation of register and routine data several limitations of published data should be taken into account. In many cases essential parameters of study cohorts - such as age, comorbidities, the patients' risk profiles or the hospital profile - are not presented. Required data and evaluation procedures differ significantly, for example, between hip and spine implants. A "one fits for all" methodology is quite unlikely to exist and vigorous efforts will be required to develop suitable standards in the next future. The new legislation will affect all high-risk products, besides joint implants also contact lenses, cardiac pacemakers or stents, for example, the new regulations can markedly enhance product quality monitoring. Register data and clinical studies should not be considered as competitors, they complement each other when used responsibly. In the future follow-up studies should increasingly focus on specific questions, while global follow-up investigations regarding product complication rates and surgical methods will increasingly be covered by registers.

  3. Recent advances in biodegradable metals for medical sutures: a critical review.

    Science.gov (United States)

    Seitz, Jan-Marten; Durisin, Martin; Goldman, Jeremy; Drelich, Jaroslaw W

    2015-09-16

    Sutures that biodegrade and dissolve over a period of several weeks are in great demand to stitch wounds and surgical incisions. These new materials are receiving increased acceptance across surgical procedures whenever permanent sutures and long-term care are not needed. Unfortunately, both inflammatory responses and adverse local tissue reactions in the close-to-stitching environment are often reported for biodegradable polymeric sutures currently used by the medical community. While bioabsorbable metals are predominantly investigated and tested for vascular stent or osteosynthesis applications, they also appear to possess adequate bio-compatibility, mechanical properties, and corrosion stability to replace biodegradable polymeric sutures. In this Review, biodegradable alloys made of iron, magnesium, and zinc are critically evaluated as potential materials for the manufacturing of soft and hard tissue sutures. In the case of soft tissue closing and stitching, these metals have to compete against currently available degradable polymers. In the case of hard tissue closing and stitching, biodegradable sternal wires could replace the permanent sutures made of stainless steel or titanium alloys. This Review discusses the specific materials and degradation properties required by all suture materials, summarizes current suture testing protocols and provides a well-grounded direction for the potential future development of biodegradable metal based sutures.

  4. Advanced earthquake monitoring system for U.S. Department of Veterans Affairs medical buildings--instrumentation

    Science.gov (United States)

    Kalkan, Erol; Banga, Krishna; Ulusoy, Hasan S.; Fletcher, Jon Peter B.; Leith, William S.; Reza, Shahneam; Cheng, Timothy

    2012-01-01

    In collaboration with the U.S. Department of Veterans Affairs (VA), the National Strong Motion Project (NSMP; http://nsmp.wr.usgs.gov/) of the U.S. Geological Survey has been installing sophisticated seismic systems that will monitor the structural integrity of 28 VA hospital buildings located in seismically active regions of the conterminous United States, Alaska, and Puerto Rico during earthquake shaking. These advanced monitoring systems, which combine the use of sensitive accelerometers and real-time computer calculations, are designed to determine the structural health of each hospital building rapidly after an event, helping the VA to ensure the safety of patients and staff. This report presents the instrumentation component of this project by providing details of each hospital building, including a summary of its structural, geotechnical, and seismic hazard information, as well as instrumentation objectives and design. The structural-health monitoring component of the project, including data retrieval and processing, damage detection and localization, automated alerting system, and finally data dissemination, will be presented in a separate report.

  5. Developing retention and return strategies for South African advanced life support paramedics: A qualitative study

    Directory of Open Access Journals (Sweden)

    Kevin Govender

    2013-06-01

    Results and discussion: Findings suggest that the success of retention and return strategies depends on the degree of collaborative stewardship that must exist between the SA National and Provincial Department of Health, the Emergency Medical Service/s (EMS statutory governing body, training institutions, and private and public EMS providers. In addition, the constructs of return and retention strategies have to extend as far as revising both acceptance criteria and candidate recruitment policies. Furthermore, while particular attention must be placed on improving working conditions, security, and remuneration of ALS paramedics, return and retention strategies have to be continuously monitored, and updated.

  6. Managing occupations in everyday life for people with advanced cancer at home

    DEFF Research Database (Denmark)

    Peoples, Hanne; Brandt, Åse; Wæhrens, Eva Elisabet Ejlersen;

    2016-01-01

    in the study. The participants were consecutively recruited from a Danish university hospital. Qualitative interviews were performed at the homes of the participants. Content analysis was applied to the data. Results: Managing occupations were manifested in two main categories; 1) Conditions influencing...... limited research that specifically explores how these occupational difficulties are managed. Objective: To describe and explore how people with advanced cancer manage occupations when living at home. Material and methods: A sub-sample of 73 participants from a larger occupational therapy project took part...

  7. Managing occupations in everyday life for people with advanced cancer at home

    DEFF Research Database (Denmark)

    Peoples, Hanne; Brandt, Åse; Wæhrens, Eva Elisabet Ejlersen;

    university hospital. Qualitative interviews were performed in the participant’s homes. Interviews were audio recorded and transcribed verbatim. Information on demographic and use of social service was included. Thematic and content analysis were performed. Results: The analysis resulted in a core category......, there are limited research that more specifically explore how these are managed. The objective was to describe and explore how people with advanced cancer manage occupations at home. Material and methods: A qualitative descriptive design was applied. 73 participants were consecutively recruited from a Danish...

  8. An equivalent strain/Coffin-Manson approach to multiaxial fatigue and life prediction in superelastic Nitinol medical devices.

    Science.gov (United States)

    Runciman, Amanda; Xu, David; Pelton, Alan R; Ritchie, Robert O

    2011-08-01

    Medical devices, particularly endovascular stents, manufactured from superelastic Nitinol, a near-equiatomic alloy of Ni and Ti, are subjected to complex mixed-mode loading conditions in vivo, including axial tension and compression, radial compression, pulsatile, bending and torsion. Fatigue lifetime prediction methodologies for Nitinol, however, are invariably based on uniaxial loading and thus fall short of accurately predicting the safe lifetime of stents under the complex multiaxial loading conditions experienced physiologically. While there is a considerable body of research documented on the cyclic fatigue of Nitinol in uniaxial tension or bending, there remains an almost total lack of comprehensive fatigue lifetime data for other loading conditions, such as torsion and tension/torsion. In this work, thin-walled Nitinol tubes were cycled in torsion at various mean and alternating strains to investigate the fatigue life behavior of Nitinol and results compared to equivalent fatigue data collected under uniaxial tensile/bending loads. Using these strain-life results for various loading modes and an equivalent referential (Lagrangian) strain approach, a strategy for normalizing these data is presented. Based on this strategy, a fatigue lifetime prediction model for the multiaxial loading of Nitinol is presented utilizing a modified Coffin-Manson approach where the number of cycles to failure is related to the equivalent alternating transformation strain.

  9. The Effect of Diabetes Medication on Cognitive Function: Evidence from the PATH Through Life Study

    Directory of Open Access Journals (Sweden)

    Pushpani M. Herath

    2016-01-01

    Full Text Available Objective. To examine the effect of diabetes treatment on change of measures of specific cognitive domains over 4 years. Research Design and Methods. The sample was drawn from a population-based cohort study in Australia (the PATH Through Life Study and comprised 1814 individuals aged 65–69 years at first measurement, of whom 211 were diagnosed with diabetes. Cognitive function was measured using 10 neuropsychological tests. The effect of type of diabetes treatment (diet, oral hypoglycemic agents, and insulin on measures of specific cognitive domains was assessed using Generalized Linear Models adjusted for age, sex, education, smoking, physical activity level, BMI, and hypertension. Results. Comparison of cognitive function between diabetes treatment groups showed no significant effect of type of pharmacological treatment on cognitive function compared to diet only group or no diabetes group. Of those on oral hypoglycaemic treatment only, participants who used metformin alone had better cognitive function at baseline for the domains of verbal learning, working memory, and executive function compared to participants on other forms of diabetic treatment. Conclusion. This study did not observe significant effect from type of pharmacological treatment for diabetes on cognitive function except that participants who only used metformin showed significant protective effect from metformin on domain of verbal learning, working memory, and executive function.

  10. Life expectancy with perioperative chemotherapy and chemoradiotherapy for locally advanced gastric adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Sadighi S

    2008-12-01

    Full Text Available "nBackground: Although postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach, curative surgery occurs in less than 50% of nonmetastatic gastric cancers. A regimen of docetaxel, cisplatin and infusional fluorouracil improves survival of patients with incurable locally-advanced gastric adenocarcinoma. So we assessed the perioperative regimen of docetaxel, cisplatin and infusions 5FU (TCF and postoperative chemoradiotherapy to improve outcomes in patients with potentially resectable gastric adenocarcinoma. "nMethods: Between March 2005 and March 2008, we 100 enrolled patients with stage II to IV (M0 adenocarcinoma of the stomach who had not been treated previously. Treatment consisted of three preoperative and one postoperative cycles of TCF followed by chemoradiotherapy. The primary end point was overall survival. The secondary end points were progression-free survival and toxicity of treatment. "nResults: A total of 100 patients participated, 83 of whom received neoadjuvant and 17 received adjuvant chemotherapy. Seventy-five patients underwent at least D0 gastrectomy. After chemotherapy, tumor stages were significantly lower than before beginning the protocol. Out of 100 patients, 44 had stage IV before chemotherapy versus 15 after the treatment. Three patients showed complete pathologic response. The median survival time was 25 months. "nConclusion: Docetaxel, cisplatin and 5FU combination chemotherapy is an active preoperative treatment in locally advanced gastric cancer. Perioperative chemoradio-therapy should be considered as an option to lengthen patient survival.

  11. Life Cycle Assessment of Environmental and Economic Impacts of Advanced Vehicles

    Directory of Open Access Journals (Sweden)

    Zach C. Winfield

    2012-03-01

    Full Text Available Many advanced vehicle technologies, including electric vehicles (EVs, hybrid electric vehicles (HEVs, and fuel cell vehicles (FCVs, are gaining attention throughout the World due to their capability to improve fuel efficiencies and emissions. When evaluating the operational successes of these new fuel-efficient vehicles, it is essential to consider energy usage and greenhouse gas (GHG emissions throughout the entire lifetimes of the vehicles, which are comprised of two independent cycles: a fuel cycle and a vehicle cycle. This paper intends to contribute to the assessment of the environmental impacts from the alternative technologies throughout the lifetimes of various advanced vehicles through objective comparisons. The methodology was applied to six commercial vehicles that are available in the U.S. and that have similar dimensions and performances. We also investigated the shifts in energy consumption and emissions through the use of electricity and drivers’ behavior regarding the frequencies of battery recharging for EVs and plug-in hybrid electric vehicles (PHEVs. This study thus gives insight into the impacts of the electricity grid on the total energy cycle of a vehicle lifetime. In addition, the total ownership costs of the selected vehicles were examined, including considerations of the fluctuating gasoline prices. The cost analysis provides a resource for drivers to identify optimal choices for their driving circumstances.

  12. Advanced Failure Determination Measurement Techniques Used in Thermal Fatigue Life Testing of Electronic Packaging

    Science.gov (United States)

    Wallace, A. P.; Cornford, S. L.; Gross, M. A.

    1996-01-01

    Thermal fatigue life testing of various electronic packaging technologies is being performed by the Reliability Technology Group at the Jet Propulsion Laboratory. These testing efforts are in progress to improve uderstanding of the reliability issues associated with low volume packaging technologies for space applications and to develop qualification and acceptance approaches for these technologies. The work described here outlines the electrical failure detection techniques used during testing by documenting the circuits and components used to make these measurements, the sensitivity of the measurements, and the applicability of each specific measurement.

  13. Uncertainties in Life Cycle Greenhouse Gas Emissions from Advanced Biomass Feedstock Logistics Supply Chains in Kansas

    Directory of Open Access Journals (Sweden)

    Long Nguyen

    2014-11-01

    Full Text Available To meet Energy Independence and Security Act (EISA cellulosic biofuel mandates, the United States will require an annual domestic supply of about 242 million Mg of biomass by 2022. To improve the feedstock logistics of lignocellulosic biofuels in order to access available biomass resources from areas with varying yields, commodity systems have been proposed and designed to deliver quality-controlled biomass feedstocks at preprocessing “depots”. Preprocessing depots densify and stabilize the biomass prior to long-distance transport and delivery to centralized biorefineries. The logistics of biomass commodity supply chains could introduce spatially variable environmental impacts into the biofuel life cycle due to needing to harvest, move, and preprocess biomass from multiple distances that have variable spatial density. This study examines the uncertainty in greenhouse gas (GHG emissions of corn stover logistics within a bio-ethanol supply chain in the state of Kansas, where sustainable biomass supply varies spatially. Two scenarios were evaluated each having a different number of depots of varying capacity and location within Kansas relative to a central commodity-receiving biorefinery to test GHG emissions uncertainty. The first scenario sited four preprocessing depots evenly across the state of Kansas but within the vicinity of counties having high biomass supply density. The second scenario located five depots based on the shortest depot-to-biorefinery rail distance and biomass availability. The logistics supply chain consists of corn stover harvest, collection and storage, feedstock transport from field to biomass preprocessing depot, preprocessing depot operations, and commodity transport from the biomass preprocessing depot to the biorefinery. Monte Carlo simulation was used to estimate the spatial uncertainty in the feedstock logistics gate-to-gate sequence. Within the logistics supply chain GHG emissions are most sensitive to the

  14. Life prediction methodology for ceramic components of advanced vehicular heat engines: Volume 1. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Khandelwal, P.K.; Provenzano, N.J.; Schneider, W.E. [Allison Engine Co., Indianapolis, IN (United States)

    1996-02-01

    One of the major challenges involved in the use of ceramic materials is ensuring adequate strength and durability. This activity has developed methodology which can be used during the design phase to predict the structural behavior of ceramic components. The effort involved the characterization of injection molded and hot isostatic pressed (HIPed) PY-6 silicon nitride, the development of nondestructive evaluation (NDE) technology, and the development of analytical life prediction methodology. Four failure modes are addressed: fast fracture, slow crack growth, creep, and oxidation. The techniques deal with failures initiating at the surface as well as internal to the component. The life prediction methodology for fast fracture and slow crack growth have been verified using a variety of confirmatory tests. The verification tests were conducted at room and elevated temperatures up to a maximum of 1371 {degrees}C. The tests involved (1) flat circular disks subjected to bending stresses and (2) high speed rotating spin disks. Reasonable correlation was achieved for a variety of test conditions and failure mechanisms. The predictions associated with surface failures proved to be optimistic, requiring re-evaluation of the components` initial fast fracture strengths. Correlation was achieved for the spin disks which failed in fast fracture from internal flaws. Time dependent elevated temperature slow crack growth spin disk failures were also successfully predicted.

  15. Anaerobic fungi (phylum Neocallimastigomycota): advances in understanding their taxonomy, life cycle, ecology, role and biotechnological potential.

    Science.gov (United States)

    Gruninger, Robert J; Puniya, Anil K; Callaghan, Tony M; Edwards, Joan E; Youssef, Noha; Dagar, Sumit S; Fliegerova, Katerina; Griffith, Gareth W; Forster, Robert; Tsang, Adrian; McAllister, Tim; Elshahed, Mostafa S

    2014-10-01

    Anaerobic fungi (phylum Neocallimastigomycota) inhabit the gastrointestinal tract of mammalian herbivores, where they play an important role in the degradation of plant material. The Neocallimastigomycota represent the earliest diverging lineage of the zoosporic fungi; however, understanding of the relationships of the different taxa (both genera and species) within this phylum is in need of revision. Issues exist with the current approaches used for their identification and classification, and recent evidence suggests the presence of several novel taxa (potential candidate genera) that remain to be characterised. The life cycle and role of anaerobic fungi has been well characterised in the rumen, but not elsewhere in the ruminant alimentary tract. Greater understanding of the 'resistant' phase(s) of their life cycle is needed, as is study of their role and significance in other herbivores. Biotechnological application of anaerobic fungi, and their highly active cellulolytic and hemi-cellulolytic enzymes, has been a rapidly increasing area of research and development in the last decade. The move towards understanding of anaerobic fungi using -omics based (genomic, transcriptomic and proteomic) approaches is starting to yield valuable insights into the unique cellular processes, evolutionary history, metabolic capabilities and adaptations that exist within the Neocallimastigomycota.

  16. The life of Rudolf Nissen: advancing surgery through science and principle.

    Science.gov (United States)

    Fults, D W; Taussky, P

    2011-06-01

    Rudolf Nissen (1896-1981) was a surgeon whose career began in Germany during the first third of the 20th century, a period of rapid progress in biomedical technology, during which neurosurgery, anesthesiology, and other specialties emerged. A protégé and later close colleague of thoracic surgery pioneer Ferdinand Sauerbruch (1875-1951), Nissen resigned from the Berlin Charité Clinic and left Germany in 1933, in response to the rise of Nazi fascism. Throughout his subsequent career in Istanbul, Turkey, the American cities of Boston and New York, and finally Basel, Switzerland, Nissen developed innovative surgical techniques, advocated for patient-centered medical education, and promoted surgical subspecialization. A lifelong proponent of clear scientific writing, Nissen expressed, in extensively published work, his philosophy that progress in surgery depends critically on rigorously applying the scientific method, upholding professional integrity, and respecting human dignity.

  17. An Advance in Prescription Opioid Vaccines: Overdose Mortality Reduction and Extraordinary Alteration of Drug Half-Life.

    Science.gov (United States)

    Kimishima, Atsushi; Wenthur, Cody J; Zhou, Bin; Janda, Kim D

    2017-01-20

    Prescription opioids (POs) such as oxycodone and hydrocodone are highly effective medications for pain management, yet they also present a substantial risk for abuse and addiction. The consumption of POs has been escalating worldwide, resulting in tens of thousands of deaths due to overdose each year. Pharmacokinetic strategies based upon vaccination present an attractive avenue to suppress PO abuse. Herein, the preparation of two active PO vaccines is described that were found to elicit high-affinity antiopioid antibodies through a structurally congruent drug-hapten design. Administration of these vaccines resulted in a significant blockade of opioid analgesic activity, along with an unprecedented increase in drug serum half-life and protection against lethal overdose.

  18. Life Cycle Assessment of an Advanced Bioethanol Technology in the Perspective of Constrained Biomass Availability

    DEFF Research Database (Denmark)

    Hedegaard, Karsten; Thyø, Kathrine Anker; Wenzel, Henrik

    2008-01-01

    of whether a global or European perspective is applied, the amount of biomass, which can become available for bioethanol or other energy uses, will be physically and economically constrained. This implies that use of biomass or land for bioethanol production will most likely happen at the expense......Among the existing environmental assessments of bioethanol, the studies suggesting an environmental benefit of bioethanol all ignore the constraints on the availability of biomass resources and the implications competition for biomass has on the assessment. We show that toward 2030, regardless...... of alternative uses. In this perspective, we show that for the case of a new advanced bioethanol technology, in terms of reducing greenhouse emissions and fossil fuel dependency, more is lost than gained when prioritizing biomass or land for bioethanol. Technology pathways involving heat and power production and...

