Clinical trial participation. Viewpoints from racial/ethnic groups.

Science.gov (United States)

Roberson, N L

1994-11-01

Racial/ethnic groups' participation in clinical trials is a relatively new area of research that warrants attention. Although racial/ethnic groups have been included in experimental studies since the 1940s, they were not included in significant numbers in clinical trials for cancer. Clinical trials play a dominant role in clinical oncology. Despite this state-of-the-art cancer treatment, however, there is mounting concern that this scientific progress is not being shared equitably by all segments of the U.S. population. There is underrepresentation of members of racial/ethnic groups in cancer clinical trials, which suggests that participation may be a critical issue. Unfortunately, little is known or documented about these groups' participation in clinical trials. This paper discusses racial/ethnic groups' views and opinions about clinical trial participation. Diagnostic research was conducted as a beginning phase to investigate this new area of research. African Americans, Hispanics, and Native Americans in three Buffalo, New York, communities were selected as study subjects. Data were collected via telephone surveys. Qualitative methods were employed for data analysis and reporting. Findings showed that study subjects knew little about cancer clinical trials and basically had no opportunity to participate. They believed that participation in clinical trials could be beneficial. In each of the three groups, however, there were cultural factors believed to influence participation. A primary concern was "mistrust of white people" and the feeling of being treated like "guinea pigs." Based on study findings, it was evident that recruitment for improving participation requires strategic planning that involves participants representative of the study population. To yield results, the plan should be tailored to the target group, presented as a credible study, designed to reflect trust in the medical care team, and implemented through a continuous educational process.

COMPARACIÓN DE HABILIDADES SOCIALES Y AJUSTE PSICOLÓGICO EN NIÑOS MEXICANOS DE TRES CONDICIONES

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Claudia González Fragoso; Amada Ampudia Rueda; Yolanda Guevara Benítez

2014-01-01

Las habilidades sociales en la infancia guardan una estrech a relación con aspectos como autoestima, ansiedad y depresión. Tales variables son indicadoras del ajuste psicológico, que puede alterarse en los niños que son víctimas de violencia o que viven en institucion es. Para contar con datos sobre niños mexicanos, el presente estudio exploratorio evaluó y comparó los niveles mostrados en habilidades sociales, autoestima, ansiedad y depresión en tres grupos de niños que se hallaban en cond...

Análisis de los factores de ajuste por utilización de carril en intersecciones semaforizadas de Bogotá D. C.

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Ricardo José Peña Lindarte

2010-01-01

Full Text Available Este artículo está basado en el planteamiento metodológico desarrollado en el Manual de Capacidad de Carreteras de Estados Unidos (HCM - Highway Capacity Manual, de la Transportation Research Board (TRB, para el análisis de capacidad y niveles de servicio en intersecciones semaforizadas, asociado al factor de ajuste por utilización de carril (fLU, que corresponde a uno de los once factores de ajuste propuestos en la metodología de cálculo, en el módulo de intensidades de saturación. La estimación del factor fLU plantea la definición de una metodología teniendo en cuenta las condiciones operacionales de intersecciones se- maforizadas en Bogotá D. C. a partir del análisis de las corrientes vehiculares, que incluye caracterización vial y del tránsito, con base en muestreos estadísticos, toma y procesamiento de información de campo y análisis de datos. El estudio establece, entre otros aspectos, ecuaciones que permiten obtener datos referenciales para la determinación de factores de ajuste por utilización de carril en vías de Bogotá en función de las tipologías de los accesos y el volumen vehicular prevaleciente para el análisis de intersecciones semaforizadas; por ejemplo, para el caso específico de vías con accesos de dos carriles directos (2CCD la ecuación básica determinada fue y=-3,03E-08X2+3,44E-05X+0,888988, con coeficiente de correlación igual a 1,0, donde la variable dependiente y corresponde al factor fLU y la variable independiente X es el volumen en vehículos mixtos/hora, ecuación considerada estadísticamente significativa. Finalmente, se presenta el análisis comparativo de los factores de ajuste por utilización de carril estimados en el estudio, comparando los valores recomendados por el HCM, sustentándose así las conclusiones y recomendaciones, de las cuales se extracta la validación de los factores recomendados por el HCM, y se propone utilizar para los proyectos de diseño y planeamiento semaf

Influencia de los cementos y de los diseños protésicos en el ajuste interno de estructuras de zirconia confeccionadas mediante tecnología Cad-Cam para prótesis fija

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Sánchez Monescillo, Andrés

2015-01-01

1. INTRODUCCIÓN Y JUSTIFICACIÓN Aún quedan gran cantidad de elementos y variables que pueden influir en el ajuste interno de las restauraciones y cuyo desconocimiento obliga a seguir investigando. Este estudio permite conocer si existe una influencia real en el ajuste interno de estructuras de zirconia fabricadas mediante tecnología CAD-CAM en función del tipo de cemento utilizado y del tipo de convergencia oclusal de la preparación realizada. 2. OBJETIVOS - Evaluar la influencia de disti...

Efectos de entrenar para cumplir criterios de congruencia en tareas de ajuste lector

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Germán Morales-Chávez

2010-01-01

Full Text Available La presente investigación evaluó los efectos de entrenar estudiantes universitarios para satisfacer criterios de congruencia en tareas de ajuste lector con base en parámetros de congruencia y de coherencia. El grupo experimental fue entrenado para satisfacer criterios de congruencia y fue expuesto a dos pruebas de evaluación en satisfacción de criterios de congruencia y coherencia. El grupo control solo fue sometido a las pruebas de evaluación. Los resultados revelan que el entrenamiento favoreció la satisfacción de criterios tanto de congruencia como de coherencia. Se discute la relevancia del desempeño efectivo en una situación lectora con criterios de congruencia como condición para el desarrollo de conductas lectoras funcionalmente más complejas.

Algoritmos Evolutivos y su empleo en el ajuste de controladores del tipo PID: Estado Actual y Perspectivas

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Gilberto Reynoso-Meza

2013-07-01

Full Text Available Resumen: Los controladores PID continúan siendo una solución fiable, robusta, práctica y sencilla para el control de procesos. Actualmente constituyen la primera capa de control de la gran mayoría de las aplicaciones industriales. De ahí que un número importante de trabajos de investigación se han orientado a mejorar su rendimiento y prestaciones. Las líneas de investigación en este campo van desde nuevos métodos de ajuste, pasando por nuevos tipos de estructura hasta metodologías de diseño integrales. Particularizando en el ajuste de parámetros, una de las formas de obtener una solución novedosa consiste en plantear un problema de optimización, el cual puede llegar a ser no-lineal, no-convexo y con restricciones. Dado que los algoritmos evolutivos han mostrado un buen desempeño para solucionar problemas complejos de optimización, han sido utilizados en diversas propuestas relacionadas con el ajuste de controladores PID. Este trabajo muestra un revisión de estas propuestas y las prestaciones obtenidas en cada caso. Así mismo, se identifican algunas tendencias y posibles líneas de trabajo futuras. Abstract: PID controllers are a reliable, robust, practical and easy to implement control solution for industrial processes. They provide the first control layer for a vast majority of industrial applications. Owing to this, several researches invest time and resources to improve their performance. The research lines in this field scope with new tuning methods, new types of structures and integral design methods. For tuning methods, improvements could be fulfilled stating an optimization problem, which could be non-linear, non-convex and highly constrained. In such instances, evolutionary algorithms have shown a good performance and have been used in various proposals related with PID controllers tuning. This work shows a review of these proposals and the benefits obtained in each case. Some

Ajustement de la courbe de lactation de la chèvre locale dans les zones arides Tunisiennes

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Ilyes Mekki

2011-10-01

Full Text Available Les performances laitières de la chèvre locale dans les zones arides tunisiennes dépendent des capacités génétiques de l’effet des conditions du milieu et du mode de conduite des troupeaux. L’objectif de cette étude est d’analyser les performances laitières de la chèvre locale en fonction de ces facteurs à travers l’ajustement de la courbe de lactation. De telles connaissances sont indispensables pour planifier la gestion raisonnable de cette ressource animale rustique dans des conditions naturelles difficiles. Les données utilisées pour cette étude sont issues de 10 campagnes de contrôle laitier réalisé au niveau d’un troupeau caprin expérimental conduit dans les régions arides. Suite à l’élaboration des données, l’application des procédures de régression non linéaire a identifié le modèle de Wood comme le plus adaptée pour l’ajustement de la courbe de lactation de la chèvre locale. Ce modèle a été appliqué pour estimer les paramètres de la lactation individuelle et l’étude des facteurs de variation. Les résultats d’ajustements des données montrent que la lactation de la chèvre locale évolue après la mise bas selon une trajectoire assez aplatie. Les performances de la chèvre locale sont assez réduites et similaires à celles observées pour des populations élevées dans des zones difficiles tunisiennes de point de vue climatique et pastorale. La moyenne de production initiale observée est de 720 g/j, le pic de lactation est observé au 17ème jour lorsqu’une chèvre produit en moyenne 980g/j. La réduction des potentialités laitières de la chèvre locale illustre les effets du processus de sélection naturelle qui a favorisé l’adaptation aux conditions difficiles des régions arides. Les résultats contribuent à la caractérisation de la chèvre locale et à la planification de son amélioration comme étant une ressource génétique locale et rustique.

El ajuste o desajuste de las prácticas normativas en Ignacio Ellacuría: hacia una nueva dimensión de lo normativo /

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Senent, Juan Antonio

2011-08-01

Full Text Available Abstract: This work provides an analysis of adjustment or disadjustment of human rights from Ignacio Ellacuría thesis. We must first place this analysis in the critical context that animatesit, the horizon of historical praxis. From there, a rationale for its adjustment in relation to human praxis is proposed, as well as a critical study of the role such adjustment or maladjustment of regulatory schemes currently plays in the overall regulatory process within the social practices in the contemporary civilization stage.In turn, we conduct an analysis of the struggle to articulate other regulatory schemes that respond more tightly to the demands of justiceagainst others and nature.Resumo: Este trabajo realiza un análisis sobre el ajuste o desajuste de los derechos humanos a partir de la tesis de Ignacio Ellacuría. Se trata primero de ubicar este análisis en el contexto crítico que lo anima, el horizonte de la praxis histórica. Desde ahí se propone una fundamentación del ajuste en su relación con la praxis humana, así como el estudio crítico del papel que ese ajuste o desajuste de los esquemas normativos juega actualmente en el conjunto del procesonormativo en el seno de las prácticas sociales en la presente fase civilizatoria. A su vez, se aborda un análisis de la lucha por articular otros esquemas normativos que respondan más ajustadamentea las exigencias de la justicia frente a los otros y a la naturaleza.

Um Estudo sobre a Governança Corporativa e o Nível de Atendimento aos Critérios de Evidenciação do Ajuste a Valor Presente em Empresas de Construção e Transporte

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Juliana Gonçalves de Araújo

2015-08-01

Full Text Available Esta pesquisa tem como objetivo verificar a relação do nível de governança com o atendimento aos critérios de evidenciação dispostos no CPC 12, referente às práticas do Ajuste a Valor Presente, nas empresas do setor de Construção e Transporte listadas na BM&FBovespa entre os anos de 2008 a 2012. No entanto, foram excluídas algumas empresas, por estas não apresentarem indícios, em quaisquer dos anos, da realização do Ajuste a Valor Presente. Assim, a amostra deste estudo foi composta por 72 companhias, as quais evidenciaram, seja em Nota Explicativa ou em conta de Balanço Patrimonial, indício da prática de Ajuste a Valor Presente. Foi possível verificar que as divulgações realizadas estão aquém das propostas pelo CPC 12, e que as mudanças ocorridas no processo de ajuste são pouco divulgadas, constituindo um cenário que pouco se modifica. O único item que sofreu uma grande elevação de atendimento foi o da divulgação das práticas gerais de Ajuste a Valor Presente em Notas Explicativas, principalmente no ano de 2010, devido à compulsoriedade da aplicação das normas contábeis nas entidades de capital aberto. O item que menos foi atendido referiu-se à evidenciação dos modelos de cálculos para aplicação do Ajuste a Valor Presente. Apesar da descrição do item objeto do Ajuste a Valor Presente ter grande representatividade, as entidades ainda necessitam divulgar melhor as premissas, montante e horizonte temporal destes. Também foi possível observar, através do uso do teste Exato de Fisher, uma relação entre o nível de governança e o nível de atendimento, onde aquelas que pertencem ao Novo Mercado se apresentam mais propensas a evidenciar melhor suas informações, enquanto as que não estão enquadradas nos níveis de governança apresentam um nível de atendimento insatisfatório.

Ajuste econômico e desemprego recente no Brasil metropolitano

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MARCIO POCHMANN

2015-12-01

Full Text Available resumo O presente artigo trata da evolução da taxa de desemprego no início do ano 2015. Três partes compõem de forma consecutiva e encadeada a partir da premissa de que as mudanças no interior do mercado de trabalho sinalizadas principalmente pelo aumento dos desempregados são geradas fundamentalmente pelo avanço da recessão na economia brasileira. A primeira parte aponta as principais alterações no rendimento e emprego da mão de obra no mercado de trabalho do Brasil metropolitano durante os meses de janeiro a julho de 2015, enquanto a segunda parte descreve brevemente as características mais importantes que decorrem do aumento recente da taxa de desemprego. Por fim, a terceira parte registra comparativamente os reflexos da adoção das políticas de ajustes econômicos no desemprego em anos selecionados durante as últimas três décadas. Dessa forma, constata-se o grau de intensidade atual na evolução da taxa de desemprego com a de outros momentos vividos no país.

Complex contexts and relationships affect clinical decisions in group therapy.

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Tasca, Giorgio A; Mcquaid, Nancy; Balfour, Louise

2016-09-01

Clinical errors tend to be underreported even though examining them can provide important training and professional development opportunities. The group therapy context may be prone to clinician errors because of the added complexity within which therapists work and patients receive treatment. We discuss clinical errors that occurred within a group therapy in which a patient for whom group was not appropriate was admitted to the treatment and then was not removed by the clinicians. This was countertherapeutic for both patient and group. Two clinicians were involved: a clinical supervisor who initially assessed and admitted the patient to the group, and a group therapist. To complicate matters, the group therapy occurred within the context of a clinical research trial. The errors, possible solutions, and recommendations are discussed within Reason's Organizational Accident Model (Reason, 2000). In particular, we discuss clinician errors in the context of countertransference and clinician heuristics, group therapy as a local work condition that complicates clinical decision-making, and the impact of the research context as a latent organizational factor. We also present clinical vignettes from the pregroup preparation, group therapy, and supervision. Group therapists are more likely to avoid errors in clinical decisions if they engage in reflective practice about their internal experiences and about the impact of the context in which they work. Therapists must keep in mind the various levels of group functioning, especially related to the group-as-a-whole (i.e., group composition, cohesion, group climate, and safety) when making complex clinical decisions in order to optimize patient outcomes. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Elementos para el análisis de los programas de ajuste

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Villamizar Helena

1991-12-01

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La aplicación de las políticas generales, preconizadas por los programas de ajuste en América Latina, en la mayoría de los casos no dieron los resultados deseados. Su éxito necesariamente requería del cumplimiento de ciertos supuestos y condiciones que permitieran que las políticas de "gestión de demanda no generaran efectos negativos sobre el crecimiento en el largo plazo. Al no cumplirse algunos de 105 supuestos teóricos básicos, y al no contar los países con flujos de capitales adecuados y con un entorno externo abierto, la aplicación de estos programas se tradujo en grandes sacrificios en el crecimiento y muchas veces en la perpetuación de situaciones recesivas. Puesto que la región aun no ha encontrado una verdadera vía de solución, se hace imperioso abordar la construcción de una nueva perspectiva teórica, basada en supuestos realistas, que permita abordar los apremiantes problemas del desarrollo latinoamericano.

ABO blood groups and malaria related clinical outcome.

Science.gov (United States)

Deepa; Alwar, Vanamala A; Rameshkumar, Karuna; Ross, Cecil

2011-03-01

The study was undertaken to correlate the blood groups and clinical presentations in malaria patients and to understand the differential host susceptibility in malaria. From October 2007 to September 2008, malaria positive patients' samples were evaluated in this study. Hemoglobin, total leukocyte count, and platelet count of each patient were done on an automated cell counter. After determining the blood groups, malarial species and the severity of clinical course were correlated. A total of 100 patients were included in the study, of which 63 cases were positive for Plasmodium falciparum and 37 cases were positive for P. vivax infection and 11 patients had mixed infection. The results of the blood groups showed 22 - 'A' group, 42 - 'B' group, 35 - 'O' group and 1 was 'AB' group. When the clinical courses between different groups were compared using the following parameters for severe infection--a parasitic load of >10/1000 RBCs, severe anemia with hemoglobin 101°F and other organ involvement, it was observed that 'O' group had an advantage over other the groups. The difference in rosetting ability between red blood cells of different 'ABO' blood groups with a diminished rosetting potential in blood group 'O' red blood cells was due to the differential host susceptibility. 'O' group had an advantage over the other three blood groups. Based on literature and the results of this study, the diminished rosetting potential in blood group 'O' red blood cells is suggested as the basis for the differential host susceptibility.

ALTAS HABILIDADES/SUPERDOTAÇÃO: um olhar para o desenvolvimento cognitivo, ajuste emocional e seus impactos na vida profissional

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Alberto Padrón Abad

2016-12-01

El objetivo del presente artículo es analizar los factores de desarrollo cognitivo, ajuste emocional del individuo AH/SD y sus impactos en la vida profesional y laboral. La metodología empleada está basada en una investigación bibliográfica, exploratoria y descriptiva realizada a partir de referencias teóricas, referentes al tema, previamente analizadas y publicadas. En este sentido, se iniciará considerando los factores que facilitan el ajuste emocional de individuos AH/SD (familiares, escolares, laborales e interpersonales. Posteriormente, se analizará la pregunta: ¿por qué existen personas que a pesar de vivir en situaciones sociales y económicas desfavorables pueden desarrollar sus AH/SD y ser profesionales de éxito, mientras otros, con todas las oportunidades en la vida no llegan al éxito profesional ni contribuyen efectivamente con la sociedad? Con la intención de responder esa pregunta se estudiarán: el concepto de resiliencia, la Teoría de la Evaluación Cognitiva de Lazarus y la Teoría de la Desintegración Positiva de Dabrowski. De esta manera, se concluye la importancia de aplicar de manera efectiva los modelos teóricos ya propuestos, de modo comprensivo y explicativo, de las AH/SD acerca de los aspectos del desarrollo cognitivo y emocional de los individuos.

Comparación entre varias poblaciones estándar para el ajuste por edades

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Javier Llorca Díaz

2000-01-01

Full Text Available FUNDAMENTO: Analizar el efecto que tiene la elección de una población de referencia sobre diferentes indicadores derivados de las tasas de mortalidad ajustadas por edad. MÉTODOS: Las tasas de mortalidad por diferentes causas de muerte en España de 1971 a 1992 son ajustadas empleando cuatro poblaciones de referencia: poblaciones españolas de 1971 y 1992, población estándar europea y población estándar mundial. Los resultados obtenidos con las cuatro poblaciones se comparan empleando tres indicadores: diferencia entre las tasas de 1992 y 1971, razón entre las tasas de 1992 y 1971y cambio anual porcentual entre 1971 y 1992. RESULTADOS: En la mayor parte de las causas de muerte estudiadas incluyendo el total de causas, la cardiopatía isquémica y casi todos los tumores, la razón de tasas y el porcentaje de cambio anual son similares con independencia de cuál sea la población estándar empleada. En cambio, la diferencia de tasas es muy diferente en función de la población de referencia. En las enfermedades infecciosas y el cáncer de testículo se produce la situación contraria: la diferencia de tasas es robusta mientras que la razón de tasas varía con la población estándar. Finalmente, la mortalidad por neumonía, enfermedad de Parkinson y cáncer de encéfalo muestra cambios en los tres indicadores utilizados. CONCLUSIONES: Es necesario realizar un análisis de las tasas específicas por edad antes de proceder a su ajuste. Este análisis permite averiguar si el ajuste por edades es correcto y qué indicador (diferencia, razón o cambio porcentual será adecuado para realizar comparaciones.

What to Expect During a Colonoscopy

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Os benefícios da hipoterapia nos ajustes posturais em crianças portadoras de paralisia cerebral

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Daniela Carrogi Vianna; Maria Elisabete Salina Saldanha; Leide Masieiro Taques Moeckel Amaral

2017-01-01

Paralisia Cerebral é uma afecção encefálica que ocorre na fase maturacional, apresentando seqüelas variáveis, envolvendo desordens de postura e movimentos. Examinaram-se alterações posturais de pacientes portadores de Paralisia Cerebral durante e após a realização de Hipoterapia, observando ajustes posturais. Participaram oito crianças, entre 6 e 12 anos, com tetraparesia espástica, apresentando déficics das reações básicas de endireitamento, proteção e equilíbrio. Utilizou-se a Hipoterapia c...

Ajuste psicosocial y vivencia de la adopción en niños/as adoptados/as internacionalmente

OpenAIRE

Reinoso Bernuz, Marta

2013-01-01

[esp] La adopción internacional ha adquirido en España unas muy notables dimensiones y el desarrollo y la adaptación de estos niños se ha convertido en un asunto de gran importancia. La presente tesis doctoral pretende contribuir al conocimiento en esta área y tiene por objetivo analizar el nivel de ajuste psicosocial, la vivencia de la adopción y el afrontamiento del estrés en la mediana infancia (8-12 años) de los niños adoptados internacionalmente en nuestro país. Esta tesis se con...

What to Expect During a Colonoscopy

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Evaluation of Macular Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer in Primary Craniopharyngioma by Fourier-Domain Optical Coherence Tomography.

Science.gov (United States)

Yang, Liu; Qu, Yuanzhen; Lu, Wen; Liu, Fengjun

2016-07-03

BACKGROUND The aim of this study was to compare the differences in macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) in child and adult patients with primary craniopharyngioma by Fourier-domain optical coherence tomography (FD-OCT) and to evaluate their significance in the diagnosis of primary craniopharyngioma. MATERIAL AND METHODS Ninety-six participants were divided into 3 groups: 32 in the child craniopharyngioma group (CCG) and 32 in the adult craniopharyngioma group (ACG) who were treated in Beijing Tiantan Hospital between November 2013 and October 2014, and 32 in the normal group (NG). All subjects were scanned by FD-OCT to map GCC and pRNFL thicknesses. Spearman correlation coefficient was used to assess the correlation between GCC and pRNFL thickness, and pRNFL thickness and optic nerve head (ONH) parameters, including horizontal cup-disc ratio (HCDR), vertical cup-disc ratio (VCDR), optic disc area (ODA), and cup area (CA), respectively. RESULTS The correlation between GCC and pRNFL thickness in the CCG was slightly stronger compared with the ACG. A significant difference in GCC thickness was observed among the CCG, ACG, and NG. Although the pRNFL thickness in both the CCG and ACG was significantly higher than that in NG, no significant difference in pRNFL thickness was detected between the 2 craniopharyngioma groups. The average, superior, and inferior pRNFL thicknesses were negatively correlated with VCDR in the CCG (in double eyes) and ACG (only in left eyes). CONCLUSIONS GCC was more sensitive than pRNFL in detecting optic nerve damage in the eyes of craniopharyngioma patients. A thinner pRNFL was especially correlated with VCDR in child craniopharyngioma patients.

Ajuste fiscal nos estados: uma análise do período 1998-2006 Fiscal adjustment in brazilian states

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Sérgio Wulff Gobetti

2010-01-01

Full Text Available O objetivo deste artigo é analisar a forma de enquadramento dos estados ao Programa de Ajuste Fiscal (PAF e à Lei de Responsabilidade Fiscal (LRF, destacando seus impactos nas escolhas de alocação dos recursos públicos e na taxa de investimento. Os resultados obtidos após minucioso trabalho de depuração das bases de dados confirmam a melhoria da situação financeira de estados no período posterior à LRF, mas sugerem que existe um trade-off entre os indicadores fiscais, de um lado, e os investimentos e gastos em infraestrutura, de outro, exigindo uma reflexão sobre a qualidade e sustentabilidade do ajuste fiscal. Os dados orçamentários analisados também apontam evidências de contabilidade criativa.The objective of this article is to offer an analysis of the accommodation by Brazilian states with Fiscal Adjustment Program and with Fiscal Responsibility Act (FRA, showing their impacts on the choices of public resources allocation and on the investment rate. The results obtained after detailed work of data depuration confirm the improvement of financial situation of the states in the period post FRA, but also suggest the existence of a trade-off between fiscal indicators and infrastructure investment, demanding a reflection about the quality and the sustainability of the fiscal adjustment. The budget data analyzed also indicate evidences of creative accountability.

Afectividad inducida e impacto en la creatividad, crecimiento personal después del cambio y ajuste percibido al narrar una experiencia emocional intensa

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Silvia da Costa

2015-05-01

Full Text Available Se examinan en un estudio experimental los efectos de la inducción de afectividad positiva en la creatividad y la importancia de las emociones como variables mediadoras. Se indujo alta y baja afectividad positiva pidiendo a las personas participantes que redactaran tres poemas haikus sobre dos estímulos de connotación positiva, alta (N = 28 y baja (N = 28. Las personas escribieron sobre su experiencia de enamoramiento más intenso y contestaron una escala sobre las emociones sentidas al redactar el texto, una medida de crecimiento personal y una tercera referida a la obtención de metas adaptativas después del episodio. En la condición de alta afectividad positiva se informó de más emociones positivas y menos negativas al narrar la experiencia, un mayor crecimiento personal y un mayor ajuste. Jueces independientes evaluaron como más originales el último poema y la narración de la experiencia en la condición de alta afectividad positiva. Un análisis mediacional mostró que las emociones positivas explicaban la influencia de la manipulación sobre el crecimiento personal y el ajuste percibido.

Clinical and no-clinical setting specificities in first session short-term psychotherapy psychodrama group.

Science.gov (United States)

Drakulić, Aleksandra Mindoljević

2011-03-01

Modern history of short-term group psychotherapy dates back to the late 1950-ies. From then to present day, this psychotherapeutic method has been used in various forms, from dynamic-oriented to cognitive behavioural psychotherapies. Although it has always been considered rather controversial, due its cost-effectiveness, it has been capturing more and more popularity. This paper presents the specificities of first session short-term psychotherapy psychodrama group through session work with two examined groups: a group of 20 adult women who suffer from mild or moderate forms of unipolar depression and a group of 20 students of the School of Medicine in Zagreb without any psychiatric symptomatology. The results indicate the high importance of having structure in first psychodrama session, of relating it with the previously thoroughly conducted, initial, clinical, interviews, and of the clarity and focus in terms of determining the goals of therapy, especially in a clinical context. This study also confirmed assumptions regarding the need for different approaches of warming-up in psychodrama, both in the clinical and in non-clinical samples. A psychodrama psychotherapist should have good time managing skills and capability to convert the time available into an opportunity for directly boosting the group energy and work on therapeutic alliance.

El papel de la categorización social y las diferencias sociodemográficas en la autoestima, el ajuste y el bienestar psicológicos de una muestra de inmigrantes

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José Andrés Peña-Pinzón

2014-05-01

Full Text Available Se explora el efecto de la saliencia de la categorización social inmigrante y su interacción con diferencias sociodemográficas (nivel de estudios, situación laboral, sexo de los sujetos, en ajuste psicológico, bienestar psicológico y autoestima. 210 inmigrantes de origen sudamericano, residentes en las provincias de Granada y Almería, fueron distribuidos en dos condiciones experimentales: "saliencia baja/alta de la categorización social inmigrante". Encontramos efecto de la manipulación sobre las medidas de pertenencia e identidad (autoestima colectiva, autoestima individual, ansiedad (SA-45 y bienestar laboral. Cuando la saliencia de la categorización social es baja (vs. alta, los sujetos presentan mejor autoestima, menos ansiedad y menos bienestar laboral. El sexo se asocia con la manipulación experimental en las escalas privada y pública (autoestima colectiva y en somatización, depresión y ansiedad (SA45. Los hombres para los que es menos saliente su condición de inmigrante presentan resultados más óptimos. El nivel de estudios y la situación laboral se asocian con ajuste psicológico: los sujetos sin trabajo (vs. los que están trabajando y los de estudios básicos o sin estudios (vs. los de estudios medios o superiores presentan peor ajuste.

Influence of lyophilization factors and gelatin concentration on pore structures of atelocollagen/gelatin sponge biomaterial.

Science.gov (United States)

Yang, Longqiang; Tanabe, Koji; Miura, Tadashi; Yoshinari, Masao; Takemoto, Shinji; Shintani, Seikou; Kasahara, Masataka

2017-07-26

This study aimed to investigate influences of lyophilization factors and gelatin concentration on pore structures of ACG sponge. ACG sponges of different freezing temperatures (-30, -80 and -196 o C), freezing times (1, 2 and 24 h), gelatin concentrations (0.6%AC+0.15%G, 0.6%AC+0.6%G and 0.6%AC+2.4%G), and with 500 μM fluvastatin were fabricated. Pore structures including porosity and pore size were analyzed by scanning electron microscopy and ImageJ. The cytotoxic effects of ACG sponges were evaluated in vitro. Freezing temperature did not affect porosity while high freezing temperature (-30 o C) increased pore size. The high gelatin concentration group (0.6%AC+2.4%G) had decreased porosity and pore size. Freezing time and 500 μM fluvastatin did not affect pore structures. The cytotoxicity and cell proliferation assays revealed that ACG sponges had no cytotoxic effects on human mesenchymal stromal cell growth and proliferation. These results indicate that ACG sponge may be a good biomaterial scaffold for bone regeneration.

Cirurgia de estrabismo ajustável no peroperatório com anestesia tópica em pacientes com orbitopatia de Graves Intraoperative adjustable strabismus surgery under drop anesthesia in patients with Graves' orbitopathy

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Patrícia Grativol Costa

2008-06-01

Full Text Available OBJETIVO: Descrever as características clínicas pré-operatórias dos pacientes com estrabismo secundário à orbitopatia de Graves e os resultados da cirurgia com anestesia tópica e sutura ajustável. MÉTODOS: Estudo retrospectivo realizado no Hospital das Clínicas da Universidade de São Paulo. Foram pesquisados os prontuários de todos os pacientes atendidos no ambulatório de estrabismo no período de março de 1994 a maio de 2004. Destes, foram separados aqueles com estrabismo associado à orbitopatia de Graves submetidos à cirurgia ajustável com anestesia tópica. As características clínicas pré-operatórias e os resultados cirúrgicos foram levantados a partir desta análise. RESULTADOS: Foram incluídos 13 pacientes. O tipo de desvio mais freqüentemente encontrado foi esotropia com hipotropia. Em 9 pacientes modificou-se o retrocesso programado no pré-operatório. Três casos necessitaram de uma segunda cirurgia. Após 6 meses de seguimento, 8 dos 13 pacientes estavam ortotrópicos ou com foria pequena e com algum grau de estereopsia. CONCLUSÃO: Neste estudo observou-se que 62% (8/13 dos pacientes apresentavam hipotropia com esotropia, provavelmente por causa do comprometimento associado do reto inferior e reto medial. Nove dos 13 pacientes necessitaram de ajuste no peroperatório e apenas 3 foram reoperados, indicando a importância da técnica ajustável para melhor alinhamento ocular no pós-operatório, possibilitando obter resultados mais satisfatórios.PURPOSE: To report the clinical features of strabismus associated with Graves' orbitopathy, and the results of surgery with adjustable suture under drop anesthesia. METHODS: The charts of 13 patients who had surgical treatment for strabismus related to Graves' orbitopathy at Hospital das Clínicas of University of São Paulo were retrospectively reviewed. Ocular motility, sensorial examination and the follow-up after strabismus correction were studied. RESULTS

Capacidade máxima de adsorção de fósforo e constante de energia em Latossolo Bruno em razão de diferentes ajustes do modelo Langmuir

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Clovisson Menotti Boeira de Oliveira

2014-12-01

Full Text Available A capacidade máxima de adsorção de fósforo (CMAP é um parâmetro bastante útil para caracterizar a capacidade de adsorção de fósforo (P do solo e, por isso, o modelo de Langmuir, que possibilita essa estimativa, é bastante difundido. Porém, se o ajuste da equação for realizado por modelos não lineares ou linearizados, ou se forem escolhidos modelos de região única ou múltiplas, nem sempre os valores estimados da CMAP e da constante de energia de ligação (k são semelhantes. O objetivo deste trabalho foi avaliar o efeito do uso de diferentes métodos de ajuste do modelo de Langmuir sobre os valores estimados de CMAP e k. Para isso, utilizouse um único solo de alta capacidade de adsorção de P, o qual foi misturado a quantidades crescentes de areia lavada, construindo-se sistemas com capacidades de sorção crescentes, mas com a fase sólida constituída da mesma mineralogia. Foi utilizado solo do horizonte B de um Latossolo Bruno com 800 g kg-1 de argila, o qual foi misturado com areia em quantidades para obterem-se solos artificiais com 0, 200, 400, 600 e 800 g kg-1 de argila. Esses solos artificiais foram incubados por 30 dias com calcário para elevar o pH(H2O até 6,0 e, após, foram secos em estufa e peneirados. Foram realizadas as isotermas de adsorção e os dados ajustados pelo modelo de Langmuir, usando os seguintes métodos: NLin - não linear com região única; L-1R - linearização com região única; L-2RG - linearização com duas regiões, ajuste gráfico; L-3RG - linearização com três regiões, ajuste gráfico; L-2RE linerização com duas regiões, ajuste estatístico. Os resultados evidenciaram que todos os métodos utilizados estimaram valores de CMAP proporcionais ao teor de argila dos solos e poderiam ser usados para caracterizar os solos. Contudo, quando utilizados ajustes com mais de uma região de adsorção, os valores da CMAP para a última região foram sensivelmente superiores �

Acontecimientos vitales estresantes, estilo de afrontamiento y ajuste adolescente: un análisis longitudinal de los efectos de moderación

OpenAIRE

Rosa María Estévez Campos; Alfredo Oliva Delgado; Águeda Parra Jiménez

2012-01-01

El objetivo principal de este estudio fue analizar la relación entre la vivencia de los acontecimientos vitales estresantes y los problemas de ajuste emocional y comportamental durante la adolescencia, prestando atención al posible efecto moderador del estilo de afrontamiento. La muestra estuvo compuesta por 90 adolescentes que fueron seguidos durante seis años, desde su adolescencia media (15-16 años) hasta la adultez emergente (21-22 años). Completaron cuestionarios sobre su vivencia de aco...

Test-retest reliability of the assessment of postural stability in typically developing children and in hearing impaired children.

Science.gov (United States)

De Kegel, A; Dhooge, I; Cambier, D; Baetens, T; Palmans, T; Van Waelvelde, H

2011-04-01

The purpose of this study was to establish test-retest reliability of centre of pressure (COP) measurements obtained by an AccuGait portable forceplate (ACG), mean COG sway velocity measured by a Basic Balance Master (BBM) and clinical balance tests in children with and without balance difficulties. 49 typically developing children and 23 hearing impaired children, with a higher risk for stability problems, between 6 and 12 years of age participated. Each child performed the modified Clinical Test of Sensory Interaction on Balance (mCTSIB), Unilateral Stance (US) and Tandem Stance on ACG, mCTSIB and US on BBM and clinical balance tests: one-leg standing, balance beam walking and one-leg hopping. All subjects completed 2 test sessions on 2 different days in the same week assessed by the same examiner. Among COP measurements obtained by the ACG, mean sway velocity was the most reliable parameter with all ICCs higher than 0.72. The standard deviation (SD) of sway velocity, sway area, SD of anterior-posterior and SD of medio-lateral COP data showed moderate to excellent reliability with ICCs between 0.55 and 0.96 but some caution must be taken into account in some conditions. BBM is less reliable but clinical balance tests are as reliable as ACG. Hearing impaired children exhibited better relative reliability (ICC) and comparable absolute reliability (SEM) for most balance parameters compared to typically developing children. Reliable information regarding postural stability of typically developing children and hearing impaired children may be obtained utilizing COP measurements generated by an AccuGait system and clinical balance tests. Copyright © 2011 Elsevier B.V. All rights reserved.

What to Expect During a Colonoscopy

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Adolescent postabortion groups: risk reduction in a school-based health clinic.

Science.gov (United States)

Daly, Joan Ziegler; Ziegler, Robert; Goldstein, Donna J

2004-10-01

A short-term postabortion group for adolescents was developed. Three groups were conducted in an adolescent mental health clinic within an urban high school-based health clinic. The clinical group experiences offered the adolescents an opportunity to integrate the experience of pregnancy and the abortion decision into their lives. At follow up, adolescents who participated in th postabortion counseling group indicated that they chose and used a method of birth control, did not repeat an unplanned pregnancy, and remained in high school.

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

Science.gov (United States)

Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

2015-09-01

Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

What to Expect During a Colonoscopy

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What to Expect During a Colonoscopy

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Les particules illocutoires, variable d’ajustement de la traduction sous-titrante au cinéma

Directory of Open Access Journals (Sweden)

Ève Vayssière

2010-12-01

Full Text Available Die illokutiven Partikel fungieren als Anpassungsvariable, die beim Übersetzungsakt zur Untertitelung von Filmen entweder weggelassen werden oder erscheinen. Wenn sie einfach gelöscht werden, ergeben sich weder grammatikalische Störungen noch Informationsverlust. Das Auftauchen dieser Partikel in den deutschen Untertiteln zeigt jedoch, wie wichtig sie sind: Als Partikel der Oralität tragen sie zur Idiomatizität bei.Les particules illocutoires sont des variables d’ajustement lors de l’acte de traduction sous-titrante au cinéma, elles peuvent être supprimées sans que cela occasionne de dysfonctionnement grammatical et elles disparaissent lors de la traduction en français sans que cela occasionne une perte d’informations. Leur apparition dans les sous-titres allemands montre néanmoins leur importance : particules de l’oralité, elles sont vecteur d’« idiomaticité ».

Core schemas across the continuum of psychosis: a comparison of clinical and non-clinical groups.

Science.gov (United States)

Taylor, Hannah E; Stewart, Suzanne L K; Dunn, Graham; Parker, Sophie; Fowler, David; Morrison, Anthony P

2014-11-01

Research suggests that core schemas are important in both the development and maintenance of psychosis. The aim of the study was to investigate and compare core schemas in four groups along the continuum of psychosis and examine the relationships between schemas and positive psychotic symptomatology. A measure of core schemas was distributed to 20 individuals experiencing first-episode psychosis (FEP), 113 individuals with "at risk mental states" (ARMS), 28 participants forming a help-seeking clinical group (HSC), and 30 non-help-seeking individuals who endorse some psychotic-like experiences (NH). The clinical groups scored significantly higher than the NH group for negative beliefs about self and about others. No significant effects of group on positive beliefs about others were found. For positive beliefs about the self, the NH group scored significantly higher than the clinical groups. Furthermore, negative beliefs about self and others were related to positive psychotic symptomatology and to distress related to those experiences. Negative evaluations of the self and others appear to be characteristic of the appraisals of people seeking help for psychosis and psychosis-like experiences. The results support the literature that suggests that self-esteem should be a target for intervention. Future research would benefit from including comparison groups of people experiencing chronic psychosis and people who do not have any psychotic-like experiences.

Ajuste social em pacientes com transtorno afetivo bipolar, unipolar, distimia e depressão dupla Social disability in patients with bipolar and unipolar affective disorders, dysthymia and double depression

Directory of Open Access Journals (Sweden)

Adriana M Tucci

2001-06-01

family disability in affective disorder patients (bipolar and unipolar disorders, dysthymia, and double depression; and then compare the results among diagnostic groups to identify variables associated with an increased level of disability. METHODS: Socioeconomic and demographic data as well as evolution, outcome and disease history data were collected using a specific questionnaire. To assess social disability, the Disability Assessment Scale (DAS-WHO, 1988 was used. Family relationship distress was assessed through the Global Assessment of Relational Functioning Scale (GARF-APA, 1994. A hundred patients who were under treatment for at least 6 months at the university outpatient clinic were studied. RESULTS/CONCLUSIONS: Most of the patients were females, 50 years old or more, had at least 2 years of follow-up, and low educational and socioeconomic level. There was no statistical significant differences among demographic and socioeconomic levels and different diagnostic categories. Logistic regression analysis showed an important impact in social functioning due to the diagnosis and family relationship. Unipolar and dysthymic patients had better outcome in social and family functioning than bipolar and double depression ones.

Marine biodiversity baseline for Área de Conservación Guanacaste, Costa Rica: published records

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Jorge Cortés

2017-02-01

Full Text Available The diversity of tropical marine organisms has not been studied as intensively as the terrestrial biota worldwide. Additionally, marine biodiversity research in the tropics lags behind other regions. The 43,000 ha Sector Marino of Área de Conservación Guanacaste (ACG, Marine Sector of Guanacaste Conservation Area, on the North Pacific coast of Costa Rica is no exception. For more than four decades, the terrestrial flora and fauna has been studied continuously. The ACG marine biodiversity was studied in the 1930’s by expeditions that passed through the area, but not much until the 1990’s, except for the marine turtles. In the mid 1990’s the Center for Research in Marine Science and Limnology (CIMAR of the Universidad de Costa Rica (UCR initiated the exploration of the marine environments and organisms of ACG. In 2015, ACG, in collaboration with CIMAR, started the BioMar project whose goal is to inventory the species of the marine sector of ACG (BioMar ACG project. As a baseline, here I have compiled the published records of marine ACG species, and found that 594 marine species have been reported, representing 15.5% of the known species of the Pacific coast of Costa Rica. The most diverse groups were the crustaceans, mollusks and cnidarians comprising 71.7% of the ACG species. Some taxa, such as mangroves and fish parasites are well represented in ACG when compared to the rest of the Costa Rican coast but others appear to be greatly underrepresented, for example, red algae, polychaetes, copepods, equinoderms, and marine fishes and birds, which could be due to sampling bias. Thirty species have been originally described with specimens from ACG, and 89 species are not known from other localities on the Pacific coast of Costa Rica except ACG. Most of the sampling has been concentrated in a few localities in Sector Marino, Playa Blanca and Islas Murciélago, and in the nearby waters of Bahía Santa Elena. In an effort to fill this gap, CIMAR

What to Expect During a Colonoscopy

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Radiation Therapy Oncology Group clinical trials with misonidazole

International Nuclear Information System (INIS)

Wasserman, T.H.; Stetz, J.; Phillips, T.L.

1981-01-01

This paper presents a review of the progressive clinical trials of the hypoxic cell radiosensitizer, misonidazole, in the Radiation Therapy Oncology Group (RTOG). Presentation is made of all the schemas of the recently completed and currently active RTOG Phase II and Phase III studies. Detailed information is provided on the clinical toxicity of the Phase II trials, specifically regarding neurotoxicity. With limitations in drug total dose, a variety of dose schedules have proven to be tolerable, with a moderate incidence of nausea and vomiting and mild peripheral neuropathy or central neuropathy. No other organ toxicity has been seen, specifically no liver, renal or bone marrow toxicities. An additional Phase III malignant glioma trial in the Brain Tumor Study Group is described

What to Expect During a Colonoscopy

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Building clinical data groups for electronic medical record in China.

Science.gov (United States)

Tu, Haibo; Yu, Yingtao; Yang, Peng; Tang, Xuejun; Hu, Jianping; Rao, Keqin; Pan, Feng; Xu, Yongyong; Liu, Danhong

2012-04-01

This article aims at building clinical data groups for Electronic Medical Records (EMR) in China. These data groups can be reused as basic information units in building the medical sheets of Electronic Medical Record Systems (EMRS) and serve as part of its implementation guideline. The results were based on medical sheets, the forms that are used in hospitals, which were collected from hospitals. To categorize the information in these sheets into data groups, we adopted the Health Level 7 Clinical Document Architecture Release 2 Model (HL7 CDA R2 Model). The regulations and legal documents concerning health informatics and related standards in China were implemented. A set of 75 data groups with 452 data elements was created. These data elements were atomic items that comprised the data groups. Medical sheet items contained clinical records information and could be described by standard data elements that exist in current health document protocols. These data groups match different units of the CDA model. Twelve data groups with 87 standardized data elements described EMR headers, and 63 data groups with 405 standardized data elements constituted the body. The later 63 data groups in fact formed the sections of the model. The data groups had two levels. Those at the first level contained both the second level data groups and the standardized data elements. The data groups were basically reusable information units that served as guidelines for building EMRS and that were used to rebuild a medical sheet and serve as templates for the clinical records. As a pilot study of health information standards in China, the development of EMR data groups combined international standards with Chinese national regulations and standards, and this was the most critical part of the research. The original medical sheets from hospitals contain first hand medical information, and some of their items reveal the data types characteristic of the Chinese socialist national health system

Imaging Frontostriatal Function in Ultra-High-Risk, Early, and Chronic Schizophrenia During Executive Processing

Science.gov (United States)

Morey, Rajendra A.; Inan, Seniha; Mitchell, Teresa V.; Perkins, Diana O.; Lieberman, Jeffrey A.; Belger, Aysenil

2009-01-01

Context Individuals experiencing prodromal symptoms of schizophrenia (ultra-high-risk group) demonstrate impaired performance on tasks of executive function, attention, and working memory. The neurobiological underpinnings of such executive deficits in ultra-high-risk individuals remains unclear. Objective We assessed frontal and striatal functions during a visual oddball continuous performance task, in ultra-high-risk, early, and chronic schizophrenic patients with the use of functional magnetic resonance imaging. Design Cross-sectional case-control design. Setting Community; outpatient clinic. Patients Fifty-two individuals (control, n = 16; ultra-high risk, n = 10; early, n = 15; chronic, n = 11) from a referred clinical sample and age- and sex-matched control volunteers underwent scanning. Main Outcome Measures Percentage of active voxels and percentage signal change calculated for the anterior cingulate gyrus (ACG), middle frontal gyrus (MFG), inferior frontal gyrus (IFG), basal ganglia, and thalamus. Performance on the visual oddball task was measured with percentage of hits and d′ (a measure based on the hit rate and the false-alarm rate). Results The ultra-high-risk group showed significantly smaller differential activation between task-relevant and task-irrelevant stimuli in the frontal regions (ACG, IFG, MFG) than the control group. Frontostriatal activation associated with target stimuli in the early and chronic groups was significantly lower than the control group, while the ultra-high-risk group showed a trend toward the early group. Conclusions Our findings suggest that prefrontal function begins to decline before the onset of syndromally defined illness and hence may represent a vulnerability marker in assessing the risk of developing psychotic disorders among ultra-high-risk individuals. PMID:15753238

Clinical course teaching in transport of critically ill patients: Small group methods

Directory of Open Access Journals (Sweden)

Mohammad Taghi Beigmohammadi

2016-10-01

Full Text Available Critically ill patient transfer is potentially risky and may be lead to morbidity and mortality. Physicians' skill is very important for safe transport. We want to evaluate the effect of clinical course teaching on the promotion of physicians' abilities in the transport of critically ill patients. In an interventional study, 320 interns, male and female, were taught about patient transfer in two groups include in one day clinical course as the small group system (n=160 and other group the lecture base learning (n=160. In the clinical course, each participant under observation of an anesthesiologist in the operation room and ICU was acquainted with mask ventilation, intubation and learned to work with a defibrillator, infusion pump, portable ventilator and pulse oximeter. In lecture group, the anesthesiologist explained the topics by video and dummy. At the end of education course, the interns’ abilities were evaluated based on checklist method and scored by the project colleague in all educational items. Three hundred twenty interns, 122 males, and 198 females; were enrolled, two groups. The clinical course training caused improvements in the interns’ knowledge and abilities in intubation and use of the defibrillator and portable ventilator vs.lecture group significantly (P<0.005. The males were better than females in laryngoscopy, but the progress of the females was significantly better than males (P=0.003. The rate of adverse events was reduced significantly after clinical course teaching (P=0.041 Clinical course teaching could promote interns' clinical competencies in the transport of critically ill patients.

Population Analysis of Adverse Events in Different Age Groups Using Big Clinical Trials Data.

Science.gov (United States)

Luo, Jake; Eldredge, Christina; Cho, Chi C; Cisler, Ron A

2016-10-17

Understanding adverse event patterns in clinical studies across populations is important for patient safety and protection in clinical trials as well as for developing appropriate drug therapies, procedures, and treatment plans. The objective of our study was to conduct a data-driven population-based analysis to estimate the incidence, diversity, and association patterns of adverse events by age of the clinical trials patients and participants. Two aspects of adverse event patterns were measured: (1) the adverse event incidence rate in each of the patient age groups and (2) the diversity of adverse events defined as distinct types of adverse events categorized by organ system. Statistical analysis was done on the summarized clinical trial data. The incident rate and diversity level in each of the age groups were compared with the lowest group (reference group) using t tests. Cohort data was obtained from ClinicalTrials.gov, and 186,339 clinical studies were analyzed; data were extracted from the 17,853 clinical trials that reported clinical outcomes. The total number of clinical trial participants was 6,808,619, and total number of participants affected by adverse events in these trials was 1,840,432. The trial participants were divided into eight different age groups to support cross-age group comparison. In general, children and older patients are more susceptible to adverse events in clinical trial studies. Using the lowest incidence age group as the reference group (20-29 years), the incidence rate of the 0-9 years-old group was 31.41%, approximately 1.51 times higher (P=.04) than the young adult group (20-29 years) at 20.76%. The second-highest group is the 50-59 years-old group with an incidence rate of 30.09%, significantly higher (Pgroup. The adverse event diversity also increased with increase in patient age. Clinical studies that recruited older patients (older than 40 years) were more likely to observe a diverse range of adverse events (Page group (older

Creencias y ajuste psicológico de la persona que acompaña al drogodependiente y creencias de éste durante el tratamiento

OpenAIRE

José Miguel Martínez González; Humberto Manuel Trujillo Mendoza

2005-01-01

El objetivo de esta investigación fue estudiar si las creencias relacionadas con la vivencia del acompañamiento de un familiar en el tratamiento de un drogodependiente, y las del mismo paciente, varían en función de aspectos como el tiempo de abstinencia, el tiempo dedicado al tratamiento, la presencia de patología dual en el drogodependiente, la gravedad de ajuste psicológico del acompañante, los años de evolución de la drogodependencia y el tiempo transcurrido desde que se co...

Ajuste oclusal na Ortodontia: por que, quando e como? Occlusal adjustment in Orthodontics: why, when and how?

Directory of Open Access Journals (Sweden)

Roberto Carlos Bodart Brandão

2008-06-01

Full Text Available INTRODUÇÃO: o conhecimento sobre oclusão dentária deve ser considerado condição fundamental para a prática de uma Ortodontia de qualidade. O diagnóstico feito sem a manipulação do paciente em Relação Cêntrica pode levar à surpresa desagradável de se planejar o tratamento de uma má oclusão e se deparar com outra, depois dos primeiros arcos de nivelamento. Ao usar arcos retangulares, é importante a checagem dos contatos oclusais para se definir o tipo de movimento dentário necessário para o alcance do equilíbrio oclusal e, principalmente, verificar se este movimento é exeqüível. Durante o tratamento ortodôntico, devido à complexidade das superfícies oclusais, o ajuste oclusal por desgaste deve ser realizado para viabilizar movimentos dentários verticais, reduzindo o tempo de tratamento. Interferências oclusais são responsáveis tanto por efeitos adversos na biomecânica, quanto por aplicação de forças excessivas, que podem causar reabsorções radiculares. Após a Ortodontia, o ajuste oclusal é um dos determinantes da estabilização dentária, devendo-se obter, para cada dente posterior, contatos oclusais "A" e "B", ou "B" e "C" no sentido vestibulolingual, além dos contatos de "parada" e "equilíbrio" no sentido mesiodistal. Os dentes anteriores passam a funcionar em movimentos mandibulares, desocluindo de imediato os dentes posteriores, o que é denominado de guia anterior, visando equilíbrio muscular e proteção do sistema estomatognático. O desgaste seletivo não deve ser utilizado como substituto da movimentação ortodôntica. OBJETIVO: apresentar os princípios relacionados ao ajuste oclusal em Ortodontia.INTRODUCTION: The knowledge of dental occlusion should be considered the basic foundation to an excellent orthodontic practice. The patient’s diagnose without the centric relation assessment can take the orthodontist to an unpleasant surprises. The use of rectangular archwires requires occlusal

Modifier le cadre participatif pour résoudre un problème client : exemples d’ajustement opéré par les professionnels dans les interactions en centre d’appels

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Colón De Carvajal Isabel

2012-07-01

Full Text Available Si, dans les interactions de service en centre d’appels, la conversation principale est celle engagée entre l’appelant et l’appelé, une multitude d’autres interactions caractérise le travail des opérateurs. Cet article présente une étude linguistique sur les interactions entre les opérateurs du centre d’appels LocBike, qui propose l’accès à des vélos en libre service dans une grande ville française, et les clients, qui empruntent ces vélos et appellent le centre en cas de problèmes. Ces interactions ont la particularité d’être menées autour d’objets technologiques, afin d’interagir avec le client et traiter son dossier. L’accès à cet environnement d’interactions téléphoniques médiées par ordinateur permet d’analyser la résolution du problème client du point de vue de l’opérateur, et d’observer que ce travail se réalise parfois en collaboration avec son collègue co-présent dans son environnement immédiat. Les professionnels opèrent alors des ajustements par rapport au dispositif de communication, ou s’ajustent eux-mêmes à ce dispositif, pendant l’interaction principale avec le client, ce qui tend à modifier le cadre participatif. L’objectif de notre travail est d’analyser les pratiques des professionnels lors de modifications du cadre participatif, et ce, dans le but de résoudre un problème client. A travers des exemples de collaboration, nous étudierons les formes d’ajustement que les professionnels mettent en place par rapport au dispositif de communication, modifiant ainsi temporairement le cadre participatif.

Variation in clinical phenotype of human infection among genetic groups of Blastomyces dermatitidis

Science.gov (United States)

Meece, Jennifer K.; Anderson, Jennifer L.; Gruszka, Sarah; Sloss, Brian L.; Sullivan, Bradley; Reed, Kurt D.

2013-01-01

Background. Blastomyces dermatitidis, the etiologic agent of blastomycosis, has 2 genetic groups and shows varied clinical presentation, ranging from silent infections to fulminant respiratory disease and dissemination. The objective of this study was to determine whether clinical phenotype and outcomes vary based on the infecting organism's genetic group.Methods. We used microsatellites to genotype 227 clinical isolates of B. dermatitidis from Wisconsin patients. For each isolate, corresponding clinical disease characteristics and patient demographic information were abstracted from electronic health records and Wisconsin Division of Health reportable disease forms and questionnaires.Results. In univariate analysis, group 1 isolates were more likely to be associated with pulmonary-only infections (P 1 month (P smoking status (P = .0001) remained predictors for group 2 infections.Conclusions. This study identified previously unknown associations between clinical phenotype of human infection and genetic groups of B. dermatitidis and provides a framework for further investigations of the genetic basis for virulence in B. dermatitidis.

What to Expect During a Colonoscopy

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Clinical investigation of proximate exposed group, 1

International Nuclear Information System (INIS)

Ito, Chikako; Hasegawa, Kazuyo; Kato, Masafumi; Kumasawa, Toshihiko

1984-01-01

In order to investigate effects of the A-bombing on prevalence of diabetes mellitus, follow-up studies were made on 5907 A-bomb survivors who received glucose tolerance test (GTT) during 20 years between 1963 and 1983. The A-bomb survivors were divided into the group A (1899 men and 1165 women exposed within 1.9 km from the hypocenter) and the group B (1725 men and 1118 women exposed 3.0 km or farther from it). Among non-obese survivors, 21.9% and 21.8% were being treated for diabetes mellitus or were evaluated as having diabetic type on GTT in the group A and the group B, respectively; while this was seen in 52.1% of obese survivors in the group A and 49.9% in the group B. There was no difference between the groups. In non-obese survivors, the annual development rate from the normal type to the diabetic type was 0.89% in the group A and 0.65% in the group B; the annual development rate from the borderline type to the diabetic type was 5.73% in the group A and 5.49% in the group B, showing no differences between the groups. The annual development rate from the normal or borderline type to the diabetic type was two times or higher in obese survivors than in non-obese survivors irrespective of exposure status. Regarding the number of diabetic survivors who became non-diabetic type in spite of having no treatment, and prevalence of diabetic complications, no difference was seen between the groups. These results suggest that the A-bombing has scarcely influenced the prevalence of diabetes mellitus and clinical course. (Namekawa, K.)

A General Factor of Death Distress in Seven Clinical and Non-Clinical Groups

Science.gov (United States)

Abdel-Khalek, Ahmed M.

2004-01-01

The Arabic Scale of Death anxiety (ASDA), the Death Depression Scale (DDS), and the Death Obsession Scale (DOS) were administered, individually, to 7 groups (n = 765) of Egyptian normal participants (non-clinical), anxiety disorder patients, patients suffering from schizophrenia (males and females), and addicts (males only). They were generally…

Aplicación de dos pruebas estadísticas de bondad de ajuste en muestras complejas: un caso práctico en el campo forestal

OpenAIRE

Quintero-Méndez, María A.; Durán-Núñez, Mariano J.

2008-01-01

En esta investigación se comparan dos pruebas de bondad de ajuste en términos de su error tipo I: ji-cuadrada de Pearson y Rao-Scott con corrección de segundo orden, aplicadas a datos recolectados mediante técnicas de muestreo que no cumplen los supuestos de independencia e igual probabilidad de inclusión de las observaciones, llamadas muestras complejas. Ambas pruebas se usaron para ajustar categorías diamétricas en una plantación de gmelina (Gmelina arborea), aplicando muestreo sistemático ...

Curvas de Lactação em Rebanhos da Raça Holandesa no Estado de Minas Gerais: Escolha do Modelo de Melhor Ajuste

Directory of Open Access Journals (Sweden)

Gonçalves Tarcísio de Moraes

2002-01-01

Full Text Available Para selecionar o modelo de curva de lactação de melhor ajuste aos dados de produção de leite no dia de controle de animais da raça Holandesa no Estado de Minas Gerais, utilizaram-se 157.932 controles de 17.150 lactações, de 1990 a 1996, do arquivo inicial com 305.506 controles de 56.422 lactações, do Serviço de Controle Leiteiro da ACGHMG. Ajustaram-se os dados para os fatores: região, nível de produção, ano-estação de parto, classes de ordem e idade ao parto (COPI, grupo genético, número de controles e interações, além dos efeitos linear e quadrático da duração da lactação. Para verificar o melhor ajuste aos modelos Quadrático logarítmico, Gamma Incompleta, Regressão Múltipla e Multifásico (Monofásico e difásico, foram usados menor desvio padrão residual, R² ajustado ao número de parâmetros das equações, autocorrelação de primeira ordem e teste de Durbin-Watson. O uso de uma função difásica para predizer a produção de leite em programas de seleção é recomendado, sendo também possível estimar, com base nessa função, a produção de leite em 305 dias.

Ajuste psicosocial en agresores, víctimas puras y víctimas agresivas en la escuela. Psychosocial adjustment in aggressors, pure victims and aggressive

Directory of Open Access Journals (Sweden)

Estefanía Estévez

2008-07-01

Full Text Available

En el presente estudio se examinan las diferencias entre cuatro categorías de adolescentes –agresores, víctimas puras, víctimas agresivas y estudiantes no implicados en problemas comportamentales o de victimización en la escuela– en relación con la autoestima, la sintomatología depresiva, el estrés percibido, el sentimiento de soledad, y una medida general de satisfacción con la vida. Los participantes fueron 1.319 adolescentes con edades comprendidas entre los 11 y los 16 años (47% chicos y escolarizados en siete centros públicos de enseñanza secundaria ubicados en Valencia (España. Los análisis de varianza indicaron la existencia de diferencias significativas entre las cuatro categorías de estudiantes. Así, los adolescentes no implicados mostraron un mejor ajuste psicosocial general: niveles más elevados de autoestima y satisfacción con la vida y niveles inferiores de sintomatología depresiva, estrés percibido y sentimiento de soledad. Las puntuaciones en este grupo fueron equivalentes a aquellas obtenidas por los agresores con respecto a la autoestima, la sintomatología depresiva y la soledad. Sin embargo, los agresores percibieron más estrés y expresaron menor satisfacción con sus vidas, como así también hicieron los otros dos grupos, a saber: víctimas puras y víctimas agresivas. Las víctimas mostraron los niveles más elevados de sentimiento de soledad.

Palabras clave: Agresor, víctima, víctima agresiva, violencia escolar, ajuste psicosocial.

The present study examined differences among four categories of adolescents –aggressors, pure victims, aggressive victims, and students not involved in behavioural or victimization problems at school– with respect to self-esteem, depressive symptomatology, perceived stress, feeling of loneliness, and a general measure of satisfaction with life. Participants were 1,319 adolescents aged from 11 to 16 years old (47% male and drawn from seven state

Usefulness of Cochrane Skin Group reviews for clinical practice.

Science.gov (United States)

Davila-Seijo, P; Batalla, A; Garcia-Doval, I

2013-10-01

Systematic reviews are one of the most important sources of information for evidence-based medicine. However, there is a general impression that these reviews rarely report results that provide sufficient evidence to change clinical practice. The aim of this study was to determine the percentage of Cochrane Skin Group reviews reporting results with the potential to guide clinical decision-making. We performed a bibliometric analysis of all the systematic reviews published by the Cochrane Skin Group up to 16 August, 2012. We retrieved 55 reviews, which were analyzed and graded independently by 2 investigators into 3 categories: 0 (insufficient evidence to support or reject the use of an intervention), 1 (insufficient evidence to support or reject the use of an intervention but sufficient evidence to support recommendations or suggestions), and 2 (sufficient evidence to support or reject the use of an intervention). Our analysis showed that 25.5% (14/55) of the studies did not provide sufficient evidence to support or reject the use of the interventions studied, 45.5% (25/25) provided sufficient but not strong evidence to support recommendations or suggestions, and 29.1% (16/55) provided strong evidence to support or reject the use of 1 or more of the interventions studied. Most of the systematic reviews published by the Cochrane Skin Group provide useful information to improve clinical practice. Clinicians should read these reviews and reconsider their current practice. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

Maternity groups in the postpartum period at well child clinics - mothers' experiences.

Science.gov (United States)

Glavin, Kari; Tveiten, Sidsel; Økland, Toril; Hjälmhult, Esther

2017-10-01

To explore mothers' experiences as participants in maternity groups at well child clinics (WCCs). The level of psychological distress that new mothers have may be related to the quantity of social support they receive. Maternity groups to support new parents have a long tradition at WCCs in Norway, and most of the clinics have offered these groups. However, there is little knowledge about mothers' experiences of participating in these groups. Qualitative design. Focus group interviews with mothers who had participated in maternity groups facilitated by public health nurses (PHNs) at WCCs. Interpretive description was used to analyse the transcripts from the interviews. Eight focus group interviews were conducted with a total of 30 mothers who had participated in maternity groups at WCCs in two counties in eastern Norway. The analysis resulted in one main category, 'The maternity group's salutogenic importance' and three subcategories, 'Networks that can last for many years', 'Fellowship with others in the same situation' and 'Become confident in mothering'. Mothers wanted fellowship and found it important to share experiences with other mothers. Maternity groups offered to parents are essential to meet parents' need to discuss experiences and challenges related to parenting. Maternity groups can also create a basis for establishing a social network for those who want it. Well child clinics should offer all mothers the opportunity to participate in groups to strengthen their social relations and their confidence in parenting. PHNs play an important role in facilitating groups for first-time parents. Group leadership can influence how mothers in a group connect and whether the parental role is affected. © 2016 John Wiley & Sons Ltd.

Association of complementation group and mutation type with clinical outcome in fanconi anemia. European Fanconi Anemia Research Group.

Science.gov (United States)

Faivre, L; Guardiola, P; Lewis, C; Dokal, I; Ebell, W; Zatterale, A; Altay, C; Poole, J; Stones, D; Kwee, M L; van Weel-Sipman, M; Havenga, C; Morgan, N; de Winter, J; Digweed, M; Savoia, A; Pronk, J; de Ravel, T; Jansen, S; Joenje, H; Gluckman, E; Mathew, C G

2000-12-15

Fanconi anemia (FA) is a clinically and genetically heterogeneous disorder. Clinical care is complicated by variable age at onset and severity of hematologic symptoms. Recent advances in the molecular biology of FA have allowed us to investigate the relationship between FA genotype and the nature and severity of the clinical phenotype. Two hundred forty-five patients from all 7 known complementation groups (FA-A to FA-G) were studied. Mutations were detected in one of the cloned FANC genes in 169 patients; in the remainder the complementation group was assigned by cell fusion or Western blotting. A range of qualitative and quantitative clinical parameters was compared for each complementation group and for different classes of mutation. Significant phenotypic differences were found. FA-G patients had more severe cytopenia and a higher incidence of leukemia. Somatic abnormalities were less prevalent in FA-C, but more common in the rare groups FA-D, FA-E, and FA-F. In FA-A, patients homozygous for null mutations had an earlier onset of anemia and a higher incidence of leukemia than those with mutations producing an altered protein. In FA-C, there was a later age of onset of aplastic anemia and fewer somatic abnormalities in patients with the 322delG mutation, but there were more somatic abnormalities in patients with IVS4 + 4A --> T. This study indicates that FA patients with mutations in the FANCG gene and patients homozygous for null mutations in FANCA are high-risk groups with a poor hematologic outcome and should be considered as candidates both for frequent monitoring and early therapeutic intervention. (Blood. 2000;96:4064-4070)

What to Expect During a Colonoscopy

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Full Text Available ... and Meetings Endorsed Courses Online Education ACG Education Universe Journal CME ACG Self-Assessment Test ACG SAP- ... Training Curriculum GI Training Pathway on the Education Universe NYU OSCE Toolkit GI Fellowship Programs Find a ...

What to Expect During a Colonoscopy

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Full Text Available ... programs across North America, the GI Match, ACG's Mentoring Program and many other educational materials uniquely tailored ... Week GI Jeopardy Competition ACG Case Reports Journal Mentoring Program ACG-FDA Visiting Fellowship Program Job Search / ...

What to Expect During a Colonoscopy

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Full Text Available ... MOC Trainee Events and Meetings Endorsed Courses Online Education ACG Education Universe Journal CME ACG Self-Assessment ... Awards Colorectal Cancer Prevention Action Plan and RFAs Education Campaigns and Treatment Resources Evidence-Based Reviews ACG ...

What to Expect During a Colonoscopy

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Full Text Available ... and physicians alike. About the Institute Mission and Leadership Institute Annual Reports Donation Form ACG Visiting Professor ... Media ACG Media Journalists access information on digestive health, including the latest ACG news and up-to- ...