  19. Experience with using second life for medical education in a family and community medicine education unit

    Directory of Open Access Journals (Sweden)

    Melús-Palazón Elena

    2012-05-01

    Full Text Available Abstract Background The application of new technologies to the education of health professionals is both a challenge and a necessity. Virtual worlds are increasingly being explored as a support for education. Aim: The aim of this work is to study the suitability of Second Life (SL as an educational tool for primary healthcare professionals. Methods Design: Qualitative study of accredited clinical sessions in SL included in a continuing professional development (CPD programme for primary healthcare professionals. Location: Zaragoza I Zone Family and Community Medicine Education Unit (EU and 9 health centres operated by the Aragonese Health Service, Aragon, Spain. Method: The EU held two training workshops in SL for 16 healthcare professionals from 9 health centres by means of two workshops, and requested them to facilitate clinical sessions in SL. Attendance was open to all personnel from the EU and the 9 health centres. After a trail period of clinical sessions held at 5 health centres between May and November 2010, the CPD-accredited clinical sessions were held at 9 health centres between February and April 2011. Participants: 76 healthcare professionals attended the CPD-accredited clinical sessions in SL. Main measurements: Questionnaire on completion of the clinical sessions. Results Response rate: 42-100%. Questionnaire completed by each health centre on completion of the CPD-accredited clinical sessions: Access to SL: 2 centres were unable to gain access. Sound problems: 0% (0/9. Image problems: 0% (0/9. Voice/text chat: used in 100% (10/9; 0 incidents. Questionnaire completed by participants in the CPD-accredited clinical sessions: Preference for SL as a tool: 100% (76/76. Strengths of this method: 74% (56/76 considered it eliminated the need to travel; 68% (52/76 believed it made more effective use of educational resources; and 47% (36/76 considered it improved accessibility. Weaknesses: 91% (69/76 experienced technical problems, while; 9

  20. Proposed Schematics for an Advanced Development Lunar Portable Life Support System

    Science.gov (United States)

    Conger, Bruce; Chullen, Cinda; Barnes, Bruce; Leavitt, Greg

    2010-01-01

    The latest development of the NASA space suit is an integrated assembly made up of primarily a Pressure Garment System (PGS) and a Portable Life Support System (PLSS). The PLSS is further composed of an oxygen (O2) subsystem, a ventilation subsystem, and a thermal subsystem. This paper baselines a detailed schematic of the PLSS to provide a basis for current and future PLSS development efforts. Both context diagrams and detailed schematics describe the hardware components and overall functions for all three of the PLSS subsystems. The various modes of operations for the PLSS are also presented. A comparison of the proposed PLSS to the Apollo and Shuttle PLSS designs is presented, highlighting several anticipated improvements over the historical PLSS architectures.

  1. Life cycle assessment of advanced bioethanol production from pulp and paper sludge.

    Science.gov (United States)

    Sebastião, Diogo; Gonçalves, Margarida S; Marques, Susana; Fonseca, César; Gírio, Francisco; Oliveira, Ana C; Matos, Cristina T

    2016-05-01

    This work evaluates the environmental performance of using pulp and paper sludge as feedstock for the production of second generation ethanol. An ethanol plant for converting 5400 tons of dry sludge/year was modelled and evaluated using a cradle-to-gate life cycle assessment approach. The sludge is a burden for pulp and paper mills that is mainly disposed in landfilling. The studied system allows for the valorisation of the waste, which due to its high polysaccharide content is a valuable feedstock for bioethanol production. Eleven impact categories were analysed and the results showed that enzymatic hydrolysis and neutralisation of the CaCO3 are the environmental hotspots of the system contributing up to 85% to the overall impacts. Two optimisation scenarios were evaluated: (1) using a reduced HCl amount in the neutralisation stage and (2) co-fermentation of xylose and glucose, for maximal ethanol yield. Both scenarios displayed significant environmental impact improvements.

  2. Intelligent Human Machine Interface Design for Advanced Product Life Cycle Management Systems

    CERN Document Server

    Ahmed, Zeeshan

    2010-01-01

    Designing and implementing an intelligent and user friendly human machine interface for any kind of software or hardware oriented application is always be a challenging task for the designers and developers because it is very difficult to understand the psychology of the user, nature of the work and best suit of the environment. This research paper is basically about to propose an intelligent, flexible and user friendly machine interface for Product Life Cycle Management products or PDM Systems since studies show that usability and human computer interaction issues are a major cause of acceptance problems introducing or using such systems. Going into details of the proposition, we present prototype implementations about theme based on design requirements, designed designs and technologies involved for the development of human machine interface.

  3. Spacesuit Water Membrane Evaporator; An Enhanced Evaporative Cooling Systems for the Advanced Extravehicular Mobility Unit Portable Life Support System

    Science.gov (United States)

    Bue, Grant C.; Makinen, Janice V.; Miller, Sean.; Campbell, Colin; Lynch, Bill; Vogel, Matt; Craft, Jesse; Petty, Brian

    2014-01-01

    Spacesuit Water Membrane Evaporator - Baseline heat rejection technology for the Portable Life Support System of the Advanced EMU center dot Replaces sublimator in the current EMU center dot Contamination insensitive center dot Can work with Lithium Chloride Absorber Radiator in Spacesuit Evaporator Absorber Radiator (SEAR) to reject heat and reuse evaporated water The Spacesuit Water Membrane Evaporator (SWME) is being developed to replace the sublimator for future generation spacesuits. Water in LCVG absorbs body heat while circulating center dot Warm water pumped through SWME center dot SWME evaporates water vapor, while maintaining liquid water - Cools water center dot Cooled water is then recirculated through LCVG. center dot LCVG water lost due to evaporation (cooling) is replaced from feedwater The Independent TCV Manifold reduces design complexity and manufacturing difficulty of the SWME End Cap. center dot The offset motor for the new BPV reduces the volume profile of the SWME by laying the motor flat on the End Cap alongside the TCV.

  4. Effect of simulation on knowledge of advanced cardiac life support, knowledge retention, and confidence of nursing students in Jordan.

    Science.gov (United States)

    Tawalbeh, Loai I; Tubaishat, Ahmad

    2014-01-01

    This study examined the effect of simulation on nursing students' knowledge of advanced cardiac life support (ACLS), knowledge retention, and confidence in applying ACLS skills. An experimental, randomized controlled (pretest-posttest) design was used. The experimental group (n = 40) attended an ACLS simulation scenario, a 4-hour PowerPoint presentation, and demonstration on a static manikin, whereas the control group (n = 42) attended the PowerPoint presentation and a demonstration only. A paired t test indicated that posttest mean knowledge of ACLS and confidence was higher in both groups. The experimental group showed higher knowledge of ACLS and higher confidence in applying ACLS, compared with the control group. Traditional training involving PowerPoint presentation and demonstration on a static manikin is an effective teaching strategy; however, simulation is significantly more effective than traditional training in helping to improve nursing students' knowledge acquisition, knowledge retention, and confidence about ACLS.

  5. [Advanced Trauma Life Support (ATLS) in the emergency room. Is it suitable as an SOP?].

    Science.gov (United States)

    Shafizadeh, S; Tjardes, T; Steinhausen, E; Balke, M; Paffrath, T; Bouillon, B; Bäthis, H

    2010-08-01

    There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient's physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.

  6. Biogenicity and Syngeneity of Organic Matter in Ancient Sedimentary Rocks: Recent Advances in the Search for Evidence of Past Life

    Energy Technology Data Exchange (ETDEWEB)

    Oehler, Dorothy Z.; Cady, Sherry L.

    2014-12-01

    he past decade has seen an explosion of new technologies for assessment of biogenicity and syngeneity of carbonaceous material within sedimentary rocks. Advances have been made in techniques for analysis of in situ organic matter as well as for extracted bulk samples of soluble and insoluble (kerogen) organic fractions. The in situ techniques allow analysis of micrometer-to-sub-micrometer-scale organic residues within their host rocks and include Raman and fluorescence spectroscopy/imagery, confocal laser scanning microscopy, and forms of secondary ion/laser-based mass spectrometry, analytical transmission electron microscopy, and X-ray absorption microscopy/spectroscopy. Analyses can be made for chemical, molecular, and isotopic composition coupled with assessment of spatial relationships to surrounding minerals, veins, and fractures. The bulk analyses include improved methods for minimizing contamination and recognizing syngenetic constituents of soluble organic fractions as well as enhanced spectroscopic and pyrolytic techniques for unlocking syngenetic molecular signatures in kerogen. Together, these technologies provide vital tools for the study of some of the oldest and problematic carbonaceous residues and for advancing our understanding of the earliest stages of biological evolution on Earth and the search for evidence of life beyond Earth. We discuss each of these new technologies, emphasizing their advantages and disadvantages, applications, and likely future directions.

  7. Biogenicity and Syngeneity of Organic Matter in Ancient Sedimentary Rocks: Recent Advances in the Search for Evidence of Past Life

    Directory of Open Access Journals (Sweden)

    Dorothy Z. Oehler

    2014-08-01

    Full Text Available The past decade has seen an explosion of new technologies for assessment of biogenicity and syngeneity of carbonaceous material within sedimentary rocks. Advances have been made in techniques for analysis of in situ organic matter as well as for extracted bulk samples of soluble and insoluble (kerogen organic fractions. The in situ techniques allow analysis of micrometer-to-sub-micrometer-scale organic residues within their host rocks and include Raman and fluorescence spectroscopy/imagery, confocal laser scanning microscopy, and forms of secondary ion/laser-based mass spectrometry, analytical transmission electron microscopy, and X-ray absorption microscopy/spectroscopy. Analyses can be made for chemical, molecular, and isotopic composition coupled with assessment of spatial relationships to surrounding minerals, veins, and fractures. The bulk analyses include improved methods for minimizing contamination and recognizing syngenetic constituents of soluble organic fractions as well as enhanced spectroscopic and pyrolytic techniques for unlocking syngenetic molecular signatures in kerogen. Together, these technologies provide vital tools for the study of some of the oldest and problematic carbonaceous residues and for advancing our understanding of the earliest stages of biological evolution on Earth and the search for evidence of life beyond Earth. We discuss each of these new technologies, emphasizing their advantages and disadvantages, applications, and likely future directions.

  8. The Life Value and Bioethics Education in Medical Students%医学生生命价值观与生命伦理教育

    Institute of Scientific and Technical Information of China (English)

    张东军

    2012-01-01

    The life value is the basic attitude for individual life and the life value; Bioethics is the moral norms and principles system for human being when refers to the environment, their own and other living life value and dignity. The professional characteristics of medicine determine that the educations of life value and bioethics supplement each other, promote each other. To carry out medical students'life values education and bioethical education, it needs their correct understandings of life, pay more attention to life education, cultivate the correct life values; the life value education and bioethics education should be combined; strengthen the construction of the teaching staff; promote the medical students'thinking on life ethics, cultivate their humanistic concept.%生命价值观是个体对生命和生命价值的基本态度;生命伦理是指人作为生命主体在面对环境、自身和其他生命体的生命价值、尊严时应该遵循的道德规范和原则体系,医学的专业特点决定了医学生的生命价值教育与生命伦理教育相辅相成,相互促进.开展医学生生命价值观教育和生命伦理教育,需要医学生正确认识生命,重视生命教育,培养正确的生命价值观;把生命价值教育与生命伦理教育相结合;加强师资队伍建设;促进医学生生命伦理思考,培养其人文价值理念.

  9. Social workers' roles in addressing the complex end-of-life care needs of elders with advanced chronic disease.

    Science.gov (United States)

    Kramer, Betty J

    2013-01-01

    This study examined social workers' roles in caring for low-income elders with advanced chronic disease in an innovative, community-based managed care program, from the perspective of elders, family, team members, and social workers. The results are drawn from a larger longitudinal, multimethod case study. Sources of data include survey reports of needs addressed by social workers for 120 deceased elders, five focus groups with interdisciplinary team members, and in-depth interviews with 14 elders and 10 of their family caregivers. A thematic conceptual matrix was developed to detail 32 distinctive social work roles that address divergent needs of elders, family, and team members. Distinctive perceptions of social workers' roles were identified for the different stakeholder groups (i.e., elders, family caregivers, team members, and social workers). Findings from this study may inform supervisors and educators regarding training needs of those preparing to enter the rapidly growing workforce of gerontological social workers who may be called upon to care for elders at the end of life. Training is particularly warranted to help social workers gain the skills needed to more successfully treat symptom management, depression, anxiety, agitation, grief, funeral planning, and spiritual needs that are common to the end of life.

  10. Love and the Value of Life in Health Care: A Narrative Medicine Case Study in Medical Education

    Science.gov (United States)

    Pentiado, Jorge Alberto Martins; de Almeida, Helcia Oliveira; Amorim, Fábio Ferreira; Facioli, Adriano Machado; Trindade, Eliana Mendonça Vilar; de Almeida, Karlo Jozefo Quadros

    2016-01-01

    This case study is an example of narrative medicine applied to promote self-awareness and develop humanistic contents in medical education. The impact and the human appeal of the narrative lie in the maturity and empathy shown by a student when reporting his dramatic experience during the care given to a newborn (with Patau syndrome and multiple malformations diagnosed at birth) and to her mother. The narrative approach helped the student to be successful in bringing out the meaning behind the story and to position himself from the mother’s and newborn’s perspective. The student’s introspection changed a seemingly scary interaction into a positive experience, overcoming many initial negative emotions, such as fear, disappointment, horror, hopelessness, and insecurity in the face of the unexpected. It is uplifting how the student was strengthened by the power of maternal love to the point of overcoming any remaining feelings of eugenics or rejection. Other important lessons emerging from the case study were the art of listening and the value of silence. This narrative shows how the development of narrative competence can help establish a good physician-patient relationship, because the physician or the student with such competence usually confirms the patient’s value and demonstrates concern for them, focusing on what they say and allowing genuine contact to be established, which is necessary for effective therapeutic alliance. The student’s interpretations of the meaning of love and value of life inspired him on his reframing process of a medical practice marked by vicarious suffering. PMID:26901271

  11. Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE planning – anxiety, depression, quality of life

    Directory of Open Access Journals (Sweden)

    Maureen E Lyon

    2010-02-01

    Full Text Available Maureen E Lyon1, Patricia A Garvie2, Linda Briggs3, Jianping He4, Robert Malow5, Lawrence J D’Angelo1, Robert McCarter41Children’s National Medical Center and George Washington School of Medicine and Health Sciences, Washington, District of Columbia; 2St Jude Children’s Research Hospital, Memphis, Tennessee; 3Gundersen Lutheran Medical Foundation, Inc., Madison, Wisconsin; 4Children’s Research Institute, Washington, District of Columbia; 5Florida International University, Miami, FloridaPurpose: To determine the safety of engaging HIV-positive (HIV+ adolescents in a Family Centered Advance Care (FACE planning intervention.Patients and methods: We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006–2008 with HIV+ adolescents and their surrogates (n = 76. Three 60–90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey©, the Respecting Choices® interview, and completion of The Five Wishes©. The Healthy Living Control (HLC received: Developmental History, Healthy Tips, Future Planning (vocational, school or vocational rehabilitation. Three-month post-intervention outcomes were: completion of advance directive (Five Wishes©; psychological adjustment (Beck Depression, Anxiety Inventories; quality of life (PedsQL™; and HIV symptoms (General Health Self-Assessment.Results: Adolescents had a mean age, 16 years; 40% male; 92% African-American; 68% with perinatally acquired HIV, 29% had AIDS diagnosis. FACE participants completed advance directives more than controls, using time matched comparison (P < 0.001. Neither anxiety, nor depression, increased at clinically or statistically significant levels post-intervention. FACE adolescents maintained quality of life. FACE families perceived their adolescents as worsening in their school (P = 0.018 and emotional (P = 0.029 quality of life at 3 months, compared with controls.Conclusions: Participating

  12. Advances in ITP--therapy and quality of life--a patient survey.

    Directory of Open Access Journals (Sweden)

    Axel C Matzdorff

    Full Text Available BACKGROUND: Current guidelines recommend glucocorticoids and splenectomy as standard 1(st and 2(nd line treatments for chronic immune thrombocytopenia (ITP. We sought to find out how German ITP-patients are treated with respect to these guidelines. METHODS: Members of a patient support association ≥18 years with a self-reported history of chronic ITP>12 months were surveyed with a web-based questionnaire. RESULTS: 122 questionnaires were evaluated. 70% of patients had chronic ITP for more than 5 years and 20% an average platelet count of ≤30·10(9/L. 41% of the patients reported haematomas or petechiae more than once or twice and up to 12 times or more per year and 17% oropharyngeal and nasal bleeds. 11% had been admitted to hospital during the last 12 months. 88% had received or currently receive glucocorticoids, 27% were splenectomised. IVIG had been given to 55%, rituximab to 22%, anti-D to 12%, ciclosporin to 7%, while complementary and alternative medical treatments had been used by 36%. 50 women responded to questions concerning pregnancy. 14 (28% had been advised not to become pregnant. 23 reported pregnancies and 10 (44% required treatment for their ITP during pregnancy. CONCLUSION: Glucocorticoids are the most common therapy for chronic ITP but complementary and alternative treatments already come second and less than ⅓ of patients are splenectomised. This and the frequent use of complementary medicines suggests patients' dissatisfaction with conventional approaches. Many patients receive off-label therapies. There is a major need for adequate counselling and care for pregnant ITP-patients.

  13. Policy statements and practice guidelines for medical end-of-life decisions in Dutch health care institutions: Developments in the past decade

    NARCIS (Netherlands)

    Pasman, H.R.W.; Wolf, de JT; Hesselink, B.A.M.; Heide, van der A.; Wal, van der G.; Maas, van der P.J.; Philipsen, B.D.

    2009-01-01

    OBJECTIVES: To describe the existence of policy statements on euthanasia and physician-assisted suicide (EAS) and practice guidelines for all medical end-of-life decisions in Dutch health care institutions in 2005, whether the existence of practice guidelines is related to characteristics of institu

  14. Advances in nutrition support for quality of life in HIV+/AIDS.

    Science.gov (United States)

    Suttajit, Maitree

    2007-01-01

    Globally, acquired immunodeficiency syndrome (AIDS) is an epidemic, severe and fatal disease. Along with the etiological factors of human immunodeficiency virus infection (HIV+) and decreased immunity, there are a number of other risk factors including opportunistic infection, malnutrition, wasting syndrome, and oxidative stress. The nutritional problems have been shown to be significant and contribute to health and death in HIV+/AIDS patients. Weight loss, lean tissue depletion, lipoatrophy, loss of appetite, diarrhea, and the hypermetabolic state each increase risk of death. The role of nutrition and how oxidative stress is involved in the pathogenesis of HIV+ leading to AIDS is reviewed. Studies consistently show that serum antioxidant vitamins and minerals decrease while oxidative stress increases during AIDS progression. The optimization of nutritional status, intervention with foods and supplements, including nutrients and other bio-active food components, are needed to maintain the immune system. Various food components may be recommended to reduce the incidence and severity of infectious illnesses by forms of bio-protection which include reduced oxidative stress due to reactive oxygen species which stimulate HIV replication and AIDS progression. Probiotics or lactic acid bacteria and prebiotics are sometimes given on the presumed basis that they help maintain integrity of mucosal surfaces, improve antibody responses and increase white blood cell production. People with HIV+/AIDS can be informed about the basic concepts of optimal nutrition by identifying key foods and nutrients, along with lifestyle changes, that contribute to a strengthened immune system. Moreover, nutritional management, counseling and education should be beneficial to the quality and extension of life in AIDS.

  15. Advanced anaerobic bioconversion of lignocellulosic waste for the melissa life support system

    Science.gov (United States)

    Lissens, G.; Verstraete, W.; Albrecht, T.; Brunner, G.; Creuly, C.; Dussap, G.; Kube, J.; Maerkl, H.; Lasseur, C.

    The feasibility of nearly-complete conversion of lignocellulosic waste (70% food crops, 20% faecal matter and 10% green algae) into biogas was investigated in the context of the MELiSSA loop (Micro-Ecological Life Support System Alternative). The treatment comprised a series of processes, i.e. a mesophilic laboratory scale CSTR (continuously stirred tank reactor), an upflow biofilm reactor, a fiber liquefaction reactor employing the rumen bacterium Fibrobacter succinogenes and a hydrothermolysis system in near-critical water. By the one-stage CSTR, a biogas yield of 75% with a specific biogas production of 0.37 l biogas g-1 VSS (volatile suspended solids) added at a RT (hydraulic retention time) of 20-25 d was obtained. Biogas yields could not be increased considerably at higher RT, indicating the depletion of readily available substrate after 25 d. The solids present in the CSTR-effluent were subsequently treated in two ways. Hydrothermal treatment (T ˜ 310-350C, p ˜ 240 bar) resulted in effective carbon liquefaction (50-60% without and 83% with carbon dioxide saturation) and complete sanitation of the residue. Application of the cellulolytic Fibrobacter succinogenes converted remaining cellulose contained in the CSTR-effluent into acetate and propionate mainly. Subsequent anaerobic digestion of the hydrothermolysis and the Fibrobacter hydrolysates allowed conversion of 48-60% and 30%, respectively. Thus, the total process yielded biogas corresponding with conversions up to 90% of the original organic matter. It appears that particularly mesophilic digestion in conjunction with hydrothermolysis offers interesting features for (nearly) the MELiSSA system. The described additional technologies show that complete and hygienic carbon and energy recovery from human waste within MELiSSA is technically feasible, provided that the extra energy needed for the thermal treatment is guaranteed.