What to Expect During a Colonoscopy

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Full Text Available ... Int’l GI Training Grant Award Awardees and Special Lecturers Awards Brochure ACG Institute ACG Institute The ... Match Applying to GI Fellowship Programs: What You Need to Know Media ACG Media Journalists access information ...

What to Expect During a Colonoscopy

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Full Text Available ... Pathway on the Education Universe NYU OSCE Toolkit GI Fellowship Programs Find a GI Fellowship Program GI ... Video & PSAs (YouTube) Podcasts ACG Sites GI.ORG GI.ORG cancel GI.ORG ACG CASE REPORTS ACG ...

Père ou pair? Décalages et ajustements co-énonciatifs

Directory of Open Access Journals (Sweden)

Christiane Préneron

2010-12-01

Full Text Available

L’objet de notre analyse dialogique et co-énonciative concerne la forme prise par la relation entre un père et son fi ls au cours d’échanges verbaux. Dans cette dimension relationnelle, nous avons cherché plus particulièrement à éclairer le statut d’énonciateur que chacun octroie à lui-même et à l’autre. Les images qu’un père et un fi ls ont l’un de l’autre et les places qu’ils occupent dans le dialogue sont en partie déterminées par leur statut de père et d’enfant. Ces places ne confi gurent pas un mode relationnel homogène. Au contraire, cet extrait de corpus est frappant par la grande diversité d’attitudes adoptées par le père avec son enfant: tour à tour il lui donne des ordres, des permissions, le réconforte, joue avec lui, lui propose des défi s ou rivalise avec lui. Daniel peut entrer dans le jeu proposé par son père ou s’y opposer, se laisser guider ou refuser, mais aussi être à l’initiative par des demandes ou des jeux. C’est cette diversité que nous tentons de mettre au jour, sachant que certaines séquences se caractérisent plus particulièrement par des décalages entre les interlocuteurs, alors que d’autres conduisent à des ajustements. Si la diversité qui caractérise cet extrait ne saurait être étendue comme caractérisant toute interaction père/enfant, l’analyse qui en est faite peut servir de repère pour l’étude de nouvelles interactions parent/enfant.

Técnica de suturas ajustables: Resultados Technique of adjustable sutures: Results

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Lourdes R. Hernández Santos

2001-06-01

Full Text Available Se realizó un estudio sensorial y motor preoperatorio y posoperatorio a 84 pacientes que acudieron a la consulta de Visión Binocular con el diagnóstico de estrabismo horizontal a partir de los 13 años de edad. El método estadístico utilizado fue "t" o Chi cuadrado. Nos trazamos como objetivo determinar los resultados posoperatorios de la cirugía de estrabismo realizada con la técnica de suturas ajustables, que fueron los siguientes: el 61 % de los pacientes con exotropía y el 71,4 % con el diagnóstico de exotropía se encontraban en ortotropía a los 6 meses de la intervención. El 71,4 % de los pacientes con esotropía y el 83,3 % con el diagnóstico de esotropía se encontraban en ortotropía al año de la intervención. Esta técnica quirúrgica permite la modificación de la desviación en el posoperatorio inmediato.A preoperative and postoperative sensorial and motor study was conducted among 84 patients who received attention at the consultation room of Binocular Vision with the diagnosis of horizontal strabismus from the age of 13 years old on. The statistical method used was "t" or chi square test. Our objective was to determine the postoperative results of the strabismus surgery performed by the technique of adjustable sutures. The results were as follows: 61 % of the patients with exotropia and 71.4 % with the diagnosis of exotropia were in orthotropia 6 months after the operation. 71.4 % of the patients with exotropia and 83.3 % with the diagnosis of exotropia were in orthotropia a year after the operation. This surgical technique allows the modification of the deviation in the immediate postoperative.

What to Expect During a Colonoscopy

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El ajuste entre la estrategia competitiva y la estrategia de innovación tecnológica: Su implicación en el resultado de la empresa

OpenAIRE

González Moreno, Ángela

2011-01-01

A pesar de la importancia de la innovación tecnológica en la obtención de la ventaja competitiva, las relaciones entre la estrategia competitiva y la estrategia de innovación no han sido tratadas en profundidad. Esta tesis pone de manifiesto la necesidad del buen acoplamiento entre estos dos tipos de estrategia, proporcionando evidencia empírica acerca de como el ajuste entre ambas repercute positivamente en el resultado. El análisis aplicado a empresas del sector industrial de la electrón...

Diabetes quality management in care groups and outpatient clinics

NARCIS (Netherlands)

Campmans-Kuijpers, M.J.E.

2015-01-01

This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with

Enacting localist health policy in the English NHS: the 'governing assemblage' of Clinical Commissioning Groups.

Science.gov (United States)

Hammond, Jonathan; Coleman, Anna; Checkland, Kath

2018-01-01

Objectives The Health and Social Care Act 2012 introduced Clinical Commissioning Groups to take responsibility for commissioning (i.e. planning and purchasing) the majority of services for local populations in the English NHS. Constituted as 'membership organizations', with membership compulsory for all GP practices, Clinical Commissioning Groups are overseen by, and are accountable to, a new arm's-length body, NHS England. This paper critically engages with the content and policy narrative of the 2012 Act and explores this in relation to the reality of local policy enactment. Methods Set against a careful review of the 2012 Act, a case study of a nascent Clinical Commissioning Groups was conducted. The research included observations of Clinical Commissioning Group meetings and events (87 h), and in-depth interviews (16) with clinical commissioners, GPs, and managers. Results The 2012 Act was presented as part of a broader government agenda of decentralization and localism. Clinical Commissioning Group membership organizations were framed as a means of better meeting the needs and preferences of local patients and realizing a desirable increase in localism. The policy delineated the 'governing body' and 'the membership', with the former elected from/by the latter to oversee the organization. 'The membership' was duty bound to be 'good', engaged members and to represent their patients' interests. Fieldwork with Notchcroft Clinical Commissioning Group revealed that Clinical Commissioning Groups' statutory duty to NHS England to 'ensure the continuous improvement' of GP practice members involved performance scrutiny of GP practices. These governance processes were carried out by a varied cast of individuals, many of whom did not fit into the binary categorization of membership and governing body constructed in the policy. A concept, the governing assemblage, was developed to describe the dynamic cast of people involved in shaping the work and direction of the Clinical

A 25-year analysis of the American College of Gastroenterology Research Grant Program:

Science.gov (United States)

Crockett, Seth D.; Dellon, Evan S.; Bright, Stephanie D.; Shaheen, Nicholas J.

2011-01-01

Introduction The American College of Gastroenterology (ACG) has awarded research grants for 25 years. We assessed the characteristics of grant recipients, their current academic status, and the likelihood of publication resulting from the grant. Methods Demographic data, year and amount of award, title of project, and recipient’s institution were extracted from ACG databases. Using ACG reports and medical literature search engines, we assessed publication based on grant-funded research, as well as career publication record. We also determined the current position of awardees. Similar analysis was performed for recipients of junior investigator awards. Results A total of 396 clinical research awards totaling $5,374,497 ($6,867,937 in 2008 dollars) were awarded to 341 recipients in the 25 years between 1983 and 2008. The most commonly funded areas of research were endoscopy (22% of awards) and motility/functional disorders (21%). At least one peer-reviewed publication based on grant-funded research occurred in 255 of the awards (69%). Higher award value was associated with subsequent publication. Of 341 past awardees, 195 (62%) are currently in academic positions. Factors associated with staying in academics included higher award value (pacademics. Overall, the mean cost in grant dollars per published paper based on the research was $14,875. Conclusion The majority of ACG grant recipients published the results of their research and remained in academics. Higher amount of award, holding an advanced degree, and publication were associated with careers in academics. The ACG research grant award program is an important engine of investigation, publications, and academic career development in the field of gastroenterology. PMID:19319125

A 25-year analysis of the American College of Gastroenterology research grant program: factors associated with publication and advancement in academics.

Science.gov (United States)

Crockett, Seth D; Dellon, Evan S; Bright, Stephanie D; Shaheen, Nicholas J

2009-05-01

The American College of Gastroenterology (ACG) has awarded research grants for 25 years. We assessed the characteristics of grant recipients, their current academic status, and the likelihood of publication resulting from the grant. Demographic data, the year and amount of award, title of project, and recipient's institution were extracted from ACG databases. Using ACG reports and medical literature search engines, we assessed publication based on grant-funded research, as well as career publication record. We also determined the current position of awardees. A similar analysis was performed for recipients of junior investigator awards. A total of 396 clinical research awards totaling $5,374,497 ($6,867,937 in 2008 dollars) were awarded to 341 recipients in the 25 years between 1983 and 2008. The most commonly funded areas of research were endoscopy (22% of awards) and motility/functional disorders (21%). At least one peer-reviewed publication based on grant-funded research occurred with 255 of the 368 awards (69%) for 1983-2006 [corrected]. Higher award value was associated with subsequent publication. Of the 313 awardees over the same period, 195 (62%) are currently in academic positions [corrected]. Factors associated with staying in academics included higher award value (P academics. Overall, the mean cost in grant dollars per published paper based on the research was $14,875. The majority of ACG grant recipients published the results of their research and remained in academics. Higher amount of award, holding an advanced degree, and publication were associated with careers in academics. The ACG research grant award program is an important engine of investigation, publication, and academic career development in the field of gastroenterology.

[Leadership Experience of Clinical Nurses: Applying Focus Group Interviews].

Science.gov (United States)

Lee, Byoung Sook; Eo, Yong Sook; Lee, Mi Aie

2015-10-01

The purpose of this study was to understand and describe the leadership experience of clinical nurses. During 2014, data were collected using focus group interviews. Three focus group interviews were held with a total of 20 clinical nurses participating. All interviews were recorded as they were spoken and transcribed and data were analyzed using qualitative content analysis. Fifteen categories emerged from the five main themes. 1) Thoughts on the leadership category: to lead others, to cope with problem situations adequately and to serve as a shield against difficulties. 2) Situations requiring leadership: situation that requires correct judgement, coping and situations that need coordination and cooperation. 3-1) Leadership behaviors: other-oriented approach and self-oriented approach. 3-2) Leadership behavior consequences: relevant compensation and unfair termination. 4-1) Facilitators of leadership: confidence and passion for nursing and external support and resources. 4-2) Barriers to leadership: non-supportive organization culture and deficiency in own leadership competencies. 5) Strategies of leadership development: strengthen leadership through self-development and organizational leadership development. In conclusion, the results indicate that it is necessary to enhance clinical nurses' leadership role in healthcare. Enhancement can be achieved through leadership programs focused on enlarging leadership experience, constant self-development, leadership training, and development of leadership competencies suited to the nursing environment.

Group-Sequential Strategies in Clinical Trials with Multiple Co-Primary Outcomes

Science.gov (United States)

Hamasaki, Toshimitsu; Asakura, Koko; Evans, Scott R; Sugimoto, Tomoyuki; Sozu, Takashi

2015-01-01

We discuss the decision-making frameworks for clinical trials with multiple co-primary endpoints in a group-sequential setting. The decision-making frameworks can account for flexibilities such as a varying number of analyses, equally or unequally spaced increments of information and fixed or adaptive Type I error allocation among endpoints. The frameworks can provide efficiency, i.e., potentially fewer trial participants, than the fixed sample size designs. We investigate the operating characteristics of the decision-making frameworks and provide guidance on constructing efficient group-sequential strategies in clinical trials with multiple co-primary endpoints. PMID:25844122

Comparison of the efficacy of tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of female stress urinary incontinence: a 1-year follow-up randomized trial.

Science.gov (United States)

Masata, Jaromir; Svabik, Kamil; Zvara, Karel; Hubka, Petr; Toman, Ales; Martan, Alois

2016-10-01

The aim of this study was to compare the efficacy of the tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of stress urinary incontinence in a randomized two-arm study with a 1-year follow-up. This single-centre randomized trial compared the objective and subjective cure rates of TVT-O and Ajust using objective criteria (cough test) and subjective criteria (International Consultation on Incontinence Questionnaire short form, ICIQ-UI SF). The objective cure rate was defined as the number of patients with a negative cough stress test. Subjective cure was defined as no stress leakage of urine after surgery based on the ICIQ-UI SF. The primary outcome was to establish differences in objective and subjective cure rates between the TVT-O and Ajust groups. We also compared postoperative pain profiles using a visual analogue scale (VAS), improvement in quality of life using the ICIQ- UI SF and the Incontinence Quality of Life questionnaire, and overall satisfaction with the surgical procedure using a VAS and a five-item Likert scale. Inclusion criteria were age over 18 years, signed informed consent, and urodynamic stress urinary incontinence. Following a power calculation, 50 patients were enrolled into each group (Ajust and TVT-O). The mean follow-up after surgery was 445 days (SD 157.6 days) in the TVT-O group and 451.8 days (SD 127.6 days) in the Ajust group (p = 76.6 %). At 1 year, 47 patients were evaluated in the TVT-O group and 49 in the Ajust group. No differences in subjective cure rates or objective cure rates were observed. In the Ajust and TVT-O groups, the rates for no subjective stress leakage were 89.8 % and 91.5 %, respectively (p = 1.0, OR 1.22, 95 % CI 0.24 - 6.58), and the rates for a negative stress test were 89.8 % and 87.2 %, respectively (p = 0.76, OR 0.77, 95 % CI 0.17 - 3.32). In the Ajust group two patients reported de novo pain during sexual

The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

Science.gov (United States)

Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol

2014-07-01

Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Mechanism underlying the development of unilateral spatial neglect

International Nuclear Information System (INIS)

Nishikiori, Etsuko

1992-01-01

To test the hypothesis that functional disturbance of the neural network involving the inferior parietal lobule (IPL), anterior cingulate gyrus (ACG), dorsolateral frontal lobe (DLF), and thalamus (TH) as components of the right hemisphere underlies the development of unilateral spatial neglect (USN), cerebral perfusion was measured by 123 I-IMP SPECT in 32 patients with cerebrovascular right brain damage, 20 of whom had USN and 12 of whom did not. In analyzing the SPECT data, RI uptake in the four component regions and cerebellum (serving as a control) were estimated by symmetrically placing 'regions of interest' from both hemispheres on SPECT slices, most suitable for each region. The 'regional to cerebellar ratio' (R/CE ratio) for each component region was calculated and the values were compared. In the USN group, R/CE ratio values for each component region in the right hemisphere were significantly lower than those in the left, whereas in the non-USN group there was no right-left difference. When R/CE ratio values for each component region in the right hemisphere were compared between the USN and non-USN group, those for the IPL, ACG and TH were significantly lower in the USN group; the value for the DLF was also lower in the USN group, although the difference was not significant. Significantly lower values of R/CE for each component region in the right hemisphere were noticed when the regions showed apparent involvement on X-ray CT/MRI. Furthermore, in seven of the USN patients where lesions revealed by CT/MRI did not involve network components, the R/CE ratio values for the components in the right hemisphere were lower than those in the left; the difference was significant for the IPL, ACG and TH, but not for the DLF. It is suggested that functional disturbance of the neural network involving the IPL, ACG, DLF and TH in the right hemisphere might underlie the development of USN. (author)

Factors Influencing Electronic Clinical Information Exchange in Small Medical Group Practices

Science.gov (United States)

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

2012-01-01

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

Diabetes quality management in Dutch care groups and outpatient clinics: a cross-sectional study.

Science.gov (United States)

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E H M

2014-08-07

In recent years, most Dutch general practitioners started working under the umbrella of diabetes care groups, responsible for the organisation and coordination of diabetes care. The quality management of these new organisations receives growing interest, although its association with quality of diabetes care is yet unclear. The best way to measure quality management is unknown and it has not yet been studied at the level of outpatient clinics or care groups. We aimed to assess quality management of type 2 diabetes care in care groups and outpatient clinics. Quality management was measured with online questionnaires, containing six domains (see below). They were divided into 28 subdomains, with 59 (care groups) and 57 (outpatient clinics) questions respectively. The mean score of the domains reflects the overall score (0-100%) of an organisation. Two quality managers of all Dutch care groups and outpatient clinics were invited to fill out the questionnaire.Sixty care groups (response rate 61.9%) showed a mean score of 59.6% (CI 57.1-62.1%). The average score in 52 outpatient clinics (response rate 50.0%) was 61.9% (CI 57.5-66.8%).Mean scores on the six domains for care groups and outpatient clinics respectively were: 'organisation of care' 71.9% (CI 68.8-74.9%), 76.8% (CI 72.8-80.7%); 'multidisciplinary teamwork' 67.1% (CI 62.4-71.9%), 71.5% (CI 65.3-77.8%); 'patient centeredness' 46.7% (CI 42.6-50.7%), 62.5% (CI 57.7-67.2%); 'performance management' 63.3% (CI 61.2-65.3%), 50.9% (CI 44.2-57.5%); 'quality improvement policy' 52.6% (CI 49.2-56.1%), 50.9% (CI 44.6-57.3%); and 'management strategies' 56.0% (CI 51.4-60.7%), 59.0% (CI 52.8-65.2%). On subdomains, care groups scored highest on 'care program' (83.3%) and 'measured outcomes' (98.3%) and lowest on 'patient safety' (15.1%) and 'patient involvement' (17.7%). Outpatient clinics scored high on the presence of a 'diabetic foot team' (81.6%) and the support in 'self-management' (81.0%) and low on 'patient

Series de días hábiles en Colombia: una aplicación al ajuste del crecimiento industrial

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Álvaro Montenegro García

2014-06-01

Full Text Available Si bien muchos economistas son conscientes del efecto de los días hábiles sobre la medición de la producción, aún es frecuente encontrar que estas cifras se analizan sin el correspondiente ajuste. En general, el número de días hábiles en un mes cambia de un año a otro, lo cual es cierto para todos los meses, no solo para los que contienen la Semana Santa. Este trabajo recopila la serie de días hábiles mensuales tomando en cuenta los festivos actuales y anteriores a la Ley Emiliani, y la utiliza para ajustar la serie de producción manufacturera del DANE. Para algunos meses, la diferencia entre la cifra de crecimiento industrial reportada por el DANE y la cifra ajustada por días hábiles puede acercarse a los 12 puntos porcentuales, en cualquier dirección

La industria manufacturera en Centroamérica: Perspectivas del Ajuste a la nueva política comercial regional

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Fernando RUEDA-JUNQUERA

2009-11-01

Full Text Available RESUMEN: La nueva política comercial del Mercado Común Centroamericano está dando lugar a cambios en los flujos comerciales, que inducirán un ajuste inter-/intraindustrial en el sector manufacturero regional. Este artículo presenta y analiza los principales resultados de un estudio empírico que evaluó el impacto del nuevo programa de integración regional en el patrón de especialización y comercio de manufacturas de cada país miembro. El enfoque empírico empleado conllevó la construcción de hojas de balance que integraron en una base comparable los datos de producción y comercio para el sector manufacturero de cada país. Asimismo, se obtuvieron dos grupos de ratios que midieron respectivamente, la importancia relativa de los mercados regional y mundial para los subsectores manufactureros de cada país, y el potencial de éstos para una especialización inter-/intraindustrial en los dos mercados.ABSTRACT: The new trade policy in the Central American Common Market is given rise to changes in trade flows that will induce an inter-/intraindustry adjustment in the regional manufacturing sector. This article presents and analyses the main results of an empirical study which assessed the impact of the new integration scheme on each member country's pattern of trade and specialisation in manufactures. The empirical approach used in the study involved the construction of balance sheets integrating production and trade data on a comparable basis for each country's manufacturing sector. Likewise, two groups of ratios were obtained. They measured respectively, the relative importance of the regional and world market for the manufacturing subsectors of each country and the subsectoral potential for an inter-/intraindustry specialisation in the two markets.

Avaliação de marcapasso unicameral de ajuste automático de freqüência de pulso mediado por movimentação corporal

OpenAIRE

Brofman,Paulo R; Loures,Danton R. da Rocha; Rossi,Paulo R. F; Ardito,Roberto V; Greco,Osvaldo T; Braile,Domingo M; Sant'Anna,João R; Lucchese,Fernando A; Kalil,Renato A. K; Eloy,Ricardo; Barros,Rubens T; Andrade,José Carlos S; Pesarini,Aldo; Gauch,Paulo R. A

1987-01-01

Quarenta e oito pacientes com marcapasso unicameral de ajuste automático de freqüência de pulso mediado por movimentação corporal (AAI-R/VVI-R) foram avaliados através da eletrocardiografia dinâmica, para correlacionar a atividade física com a variação da freqüência de estímulos e teste ergométrico em esteira (pareados e randomizados em modo AAI/VVI e modo AAI-R/VVI-R), para quantificar a capacidade de realizar esforço físico, um mês após o implante do gerador de pulso Activitrax 8400. A idad...

Role of angiocardiography in the diagnosis and management of complex/complicated congenital heart disease

International Nuclear Information System (INIS)

Ling Jian; Liu Yuqing

2006-01-01

Objective: To evaluate the role of angiocadiography (ACG) in the diagnosis and management of complex/complicated congenital heart disease (CHD). Methods: A retrospective study of ACG findings in 360 cases with complex/complicated CHD was performed with a comparision to that of echocardiography (Echo) and related clinical examination. Results: The present series of CHD cases included pulmonary atresia with ventricular septal defect in 75 cases, double outlet of right ventricle in 62 cases, Fallot's tetralogy in 60 cases, single ventricle in 52 cases, transposition of the great arteries in 42 cases, tricuspid valve atresia in 15 cases, coronary abnormality in 6 eases, total abnormal pulmonary venous connection in 5 cases, total endocardial cushion defect in 5 cases, persistent truncus arteriosus in 4 cases, pulmonary atresia with normal ventricular septum in 3 cases, other disorders in 7 eases, and postsurgical operation in 24 cases. ACG was superior to that of Echo in demonstrating the abnormalities of systemic, pulmonary, and coronary arteries and their branches of complex/complicated CHD as well as measuring the pressure of pulmonary artery, vein, and systemic-pulmonary collateral vessels. Conclusion: In the diagnosis and differential diagnosis of knotty cases with complex and complicated CHD, particularly in the demonstration of full view of systemic, pulmonary, and coronary arterial branches and accurate measurement of' pulmonary arterial pressure/resistance, and atrial, ventricular, and systemic arterial pressure, ACG (including DSA) still plays an important and irreplaceable role. (authors)

Validez del modelo bidimensional de socialización parental en diferentes entornos sociales de la cultura española : implicaciones para el ajuste psicosocial de los adolescentes

OpenAIRE

Fuentes Durán, María del Castillo

2014-01-01

Durante las últimas décadas, la literatura empírica ha demostrado en repetidas ocasiones la influencia que tienen las diferentes formas de actuación de los padres en el proceso de socialización en el ajuste psicológico y social de los hijos. La investigación en torno a la socialización familiar se ha basado tradicionalmente en el modelo teórico de dos grandes dimensiones teóricamente independientes (aceptación/implicación y severidad/imposición, Darling y Steinberg, 1993; Maccoby y Martin...

Combined social cognitive and neurocognitive rehabilitation strategies in schizophrenia: neuropsychological and psychopathological influences on Theory of Mind improvement.

Science.gov (United States)

Bechi, M; Bosia, M; Spangaro, M; Buonocore, M; Cocchi, F; Pigoni, A; Piantanida, M; Guglielmino, C; Bianchi, L; Smeraldi, E; Cavallaro, R

2015-11-01

Neurocognitive and social cognitive impairments represent important treatment targets in schizophrenia, as they are significant predictors of functional outcome. Different rehabilitative interventions have recently been developed, addressing both cognitive and psychosocial domains. Although promising, results are still heterogeneous and predictors of treatment outcome are not yet identified. In this study we evaluated the efficacy of two newly developed social cognitive interventions, respectively based on the use of videotaped material and comic strips, combined with domain-specific Cognitive Remediation Therapy (CRT). We also analysed possible predictors of training outcome, including basal neurocognitive performance, the degree of cognitive improvement after CRT and psychopathological variables. Seventy-five patients with schizophrenia treated with CRT, were randomly assigned to: social cognitive training (SCT) group, Theory of Mind Intervention (ToMI) group, and active control group (ACG). ANOVAs showed that SCT and ToMI groups improved significantly in ToM measures, whereas the ACG did not. We reported no influences of neuropsychological measures and improvement after CRT on changes in ToM. Both paranoid and non-paranoid subjects improved significantly after ToMI and SCT, without differences between groups, despite the better performance in basal ToM found among paranoid patients. In the ACG only non-paranoid patients showed an improvement in non-verbal ToM. Results showed that both ToMI and SCT are effective in improving ToM in schizophrenia with no influence of neuropsychological domains. Our data also suggest that paranoid symptoms may discriminate between different types of ToM difficulties in schizophrenia.

AJUSTE DE ECUACIONES DE BIOMASA PARA Pinus durangensis (Martínez M. EN LA REGIÓN DE EL SALTO, DURANGO

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E. Montes de Oca-Cano

2009-01-01

Full Text Available El objetivo del presente estudio fue ajustar ecuaciones lineales y no lineales para estimar biomasa por componente de hojas, ramas, fuste y total, para árboles con edades entre tres y diez años, en la región de El Salto, Dgo. Los resultados indican que las ecuaciones se ajustan mejor a nivel individual, el componente total muestra los mejores estadísticos de ajuste, mientras que las mayores variaciones se detectan en las ramas y en el fuste. Adicionalmente se analizan porcentajes de biomasa por componente donde se observa que el fuste aporta 46.9 % de la biomasa, las hojas 35.6 % y las ramas solamente 17.3 % de la biomasa total. Así mismo, dentro del rango de edad analizado, la biomasa en el fuste aumenta anualmente 2.96 %; la biomasa en las hojas disminuye 3.13 % y la biomasa en las ramas aumenta 0.17 %.

Estudio de las primeras consultas en un Centro de Salud Mental (II). Características clínicas, sucesos vitales, ajuste y apoyo social, motivación y expectativas.

OpenAIRE

Oscar Martínez Azumendi; Miriam Beitia; Karmelo J Araluce; José M Ayerra; Carlos Cela; Jorge Grijalvo; José Ignacio Mendezona; Dolores Azkunaga; Patricia Insúa

1997-01-01

Proyecto de evaluación de 749 consultas consecutivas durante año y medio en un Centro de Salud Mental Comunitario. Se presentan las características y diferencias por sexos en relación con la sintomatolog��a diagnóstico, valoración global de la gravedad del caso, ajuste social, autoestima y apoyo social percibido. Además se describe el número y tipo de sucesos vitales referidos en los 6 meses anteriores, así como motivación y expectativas que traen al servicio.

Correlative Studies in Clinical Trials: A Position Statement From the International Thyroid Oncology Group.

Science.gov (United States)

Bible, Keith C; Cote, Gilbert J; Demeure, Michael J; Elisei, Rossella; Jhiang, Sissy; Ringel, Matthew D

2015-12-01

Patients with progressive thyroid cancer in distant metastatic sites represent a population with a need for new therapeutic options. Aspiring to improve the treatment of such patients, the objective of this position statement from the International Thyroid Oncology Group (ITOG) is to clarify the importance of incorporating high-quality correlative studies into clinical trials. ITOG was formed to develop and support high-quality multicenter and multidisciplinary clinical trials for patients with aggressive forms of thyroid cancer. The Correlative Sciences Committee of the ITOG focuses on the quality and types of correlative studies included in ITOG-associated clinical trials. This document represents expert consensus from ITOG regarding this issue based on extensive collective experience in clinical and translational trials informed by basic science. The Correlative Studies Committee identified an international writing group representative of diverse specialties, including basic sciences. Drafts were reviewed by all members of the writing group, the larger committee, and the ITOG board. After consideration of all comments by the writing group and modification of the document, the final document was then approved by the authors and the ITOG board. High-quality correlative studies, which include variety in the types of correlates, should be intrinsic to the design of thyroid cancer clinical trials to offer the best opportunity for each study to advance treatment for patients with advanced and progressive thyroid cancer.

El papel de la categorización social y las diferencias sociodemográficas en la autoestima, el ajuste y el bienestar psicológicos de una muestra de inmigrantes

OpenAIRE

José Andrés Peña-Pinzón; Carmen Gómez-Berrocal; Antonio Fernández-Parra

2014-01-01

Se explora el efecto de la saliencia de la categorización social inmigrante y su interacción con diferencias sociodemográficas (nivel de estudios, situación laboral, sexo) de los sujetos, en ajuste psicológico, bienestar psicológico y autoestima. 210 inmigrantes de origen sudamericano, residentes en las provincias de Granada y Almería, fueron distribuidos en dos condiciones experimentales: "saliencia baja/alta de la categorización social inmigrante". Encontramos efecto de la manipulación sobr...

Parents' experiences and perceptions of group-based antenatal care in four clinics in Sweden.

Science.gov (United States)

Andersson, Ewa; Christensson, Kyllike; Hildingsson, Ingegerd

2012-08-01

group-based antenatal care consists of six to nine two-hour sessions in which information is shared and discussed during the first hour and individual examinations are conducted during the second hour. Groups generally consist of six to eight pregnant women. Parent education is built into the programme, which originated in the United States and was introduced in Sweden at the beginning of the year of 2000. to investigate parents' experiences of group antenatal care in four different clinics in Sweden. a qualitative study was conducted using content analysis five group interviews and eleven individual interviews with parents who experienced group-based antenatal care. An interview guide was used. the study was set in four antenatal clinics that had offered group-based antenatal care for at least one year. The clinics were located in three different areas of Sweden. the participants were women and their partners who had experienced group-based antenatal care during pregnancy. Other criteria for participation were mastery of the Swedish language and having followed the care programme. three themes emerged, 'The care-combining individual physical needs with preparation for parenthood, refers to the context, organisation, and content of care'. Group antenatal care with inbuilt parent education was appreciated, but respondents reported that they felt unprepared for the first few weeks after birth. Their medical needs (for physical assessment and screening) were, however, fulfilled. The theme, 'The group-a composed recipient of care', showed the participants role and experience. The role could be passive or active in groups or described as sharers. Groups helped parents normalise their symptoms. The theme, 'The midwife-a controlling professional', showed midwives are ignorant of gender issues but, for their medical knowledge, viewed as respectable professionals. in the four clinics studied, group-based antenatal care appeared to meet parents' needs for physical assessment

Política socioambiental e de entorno do BNDES: dos ajustes espaciais aos corretivos territoriais: os casos das UHEs de Santo Antônio e Jirau (RO e da UHE de Belo Monte (PA

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Luis Fernando Novoa Garzon

2015-07-01

Full Text Available O artigo procura apresentar a posição e o discurso paradoxais de um Banco que é ao mesmo tempo viabilizador de macro-ajustes espaciais e propositor de micro-correções territoriais. A política socioambiental e de entorno do BNDES são avaliadas a partir dos casos dos grandes projetos, especificamente o Complexos Hidrelétricos do Madeira e de Belo Monte.

Programa de ajuste multiparamétrico de curvas de titulação potenciométricas de ácidos húmicos Multiparametric adjustment program of potentiometric titration curves of humic acids

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Clausius Duque Gonçalves Reis

2010-04-01

Full Text Available Tendo em vista a dificuldade de determinação dos pontos de inflexão na curva de titulação potenciométrica de ácidos húmicos, por metodologias tradicionais, foi desenvolvido foi desenvolvido um programa na linguagem Delphi para ajuste multiparamétrico de dados de titulação potenciométrica. Para isso um processo iterativo para estimar as raízes de um polinômio, com base no método de Newton-Raphson, foi utilizado. Os dados das titulações potenciométricas de ácidos húmicos usados nas regressões foram obtidos em um sistema automatizado de titulação potenciométrica. O programa desenvolvido na linguagem Delphi permite maior versatilidade e facilidade de operação, com uma interação mais amigável com o usuário. As curvas de titulação potenciométricas ajustadas sobrepuseram-se quase que totalmente às curvas experimentais. Os valores de pKa e as percentagens de grupos tituláveis dos ácidos húmicos, parâmetros ajustáveis na regressão multiparamétrica, apresentaram valores comparáveis com dados da literatura.Regarding the difficulty of determining the inflection points in the potentiometric titration curve of humic acids by means of traditional methodologies, a Delphi program a Delphi program was developed for the multiparametric data adjustment in potentiometric titration. For this purpose, an iterative process was used, based on the Newton-Raphson method to estimate the roots of a polynomial. The humic acid potentiometric titration data, used in regressions, were obtained in an automated system of potentiometric titration. The program developed in Delphi language features greater versatility, ease of operation and better interaction with the user. The adjusted potentiometric titration curves overlap the experimental curves almost entirely. The pKa values and percentages of titrable groups of humic acids extracted from soil, adjustable parameters in the multiparametric regression, were comparable with those reported

Ajuste de modelos estocásticos lineares e não-lineares para a descrição do perfil longitudinal de árvores Fitting linear and nonlinear stochastic models to describe longitudinal tree profile

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Leonardo Machado Pires

2007-10-01

Full Text Available Os modelos polinomiais são mais difundidos no meio florestal brasileiro na descrição do perfil de árvores devido à sua facilidade de ajuste e precisão. O mesmo não ocorre com os modelos não-lineares, os quais possuem maior dificuldade de ajuste. Dentre os modelos não-lineares clássicos, na descrição do perfil, podem-se citar o de Gompertz, o Logístico e o de Weibull. Portanto, este estudo visou comparar os modelos lineares e não lineares para a descrição do perfil de árvores. As medidas de comparação foram o coeficiente de determinação (R², o erro-padrão residual (s yx, o coeficiente de determinação corrigido (R²ajustado, o gráfico dos resíduos e a facilidade de ajuste. Os resultados ressaltaram que, dentre os modelos não-lineares, o que obteve melhor desempenho, de forma geral, foi o modelo Logístico, apesar de o modelo de Gompertz ser melhor em termos de erro-padrão residual. Nos modelos lineares, o polinômio proposto por Pires & Calegario foi superior aos demais. Ao comparar os modelos não-lineares com os lineares, o modelo Logístico foi melhor em razão, principalmente, do fato de o comportamento dos dados ser não-linear, à baixa correlação entre os parâmetros e à fácil interpretação deles, facilitando a convergência e o ajuste.Polynomial models are most commonly used in Brazilian forestry for taper modeling due to its straightforwardly fitting and precision. The use of nonlinear regression classic models, like Gompertz, Logistic and Weibull, is not very common in Brazil. Therefore, this study aimed to verify the best nonlinear and linear models, and among these the best model to describe the longitudinal tree profile. The comparison measures were: R², syx, R²adjusted, residual graphics and fitting convergence. The results pointed out that among the non-linear models the best behavior, in general, was given by the Logistic model, although the Gompertz model was superior compared with the Weibull

A virtual dosimetry audit - Towards transferability of gamma index analysis between clinical trial QA groups.