  16. The Giant Snail Achatina fulica as a Candidate Species for Advanced Bioregenerative Life Support Systems

    Science.gov (United States)

    Verbitskaya, Olga; Manukovsky, Nickolay; Kovalev, Vladimir

    Maintenance of crew health is of paramount importance for long duration space missions. Weight loss, bone and calcium loss, increased exposure to radiation and oxidative stress are critical concerns that need to be alleviated. Rational nutrition is a resource for mitigating the influence of unfavorable conditions. The insufficiency of vegetarian diet has been examined by the Japanese, Chinese and U.S. developers of bioregenerative life support systems (BLSS). Hence, inclusion of animals such as silkworm in BLSS looks justified. The giant snail is currently under studying as a source of animal food and a species of reducing waste in BLSS. An experimental system to conduct cultivation of giant snail was developed. It was established that there are some reasons to use the giant snails in BLSS. It could be a source of delicious meat. A. fulica is capable of consuming a wide range of feedstuffs including plant residues. Cultivation of snail in the limited volume does not demand the big expenditures of labor. The production of crude edible biomass and protein of A. fulica was 60±15 g and 7±1.8 g respectively per 1 kg of consumed forage (fresh salad leaves, root and leafy tops of carrot). To satisfy daily animal protein needs (30-35 g) a crewman has to consume 260-300 g of snail meat. To produce such amount of snail protein it takes to use 4.3-5.0 kg of plant forage daily. The nutritional composition of A. fulica whole bodies (without shell) and a meal prepared in various ways was quantitatively determined. Protein, carbohydrate, fat acid and ash content percentages were different among samples prepared in various ways. The protein content was highest (68 %) in the dry sample washed with CH3 COOH solution. Taking into consideration the experimental results a conceptual configuration of BLSS with inclusion of giant snail was developed and mass flow rates between compartments were calculated. Keywords: animal food; protein; giant snail; BLSS; conceptual configuration.

  17. [Development and correlation of work-related behavior and experience patterns, burnout and quality of life in medical students from their freshmanship to the first state examination].

    Science.gov (United States)

    Scholz, Michael; Neumann, Carolin; Steinmann, Cornelia; Hammer, Christian M; Schröder, Antje; Eßel, Nicole; Paulsen, Friedrich; Burger, Pascal H M

    2015-03-01

    Symptoms of burnout are common among medical students. Although they usually start with a good health status, their condition deteriorates over the course of their studies. In our study ESTRELLAS we examined 530 medical students in the preclinical semesters with validated psychological questionnaires. The longer the students were studying, the more showed risky working habits. Cognitive and emotional burnout symptoms increased coincidentally in their intensity, whereas the mental quality of life continuously deteriorated. Medical students' cognitive and emotional burnout symptoms are constantly increasing from the beginning of their studies. Contemporaneously, the mental quality of life is deteriorating. This might be based on a drastic change towards risky working habits. We suggest to actively work against this process to keep our motivated students and prospective physicians productive and in good mental health.

  18. Impact of hypoglycemia on patients with type 2 diabetes mellitus and their quality of life, work productivity, and medication adherence

    Directory of Open Access Journals (Sweden)

    Lopez JMS

    2014-05-01

    Full Text Available Janice MS Lopez,1 Kathy Annunziata,2 Robert A Bailey,1 Marcia FT Rupnow,1 Donald E Morisky31Janssen Scientific Affairs, LLC, Raritan, NJ, 2Kantar Health, Princeton, NJ, 3University of California at Los Angeles Fielding School of Public Health, Los Angeles, CA, USABackground: The purpose of this study was to determine the characteristics of adults with type 2 diabetes mellitus (T2DM that correlate with greater risk of hypoglycemia and determine the impact of hypoglycemia on health-related quality of life, work productivity, and medication adherence from a patient perspective.Methods: Data from a large web-based survey were retrospectively analyzed. Adults with a diagnosis of T2DM taking antihyperglycemic agents were included in the analysis. Participants with knowledge of their hypoglycemic history were divided into three groups: those experiencing recent hypoglycemia (previous 3 months, those experiencing nonrecent hypoglycemia, and those never experiencing hypoglycemia.Results: Of the participants with T2DM taking antihyperglycemic agents who were knowledgeable of their hypoglycemia history, 55.7% had ever experienced hypoglycemia. Of those, 52.7% had recent hypoglycemia. Compared with those who never experienced hypoglycemia, those who experienced hypoglycemia tended to: be younger; be more aware of their glycated hemoglobin (HbA1c levels; have higher HbA1c levels; have a higher body mass index; have higher Charlson Comorbidity Index scores; be on insulin, sulfonylureas, and/or glucagon-like peptide-1 agonists; and be less adherent to their antihyperglycemic agents. Hypoglycemia interfered with social activities, caused more missed work (absenteeism, more impairment while at work (presenteeism, and decreased overall work productivity compared with patients who had never experienced hypoglycemia. Overall health-related quality of life, as determined by the Short Form-36 health questionnaire, was negatively impacted by hypoglycemia. Both

  19. Disability in activities of daily living, depression, and quality of life among older medical ICU survivors: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Pisani Margaret A

    2011-02-01

    Full Text Available Abstract Background Accurate measurement of quality of life in older ICU survivors is difficult but critical for understanding the long-term impact of our treatments. Activities of daily living (ADLs are important components of functional status and more easily measured than quality of life (QOL. We sought to determine the cross-sectional associations between disability in ADLs and QOL as measured by version one of the Short Form 12-item Health Survey (SF-12 at both one month and one year post-ICU discharge. Methods Data was prospectively collected on 309 patients over age 60 admitted to the Yale-New Haven Hospital Medical ICU between 2002 and 2004. Among survivors an assessment of ADL's and QOL was performed at one month and one-year post-ICU discharge. The SF-12 was scored using the version one norm based scoring with 1990 population norms. Multivariable regression was used to adjust the association between ADLs and QOL for important covariates. Results Our analysis of SF-12 data from 110 patients at one month post-ICU discharge showed that depression and ADL disability were associated with decreased QOL. Our model accounted for 17% of variability in SF12 physical scores (PCS and 20% of variability in SF12 mental scores (MCS. The mean PCS of 37 was significantly lower than the population mean whereas the mean MCS score of 51 was similar to the population mean. At one year mean PCS scores improved and ADL disability was no longer significantly associated with QOL. Mortality was 17% (53 patients at ICU discharge, 26% (79 patients at hospital discharge, 33% (105 patients at one month post ICU admission, and was 45% (138 patients at one year post ICU discharge. Conclusions In our population of older ICU survivors, disability in ADLs was associated with reduced QOL as measured by the SF-12 at one month but not at one year. Although better markers of QOL in ICU survivors are needed, ADLs are a readily observable outcome. In the meantime, clinicians

  20. HIV-Related Stress and Life Chaos Mediate the Association Between Poverty and Medication Adherence Among People Living with HIV/AIDS.

    Science.gov (United States)

    Kalichman, Seth C; Kalichman, Moira O

    2016-12-01

    HIV treatment depends on high-levels of antiretroviral therapy (ART) adherence, which is severely impeded by poverty. Men and women living with HIV infection (N = 92) completed computerized interviews of demographic and health characteristics, poverty markers, stressful life events, and life chaos, as well as unannounced pill counts to determine prospective medication adherence and medical record chart abstractions for HIV viral load. Poverty markers were associated with both stressors and chaos, and the direct effects of all three factors predicted ART non-adherence. The multiple mediation model showed that accounting for stressors and chaos resulted in a non-significant association between poverty markers and ART adherence. The indirect effect of poverty markers on adherence through life chaos was significant, whereas the indirect effect of poverty markers on adherence through stressors was not significant. Factors that render HIV-related stress and create chaos offer intervention targets that are more amenable to change than poverty itself.

  1. Advancing Innovation Through Collaboration: Implementation of the NASA Space Life Sciences Strategy

    Science.gov (United States)

    Davis, Jeffrey R.; Richard, Elizabeth E.

    2010-01-01

    On October 18, 2010, the NASA Human Health and Performance center (NHHPC) was opened to enable collaboration among government, academic and industry members. Membership rapidly grew to 90 members (http://nhhpc.nasa.gov ) and members began identifying collaborative projects as detailed in this article. In addition, a first workshop in open collaboration and innovation was conducted on January 19, 2011 by the NHHPC resulting in additional challenges and projects for further development. This first workshop was a result of the SLSD successes in running open innovation challenges over the past two years. In 2008, the NASA Johnson Space Center, Space Life Sciences Directorate (SLSD) began pilot projects in open innovation (crowd sourcing) to determine if these new internet-based platforms could indeed find solutions to difficult technical problems. From 2008 to 2010, the SLSD issued 34 challenges, 14 externally and 20 internally. The 14 external challenges were conducted through three different vendors: InnoCentive, Yet2.com and TopCoder. The 20 internal challenges were conducted using the InnoCentive platform, customized to NASA use, and promoted as NASA@Work. The results from the 34 challenges involved not only technical solutions that were reported previously at the 61st IAC, but also the formation of new collaborative relationships. For example, the TopCoder pilot was expanded by the NASA Space Operations Mission Directorate to the NASA Tournament Lab in collaboration with Harvard Business School and TopCoder. Building on these initial successes, the NHHPC workshop in January of 2011, and ongoing NHHPC member discussions, several important collaborations have been developed: (1) Space Act Agreement between NASA and GE for collaborative projects (2) NASA and academia for a Visual Impairment / Intracranial Hypertension summit (February 2011) (3) NASA and the DoD through the Defense Venture Catalyst Initiative (DeVenCI) for a technical needs workshop (June 2011) (4

  2. The making of an endocrinologist in India: Life and times at Institute of Post Graduate Medical Education and Research Calcutta.

    Science.gov (United States)

    Dutta, Deep

    2015-01-01

    Endocrinology is relatively one of the newer super-specialties of internal medicine. Following higher secondary schooling, it takes anywhere between 13 and 18 years to become a super-specialist in India, which holds true for endocrinology also. This article intends to highlight the life and the journey of making an endocrinologist in India, through personal experiences, focusing on Institute of Post Graduate Medical Education and Research (IPGMER) Calcutta, the largest super-specialty teaching hospital and research institute of Eastern India. In general, there is lack of adequate exposure to endocrinology during the Bachelor of Medicine, Bachelor of Surgery and MD Internal Medicine Training in India. Pre-Doctorate of Medicine (DM) senior residency goes a long way in developing an orientation for endocrinology. Endocrinology DM entrance examinations are usually a rigorous intimidating affair. Endocrinology training at IPGMER was a heady mix of managing huge number of patients with diverse endocrinopathies, laboratory work, academic presentations, and clinical research. The support and back up provided by the entire faculty enhanced the learning process. As I look back, the 3 years of DM residency flew by like the wink of the eye. The journey of endocrinology is the journey of a lifetime.

  3. Osteoarthritis: quality of life, comorbidities, medication and health service utilization assessed in a large sample of primary care patients

    Directory of Open Access Journals (Sweden)

    Szecsenyi Joachim

    2007-06-01

    Full Text Available Abstract Objective To assess the gender related impact of osteoarthritis (OA on quality of life (QoL and health service utilization (HSU of primary care patients in Germany. Methods Cross sectional study with 1250 OA patients attending 75 primary care practices from March to May 2005. QoL was assessed using the GERMAN-AIMS2-SF. Data about comorbidities, prescriptions, health service utilization, and physical activity were obtained by questioning patients or from the patients' medical files. Depression was assessed by means of the Patient Health Questionnaire (PHQ-9. Results 1021 (81.7% questionnaires were returned. 347 (34% patients were male. Impact of OA on QoL was different between gender: women achieved significantly higher scores in the AIMS 2-SF dimensions lower body (p Conclusion The extent to which OA impacts men and women differs in primary care patients. This might have resulted in the revealed differences in the pharmacological treatment and the HSU. Further research is needed to confirm our findings and to assess causality.

  4. Exploring uncertainty in advance care planning in African Americans: does low health literacy influence decision making preference at end of life.

    Science.gov (United States)

    Melhado, Lolita; Bushy, Angeline

    2011-11-01

    African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. But health needs are the same at end of life, yet care is less than optimal. African Americans are less likely to have advance directives nonetheless desire communication, information, respect, and a trusting doctor-patient relationship. Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans.

  5. Advanced Medical Countermeasures Consortium

    Science.gov (United States)

    2010-10-01

    fetal bovine calf serum (Hyclone, Logan, UT), 5 % penicillin /streptomycin (Gibco BRL, Grand Island, NY) and 25 µg/ml heparin (Sigma, St. Louis, MO...cytokine production, Th priming and contact hypersensitivity . J Neuroimmunol 144: 91–99. 14. Benschop RJ, Nieuwenhuis EE, Tromp EA, Godaert GL, Ballieux...with 5% CO2 in RPMI-1640 medium with 10% fetal bovine serum, 50 U/ml penicillin and 50 mg/ml streptomycin (GiBcoBRL Grand Island, NY). CEES was used

  6. 以优秀医学文化培育高素质医学人才%To cultivate advanced medical personnel with excellent culture

    Institute of Scientific and Technical Information of China (English)

    王飞; 韩晓宏; 冯孟潜; 邵小轩; 王玉柱

    2012-01-01

    《国家中长期教育改革和发展规划纲要(2010-2020年)》为高素质医学人才培养指明了方向,也提出了新的要求.以先进文化理念引领医学人才培养,以优秀医学文化精神培育医学人才,以创新文化载体激活医学人才培养,是促进高素质医学人才脱颖而出的有效抓手.%National long-term education reform and development plan (2010-2020) for advanced medical personnel training specified the direction of new requirements.There is no uniform understanding about how to cultivate high-level medical personnel and the relevant work is still being explored.Cultivation of medical talents with the leading of the advanced culture concept,with excellent spirit of medical culture,and with the activation of innovation vector,which is effective starting point to promote a large number of senior medical personnel come to the fore.

  7. Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies.

    Directory of Open Access Journals (Sweden)

    Susi Lund

    Full Text Available Advance Care Plans (ACPs enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges.To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice.An explanatory systematic review of qualitative implementation studies.Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched.Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes.13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations.This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows.

  8. Barriers to Advance Care Planning at the End of Life: An Explanatory Systematic Review of Implementation Studies

    Science.gov (United States)

    Lund, Susi; Richardson, Alison; May, Carl

    2015-01-01

    Context Advance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges. Objective To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice. Design An explanatory systematic review of qualitative implementation studies. Data sources Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched. Methods Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes. Results 13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations. Conclusions This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows. PMID:25679395

  9. Intraduodenal levodopa-carbidopa intestinal gel infusion improves both motor performance and quality of life in advanced Parkinson's disease.

    Science.gov (United States)

    Chang, Florence C F; Kwan, Vu; van der Poorten, David; Mahant, Neil; Wolfe, Nigel; Ha, Ainhi D; Griffith, Jane M; Tsui, David; Kim, Samuel D; Fung, Victor S C

    2016-03-01

    We report the efficacy and adverse effect profile of intraduodenal levodopa-carbidopa intestinal gel (LCIG) infusion from patients treated in a single Australian movement disorder centre. We conducted an open-label, 12 month prospective study of treatment with LCIG in patients with advanced Parkinson's disease in a single tertiary referral hospital unit specialising in movement disorders. Patients with levodopa-responsive, advanced Parkinson's disease with motor fluctuations despite optimal pharmacological treatment were enrolled and underwent a 16 hour daily infusion of LCIG for 12 months. Fifteen participants completed the trial. The mean (± standard deviation) improvement in Unified Parkinson's Disease Rating Scale part III was 37 ± 11%, mean daily "off" period reduced from 6.3 ± 2 to 1.9 ± 2 hours, total daily "on" time increased from 10.2 ± 3 to 13.7 ± 2 hours, "on" period without dyskinesia increased from 4.5 ± 3 to 7.5 ± 5 hours, and 39-item Parkinson's Disease Questionnaire Summary Index score improved by 32.5 ± 35%. The most common adverse event was reversible peripheral neuropathy secondary to vitamin B12 ± B6 deficiency (40%), local tube problems (40%), and impulse control disorder (ICD) (27%). No patient had stoma bleeding or peritonitis. All patients with ICD had a past psychiatric diagnosis of depression with or without anxiety and a higher daily levodopa intake at 6 and 12 months of LCIG infusion. Intraduodenal LCIG improves motor performance, quality of life and daily "on" period. Prior to and during duodenal LCIG infusion, clinicians should monitor for peripheral neuropathy and vitamin B12 and B6 deficiency, as supplementation can reverse peripheral neuropathy. This trial is registered at Clinicaltrials.gov as CT00335153.

  10. Advances in Electromyogram Signal Classification to Improve the Quality of Life for the Disabled and Aged People

    Directory of Open Access Journals (Sweden)

    M. D.R. Ahsan

    2010-01-01

    Full Text Available Problem statement: The social demands for the Quality Of Life (QOL are increasing with the exponentially expanding silver generation. To improve the QOL of the disabled and elderly people, robotic researchers and biomedical engineers have been trying to combine their techniques into the rehabilitation systems. Various biomedical signals (biosignals acquired from a specialized tissue, organ, or cell system like the nervous system are the driving force for the entire system. Examples of biosignals include Electro-Encephalogram (EEG, Electrooculogram (EOG, Electroneurogram (ENG and (EMG. Approach: Among the biosignals, the research on EMG signal processing and controlling is currently expanding in various directions. EMG signal based research is ongoing for the development of simple, robust, user friendly, efficient interfacing devices/systems for the disabled. The advancement can be observed in the area of robotic devices, prosthesis limb, exoskeleton, wearable computer, I/O for virtual reality games and physical exercise equipments. An EMG signal based graphical controller or interfacing system enables the physically disabled to use word processing programs, other personal computer software and internet. Results: Depending on the application, the acquired and processed signals need to be classified for interpreting into mechanical force or machine/computer command. Conclusion: This study focused on the advances and improvements on different methodologies used for EMG signal classification with their efficiency, flexibility and applications. This review will be beneficial to the EMG signal researchers as a reference and comparison study of EMG classifier. For the development of robust, flexible and efficient applications, this study opened a pathway to the researchers in performing future comparative studies between different EMG classification methods.

  11. Continuing medical education.

    Science.gov (United States)

    Todd, D

    1987-04-01

    With the rapid advances in medical science and increasing complexities of patient care, the need for continuing medical education (CME) is widely accepted by the profession. CME follows general and higher professional training, and should be a life long process. Teaching hospitals and postgraduate professional institutions play vital roles in organising, promoting, and monitoring this activity. CME directorates should be established. University authorities must recognise the important role of medical teachers in postgraduate and continuing medical education, and the staff establishment and terms of service should be held regularly. Medical libraries should have easy borrowing facilities. Self-assessment and audio-visual material are particularly helpful to the busy practitioner and inexpensive local or regional journals of quality can provide pertinent and up-to-date information. All charges for attending scientific meetings and educational material should be tax deductible or subsidized. The effectiveness of CME is difficult to assess and participation is almost impossible to enforce. Much depends on the standard of medical practice wanted by society. Recertification of general practitioners or specialists poses many problems. On the other hand, completion of self-assessment programmes, active participation at medical meetings, contributions to scientific literature, and membership of medical societies with built-in peer review could be monitored and regularly used to evaluate professional status.

  12. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Kanwalpreet Sodhi

    2011-01-01

    Full Text Available Background: Guidelines on performing cardiopulmonary resuscitation (CPR have been published from time to time, and formal training programs are conducted based on these guidelines. Very few data are available in world literature highlighting the impact of these trainings on CPR outcome. Aim: The aim of our study was to evaluate the impact of the American Heart Association (AHA-certified basic life support (BLS and advanced cardiac life support (ACLS provider course on the outcomes of CPR in our hospital. Materials and Methods : An AHA-certified BLS and ACLS provider training programme was conducted in our hospital in the first week of October 2009, in which all doctors in the code blue team and intensive care units were given training. The retrospective study was performed over an 18-month period. All in-hospital adult cardiac arrest victims in the pre-BLS/ACLS training period (January 2009 to September 2009 and the post-BLS/ACLS training period (October 2009 to June 2010 were included in the study. We compared the outcomes of CPR between these two study periods. Results: There were a total of 627 in-hospital cardiac arrests, 284 during the pre-BLS/ACLS training period and 343 during the post-BLS/ACLS training period. In the pre-BLS/ACLS training period, 52 patients (18.3% had return of spontaneous circulation, compared with 97 patients (28.3% in the post-BLS/ACLS training period (P < 0.005. Survival to hospital discharge was also significantly higher in the post-BLS/ACLS training period (67 patients, 69.1% than in the pre-BLS/ACLS training period (12 patients, 23.1% (P < 0.0001. Conclusion : Formal certified BLS and ACLS training of healthcare professionals leads to definitive improvement in the outcome of CPR.