Science.gov (United States)

Hussein, Mohammad; Clementel, Enrico; Eaton, David J; Greer, Peter B; Haworth, Annette; Ishikura, Satoshi; Kry, Stephen F; Lehmann, Joerg; Lye, Jessica; Monti, Angelo F; Nakamura, Mitsuhiro; Hurkmans, Coen; Clark, Catharine H

2017-12-01

Quality assurance (QA) for clinical trials is important. Lack of compliance can affect trial outcome. Clinical trial QA groups have different methods of dose distribution verification and analysis, all with the ultimate aim of ensuring trial compliance. The aim of this study was to gain a better understanding of different processes to inform future dosimetry audit reciprocity. Six clinical trial QA groups participated. Intensity modulated treatment plans were generated for three different cases. A range of 17 virtual 'measurements' were generated by introducing a variety of simulated perturbations (such as MLC position deviations, dose differences, gantry rotation errors, Gaussian noise) to three different treatment plan cases. Participants were blinded to the 'measured' data details. Each group analysed the datasets using their own gamma index (γ) technique and using standardised parameters for passing criteria, lower dose threshold, γ normalisation and global γ. For the same virtual 'measured' datasets, different results were observed using local techniques. For the standardised γ, differences in the percentage of points passing with γ audit has been an informative step in understanding differences in the verification of measured dose distributions between different clinical trial QA groups. This work lays the foundations for audit reciprocity between groups, particularly with more clinical trials being open to international recruitment. Copyright © 2017 Elsevier B.V. All rights reserved.

Use of gonioscopy in medicare beneficiaries before glaucoma surgery.

Science.gov (United States)

Coleman, Anne L; Yu, Fei; Evans, Stacy J

2006-12-01

The American Academy of Ophthalmology Preferred Practice Patterns for angle closure and open-angle glaucoma (OAG) patients recommends performing bilateral gonioscopy upon initial presentation to evaluate the possibility of narrow angle or angle-closure glaucoma (ACG) and then repeating the examination at least every 5 years. This study aims to assess how commonly eye care providers perform gonioscopy before planned glaucoma surgery in OAG, anatomic narrow angle, and ACG in the Medicare population. Data obtained from a 5% random sample of Medicare beneficiaries undergoing glaucoma surgery in the United States in 1999 were retrospectively reviewed. The proportion of patients with evidence of at least one gonioscopic examination before glaucoma surgery was determined for the period of 1995 to 1999. Demographic and clinical factors potentially influencing the decision to perform gonioscopy were also examined. Overall, gonioscopy is apparently performed in 49% of Medicare beneficiaries during the 4 to 5 years preceding glaucoma surgery. This rate was significantly lower (P gonioscopy rates (P Gonioscopy examination before glaucoma surgery in Medicare beneficiaries is underused, undercoded, and/or miscoded, given current recommendations. Underuse is of particular concern in patients undergoing laser iridotomy as it is the diagnostic test of choice in ACG.

The Rules of Engagement: CTTI Recommendations for Successful Collaborations Between Sponsors and Patient Groups Around Clinical Trials.

Science.gov (United States)

Bloom, Diane; Beetsch, Joel; Harker, Matthew; Hesterlee, Sharon; Moreira, Paulo; Patrick-Lake, Bray; Selig, Wendy; Sherman, Jeffrey; Smith, Sophia K; Valentine, James E; Roberts, Jamie N

2018-03-01

To identify the elements necessary for successful collaboration between patient groups and academic and industry sponsors of clinical trials, in order to develop recommendations for best practices for effective patient group engagement. In-depth interviews, informed by a previously reported survey, were conducted to identify the fundamentals of successful patient group engagement. Thirty-two respondents from 3 sectors participated: patient groups, academic researchers, and industry. The findings were presented to a multistakeholder group of experts in January 2015. The expert group came to consensus on a set of actionable recommendations for best practices for patient groups and research sponsors. Interview respondents acknowledged that not all patient groups are created equal in terms of what they can contribute to a clinical trial. The most important elements for effective patient group engagement include establishing meaningful partnerships, demonstrating mutual benefits, and collaborating as partners from the planning stage forward. Although there is a growing appreciation by sponsors about the benefits of patient group engagement, there remains some resistance and some uncertainty about how best to engage. Barriers include mismatched expectations and a perception that patient groups lack scientific sophistication and that "wishful thinking" may cloud their recommendations. Patient groups are developing diverse skillsets and acquiring assets to leverage in order to become collaborators with industry and academia on clinical trials. Growing numbers of research sponsors across the clinical trials enterprise are recognizing the benefits of continuous and meaningful patient group engagement, but there are still mindsets to change, and stakeholders need further guidance on operationalizing a new model of clinical trial conduct.

Combining bimodal presentation schemes and buzz groups improves clinical reasoning and learning at morning report.

Science.gov (United States)

Balslev, Thomas; Rasmussen, Astrid Bruun; Skajaa, Torjus; Nielsen, Jens Peter; Muijtjens, Arno; De Grave, Willem; Van Merriënboer, Jeroen

2014-12-11

Abstract Morning reports offer opportunities for intensive work-based learning. In this controlled study, we measured learning processes and outcomes with the report of paediatric emergency room patients. Twelve specialists and 12 residents were randomised into four groups and discussed the same two paediatric cases. The groups differed in their presentation modality (verbal only vs. verbal + text) and the use of buzz groups (with vs. without). The verbal interactions were analysed for clinical reasoning processes. Perceptions of learning and judgment of learning were reported in a questionnaire. Diagnostic accuracy was assessed by a 20-item multiple-choice test. Combined bimodal presentation and buzz groups increased the odds ratio of clinical reasoning to occur in the discussion of cases by a factor of 1.90 (p = 0.013), indicating superior reasoning for buzz groups working with bimodal materials. For specialists, a positive effect of bimodal presentation was found on perceptions of learning (p presentation on diagnostic accuracy was noted in the specialists (p presentation and buzz group discussion of emergency cases improves clinicians' clinical reasoning and learning.

La influencia de las diferencias entre el padre y la madre sobre el ajuste adolescente

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Antonia Jiménez-Iglesias

2015-01-01

Full Text Available Este trabajo se centra en analizar cómo influyen en el consumo de sustancias (tabaco, alcohol y cannabis y el bienestar psicológico adolescente (calidad de vida relacionada con la salud y satisfacción vital las diferencias entre el padre y la madre en afecto, promoción de la autonomía, revelación, interés y conocimiento. La muestra estuvo compuesta por 10170 chicos y chicas españoles de 13 a 18 años de familias biparentales que participaron en la edición 2006 del estudio Health Behaviour in School-aged Children (HBSC. Los resultados mostraron que los adolescentes que indicaron que su padre y madre coincidían en presentar altos niveles en las dimensiones familiares analizadas consumieron menos sustancias y tuvieron mejor bienestar psicológico. Por el contrario, el ajuste de los adolescentes cuyos progenitores (padre y madre tenían bajos niveles en esas dimensiones familiares fue peor. Concretamente, la dimensión más importante para el consumo de sustancias fue el conocimiento parental y para el bienestar psicológico lo fue el afecto parental; la revelación adolescente solo fue relevante para el consumo de alcohol y la calidad de vida, mientras que la promoción parental de la autonomía lo fue para la calidad de vida.

Dimensiones familiares relevantes en la consecución del conocimiento parental y sus repercusiones sobre el ajuste adolescente. Un análisis internacional, nacional y local sobre la familia en la adolescencia.

OpenAIRE

Jiménez Iglesias, Antonia María

2013-01-01

La familia constituye el contexto principal y fundamental de socialización, que continua ejerciendo gran influencia durante la adolescencia. La evidencia disponible indica que el predictor más simple y consistente de la salud y el ajuste adolescente es la calidad de las relaciones de los chicos y las chicas con sus progenitores. La importancia de la familia en la adolescencia es bien conocida por el Estudio sobre Conductas de los Escolares Relacionadas con la Salud o Health Beha...

Ajustes de funções de distribuição de probabilidade à radiação solar global no Estado do Rio Grande do Sul Adjustments of probability distribution functions to global solar radiation in Rio Grande do Sul State

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Alberto Cargnelutti Filho

2004-12-01

Full Text Available O objetivo deste trabalho foi verificar o ajuste das séries de dados de radiação solar global média decendial, de 22 municípios do Estado do Rio Grande do Sul, às funções de distribuições de probabilidade normal, log-normal, gama, gumbel e weibull. Aplicou-se o teste de aderência de Kolmogorov-Smirnov, nas 792 séries de dados (22 municípios x 36 decêndios de radiação solar global média decendial, para verificar o ajuste dos dados às distribuições normal, log-normal, gama, gumbel e weibull, totalizando 3.960 testes. Os dados decendiais de radiação solar global média se ajustam às funções de distribuições de probabilidade normal, log-normal, gama, gumbel e weibull, e apresentam melhor ajuste à função de distribuição de probabilidade normal.The objective of this work was to verify the adjustment of data series for average global solar radiation to the normal, log-normal, gamma, gumbel and weibull probability distribution functions. Data were collected from 22 cities in Rio Grande do Sul State, Brazil. The Kolmogorov-Smirnov test was applied in the 792 series of data (22 localities x 36 periods of ten days of average global solar radiation to verify the adjustment of the data to the normal, log-normal, gamma, gumbel and weibull probability distribution functions, totalizing 3,960 tests. The data of average global solar radiation adjust to the normal, log-normal, gamma, gumbel and weibull probability distribution functions, and present a better adjustment to the normal probability function.

Probing the Hypothesis of SAR Continuity Restoration by the Removal of Activity Cliffs Generators in QSAR.

Science.gov (United States)

Cruz-Monteagudo, Maykel; Medina-Franco, José L; Perera-Sardiña, Yunier; Borges, Fernanda; Tejera, Eduardo; Paz-Y-Miño, Cesar; Pérez-Castillo, Yunierkis; Sánchez-Rodríguez, Aminael; Contreras-Posada, Zuleidys; Cordeiro, M Natália D S

2016-01-01

In this work we report the first attempt to study the effect of activity cliffs over the generalization ability of machine learning (ML) based QSAR classifiers, using as study case a previously reported diverse and noisy dataset focused on drug induced liver injury (DILI) and more than 40 ML classification algorithms. Here, the hypothesis of structure-activity relationship (SAR) continuity restoration by activity cliffs removal is tested as a potential solution to overcome such limitation. Previously, a parallelism was established between activity cliffs generators (ACGs) and instances that should be misclassified (ISMs), a related concept from the field of machine learning. Based on this concept we comparatively studied the classification performance of multiple machine learning classifiers as well as the consensus classifier derived from predictive classifiers obtained from training sets including or excluding ACGs. The influence of the removal of ACGs from the training set over the virtual screening performance was also studied for the respective consensus classifiers algorithms. In general terms, the removal of the ACGs from the training process slightly decreased the overall accuracy of the ML classifiers and multi-classifiers, improving their sensitivity (the weakest feature of ML classifiers trained with ACGs) but decreasing their specificity. Although these results do not support a positive effect of the removal of ACGs over the classification performance of ML classifiers, the "balancing effect" of ACG removal demonstrated to positively influence the virtual screening performance of multi-classifiers based on valid base ML classifiers. Specially, the early recognition ability was significantly favored after ACGs removal. The results presented and discussed in this work represent the first step towards the application of a remedial solution to the activity cliffs problem in QSAR studies.

The Hampstead Clinic at work. Discussions in the Diagnostic Profile Research Group.

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Koch, Ehud

2012-01-01

Minutes of the Hampstead Clinic's Diagnostic Profile Research Group during a fifteen-month period (1964-1965) are reviewed and discussed. A wide range of topics were considered and discussed, with a special focus on the affective life, object relations, and ego function of atypical children in comparison to the early ego functions and differentiation of normal and neurotic children. These lively clinical and theoretical discussions and their implications for therapeutic work with a wide range of children, demonstrate the multifaceted leadership and contributions of Anna Freud as teacher, clinician, and thinker, and of the Hampstead Clinic as a major center for psychoanalytic studies.

Adventure Counseling as an Adjunct to Group Counseling in Hospital and Clinical Settings

Science.gov (United States)

Gillen, Mark C.; Balkin, Richard S.

2006-01-01

Adventure counseling has been thought of as a highly specialized application of group counseling skills in a wilderness environment. In fact, adventure counseling is based on a developmental theory of group, can be useful for a variety of clients, and can be thoughtfully integrated into clinical and hospital settings. This article describes the…

La norma L1 como alternativa a la norma L2 en el ajuste de la regresión

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Carlos N. Bouza

2002-01-01

Full Text Available En este trabajo analizamos el desarrollo y los conceptos de las normas L1 y L2 y se comparan con algunos ejemplos. Por una parte la norma L1 es óptima bajo los supuestos de que los errores tienen la distribución de Laplace. Esta fue propuesta mucho antes que el MC, pero las facilidades de cómputo de éstos últimos le dieron primacía. Actualmente va adquiriendo gran importancia para las aplicaciones económicas, dado que en general los problemas de finanzas y de series temporales incumplen con las hipótesis usadas en el teorema de Gauss-Markoff. El uso de la norma L2, es el método de universal aceptación en el ajuste de la regresión. Sin embargo su optimalidad solo es válida bajo una serie de supuestos que no se cumplen en general (Teorema de Gaus- Markoff. Por lo tanto, norma L1 aparece como una alternativa mejor que la L2 en muchas aplicaciones dada su robustez ante las observaciones atípicas.

The genesis of 'the Neophytes': a writing support group for clinical nurses.

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Stone, Teresa; Levett-Jones, Tracy; Harris, Margaret; Sinclair, Peter M

2010-10-01

This paper profiles the establishment and evaluation of the Neophyte Writers' Group, run by nurse academics in collaboration with clinical nurses. The growing demand for nurses to write, publish and present their work had inspired the introduction of a series of workshops designed to develop and improve writing and presentation skills, which eventuated in formation of the Neophytes. The group was founded on the basis of Bandura's theory of self-efficacy (1997), a concept which has been discussed extensively in social psychology literature to explain motivation and learning theory. People with high assurance in their capabilities regard difficult tasks as challenges to be mastered rather than as threats to be avoided (Bandura, 1994). The Neophytes' group employs a collaborative approach intended to increase and reinforce members' self-confidence; the underlying philosophy is to promote and enhance writers' motivation, capacity and self-efficacy in order to achieve future publication goals confidently and independently. Support which engenders these strengths through a program relevant to participants' needs is likely, as this group found, to increase publication productivity. Additional unexpected outcomes resulted, such as engagement by clinical nurses' in academic work, and an increase in research higher degree enrolments. Copyright © 2010 Elsevier Ltd. All rights reserved.

A single mothers' group for mothers of children attending an outpatient psychiatric clinic: preliminary results.

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McNamee, J E; Lipman, E L; Hicks, F

1995-09-01

To provide a preliminary report of data from 2 support groups for single mothers, all of whom were mothers of children attending a child outpatient psychiatric clinic. The groups' 2 purposes were: 1. to assess the feasibility of adding structured evaluation to a common clinical intervention; 2. to improve single mothers' parenting skills through raised levels of self-esteem, increased capacity for family functioning and reduced levels of depression. Three structured evaluation instruments were used to measure the domains of self-esteem, family functioning and depression. These instruments were given to both groups of women on 3 occasions: 1. before the group; 2. after the group; 3. at a follow-up session 4 months after group termination. Open-ended questions were also asked at group termination. The questionnaire response rate was 100%; overall response rate for the 3 open-ended questions was 89%. Comparisons of pre-group and post-group scores showed that there was a significant increase in self-esteem (p parenting skills. Methodologic concerns and future directions are discussed.

Experimenting Clinical Pathways in General Practice: a Focus Group Investigation with Italian General Practitioners

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Zannini, Lucia; Cattaneo, Cesarina; Peduzzi, Paolo; Lopiccoli, Silvia; Auxilia, Francesco

2012-01-01

Background Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners’ (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment. Acknowledgments the Authors thank Dr. AP. Cantù and Dr D. Cereda who participated in the two focus groups as observers. PMID:25181354

Recommendations for Collection and Handling of Specimens From Group Breast Cancer Clinical Trials

Science.gov (United States)

Leyland-Jones, Brian R.; Ambrosone, Christine B.; Bartlett, John; Ellis, Matthew J.C.; Enos, Rebecca A.; Raji, Adekunle; Pins, Michael R.; Zujewski, Jo Anne; Hewitt, Stephen M.; Forbes, John F.; Abramovitz, Mark; Braga, Sofia; Cardoso, Fatima; Harbeck, Nadia; Denkert, Carsten; Jewell, Scott D.

2008-01-01

Recommendations for specimen collection and handling have been developed for adoption across breast cancer clinical trials conducted by the Breast International Group (BIG)-sponsored Groups and the National Cancer Institute (NCI)-sponsored North American Cooperative Groups. These recommendations are meant to promote identifiable standards for specimen collection and handling within and across breast cancer trials, such that the variability in collection/handling practices that currently exists is minimized and specimen condition and quality are enhanced, thereby maximizing results from specimen-based diagnostic testing and research. Three working groups were formed from the Cooperative Group Banking Committee, BIG groups, and North American breast cancer cooperative groups to identify standards for collection and handling of (1) formalin-fixed, paraffin-embedded (FFPE) tissue; (2) blood and its components; and (3) fresh/frozen tissue from breast cancer trials. The working groups collected standard operating procedures from multiple group specimen banks, administered a survey on banking practices to those banks, and engaged in a series of discussions from 2005 to 2007. Their contributions were synthesized into this document, which focuses primarily on collection and handling of specimens to the point of shipment to the central bank, although also offers some guidance to central banks. Major recommendations include submission of an FFPE block, whole blood, and serial serum or plasma from breast cancer clinical trials, and use of one fixative and buffer type (10% neutral phosphate-buffered formalin, pH 7) for FFPE tissue across trials. Recommendations for proper handling and shipping were developed for blood, serum, plasma, FFPE, and fresh/frozen tissue. PMID:18955459

Treating panic symptoms within everyday clinical settings: the feasibility of a group cognitive behavioural intervention

DEFF Research Database (Denmark)

Austin, S.F.; Sumbundu, A.D.; Lykke, J.

2008-01-01

of significant clinical change displayed and resources required to carry out the intervention. A small sample of GP-referred patients displaying panic symptoms completed a 2-week intensive cognitive-behavioural intervention. Results collected post-intervention revealed significant clinical reductions in panic......Panic disorder is a common and debilitating disorder that has a prevalence rate of 3-5% in the general population. Cognitive-behavioural interventions have been shown to be an efficacious treatment for panic, although a limited number of studies have examined the effectiveness of such interventions...... implemented in everyday clinical settings. The aim of the following pilot study was to examine the feasibility of a brief group cognitive-behavioural intervention carried out in a clinical setting. Salient issues in determining feasibility include: representativeness of patient group treated, amount...

Influência do tamanho e da rigidez dos objetos nos ajustes proximais e distais do alcance de lactentes Influence of object size and rigidity on proximal and distal adjustments to infant reaching

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NACF Rocha

2006-09-01

Full Text Available CONTEXTUALIZAÇÃO: Estudos têm identificado que as propriedades dos objetos induzem os ajustes no alcance; no entanto, poucos investigaram a influência específica do tamanho e rigidez dos objetos em lactentes jovens. OBJETIVO: Verificar se lactentes de 4 a 6 meses realizam ajustes proximais e distais ao alcançarem objetos de diferentes tamanhos e rigidez. MÉTODOS: Nove lactentes saudáveis foram posicionados em uma cadeira inclinada a 50º. Quatro objetos foram apresentados, um rígido grande (RG, um rígido pequeno (RP, um maleável grande (MG e um maleável pequeno (MP, por um período de 1 minuto cada. Em um total de 384 alcances, foram analisados os ajustes proximais (alcance uni e bimanual e distais (orientação da mão horizontal, vertical e oblíqua; mão aberta, fechada e semi-aberta e o sucesso do alcance dos objetos. RESULTADOS: Constatou-se ajuste bimanual para o objeto RG e unimanual para os demais. A orientação da mão oblíqua foi predominante no toque dos objetos, enquanto para a preensão dos mesmos, a predominância foi a vertical, principalmente para o objeto RG. A orientação horizontal não foi observada na preensão do objeto RG. A mão semi-aberta foi mais freqüente no início do alcance para todos os objetos, enquanto no toque do objeto RG a mão aberta foi predominante. O sucesso do alcance foi maior para os objetos maleáveis (MG, MP do que para os rígidos (RG e RP. CONCLUSÃO: Lactentes jovens estudados são capazes de planejar e ajustar seus movimentos baseados na percepção das propriedades físicas dos objetos, o que sugere interação percepção-ação.BACKGROUND: Studies have identified that object properties lead to adjustments to reaching. However, few have investigated the specific influence of object size and rigidity among young infants. OBJECTIVE: To verify whether four to six-month-old infants make proximal and distal adjustments when reaching for objects of different sizes and rigidity. METHOD

Clinical Characteristics of Chronic Perforated Otitis Media in Different Age Groups.

Science.gov (United States)

Hasegawa, Masayo; Shinnabe, Akihiro; Kanazawa, Hiromi; Iino, Yukiko; Yoshida, Naohiro

2017-08-01

We aimed to analyze preoperative and intraoperative clinical characteristics of chronic perforated otitis media by patient age. We analyzed 137 tympanoplasties for chronic perforated otitis media in 133 patients. Exclusion criteria were ear adhesions, cholesteatoma, and a history of tympanoplasty. Patients were divided into a younger group (aged 15-39 years), a middle group (40-64 years), and an elderly group (≥65 years). We compared tympanoplasty technique (using Wullstein classification), mastoid air-cell area measured by temporal bone computed tomography, preoperative aeration of the temporal bone, mean preoperative hearing (at 500 Hz, 1000 Hz, and 2000 Hz), and patch effect calculated by the pre- and post-patch air-bone gap at frequencies of 250 Hz and 500 Hz among the three age groups. Although type I tympanoplasty was performed most frequently in all age groups, it was performed significantly less often in the elderly group (pgroup (page groups (pgroups. The mean patch effect was significantly better in the younger group than in middle or elderly groups (p<0.05). The less pneumatized mastoid and ossicular diseases in elderly patients with chronic perforated otitis media suggest that they had longer lasting and more severe childhood middle ear pathologies than did younger patients.

Parenting Stress through the Lens of Different Clinical Groups: a Systematic Review & Meta-Analysis

Science.gov (United States)

Mendez, Lucybel; Graziano, Paulo A.; Bagner, Daniel M.

2017-01-01

Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress and child behavior problems among different clinical groups (i.e., ASD/DD, chronic illness, with or at-risk for behavioral and/or mood disorders). We also examined demographic and methodological variables as moderators and differences in overall levels of parenting stress between the clinical groups. This systematic review documents a link between parenting stress and child behavior problems with an emphasis on externalizing behavior. One-hundred thirty-three studies were included for quantitative analysis. Parenting stress was more strongly related to child externalizing (weighted ES r = 0.57, d = 1.39) than internalizing (weighted ES r = 0.37, d = 0.79) problems. Moderation analyses indicated that the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples. Overall, parenting stress levels were higher for parents of children with ASD/DD compared to parents of children from other clinical groups. Findings document the association between parenting stress and child behavior problems and highlight the importance of assessing parenting stress as part of routine care and throughout behavioral intervention programs, especially for groups of children at high risk for behavior problems, such as children with ASD/DD, in order to identify support for both the parent(s) and child. PMID:28555335

Clinical workplace learning: perceived learning value of individual and group feedback in a collectivistic culture.

Science.gov (United States)

Suhoyo, Yoyo; Schönrock-Adema, Johanna; Emilia, Ova; Kuks, Jan B M; Cohen-Schotanus, Janke

2018-04-19

Feedback is essential for workplace learning. Most papers in this field concern individual feedback. In collectivistic cultures, however, group feedback is common educational practice. This study was conducted to investigate the perceived learning value and characteristics of individual and group feedback in a collectivistic culture. During two weeks, on a daily basis, clerkship students (n = 215) from 12 clinical departments at Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, recorded individual and group feedback moments by using a structured form: the providers, focus and perceived learning value of feedback. Data were analysed with logistic regression and multilevel techniques. Students reported 2687 group and 1535 individual feedback moments. Group feedback more often focused on history taking, clinical judgment, patient management, patient counselling, and professional behaviour (OR ranging from 1.232, p cultures, group feedback may add to the array of educational measures that optimize student learning. Congruence between culture and type of feedback may be important for the effectiveness of feedback.

Resistance to group clinical supervision: A semistructured interview study of non-participating mental health nursing staff members.

Science.gov (United States)

Buus, Niels; Delgado, Cynthia; Traynor, Michael; Gonge, Henrik

2018-04-01

This present study is a report of an interview study exploring personal views on participating in group clinical supervision among mental health nursing staff members who do not participate in supervision. There is a paucity of empirical research on resistance to supervision, which has traditionally been theorized as a supervisee's maladaptive coping with anxiety in the supervision process. The aim of the present study was to examine resistance to group clinical supervision by interviewing nurses who did not participate in supervision. In 2015, we conducted semistructured interviews with 24 Danish mental health nursing staff members who had been observed not to participate in supervision in two periods of 3 months. Interviews were audio-recorded and subjected to discourse analysis. We constructed two discursive positions taken by the informants: (i) 'forced non-participation', where an informant was in favour of supervision, but presented practical reasons for not participating; and (ii) 'deliberate rejection', where an informant intentionally chose to not to participate in supervision. Furthermore, we described two typical themes drawn upon by informants in their positioning: 'difficulties related to participating in supervision' and 'limited need for and benefits from supervision'. The findings indicated that group clinical supervision extended a space for group discussion that generated or accentuated anxiety because of already-existing conflicts and a fundamental lack of trust between group members. Many informants perceived group clinical supervision as an unacceptable intrusion, which could indicate a need for developing more acceptable types of post-registration clinical education and reflective practice for this group. © 2017 Australian College of Mental Health Nurses Inc.

Atopic dermatitis in diverse racial and ethnic groups-Variations in epidemiology, genetics, clinical presentation and treatment.

Science.gov (United States)

Kaufman, Bridget P; Guttman-Yassky, Emma; Alexis, Andrew F

2018-04-01

Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects diverse ethnic groups with varying prevalence. Despite a predominance of studies in individuals of European ancestry, AD has been found to occur more frequently in Asian and Black individuals than Whites. Therefore, an understanding of the unique clinical features of AD in diverse ethnic groups, as well as the differences in genetic polymorphisms that influence susceptibility to AD and response to current therapies, is paramount for management of an increasingly diverse patient population. In this article, we review key nuances in the epidemiology, pathophysiology, clinical presentation and treatment of AD in non-White ethnic groups, which are largely underappreciated in the literature. We highlight the need for studies evaluating the tissue molecular and cellular phenotypes of AD in non-White patients, as well as greater inclusion of minority groups in clinical trials, to develop targeted treatments for a multi-ethnic population. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Monte Carlo electron-transport calculations for clinical beams using energy grouping

Energy Technology Data Exchange (ETDEWEB)

Teng, S P; Anderson, D W; Lindstrom, D G

1986-01-01

A Monte Carlo program has been utilized to study the penetration of broad electron beams into a water phantom. The MORSE-E code, originally developed for neutron and photon transport, was chosen for adaptation to electrons because of its versatility. The electron energy degradation model employed logarithmic spacing of electron energy groups and included effects of elastic scattering, inelastic-moderate-energy-loss-processes and inelastic-large-energy-loss-processes (catastrophic). Energy straggling and angular deflections were modeled from group to group, using the Moeller cross section for energy loss, and Goudsmit-Saunderson theory to describe angular deflections. The resulting energy- and electron-deposition distributions in depth were obtained at 10 and 20 MeV and are compared with ETRAN results and broad beam experimental data from clinical accelerators.

Clinical and immunological characteristics of hemorrhagic fever with renal syndrome in women of different age groups

Directory of Open Access Journals (Sweden)

Kutdusova A.M.

2012-09-01

Full Text Available Objective: To evaluate the clinical and immunological features of the hemorrhagic fever with renal syndrome in women of different age groups. Materials and methods: Clinical and laboratory characteristics of hemorrhagic fever with renal syndrome in 148 women aged 17 to 65 years old have been investigated. Patients have been divided into two groups: group I included 101 patients with normal menstrual rhythm, group II included 47 female patients with menopause. In 57 women (36 from group I, 21 — from group II the content of CD3+, CD4+, CD8+, CD16+, CD19+ — sub-populations of peripheral blood lymphocytes has been determined. Results: In compared groups significant differences in structure and frequency of complications of the disease have been revealed. Unidirectional tendency to increase significantly reduced absolute rates of investigated lymphocyte subpopulations in dynamics of the disease has been identified. It also has been stated that by the time of early convalescence in case of severe form of HFRS the indices did not reach the standard level. In an older group of women deeper damage and long-term recovery of immune system have been marked. Conclusion: According to the results of clinical and immunological studies the research work has revealed that in young women the response of the immune system to HFRS has developed faster and stronger than that in patients during the menopause period.

Ajuste de modelos de platô de resposta via regressão isotônica Response plateau models fitting via isotonic regression

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Renata Pires Gonçalves

2012-02-01

Full Text Available Dentro do contexto nutricional, a suplementação de microminerais em rações para aves frequentemente é feita em quantidades superiores às exigidas na tentativa de assegurar o bom desempenho dos animais. Os experimentos do tipo dose resposta são muito comuns na determinação de níveis ótimos dos nutrientes na ração e contemplam a utilização de modelos de regressão para atingir tal objetivo. Porém, na análise de regressão usual, geralmente, não se usa uma informação a priori sobre uma possível relação de ordem na variável resposta. A regressão isotônica é um método de estimação por mínimos quadrados que gera estimativas que satisfazem a mesma ordenação dos dados. Na teoria da regressão isotônica, essa informação é utilizada de forma essencial e espera-se que a eficiência do ajuste seja aumentada quando se faz uso dela. Diante do exposto, o presente trabalho tem como objetivo utilizar uma metodologia de regressão isotônica, como uma forma alternativa para analisar dados de deposição de zinco (Zn na tíbia de aves machos da linhagem Hubbard. No estudo, foram considerados os modelos de platô de resposta polinomial quadrático e não linear exponencial. Além desses modelos, também foi proposto o ajuste de um modelo logarítmico para os dados e a eficiência da metodologia foi avaliada por meio de um estudo de simulação Monte Carlo, considerando diferentes cenários para os valores paramétricos. A isotonização dos dados propiciou uma melhora em todos os avaliadores de qualidade de ajuste considerados no trabalho. Dentre os modelos utilizados, o logarítmico apresentou estimativas dos parâmetros mais coerentes com os valores relatados na literatura, para os dados de deposição de Zn na tíbia de aves machos.Within the nutritional context, the supplementation of microminerals in bird food is often made in quantities exceeding those required in the attempt to ensure the proper performance of the animals

Do clinical practice education groups result in sustained change in GP prescribing?

Science.gov (United States)

Richards, Dee; Toop, Les; Graham, Patrick

2003-04-01

Concern has been expressed at the poor uptake of evidence into clinical practice. This is despite the fact that continuing education is an embedded feature of quality assurance in general practice. There are a variety of clinical practice education methods available for dissemination of new evidence. Recent systematic reviews indicate that the effectiveness of these different strategies is extremely variable. Our aim was to determine whether a peer-led small group education pilot programme used to promote rational GP prescribing is an effective tool in changing practice when added to prescribing audit and feedback, academic detailing and educational bulletins, and to determine whether any effect seen decays over time. A retrospective analysis of a controlled trial of a small group education strategy with 24 month follow-up was carried out. The setting was an independent GPs association (IPA) of 230 GPs in the Christchurch New Zealand urban area. All intervention and control group GPs were already receiving prescribing audit and feedback, academic detailing and educational bulletins. The intervention group were the first 52 GPs to respond to an invitation to pilot the project. Two control groups were used, one group who joined the pilot later and a second group which included all other GPs in the IPA. The main outcome measures were targeted prescribing data for 12 months before and 24 months after each of four education sessions. An effect in the expected direction was seen in six of the eight key messages studied. This effect was statistically significant for five of the eight messages studied. The effect size varied between 7 and 40%. Where a positive effect was seen, the effect decayed with time but persisted to a significant level for 6-24 months of observation. The results support a positive effect of the education strategy on prescribing behaviour in the intervention group for most outcomes measured. The effect seen is statistically significant, sustained and

[Role of multicenter study groups for clinical research in hematology and oncology].

Science.gov (United States)

Gökbuget, N; Hoelzer, D

2009-04-01

During the past 25 years a highly effective infrastructure for clinical trials was developed in hematology. Following initial funding by the BMFT (Ministry for Research and Technology) a number of large multicenter study groups for leukemia and lymphoma were developed. Treatment results from these studies often represent the"gold standard". However, since no standard therapy is defined for these diseases, the study groups aim to treat all patients within treatment optimization trials (TOT) to combine research and care. They contribute considerably to quality control in therapy and diagnostics, e.g., by establishing central reference laboratories. The regulatory requirements for clinical trials were extended considerably after the activation of the 12th drug law and TOTs now have to fulfill requirements similar to registration trials in the pharmaceutical industry. Due to the considerable bureaucratic effort and increased costs, only few large multicenter trials could thereafter be initiated and a substantial disadvantage for independent academic research becomes clearly evident.

Undetected angle closure in patients with a diagnosis of open-angle glaucoma.

Science.gov (United States)

Varma, Devesh K; Simpson, Sarah M; Rai, Amandeep S; Ahmed, Iqbal Ike K

2017-08-01

The aim of this study was to identify the proportion of patients referred to a tertiary glaucoma centre with a diagnosis of open-angle glaucoma (OAG) who were found to have angle closure glaucoma. Retrospective chart review. Consecutive new patients referred for glaucoma management to a tertiary centre between July 2010 and December 2011 were reviewed. Patients whose referrals for glaucoma assessment specified angle status as "open" were included. The data collected included glaucoma specialist's angle assessment, diagnosis, and glaucoma severity. The status of those with 180 degrees or more Shaffer angle grading of 0 was classified as "closed." From 1234 glaucoma referrals, 179 cases were specified to have a diagnosis of OAG or when angles were known to be open. Of these, 16 (8.9%) were found on examination by the glaucoma specialist to have angle closure. Pseudoexfoliation was present in 4 of 16 patients (25%) in the missed angle-closure glaucoma (ACG) group and 22 of 108 patients (13.5%) in the remaining OAG group. There was no difference found in demographic or ocular biometric parameters between those with confirmed OAG versus those with missed ACG. Almost 1 in 11 patients referred by ophthalmologists to a tertiary glaucoma centre with a diagnosis of OAG were in fact found to have angle closure. Given the different treatment approaches for ACG versus OAG, this study suggests a need to strengthen angle evaluations. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

What to Expect During a Colonoscopy

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What to Expect During a Colonoscopy

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Linear study and bundle adjustment data fusion; Application to vision localization; Recherche lineaire et fusion de donnees par ajustement de faisceaux; Application a la localisation par vision

Energy Technology Data Exchange (ETDEWEB)

Michot, J.

2010-12-09

integrate this additional information directly into an extended bundle adjustment, by adding a constraint term in the weighted cost function. We evaluate three methods (based on machine learning or regularization) that dynamically select the weight associated to the constraint and show that these methods can be used in a real time multi-sensor SLAM, and validate them with different types of constraint on the orientation or on the scale. Experiments conducted on real video sequences show that this technique of constrained bundle adjustment reduces the drifts observed with the classical vision algorithms and improves the global accuracy of the positioning system. (author) [French] Les travaux presentes dans ce manuscrit concernent le domaine de la localisation et la reconstruction 3D par vision artificielle. Dans ce contexte, la trajectoire d'une camera et la structure 3D de la scene filmee sont initialement estimees par des algorithmes lineaires puis optimisees par un algorithme non-lineaire, l'ajustement de faisceaux. Cette these presente tout d'abord une technique de recherche de l'amplitude de deplacement (recherche lineaire), ou line search pour les algorithmes de minimisation iterative. La technique proposee est non iterative et peut etre rapidement implantee dans un ajustement de faisceaux traditionnel. Cette technique appelee recherche lineaire algebrique globale (G-ALS), ainsi que sa variante a deux dimensions (Two way-ALS), accelerent la convergence de l'algorithme d'ajustement de faisceaux. L'approximation de l'erreur de reprojection par une distance algebrique rend possible le calcul analytique d'une amplitude de deplacement efficace (ou de deux pour la variante Two way-ALS), par la resolution d'un polynome de degre 3 (G-ALS) ou 5 (Two way-ALS). Nos experimentations sur des donnees simulees et reelles montrent que cette amplitude, optimale en distance algebrique, est performante en distance euclidienne, et permet

Effectiveness of group cognitive–behavioral treatment for childhood anxiety disorders in community clinics: benchmarking against an efficacy trial at a university clinic

DEFF Research Database (Denmark)

Jónsson, Hjalti; Arendt, Kristian Bech; Jørgensen, Lisbeth

in Denmark (Arendt & Thastum, 2013). Objective: To evaluate the outcomes of evidence based, manualized group cognitive-behavioural treatment (CBT) for children and adolescent with anxiety disorders, when delivered in an outpatient Child and Adolescent Psychiatry or in a community based School Counselling...... Service in Denmark. Method: Psychologists and psychiatrists from three Child and Adolescent Psychiatry clinics and four community bases School Counselling Services are trained and supervised in a manualized group CBT treatment program (Cool Kids) for Childhood anxiety. Ninety-six children with anxiety...... disorders aged between 7 - 14 are expected to be included, equally divided between Psychiatric clinics (n = 48) and School Counselling services (n =48). The treatment consists of 10 2-hour group sessions with 5-6 children and their parents. Results are measured by independent diagnostic interviews...

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Los Programas de Desarrollo Rural en la Argentina (en el contexto del ajuste macroeconómico neoliberal

Directory of Open Access Journals (Sweden)

Mabel Manzanal

2000-09-01

Full Text Available Este trabajo expone las estrategias de los principales programas de desarrollo rural en la Argentina, y sus alcances y posibilidades en el contexto del ajuste macroeconómico neoliberal. Discute si se están dando, o no, los cursos de acción adecuados, y si es viable la asistencia a los pobres rurales, promovida por los organismos internacionales de financiamiento, frente al impacto negativo de las políticas neoliberales sobre los pequeños y medianos productores agropecuarios.El desarrollo rural se inicia en la Argentina junto con la recuperación democrática de la década del 80, pero las primeras acciones recién comienzan a ejecutarse a principios de los 90. Desde entonces se sucedieron y se superpusieron diferentes programas, que son el objeto de este artículoThis paper discusses the strategies of Argentina’s main rural development programs, and their accomplishments and possibilities in the context of neoliberal macroeconomic adjustment. It analyzes whether the actions being carried out are suitable and whether assistance to the rural poor (promoted by international financing organizations is feasible in the face of the neoliberal policies’ negative impact on small and intermediate farmers and ranchers. Although rural development programs began in Argentina with the restoration of democracy in the 1980s, the first significant actions were not taken until the 1990s. The different programs that have followed, often overlapping, are the object of our study

Group Cognitive-Behavioral Therapy for Insomnia in a VA Mental Health Clinic

Science.gov (United States)

Perlman, Lawrence M.; Arnedt, J. Todd; Earnheart, Kristie L.; Gorman, Ashley A.; Shirley, Katherine G.

2008-01-01

Effective cognitive-behavioral therapies for insomnia have been developed over the past 2 decades, but they have not been systematically evaluated in some clinical settings. While insomnia is common among veterans with mental health problems, the availability of effective treatments is limited. We report on the group application of a…

Carbapenem Breakpoints for Acinetobacter baumannii Group: Supporting Clinical Outcome Data from Patients with Bacteremia.

Science.gov (United States)

Lee, Yi-Tzu; Chiang, Mei-Chun; Kuo, Shu-Chen; Wang, Yung-Chih; Lee, I-Hsin; Chen, Te-Li; Yang, Ya-Sung

2016-01-01

The carbapenem breakpoints set by different organizations for Acinetobacter are discordant, but supporting clinical data are lacking. This study aimed to provide the first clinical outcome data to support the carbapenem breakpoints for Acinetobacter baumannii (Ab) group in patients with bacteremia. This study included 117 adults who received carbapenems for treatment of Ab group bacteremia in Taipei Veterans General Hospital over an 8-year period. We analyzed 30-day mortality rates among patient groups acquiring isolates with different carbapenem minimal inhibitory concentrations (MICs). The carbapenem MIC breakpoint derived from classification and regression tree (CART) analysis to delineate the risk of 30-day mortality was between MICs of ≤ 4 mg/L and ≥ 8 mg/L. Mortality rate was higher in patients acquiring isolates with carbapenem MIC ≥ 8 mg/L than ≤ 4 mg/L, by bivariate (54.9% [28/51] vs 25.8% [17/66]; P = 0.003) and survival analysis (P = 0.001 by log-rank test). Multivariate analysis using logistic regression and Cox regression models including severity of illness indices demonstrated that treating patients with Ab group bacteremia caused by isolates with a carbapenem MIC ≥ 8 mg/L with carbapenem was an independent predictor of 30-day mortality (odds ratio, 5.125; 95% confidence interval [CI], 1.946-13.498; P = 0.001, and hazard ratio, 2.630; 95% CI, 1.431-4.834; P = 0.002, respectively). The clinical outcome data confirmed that isolates with MIC ≤ 4 mg/L were susceptible to carbapenem, and those with MIC ≥ 8 mg/L were resistant in patients with Ab group bacteremia.

RETIRO LABORAL Y AJUSTE A LA JUBILACIÓN DE HOMBRES Y MUJERES EN LA MEDIANA EDAD (WORK RETIREMENT AND ADJUSTMENT TO RETIREMENT OF MEN AND WOMEN IN THE MIDDLE-AGED

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Cruz Meléndez Roxana

2011-04-01

Full Text Available Resumen:En este artículo se presentan los resultados de una investigación aplicada cuyo objeto de estudio fue un grupo de hombres exfuncionarios y mujeres exfuncionarias del área administrativa de la Universidad de Costa Rica (UCR que se encuentran en la etapa de vida denominada “la mediana edad” y que enfrentan el proceso trabajo-retiro laboral. El estudio consistió en identificar los principales factores que inciden en el retiro laboral a una edad más temprana; la viviencia del proceso, el ajuste a la jubilación y sus implicaciones a nivel personal y social. La información recopilada se obtuvo a partir de la técnica “la entrevista fenomenológica” concebida como una exploración profunda que proporciona datos de gran valor conceptual y humana; en ella, tanto la persona que entrevista como la entrevistada mantienen un compromiso para que la búsqueda de la información sea dentro de una relación empática. Partiendo de lo subjetivo por su historia de vida al mandato social por lo roles asignados y asumidos por la población en estudio. Los resultados obtenidos indican que pareciera que la valoración que cada uno de los participantes hace de su rol laboral y el significado del trabajo en sus vidas es determinante en el proceso de retiro laboral y su ajuste al rol de persona jubilada.Abstract: This article presents the results of applied research study that was aimed at a group of men and women, former administrative staff of the University of Costa Rica that are in the stage of life called middle age and facing work-retirement process work. The study consist in identify the main factors affecting the removal from work at a younger age, the experiencing process, adjustment to retirement and its implications for personal and social level. Information collected was obtained from the technique "the phenomenological interview “conceived as a deep exploration that provides valuable data conceptual and human, in her interview both

1Department of Finance, University of Ilorin

African Journals Online (AJOL)

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2017-03-15

Mar 15, 2017 ... in food crops as a function of changes in ACGS, this paper examines the influence of changes in ACGS ... Rights in 1948 (UN, 1999; Ijaiya, 2016), the Federal ..... Women: Lessons from Rural Asia, ... World Review of Business.

Cognitive-behavioral group therapy in obsessive-compulsive disorder: a clinical trial

Directory of Open Access Journals (Sweden)

Cordioli Aristides V

2002-01-01

Full Text Available Objective: To develop a cognitive-behavioral group therapy protocol and to verify its efficacy to reduce obsessive-compulsive symptoms. Methods: An open clinical trial with 32 obsessive-compulsive patients was performed, in which a cognitive-behavioral group therapy protocol of 12 weekly sessions of two hours, in 5 consecutive groups, was applied. The severity of symptoms was rated with the Yale-Brown Obsessive-Compulsive (Y-BOCS, Hamilton Anxiety (HAM A and Hamilton Depression (HAM D scales. The patients were followed up for 3 months after the end of the treatment. Results: There was a significant reduction in the scores of Y-BOCS, HAM A and HAM D scales with the treatment regardless the use of anti-obsessive medications. The rate of improved patients (decrease of > or = 35% in Y-BOCS was 78.1%. Two patients (6.25% dropped out from the study. The effect size calculated for the Y-BOCS scale was 1.75. Conclusions: This study suggests that cognitive-behavioral group therapy reduces obsessive-compulsive symptoms. In addition, patients presented good compliance.

[Clinical characteristics of patients with workplace-associated mood disorder --comparison with non-workplace-associated group].

Science.gov (United States)

Okazaki, Tsubasa; Kato, Satoshi

2011-01-01

The purpose of this study was to describe the clinical characteristics of patients with workplace-associated mood disorder. We conducted a clinical survey involving 84 clinical cases (regular employees suffering from mood disorder) who were hospitalized in the Psychiatry Department of Jichi Medical University Hospital, for a period over 8 years and 4 months between April 1st, 2000 and July 31st, 2008. The size of the workplace-associated group as a percentage of those patients in whom the onset of the symptom was occasioned by an evident issue at their workplace was 65%. This rate accounted for 74% of the total patients if clinical cases in which an evident issue at the workplace served as a significant trigger for the symptom were added to these patients in the case of an initial episode in the "non-workplace associated group". In the workplace-associated group, cases in which the premorbid character was a "depression-related personality" comprised only 42%, and was noticeably characterized by a perfection-oriented habit, enthusiastic character, conformity with other people, etc. Furthermore, the percentage of patients who were diagnosed with a "depression-related personality" comprised only 59% of the "overworked group", in which a heavy workload was evident in the workplace-associated group. In the workplace-associated group, the percentage of cases involving managerial workers was significantly high; their rate as initial cases was significantly high, as well the proportion of favorable outcomes. In the workplace-associated group, the percentage of patients who showed unambiguous depression at the initial stage was significantly low. Likewise, a similar result was obtained in the overworked group. Workplace-associated mood disorder today tends to have a stress-related aspect, or aspect of adjustment disorder. There was a period in many cases during which the main symptoms were insomnia, headache, panic attack, etc., prior to the onset of unambiguous depression

COSTA RICA EN LA ENCRUCIJADA: LOS LÍMITES DEL AJUSTE ESTRUCTURAL Y LOS URGENTES DESAFÍOS DE LA REFORMA ECONÓMICA Y SOCIAL

Directory of Open Access Journals (Sweden)

Henry Manuel Mora Jiménez

2011-09-01

Full Text Available Aunque en Costa Rica no se ha seguido en los últimos quince años una política económica neoliberal a ultranza, sino una “a la tica”; todo el debate económico y el accionar del sector público durante este período ha sido permeable a la lógica del ajuste estructural. Pero la actual encrucijada obliga a “tirios y troyanos”, a críticos y defensores del ajuste, a superar este enfoque aún predominante. Independientemente de los logros y fracasos acumulados desde 1983 hasta la fecha, en el campo económico y social, el país debe, urgentemente, realizar un “viraje estratégico”, pues la sensación de estancamiento o lento crecimiento de los últimos años se ha convertido en cruda realidad, con el agravante de que ya no podemos seguir viviendo del pasado. En el texto se aborda la problemática nacional en las siguientes cinco áreas:Estabilidad macroeconómica: sin ser artificial, continúa siendo frágil, dependiente en alto grado de la entrada de capitales externos y arrastrando una crisis fiscal latente que recurrentemente estalla. Esto en gran parte se explica por los rasgos de inestabilidad estructural que aun persisten.Gobernabilidad y Reforma del Estado: el estilo de gobernabilidad moldeada durante el período 1950-1975 ya no es viable, y la vacilante reforma del Estado está contribuyendo solo de manera precaria a construir nuevas formas de gobernabilidad acordes con las exigencias de las modernas sociedades democráticas. La gran tarea por delante es reconstruir un Estado estratégico y solidario; que facilite la irrupción de la sociedad civil en la vida pública nacional.Transformación productiva y competitividad: avanza, pero sin un rumbo claro y seguro, pues se adolece de una estrategia nacional de desarrollo de la competitividad internacional, que supere prácticas anticuadas de intervención estatal y viejos pero maquillados dogmas antiestatales que conducen a visiones parciales sobre el papel de las empresas y del

ABO blood groups and oral premalignancies: A clinical study in selected Indian population.

Science.gov (United States)

Bhateja, S; Arora, G

2014-01-01

Background: The ABO blood group antigens are present on the surface of red blood cells and various epithelial cells. As the majority of human cancers are derived from epithelial cells, changes in blood group antigens constitute an important aspect of human cancers. The aim of the study was to establish clinical usefulness of ABO blood group as a predisposing factor in early diagnosis and management of patients with oral precancerous lesions/conditions. Materials and Methods: The study sample consisted of 50 control and 50 oral precancer (25 leukoplakia and 25 Oral Submucous Fibrosis) confirmed by histopathologic examination. All samples were subjected to blood group testing and their prevalence was compared by Z-test using STATA version 8. Results: The "A" blood group was prevalent among the precancerous group. Significant differences on prevalences of blood groups were found (P blood group. Conclusion: Blood group type should be considered along with other risk factors to understand the individual patient's risk and further studies in larger samples with inclusion of Rh factor is needed to elucidate the relationship with ABO blood group types.

Cálculo, mediante la aplicación del algoritmo de ajuste por mínimos cuadrados, de los componentes de velocidad para estaciones GNSS continuas

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Jorge Moya Zamora

2014-07-01

Full Text Available El cálculo de la velocidad de una estación de observación continua GNSS representa un insumo fundamental en la geodesia moderna. El hecho de determinar la posición de las estaciones GNSS de forma diaria implica que se puedan establecer las series temporales de las estaciones, con base en las cuales se puede obtener información de la influencia de fenómenos que afecten el comportamiento de estas. En este artículo se plantea una descripción del algoritmo de ajuste por mínimos cuadrados adaptado y aplicado a la determinación de los componentes de velocidad de estaciones de observación continua. Además, se aplica este algoritmo para la calcular la velocidad de la estación ETCG, perteneciente al Sistema Geocéntrico para las Américas (SIRGAS.

Ajuste empírico da curva de calibração do termopar Chromel-Alumel através de calçuladoras programáveis

Directory of Open Access Journals (Sweden)

Klemensas Rimgaudas Juraitis

1982-11-01

Full Text Available Computation of polynomial regression with precision is possible with some programmable calculators. In this paper, a program of a polynomial regression, using a Texas 77-59 pocket calculator, is presented in a didactic manner. The method is exemplified by means of fitting data of a curve of calibration for Chromel-Alumel thermocouple in the temperature range between CR c and J. 2009 C.Uma regressão polonomial pode ser utilizada com precisão, utilizando-se certas calculadoras programáveis. No presente trabalho apresenta-se, da maneira didática, um programa de regressão polinomial, usando-se uma calculadora programável Texas Tl-59, exemplificando-se o método através do ajuste de uma curva de calibração de um termopar Chromel-Alumel na faixa de temperatura de 0 a 1200 graus centígrados.

Experimenting clinical pathways in general practice: a focus group investigation with Italian general practitioners

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Lucia Zannini

2012-07-01

Full Text Available Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB, Italy, to develop general practitioners’ (GPs care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i clinical pathways can result in GPs working in a more efficient and effective fashion; ii they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.

Epidemiology, Clinical Characteristics, and Antimicrobial Susceptibility Profiles of Human Clinical Isolates of Staphylococcus intermedius Group.

Science.gov (United States)

Yarbrough, Melanie L; Lainhart, William; Burnham, C A

2018-03-01

The veterinary pathogens in the Staphylococcus intermedius group (SIG) are increasingly recognized as causes of human infection. Shared features between SIG and Staphylococcus aureus may result in the misidentification of SIG in human clinical cultures. This study examined the clinical and microbiological characteristics of isolates recovered at a tertiary-care academic medical center. From 2013 to 2015, 81 SIG isolates were recovered from 62 patients. Patients were commonly ≥50 years old, diabetic, and/or immunocompromised. Documentation of dog exposure in the electronic medical record was not common. Of the 81 SIG isolates, common sites of isolation included 37 (46%) isolates from wound cultures and 17 (21%) isolates from respiratory specimens. Although less common, 10 (12%) bloodstream infections were documented in 7 unique patients. The majority of SIG (65%) isolates were obtained from polymicrobial cultures. In comparison to S. aureus isolates from the same time period, significant differences were noted in proportion of SIG isolates that were susceptible to doxycycline (74% versus 97%, respectively; P SIG isolates. All MR isolates detected by an oxacillin disk diffusion test would have been misclassified as methicillin susceptible using a cefoxitin disk diffusion test. Thus, SIG is recovered from human clinical specimens, and distinction of SIG from S. aureus is critical for the accurate characterization of MR status in these isolates. Copyright © 2018 American Society for Microbiology.

Psychiatric hospital nursing staff's experiences of participating in group-based clinical supervision:

DEFF Research Database (Denmark)

Buus, Niels; Angel, Sanne; Traynor, Michael

2010-01-01

Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses' experiences of participating in groupbased supervision and identifying psychosocial...... reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense...... of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses....

Patient Engagement Practices in Clinical Research among Patient Groups, Industry, and Academia in the United States: A Survey.

Directory of Open Access Journals (Sweden)

Sophia K Smith

Full Text Available Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed.Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions.Survey respondents (n = 179 valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p < .001. Patient group respondents placed higher value in open communications, clear expectations, and detailed contract execution than did non-patient group respondents (all p < .05. Industry and academic respondents more often cited internal bureaucratic processes and reluctance to share information as engagement barriers than did patient group respondents (all p < .01. Patient groups reported that a lack of transparency and understanding of the benefits of collaboration on the part of industry and academia were greater barriers than did non-patient group respondents (all p< .01.Despite reported similarities among approaches to engagement by the three stakeholder groups, key differences exist in perceived barriers and benefits to partnering with patient groups among the

What to Expect During a Colonoscopy

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Ausentismo y producción: el esquema de ajuste de primas por siniestralidad observada aplicado al seguro de salud en Francia

Directory of Open Access Journals (Sweden)

Sébastien Ménard

2018-01-01

Full Text Available En este trabajo se analizan los efectos de la introducción de un esquema de ajuste (experience rating en las contribuciones patronales al seguro de salud. Para ello, se desarrolla un modelo de búsqueda y emparejamiento en un mercado de trabajo segmentado. En el segmento donde los empleos son más riesgosos, las ausencias por enfermedad son más frecuentes y la producción media es más baja. El modelo es calibrado para Francia y los resultados de las simulaciones muestran que la introducción de este esquema mejora levemente la producción y el empleo. En términos cuantitativos, una variación del 1 % en la tasa de experience rating induce una reducción de 0,48 % en la duración del desempleo y de 1,07 % en los días de ausencia, así como un aumento de 0,1 % en la producción. Finalmente, se encuentra que esta política conduce también a un desempeño económico ligeramente mejor que la privatización del seguro de salud

[Study of continuous quality improvement for clinical laboratory processes via the platform of Hospital Group].

Science.gov (United States)

Song, Wenqi; Shen, Ying; Peng, Xiaoxia; Tian, Jian; Wang, Hui; Xu, Lili; Nie, Xiaolu; Ni, Xin

2015-05-26

The program of continuous quality improvement in clinical laboratory processes for complete blood count (CBC) was launched via the platform of Beijing Children's Hospital Group in order to improve the quality of pediatric clinical laboratories. Fifteen children's hospitals of Beijing Children's Hospital group were investigated using the method of Chinese adapted continuous quality improvement with PDCA (Plan-Do-Check-Action). The questionnaire survey and inter-laboratory comparison was conducted to find the existing problems, to analyze reasons, to set forth quality targets and to put them into practice. Then, targeted training was conducted to 15 children's hospitals and the second questionnaire survey, self examinations by the clinical laboratories was performed. At the same time, the Group's online internal quality control platform was established. Overall effects of the program were evaluated so that lay a foundation for the next stage of PDCA. Both quality of control system documents and CBC internal quality control scheme for all of clinical laboratories were improved through this program. In addition, standardization of performance verification was also improved, especially with the comparable verification rate of precision and internal laboratory results up to 100%. In terms of instrument calibration and mandatory diagnostic rates, only three out of the 15 hospitals (20%) failed to pass muster in 2014 from 46.67% (seven out of the 15 hospitals) in 2013. The abnormal data of intraday precision variance coefficients of the five CBC indicator parameters (WBC, RBC, Hb, Plt and Hct) of all the 15 laboratories accounted for 1.2% (2/165) in 2014, a marked decrease from 9.6% (14/145) in 2013. While the number of the hospitals using only one horizontal quality control object for daily quality control has dropped to three from five. The 15 hospitals organized a total of 263 times of training in 2014 from 101 times in 2013, up 160%. The quality improvement program for

The skeletal phenotype of achondrogenesis type 1A is caused exclusively by cartilage defects.

Science.gov (United States)

Bird, Ian M; Kim, Susie H; Schweppe, Devin K; Caetano-Lopes, Joana; Robling, Alexander G; Charles, Julia F; Gygi, Steven P; Warman, Matthew L; Smits, Patrick J

2018-01-08

Inactivating mutations in the ubiquitously expressed membrane trafficking component GMAP-210 (encoded by Trip11 ) cause achondrogenesis type 1A (ACG1A). ACG1A is surprisingly tissue specific, mainly affecting cartilage development. Bone development is also abnormal, but as chondrogenesis and osteogenesis are closely coupled, this could be a secondary consequence of the cartilage defect. A possible explanation for the tissue specificity of ACG1A is that cartilage and bone are highly secretory tissues with a high use of the membrane trafficking machinery. The perinatal lethality of ACG1A prevents investigating this hypothesis. We therefore generated mice with conditional Trip11 knockout alleles and inactivated Trip11 in chondrocytes, osteoblasts, osteoclasts and pancreas acinar cells, all highly secretory cell types. We discovered that the ACG1A skeletal phenotype is solely due to absence of GMAP-210 in chondrocytes. Mice lacking GMAP-210 in osteoblasts, osteoclasts and acinar cells were normal. When we inactivated Trip11 in primary chondrocyte cultures, GMAP-210 deficiency affected trafficking of a subset of chondrocyte-expressed proteins rather than globally impairing membrane trafficking. Thus, GMAP-210 is essential for trafficking specific cargoes in chondrocytes but is dispensable in other highly secretory cells. © 2018. Published by The Company of Biologists Ltd.

Focus group interviews examining the contribution of intellectual disability clinical nurse specialists in Ireland.

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Doody, Owen; Slevin, Eamonn; Taggart, Laurence

2017-10-01

To explore the contribution of clinical nurse specialists in intellectual disability nursing in Ireland. While clinical nurse specialists exist since the 1940s, they have only been a reality in Ireland since 2001. While the role of clinical nurse specialist has developed over the years, it still however is often seen as a complex multifaceted role that causes confusion, frustration and controversy. A exploratory qualitative approach using focus groups with Irish intellectual disability clinical nurse specialists (n = 31). Five focus group interviews were conducted to gather qualitative data to gain insight into the attitudes, perceptions and opinions of the participants. Data were audio-recorded, transcribed and analysed using Burnard's (Vital Notes for Nurses: Research for Evidence-Based Practice in Healthcare, 2011, Blackwell Publishing, Oxford) framework. Ethical approval was gained from the researcher's university and access granted by the national council for the professional development of nursing/midwifery in Ireland. The study highlights that intellectual disability clinical nurse specialists contribute to and support care delivery across a range of areas including client-focused and family-centred care, staff support, organisation support, community support and supporting other agencies. Overall, the study shows the importance of intellectual disability clinical nurse specialists and their contribution across a range of services, care environments and the support they offer to clients/families/staff/multidisciplinary team members and outside agencies. Ireland is in a unique position to develop knowledge regarding specialist care for people with intellectual disability that can be shared and adapted by other healthcare professionals in other countries that do not have specialised intellectual disability nurses. © 2016 John Wiley & Sons Ltd.

Mobile Health (mHealth) Versus Clinic-Based Group Intervention for People With Serious Mental Illness: A Randomized Controlled Trial.

Science.gov (United States)

Ben-Zeev, Dror; Brian, Rachel M; Jonathan, Geneva; Razzano, Lisa; Pashka, Nicole; Carpenter-Song, Elizabeth; Drake, Robert E; Scherer, Emily A

2018-05-25

mHealth approaches that use mobile phones to deliver interventions can help improve access to care for people with serious mental illness. The goal was to evaluate how mHealth performs against more traditional treatment. A three-month randomized controlled trial was conducted of a smartphone-delivered intervention (FOCUS) versus a clinic-based group intervention (Wellness Recovery Action Plan [WRAP]). Participants were 163 clients, mostly from racial minority groups and with long-term, serious mental illness (schizophrenia or schizoaffective disorder, 49%; bipolar disorder, 28%; and major depressive disorder, 23%). Outcomes were engagement throughout the intervention; satisfaction posttreatment (three months); and improvement in clinical symptoms, recovery, and quality of life (assessed at baseline, posttreatment, and six months). Participants assigned to FOCUS were more likely than those assigned to WRAP to commence treatment (90% versus 58%) and remain fully engaged in eight weeks of care (56% versus 40%). Satisfaction ratings were comparably high for both interventions. Participants in both groups improved significantly and did not differ in clinical outcomes, including general psychopathology and depression. Significant improvements in recovery were seen for the WRAP group posttreatment, and significant improvements in recovery and quality of life were seen for the FOCUS group at six months. Both interventions produced significant gains among clients with serious and persistent mental illnesses who were mostly from racial minority groups. The mHealth intervention showed superior patient engagement and produced patient satisfaction and clinical and recovery outcomes that were comparable to those from a widely used clinic-based group intervention for illness management.

A Comparative Study of Deep Neck Abscess with Regards to Anatomical Location and Age Groups Using CT and Clinical Data

International Nuclear Information System (INIS)

Park, Chan Ho; Han, Jong Kyu; Kim, Young Tong; Shin, Hyeong Cheol; Kim, Hyung Hwan; Jou, Sung Shick

2012-01-01

To evaluate differences anatomical location and age groups on CT and clinical data in deep neck abscess. This study included 200 patients who underwent CT and were diagnosed with a deep neck abscess, from December 2005 to July 2010. Patients were divided into four groups by age (children, adolescent, adult, elderly). Next, the anatomic location, location multiplicity and clinical data regarding the deep neck abscesses were analyzed retrospectively. The deep neck abscesses observed were defined as superficial or deep and partitioned into sub-groups, with further analysis of their clinical data. The incidence of the parapharyngeal abscess was more frequent in children and elderly groups (p < 0.05). The masticator abscess was only observed among patients in the elderly group (p < 0.05). Multiple locations were observed with increased frequency in children and elderly groups (p < 0.05). Swelling in the neck was more frequently observed in children and elderly groups (p < 0.05), cervical lymphadenitis was frequently seen in children and adolescent groups (p < 0.05), and the incidence of symptoms including sore throat were significantly increased in adolescent and adult groups (p < 0.05). Location multiplicity was significantly higher in parapharyngeal, retropharyngeal, submandibular, danger, visceral and masticator spaces than other spaces (p < 0.05). With regards to anatomic location, neck swelling was more frequent in superficial group and sore throat was more frequent in deep group (p < 0.05). Deep neck abscess would show significant differences with regards to the abscess location, location multiplicity, and clinical symptoms according to age. The clinical symptoms observed are dependent on the anatomic location as defined by a superficial or deep abscess.

Privacy enhanced group communication in clinical environment

Science.gov (United States)

Li, Mingyan; Narayanan, Sreeram; Poovendran, Radha

2005-04-01

Privacy protection of medical records has always been an important issue and is mandated by the recent Health Insurance Portability and Accountability Act (HIPAA) standards. In this paper, we propose security architectures for a tele-referring system that allows electronic group communication among professionals for better quality treatments, while protecting patient privacy against unauthorized access. Although DICOM defines the much-needed guidelines for confidentiality of medical data during transmission, there is no provision in the existing medical security systems to guarantee patient privacy once the data has been received. In our design, we address this issue by enabling tracing back to the recipient whose received data is disclosed to outsiders, using watermarking technique. We present security architecture design of a tele-referring system using a distributed approach and a centralized web-based approach. The resulting tele-referring system (i) provides confidentiality during the transmission and ensures integrity and authenticity of the received data, (ii) allows tracing of the recipient who has either distributed the data to outsiders or whose system has been compromised, (iii) provides proof of receipt or origin, and (iv) can be easy to use and low-cost to employ in clinical environment.

Clinical use of the Kessler psychological distress scales with culturally diverse groups.

Science.gov (United States)

Stolk, Yvonne; Kaplan, Ida; Szwarc, Josef

2014-06-01

The Kessler 10 (K10) and embedded Kessler 6 (K6) was developed to screen for non-specific psychological distress and serious mental illness in mental health surveys of English-speaking populations, but has been adopted in Western and non-Western countries as a screening and outcome measure in primary care and mental health settings. This review examines whether the original K6/K10's validity for culturally diverse populations was established, and whether the cultural equivalence, and sensitivity to change of translated or culturally adapted K6/K10s, has been demonstrated with culturally diverse client groups. Evidence for the original K6/K10's validity for culturally diverse populations is limited. Questions about the conceptual and linguistic equivalence of translated/adapted K6/K10s arise from reports of changes in item connotation and differential item functioning. Evidence for structural equivalence is inconsistent, as is support for criterion equivalence, with the majority of studies compromising on accuracy in case prediction. Research demonstrating sensitivity to change with culturally diverse groups is lacking. Inconsistent evidence for the K6/K10's cultural appropriateness in clinical settings, and a lack of clinical norms for either majority or culturally diverse groups, indicate the importance of further research into the psychological distress construct with culturally diverse clients, and the need for caution in interpreting K6/K10 scores. Copyright © 2014 John Wiley & Sons, Ltd.