  13. Management practices for end-of-life cathode ray tube glass: Review of advances in recycling and best available technologies.

    Science.gov (United States)

    Iniaghe, Paschal O; Adie, Gilbert U

    2015-11-01

    Cathode ray tubes are image display units found in computer monitors and televisions. In recent years, cathode ray tubes have been generated as waste owing to the introduction of newer and advanced technologies in image displays, such as liquid crystal displays and high definition televisions, among others. Generation and subsequent disposal of end-of-life cathode ray tubes presents a challenge owing to increasing volumes and high lead content embedded in the funnel and neck sections of the glass. Disposal in landfills and open dumping are anti-environmental practices considering the large-scale contamination of environmental media by the potential of toxic metals leaching from glass. Mitigating such environmental contamination will require sound management strategies that are environmentally friendly and economically feasible. This review covers existing and emerging management practices for end-of-life cathode ray tubes. An in-depth analysis of available technologies (glass smelting, detoxification of cathode ray tube glass, lead extraction from cathode ray tube glass) revealed that most of the techniques are environmentally friendly, but are largely confined to either laboratory scale, or are often limited owing to high cost to mount, or generate secondary pollutants, while a closed-looped method is antiquated. However, recycling in cementitious systems (cement mortar and concrete) gives an added advantage in terms of quantity of recyclable cathode ray tube glass at a given time, with minimal environmental and economic implications. With significant quantity of waste cathode ray tube glass being generated globally, cementitious systems could be economically and environmentally acceptable as a sound management practice for cathode ray tube glass, where other technologies may not be applicable.

  14. Changes in and Associations Among Functional Status and Perceived Quality of Life of Patients With Metastatic/Locally Advanced Cancer Receiving Rehabilitation for General Disability.

    Science.gov (United States)

    Sekine, Ryuichi; Ogata, Masami; Uchiyama, Ikuyo; Miyakoshi, Koichi; Uruma, Megumi; Miyashita, Mitsunori; Morita, Tatsuya

    2015-11-01

    The primary aims were to clarify the changes in the functional status and quality of life of patients with metastatic/locally advanced cancer who received rehabilitation therapy. This is a cohort study, and all consecutive patients who received rehabilitation therapy were evaluated before and 2 weeks after. Outcome measures were the Functional Independence Measure (FIM), perceived independence, and overall quality of life (European Organization for Research and Treatment of Cancer C30). A total of 128 patients were included. Although the FIM score significantly decreased, the overall quality of life significantly increased. Even in the patients with deteriorated FIM scores, the overall quality of life was maintained despite a significantly decreased perceived independence. Terminally ill patients with cancer who received a rehabilitation program maintained their overall quality of life despite an objective decline in the physical functional status.

  15. Advance directives in action in a regional palliative care service: "road testing" the provisions of the Medical Treatment Act 1988 (VIC).

    Science.gov (United States)

    Brown, Margaret; Fisher, John W; Brumley, David J; Ashby, Michael A; Milliken, Jan

    2005-11-01

    In order to explore the usefulness and acceptability of the provisions of the Medical Treatment Act 1988 (Vic) for palliative care patients in a rural region in Victoria, Australia, between July and December 2004 patients were given information explaining the Act and the opportunity to discuss it with the research officer. Grounded theory methodology was used to evaluate client responses. Findings suggested that palliative care patients are willing to engage in advance care planning but they have to be well enough and need skilled, practical, face-to-face assistance to complete the required legal forms. Written materials alone are not adequate, but provide the opportunity for medical staff to have conversations about death and dying. Doctors and nurses should understand the provisions of the Act to assist patients and families. It is recommended that advance care planning, appropriate to the jurisdiction, be an integral part of the palliative care assessment process.

  16. Gastric cancer: a primer on the epidemiology and biology of the disease and an overview of the medical management of advanced disease.

    Science.gov (United States)

    Shah, Manish A; Kelsen, David P

    2010-04-01

    Gastric cancer is a cause of significant morbidity and cancer-related mortality worldwide. Despite recent advances in targeted therapy and understanding of the biology and development of the malignancy, progress in the treatment of gastric cancer has been limited. Most newly diagnosed patients will present with incurable disease, and have a median survival of less than 1 year. Although the disease has widespread ethnic and epidemiologic differences, medical management of gastric cancer does not distinguish among the various disease subtypes. The recent report of the ToGA phase III study has validated Her2 as a molecular target in this disease, supporting the concept that a greater understanding of the biology of gastric cancer subsets may improve treatment selection and overall outcome of individual patients. This article summarizes the epidemiology and ethnic variation of this disease to crystalize subtypes of gastric cancer in the context of current and future medical management of advanced disease.

  17. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: is the whole greater than the sum of its parts?

    OpenAIRE

    Wee, HL; Cheung, YB; Li, SC; Fong, KY; Thumboo, J

    2005-01-01

    Abstract Background Diabetes mellitus (DM) is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1) evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL) (which could be additive, synergistic or subtractive); (2) to determine the extent to which the SF-6D (a single-index preference measure)...

  18. A census of fishes and everything they eat: How the census of marine life advanced fisheries science

    Science.gov (United States)

    O'Dor, Ron; Boustany, Andre M.; Chittenden, Cedar M.; Costello, Mark J.; Moustahfid, Hassan; Payne, John; Steinke, Dirk; Stokesbury, Michael J. W.; Vanden Berghe, Edward

    2012-01-01

    The Census of Marine Life was a 10-year, international research effort to explore poorly known ocean habitats and conduct large-scale experimentation with new technology. The goal of Census 2010 in its mission statement was to describe what did live in the oceans, what does live in the oceans, and what will live in the ocean. Many of the findings and techniques from census research may prove valuable in making a transition, which many governments have publicly endorsed, from single-species fisheries management to more holistic ecosystem management. Census researchers sampled continental margins, mid-Atlantic ridges, ocean floor vents and seeps, and abyssal plains and polar seas and organized massive amounts of past and new information in a public online database called the Ocean Biogeographic Information System (www.iobis.org). The census described and categorized seamount biology worldwide for its vulnerability to fishing, advanced large-scale animal tracking with acoustic arrays and satellite archival tags, and accelerated species identification, including nearshore, coral reef, and zooplankton sampling using genetic barcoding and pyrotag sequencing for microbes and helped to launch the exciting new field of marine environmental history. Above all, the census showed the value of investing in large-scale, collaborative projects and sharing results publicly.

  19. Quality of life assessment with different radiotherapy schedules in palliative management of advanced carcinoma esophagus: A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Shaveta Mehta

    2008-01-01

    Full Text Available Aim: To investigate the quality of life (QOL of patients with advanced carcinoma esophagus treated with different palliative radiation schedules. Methods: Sixty-two consecutive patients with inoperable, non-metastatic carcinoma of the esophagus were randomly allocated to Arm-A (external radiotherapy 30 Gy/10 fractions + brachytherapy 12 Gy/two sessions, Arm-B (external radiotherapy 30 Gy /10 fractions and Arm-C (external radiotherapy 20Gy /five fractions. The QOL was assessed using the European Organization for Research and Treatment of Cancer questionnaire at presentation, after treatment and at 3 months follow-up. Results: The mean QOL score improved, in arm-A from 38 to 52 after treatment and 56 at 3 months, in arm-B from 30 to 44 after treatment and 55 at 3 months and in arm-C from 24 to 40 after treatment but decreased to 37 at 3 months. Improvement in dysphagia scores at the first follow-up was 46.1% in arm-A, 25.0% in arm-B and 22.6% in arm-C. The difference was maintained at 3 months, with maximum improvement in arm-A (57.6%. No significant differences were found between the three arms with regard to complications and additional procedures needed for relief of dysphagia. Conclusion: In comparison with external radiotherapy alone, external radiotherapy with intraluminal brachytherapy has shown a trend toward better QOL and consistent dysphagia relief without significant difference in adverse effects.

  20. A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information.

    Science.gov (United States)

    Parker, Sharon M; Clayton, Josephine M; Hancock, Karen; Walder, Sharon; Butow, Phyllis N; Carrick, Sue; Currow, David; Ghersi, Davina; Glare, Paul; Hagerty, Rebecca; Tattersall, Martin H N

    2007-07-01

    Evidence-based recommendations concerning how to discuss dying, life expectancy, and likely future symptoms with patients with a limited life expectancy and their families are lacking. The aim of this systematic review was to review studies regarding prognostic/end-of-life communication with adult patients in the advanced stages of a life-limiting illness and their caregivers. Relevant studies meeting the inclusion criteria were identified by searching computerized databases up to November 2004. One hundred twenty-three studies met the criteria for the full review, and 46 articles reported on patient/caregiver preferences for content, style, and timing of information. The majority of the research was descriptive. Although there were individual differences, patients/caregivers in general had high levels of information need at all stages of the disease process regarding the illness itself, likely future symptoms and their management, and life expectancy and information about clinical treatment options. Patient and caregiver information needs showed a tendency to diverge as the illness progressed, with caregivers needing more and patients wanting less information. Patients and caregivers preferred a trusted health professional who showed empathy and honesty, encouraged questions, and clarified each individual's information needs and level of understanding. In general, most patients/caregivers wanted at least some discussion of these topics at the time of diagnosis of an advanced, progressive, life-limiting illness, or shortly after. However, they wanted to negotiate the content and extent of this information.

  1. 医学院校生命教育实践探索%Life Education Practice in Medical Colleges and Universities

    Institute of Scientific and Technical Information of China (English)

    李翩翩

    2015-01-01

    论述了医学院校开展生命教育的特殊性和必要性,从课程设置和文化活动两个方面分析了当前我国医学院校生命教育中存在的问题,并结合医学院校特点提出以下实践对策:通过相关课程开设,开展生命教育理论教学;加强校园文化建设,营造生命教育校园氛围;开展相关志愿服务,提升生命境界。%This paper discussed the necessity and the particularity of medical colleges and universities to carry out life education , and analyzed the current problems of life education in the universities of China from curriculum and cultural activity .And the author put forward the following countermeasures by combining with the characteris-tics of medical colleges:carrying out life education theory teaching;strengthening the construction of campus cul-ture and life education campus atmosphere;carrying out related volunteer service , to improve life quality .

  2. 肿瘤科医护人员对晚期肿瘤患者实施预先指示的质性研究%Attitudes of Oncology Medical Staffs on Advance Directives for Advanced Cancer Patients: a Qualitative Study

    Institute of Scientific and Technical Information of China (English)

    王丽英; 胡雁; 陆箴琦; 顾文英

    2011-01-01

    The research was to explore the attitudes of oncology medical staffs on advance directives (AD) for advancedcancer patients. 8 oncology medical staffs selected by purposive sampling participated in the semi - structure interviews.Three themes were extracted from the attitudes of oncology medical staffs towards AD: accepting and demanding it; beingdifficult to carry it out j being possible to try it out with some countermeasures. Although there are still some difficulties,oncology medical staffs support AD in general. And the implementation of AD in mainland of China needs a long time oflocalization.%探讨肿瘤科医护人员对晚期肿瘤患者实施预先指示(advance directives,AD)的态度.使用目的抽样法对8位肿瘤科医护人员进行半结构式访谈.结果显示,肿瘤科医护人员对实施AD的态度可归纳为:(1)认可并有需求;(2)具体实施仍有一定困难;(3)可尝试应用但需一定对策.因此,肿瘤科医护人员总体非常支持AD的实施,但具体应用还需一定时期的本土化过程.

  3. Advancing medical education: connecting interprofessional collaboration and education opportunities with integrative medicine initiatives to build shared learning.

    Science.gov (United States)

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2016-12-01

    BackgroundImproved teamwork between conventional and complementary medicine (CM) practitioners is indicated to achieve effective healthcare. However, little is known about interprofessional collaboration and education in the context of integrative medicine (IM). MethodsThis paper reports the findings from a constructivist-grounded theory method study that explored and highlighted Australian medical students' experiences and opportunities for linking interprofessional collaboration and learning in the context of IM. Following ethical approval, in-depth semi-structured interviews were conducted with 30 medical students from 10 medical education faculties across Australian universities. Results Medical students recognised the importance of interprofessional teamwork between general medical practitioners and CM professionals in patient care and described perspectives of shared responsibilities, profession-specific responsibilities, and collaborative approaches within IM. While students identified that limited interprofessional collaboration currently occurred in the medical curriculum, interprofessional education was considered a means of increasing communication and collaboration between healthcare professionals, helping coordinate effective patient care, and understanding each healthcare team members' professional role and value. Conclusions The findings suggest that medical curricula should include opportunities for medical students to develop required skills, behaviours, and attitudes for interprofessional collaboration and interprofessional education within the context of IM. While this is a qualitative study that reflects theoretical saturation from a selected cohort of medical students, the results also point to the importance of including CM professionals within interprofessional collaboration, thus contributing to more person-centred care.

  4. Real life cost and quality of life associated with continuous intraduodenal levodopa infusion compared with oral treatment in Parkinson patients

    DEFF Research Database (Denmark)

    Lundqvist, C.; Beiske, A. G.; Reiertsen, O.

    2014-01-01

    Advanced-stage Parkinson's disease (PD) strongly affects quality of life (QoL). Continuous intraduodenal administration of levodopa (IDL) is efficacious, but entails high costs. This study aims to estimate these costs in routine care. 10 patients with advanced-PD who switched from oral medication...

  5. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims

    OpenAIRE

    Gholipour, Changiz; Vahdati, Samad Shams; NOTASH, Mehdi; MIRI, Seyed Hassan; Ghafouri, Rouzbeh Rajaei

    2016-01-01

    SUMMARY Objectives Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a s...

  6. Physician-based emergency medical service deployment characteristics in severe traumatic brain injury : A Dutch multicenter study

    NARCIS (Netherlands)

    Franschman, G.; Andriessen, T. M. J. C.; Boer, C.; Van der Naalt, J.; Horn, J.; Haitsma, I.; Vos, P. E.

    2013-01-01

    Introduction: Prehospital guidelines advise advanced life support in all patients with severe traumatic brain injury (TBI). In the Netherlands, it is recommended that prehospital advanced life support is particularly provided by a physician-based helicopter emergency medical service (P-HEMS) in addi

  7. Spacesuit Water Membrane Evaporator; An Enhanced Evaporative Cooling System for the Advanced Extravehicular Mobility Unit Portable Life Support System

    Science.gov (United States)

    Bue, Grant C.; Makinen, Janice V.; Miller, Sean; Campbell, Colin; Lynch, Bill; Vogel, Matt; Craft, Jesse; Wilkes, Robert; Kuehnel, Eric

    2014-01-01

    Development of the Advanced Extravehicular Mobility Unit (AEMU) portable life support subsystem (PLSS) is currently under way at NASA Johnson Space Center. The AEMU PLSS features a new evaporative cooling system, the Generation 4 Spacesuit Water Membrane Evaporator (Gen4 SWME). The SWME offers several advantages when compared with prior crewmember cooling technologies, including the ability to reject heat at increased atmospheric pressures, reduced loop infrastructure, and higher tolerance to fouling. Like its predecessors, Gen4 SWME provides nominal crew member and electronics cooling by flowing water through porous hollow fibers. Water vapor escapes through the hollow fiber pores, thereby cooling the liquid water that remains inside of the fibers. This cooled water is then recirculated to remove heat from the crew member and PLSS electronics. Test results from the backup cooling system which is based on a similar design and the subject of a companion paper, suggested that further volume reductions could be achieved through fiber density optimization. Testing was performed with four fiber bundle configurations ranging from 35,850 fibers to 41,180 fibers. The optimal configuration reduced the Gen4 SWME envelope volume by 15% from that of Gen3 while dramatically increasing the performance margin of the system. A rectangular block design was chosen over the Gen3 cylindrical design, for packaging configurations within the AEMU PLSS envelope. Several important innovations were made in the redesign of the backpressure valve which is used to control evaporation. A twin-port pivot concept was selected from among three low profile valve designs for superior robustness, control and packaging. The backpressure valve motor, the thermal control valve, delta pressure sensors and temperature sensors were incorporated into the manifold endcaps, also for packaging considerations. Flight-like materials including a titanium housing were used for all components. Performance testing

  8. Effectiveness of beneficial plant-microbe interactions under hypobaric and hypoxic conditions in an advanced life support system

    Science.gov (United States)

    MacIntyre, Olathe; Stasiak, Michael; Cottenie, Karl; Trevors, Jack; Dixon, Mike

    An assembled microbial community in the hydroponics solution of an advanced life support system may improve plant performance and productivity in three ways: (1) exclusion of plant pathogens from the initial community, (2) resistance to infection, and (3) plant-growth promotion. However, the plant production area is likely to have a hypobaric (low pressure) and hypoxic (low oxygen) atmosphere to reduce structural mass and atmosphere leakage, and these conditions may alter plant-microbe interactions. Plant performance and productivity of radish (Raphanus sativus L. cv. Cherry Bomb II) grown under hypobaric and hypoxic conditions were investigated at the University of Guelph's Controlled Environment Systems Research Facility. Changes in the microbial communities that routinely colonized the re-circulated nutrient solution, roots, and leaves of radishes in these experiments were quantified in terms of similarity in community composition, abundance of bacteria, and community diversity before and after exposure to hypobaric and hypoxic conditions relative to communities maintained at ambient growth conditions. The microbial succession was affected by extreme hypoxia (2 kPa oxygen partial pressure) while hypobaria as low as 10 kPa total pressure had little effect on microbial ecology. There were no correlations found between the physiological profile of these unintentional microbial communities and radish growth. The effects of hypobaric and hypoxic conditions on specific plant-microbe interactions need to be determined before beneficial gnotobiotic communities can be developed for use in space. The bacterial strains Tal 629 of Bradyrhizobium japonicum and WCS417 of Pseudomonas fluorescens, and the plant pathogen Fusarium oxysporum f. sp. raphani will be used in future experiments. B. japonicum Tal 629 promotes radish growth in hydroponics systems and P. fluorescens WCS417 induces systemic resistance to fusarium wilt (F. oxysporum f. sp. raphani) in radish under ambient

  9. Decay in chest compression quality due to fatigue is rare during prolonged advanced life support in a manikin model

    Directory of Open Access Journals (Sweden)

    Bjørshol Conrad A

    2011-08-01

    Full Text Available Abstract Background The aim of this study was to measure chest compression decay during simulated advanced life support (ALS in a cardiac arrest manikin model. Methods 19 paramedic teams, each consisting of three paramedics, performed ALS for 12 minutes with the same paramedic providing all chest compressions. The patient was a resuscitation manikin found in ventricular fibrillation (VF. The first shock terminated the VF and the patient remained in pulseless electrical activity (PEA throughout the scenario. Average chest compression depth and rate was measured each minute for 12 minutes and divided into three groups based on chest compression quality; good (compression depth ≥ 40 mm, compression rate 100-120/minute for each minute of CPR, bad (initial compression depth 120/minute or decay (change from good to bad during the 12 minutes. Changes in no-flow ratio (NFR, defined as the time without chest compressions divided by the total time of the ALS scenario over time was also measured. Results Based on compression depth, 5 (26%, 9 (47% and 5 (26% were good, bad and with decay, respectively. Only one paramedic experienced decay within the first two minutes. Based on compression rate, 6 (32%, 6 (32% and 7 (37% were good, bad and with decay, respectively. NFR was 22% in both the 1-3 and 4-6 minute periods, respectively, but decreased to 14% in the 7-9 minute period (P = 0.002 and to 10% in the 10-12 minute period (P Conclusions In this simulated cardiac arrest manikin study, only half of the providers achieved guideline recommended compression depth during prolonged ALS. Large inter-individual differences in chest compression quality were already present from the initiation of CPR. Chest compression decay and thereby fatigue within the first two minutes was rare.

  10. Advancing the Integration of Population Medicine into Medical Curricula at The Warren Alpert Medical School of Brown University: A New Master's Degree Program.

    Science.gov (United States)

    Mello, Michael J; Feller, Edward; George, Paul; Borkan, Jeffrey

    2015-09-01

    Additional knowledge, attitudes and skills are required for the next generation of medical students as they expand the traditional focus on individual patients to include population-based health and scholarly investigation. The Warren Alpert Medical School of Brown University (AMS) is initiating a master's degree program as a key component of the new Primary Care-Population Medicine program at AMS leading to both a Doctorate in Medicine (MD) and Master of Science in Population Medicine (ScM) degrees in four years. The ScM is composed of a series of nine courses, integrated into the four-year MD curriculum, as well as a thesis. Additional attention will be given to leadership and quality improvement training. The goal is to produce graduates competent in the care of individual patients, panels, communities, and populations.

  11. Health-Related Quality of Life in Locally Advanced Cervical Cancer Patients After Definitive Chemoradiation Therapy Including Image Guided Adaptive Brachytherapy: An Analysis From the EMBRACE Study

    DEFF Research Database (Denmark)

    Kirchheiner, Kathrin; Pötter, Richard; Tanderup, Kari

    2016-01-01

    Purpose This study analyzed functioning and symptom scores for longitudinal quality of life (QoL) from patients with locally advanced cervical cancer who underwent definitive chemoradiation therapy with image guided adaptive brachytherapy in the EMBRACE study. Methods and Materials In total, 744...... patients at a median follow-up of 21 months were included. QoL was prospectively assessed using European Organization for Research and Treatment of Cancer Quality of Life core module 30 (EORTC QLQ-C30) and EORTC cervical cancer module 24 (CX24) questionnaires at baseline, then every 3 months during...

  12. 人生回顾对晚期癌症患者生存质量的影响%Effect of a life review program on the quality of life among patients with advanced cancer at home

    Institute of Scientific and Technical Information of China (English)

    肖惠敏; 邝惠容; 彭美慈; 莫孙淑冰

    2012-01-01

    目的 探讨人生回顾对晚期癌症患者生存质量的影响.方法 选择晚期癌症患者80例,随机分成两组,试验组接受人生回顾干预,对照组接受常规照顾.在干预前后分别测量两组的生存质量,通过半结构访谈收集其对人生回顾的感受.结果 干预后两组在整体生存质量、支持、负面情绪、疏离感、存在困扰及生活价值等方面比较,差异均有统计学意义(P<0.05).参与者对人生回顾干预的感受包括:接受独特的人生、情绪上的解脱、获得生命意义感、留下个人精神遗产.结论 人生回顾是促进晚期癌症患者心理、精神健康的有效措施.%Objective To evaluate the effect of a life review program on the quality of life among patients with advanced cancer at home. Method Eighty patients with advanced cancer at home were randomly divided into two groups. The 40 patients in the experimental group received a life review program,while the 40 patients in the control group received routine home care. The patients' were investigated with the scale of Quality of Life(QOL) for cancer patients before and after intervention. Their perceptions of the life review program were collected through individual semi-structured interviews after intervention. Results The patients in the experimental group demonstrated a significant improvement in overall QOL,support and value of life,and a significant reduction in negative emotions, sense of alienation, and existential distress. The four categories identified in the qualitative analysis were:accepting one's unique life,feelings of emotional relief,bolstering a sense of meaning in life,and leaving a personal legacy. Conclusion The life review program is an effective intervention to improve the psycho-spiritual well of patients with advanced cancer.

  13. Effects of shared medical appointments on quality of life and cost-effectiveness for patients with a chronic neuromuscular disease. Study protocol of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van der Wilt Gert-Jan

    2011-08-01

    Full Text Available Abstract Background Shared medical appointments are a series of one-to-one doctor-patient contacts, in presence of a group of 6-10 fellow patients. This group visits substitute the annual control visits of patients with the neurologist. The same items attended to in a one-to- one appointment are addressed. The possible advantages of a shared medical appointment could be an added value to the present management of neuromuscular patients. The currently problem-focused one-to-one out-patient visits often leave little time for the patient's psychosocial needs, patient education, and patient empowerment. Methods/design A randomized, prospective controlled study (RCT with a follow up of 6 months will be conducted to evaluate the clinical and cost-effectiveness of shared medical appointments compared to usual care for 300 neuromuscular patients and their partners at the Radboud University Nijmegen Medical Center. Every included patient will be randomly allocated to one of the two study arms. This study has been reviewed and approved by the medical ethics committee of the region Arnhem-Nijmegen, the Netherlands. The primary outcome measure is quality of life as measured by the EQ-5D, SF-36 and the Individualized neuromuscular Quality of Life Questionnaire. The primary analysis will be an intention-to-treat analysis on the area under the curve of the quality of life scores. A linear mixed model will be used with random factor group and fixed factors treatment, baseline score and type of neuromuscular disease. For the economic evaluation an incremental cost-effectiveness analysis will be conducted from a societal perspective, relating differences in costs to difference in health outcome. Results are expected in 2012. Discussion This study will be the first randomized controlled trial which evaluates the effect of shared medical appointments versus usual care for neuromuscular patients. This will enable to determine if there is additional value of shared

  14. Implantable Medical Devices

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Implantable Medical Devices Updated:Sep 16,2016 For Rhythm Control ... a Heart Attack Introduction Medications Surgical Procedures Implantable Medical Devices • Life After a Heart Attack • Heart Attack ...

  15. [Report from the Committee for Advanced Therapies (CAT). Pitfalls on the way from concept to medical treatment with advanced therapy medicinal products].

    Science.gov (United States)

    Reiss, M; Büttel, I C; Schneider, C K

    2011-07-01

    Advanced therapy medicinal products (ATMP) are highly innovative and complex medicines. They comprise gene therapy medicinal products, somatic cell therapy medicinal products, and tissue-engineered products (TEP). With the European Regulation on ATMP that came into force in 2008, a consolidated regulatory framework was created, where the Committee for Advanced Therapies (CAT) at the European Medicines Agency (EMA) plays a central role. This article discusses pitfalls and challenges that the CAT has experienced in its discussions of various procedures. Often ATMPs are developed by small and medium-sized enterprises (SME) which also face nonscientific challenges. The CAT wishes to meet these challenges on a scientific and regulatory level during its 2010-2015 work program.

  16. Impact of childlessness on life and attitudes towards continuation of medically assisted reproduction and/or adoption

    DEFF Research Database (Denmark)

    Petersen, Gitte L; Blenstrup, Lene T; Peterson, Brennan D

    2015-01-01

    Infertility and fertility treatment have the potential to impact and disrupt a couple's overall life. In order to study the associations between the impact of childlessness on one's life, and men and women's attitudes towards fertility treatment continuation and/or adoption, we analysed data from...

  17. Paul Scherrer Institut annual report 1995. Annex II: PSI life sciences and institute for medical radiobiology newsletter 1995

    Energy Technology Data Exchange (ETDEWEB)

    Blaeuenstein, P.; Gschwend, B. [eds.

    1996-09-01

    The newsletter presents the 1995 progress report of PSI F2-Department and of the Institute for Medical Radiobiology in the fields of radiation medicine, radiopharmacy and radiation hygiene. figs., tabs., refs.

  18. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel

    Directory of Open Access Journals (Sweden)

    Camila Uanne Resende Avelino

    2015-04-01

    Full Text Available OBJECTIVE: Non-small cell lung carcinoma (NSCLC is the most common type of lung cancer. Most patients are diagnosed at an advanced stage, palliative chemotherapy therefore being the only treatment option. This study was aimed at evaluating the health-related quality of life (HRQoL of advanced-stage NSCLC patients receiving palliative chemotherapy with carboplatin and paclitaxel. METHODS: This was a multiple case study of advanced-stage NSCLC outpatients receiving chemotherapy at a public hospital in Rio de Janeiro, Brazil. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire was used in conjunction with its supplemental lung cancer-specific module in order to assess HRQoL. RESULTS: Physical and cognitive functioning scale scores differed significantly among chemotherapy cycles, indicating improved and worsened HRQoL, respectively. The differences regarding the scores for pain, loss of appetite, chest pain, and arm/shoulder pain indicated improved HRQoL. CONCLUSIONS: Chemotherapy was found to improve certain aspects of HRQoL in patients with advanced-stage NSCLC.

  19. Attitudes toward advance directives for medical care in family members of advanced cancer patients: a qualitative study%家属对晚期肿瘤患者实施预立医疗照护计划态度的质性研究

    Institute of Scientific and Technical Information of China (English)

    王丽英; 陆箴琦; 胡雁; 顾文英

    2012-01-01

    目的 了解家属对晚期肿瘤患者实施预立医疗照护计划的态度,为姑息照护领域相关医疗决策的制定提供依据.方法 对17名晚期肿瘤患者家属进行深度访谈,采用现象学分析法分析资料.结果 家属对预立医疗照护计划的态度提炼出4个主题:如患者主动提出,自己愿意支持;预立医疗照护计划本意较好,但不忍患者面对;预立医疗照护计划本身存在一定缺陷,效果令人质疑;目前实施有难度,将来有望推广.家属对晚期肿瘤患者终末治疗的选择提炼出2个主题:不忍患者受苦,选择放弃抢救;进退两难,抢救为无奈之举.结论 晚期肿瘤患者家属在认可预立医疗照护计划的同时存在很多顾虑,知晓抢救的无效性但因外在压力和良心不安选择抢救;医护人员应做好家属健康教育,并协助家属与患者、家属与家属之间进行坦诚沟通,以推广预立医疗照护计划的理念.%Objective To explore attitudes toward advance directives (ADs) for medical care in family members of advanced cancer patients, and to provide guidance for medical policy-making in palliative care. Methods Seventeen family members of advanced cancer patients participated in the semi-structure interviews. Data were analyzed by using Claizzi s phenomenological procedure. Results The data revealed four themes about family members' attitudes toward ADs: they would support ADs if patients proposed; though ADs had many benefits, they could not stand patients facing it; they doubted effects of ADs for it showed many defects; they thought that it was difficult to implement ADs right now, but the situation would change in the future. Family members' decision-making about life-sustaining treatment were concluded into two perspectives: they would give up life-sustaining treatment to decrease patients' pain; they were in dilemma as they felt ashamed to give up treatment and had no choice but withholding life-sustaining therapy

  20. Application of behavior-based ergonomics therapies to improve quality of life and reduce medication usage for Alzheimer's/dementia residents.

    Science.gov (United States)

    Mowrey, Corinne; Parikh, Pratik J; Bharwani, Govind; Bharwani, Meena

    2013-02-01

    Behavior-based ergonomics therapy (BBET) has been proposed in the past as a viable individualized non-pharmacological intervention to manage challenging behaviors and promote engagement among long-term care residents diagnosed with Alzheimer's/dementia. We evaluate the effect of BBET on quality of life and behavioral medication usage in an 18-bed dementia care unit at a not-for-profit continuing care retirement community in West Central Ohio. Comparing a target cohort during the 6-month pre-implementation period with the 6-month post-implementation period, our study indicates that BBET appears to have a positive impact on the resident's quality of life and also appears to correlate with behavioral medical reduction. For instance, the number of days with behavioral episodes decreased by 53%, the total Minimum Data Set (MDS) mood counts decreased by 70%, and the total MDS behavior counts decreased by 65%. From a medication usage standpoint, the number of pro re nata (PRN) Ativan doses decreased by 57%.

  1. Objectively Assessed Exercise Behavior in Chinese Patients with Early-Stage Cancer: A Predictor of Perceived Benefits, Communication with Doctors, Medical Coping Modes, Depression and Quality of Life.

    Science.gov (United States)

    Liu, Zhunzhun; Zhang, Lanfeng; Shi, Songsong; Xia, Wenkai

    2017-01-01

    This study sought to identify factors associated with objectively assessed exercise behavior in Chinese patients with early-stage cancer. Three hundred and fifty one cancer patients were recruited from the Affiliated Jiangyin Hospital of Southeast University Medical College and the Nantong Tumor Hospital. One-way ANOVA, Pearson Chi-square tests and regression analysis were employed to identify the correlations between physical exercise and the measured factors. The results showed that occupation type (χ2 = 14.065; p = 0.029), monthly individual monthly income level (χ2 = 24.795; p = 0.003), BMI (χ2 = 15.709; p = 0.015) and diagnosis (χ2 = 42.442; p Benefit Finding (BF) (F = 24.651; p communication with doctors (F = 15.285; p benefit finding, medical coping modes, communication with doctors, social support, depression and quality of life were significantly correlated with exercise. The variance in several psychosocial factors (benefit finding, medical coping modes, the communication with doctors, depression and quality of life) could be explained by exercise. Psychosocial factors should be addressed and examined over time when evaluating the effect of physical exercise that is prescribed as a clinically relevant treatment.

  2. Quality of life and management project for patients with advanced lung cancer%晚期肺癌生活质量与治疗方案选择

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Compared with best supportive care,chemotherapy can prolong survival and improve quality of life,and symptoms associated with society activities and disease.Chemotherapy can improve quality of life of patients with effective treatment and stable treatment. Treatment benefit was often underestimated using clinical relief rate,so which should not chosen as index for evaluating effect of palliative treatment. So for patients with poor status ,and objective of relieving symptoms,short term,low dose chemotherapy should be suggested due to its characteristic of low cost,short inhospitalization time,and favorable improvement of quality of life. For patients with good condition in limited advanced stage,radical treatment is objective,and hence single chemotherapy of standard dose or chemotherapy combining radiotherapy should be suggested.

  3. Effect of music intervention on quality of life in advanced cancer patients during chemotherapy%音乐干预对晚期肿瘤患者化疗期间生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    李春梅; 谭华凤; 刘艳华

    2011-01-01

    Objective To explore the effect of music therapy on reducing chemotherapy toxicity, improving the quality of life of the patients with advanced cancer patients during chemotherapy.Methods According to psychological law characteristics of patients, we design a music system, including: morning nursing "A" song, analgesia "B", dine "C" song, sleep "D" song. 100 advanced cancer patients from the affiliated hospital of guangdong medical college, between June 2009 and June 2010, were enrolled in this study. They were randomly divided into two groups according to numerical table. The control group (50 patients) received routine nursing, while the experimental group (50 patients) received music therapy intervention during each chemotherapy process or break. The effects were evaluated from two aspects: the side effects of chemotherapy and the changes of blood-routine after chemotherapy.Results The experimental group feel cheerfulness, tranquil at every time after chemotherapy and the degree of adverse reaction is light, than the control group, and there were significant differences between them (P.05), and the SANS scores were significantly different between the two groups(P.05);治疗后两组SANS评分比较差异有统计学意义(P<0.05).结论 在患者化疗期间实施音乐干预可减轻化疗副作用,稳定患者血象,减轻患者心理恐惧,直接提高患者生存质量.

  4. Isotope-based medical research in the post genome era: Gene-orchestrated life functions in medicine seen and affected by isotopes. Workshop report

    Energy Technology Data Exchange (ETDEWEB)

    Feinendegen, L.E.

    1997-12-31

    The US Department of Energy (DOE) and the National Institutes of Health (NIH) conducted a workshop on Isotope-Based Medical Research in the Post Genome Era at NIH, Bethesda, Maryland, November 12--14, 1997. The workshop aimed at identifying the role of stable and radioisotopes for advanced diagnosis and therapy of a wide range of illnesses using the new information that comes from the human genome program. In this sense, the agenda addressed the challenge of functional genomics in humans. The workshop addressed: functional genomics in clinical medicine; new diagnostic potentials; new therapy potentials; challenge to tracer- and effector-pharmaceutical chemistry; and project plans for joint ventures.

  5. Final Report for The University of Texas at Arlington Optical Medical Imaging Section of Advanced Imaging Research Center

    Energy Technology Data Exchange (ETDEWEB)

    Khosrow Behbehani

    2013-02-26

    The goal of this project was to create state-of-the-art optical medical imaging laboratories for the Biomedical Engineering faculty and student researchers of the University of Texas at Arlington (UTA) on the campus of the University of Texas Southwestern Medical Center (UTSW). This has been successfully achieved. These laboratories provide an unprecedented opportunity for the bioengineers (from UTA) to bring about new breakthroughs in medical imaging using optics. Specifically, three major laboratories have been successfully established and state-of-the-art scientific instruments have been placed in the labs. As a result of this grant, numerous journal and conference publications have been generated, patents for new inventions have been filed and received, and many additional grants for the continuation of the research has been received.

  6. The social life of the dead: The role of post-mortem examinations in medical student socialisation.

    Science.gov (United States)

    Goodwin, Dawn; Machin, Laura; Taylor, Adam

    2016-07-01

    Dissection has held a privileged position in medical education although the professional values it inculcates have been subject to intense debate. Claims vary from it generating a dehumanising level of emotional detachment, to promotion of rational and dispassionate decision-making, even to being a positive vehicle for ethical education. Social scientists have positioned dissection as a critical experience in the emotional socialisation of medical students. However, curricular revision has provoked debate about the style and quantity of anatomy teaching thus threatening this 'rite of passage' of medical students. Consequently, some UK medical schools do not employ dissection at all. In its place, observation of post-mortem examinations - a long established, if underutilised, practice - has re-emerged in an attempt to recoup aspects of anatomical knowledge that are arguably lost when dissection is omitted. Bodies for post-mortem examinations and bodies for dissection, however, have striking differences, meaning that post-mortem examinations and dissection cannot be considered comparable opportunities to learn anatomy. In this article, we explore the distinctions between dissection and post-mortem examinations. In particular, we focus on the absence of a discourse of consent, concerns about bodily integrity, how the body's shifting ontology, between object and person, disrupts students' attempts to distance themselves, and how the observation of post-mortem examinations features in the emotional socialisation of medical students.

  7. Oxygen in human health from life to death – An approach to teaching redox biology and signaling to graduate and medical students

    Directory of Open Access Journals (Sweden)

    Margaret M. Briehl

    2015-08-01

    Full Text Available In the absence of oxygen human life is measured in minutes. In the presence of oxygen, normal metabolism generates reactive species (ROS that have the potential to cause cell injury contributing to human aging and disease. Between these extremes, organisms have developed means for sensing oxygen and ROS and regulating their cellular processes in response. Redox signaling contributes to the control of cell proliferation and death. Aberrant redox signaling underlies many human diseases. The attributes acquired by altered redox homeostasis in cancer cells illustrate this particularly well. This teaching review and the accompanying illustrations provide an introduction to redox biology and signaling aimed at instructors of graduate and medical students.

  8. Learning new lines. New 'playbook' advises hospitals how to win bigger reimbursement for medical procedures that use expensive advanced technology.

    Science.gov (United States)

    Taylor, Mark

    2003-07-28

    If hospitals' tough negotiating tactics with managed care often seem to be taken from an instruction manual, then that perception would be correct. Profiting From Innovation is a research group's latest report to its hospital clients, telling them just how to get managed-care plans to pay for pricey medical technology.

  9. Development and pilot evaluation of user acceptance of advanced mass-gathering emergency medical services PDA support systems.

    Science.gov (United States)

    Chang, Polun; Hsu, Yueh-Shuang; Tzeng, Yuann-Mei; Hou, I-Ching; Sang, Yiing-Yiing

    2004-01-01

    The support systems for the Emergency Medical Services (EMS) in the mass gatherings, such as the local marathon or the large international baseball games, had been underdeveloped. The purposes for this study were to develop triage-based EMS Personal Digital Assistant (PDA) support systems for the mass-gatherings and to evaluate users' perceived ease of use and usefulness of the systems in terms of Davis' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms-the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. 23 nurses and 6 physicians in the medical center, who had ever served in the mass gatherings, were invited to examine the new systems and answered the TAM questionnaire. The results showed that the PDA systems included as many 450 information items inside 42 screens under 6 categories and the great potential of using triage-based PDA systems in the mass gatherings. Overall, most of the subjects agreed with that the systems were easy to use and useful for the mass gatherings, and they were willing to accept the systems.

  10. Can the Tools of Activity Theory Help Us in Advancing Understanding and Organisational Change in Undergraduate Medical Education?