Nursing leadership from the perspective of clinical group supervision: a paradoxical practice.

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Bondas, Terese

2010-05-01

Increase understanding of nursing leadership in group clinical supervision (CS). Leadership in CS has received little interest besides the theories in use and administrative CS. Hermeneutic interpretation of written narratives of 24 clinical nurse supervisors. Continuity in structuring, story and mission and reflection in group and leadership processes and theories of nursing and caring characterize leadership in CS. Leadership by inhibiting and creating fear, inapproachability and indistinctiveness were patterns in content brought to CS. Supervision when leadership was involved illuminated a reflexive change in focus from leadership to nursing care, from particular experiences to nursing and caring science, and from the unfamiliar to the well known and the well known to the unknown. Continuity and reflective changes using nursing and caring theories seem to be core ideas of nursing leadership from the perspective of CS. The poles of separation and communion show opposites of nursing leadership as it is illuminated in CS. The findings add knowledge to Bondas' theory of caritative leadership. CS is a reflexive practice of support and guidance that seems to have an impact on the trajectory of nursing care and staff development using nursing and caring theories.

The clinical role of lecturers in nursing in Ireland: perceptions from key stakeholder groups in nurse education on the role.

Science.gov (United States)

Meskell, Pauline; Murphy, Kathleen; Shaw, David

2009-10-01

The clinical role of lecturers in nursing has been a focus of debate since the integration of nurse education into higher education institutions. The purpose of this paper is to report the findings from the preliminary phase of a study, undertaken to investigate the perceptions of key stakeholder groups in nurse education, regarding the current clinical role of nurse lecturers in Ireland. A descriptive exploratory design was used involving focus group and individual interviews, soliciting views of purposefully selected educationalists, clinicians, policy formulators and students. The issue was examined from a policy perspective, aiming to collectively represent views of all participant groups. This approach facilitated a more complete picture of perceptions of the role to emerge, to better inform future decision making. Twenty two focus group interviews and twenty one individual interviews were conducted. Content analysis was used to identify themes. All groups were in agreement that role definition was urgently required to dispel ambiguities surrounding what the clinical role should involve. Conflicting views were evident among groups regarding lecturers' clinical credibility, visibility and teaching effectiveness. Findings highlight the essential nature of nurse lecturers engaging with clinical areas to maintain their skills, demonstrate a value for the practice component of the role and provide a link between education and practice.

Can the Liebowitz Social Anxiety Scale - self-report version be used to differentiate clinical and non-clinical SAD groups among Brazilians?

Science.gov (United States)

Santos, Larissa F; Loureiro, Sonia R; Crippa, José A S; Osório, Flávia L

2015-01-01

The Liebowitz Social Anxiety Scale (LSAS) was the first evaluation instrument developed for screening for the signs and symptoms of Social Anxiety Disorder (SAD) and is currently still the most used worldwide. The aim of this study is to evaluate the ability of the LSAS - self-report version (LSAS-SR) to discriminate different Social Anxiety Disorder (SAD) clinical groups. The sample was composed of Brazilians university students, allocated into three different groups, i.e., cases (C=118), non-cases (NC=95) and subclinical cases (SC=39). To achieve the aim, calculations of the ROC Curve and ANOVA were performed. The results found were excellent regardless of the technique used, highlighting the discriminatory capacity of the LSAS-SR. The score equal to or greater than 32 is suggested as a cutoff score for the Brazilian population, since this presented balance between the standards evaluated and the ability to differentiate both clinical and subclinical SAD cases from non-cases. Despite the specific sample used in this study being composed only of university students, the use of the LSAS-SR can be indicated, in the Brazilian setting, for SAD screening in both clinical and research contexts.

Postgraduate Training in Clinical Oncology. Report on a WHO Working Group (The Hague, The Netherlands, December 6-8, 1978).

Science.gov (United States)

World Health Organization, Copenhagen (Denmark). Regional Office for Europe.

The 1978 report of the Working Group of Postgraduate Training in Clinical Oncology, convened by the World Health Organization (WHO) Regional Office for Europe in collaboration with the government of The Netherlands, is presented. The groups analyzed models of postgraduate training in clinical oncology and evaluated their suitability in relation to…

Blood stream infections caused by Acinetobacter baumannii group in Japan - Epidemiological and clinical investigation.

Science.gov (United States)

Fujikura, Yuji; Yuki, Atsushi; Hamamoto, Takaaki; Kawana, Akihiko; Ohkusu, Kiyofumi; Matsumoto, Tetsuya

2016-06-01

Acinetobacter calcoaceticus-Acinetobacter baumannii complex, especially A. baumannii, Acinetobacter pittii and Acinetobacter nosocomialis, constitutes an important group of nosocomial pathogens; however, epidemiological or clinical characteristics and prognosis is limited in Japan. From 2009 to 2013, 47 blood stream infection cases resulting from A. baumannii group were reviewed at the National Defense Medical College, an 800-bed tertiary hospital. To determine the genospecies, further comparative nucleotide sequence analyses of the RNA polymerase b-subunit (rpoB) gene were performed. Sequence analysis of rpoB gene showed that 25 (49.0%), 17 (33.3%) and 5 (9.8%) cases were caused by A. baumannii, A. pittii and A. nosocomialis, respectively. The 30-day and in-hospital mortality rates of A. baumannii were 8.5% and 25.5%, respectively, and there were no significant differences between Acinetobacter species. Clinical characteristics were statistically insignificant. Multidrug-resistant Acinetobacter species were detected in 3 cases (5.9%) with same pulsed-field gel electrophoresis (PFGE) pattern and A. baumannii was less susceptible to amikacin and levofloxacin. In this study, the mortality and clinical characteristics were similar among A. baumannii group isolate cases despite some showing drug resistance. However, identification of Acinetobacter species helps to initiate appropriate antibiotic therapy in earlier treatment phase, because A. baumannii shows some drug resistance. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Sociodemographic analysis of patients in radiation therapy oncology group clinical trials

International Nuclear Information System (INIS)

Chamberlain, Robert M.; Winter, Kathryn A.; Vijayakumar, Srinivasan; Porter, Arthur T.; Roach, M.; Streeter, Oscar; Cox, James D.; Bondy, Melissa L.

1998-01-01

Purpose: To assess the degree to which the sociodemographic characteristics of patients enrolled in Radiation Therapy Oncology Group (RTOG) clinical trails are representative of the general population. Methods and Materials: Sociodemographic data were collected on 4016 patients entered in 33 open RTOG studies between July 1991 and June 1994. The data analyzed included educational attainment, age, gender, and race. For comparison, we obtained similar data from the U.S. Department of Census. We also compared our RTOG data with Surveillance Epidemiology and End Results (SEER) data for patients who received radiation therapy, to determine how RTOG patients compared with cancer patients in general, and with patients with cancers at sites typically treated with radiotherapy. Results: Overall, the sociodemographic characteristics of patients entered in RTOG trials were similar to those of the Census data. We found that, in every age group of African-American men and at nearly every level of educational attainment, the proportion of RTOG trial participants mirrored the proportion in the census data. Significant differences were noted only in the youngest category of African-American men, where the RTOG accrues more in the lower educational categories and fewer with college experience. For African-American women, we found a similar pattern in every age group and at each level of educational attainment. As with men, RTOG trials accrued a considerably larger proportion of younger, less educated African-American women than the census reported. Using SEER for comparison, the RTOG enrolled proportionately more African-American men to trials all cancer sites combined, and for prostate and head and neck cancer. In head and neck trials, the RTOG enrolled nearly twice as many African-American men than would be predicted by SEER data. In lung cancer trials, RTOG underrepresented African-American men significantly; however, there was no difference for brain cancer trials. There were

Modelo experimental de bandagem ajustável do tronco pulmonar para preparo rápido do ventrículo

Directory of Open Access Journals (Sweden)

DIAS Carlos A.

2000-01-01

Full Text Available OBJETIVO: Um dispositivo de bandagem do tronco pulmonar (TP com ajuste percutâneo foi desenvolvido com o objetivo de induzir a hipertrofia rápida do ventrículo subpulmonar. MATERIAL E MÉTODOS: Consiste de um manguito de silicone insuflável percutaneamente, através de um botão de silicone auto-selante. Os corações de 7 cabritos jovens (peso médio: 8,7 kg foram submetidos à sobrecarga sistólica imposta pelo dispositivo e avaliados sob os aspectos hemodinâmicos, ecocardiográficos e morfológicos. Foram extraídas biópsias basais do miocárdio do ventrículo direito (VD para análise microscópica (perímetro e área do miócito. O dispositivo foi implantado no TP. As pressões do VD, TP e aorta foram monitorizadas. Após convalescença, foi iniciado o protocolo de insuflação do dispositivo de bandagem do TP. Foi injetada água destilada no botão auto-selante (via percutânea, até que a pressão sistólica do VD atingisse 70% da pressão sistólica do VE. As avaliações ecocardiográfica e hemodinâmica foram realizadas a cada 24 horas. A sobrecarga sistólica do VD foi mantida por um período de 96 horas, com insuflações progressivas no limite máximo tolerado, a cada 24 horas. Após esse período, os animais foram sacrificados para análise morfológica dos corações. Outros 9 cabritos (peso médio: 7,7 kg foram utilizados como grupo controle, para análise do peso do VD. RESULTADOS: Após 96 horas de sobrecarga sistólica do VD, foi observado um aumento do gradiente sistólico VD/TP de 10,1±4,3 mmHg para 60,0±11,0 mmHg e da pressão sistólica no VD de 22,4±4,1 mmHg para 71,0±10,0 mmHg (p<0,0001. O ecocardiograma revelou aumento da espessura muscular do VD, de 4,4±0,5 mm para 7,3±1,7 mm (p=0,001. Quando comparado ao grupo controle, houve um ganho de peso de 74% do VD submetido à sobrecarga sistólica (p<0,0001. À microscopia óptica, foi observado aumento de 27% no perímetro e de 69% na área dos miócitos (p=0

Challenges in the transition to clinical training in dentistry: An ADEE special interest group initial report.

Science.gov (United States)

Serrano, C M; Botelho, M G; Wesselink, P R; Vervoorn, J M

2018-02-03

Curricular integration in higher education has been widely supported in the educational literature. As a result, several health care and specifically dental curricula have evolved from compartmentalised disciplinary training to integrated modalities; however, in many courses, a pre-clinical-clinical watershed remains a barrier to integration in dental education. This article introduces a general description of the pre-clinical-clinical transition in dentistry according to the outcomes of the discussion held during the first working group session of the "Transition to Clinical Training" Special Interest Group during the 2016 annual meeting of the Association for Dental Education in Europe. An online questionnaire was made available before the meeting to survey the curricular characteristics of the participants' schools. During the meeting, a working session related to the pre-clinical-clinical transition occurred. Conclusions from the discussion are summarised in this article. Fourteen dental schools from 12 countries participated in the online survey. The included programmes had an average duration of 5.3 years (SD = 0.48), with high school or the local equivalent as the required entrance level for dentistry. The hybrid curriculum was the leading curriculum design (n = 9) followed by competence-based curricula (n = 3), with patient treatment as the core of clinical training in every included programme. The pre-clinical-clinical transition in dentistry is a recognisable matter in dental education that requires assessment and research to ease the management of a stage with relevant influence on educational outcomes. This article presents an initial framework for further research and educational intervention. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Aggression in children with autism spectrum disorders and a clinic-referred comparison group

Science.gov (United States)

Farmer, Cristan; Butter, Eric; Mazurek, Micah O.; Cowan, Charles; Lainhart, Janet; Cook, Edwin H.; DeWitt, Mary Beth; Aman, Michael

2015-01-01

A gap exists in the literature regarding aggression in autism spectrum disorders (ASD) and how this behavior compares to other groups. In this multisite study, the Children’s Scale for Hostility and Aggression: Reactive/Proactive (C-SHARP) and the Aggression subscale of the Child Behavior Checklist (CBCL) were rated for 414 children with ASD (Autistic Disorder, 69%; PDD-NOS, 24%; Asperger’s Disorder, 7%) and 243 clinic-referred children without ASD, aged 1-21 years (mean age about 7). Participants were not selected for aggressive behavior. Relative to the comparison group, children with ASD were reported to have less aggression and were more likely to be rated as reactive rather than proactive. Among all subjects, sex was not associated with aggression; higher IQ/adaptive behavior and older age were associated with more sophisticated types of aggression while lower scores on IQ, adaptive behavior, and communication measures were associated with more physical aggression. The interaction between demographic variables and diagnosis was significant only for age: younger but not older children with ASD showed less aggression than clinic-referred controls. PMID:24497627

The clinical features of respiratory infections caused by the Streptococcus anginosus group

OpenAIRE

Noguchi, Shingo; Yatera, Kazuhiro; Kawanami, Toshinori; Yamasaki, Kei; Naito, Keisuke; Akata, Kentaro; Shimabukuro, Ikuko; Ishimoto, Hiroshi; Yoshii, Chiharu; Mukae, Hiroshi

2015-01-01

Background The Streptococcus anginosus group (SAG) play important roles in respiratory infections. It is ordinarily difficult to distinguish them from contaminations as the causative pathogens of respiratory infections because they are often cultured in respiratory specimens. Therefore, it is important to understand the clinical characteristics and laboratory findings of respiratory infections caused by the SAG members. The aim of this study is to clarify the role of the SAG bacteria in respi...

Ajustamento psicológico e perspectiva de velhice pessoal em adultos com deficiência física Ajuste psicológico e la perspectiva percibida del envejecimiento personal en adulto y adultos moyores con discapacidad física Psychological adjustment and personal aging perspective in adults and older adults with physical disability

Directory of Open Access Journals (Sweden)

Marineia Crosara de Resende

2009-12-01

Full Text Available Foram investigadas relações entre senso de ajustamento psicológico e perspectiva de velhice em adultos e idosos com deficiência física. Participaram 90 pessoas, de ambos os sexos, com idade entre 25 e 84 anos, que responderam aos instrumentos: questionários sociodemografico e sobre a deficiência física; Inventário Sheppard de Atitudes em Relação à Velhice Pessoal; Escala de Desenvolvimento Pessoal (ajustamento psicológico. Os índices de ajustamento pessoal foram de moderados a altos, mas as mulheres pontuaram mais baixo. Para toda a amostra, quanto maior o senso de ajustamento, mais positiva a perspectiva de velhice pessoal. Os com deficiência congênita e os mais ajustados psicologicamente mostraram perspectivas mais positivas de velhice pessoal. Concluiu-se que envelhecer com uma deficiência física é um processo que exige competência adaptativa e resiliência aos eventos de vida e aos desafios acarretados pela deficiência.Realizamos una investigación para analizar las relaciones entre el ajuste psicológico y la perspectiva percibida del envejecimiento personal en adulto y adultos mayores con discapacidad física. Materiales y método: 90 participantes, ambos géneros, adultos con 25 a 84 respondieron a cuestionarios contestados pidiendo la información sobre características socio demográficas y discapacidad; el inventario de Sheppard de actitudes acerca del propio envejecimiento; y una escala que determina el ajuste psicológico percibido. Resultados: Los índices del ajuste personal eran moderados y altos. Las mujeres tenían las cuentas más bajas. Había correlaciones positivas observadas entre el ajuste psicológico positivo y las actitudes positivas acerca del propio envejecimiento. Los que tenían discapacidad congénita y el ajuste psicológico más alto divulgado demostraron perspectivas más positivas del envejecimiento personal. Conclusión: El envejecer con discapacidad física es un proceso complejo que

Risk factors for treatment related clinical fluctuations in Guillain-Barré syndrome. Dutch Guillain-Barré study group

NARCIS (Netherlands)

L.H. Visser (Leendert); F.G.A. van der Meché (Frans); J. Meulstee (Jan); P.A. van Doorn (Pieter)

1998-01-01

textabstractThe risk factors for treatment related clinical fluctuations, relapses occurring after initial therapeutic induced stabilisation or improvement, were evaluated in a group of 172 patients with Guillain-Barre syndrome. Clinical, laboratory, and electrodiagnostic features

Effects of Two Traditional Chinese Cooking Oils, Canola and Pork, on pH and Cholic Acid Content of Faeces and Colon Tumorigenesis in Kunming Mice.

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He, Xiao-Qiong; Duan, Jia-Li; Zhou, Jin; Song, Zhong-Yu; Cichello, Simon Angelo

2015-01-01

Faecal pH and cholate are two important factors that can affect colon tumorigenesis, and can be modified by diet. In this study, the effects of two Chinese traditional cooking oils (pork oil and canola/rapeseed oil) on the pH and the cholic acid content in feces, in addition to colon tumorigenesis, were studied in mice. Kunming mice were randomized into various groups; negative control group (NCG), azoxymethane control group (ACG), pork oil group (POG), and canola oil Ggroup (COG). Mice in the ACG were fed a basic rodent chow; mice in POG and COG were given 10% cooking oil rodent chow with the respective oil type. All mice were given four weekly AOM (azoxymethane) i.p. injections (10 mg/kg). The pH and cholic acid of the feces were examined every two weeks. Colon tumors, aberrant crypt foci and organ weights were examined 32 weeks following the final AOM injection. The results showed that canola oil significantly decreased faecal pH in female mice (P0.05). Pork oil significantly increased the feces pH in both male and female mice (Pcooking oil effects faecal pH, but does not affect the faecal cholic acid content and thus AOM-induced colon neoplastic ACF is modified by dietary fat.

How do small groups make decisions? : A theoretical framework to inform the implementation and study of clinical competency committees.

Science.gov (United States)

Chahine, Saad; Cristancho, Sayra; Padgett, Jessica; Lingard, Lorelei

2017-06-01

In the competency-based medical education (CBME) approach, clinical competency committees are responsible for making decisions about trainees' competence. However, we currently lack a theoretical model for group decision-making to inform this emerging assessment phenomenon. This paper proposes an organizing framework to study and guide the decision-making processes of clinical competency committees.This is an explanatory, non-exhaustive review, tailored to identify relevant theoretical and evidence-based papers related to small group decision-making. The search was conducted using Google Scholar, Web of Science, MEDLINE, ERIC, and PsycINFO for relevant literature. Using a thematic analysis, two researchers (SC & JP) met four times between April-June 2016 to consolidate the literature included in this review.Three theoretical orientations towards group decision-making emerged from the review: schema, constructivist, and social influence. Schema orientations focus on how groups use algorithms for decision-making. Constructivist orientations focus on how groups construct their shared understanding. Social influence orientations focus on how individual members influence the group's perspective on a decision. Moderators of decision-making relevant to all orientations include: guidelines, stressors, authority, and leadership.Clinical competency committees are the mechanisms by which groups of clinicians will be in charge of interpreting multiple assessment data points and coming to a shared decision about trainee competence. The way in which these committees make decisions can have huge implications for trainee progression and, ultimately, patient care. Therefore, there is a pressing need to build the science of how such group decision-making works in practice. This synthesis suggests a preliminary organizing framework that can be used in the implementation and study of clinical competency committees.

Moving the Self-Esteem of People with Epilepsy by Supportive Group: A Clinical Trial

Directory of Open Access Journals (Sweden)

Kritaya Sawangchareon

2013-11-01

Full Text Available Introduction: People with epilepsy (PWE face physical and mental illness, and social stigma, which affect their self-esteem and quality of life. The purpose of this study was to examine the effects of a support group on the self-esteem of PWE. Methods: A Quasi-experimental study was performed on 120 PWE in the Epilepsy Clinic at Srinagarind Hospital. The experimental group (N=60 attended the support group before receiving regular health care services. The control group (N=60 received only regular healthcare services. Data was collected by using the Rosenberg self-esteem scale scoring before and after the experiment. The score was analyzed by using a paired t-test and an independent t-test. Results: The study showed that before the experiment, the self–esteem score of the control group was significantly higher than the experimental group. After the experiment, the scores of the control group and the experimental group showed a significant statistical difference. The score in the control group was significantly lower than the experimental group, while the score in the experimental group was significantly higher than before the experiment. Conclusion: The support group improves the self-esteem of PWE. Medical personnel should set up a support group for PWE to enhance their self-esteem.

Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups

Science.gov (United States)

Zachariadis, Markos; Oborn, Eivor; Barrett, Michael; Zollinger-Read, Paul

2013-01-01

Objective To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation. Design Mixed-method, multisite and case study research. Setting Six clinical commissioning groups and local clusters in the East of England area, covering in total 208 GPs and 1 662 000 population. Methods Semistructured interviews with 56 lead GPs, practice managers and staff from the local health authorities (primary care trusts, PCT) as well as various healthcare professionals; 21 observations of clinical commissioning group (CCG) board and executive meetings; electronic survey of 58 CCG board members (these included GPs, practice managers, PCT employees, nurses and patient representatives) and subsequent social network analysis. Main outcome measures Collaborative relationships between CCG board members and stakeholders from their healthcare network; clarifying the role of GPs as network leaders; strengths and areas for development of CCGs. Results Drawing upon innovation network theory provides unique insights of the CCG leaders’ activities in establishing best practices and introducing new clinical pathways. In this context we identified three network leadership roles: managing knowledge flows, managing network coherence and managing network stability. Knowledge sharing and effective collaboration among GPs enable network stability and the alignment of CCG objectives with those of the wider health system (network coherence). Even though activities varied between commissioning groups, collaborative initiatives were common. However, there was significant variation among CCGs around the level of engagement with providers, patients and local authorities. Locality (sub) groups played an important role because they linked commissioning decisions with

Texture-based classification of different gastric tumors at contrast-enhanced CT

Energy Technology Data Exchange (ETDEWEB)

Ba-Ssalamah, Ahmed, E-mail: ahmed.ba-ssalamah@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Muin, Dina; Schernthaner, Ruediger; Kulinna-Cosentini, Christiana; Bastati, Nina [Department of Radiology, Medical University of Vienna (Austria); Stift, Judith [Department of Pathology, Medical University of Vienna (Austria); Gore, Richard [Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL (United States); Mayerhoefer, Marius E. [Department of Radiology, Medical University of Vienna (Austria)

2013-10-01

Purpose: To determine the feasibility of texture analysis for the classification of gastric adenocarcinoma, lymphoma, and gastrointestinal stromal tumors on contrast-enhanced hydrodynamic-MDCT images. Materials and methods: The arterial phase scans of 47 patients with adenocarcinoma (AC) and a histologic tumor grade of [AC-G1, n = 4, G1, n = 4; AC-G2, n = 7; AC-G3, n = 16]; GIST, n = 15; and lymphoma, n = 5, and the venous phase scans of 48 patients with AC-G1, n = 3; AC-G2, n = 6; AC-G3, n = 14; GIST, n = 17; lymphoma, n = 8, were retrospectively reviewed. Based on regions of interest, texture analysis was performed, and features derived from the gray-level histogram, run-length and co-occurrence matrix, absolute gradient, autoregressive model, and wavelet transform were calculated. Fisher coefficients, probability of classification error, average correlation coefficients, and mutual information coefficients were used to create combinations of texture features that were optimized for tumor differentiation. Linear discriminant analysis in combination with a k-nearest neighbor classifier was used for tumor classification. Results: On arterial-phase scans, texture-based lesion classification was highly successful in differentiating between AC and lymphoma, and GIST and lymphoma, with misclassification rates of 3.1% and 0%, respectively. On venous-phase scans, texture-based classification was slightly less successful for AC vs. lymphoma (9.7% misclassification) and GIST vs. lymphoma (8% misclassification), but enabled the differentiation between AC and GIST (10% misclassification), and between the different grades of AC (4.4% misclassification). No texture feature combination was able to adequately distinguish between all three tumor types. Conclusion: Classification of different gastric tumors based on textural information may aid radiologists in establishing the correct diagnosis, at least in cases where the differential diagnosis can be narrowed down to two

Texture-based classification of different gastric tumors at contrast-enhanced CT

International Nuclear Information System (INIS)

Ba-Ssalamah, Ahmed; Muin, Dina; Schernthaner, Ruediger; Kulinna-Cosentini, Christiana; Bastati, Nina; Stift, Judith; Gore, Richard; Mayerhoefer, Marius E.

2013-01-01

Purpose: To determine the feasibility of texture analysis for the classification of gastric adenocarcinoma, lymphoma, and gastrointestinal stromal tumors on contrast-enhanced hydrodynamic-MDCT images. Materials and methods: The arterial phase scans of 47 patients with adenocarcinoma (AC) and a histologic tumor grade of [AC-G1, n = 4, G1, n = 4; AC-G2, n = 7; AC-G3, n = 16]; GIST, n = 15; and lymphoma, n = 5, and the venous phase scans of 48 patients with AC-G1, n = 3; AC-G2, n = 6; AC-G3, n = 14; GIST, n = 17; lymphoma, n = 8, were retrospectively reviewed. Based on regions of interest, texture analysis was performed, and features derived from the gray-level histogram, run-length and co-occurrence matrix, absolute gradient, autoregressive model, and wavelet transform were calculated. Fisher coefficients, probability of classification error, average correlation coefficients, and mutual information coefficients were used to create combinations of texture features that were optimized for tumor differentiation. Linear discriminant analysis in combination with a k-nearest neighbor classifier was used for tumor classification. Results: On arterial-phase scans, texture-based lesion classification was highly successful in differentiating between AC and lymphoma, and GIST and lymphoma, with misclassification rates of 3.1% and 0%, respectively. On venous-phase scans, texture-based classification was slightly less successful for AC vs. lymphoma (9.7% misclassification) and GIST vs. lymphoma (8% misclassification), but enabled the differentiation between AC and GIST (10% misclassification), and between the different grades of AC (4.4% misclassification). No texture feature combination was able to adequately distinguish between all three tumor types. Conclusion: Classification of different gastric tumors based on textural information may aid radiologists in establishing the correct diagnosis, at least in cases where the differential diagnosis can be narrowed down to two

MR urography of obstructive uropathy: diagnostic value of the method in selected clinical groups

Energy Technology Data Exchange (ETDEWEB)

Zielonko, J.; Studniarek, M. [Department of Radiology, Institute of Radiology and Nuclear Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdansk (Poland); Markuszewski, M. [Department of Radiology, Clinical Hospital No. 3, Kieturakisa 1, 80-742 Gdansk (Poland)

2003-04-01

The aim of the study was to evaluate the role of MR urography (MRU) in the diagnosis of obstructive uropathy in selected groups of patients. The groups involved following pathologies: calculi; strictures of ureteropelvic junction (UPJ); benign and malignancy-induced ureterostenosis. Sixty patients with clinical diagnosis of obstructive uropathy were subjected to static fluid MRU (sMRU) with the use of 3D turbo spin echo (TSE) sequence in a 0.5-T magnet. The examination was completed with conventional MR sequences and in 12 cases additionally with sequences after the administration of Gd-DTPA and excretory MRU. The results were compared with intravenous urography (IVU), CT, US, clinical and histopathological data. The degree of the urinary tract dilatation as well as the level and type of obstruction were estimated. In patients with urolithiasis sMRU correctly depicted the degree of ureterohydronephrosis in 85%, in cases of UPJ stenosis and malignancy-induced ureterostenosis in 100% and in the group of benign ureterostenosis in 91% of patients. Determination of obstruction level in patients with stones was adequate in 92% and in cases of non-calculous ureteral strictures in 100% of patients. The sMRU sequence alone could not specify the nature of obstruction except 1 case of bladder carcinoma. Filling defects in ureters visible on MR urograms were verified with IVU or CT to exclude intrinsic tumours. Completed with conventional MR sequences sMRU enabled the depiction of solid mass or infiltration in 83% cases of malignancy-induced ureterostenosis, and in the remaining groups of patients neoplastic process was excluded in 91%. In conjunction with excretory MRU and conventional MR images sMRU appears to be a highly useful technique in assessment of obstructive uropathy, especially that of non-calculous origin. Among different clinical applications MRU is superior in the evaluation of dilated urinary tract in altered anatomical conditions (e.g. in patients with ileal

Radiotherapy in cooperative clinical trials: Northern California Oncology Group (NCOG) method

International Nuclear Information System (INIS)

MacDonald, E.A.; Meurk, M.L.; Ray, G.; Phillips, T.L.; Carter, S.K.

1980-01-01

The inclusion of radiation therapy in multimodality clinical research has demonstrated the need for consultion and standardization of terminology and practice between participating centers. A set of guidelines has been developed to ensure that the radiotherapy section of a cooperative study is comprehensive and unambiguous, and that the techniques, fractionation and dosage used are sufficiently uniform to provide a homogeneous group of patients for comparative purposes. An outline is given for the preparation of radiotherapy protocols including the necessary details of physical factors, localization and simulation, portal and treatment volume definition, dosimetry requirements, specification of dose, and treatment documentation

Clinical patch test data evaluated by multivariate analysis. Danish Contact Dermatitis Group

DEFF Research Database (Denmark)

Christophersen, J; Menné, T; Tanghøj, P

1989-01-01

The aim of the present study was to evaluate the influence of individual explanatory factors, such as sex, age, atopy, test time and presence of diseased skin, on clinical patch test results, by application of multivariate statistical analysis. The study population was 2166 consecutive patients...... patch tested with the standard series of the International Contact Dermatitis Research Group (ICDRG) by members of the Danish Contact Dermatitis Group (DCDG) over a period of 6 months. For the 8 test allergens most often found positive (nickel, fragrance-mix, cobalt, chromate, balsam of Peru, carba......-mix, colophony, and formaldehyde), one or more individual factors were of significance for the risk of being sensitized, except for chromate and formaldehyde. It is concluded that patch test results can be compared only after stratification of the material or by multivariate analysis....

[Ecologic and epidemiologic features of the circulation of streptococcus group B at a maternity clinic].

Science.gov (United States)

Bochkov, I A; Shevchuk, M S; Semina, N A; Fiks, L I; Elinkova, Ia

1989-04-01

In a maternity clinic the circulation of group B streptococci among the newborns, their mothers and the personnel was established during the period of 1982-1985. Group B streptococci were detected at different biotypes of newborns (the pharynx, the imbilical stump, external suditory meatus, nasal and oral mucosa, eyes and feces), their mothers (the vagina, the perianal area, breast milk, the pharynx, urine, the umbilical cord, amniotic fluid) and in the pharynx of the personnel. In this maternity clinic 15 combinations of type antigens were detected, two combinations (1a/c and 1 b/c) prevailing among them. These results confirmed earlier data concerning two possible ways of transferring infection to newborn infants: vertical, i.e. from the mother to the child during parturition, and nosocomial, i.e. from contaminated newborns or members of the personnel.

Return of individual research results and incidental findings in the clinical trials cooperative group setting.

Science.gov (United States)

Ferriere, Michael; Van Ness, Brian

2012-04-01

The National Cancer Institute (NCI)-funded cooperative group cancer clinical trial system develops experimental therapies and often collects samples from patients for correlative research. The cooperative group bank (CGB) system maintains biobanks with a current policy not to return research results to individuals. An online survey was created, and 10 directors of CGBs completed the surveys asking about understanding and attitudes in changing policies to consider return of incidental findings (IFs) and individual research results (IRRs) of health significance. The potential impact of the 10 consensus recommendations of Wolf et al. presented in this issue are examined. Reidentification of samples is often not problematic; however, changes to the current banking and clinical trial systems would require significant effort to fulfill an obligation of recontact of subjects. Additional resources, as well as a national advisory board would be required to standardize implementation.

Role modelling of clinical tutors: a focus group study among medical students.

Science.gov (United States)

Burgess, Annette; Goulston, Kerry; Oates, Kim

2015-02-14

Role modelling by clinicians assists in development of medical students' professional competencies, values and attitudes. Three core characteristics of a positive role model include 1) clinical attributes, 2) teaching skills, and 3) personal qualities. This study was designed to explore medical students' perceptions of their bedside clinical tutors as role models during the first year of a medical program. The study was conducted with one cohort (n = 301) of students who had completed Year 1 of the Sydney Medical Program in 2013. A total of nine focus groups (n = 59) were conducted with medical students following completion of Year 1. Data were transcribed verbatim. Thematic analysis was used to code and categorise data into themes. Students identified both positive and negative characteristics and behaviour displayed by their clinical tutors. Characteristics and behaviour that students would like to emulate as medical practitioners in the future included: 1) Clinical attributes: a good knowledge base; articulate history taking skills; the ability to explain and demonstrate skills at the appropriate level for students; and empathy, respect and genuine compassion for patients. 2) Teaching skills: development of a rapport with students; provision of time towards the growth of students academically and professionally; provision of a positive learning environment; an understanding of the student curriculum and assessment requirements; immediate and useful feedback; and provision of patient interaction. 3) Personal qualities: respectful interprofessional staff interactions; preparedness for tutorials; demonstration of a passion for teaching; and demonstration of a passion for their career choice. Excellence in role modelling entails demonstration of excellent clinical care, teaching skills and personal characteristics. Our findings reinforce the important function of clinical bedside tutors as role models, which has implications for faculty development and

A prospective study of group cohesiveness in therapeutic horticulture for clinical depression.