    Science.gov (United States)

    Reid, Anne-Marie; Ledger, Alison; Kilminster, Sue; Fuller, Richard

    2015-01-01

    Continued changes to healthcare delivery in the UK, and an increasing focus on patient safety and quality improvement, require a radical rethink on how we enable graduates to begin work in challenging, complex environments. Professional regulatory bodies now require undergraduate medical schools to implement an "assistantship" period in…

  11. A qualidade de vida de jovens portadores de espinha bífida do Children's National Medical Center – Washington DC The quality of life of adolescents with spina bifida at the Children's National Medical Center – Washington DC

    Directory of Open Access Journals (Sweden)

    Ana Helena Rotta Soares

    2006-09-01

    Full Text Available O presente artigo tem como objetivo explorar a qualidade de vida de jovens portadores de espinha bífida atendidos no Children's National Medical Center em Washington DC. A pesquisa baseia-se em uma perspectiva qualitativa que utiliza como referencial teórico central a "Teoria do estigma" e as discussões conceituais sobre as dimensões de qualidade de vida. Foram entrevistados 15 jovens do serviço acima citado, sendo que 8 deles participaram de um grupo focal construído através das questões levantadas durante entrevistas. Os discursos dos jovens em questão refletem a necessidade de categorias mais englobantes que não remetam a uma pulverização da experiência de vida. Evidenciou-se uma estrutura de desigualdade nas interações entre saudáveis e deficientes, e reproduzida pelos próprios jovens. Os resultados demonstram que o estigma se encontra presente em todas as dimensões da vida dos sujeitos, interferindo na inserção social, construção subjetiva do jovem e sua auto-estima, reforçando o papel do portador de deficiência como uma "não-pessoa". Embora a categoria sexualidade não seja priorizada em outros instrumentos para esta população, o tema se faz presente e central na discussão da experiência da vida dos mesmos.The present article explores the quality of life of adolescents with spina bifida at the Children's National Medical Center in Washington DC. The research is based on a qualitative perspective that utilizes the "Theory of stigma" as the central theoretical framework, in addition to the discussions of the concept of quality of life and its dimensions. Fifteen adolescents were interviewed at the above institution, eight of which then participated in a focal group structured through issues that emerged during this previous phase. The discourses reflected the need for more encompassing categories for quality of life that do not pulverize the life experience. The adolescent's discourses demonstrate an inequality

  12. Practice and effect of interactive teaching in pediatric advanced life support training%互动式教学在儿科高级生命支持培训中的实践与效果

    Institute of Scientific and Technical Information of China (English)

    杨明; 钱素云; 杨军华; 樊寻梅

    2010-01-01

    互动式教学以学员为中心,通过教员与学员之间的积极互动,可以最大限度地激发学员主动进行学习和思考.首都医科大学附属北京儿童医院在儿科高级生命支持培训中开展互动式教学实践,并对教学效果进行了评价.结果 表明,在为不同临床背景的儿科医生或护士提供标准化的高级生命支持培训时,互动式教学取得了传统教学方式难以达到的效果,值得在医学理论教学和技能培训中推广.%As a student-centered method, interactive teaching maximally inspires active thinking and learning of the trainees by reinforcing the positive interaction between instructors and trainees. In Beijing Children's Hospital interactive teaching was practiced in pediatric advanced life support training and the effect was evaluated. Through interactive teaching, standardized advanced life support information and knowledge were delivered to the trainees regardless of the different clinical background among pediatricians and nurses, and good effect which conventional teaching method could hardly get was attained. It is believed that interactive teaching could be a valuable teaching method for medical theory teaching and skill training.

  13. Combination goserelin and tamoxifen therapy in premenopausal advanced breast cancer: a multicentre study by the ITMO group. Italian Trials in Medical Oncology.

    Science.gov (United States)

    Buzzoni, R.; Biganzoli, L.; Bajetta, E.; Celio, L.; Fornasiero, A.; Mariani, L.; Zilembo, N.; Di Bartolomeo, M.; Di Leo, A.; Arcangeli, G.

    1995-01-01

    It has been suggested that tamoxifen may improve the efficacy of medical castration with luteinising hormone-releasing hormone analogues, but very few data have so far been published concerning the clinical and endocrinological activity of this therapeutic modality. In this phase II multicentre trial conducted by the Italian Trials in Medical Oncology group (ITMO), 64 premenopausal patients with hormone receptor-positive or unknown breast cancer were treated with monthly s.c. injections of goserelin 3.6 mg, in association with a tamoxifen daily dose of 20 mg, as first-line therapy for their advanced disease. All of the patients were evaluable for efficacy and there was an overall response rate of 41% (95% confidence interval 28-52%), with 7 of the 26 responders achieving complete remission. The median time to response was 4 months (range 2-17), and the median response duration was 13 months (range 6-37 +). Better responses were observed in soft tissues (51%); the response in visceral and bone metastases was respectively 19% and 37%. Serum concentrations of gonadotrophins and oestradiol were significantly decreased by the treatment, oestrogen levels being constantly suppressed to within the range observed in post-menopausal women. No significant change was detected in serum testosterone levels. In our experience, although it was not associated with any increased clinical efficacy, the concurrent use of goserelin and tamoxifen proved to be a feasible approach in the management of premenopausal advanced breast cancer. PMID:7734310

  14. The Chinese Life-Steps Program: A Cultural Adaptation of a Cognitive-Behavioral Intervention to Enhance HIV Medication Adherence

    Science.gov (United States)

    Shiu, Cheng-Shi; Chen, Wei-Ti; Simoni, Jane; Fredriksen-Goldsen, Karen; Zhang, Fujie; Zhou, Hongxin

    2013-01-01

    China is considered to be the new frontier of the global AIDS pandemic. Although effective treatment for HIV is becoming widely available in China, adherence to treatment remains a challenge. This study aimed to adapt an intervention promoting HIV-medication adherence--favorably evaluated in the West--for Chinese HIV-positive patients. The…

  15. Investigation of quality of life in the treatment of locally advanced and recurrent oropharyngeal cancer: State-of the-art

    Directory of Open Access Journals (Sweden)

    D. V. Sikorsky

    2015-01-01

    Full Text Available Postsurgical survival is considered to be indicators of treatment efficiency in most cases. However, the sociomedical rehabilitation of patients in this group is no less important; not only life expectancy, but also functional rehabilitation and quality of life are in the lead in patients with Stage III–IVA due to their low 2-year and much lower 5-year survival. The main efficiency criterion is patients, quality of life as compared to antitumor treatment programs in the absence of differences in survival.As the only chance of cure or life prolongation in most cases, multicomponent surgery for locally advanced and recurrent oropharyngeal cancer may be refused by a patient for fear of being lost to society. Identification of surgical treatment-induced changes in quality of life in patients may be used as a criterion for assessing the performed operations.The body's changes in a patient with otopharyngeal cancer are associated with impairment of basic physiological functions (deglutition, mastication, and breathing, sensitivity (taste, olfaction, and hearing, and individual characteristics of a human being (for example, appearance and voice. The quality of life is integral characteristics of the physical, psychological, emotional, and social functioning of a patient, which is based on his subjective perception. The methods for studying the quality of life include first of all questionnaires that are classified as general and special ones.The general questionnaires are intended to assess the quality of life of both healthy individuals and patients regardless of their disease; the special questionnaires are used to study that in certain categories and groups of patients. The general questionnaires allow the comparison of patients with a population of healthy people. Account must be also taken of the fact that the quality of life varies with age and comorbidities. A great deal of procedures for measuring the quality of life in different groups of

  16. Evaluation of the Army Physical Training and Weight Control Programs. Part 2. The Army Medical Department Advanced NCOES Course

    Science.gov (United States)

    1983-09-01

    Inspecion Specialist 91S - Environmental Specialist 91T - Animal Care Specialist 91W - Nuclear Lab Specialist 92B - Medical Lab Specialist 94F... Corporations have achieved excellent success with individual programs when they are supervised and receive adequate institutional backirg (Health and Fitness...The Corporate View, 1980). A safe and effective physical fitness program which is supported by the organization is an integral part of successful stress

  17. A preface on advances in diagnostics for infectious and parasitic diseases: detecting parasites of medical and veterinary importance.

    Science.gov (United States)

    Stothard, J Russell; Adams, Emily

    2014-12-01

    There are many reasons why detection of parasites of medical and veterinary importance is vital and where novel diagnostic and surveillance tools are required. From a medical perspective alone, these originate from a desire for better clinical management and rational use of medications. Diagnosis can be at the individual-level, at close to patient settings in testing a clinical suspicion or at the community-level, perhaps in front of a computer screen, in classification of endemic areas and devising appropriate control interventions. Thus diagnostics for parasitic diseases has a broad remit as parasites are not only tied with their definitive hosts but also in some cases with their vectors/intermediate hosts. Application of current diagnostic tools and decision algorithms in sustaining control programmes, or in elimination settings, can be problematic and even ill-fitting. For example in resource-limited settings, are current diagnostic tools sufficiently robust for operational use at scale or are they confounded by on-the-ground realities; are the diagnostic algorithms underlying public health interventions always understood and well-received within communities which are targeted for control? Within this Special Issue (SI) covering a variety of diseases and diagnostic settings some answers are forthcoming. An important theme, however, throughout the SI is to acknowledge that cross-talk and continuous feedback between development and application of diagnostic tests is crucial if they are to be used effectively and appropriately.

  18. Adherence to Medical Regimens: Understanding the Effects of Cognitive Appraisal, Quality of Life, and Perceived Family Resiliency

    Science.gov (United States)

    Frain, Michael P.; Bishop, Malachy; Tschopp, Molly K.; Ferrin, Micheal J.; Frain, Judy

    2009-01-01

    Adherence studies have taken center stage due to the life-threatening risks associated with nonadherence to highly active antiretroviral therapy (HAART) regimens for people with HIV/AIDS. This study examines adherence through self-report of individuals on HAART regimens in a manner to account for demand characteristic bias, while still attempting…

  19. Quality of life, use of topical medications and socio-economic data in hand eczema: a Swedish nationwide survey.

    Science.gov (United States)

    Bingefors, Kerstin; Lindberg, Magnus; Isacson, Dag

    2011-06-01

    Hand eczema is common and has an adverse impact on the lives of patients. There is a need for population-based surveys on the pharmacoepidemiological aspects, quality of life and impact of socioeconomic factors in hand eczema. The aim of this cross-sectional study was to investigate these factors. A questionnaire-based nationwide survey of health was performed, including questions on hand eczema, use of pharmaceuticals and socioeconomic factors. Quality of life was estimated with the generic instrument Short Form 36 (SF-36). The questionnaire was sent to 7,985 persons (age range 18-84 years), response rate 61.1% (n = 4,875). The 1-year prevalence of hand eczema in the study population was 7.5%. In this group, quality of life was lower. All dimensions of SF-36 were affected, most markedly general health and those dimensions reporting on mental health. In the group with self-reported hand eczema, 51% reported using topical pharmaceuticals. Hand eczema was more common among women (9.1%, n = 2,630) than among men (5.6%, n = 2,245) and in the age group below 65 years (8.5%, n = 3,274) compared with those aged 65 years and over (4.3%, n = 1,151). This survey clearly demonstrates the impact of hand eczema on several dimensions of life and also highlights age, gender and socioeconomic differences.

  20. Physician medical decision-making at the end of life in newborns : Insight into implementation at 2 Dutch centers

    NARCIS (Netherlands)

    Verhagen, A. A. Eduard; van der Hoeven, Mark A. H.; van Meerveld, R. Corine; Sauer, Pieter J. J.

    2007-01-01

    OBJECTIVE. Decisions regarding end-of-life care in critically ill newborns in the Netherlands have received considerable criticism from the media and from the public. This might be because of a lack of proper information and knowledge. Our purpose was to provide detailed information about how and wh

  1. Development and Qualification of Advancements in Submersible Transfer Pump Performance and Life, and Implications for Advancing and Supporting Processing Options - 13343

    Energy Technology Data Exchange (ETDEWEB)

    Stover, David L. [Curtiss-Wright EMD, Cheswick, PA 15024 (United States); Bryan, Wes; Kelly, James [Washington River Protection Solutions, Richland, WA 99352 (United States)

    2013-07-01

    From the 1950's through the 1990's, relatively inexpensive, 'off-the-shelf' type, vertical turbine pumps (VTP) were used to transfer Hanford waste. The technology of those pumps was rooted primarily in the mining and agricultural (irrigation) industries. HNF-3218, Double Shell Tank (DST) Transfer Pump History and Reliability Report, 1998, provides a summary of Hanford DST pump history to that date. Such pumps operated in the Hanford radioactive waste environment for an average of only 400 hours before failure. However, at that time, operating life was not a driving criteria within the Department of Energy (DOE) complex, as the failure of transfer pumps represented a relatively low replacement and disposal cost. The Environmental Protection Agency (EPA) issuance of the 'Debris Rule' in 1992, which mandated that mixed radioactive waste contaminated equipment be decontaminated to a 'low level waste' category prior to burial, elevated the significance of transfer pump reliability and decontamination capability as life-cycle cost criteria. Minimizing the frequency of transfer pump failures and design for decontamination became significantly important and served to drive the need toward specific, designed for application pumps to meet this challenge. To this end, Washington River Protection Solutions (WRPS) and the supplier, Curtiss-Wright EMD (EMD), have recently collaborated on an intense program to further transfer pump technology and performance. (authors)

  2. Saúde e qualidade de vida de médicos residentes Health and quality of life of medical residents

    Directory of Open Access Journals (Sweden)

    Luciano Garcia Lourenção

    2010-01-01

    Full Text Available OBJETIVO: Discutir sobre saúde e qualidade de vida de médicos residentes. MÉTODOS: Estudo de revisão bibliográfica no qual se realizou a análise de conteúdo do assunto enfocado. A fonte de busca foi a Biblioteca Virtual em Saúde (BVS, por meio da BIREME (Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde, nas Bases Eletrônicas Medline (Medical Literature Analysis and Retrietal System On-Line, Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde, SciELO (Scientific Eletronic Library On Line e pelo endereço eletrônico scholar.google.com.br. Os descritores utilizados foram: qualidade de vida, estresse, internato e residência. Realizou-se o ordenamento e a análise da bibliografia científica, de modo a avaliar e discutir aspectos apresentados nos estudos com relação à temática, considerando a distribuição das publicações segundo país de origem, o período de publicação, a fonte e o título, o foco de estudo e as principais conclusões. RESULTADOS: As publicações analisadas abordam aspectos importantes como incidências elevadas de Burnout, estresse, depressão, fadiga e sono entre os residentes; dificuldade de enfrentamento; relação entre carga horária de trabalho e qualidade de vida; necessidade de melhorias na legislação da residência médica para melhorar as condições de trabalho e aprendizado. CONCLUSÃO: A implementação de programas de assistência aos residentes produz melhorias na qualidade da capacitação profissional e na qualidade de vida pessoal, melhorando o relacionamento com os pacientes. Apesar de estressante, a residência médica é uma experiência enriquecedora, que propicia o desenvolvimento profissional e pessoal dos jovens médicos.OBJECTIVE: This article highlights the relationship between health and quality of life among the resident medical staff. METHODS: A review was carried out to analyze the content of the relationship under study. Sources for

  3. 医学伦理学新进展与发展设想%New advances and prospects of medical ethics

    Institute of Scientific and Technical Information of China (English)

    杨放; 郭照江

    2011-01-01

    Objective To review and summarize the latest advances and achievements in medical ethics research since "the Eleventh Five-Year Plan". And to infer the possible developmental prospects of medical ethics in "the Twelfth Five-Year Plan". Methods Bibliographical methods were employed to retrieve the academic achievementsand dynamic developments in medical ethics since 2006 to obtain a brief overview and to conduct an in-depth study. Results Snce "the Eleventh Five-Year Plan", a series of achievements in medical ethics, especially on the upgrade of the themes, the expansion of the scope, and the renovation of the methods, have been achieved Research on medical ethics carried out in the army, such as the research on military medical ethics, bioethics, and disaster and epidemic ethics, also yielded several new achievements and played leading roles in the military and practical fields. Conclusions In the period of "the Twelfth Five-Year Plan", the localization of medical ethics research should be promoted, the level of original research should be improved, and the academic contingent and platform should be strenuously constructed. In terms of research direction, continuously strengthening basic and general research of bioethics, highlighting the characteristics and superiority of military medical ethics, enhancing non-combat and combat operation research, and strengthening ethics research for the application of advanced biotechnology in the military field are necessary.%目的 回顾和总结“十一五”以来医学伦理学所取得的新进展、新成就,分析“十二五”医学伦理学发展的环境及前景,拟定发展设想.方法 采用文献检索的方法,对2006年起至今医学伦理学界的学术发展成果和动态进行检索与整理,做出概要的综述和思考.结果 “十一五”以来,医学伦理学取得了一系列重要进展,集中体现在研究主题的提升、研究领域的扩展和研究方法 的更新;与此同时,军队

  4. Over-reaching beyond disease activity: the influence of anxiety and medical economic burden on health-related quality of life in patients with inflammatory bowel disease

    Science.gov (United States)

    Luo, Xia-peng; Mao, Ren; Chen, Bai-li; Qiu, Yun; Zhang, Sheng-hong; He, Yao; Chen, Jie; Zeng, Zhi-rong; Ben-Horin, Shomron; Chen, Min-hu

    2017-01-01

    Purpose Many patients with inflammatory bowel disease (IBD) have impaired health-related quality of life (HRQOL). The influence of psychological and economic factors on HRQOL has not been fully elucidated in IBD. Therefore, we aimed to identify the predictors of HRQOL in an IBD cohort. Patients and methods This was a cross-sectional cohort study of patients presenting to our tertiary IBD center. HRQOL was measured using the 36-item Short Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Perceived stress and perceived social support were also assessed by standardized scales. Demographic, socioeconomic and clinical data were obtained from a prespecified questionnaire and patients’ medical records. Univariate analyses and multiple regression analysis were performed to identify predictors of HRQOL. Results A total of 242 IBD patients were recruited, and the questionnaire return rate was 90.5% (219/242). The prevalence rates of anxiety and depression were 24.7% and 17.4%, respectively. In all, 30.6% of the patients spent over half of their income to cover medical costs. Multivariate analysis revealed that anxiety symptoms (PHRQOL. Conclusion Psychological factors and costs of medical care strongly impair HRQOL in IBD, independent of the disease activity. Psychological counseling and socioeconomic support programs should be considered for integration into the management of IBD patients. PMID:28053510

  5. State Institution "National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine" - research activities and scientific advance in 2013.

    Science.gov (United States)

    Bazyka, D; Sushko, V; Chumak, A; Buzunov, V; Talko, V; Yanovych, L

    2014-09-01

    Research activities and scientific advance achieved in 2013 at the State Institution "National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine" (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. Key points include the research results of XRCC1 and XPD gene polymorphism in thyroid cancer patients, CD38 gene GG genotype as a risk factor for chronic lymphocytic leukemia, frequency of 185delAG and 5382insC mutations in BRCA1 gene in women with breast cancer, cognitive function and TERF1, TERF2, TERT gene expression both with telomere length in human under the low dose radiation exposure. The "source-scattering/shielding structures- man" models for calculation of partial dose values to the eye lens and new methods for radiation risk assessment were developed and adapted. Radiation risks of leukemia including chronic lymphocytic leukemia in the cohort of liquidators were published according to the "case-control" study results after 20 years of survey. Increase of non-tumor morbidity in liquidators during the 1988-2011 with the maximum level 12-21 years upon irradiation was found. Incidence in evacuees appeared being of two-peak pattern i.e. in the first years after the accident and 12 years later. Experimental studies have concerned the impact of radio-modifiers on cellular systems, reproductive function in the population, features of the child nutrition in radiation contamination area were studied. Report also shows the results of scientific and organizational, medical and preventive work, staff training, and implementation of innovations. The NRCRM Annual Report was approved at the Scientific Council meeting of NAMS on March 3, 2014.

  6. Relationship between quality of life and clinical outcomes in advanced non-small cell lung cancer: best supportive care (BSC) versus BSC plus chemotherapy.