Science.gov (United States)

Gonzalez, Marianne Thorsen; Hartig, Terry; Patil, Grete Grindal; Martinsen, Egil W; Kirkevold, Marit

2011-04-01

This study aimed to assess changes in psychological distress and social participation in adults diagnosed with clinical depression during and after participating in a therapeutic horticulture programme, and to investigate if the changes covaried with levels of group cohesiveness during the intervention. An intervention with a single-group design was repeated with different samples in successive years (pooled n = 46). In each year, five groups of 3-7 participants went through the intervention. Data were collected before, twice during, and immediately after a 12-week therapeutic horticulture programme, as well as at 3-months' follow up. Mental health assessments included the Beck Depression Inventory, the State Subscale of Spielberger State-Trait Anxiety Inventory, the Positive Affect Scale from the Positive and Negative Affect Scale, the Perceived Stress Scale, and the Therapeutic Factors Inventory-Cohesiveness Scale. The analysis of the pooled data confirmed significant beneficial change in all mental health variables during the intervention. Change from baseline in depression severity persisted at 3-months' follow up. Increased social activity after the intervention was reported for 38% of the participants. The groups quickly established strong cohesiveness, and this continued to increase during the intervention. The average level of group cohesiveness correlated positively, but not significantly, with change in all mental health outcome variables. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Transferring clinical communication skills from the classroom to the clinical environment: perceptions of a group of medical students in the United kingdom.

Science.gov (United States)

Brown, Jo

2010-06-01

To better understand the transfer of classroom-learned clinical communication skills (CCS) to the clinical environment of the hospital ward, where they are practiced and refined by students. The author first briefly presents the literature on clinical communication, provides an overview of the debates around the notion of transfer, and presents a sociocultural model of developmental transfer applied to CCS learning. Second, she describes a focus group and nine individual interviews carried out with 17 fourth-year medical students at one medical school in the United Kingdom in 2008. The goal was to elicit their views of CCS teaching, learning, and transfer of CCS to the clinical workplace. The findings are presented under the four main themes of transition, where students experienced the transition from the medical school to the hospital ward as a mixture of positive and negative impacts on transferring their CCS skills; the clinical culture, where senior doctors had the greatest impact on student learning and emergent clinical practice; clinical communication as a vehicle for professionalism and being a "good" doctor; and, finally, transfer mechanisms, where simulated practice with actors and the clinical history template were powerful learning tools. Findings indicate that more needs to be done to support, develop, and embed CCS into the professional practice of medical students in the clinical workplace. This may be achieved by greater collaboration of educators in the academic and clinical environments. Using the developmental transfer model applied to CCS learning may help foster this relationship.

Effectiveness of a mobile cooperation intervention during the clinical practicum of nursing students: a parallel group randomized controlled trial protocol.

Science.gov (United States)

Strandell-Laine, Camilla; Saarikoski, Mikko; Löyttyniemi, Eliisa; Salminen, Leena; Suomi, Reima; Leino-Kilpi, Helena

2017-06-01

The aim of this study was to describe a study protocol for a study evaluating the effectiveness of a mobile cooperation intervention to improve students' competence level, self-efficacy in clinical performance and satisfaction with the clinical learning environment. Nursing student-nurse teacher cooperation during the clinical practicum has a vital role in promoting the learning of students. Despite an increasing interest in using mobile technologies to improve the clinical practicum of students, there is limited robust evidence regarding their effectiveness. A multicentre, parallel group, randomized, controlled, pragmatic, superiority trial. Second-year pre-registration nursing students who are beginning a clinical practicum will be recruited from one university of applied sciences. Eligible students will be randomly allocated to either a control group (engaging in standard cooperation) or an intervention group (engaging in mobile cooperation) for the 5-week the clinical practicum. The complex mobile cooperation intervention comprises of a mobile application-assisted, nursing student-nurse teacher cooperation and a training in the functions of the mobile application. The primary outcome is competence. The secondary outcomes include self-efficacy in clinical performance and satisfaction with the clinical learning environment. Moreover, a process evaluation will be undertaken. The ethical approval for this study was obtained in December 2014 and the study received funding in 2015. The results of this study will provide robust evidence on mobile cooperation during the clinical practicum, a research topic that has not been consistently studied to date. © 2016 John Wiley & Sons Ltd.

The interrelationships between clinical signs and their effect on involuntary culling among pregnant sows in group-housing systems

DEFF Research Database (Denmark)

Jensen, Tina Birk; Bonde, Marianne Kjær; Kongsted, Anne Grete

2010-01-01

Sows suffering from clinical signs of disease (e.g. lameness, wounds and shoulder ulcers) are often involuntarily culled, affecting the farmer's economy and the welfare of the animals. In order to investigate the interrelationships between clinical signs of individual pregnant group-housed sows, we...

GP leadership in clinical commissioning groups: a qualitative multi-case study approach across England.

Science.gov (United States)

Marshall, Martin; Holti, Richard; Hartley, Jean; Matharu, Tatum; Storey, John

2018-06-01

Clinical commissioning groups (CCGs) were established in England in 2013 to encourage GPs to exert greater influence over the processes of service improvement and redesign in the NHS. Little is known about the extent and the ways in which GPs have assumed these leadership roles. To explore the nature of clinical leadership of GPs in CCGs, and to examine the enablers and barriers to implementing a policy of clinical leadership in the NHS. A qualitative multi-case study approach in six localities across England. The case studies were purposefully sampled to represent different geographical localities and population demographics, and for their commitment to redesigning specified clinical or service areas. Data were collected from the case study CCGs and their partner organisations using a review of relevant documents, semi-structured individual or group interviews, and observations of key meetings. The data were analysed thematically and informed by relevant theories. GPs prefer a collaborative style of leadership that may be unlikely to produce rapid or radical change. Leadership activities are required at all levels in the system from strategy to frontline delivery, and the leadership behaviours of GPs who are not titular leaders are as important as formal leadership roles. A new alliance is emerging between clinicians and managers that draws on their different skillsets and creates new common interests. The uncertain policy environment in the English NHS is impacting on the willingness and the focus of GP leaders. GPs are making an important contribution as leaders of health service improvement and redesign but there are significant professional and political barriers to them optimising a leadership role. © British Journal of General Practice 2018.

Group Psychotherapy in Italy.

Science.gov (United States)

Giannone, Francesca; Giordano, Cecilia; Di Blasi, Maria

2015-10-01

This article describes the history and the prevailing orientations of group psychotherapy in Italy (psychoanalytically oriented, psychodrama, CBT groups) and particularly group analysis. Provided free of charge by the Italian health system, group psychotherapy is growing, but its expansion is patchy. The main pathways of Italian training in the different group psychotherapy orientations are also presented. Clinical-theoretical elaboration on self development, psychopathology related to group experiences, and the methodological attention paid to objectives and methods in different clinical groups are issues related to group therapy in Italy. Difficulties in the relationship between research and clinical practice are discussed, as well as the empirical research network that tries to bridge the gap between research and clinical work in group psychotherapy. The economic crisis in Italy has led to massive cuts in health care and to an increasing demand for some forms of psychological treatment. For these reasons, and because of its positive cost-benefit ratio, group psychotherapy is now considered an important tool in the national health care system to expand the clinical response to different forms of psychological distress.

Group formation in early clinical project

DEFF Research Database (Denmark)

Østergaard, Gert Værge

Research shows that getting involved is a key aspect of learning, and a way of getting involved is through study groups [1]. Forming groups are always a theme that is discussed, both amongst faculty and students. There is a different approach at different semesters regarding this formation...

DO INCENTIVO À CRIMINALIZAÇÃO: OS TERMOS DE AJUSTE DE CONDUTA NA ORIZICULTURA EM SANTA CATARINA - BRASIL

Directory of Open Access Journals (Sweden)

Alfredo Celso Fantini

2014-03-01

Full Text Available Em Santa Catarina os Termos de Ajuste de Conduta (TACs vêm ganhando espaço como estratégia para garantir, na zona rural, a recuperação de áreas de preservação permanente, principalmente as matas ciliares. No caso dos plantadores de arroz a situação é, no mínimo, discutível: agricultores antes incentivados pelo Estado a usarem para a produção toda a área de várzea, até o limite dos rios, são obrigados agora a recuperarem a vegetação ciliar “que nunca deveria ter sido suprimida”. Ignorando a complexidade da questão, o Ministério Público adotou o comando e controle para resolver “o problema”. Passados três anos, quase nada aconteceu na prática. Neste artigo, usamos uma abordagem sistêmica para compreender a situação-problema e apontar encaminhamentos para a sua melhoria. Em um estudo de caso realizado em Jacinto Machado-SC, foram utilizados métodos qualitativos e quantitativos (análise documental, entrevistas, inventários e oficinas e principalmente a Soft System Methodology (SSM. Os resultados revelaram que a mata ciliar é só mais um elemento de um complexo sistema de interesses, onde fatores sociais, culturais, ambientais e econômicos interagem dinamicamente. Apontam, também, a necessidade de uma aproximação entre os interessados na situação-problema para tornar possível uma acomodação entre as diferentes visões de mundo dos envolvidos

The Italian Version of the Inventory of Interpersonal Problems (IIP-32): Psychometric Properties and Factor Structure in Clinical and Non-clinical Groups.

Science.gov (United States)

Lo Coco, Gianluca; Mannino, Giuseppe; Salerno, Laura; Oieni, Veronica; Di Fratello, Carla; Profita, Gabriele; Gullo, Salvatore

2018-01-01

All versions of the Inventory of Interpersonal Problems (IIP) are broadly used to measure people's interpersonal functioning. The aims of the current study are: (a) to examine the psychometric properties and factor structure of the Italian version of the Inventory of Interpersonal Problems-short version (IIP-32); and (b) to evaluate its associations with core symptoms of different eating disorders. One thousand two hundred and twenty three participants ( n = 623 non-clinical and n = 600 clinical participants with eating disorders and obesity) filled out the Inventory of Interpersonal Problems-short version (IIP-32) along with measures of self-esteem (Rosenberg Self-Esteem Scale, RSES), psychological functioning (Outcome Questionnaire, OQ-45), and eating disorders (Eating Disorder Inventory, EDI-3). The present study examined the eight-factor structure of the IIP-32 with Confirmatory Factor Analysis (CFA) and Exploratory Structural Equation Modeling (ESEM). ESEM was also used to test the measurement invariance of the IIP-32 across clinical and non-clinical groups. It was found that CFA had unsatisfactory model fit, whereas the corresponding ESEM solution provided a better fit to the observed data. However, six target factor loadings tend to be modest, and ten items showed cross-loadings higher than 0.30. The configural and metric invariance as well as the scalar and partial strict invariance of the IIP-32 were supported across clinical and non-clinical groups. The internal consistency of the IIP-32 was acceptable and the construct validity was confirmed by significant correlations between IIP-32, RSES, and OQ-45. Furthermore, overall interpersonal difficulties were consistently associated with core eating disorder symptoms, whereas interpersonal styles that reflect the inability to form close relationships, social awkwardness, the inability to be assertive, and a tendency to self-sacrificing were positively associated with general psychological maladjustment

The Italian Version of the Inventory of Interpersonal Problems (IIP-32: Psychometric Properties and Factor Structure in Clinical and Non-clinical Groups

Directory of Open Access Journals (Sweden)

Gianluca Lo Coco

2018-03-01

Full Text Available All versions of the Inventory of Interpersonal Problems (IIP are broadly used to measure people's interpersonal functioning. The aims of the current study are: (a to examine the psychometric properties and factor structure of the Italian version of the Inventory of Interpersonal Problems—short version (IIP-32; and (b to evaluate its associations with core symptoms of different eating disorders. One thousand two hundred and twenty three participants (n = 623 non-clinical and n = 600 clinical participants with eating disorders and obesity filled out the Inventory of Interpersonal Problems—short version (IIP-32 along with measures of self-esteem (Rosenberg Self-Esteem Scale, RSES, psychological functioning (Outcome Questionnaire, OQ-45, and eating disorders (Eating Disorder Inventory, EDI-3. The present study examined the eight-factor structure of the IIP-32 with Confirmatory Factor Analysis (CFA and Exploratory Structural Equation Modeling (ESEM. ESEM was also used to test the measurement invariance of the IIP-32 across clinical and non-clinical groups. It was found that CFA had unsatisfactory model fit, whereas the corresponding ESEM solution provided a better fit to the observed data. However, six target factor loadings tend to be modest, and ten items showed cross-loadings higher than 0.30. The configural and metric invariance as well as the scalar and partial strict invariance of the IIP-32 were supported across clinical and non-clinical groups. The internal consistency of the IIP-32 was acceptable and the construct validity was confirmed by significant correlations between IIP-32, RSES, and OQ-45. Furthermore, overall interpersonal difficulties were consistently associated with core eating disorder symptoms, whereas interpersonal styles that reflect the inability to form close relationships, social awkwardness, the inability to be assertive, and a tendency to self-sacrificing were positively associated with general psychological

Acetylated cashew gum-based nanoparticles for transdermal delivery of diclofenac diethyl amine.

Science.gov (United States)

Dias, Sávia Francisca Lopes; Nogueira, Silvania Siqueira; de França Dourado, Flaviane; Guimarães, Maria Adelaide; de Oliveira Pitombeira, Nádia Aline; Gobbo, Graciely Gomides; Primo, Fernando Lucas; de Paula, Regina Célia Monteiro; Feitosa, Judith Pessoa Andrade; Tedesco, Antonio Claudio; Nunes, Lívio Cesar Cunha; Leite, José Roberto Souza Almeida; da Silva, Durcilene Alves

2016-06-05

Nanoprecipitation and dialysis methods were employed to obtain nanoparticles (NPs) of acetylated cashew gum (ACG). NPs synthesized by dialysis showed greater average size compared to those synthesized by nanoprecipitation, but they presented improved stability and yield. NPs were loaded with diclofenac diethylamine and the efficiency of the drug incorporation was over 60% for both methods, for an ACG:NP a weight ratio of 10:1. The cytotoxicity assay demonstrated that the NPs had no significant effect on the cell viability, verifying their biocompatibility. The release profile for the diclofenac diethylamine associated with the ACG-NPs showed a more controlled release compared to the free drug and a Fickian diffusion mechanism was observed. Transdermal permeation reached 90% penetration of the drug. Copyright © 2016. Published by Elsevier Ltd.

Classification of hand eczema: clinical and aetiological types. Based on the guideline of the Danish Contact Dermatitis Group

DEFF Research Database (Denmark)

Johansen, Jeanne Duus; Hald, Marianne; Andersen, Bo Lasthein

2011-01-01

Background. No generally accepted classification scheme for hand eczema exists. The Danish Contact Dermatitis Group recently developed a guideline defining common clinical types and providing criteria for aetiological types. Objectives. To test the concepts of this guideline in a group of hand...

Pediatric nurse practitioners' clinical competencies and knowing patterns in nursing: Focus group interviews.

Science.gov (United States)

Lee, Hyejung; Kim, Anna; Meong, Anna; Seo, Minjeong

2017-10-01

The generic competency domains of advanced nursing practice have been reported on in numerous countries, but rather few studies have examined competencies specific to pediatric nurse practitioners (PNPs). We identified the core clinical competencies of PNPs in South Korea and related these identified competencies to the five patterns of knowing in nursing. Focus group interviews were conducted with five PNP students and four PNPs using two thematic questions, one on clinical competencies required for PNPs and the other on competencies specific to Korean PNPs. A purposive sampling method was used to choose nurses with varying work experience and age from different hospital units. The inclusion criterion for PNP students was having at least two years of clinical experience and that for PNPs was having at least two years of clinical experience as a PNP in pediatric units in tertiary hospitals. The verbatim transcriptions of these interviews were analysed by two researchers using inductive content analysis. Six clinical competency domains were identified including advanced pediatric-specific knowledge and clinical skills, education and counseling, utilization and engagement in research, professional identity development, clinical and professional leadership, and holistic care. Some competencies identified were related to empirical and ethical knowledge that could be taught in nursing, whereas others were based on esthetic and personal knowledge, which can be mastered through professional experience. To provide holistic care for children and families, PNPs must acquire all necessary patterns of knowing through continuing education and individual reflection on personal practice.

Understanding the value added to clinical care by educational activities. Value of Education Research Group.

Science.gov (United States)

Ogrinc, G S; Headrick, L A; Boex, J R

1999-10-01

In an era of competition in health care delivery, those who pay for care are interested in supporting primarily those activities that add value to the clinical enterprise. The authors report on their 1998 project to develop a conceptual model for assessing the value added to clinical care by educational activities. Through interviews, nine key stakeholders in patient care identified five ways in which education might add value to clinical care: education can foster higher-quality care, improve work satisfaction of clinicians, have trainees provide direct clinical services, improve recruitment and retention of clinicians, and contribute to the future of health care. With this as a base, an expert panel of 13 clinical educators and investigators defined six perspectives from which the value of education in clinical care might be studied: the perspectives of health-care-oriented organizations, clinician-teachers, patients, education organizations, learners, and the community. The panel adapted an existing model to create the "Education Compass" to portray education's effects on clinical care, and developed a new set of definitions and research questions for each of the four major aspects of the model (clinical, functional, satisfaction, and cost). Working groups next drafted proposals to address empirically those questions, which were critiqued at a national conference on the topic of education's value in clinical care. The next step is to use the methods developed in this project to empirically assess the value added by educational activities to clinical care.

Dreams of deceased children and countertransference in the group psychotherapy of bereaved mothers: clinical illustration.

Science.gov (United States)

Begovac, Branka; Begovac, Ivan

2012-09-01

This article presents, in the form of a clinical illustration, a therapeutic group of bereaved mothers with special reference to their dreams about their deceased children. The article presents descriptions of the emotions of these mothers and countertransference feelings, a topic that, to our knowledge, has not been frequently studied. The group was small, analytically oriented, slow-open, comprised of women bereaved by the death of a child, and conducted by a female therapist. Over more than three years, the group included 20 members in total. This article describes a number of dreams recorded during a period when the group included seven members. Dreams helped the group members access their emotional pain, helplessness, yearning for a relationship with the deceased, guilt, and feelings of survival guilt. The transference-countertransference relationships were characterized by holding. Countertransference feelings of helplessness predominated. The therapist and the group as a whole contained various emotions, allowing the group members to return to the normal mourning processes from the parallel encouragement of group development and interpersonal relationships.

Review of the Empirical and Clinical Support for Group Therapy Specific to Sexual Abusers.

Science.gov (United States)

Jennings, Jerry L; Deming, Adam

2017-12-01

This review compiles 48 empirical studies and 55 clinical/practice articles specific to group therapy with sex offenders. Historically, group therapy has always been the predominant modality in sex offender-specific treatment. In the first decades of the field, treatment applied a psychoanalytic methodology that, although not empirically supported, fully appreciated the primary therapeutic importance of the group modality. Conversely, since the early 1980s, treatment has applied a cognitive behavioral method, but the field has largely neglected the therapeutic value of interpersonal group dynamics. The past decade has seen a growing re-appreciation of general therapeutic processes and more holistic approaches in sex offender treatment, and there is an emerging body of empirical research which, although often indirectly concerned with group, has yielded three definitive conclusions. First, the therapeutic qualities of the group therapist-specifically warmth, empathy, encouragement, and guidance-can strongly affect outcomes. Second, the quality of group cohesion can profoundly affect the effectiveness of treatment. Third, confrontational approaches in group therapy are ineffective, if not counter-therapeutic, and overwhelmingly rated as not helpful by sex offenders themselves. Additional conclusions are less strongly supported, but include compelling evidence that sex offenders generally prefer group therapy over individual therapy, that group therapy appears equally effective to individual therapy, and that mixing or separating groups by offense type is not important to therapeutic climate. Other group techniques and approaches specific to sexual abuse treatment are also summarized.

SU-E-T-181: Clinical Implementation of Task Group 176

Energy Technology Data Exchange (ETDEWEB)

Burgdorf, B [University of Pennsylvania, Philadelphia, PA (United States); Yeager, C; Zhou, F; Hand, C [Albert Einstein Medical Center, Philadelphia, PA (United States)

2015-06-15

Purpose: The implementation of TG-176 with regards to immobilization devices and couch tops as they effect dosimetric treatment planning. Methods: The external devices used clinically were scanned to measure their HU values. Plans were created in the Eclipse treatment planning system (TPS) using these devices, one that accounted for the correct HU value of the each device and another that did not include the device as a structure. A dose subtraction was performed between the two plans to evaluate the dosimetric differences. The metrics used for evaluation included attenuation and surface dose. Plan parameters were varied to evaluate the impact of the devices in different clinical scenarios. Results: While the exact HU values of our results are clinic-dependent, the protocol being implemented is widely applicable. We recommend a four step process for implementing this task group. First, physics should scan each treatment device to determine accurate HU values. Second, CT therapists should include in the setup note which table top was used during patient CT simulation and are asked to make immobilization devices as uniform in thickness as possible. Therapists should also index the devices whenever possible so beam will traverse the same area of the device. Third, the dosimetrist should manually correct the HU value for any external device, including the couch. For H&N cases, the rails must be removed from the couch structure. When rails are used during treatments, it is important to make note of their exact position in the setup notes. Finally, physicians should be made aware that there could be changes in surface doses depending on whether or not immobilization devices or couch tops are in the beam path. Conclusion: The protocol outlined above was implemented to reduce the errors that arise from ignoring effects of external devices, thus ensuring safer, more accurate patient treatments.

Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support.

Science.gov (United States)

Campmans-Kuijpers, Marjo J; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E

2015-02-01

To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P quality management score (P = 0.001). Of the 44 participating outpatient clinics, 28 completed the study. Their total score changed from 65.7% (CI 60.3-71.1%) to 67.3% (CI 62.9-71.7%; P = 0.30). Only the results in the domain multidisciplinary teamwork improved (P = 0.001). Measuring quality management and providing feedback and a benchmark improves the level of quality management in care groups but not in outpatient clinics. The questionnaires might also be a useful asset for other diabetes care groups, such as Accountable Care Organizations. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

The Effectiveness of Peer Taught Group Sessions of Physiotherapy Students within the Clinical Setting: A Quasi-Experimental Study

Science.gov (United States)

Scott, Dee; Jelsma, Jennifer

2014-01-01

The study aimed to investigate whether learning from peers, learning from a clinical educator, or being the peer teacher during clinical group sessions was more effective at enhancing student learning outcomes for different health conditions. A secondary aim was to determine which method students found more satisfactory. Physiotherapy students at…

Efecto del ajuste estructural sobre la situación de salud en América Latina y el Caribe, 1980-2000 The effect of structural adjustment on health conditions in Latin America and the Caribbean, 1980-2000

Directory of Open Access Journals (Sweden)

Álvaro Franco-Giraldo

2006-05-01

Full Text Available OBJETIVO: Evaluar el impacto del ajuste estructural sobre los indicadores de salud en América Latina y el Caribe durante el período de 1980-2000. MÉTODOS: Se trata de un estudio ecológico. Los datos del gasto público y del producto interno bruto per cápita (PIBpc se tomaron del Banco Mundial y los de la esperanza de vida (EV y mortalidad infantil (MI, de la Organización Mundial de la Salud. El ajuste estructural (adelgazamiento del Estado se evaluó mediante el cambio en el consumo de gobierno (la reducción del gasto público en los países de América Latina y el Caribe en la década de 1980-1990. El cambio en los indicadores de salud se midió por la variación porcentual de la EV y la MI. Se compararon estas variaciones en América Latina y el Caribe con las observadas en diferentes grupos de países de otras regiones del mundo durante el período de 1980-2000. Se determinaron las asociaciones entre la reducción del gasto público y los indicadores de salud mediante la prueba de Pearson. Para estimar el efecto de los cambios sobre la salud se construyó un modelo de regresión lineal multifactorial ajustado según el PIBpc. RESULTADOS: Se observó una ralentización del incremento de la EV y del descenso de la MI en América Latina y el Caribe, especialmente en la década de 1980-1990. Se encontraron asociaciones significativas entre la variación de los indicadores de salud y el cambio del gasto público en todos los grupos de países analizados. Al ajustar el modelo de regresión múltiple, las asociaciones solo se mantuvieron en América Latina y el Caribe. CONCLUSIONES: En la década de 1980, el ajuste de las políticas macroeconómicas tuvo un efecto negativo sobre los indicadores sociales, específicamente sobre los relacionados con la situación de salud en América Latina y el Caribe. Estos efectos se siguieron observando durante la década siguiente.OBJECTIVE: To assess the impact of structural adjustment on health

Resistance pattern of clinical isolates of staphylococcus aureus against five groups of antibiotics

International Nuclear Information System (INIS)

Farzana, K.; Hameed, A.

2006-01-01

Among the samples received in pathology laboratory, Pakistan institute of Medical Science, Islamabad, 5069 samples had bacterial growth, among these 2580 (51%) samples were Gram-positive cocci and 1688 were Staphylococcus aureus during a period of two years. Out of these Gram-positive cocci 56% were resistant to penicillin group, 27% were resistant to cephalosporin group, 22% were resistant to aminoglycoside group 15% were resistant to quinolone group and 31% were resistant to other antibiotics (cotrimaxazole, erythromycin, aztreonam, vancomycin, nitrofurantion and meropenam). Antibio-grams of Gram-positive cocci were determined against various antibiotics by disc diffusion method. The rate of resistance to most of the antibiotics such as ampicillin, piperacillin, carbenicillin, penicillin, cephradine, cefotaxime, erythromycin, ceclor, ofloxacin, pefloxacin, ciprofloxacin, cotrimexazole (septran), gentamicin, meropenem, ceftazidime, erythromycin, tobramycin, enoxacin was higher when tested against the isolates collected from pus as compared to those from blood and urine. Antibiotic resistant strains were more prevalent in pus samples than other clinical isolates (blood and urine). The randomly selected 155 strains of Staphylococcus aureus when tested against five groups of antibiotics showed resistance rate against ampicillin (92%), cephradine (92%), cephradine (60%), and gentamicin (58%). However intermediate resistance was found in case of vancomicin (38%), in hospitalized and non-hospitalized patients. (author)

Aqueous chemical growth and application of ZnO nanorods

Energy Technology Data Exchange (ETDEWEB)

Postels, Bianca; Kasprzak, Anna; Mofor, Augustine C.; Wehmann, Hergo-Heinrich; Bakin, Andrey; Waag, Andreas [Institute of Semiconductor Technology, Technical University Braunschweig, Hans-Sommer-Str. 66, 38106 Braunschweig (Germany)

2007-07-01

A very promising fabrication process for ZnO nanostructures is the aqueous chemical growth (ACG), since it is a cost efficient and low temperature approach. Using this growth technique we generated wafer-scale ZnO nanorod arrays on Si, sapphire, ITO coated glass and even on flexible polymer substrates. ACG is found to be only weakly influenced by the substrate material and we are also able to control the dimensions of the ZnO nanorods. Another benefit of ACG is the ability to fabricate patterned arrays of ZnO nanorods by a selective growth process on structured metallised surfaces. Results of structural analysis with SEM and XRD are reported. Additionally, optical properties were investigated by PL measurements. First attempts on the preparation of dye sensitised solar cells (DSSCs) are also reported. Here, the traditional sintered TiO{sub 2} nanoparticles are replaced by a densely packed and vertically aligned array of ACG ZnO nanorods. The size and morphology of the ZnO nanorods can be controlled. The influence of the length of the nanorods on the cell properties is investigated. A vapour phase transport technique was also used as alternative growth method.

Pica in a Child with Anterior Cingulate Gyrus Oligodendroglioma: Case Report.

Science.gov (United States)

Rangwala, Shivani D; Tobin, Matthew K; Birk, Daniel M; Butts, Jonathan T; Nikas, Dimitrios C; Hahn, Yoon S

2017-01-01

The anterior cingulate gyrus (ACG) is a continued focus of research as its exact role in brain function and vast connections with other anatomical locations is not fully understood. A review of the literature illustrates the role the ACG likely plays in cognitive and emotional processing, as well as a modulating role in motor function and goal-oriented behaviors. While lesions of the cingulate gyrus are rare, each new case broadens our understanding of its role in cognitive neuroscience and higher order processing. The authors present the case of an 8-year-old boy with a 1-month history of staring spells, agitated personality, and hyperphagia notable for the consumption of paper, who was found to have a 3-cm tumor in the left ACG. Following surgical resection of the tumor, his aggressive behavior and pica were ameliorated and the patient made an uneventful recovery, with no evidence of recurrence over the last 6 years since surgical resection. Here we discuss a unique behavioral presentation of pica, along with a review of the current literature, to illustrate functions of the ACG relevant to the location of the lesion. © 2017 S. Karger AG, Basel.

Clindamycin Affects Group A Streptococcus Virulence Factors and Improves Clinical Outcome.

Science.gov (United States)

Andreoni, Federica; Zürcher, Claudia; Tarnutzer, Andrea; Schilcher, Katrin; Neff, Andrina; Keller, Nadia; Marques Maggio, Ewerton; Poyart, Claire; Schuepbach, Reto A; Zinkernagel, Annelies S

2017-01-15

Group A Streptococcus (GAS) has acquired an arsenal of virulence factors, promoting life-threatening invasive infections such as necrotizing fasciitis. Current therapeutic regimens for necrotizing fasciitis include surgical debridement and treatment with cell wall-active antibiotics. Addition of clindamycin (CLI) is recommended, although clinical evidence is lacking. Reflecting the current clinical dilemma, an observational study showed that only 63% of the patients with severe invasive GAS infection received CLI. This work thus aimed to address whether CLI improves necrotizing fasciitis outcome by modulating virulence factors of CLI-susceptible and CLI-resistant GAS in vitro and in vivo. Treatment with CLI reduced extracellular DNase Sda1 and streptolysin O (SLO) activity in vivo, whereas subinhibitory CLI concentrations induced expression and activity of SLO, DNase, and Streptococcus pyogenes cell envelope protease in vitro. Our in vivo results suggest that CLI should be administered as soon as possible to patients with necrotizing fasciitis, while our in vitro studies emphasize that a high dosage of CLI is essential. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

The effectiveness of a health promotion with group intervention by clinical trial. Study protocol

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Campo Osaba Maria-Antonia

2012-03-01

Full Text Available Abstract Background The promotion of health and the interventions in community health continue to be one of the pending subjects of our health system. The most prevalent health problems (cardiovascular diseases, cancer, diabetes... are for the most part related to life habits. We propose a holistic and integral approach as the best option for tackling behavior and its determinants. The research team has elaborated the necessary educational material to realize group teaching, which we call "Health Workshops". The goal of the present study is to evaluate the effectiveness of these Health Workshops in the following terms: Health Related Quality of Life (HRQOL, incorporate and maintain a balanced diet, do physical activity regularly, maintain risk factors such as tension, weight, cholesterol within normal limits and diminish cardiovascular risk. Methods/Design Controlled and random clinical testing, comparing a group of persons who have participated in the Health Workshops with a control group of similar characteristics who have not participated in the Health Workshops. Field of study: the research is being done in Health Centers of the city of Barcelona, Spain. Population studied: The group is composed of 108 persons that are actually doing the Health Workshops, and 108 that are not and form the control group. They are assigned at random to one group or the other. Data Analysis: With Student's t-distribution test to compare the differences between numerical variables or their non parametric equivalent if the variable does not comply with the criteria of normality. (Kolmogorov-Smirnof test. Chi-square test to compare the differences between categorical variables and the Logistic Regression Model to analyze different meaningful variables by dichotomous analysis related to the intervention. Discussion The Health Workshop proposed in the present study constitutes an innovative approach in health promotion, placing the emphasis on the person's self

The feasibility, perceived satisfaction, and value of using synchronous webinars to educate clinical research professionals on reporting adverse events in clinical trials: a report from the Children's Oncology Group.

Science.gov (United States)

Borgerson, Dawn; Dino, Jennifer

2012-01-01

Clinical research professionals are faced with decreased funding and increased workloads; innovative methods of professional development programs are necessary to accommodate these factors. This study evaluated the feasibility, perceived satisfaction, and value of using webinars to educate clinical research professionals on reporting adverse events commonly experienced in pediatric oncology clinical trials. The setting incorporated synchronous web-based educational technology. Constructivist learning provides the theoretical framework for this study. Participants evaluated the professional development program at 2 time points: (a) at the conclusion and (b) 4 to 6 weeks afterward, using survey method. Synchronous webinars were both economical and effective in educating clinical research professionals across institutional sites. Participants reported exceptionally high levels of satisfaction with the accessibility, scope, quality, and interactivity of the professional development program. The vast majority of participants reported that the education would assist with reporting adverse events in pediatric oncology clinical trials and this perception persisted into clinical practice. Although the results of this study were intended to guide future educational efforts of the Children's Oncology Group, they may also apply to other cooperative groups.

Anterior paracingulate and cingulate cortex mediates the effects of cognitive load on speech sound discrimination.

Science.gov (United States)

Gennari, Silvia P; Millman, Rebecca E; Hymers, Mark; Mattys, Sven L

2018-06-11

Perceiving speech while performing another task is a common challenge in everyday life. How the brain controls resource allocation during speech perception remains poorly understood. Using functional magnetic resonance imaging (fMRI), we investigated the effect of cognitive load on speech perception by examining brain responses of participants performing a phoneme discrimination task and a visual working memory task simultaneously. The visual task involved holding either a single meaningless image in working memory (low cognitive load) or four different images (high cognitive load). Performing the speech task under high load, compared to low load, resulted in decreased activity in pSTG/pMTG and increased activity in visual occipital cortex and two regions known to contribute to visual attention regulation-the superior parietal lobule (SPL) and the paracingulate and anterior cingulate gyrus (PaCG, ACG). Critically, activity in PaCG/ACG was correlated with performance in the visual task and with activity in pSTG/pMTG: Increased activity in PaCG/ACG was observed for individuals with poorer visual performance and with decreased activity in pSTG/pMTG. Moreover, activity in a pSTG/pMTG seed region showed psychophysiological interactions with areas of the PaCG/ACG, with stronger interaction in the high-load than the low-load condition. These findings show that the acoustic analysis of speech is affected by the demands of a concurrent visual task and that the PaCG/ACG plays a role in allocating cognitive resources to concurrent auditory and visual information. Copyright © 2018. Published by Elsevier Inc.