    Science.gov (United States)

    Thongprasert, S; Sanguanmitra, P; Juthapan, W; Clinch, J

    1999-04-01

    In a prospective randomized study, 287 patients with advanced non-small cell lung cancer (NSCLC) stage IIIb or IV with ECOG performance status (PS) 0-1 or 2 were randomly assigned to receive either best supportive care (BSC) or supportive care plus combination chemotherapy (IEP regimen: ifosfamide 3 gm/m2 IV with mesna uroprotection, epirubicin 60 mg/m2 IV on day 1 and cisplatin 60 mg/m2 IV on day 2; or MVP regimen: mitomycin-C 8 mg/m2, cisplatin 100 mg/m2 IV on day 1, vinblastine 4 mg/m2 IV on days 1 and 15). Serial assessment of Karnofsky performance status (KPS), modified Functional Living Index-Cancer (T-FLIC) and modified Quality of Life-Index (T-QLI) were used to estimate the quality of life. Interviews were done at entry, at the third month and at 2 months post complete treatment. At least two courses of chemotherapy were considered to be adequate for response evaluation. Patients were treated for a total of four to six courses or until progression of disease. Partial response rates were 40 and 41.7% in IEP and MVP arms. Median survival durations were 5.9 and 8.1 months for the IEP and MVP chemotherapy arms, and 4.1 months for BSC (log-rank test: P = 0.0003). One year survival was 13, 29.8 and 39.3% for the BSC, IEP and MVP regimens, respectively. Two years survival was 7.8, 6.4 and 13.1% for the BSC, IEP and MVP regimens, respectively. Improvement in quality of life (QOL) scores at the first, second and third interview were seen in chemotherapy arms only, not in the BSC arm. We conclude that combination chemotherapy improves the quality of life as well as prolonging the survival of patients with advanced NSCLC.

  7. The association of quality of life with potentially remediable disruptions of circadian sleep/activity rhythms in patients with advanced lung cancer

    Directory of Open Access Journals (Sweden)

    Braun Donald P

    2011-05-01

    Full Text Available Abstract Background Cancer patients routinely develop symptoms consistent with profound circadian disruption, which causes circadian disruption diminished quality of life. This study was initiated to determine the relationship between the severity of potentially remediable cancer-associated circadian disruption and quality of life among patients with advanced lung cancer. Methods We concurrently investigated the relationship between the circadian rhythms of 84 advanced lung cancer patients and their quality of life outcomes as measured by the EORTC QLQ C30 and Ferrans and Powers QLI. The robustness and stability of activity/sleep circadian daily rhythms were measured by actigraphy. Fifty three of the patients in the study were starting their definitive therapy following diagnosis and thirty one patients were beginning second-line therapy. Among the patients who failed prior therapy, the median time between completing definitive therapy and baseline actigraphy was 4.3 months, (interquartile range 2.1 to 9.8 months. Results We found that circadian disruption is universal and severe among these patients compared to non-cancer-bearing individuals. We found that each of these patient's EORTC QLQ C30 domain scores revealed a compromised capacity to perform the routine activities of daily life. The severity of several, but not all, EORTC QLQ C30 symptom items correlate strongly with the degree of individual circadian disruption. In addition, the scores of all four Ferrans/Powers QLI domains correlate strongly with the degree of circadian disruption. Although Ferrans/Powers QLI domain scores show that cancer and its treatment spared these patients' emotional and psychological health, the QLI Health/Function domain score revealed high levels of patients' dissatisfaction with their health which is much worse when circadian disruption is severe. Circadian disruption selectively affects specific Quality of Life domains, such as the Ferrans/Powers Health

  8. Nurses' attitudes towards end-of-life decisions in medical practice: a nationwide study in Flanders, Belgium.

    Science.gov (United States)

    Inghelbrecht, E; Bilsen, J; Mortier, F; Deliens, L

    2009-10-01

    We investigated on a nationwide level the attitudes of nurses towards end-of-life decisions (ELDs) that may hasten death and towards their role in those decisions. We took a representative random sample of 6000 nurses in Flanders, Belgium. Response rate was 62.5%. Most nurses agreed with the practice of withholding/withdrawing potentially life-prolonging treatments (93%), with decisions to alleviate symptoms with possible life-shortening side effects (96%) and with the practice of euthanasia (92%). Their support for the different decisions existed regardless of whether they had cared for terminally ill patients or not. Most nurses also thought that they have an important role to play especially in the ELD-making process. Nurses' views on their proper role in the administration of drugs in euthanasia and continuous deep sedation showed a large dispersal. Overall, nurses' work setting determines their opinions on nurses' role in ELDs. In conclusion, nurses accept a wide variety of ELDs being practiced with terminally ill patients.

  9. Weighing environmental advantages and disadvantages of advanced wastewater treatment of micro-pollutants using environmental life cycle assessment

    DEFF Research Database (Denmark)

    Wenzel, Henrik; Larsen, Henrik Fred; Clauson-Kaas, Jes

    2008-01-01

    -pollutants being: heavy metals (Cd, Pb, Ni), endocrine disruptors (E2 and EE2), PAH, DEHP, and detergents (LAS & NPE). It was found, in some of the studied scenarios, that more environmental impact may be induced than removed by the advanced treatment. The study showed that for the 3 technologies, sand filtration...

  10. Weighing environmental advantages and disadvantages of advanced wastewater treatment of micro-pollutants using environmental life cycle assessment

    DEFF Research Database (Denmark)

    Wenzel, Henrik; Larsen, Henrik Fred; Clauson-Kaas, Jes

    2007-01-01

    -pollutants being: heavy metals (Cd, Pb, Ni), endocrine disruptors (E2 and EE2), PAH, DEHP, and detergents (LAS & NPE). It was found, in some of the studied scenarios, that more environmental impact may be induced than removed by the advanced treatment. The study showed that for the 3 technologies, sand filtration...

  11. How to evaluate health-related quality of life and its association with medication adherence in pulmonary tuberculosis – designing a prospective observational study in South Africa

    Directory of Open Access Journals (Sweden)

    Tanja Kastien-Hilka

    2016-05-01

    Full Text Available Introduction: Health-related quality of life (HRQOL has become an important measure to identify and shape effective and patient-relevant healthcare interventions innovations through outcomes. Adherence to tuberculosis (TB treatment is a public health concern. The main objective of this research is to develop a study design for evaluation of HRQOL and its association with medication adherence in TB in South Africa. Methodology: A conceptual framework for HRQOL in TB has been developed to identify patient-reported outcome (PRO measures for HRQOL and adherence and to generate an endpoint model. Two generic (SF-12 and EQ-5D-5L, one disease-specific (St. George´s Respiratory Questionnaire (SGRQ and one condition-specific (Hospital Anxiety and Depression Scale (HADS measure for HRQOL and Morisky Medication Adherence Scale (MMAS for adherence assessment were identified. All measures are applied in a longitudinal multicentre study at five data collection time points during standard TB treatment. Statistical analysis includes multivariable analysis. Change over time in the physical component score (PCS of SF-12 is defined as primary endpoint. Sample size estimation based thereupon has led to a recruitment target of 96 patients. This study is on-going. Discussion: This is the first longitudinal study in South Africa which evaluates HRQOL and its association with medication adherence in TB in a comprehensive manner. Results will help to improve current treatment programmes and medication adherence and will support the identification of sustainable health innovations in TB, determining the value of new products, and supporting decision making with regard to health policy and pricing.

  12. The break-even point: when medical advances are less important than improving the fidelity with which they are delivered.

    Science.gov (United States)

    Woolf, Steven H; Johnson, Robert E

    2005-01-01

    Society invests billions of dollars in the development of new drugs and technologies but comparatively little in the fidelity of health care, that is, improving systems to ensure the delivery of care to all patients in need. Using mathematical arguments and a nomogram, we demonstrate that technological advances must yield dramatic, often unrealistic increases in efficacy to do more good than could be accomplished by improving fidelity. In 2 examples (the development of anti-platelet agents and statins), we show that enhanced efficacy failed to achieve the health gains that would have occurred by delivering older agents to all eligible patients. Society's huge investment in technological innovations that only modestly improve efficacy, by consuming resources needed for improved delivery of care, may cost more lives than it saves. The misalignment of priorities is driven partly by the commercial interests of industry and by the public's appetite for technological breakthroughs, but health outcomes ultimately suffer. Health, economic, and moral arguments make the case for spending less on technological advances and more on improving systems for delivering care.

  13. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: Is the whole greater than the sum of its parts?

    Directory of Open Access Journals (Sweden)

    Fong Kok-Yong

    2005-01-01

    Full Text Available Abstract Background Diabetes mellitus (DM is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1 evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL (which could be additive, synergistic or subtractive; (2 to determine the extent to which the SF-6D (a single-index preference measure captures the multidimensional information provided by the SF-36 (a profile measure. Methods Using data from a cross-sectional, population-based survey of Chinese, Malay and Indians in Singapore, we developed 9 separate multiple linear regression models, with each SF-36 scale or SF-6D index score being the dependent variable for one model. The influence of DM and a second chronic medical condition (hypertension (HTN, heart disease (HD, musculoskeletal illnesses (MS and their interactions were studied after adjusting for the influence of potential confounding variables. Results Among 5,224 subjects, the prevalence of DM, HTN, HD and MS were 5.9%, 10.7%, 2.4% and 26.6% respectively. DM lowered SF-36 scores by more than 2 points on 3 SF-36 scales and lowered SF-6D scores by 0.03 points. Subjects with DM and HTN, DM and HD or DM and MS experienced further lowering of SF-36 scores exceeding 2 points on at least 6 scales and further lowering of SF-6D scores by 0.05, 0.08 and 0.10 points respectively. Generally, DM and co-existing medical conditions exerted additive effects on HRQoL, with the exception of DM and heart disease, where a subtractive effect was noted. SF-6D index scores generally reflected the patterns of influence of DM and chronic medical conditions on SF-36 scores. Conclusion DM and chronic medical conditions generally reduced HRQoL in this multiethnic general population in an additive, rather than synergistic or subtractive fashion. In this study, the SF

  14. Parental refusal of life-saving treatments for adolescents: Chinese familism in medical decision-making re-visited.

    Science.gov (United States)

    Hui, Edwin

    2008-06-01

    This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the 'AP-physician-family-relationship' and the dominant role Chinese families play in medical decision-making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers from Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives 'weak' family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re-interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its 'parens patriae' power to defend the defenseless in society and the integrity of the medical profession.

  15. Life sciences

    Energy Technology Data Exchange (ETDEWEB)

    Day, L. (ed.)

    1991-04-01

    This document is the 1989--1990 Annual Report for the Life Sciences Divisions of the University of California/Lawrence Berkeley Laboratory. Specific progress reports are included for the Cell and Molecular Biology Division, the Research Medicine and Radiation Biophysics Division (including the Advanced Light Source Life Sciences Center), and the Chemical Biodynamics Division. 450 refs., 46 figs. (MHB)

  16. Oxidation and the Effects of High Temperature Exposures on Notched Fatigue Life of an Advanced Powder Metallurgy Disk Superalloy

    Science.gov (United States)

    Sudbrack, Chantal K.; Draper, Susan L.; Gorman, Timothy T.; Telesman, Jack; Gab, Timothy P.; Hull, David R.

    2012-01-01

    Oxidation and the effects of high temperature exposures on notched fatigue life were considered for a powder metallurgy processed supersolvus heat-treated ME3 disk superalloy. The isothermal static oxidation response at 704 C, 760 C, and 815 C was consistent with other chromia forming nickel-based superalloys: a TiO2-Cr2O3 external oxide formed with a branched Al2O3 internal subscale that extended into a recrystallized - dissolution layer. These surface changes can potentially impact disk durability, making layer growth rates important. Growth of the external scales and dissolution layers followed a cubic rate law, while Al2O3 subscales followed a parabolic rate law. Cr- rich M23C6 carbides at the grain boundaries dissolved to help sustain Cr2O3 growth to depths about 12 times thicker than the scale. The effect of prior exposures was examined through notched low cycle fatigue tests performed to failure in air at 704 C. Prior exposures led to pronounced debits of up to 99 % in fatigue life, where fatigue life decreased inversely with exposure time. Exposures that produced roughly equivalent 1 m thick external scales at the various isotherms showed statistically equivalent fatigue lives, establishing that surface damage drives fatigue debit, not exposure temperature. Fractographic evaluation indicated the failure mode for the pre-exposed specimens involved surface crack initiations that shifted with exposure from predominately single intergranular initiations with transgranular propagation to multi-initiations from the cracked external oxide with intergranular propagation. Weakened grain boundaries at the surface resulting from the M23C6 carbide dissolution are partially responsible for the intergranular cracking. Removing the scale and subscale while leaving a layer where M23C6 carbides were dissolved did not lead to a significant fatigue life improvement, however, also removing the M23C6 carbide dissolution layer led to nearly full recovery of life, with a

  17. Advances in the medication treatment of melasma%黄褐斑的药物治疗进展

    Institute of Scientific and Technical Information of China (English)

    刘宇甄; 林彤

    2014-01-01

    Melasma is a common acquired pigmentation disorder in clinic.The etiology of melasma remains unknown,and there is still no satisfying therapy.Medication treatment is the primary therapy for melasma at present,which mainly inhibits melanogenesis via suppressing tyrosinase synthesis,preventing melanosome transport to keratinocytes,and accelerating epidermal turnover.Tyrosinase inhibitors are the most widely used medication,whereas there is still no enough evidence for the application of plant extracts in the treatment of melasma.Treatment principles of melasma mainly include utilization of definitely effective therapy as well as safe and appropriate maintenance regimens.Further insights into the pathogenesis of melasma and the advent of genetic engineering therapy may provide new ideas for the treatment of melasma.%黄褐斑是临床常见的获得性色素沉着性疾病,病因不明,尚无特效疗法,目前以药物治疗为主,抑制黑素生成是主要的作用机制,包括抑制酪氨酸酶合成、抑制黑素小体转运、加速表皮更新等,其中以酪氨酸酶抑制剂使用最为广泛;植物萃取物在治疗黄褐斑方面仍缺乏足够证据.应用明确有效的治疗及安全合适的维持治疗方案是主要治疗原则.随着对黄褐斑发病机制的进一步研究及基因工程药物的出现可能为本病的治疗带来新思路.

  18. Sofosbuvir plus simeprevir for the treatment of HCV genotype 4 patients with advanced fibrosis or compensated cirrhosis is highly efficacious in real life.

    Science.gov (United States)

    Willemse, S B; Baak, L C; Kuiken, S D; van der Sluys Veer, A; Lettinga, K D; van der Meer, J T M; Depla, A C T M; Tuynman, H; van Nieuwkerk, C M J; Schinkel, C J; Kwa, D; Reesink, H W; van der Valk, M

    2016-12-01

    Chronic hepatitis C virus (HCV) infection is a major cause of chronic liver disease and liver-related death. Recently, multiple regimens of different direct-acting antiviral agents (DAAs) have been registered. Although treatment with sofosbuvir (SOF) and simeprevir (SMV) is registered for the treatment of genotype 4 patients in some countries, data on efficacy of this combination are lacking. We aimed to assess the efficacy of SOF and SMV with or without RBV during 12 weeks in a real-life cohort of genotype 4 HCV patients. A retrospective multicentre observational study was conducted in 4 hospitals in Amsterdam, the Netherlands, including patients with advanced liver fibrosis or liver cirrhosis treated with SOF plus SMV with or without RBV during 12 weeks for a genotype 4 chronic HCV infection from 1 January 2015 to 1 August 2015. Sustained viral response (SVR) was established at week 12 after end of treatment. A total of 53 patients with genotype 4 HCV infection, treatment naïve and experienced, were included. SVR was achieved in 49 of 53 patients (92%). The four failures all had a virological relapse and did not receive ribavirin. Three were nonresponder to earlier interferon-based treatment, and one was treatment naive. In this real-life cohort of patients with HCV genotype 4 infection and advanced liver fibrosis/cirrhosis, we show that treatment with SOF and SMV is effective. The addition of RBV could be considered in treatment-experienced patients as recommended in guidelines.

  19. 肺动脉高压治疗进展%Advances in medical management of pulmonary arterial hypertension

    Institute of Scientific and Technical Information of China (English)

    杨莹; 林涛; 周玲; 温明超

    2008-01-01

    Pulmonary arterial hypertension is a progressive disorder with a poor prognosis. Significant progress in the understanding of the pathobiology of pulmonary arterial hypertension has resulted in a shift from vasodilator therapy to the development of specific drugs targeting seminal molecular derangements of this disorder. This review highlights the recent advances in treatment and provides directions for the future care.%肺动脉高压是一种进行性发展且预后不良的疾病.随着对肺动脉高压发病机制研究的不断深入,其治疗已从单纯的血管扩张剂治疗发展到以疾病的分子遗传基础为靶向的药物治疗.本文着重介绍有关肺动脉高压治疗方面的进展.

  20. Recent Advances in the Use of Drosophila melanogaster as a Model to Study Immunopathogenesis of Medically Important Filamentous Fungi

    Directory of Open Access Journals (Sweden)

    Georgios Hamilos

    2012-01-01

    Full Text Available Airborne opportunistic fungi, including Aspergillus and other less common saprophytic molds, have recently emerged as important causes of mortality in immunocompromised individuals. Understanding the molecular mechanisms of host-fungal interplay in robust experimental pathosystems is becoming a research priority for development of novel therapeutics to combat these devastating infections. Over the past decade, invertebrate hosts with evolutionarily conserved innate immune signaling pathways and powerful genetics, such as Drosophila melanogaster, have been employed as a means to overcome logistic restrains associated with the use mammalian models of fungal infections. Recent studies in Drosophila models of filamentous fungi demonstrated that several genes implicated in fungal virulence in mammals also play a similarly important pathogenic role in fruit flies, and important host-related aspects in fungal pathogenesis are evolutionarily conserved. In view of recent advances in Drosophila genetics, fruit flies will become an invaluable surrogate model to study immunopathogenesis of fungal diseases.

  1. Biogenicity and Syngeneity of Organic Matter in Ancient Sedimentary Rocks: Recent Advances in the Search for Evidence of Past Life

    OpenAIRE

    Dorothy Z. Oehler; Cady, Sherry L.

    2014-01-01

    The past decade has seen an explosion of new technologies for assessment of biogenicity and syngeneity of carbonaceous material within sedimentary rocks. Advances have been made in techniques for analysis of in situ organic matter as well as for extracted bulk samples of soluble and insoluble (kerogen) organic fractions. The in situ techniques allow analysis of micrometer-to-sub-micrometer-scale organic residues within their host rocks and include Raman and fluorescence spectroscopy/imagery...

  2. Health and Quality of Life

    DEFF Research Database (Denmark)

    Gimmler, Antje; Lenk, Christian (ed.); Aumüller, Gerhard (ed.)

    How could one define health and disease? On what presuppositions, and oughtwe look for such definitions? Does quality of life inherit a subjective orobjective evaluation? Are health and quality of life culture dependentconcepts? Under the conditions of technologically advanced medicine...... and thecommon tendency towards a hedonistic lifestyle such questions come intofocus. Hence, one question is of special relevance: which role does healthplay in our quality of life? The contributions of this interdisciplinaryvolume aim at the clarification of the various concepts in use.Internationally well......-known scholars and scientists such as AlfredMusschenga, Alfons Labisch, Lennart Nordenfelt, Peter Janich, Henrik Wulffand several others outline the framework for a more comprehensive anddemanding concept of health and quality of life including philosophical andcultural aspects as well as medical...

  3. Augmenting the Cartesian medical discourse with an understanding of the person's lifeworld, lived body, life story and social identity.

    Science.gov (United States)

    Sunvisson, Helena; Habermann, Barbara; Weiss, Sara; Benner, Patricia

    2009-10-01

    Using three paradigm cases of persons living with Parkinson's Disease (PD) the authors make a case for augmenting and enriching a Cartesian medical account of the pathophysiology of PD with an enriched understanding of the lived body experience of PD, the lived implications of PD for a particular person's concerns and coping with the illness. Linking and adding a thick description of the lived experience of PD can enrich caregiving imagination and attunement to the patient's possibilities, concerns and constraints. The work of Merleau-Ponty is used to articulate the middle terms of the lived experience of dwelling in a lifeworld. Examining lived experience of embodied intentionality, skilled bodily capacities as highlighted in Merleau-Ponty's non-mechanistic physiology opens new therapeutic, coping and caregiving possibilities. Matching temporal rhythms can decrease the stress of being assisted with activities of daily living. For example, caregivers and patients alike can be taught strategies for extending their lived bodily capacities by altering rhythms, by shifting hyperactivity to different parts of the body and other strategies that change the perceptual experience associated with walking in different environment. A medical account of the pathophysiology of PD is nessessary and useful, but not sufficient for designing caregiving in ways that enrich and extend the existential skills of dwelling of persons with PD. The dominance of mechanistic physiology makes caregivers assume that it is the 'real discourse' about the disease, causing researchers and caregivers alike to overlook the equally real lived experience of the patient which requires different descriptive discourses and different sources of understanding. Lack of dialogue between the two discourses is tragic for patients because caregivers need both in order to provide attuned, effective caregiving.

  4. Somatostatin receptor expression, tumour response, and quality of life in patients with advanced hepatocellular carcinoma treated with long-acting octreotide.

    Science.gov (United States)

    Cebon, J; Findlay, M; Hargreaves, C; Stockler, M; Thompson, P; Boyer, M; Roberts, S; Poon, A; Scott, A M; Kalff, V; Garas, G; Dowling, A; Crawford, D; Ring, J; Basser, R; Strickland, A; Macdonald, G; Green, M; Nowak, A; Dickman, B; Dhillon, H; Gebski, V

    2006-10-09

    Octreotide may extend survival in hepatocellular carcinoma (HCC). Forty-one per cent of HCCs have high-affinity somatostatin receptors. We aimed to determine the feasibility, safety, and activity of long-acting octreotide in advanced HCC; to identify the best method for assessing somatostatin receptor expression; to relate receptor expression to clinical outcomes; and to evaluate toxicity. Sixty-three patients with advanced HCC received intramuscular long-acting octreotide 20 mg monthly until progression or toxicity. Median age was 67 years (range 28-81 years), male 81%, Child-Pugh A 83%, and B 17%. The aetiologies of chronic liver disease were alcohol (22%), viral hepatitis (44%), and haemochromatosis (6%). Prior treatments for HCC included surgery (8%), chemotherapy (2%), local ablation (11%), and chemoembolisation (6%). One patient had an objective partial tumour response (2%, 95% CI 0-9%). Serum alpha-fetoprotein levels decreased more than 50% in four (6%). Median survival was 8 months. Thirty four of 61 patients (56%) had receptor expression detected by scintigraphy; no clear relationship with clinical outcomes was identified. There were few grade 3 or 4 toxicities: hyperglycaemia (8%), hypoglycaemia (2%), diarrhoea (5%), and anorexia (2%). Patients reported improvements in some symptoms, but no major changes in quality of life were detected. Long-acting octreotide is safe in advanced HCC. We found little evidence of anticancer activity. A definitive randomised trial would identify whether patients benefit from this treatment in other ways.

  5. Advance directives: prerequisites and usefulness.

    Science.gov (United States)

    van Asselt, D

    2006-10-01

    Advance directives allow competent persons to extend their right of self-determination into the future, by recording choices that are intended to influence their future care should they become unable to make choices. They are considered tools to facilitate end-of-life decision making. Advance directives are a form of anticipatory decision-making. This article will focus on instruction directives against a certain treatment, so-called advance refusals. The most important legal requirement is the acknowledgement of patient autonomy. This condition is met in all European countries. The legal uncertainties surrounding advance refusals are focused on practical modalities rather than on the validity of the general principle. According to leading ethics the underlying moral rule of advanced directives is that all truly autonomous refusals of treatment must be respected, no matter what the consequences. Physicians find it hard to adhere to the wishes and choices of patients as expressed in directives. They find the text ambiguous. Another weakness is that directives give little information about what in the patient's view constitutes a good quality of life. Some health professionals lack the willingness to step outside their own value systems and fully embrace that of the patient. Empathic skills are required. Very few persons create an advance directive. Furthermore, of the created directives only some are accessible when patients are admitted to hospital. However, when directives are available they usually influence medical treatment decisions.

  6. Choosing Your Medical Specialty

    Science.gov (United States)

    ... AMA provides to help members save money. Residency & Career Planning Find resources for a range of medical career ... Fellowships Back to top Home Life & Career Residency & Career Planning Choosing a Medical Specialty Back to top Choosing ...

  7. Quality of life of medical students at the State University of Rio de Janeiro (UERJ), measured using Whoqol-bref: a multivariate analysis.

    Science.gov (United States)

    Chazan, Ana Cláudia Santos; Campos, Mônica Rodrigues; Portugal, Flávia Batista

    2015-02-01

    UERJ allocates 45% of places as scholarships to socioeconomically-challenged students. Whoqol-bref was used to assess to what extent sociodemographic and health variables, the admission process and year of graduation simultaneously influence the quality of life (QOL) domains of medical students. 394 students with a mean age of 23 years participated in the study: 61% females, 43% scholarship holders and 20% with referred chronic morbidity (RCM). The lowest QOL scores were observed among women, with RCM, scholarship holders, economic class C and students in the 3rd and 6th years. Multiple linear regression analysis showed that all the independent variables analyzed had a negative association with QOL domains, and when assessed jointly contributed partly to its explanation, achieving 22% in the "environment" domain, influenced by their social class and the admission process. The presence of RCM had a negative influence on the physical, psychological and social relations domains. The last two domains were also influenced by the year of graduation. Variables with a positive influence on QOL need to be explored further. The data obtained are enough to serve as the base for care strategies for the most vulnerable students during medical training, giving special attention to scholarship students.

  8. Study on the Life Chain Tracking Method for Supervision of Medical Device Suppliers%应用生命链跟踪法监管医疗器械供应商的探索

    Institute of Scientific and Technical Information of China (English)

    蔡梅华

    2013-01-01

    The life chain tracking method was proposed in this paper as a new methodology for supervision of qualified medical device suppliers. Through collaboration of multiple departments in supervising the whole life cycle of medical devices, the whole-process supervision of qualiifed suppliers of relevant medical devices was accomplished, which guaranteed the security of medical devices utilization in hospitals.%本文提出以生命链跟踪法来进行合格供应商监管的新模式,通过整合多个部门及工作人员的工作,对医疗器械的全生命周期进行监管,从而达到对合格供应商全程监管,保证医院使用医疗器材的安全性。

  9. [Advances in research of complementary and integrative medicine: a review of recent publications in some of the leading medical journals].

    Science.gov (United States)

    Gamus, Dorit

    2015-01-01

    This article assesses the evidence for effectiveness, adverse effects and cost-effectiveness of complementary therapies, as reflected in publications in high impact factor medical journals during the years 2012-2014. The search detected 13 randomized controlled studies (RCTs) and 14 meta-analyses, which collectively assessed results of 191 RCTs involving the participation of several thousand patients. Pain was the major focus of acupuncture research in both clinical and fMRI studies, which demonstrated that the effect of acupuncture is beyond the placebo effect. In addition, RCTs supported the use of acupuncture as an adjunctive therapy in chronic obstructive pulmonary disease and in moderate to severe depression. A promising trend was reported for the ameliorating effect of acupuncture in gout. Spinal manipulations may be helpful in cervical pain and yoga may be a useful treatment option for chronic neck pain, chronic low back pain and for pain-related disability. Beneficial effects of adding hypnosis and massage therapy to the treatment of fibromyalgia patients were also documented. Tai-chi may reduce balance impairment in mild-to-moderate Parkinson's disease and improve symptoms in patients with osteoarthritis. Products containing cranberry are associated with protective effects in some subgroups of patients with recurrent urinary tract infections. Chinese herbs may assist in glycemic control of diabetes patients and improve survival rate of patients with non-small cell lung cancer. Some of the complementary therapies were found to be cost-effective. Physicians should be aware of the possible adverse effects of these treatments and of possible drug-herb interactions. Further larger scale trials are justified.

  10. Advancing absolute sustainability assessments of products with a new Planetary Boundaries based life-cycle impact assessment methodology

    DEFF Research Database (Denmark)

    Ryberg, Morten; Owsianiak, Mikolaj; Richardson, Katherine

    an operational life-cycle impact assessment (LCIA) methodology where the definition of the impact categories is based on the control variables as defined in the PB-framework by Steffen et al (2015). This included the development and calculation of characterization factors for the Earth System processes......The Planetary Boundaries (PB)-framework introduced quantitative boundaries for a set of biophysical Earth System processes. The PBs delimit a ‘safe operating space' for humanity to act within to keep Earth in a Holocene-like state (Rockström et al 2009). The concept has gained strong interest from...

  11. Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients: the Canadian context.

    Science.gov (United States)

    Allard, Julie; Fortin, Marie-Chantal

    2016-12-28

    In June 2016, following the decision of the Supreme Court of Canada to decriminalise assistance in dying, the Canadian government enacted Bill C-14, legalising medical assistance in dying (MAID). In 2014, the province of Quebec had passed end-of-life care legislation making MAID available as of December 2015. The availability of MAID has many implications, including the possibility of combining this practice with organ donation through the controlled donation after cardiac death (cDCD) protocol. cDCD most often occurs in cases where the patient has a severe neurological injury but does not meet all the criteria for brain death. The donation is subsequent to the decision to withdraw life-sustaining treatment (LST). Cases where patients are conscious prior to the withdrawal of LST are unusual, and have raised doubts as to the acceptability of removing organs from individuals who are not neurologically impaired and who have voluntarily chosen to die. These cases can be compared with likely scenarios in which patients will request both MAID and organ donation. In both instances, patients will be conscious and competent. Organ donation in such contexts raises ethical issues regarding respect for autonomy, societal pressure, conscientious objections and the dead-donor rule. In this article, we look at relevant policies in other countries and examine the ethical issues associated with cDCD in conscious patients who choose to die.

  12. Engagement with Health Care Providers Affects Self- Efficacy, Self-Esteem, Medication Adherence and Quality of Life in People Living with HIV.

    Science.gov (United States)

    Chen, Wei-Ti; Wantland, Dean; Reid, Paula; Corless, Inge B; Eller, Lucille S; Iipinge, Scholastika; Holzemer, William L; Nokes, Kathleen; Sefcik, Elizbeth; Rivero-Mendez, Marta; Voss, Joachim; Nicholas, Patrice; Phillips, J Craig; Brion, John M; Rose, Caro Dawson; Portillo, Carmen J; Kirksey, Kenn; Sullivan, Kathleen M; Johnson, Mallory O; Tyer-Viola, Lynda; Webel, Allison R

    2013-11-01

    The engagement of patients with their health care providers (HCP) improves patients' quality of life (QOL), adherence to antiretroviral therapy, and life satisfaction. Engagement with HCP includes access to HCP as needed, information sharing, involvement of client in decision making and self-care activities, respect and support of the HCP for the client's choices, and management of client concerns. This study compares country-level differences in patients' engagement with HCP and assesses statistical associations relative to adherence rates, self-efficacy, self-esteem, QOL, and symptom self-reporting by people living with HIV (PLHIV). A convenience sample of 2,182 PLHIV was enrolled in the United States, Canada, Puerto Rico, Namibia, and China. Cross-sectional data were collected between September 2009 and January 2011. Inclusion criteria were being at least 18 years of age, diagnosed with HIV, able to provide informed consent, and able to communicate in the local language with site researchers. In the HCP scale, a low score indicated greater provider engagement. Country comparisons showed that PLHIV in Namibia had the most HCP engagement (OR 2.80, p self-efficacy for adherence (t = -5.22, p self-esteem ratings (t = 2.67, p self-reported symptoms (t = 3.25, p manage their HIV. To improve ART adherence, HCPs should work on strategies to enhance self-efficacy and self-esteem, therefore, exhibiting fewer HIV-related symptoms and missing less medication doses to achieve better QOL.

  13. Atención médica al final de la vida: Conceptos Medical care at the end of life: Concepts

    Directory of Open Access Journals (Sweden)

    M. Gómez-Sancho

    2010-04-01

    Full Text Available Hay una gran confusión terminológica en cuanto se refiere al final de la vida de los pacientes. Como quiera que es un asunto de un permanente debate, con mucha frecuencia la discusión se ve entorpecida por la interpretación que los diversos interlocutores hacen de algunos conceptos. Por este motivo, desde la Organización Médica Colegial se ha elaborado un pequeño documento en el que se clarifica el significado de las palabras que aluden a situaciones relacionadas con el final de la vida.There is great confusion as regards the therm "end of life" of patients. The subject is continuosly under debate, with the arguments often being obstructed by how various interlocutors interpret some concepts. For this reason the Medical Colleges Organisation has prepared a short document in which it clarifies the significance of these words that allude to situations associated with the end of life.

  14. Characterization of the medically important yeast Trichosporon mucoides and its close sister Trichosporon dermatis by traditional and advanced technologies.

    Science.gov (United States)

    Suh, Sung-Oui; Houseknecht, Janice L; Grosso, Kendra M; Carrion, Miguel E

    2015-10-01

    Trichosporon dermatis is a causative agent of several mycoses in immunocompromised patients but is often misidentified as Trichosporon mucoides due to their phenotypic resemblance. In order to evaluate the current identification keys for these species and to develop a rapid and reliable identification method, 11 strains of these yeasts were fully characterized in this study by traditional and advanced technologies. DNA sequences of the internal transcribed spacer (ITS), IGS1, and D1/D2 regions identified six of the yeasts as T. dermatis that were previously known as T. mucoides, including ATCC 204094 that has been used as the quality-control strain of T. mucoides for the VITEK 2 system and other commercial yeast identification kits. These two species could not be differentiated reliably by any previously known phenotypic keys for the species, such as growth patterns on ethylamine, phloroglucinol and tyramine, or by the VITEK 2 system. On the other hand, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) proved to be a rapid and reliable identification tool for the two closely related yeasts. With newly added superspectra from fully authenticated reference strains, the VITEK MS system using MALDI-TOF MS successfully separated strains of T. dermatis and T. mucoides at a similarity level of approximately 67 % for the mass spectra data, and could identify these strains at the species level with 100 % accuracy in repeated tests. Furthermore, the in vitro susceptibility results indicated that itraconazole, posaconazole and voriconazole were more effective against both T. mucoides and T. dermatis than the other antifungal agents tested in this study.

  15. [Projects to accelerate the practical use of innovative medical devices to collaborate with TWIns, Center for Advanced Biomedical Sciences, Waseda University and School of Engineering, The University of Tokyo].

    Science.gov (United States)

    Niimi, Shingo; Umezu, Mitsuo; Iseki, Hiroshi; Harada, Hiroshi Kasanuki Noboru; Mitsuishi, Mamoru; Kitamori, Takehiko; Tei, Yuichi; Nakaoka, Ryusuke; Haishima, Yuji

    2014-01-01

    Division of Medical Devices has been conducting the projects to accelerate the practical use of innovative medical devices to collaborate with TWIns, Center for Advanced Biomedical Sciences, Waseda University and School of Engineering, The University of Tokyo. The TWIns has been studying to aim at establishment of preclinical evaluation methods by "Engineering Based Medicine", and established Regulatory Science Institute for Medical Devices. School of Engineering, The University of Tokyo has been studying to aim at establishment of assessment methodology for innovative minimally invasive therapeutic devices, materials, and nanobio diagnostic devices. This report reviews the exchanges of personnel, the implement systems and the research progress of these projects.

  16. How does the quality of life and the underlying biochemical indicators correlate with the performance in academic examinations in a group of medical students of Sri Lanka?

    Directory of Open Access Journals (Sweden)

    Manjula Hettiarachchi

    2014-02-01

    Full Text Available Background: Individual variation of examination performance depends on many modifiable and non-modifiable factors, including pre-examination anxiety. Medical students’ quality of life (QoL and certain biochemical changes occurring while they are preparing for examinations has not been explored. Purpose: We hypothesize that these parameters would determine the examination performance among medical students. Methods: Fourth-year medical students (n=78 from the University of Ruhuna, Sri Lanka, were invited. Their pre- and post-exam status of QoL, using the World Health Organization Quality of Life (WHOQOL-BREF questionnaire, and the level of biochemical marker levels (i.e., serum levels of thyroid profile including thyroglobulin, cortisol and ferritin were assessed. Differences between the scores of QoL and serum parameters were compared with their performance at the examination. Results: The mean QoL score was significantly lower at pre-exam (56.19±8.1 when compared with post-exam (61.7±7.1 levels (p<0.001. The median serum TSH level prior to the exam (0.9 mIU/L; interquartile range 0.74–1.4 mIU/L was significantly lower (p=0.001 when compared with the level after the exam (median of 2.7 mIU/L; IQR 1.90–3.60. The mean±SD fT4 level was significantly higher before the exam (19.48±0.4 pmol/L at study entry vs. 17.43±0.3 pmol/L after the exam; p<0.001. Median serum ferritin (SF level prior to the exam (43.15 (23.5–63.3 µg/L was significantly lower (p≤0.001 when compared with after-exam status (72.36 (49.9–94.9 µg/L. However, there was no difference in mean serum cortisol levels (16.51±0.7 at pre-exam and 15.88±0.7 at post-exam, respectively; p=0.41. Conclusions: Students had higher fT4 and low ferritin levels on pre-exam biochemical assessment. It was evident that students who perform better at the examination had significantly higher QoL scores at each domain tested through the questionnaire (Physical health, Psychological

  17. The effect of life skills education on the mental health of First year student in Ilam university of medical science in 2013 year

    Directory of Open Access Journals (Sweden)

    L Naseri

    2015-12-01

    Full Text Available Introduction: The rapid socio-cultural changes, i.e. changing the structure of the family and human lifestyle can change the humans with various issues. The deals with these changes require psycho-social abilities. In the present paper it had been reviewed the effect of educating life skills on the mental health of students of Ilam University of medical sciences. Methods: This is a quasi-experimental research using post and pre tests. In this study, 61 freshmen were selected through stratified random sampling method in 2013. From this population, 34 ones were in the experimental group and 27 in the control group. For data collection, the general health questionnaire of Goldberg was used. The data were analyzed using SPSS20 software. The univariate analysis of covariance and multivariate analysis of covariance and paired T-test were analyzed. Results: The results showed that based on univariate analysis there was a significant correlation between the experimental and control groups in the scales of physical  symptoms (p = 0.002, social dysfunction symptoms (p = 0.001 and depression symptoms  (p = 0.048, but there was not a significant relationship in the scale of anxiety symptoms (p = 0.174. Multivariate analysis of covariance showed that there are significance deference between the subscales of mental health in experimental and control groups (P=.002. According to the analysis of paired t-test in the experimental group, life skill decreased the mean of scores in posttest compared to the pretest in the scales of the physical (p=0.001, anxiety (p=0.006, social dysfunction (0.017 and depression (p=0.001. Conclusion: Life skills training had an effect on reducing the impact of students' mental health scores. Training of these kinds of skills causes the progress among the freshmen.

  18. Dyslipidaemia and Medical Outcome (Health Related Quality of Life) in Patients with Schizophrenia Taking Antipsychotics in Enugu, Nigeria

    Science.gov (United States)

    Edet, John; Igwe, Monday Nwite; Chukwujekwu, Donald Chidozie; Aguocha, Miriam Chinyere

    2017-01-01

    Aim. Determine association between use (and type) of antipsychotics and dyslipidaemia in newly diagnosed schizophrenia patients attending Federal Neuropsychiatric Hospital, Enugu. Methods. From sixty antipsychotic naive patients with schizophrenia and sixty first-degree relatives matched for gender and age, fasting blood lipid profiles were measured at baseline and after twelve weeks. Medical Outcome Study Short Form General Health Survey was administered to patients on both occasions. Fasting lipid profile changes of both groups were compared. Results. Mean endpoint of total cholesterol (TC), low density lipoprotein (LD), and triglycerides (TG) in mmol/l for cases was significantly higher than initial values (TC 4.5 versus 4.3, t = 4.3, p < 0.0001), (LDL 2.8 versus 2.6, t = 14.3, p < 0.0001), and (TG 1.3 versus 1.0, t = 12.1, p < 0.0001). Mean endpoint of high density lipoprotein (HDL) in mmol/l for cases was significantly lower than initial values (1.1 versus 1.2, t = 12.1, p < 0.0001). Prevalence of dyslipidaemia for cases was 13%. Mean endpoint of TC, LDL, TG, and HDL in mmol/l for controls was not significantly different from initial values (TC 4.30 versus 4.27, t = 1.09, p = 0.279), (LDL 2.49 versus 2.46, t = 1.28, p = 0.205), (TG 0.96 versus 0.94, t = 1.27, p = 0.207), and (HDL 1.37 versus 1.38, t = 1.61, p = 0.113). Subjects on atypical antipsychotics had higher risk for dyslipidaemia. Conclusion. Use of antipsychotics was significantly associated with dyslipidaemia.

  19. Human Ecology and Health Advancement: The Newcastle Experience and Implications.

    Science.gov (United States)

    Graham, Jenny; Honari, Morteza

    1992-01-01

    Argues for the necessity of adopting a