Clinical gait analysis : A review of research at the Interdepartmental Research group of Kinesiology in Leiden

NARCIS (Netherlands)

Daanen, H. A M

1990-01-01

In this article the methodology used in the Interdepartmental Research Group of Kinesiology to quantify (clinical) human gait is elaborated upon. Four methods are described: analysis of temporal parameters, goniometry, accelerometry and electromyography. A correct representation of electromyographic

Reported parental characteristics in relation to trait depression and anxiety levels in a non-clinical group.

Science.gov (United States)

Parker, G

1979-09-01

Care and overprotection appear to reflect the principal dimensions underlying parental behaviours and attitudes. In previous studies of neurotically depressed patients and of a non-clinical group, subjects who scored their parents as lacking in care and/or overprotective had the greater depressive experience. The present study of another non-clinical group (289 psychology students) replicated those findings in regard to trait depression levels. In addition, associations between those parental dimensions and trait anxiety scores were demonstrated. Multiple regression analyses established that 9-10% of the variance in mood scores was accounted for by scores on those parental dimensions. Low maternal care scores predicted higher levels of both anxiety and depression, while high maternal overprotection scores predicted higher levels of anxiety but not levels of depression. Maternal influences were clearly of greater relevance than paternal influences.

Perspectives on Research Participation and Facilitation Among Dialysis Patients, Clinic Personnel, and Medical Providers: A Focus Group Study.

Science.gov (United States)

Flythe, Jennifer E; Narendra, Julia H; Dorough, Adeline; Oberlander, Jonathan; Ordish, Antoinette; Wilkie, Caroline; Dember, Laura M

2017-12-19

Most prospective studies involving individuals receiving maintenance dialysis have been small, and many have had poor clinical translatability. Research relevance can be enhanced through stakeholder engagement. However, little is known about dialysis clinic stakeholders' perceptions of research participation and facilitation. The objective of this study was to characterize the perspectives of dialysis clinic stakeholders (patients, clinic personnel, and medical providers) on: (1) research participation by patients and (2) research facilitation by clinic personnel and medical providers. We also sought to elucidate stakeholder preferences for research communication. Qualitative study. 7 focus groups (59 participants: 8 clinic managers, 14 nurses/patient care technicians, 8 social workers/dietitians, 11 nephrologists/advanced practice providers, and 18 patients/care partners) from 7 North Carolina dialysis clinics. Clinics and participants were purposively sampled. Focus groups were recorded and transcribed. Thematic analysis. We identified 11 themes that captured barriers to and facilitators of research participation by patients and research facilitation by clinic personnel and medical providers. We collapsed these themes into 4 categories to create an organizational framework for considering stakeholder (narrow research understanding, competing personal priorities, and low patient literacy and education levels), relationship (trust, buy-in, and altruistic motivations), research design (convenience, follow-up, and patient incentives), and dialysis clinic (professional demands, teamwork, and communication) aspects that may affect stakeholder interest in participating in or facilitating research. These themes appear to shape the degree of research readiness of a dialysis clinic environment. Participants preferred short research communications delivered in multiple formats. Potential selection bias and inclusion of English-speaking participants only. Our findings

The validity of clinical findings for diagnosing temporomandibular disorders in patients from different age and gender groups

International Nuclear Information System (INIS)

Igarashi, Chinami

2008-01-01

This study was to clarify the diagnostic accuracy of clinical findings for internal derangement of the temporomandibular joint (TMJ) compared with that of magnetic resonance imaging. A series of 4559 patients (879 male and 3680 female, mean age 32.7 years; range 8-85 years;) with temporomandibular disorders were clinically examined by un unspecified number of dentists. All patients underwent magnetic resonance imaging (MRI). The clinical findings that characterize disc displacement, anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR) are pain, clicking sound and limitation of maximum mouth opening. These clinical findings were compared to the MRI interpretation, which was used as the gold standard for diagnosis of temporomandibular disorders to define the diagnostic accuracy, specificity, sensitivity, positive predictive value and negative predictive value of clinical findings. The prevalence of clinical finding was 3990 joints (43%) with pain, 2775 joints (30%) with clicking sound and 1731 patients (38%) with limitation of opening. Three thousands forty seven joints were diagnosed as having a normal disc position, 510 joints with sideways disc displacement, 2312 joints with ADDwR, 3239 joints with ADDwoR on MR image. The sensitivity of clinical findings was considerably low: sensitivity was 0.48 for pain versus internal derangement, 0.51 for clicking sound versus ADDwR, 0.62 for limitation of opening versus ADDwoR. The sensitivity was higher in the younger group for clicking sound versus ADDwR, but sensitivity was higher in the older group for limitation of opening versus ADDwoR. The diagnostic accuracy based on clinical findings of internal derangement of TMJ was found to be correlated with age. This study has been that the overall diagnostic accuracy of the clinical findings to determine the status of the joint is about 50-60%. The status of the joint could not be accurately determined by clinical findings

Agreement between Cochrane Neonatal Group reviews and clinical guidelines for newborns at a Copenhagen University Hospital - a cross-sectional study

DEFF Research Database (Denmark)

Brok, Jesper; Greisen, Gorm; Jacobsen, Robert Thorkild

2007-01-01

To assess the agreement between Cochrane Neonatal Group reviews and clinical guidelines of a University Neonatology Department, to evaluate the reasons for potential disagreements and to ascertain whether Cochrane reviews were considered for the guidelines development.......To assess the agreement between Cochrane Neonatal Group reviews and clinical guidelines of a University Neonatology Department, to evaluate the reasons for potential disagreements and to ascertain whether Cochrane reviews were considered for the guidelines development....

Attachment representations in mothers, fathers, adolescents, and clinical groups : A meta-analytic search for normative data.

NARCIS (Netherlands)

IJzendoorn, van M.H.; Bakermans-Kranenburg, M.J.

1996-01-01

This meta-analysis on 33 studies, including more than 2,000 Adult Attachment Interview (AAI) classifications, presents distributions of AAI classifications in samples of nonclinical fathers and mothers, in adolescents, in samples from different cultures, and in clinical groups. Fathers, adolescents,

Mutual assumptions and facts about nondisclosure among clinical supervisors and students in group supervision

DEFF Research Database (Denmark)

Nielsen, Geir Høstmark; Skjerve, Jan; Jacobsen, Claus Haugaard

2009-01-01

In the two preceding papers of this issue of Nordic Psychology the authors report findings from a study of nondisclosure among student therapists and clinical supervisors. The findings were reported separately for each group. In this article, the two sets of findings are held together and compared......, so as to draw a picture of mutual assumptions and facts about nondisclosure among students and supervisors....

A case-mix classification system for explaining healthcare costs using administrative data in Italy.

Science.gov (United States)

Corti, Maria Chiara; Avossa, Francesco; Schievano, Elena; Gallina, Pietro; Ferroni, Eliana; Alba, Natalia; Dotto, Matilde; Basso, Cristina; Netti, Silvia Tiozzo; Fedeli, Ugo; Mantoan, Domenico

2018-03-04

The Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient and drug services. Financing of Local Health Trusts (LHTs) is based on a capitation system adjusted only for age, gender and area of residence. We applied a risk-adjustment system (Johns Hopkins Adjusted Clinical Groups System, ACG® System) in order to explain health care costs using routinely collected administrative data in the Veneto Region (North-eastern Italy). All residents in the Veneto Region were included in the study. The ACG system was applied to classify the regional population based on the following information sources for the year 2015: Hospital Discharges, Emergency Room visits, Chronic disease registry for copayment exemptions, ambulatory visits, medications, the Home care database, and drug prescriptions. Simple linear regressions were used to contrast an age-gender model to models incorporating more comprehensive risk measures aimed at predicting health care costs. A simple age-gender model explained only 8% of the variance of 2015 total costs. Adding diagnoses-related variables provided a 23% increase, while pharmacy based variables provided an additional 17% increase in explained variance. The adjusted R-squared of the comprehensive model was 6 times that of the simple age-gender model. ACG System provides substantial improvement in predicting health care costs when compared to simple age-gender adjustments. Aging itself is not the main determinant of the increase of health care costs, which is better explained by the accumulation of chronic conditions and the resulting multimorbidity. Copyright © 2018. Published by Elsevier B.V.

Project CHECO Southeast Asia Report. SEAsia Glossary, 1961-1970

Science.gov (United States)

1970-02-01

Center ACCS Airborne Command and Control Squadron ACD Air Cavalry Division 2 I ACFT Aircraft ACG Air Commando Group ACIC Aeronautical Chart and...identification number extracted from the Bombing Encyclopedia . BEQ Bachelor Enlisted Men’s Quarters BETA Designated positions over prominent landmarks in BARREL...capable of3 puncturing vehicle tires. CAMEL PATH (S) Psychological Warfare (MACV) I CAMRON Consolidated Aircraft Maintenance Squadron CANDLESTICK (S/NF

Personality disorder moderates outcome in short- and long-term group analytic psychotherapy: A randomized clinical trial.

Science.gov (United States)

Lorentzen, Steinar; Ruud, Torleif; Fjeldstad, Anette; Høglend, Per A

2015-06-01

In a randomized clinical trial, short- and long-term psychodynamic group psychotherapy (STG and LTG, respectively) schedules were equally effective for the 'typical' patient during a 3-year study period. Although several studies have reported good effects for patients with personality disorders (PD) in diverse forms of psychotherapy, the significance of treatment duration is unclear. Therefore, we tested the hypothesis that PD patients would improve more during and after LTG than STG. A randomized, longitudinal, prospective study contrasting the outcomes during and after short- and long-term dynamic group psychotherapies. One hundred and sixty-seven outpatients with mood disorders, anxiety disorders, or PD were randomized to STG or LTG (respectively, 20 or 80 weekly sessions of 90 min each). Outcome measures are as follows: symptoms (SCL-90-R), interpersonal problems (IIP-C), and psychosocial functioning (GAF split version: GAF-Symptom and GAF-Function). PD pathology (number of PD criteria items) was selected a priori as a putative moderator of treatment effects. Change during the 3-year study period was assessed using linear mixed models. The study was registered at ClinicalTrials.gov as NCT 00021417. Our hypothesis was supported, as patients with PD improved significantly more regarding all outcome variables in LTG than STG. For patients without PD, the rate of change was similar across 3 years; however, the rate of change in symptoms and interpersonal problems was higher in STG during the first 6 months. The effectiveness of LTG is higher for patients with co-morbid PD. Patients without PD do not appear to experience additional gain from LTG. Clinical implications: LTG demonstrates better effectiveness than STG for patients with personality disorder co-morbidity (PD). Patients without PD do not appear to experience additional gain from attending LTG. Correct initial allocation to treatment duration may prevent disruptive breaks in relationships and lead to both

Incorporação da densidade no ajuste de dois modelos à curva de retenção de água no solo

Directory of Open Access Journals (Sweden)

C. A. Tormena

2002-06-01

Full Text Available A curva de retenção de água no solo é fundamental para o desenvolvimento de estudos relacionados com a dinâmica da água, com a modelagem de processos físicos do solo e crescimento das plantas. Normalmente, a curva de retenção é obtida por meio de medidas simultâneas do conteúdo de água (θ e do potencial mátrico da água no solo (ψ numa única amostra. Um procedimento alternativo consiste em utilizar várias amostras por ψ para descrever a curva de retenção. A utilização deste procedimento requer a incorporação dos fatores de variação existentes entre as amostras nos parâmetros das funções matemáticas utilizadas para descrever essa curva. O objetivo deste trabalho foi obter a curva de retenção, utilizando esta última sistemática, e ajustar duas diferentes funções não-lineares aos dados de θ(ψ. Amostras indeformadas (0,05 m de diâmetro e 0,05 m de altura foram obtidas num Latossolo Vermelho distroférrico cultivado com milho sob plantio direto e preparo convencional do solo. Foram retiradas 96 amostras por sistema de preparo, na profundidade de 0-0,10 m, na linha e na entrelinha da cultura. A curva de retenção foi obtida utilizando-se 12 ψ, sendo 16 amostras por ψ: oito por sistema de preparo e quatro por posição amostrada. Os modelos de Genuchten (1980 - VG e o de Hutson & Cass (1987 - HC foram ajustados aos dados. Funções relacionando os parâmetros dos modelos com as variáveis independentes preparo, posição de amostragem e densidade do solo (Ds os substituíram no ajuste dos dados. Não houve influência estatisticamente significativa dos sistemas de preparo e posição de amostragem (p > 0,05 no ajuste das funções aos dados . Com a função de VG obtiveram-se efeitos significativos da Ds no parâmetro n, o qual foi descrito por uma função quadrática da Ds. Resultado similar foi obtido com o parâmetro "a" da função de HC. A curva de retenção foi sensível às variações da Ds e o

No differences between group versus individual treatment of childhood anxiety disorders in a randomised clinical trial

NARCIS (Netherlands)

Liber, Juliette M.; van Widenfelt, Brigit M.; Utens, Elisabeth M. W. J.; Ferdinand, Robert F.; van der Leeden, Adelinde J. M.; van Gastel, Willemijn; Treffers, Philip D. A.

2008-01-01

The present study compares an individual versus a group format in the delivery of manualised cognitive-behavioural therapy (FRIENDS) for children with anxiety disorders. Clinically referred children (aged 8 to 12) diagnosed with Separation Anxiety Disorder (n = 52), Generalised Anxiety Disorder (n =

Building the capacity for evidence-based clinical nursing leadership: the role of executive co-coaching and group clinical supervision for quality patient services.

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Alleyne, Jo; Jumaa, Mansour Olawale

2007-03-01

The general aims of this article were to facilitate primary care nurses (District Nurse Team Leaders) to link management and leadership theories with clinical practice and to improve the quality of the service provided to their patients. The specific aim was to identify, create and evaluate effective processes for collaborative working so that the nurses' capacity for clinical decision-making could be improved. This article, part of a doctoral study on Clinical Leadership in Nursing, has wider application in the workplace of the future where professional standards based on collaboration will be more critical in a world of work that will be increasingly complex and uncertain. This article heralds the type of research and development activities that the nursing and midwifery professions should give premier attention to, particularly given the recent developments within the National Health Service in the United Kingdom. The implications of: Agenda for Change, the Knowledge and Skills Framework, 'Our Health, Our Care, Our Say' and the recent proposals from the article 'Modernising Nursing Career', to name but a few, are the key influences impacting on and demanding new ways of clinical supervision for nurses and midwives to improve the quality of patient management and services. The overall approach was based on an action research using a collaborative enquiry within a case study. This was facilitated by a process of executive co-coaching for focused group clinical supervision sessions involving six district nurses as co-researchers and two professional doctoral candidates as the main researchers. The enquiry conducted over a period of two and a half years used evidence-based management and leadership interventions to assist the participants to develop 'actionable knowledge'. Group clinical supervision was not practised in this study as a form of 'therapy' but as a focus for the development of actionable knowledge, knowledge needed for effective clinical management and

Age, Gender, Biometry, Refractive Error, and the Anterior Chamber Angle among Alaskan Eskimos

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Wojciechowski, Robert; Congdon, Nathan; Anninger, William; Broman, Aimee Teo

2011-01-01

Background The prevalence of angle-closure glaucoma (ACG) is greater for Eskimos/Inuit than it is for any other ethnic group in the world. Although it has been suggested that this prevalence may be due to a population tendency toward shallower anterior chamber angles, available evidence for other populations such as Chinese with high rates of ACG has not consistently demonstrated such a tendency. Methods A reticule, slit-lamp, and standard Goldmann one-mirror goniolens were used to make measurements in the anterior chamber (AC) angle according to a previously reported protocol for biometric gonioscopy (BG) (Ophthalmology 1999;106:2161–7). Measurements were made in all four quadrants of one eye among 133 phakic Alaskan Eskimos aged 40 years and older. Automatic refraction, dilated examination of the anterior segment and optic nerve, and A-scan measurements of AC depth, lens thickness, and axial length were also carried out for all subjects. Results Both central and peripheral AC measurements for the Eskimo subjects were significantly lower than those previously reported by us for Chinese, blacks, and whites under the identical protocol. Eskimos also seemed to have somewhat more hyperopia. There were no differences in biometric measurements between men and women in this Eskimo population. Angle measurements by BG seemed to decline more rapidly over life among Eskimos and Chinese than blacks or whites. Although there was a significant apparent decrease in AC depth, increase in lens thickness, and increase in hyperopia with age among Eskimos, all of these trends seemed to reverse in the seventh decade and beyond. Conclusions Eskimos do seem to have shallower ACs than do other racial groups. Measurements of the AC angle seem to decline more rapidly over life among Eskimos than among blacks or whites, a phenomenon also observed by us among Chinese, another group with high ACG prevalence. This apparent more rapid decline may be due to a cohort effect with higher

Virtual study groups and online Observed Structured Clinical Examinations practices - enabling trainees to enable themselves.

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Davidson, Dennisa; Evans, Lois

2018-03-01

To explore online study groups as augmentation tools in preparing for the Royal Australian and New Zealand College of Psychiatrists Observed Structured Clinical Examinations (OSCE) for fellowship. An online survey of New Zealand trainees was carried out to assess exam preparedness and openness to virtual study groups and results analysed. Relevant material around virtual study groups for fellowship examinations was reviewed and used to inform a pilot virtual study group. Four New Zealand trainees took part in the pilot project, looking at using a virtual platform to augment OSCE preparation. Of the 50 respondents 36% felt adequately prepared for the OSCE. Sixty-four per cent were interested in using a virtual platform to augment their study. Virtual study groups were noted to be especially important for rural trainees, none of whom felt able to form study groups for themselves. The pilot virtual study group was trialled successfully. All four trainees reported the experience as subjectively beneficial to their examination preparation. Virtual platforms hold promise as an augmentation strategy for exam preparation, especially for rural trainees who are more geographically isolated and less likely to have peers preparing for the same examinations.

Development of a prototype clinical decision support tool for osteoporosis disease management: a qualitative study of focus groups

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Newton David

2010-07-01

Full Text Available Abstract Background Osteoporosis affects over 200 million people worldwide, and represents a significant cost burden. Although guidelines are available for best practice in osteoporosis, evidence indicates that patients are not receiving appropriate diagnostic testing or treatment according to guidelines. The use of clinical decision support systems (CDSSs may be one solution because they can facilitate knowledge translation by providing high-quality evidence at the point of care. Findings from a systematic review of osteoporosis interventions and consultation with clinical and human factors engineering experts were used to develop a conceptual model of an osteoporosis tool. We conducted a qualitative study of focus groups to better understand physicians' perceptions of CDSSs and to transform the conceptual osteoporosis tool into a functional prototype that can support clinical decision making in osteoporosis disease management at the point of care. Methods The conceptual design of the osteoporosis tool was tested in 4 progressive focus groups with family physicians and general internists. An iterative strategy was used to qualitatively explore the experiences of physicians with CDSSs; and to find out what features, functions, and evidence should be included in a working prototype. Focus groups were conducted using a semi-structured interview guide using an iterative process where results of the first focus group informed changes to the questions for subsequent focus groups and to the conceptual tool design. Transcripts were transcribed verbatim and analyzed using grounded theory methodology. Results Of the 3 broad categories of themes that were identified, major barriers related to the accuracy and feasibility of extracting bone mineral density test results and medications from the risk assessment questionnaire; using an electronic input device such as a Tablet PC in the waiting room; and the importance of including well-balanced information in

Group intervention for siblings of children with disabilities: a pilot study in a clinical setting.

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Granat, Tina; Nordgren, Ingrid; Rein, George; Sonnander, Karin

2012-01-01

To study the effectiveness of a group intervention in a clinical setting designed to increase knowledge of disability and improve sibling relationship among siblings of children with disabilities. A self-selected sample of 54 younger and older siblings with typical development (ages 8-12 years) of children with attention deficit hyperactivity disorder (ADHD) (9), Asperger syndrome (7), autistic disorder (13), physical disability (8) and intellectual disability (17) participated in collateral sibling groups. The Sibling Knowledge Interview (SKI) and Sibling Relationship Questionnaire (SRQ) were administered pre- and post-intervention. SKI scores increased (p sibling groups showed significantly different (p siblings of children with disabilities. In view of the limited empirical research on group interventions for siblings of children with disabilities future work is needed to investigate the effectiveness of such interventions. Particular attention should be given to siblings of children with autism and siblings of children with intellectual disability.

Escala de bienestar de Ryff: análisis comparativo de los modelos teóricos en distintos grupos de edad Ryff scale of well-being: factorial structure of theoretical models in different age groups

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Pablo Vera-Villarroel

2013-01-01

Full Text Available La escala de bienestar psicológico surge a partir del modelo multidimensional propuesto por Ryff (1989. Pese a su amplia utilización, su estructura teórica inicial no ha sido confirmada completamente, debido a que se han encontrado otro tipo de soluciones factoriales distintas a las 6 dimensiones propuestas por la autora. Estas divergencias podrían estar relacionadas al tipo de muestras y poblaciones utilizadas. Ante esto, la siguiente investigación compara el ajuste factorial de los modelos tradicionalmente aplicados de corrección en distintos grupos en edad adulta. Se describen las propiedades psicométricas de la adaptación al español realizada por Díaz et al. (2006, analizando los niveles de confiabilidad (consistencia interna y estabilidad temporal y estructura factorial confirmatoria, en datos de 1646 personas entre 18 y 90 años de edad. Se encuentran diferencias en los indicadores de confiabilidad para la escala total y las dimensiones, así como en los indicadores de bondad de ajuste dependiendo del grupo de edad. El modelo que presenta mejores indicadores de ajuste en la mayoría de los rangos etarios evaluados fue el de seis factores de primer orden.The scale of psychological well-being arises from the multidimensional model proposed by Ryff (1989. Despite its wide use, its initial theoretical structure has not been completely confirmed because other factorial solutions which are different from those 6 dimensions proposed by the author have been found. These differences may be related to the type of sample and population used. Given this fact, the current study compares the adjustment factor of correction models traditionally used in different groups of adults. We describe the psychometric properties of the Spanish adaptation done by Díaz et al. (2006 and analyze the levels of reliability (internal consistency and temporal stability and confirmatory factorial structure with data from 1,646 people aged from 18 to 90 years old

The importance, impact and influence of group clinical supervision for graduate entry nursing students.

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Sheppard, Fiona; Stacey, Gemma; Aubeeluck, Aimee

2018-01-01

This paper will report on an evaluation of group clinical supervision (CS) facilitated for graduate entry nursing (GEN) students whilst on clinical placement. The literature suggests educational forums which enable GEN students to engage in critical dialogue, promote reflective practice and ongoing support are an essential element of GEN curricula. The model of supervision employed was informed by Proctor's three function interactive CS model and Inskipp and Proctor's Supervision Alliance. Both emphasise the normative, formative and restorative functions of CS as task areas within an overarching humanistic supervisory approach. The three-function model informed the design of a questionnaire which intended to measure their importance, impact and influence through both structured and open-ended questions. Findings suggest the restorative function of supervision is most valued and is facilitated in an environment where humanistic principles of non-judgement, empathy and trust are clearly present. Also the opportunity to learn from others, consider alternative perspectives and question personal assumptions regarding capability and confidence are a priority for this student group. It is suggested that the restorative function of CS should be prioritised within future developments and models which view this function as a key purpose of CS should be explored. Copyright © 2017 Elsevier Ltd. All rights reserved.

CRUZAS DIALÉLICAS ENTRE POBLACIONES NATIVAS DE MAÍZ DE YUCATÁN Y POBLACIONES MEJORADAS

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José C. Segura

2010-09-01

Full Text Available Se estimó la aptitud combinatoria general (ACG y específica (ACE de dos dialelos formados cada uno con cinco poblaciones de maíz. El primer dialelo incluyó poblaciones precoces: Nalxoy Blanco, Nalxoy Amarillo, Xmehen-nal de Yaxcabá, V-533 y VS-536. El segundo incluyó maíces tardíos y precoces: Dzit-Bacal de Kantunil, Dzit-Bacal de Presumida, Dzit-Bacal de Bulukax, V-533 y VS-536. Se usaron bloques al azar con cuatro repeticiones, 10 cruzas F1 y cinco progenitores por dialelo. Los datos se analizaron con el Método 2, Modelo I de Griffing. Para rendimiento de grano, en poblaciones precoces, la ACG explicó 86% de la variación y la ACE 14%. Las poblaciones VS-536, Nalxoy Blanco y Nalxoy Amarillo presentaron ACGs  de 0.21, 0.18 y 0.10. Con base en la ACE la mejor cruza fue Nalxoy Blanco x VS-536 (0.27. Para rendimiento de grano en poblaciones tardías, la ACG contribuyó con 78% de la variación y ACE con 22%. El mejor progenitor fue Dzit-Bacal de Bulukax (ACG = 0.21 y las mejores cruzas  Dzit-Bacal de Bulukax x VS-536 (ACE = 0.54 y Dzit-Bacal de Kantunil x VS-536 (ACE = 0.10. Los materiales más rendidores fueron combinaciones de poblaciones nativas x variedades mejoradas, propuestos como base para programas de mejoramiento.

Impact of educational group strategy to improve clinical and glycemic parameters in individuals with diabetes and hypertension

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Danielli Teixeira Lima Favaro

Full Text Available Objective.To evaluate the impact of an educational group strategy to improve clinical and glycemic parameters in individuals with diabetes and hypertension. Methods. This descriptive prospective study included 172 individuals living in São José do Rio Preto-SP, Brazil, who were enrolled in a well-integrated educational group called HIPERDIA (Record System for Follow-up of Hypertensive and Diabetic Individuals coordinated by a qualified multidisciplinary team. We analyzed sociodemographic, anthropometric, clinical, and laboratory data. Data were collected in the first, fifth, and eighth meeting of the educational group. Results. A total of 68.6% of patients were women, 85.4% were white, 64.0% had an incomplete basic education, 47.7% were retired, 79.7% had been diagnosed with diabetes for 6 or more years, 9.9% were smokers, and 9.9% used alcohol. Individuals' diastolic blood pressure decreased between the fifth and eighth meeting (p<0.05. Between the first and fifth meeting, both fasting glucose levels (p<0.05 and glycated hemoglobin decreased; the latter continue to drop at the fifth and eighth meetings (p<0.001. Anthropometric parameters remained unchanged. Conclusion. The results suggest that an educational group strategy is favorable for controlling diabetes mellitus and hypertension.

Aqueous chemical growth and patterning of ZnO nanopillars on different substrate materials

Energy Technology Data Exchange (ETDEWEB)

Kreye, M.; Postels, B.; Wehmann, H.H.; Waag, A. [Institute of Semiconductor Technology, Technical University of Braunschweig, Hans-Sommer-Strasse 66, 38106 Braunschweig (Germany); Fuhrmann, D.; Hangleiter, A. [Institute of Applied Physics, Technical University of Braunschweig, Mendelssohnstrasse 2, 38106 Braunschweig (Germany)

2006-03-15

Aqueous chemical growth (ACG) is a low-temperature approach that is only weakly influenced by the substrate and allows for the growth of ZnO nanopillars on various substrates. ACG is an efficient way to generate wafer-scale and densely packed arrays of ZnO nanopillars even on polymer materials. Photoluminescence (PL) characterisation clearly shows a comparatively strong band-edge luminescence even at room temperature that is accompanied with a rather weak visible luminescence in the yellow/orange spectral range. We introduce a rather simple postgrowth lithographic technique. Patterning of ZnO nanopillars even on layered conducting and flexible substrate materials using ACG as a low-temperature growth technique is demonstrated. The economical potential for future applications and devices using ZnO nanopillar arrays is discussed. (copyright 2006 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim) (orig.)

Background on Establishing a Working Group to Create Home Clinical Cases for Education.

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Yoshitake, Taketo

2017-01-01

In Japan there are concerns that there will be a surge in social insurance costs such as medical and nursing care expenses as a result of the baby boom generation reaching the late stages of old age (75 years old and beyond) around 2025 ("The 2025 Problem"). In 2012, the "Outline on Social Insurance and Tax Reform" was approved by the Japanese cabinet and government, including "construction of regional comprehensive care". To promote participation in home medical care by pharmacists, this article presents the roles demanded of pharmacists in regional comprehensive care from the standpoint of physicians, and the discussion of case studies bridging the gap from knowledge learned in lectures to practical applications. In the field of medical education, "The 2023 Problem", regarding standards of education on a global level, caused medical schools across Japan to scramble for curriculum reform, specifically in the demand for increased time spent in clinical training and the expansion of community-based medical education. The current state of community-based medical education will be reviewed. In light of these developments, "the working group to create home clinical cases for education" was developed by clinical pharmacists in the field and university faculty members at Daiichi University of Pharmacy.

Clinical and genetic characteristics in a group of 45 patients with Turner syndrome (monocentric study).

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Bucerzan, Simona; Miclea, Diana; Popp, Radu; Alkhzouz, Camelia; Lazea, Cecilia; Pop, Ioan Victor; Grigorescu-Sido, Paula

2017-01-01

Recent years have seen a shift in perspective on Turner syndrome, as it is no longer considered a significant disability due to therapeutic advances. The delay of diagnosis and the underdiagnosis are common in Turner syndrome, especially because of the great phenotypic variability and lack of firm diagnostic criteria. Our first aim was to assess the clinical and the cytogenetic characteristics and growth rate in growth hormone (GH)-treated patients as compared to those with spontaneous growth. The second aim was to analyze the Y chromosomal sequences. We analyzed 45 patients diagnosed with Turner syndrome in Genetic Pathology Centre of Cluj Emergency Children's Hospital. We carried out a study of the clinical features, the correlations between the karyotype and the phenotype, and we also made a research of Y chromosome sequences. The average age at diagnosis was 8.9±5.4 years. A significant association was observed between the number of external phenotypical abnormalities and internal malformations ( r =0.45), particularly the cardiovascular ones ( r =0.44). Patients treated with GH showed improvement in growth rate, with final stature significantly better than in untreated patients; benefits following treatment were greater if diagnosis was made before the age of 5 years. Thirteen percent of patients experienced spontaneous and complete puberty, whereas 30% experienced incomplete puberty. Patients with the 45,X genotype had a greater stature deficit and a higher incidence of cardiac malformations, compared with patients with 45,X/46,XX mosaic karyotype. Y chromosome sequences were found in only one patient, who subsequently underwent gonadectomy. The importance of this study resides, to the best of our knowledge, in the fact that the largest group of patients in Romania was analyzed and assessed. To draw firm conclusions on the most valuable clinical indicators for Turner syndrome diagnosis in clinical practice, studies on large groups of patients should be

Sistemas homogéneos de ecuaciones diofánticas. Resolución y aplicación al ajuste automático de reacciones químicas

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Recuero, Alfonso

1984-06-01

Full Text Available An algorithm to solve systems of linear homogeneous diophantine equations is given here. Subsequently, as an example of application, a method of heuristic search for the best solution is described; this fulfils certain conditions within an infinite space of solutions of various dimensions. Finally, an application of the algorithm and of the process of heuristic search for the best solution in adjusting chemical reactions is described. The listing in BASIC of the program of application mentioned is included, for the HP-75 portable computer.

Se presenta un algoritmo de resolución de sistemas de ecuaciones diofánticas lineales y homogéneas. Seguidamente y como ejemplo de aplicación se describe un método de búsqueda heurística de una solución óptima que cumpla unas ciertas condiciones dentro de un espacio infinito de soluciones de varias dimensiones. Por último se describe la aplicación del algoritmo y del procedimiento de búsqueda heurística para el caso de ajuste de reacciones químicas. Se incluye el listado en BASIC del programa para el ordenador HP-75.

Ajuste produtivo e medidas de flexibilização da legislação trabalhista Productive adjustment and flexibilization in the labor laws

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Rosana Ribeiro

2007-05-01

Full Text Available A partir da década de 90, a introdução de inovações tecnológicas e organizacionais na indústria brasileira se intensificou significativamente. Um dos objetivos deste artigo é analisar os principais obstáculos à negociação de cláusulas referentes a essas inovações entre o sindicato dos trabalhadores da indústria de calçados, da indústria siderúrgica e da indústria têxtil e os respectivos empresários. Outro objetivo é investigar o grau de difusão das recentes medidas de flexibilização da legislação trabalhista e a estratégia desses sindicatos. Palavras-chave: Ajuste produtivo. Negociação coletiva. Flexibilização. Legislação trabalhista. During the 90’s, many new technologies and innovations in organizational structure were introduced to the Brazilian industry. One of the purposes of this article is to analyze the main obstacles to the negotiation of new labor laws in relation to theses changes between labor unions (footwear, metal and textile industry workers and the owners of the factories. The other purpose is to investigate the level of diffusion of the recent flexibilization measures of the labor legislation and the strategy of these unions. Keywords: Productive adjustment. Collective negotiation. Flexibilization. Labor laws.

Veteran satisfaction and treatment preferences in response to a posttraumatic stress disorder specialty clinic orientation group.

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Schumm, Jeremiah A; Walter, Kristen H; Bartone, Anne S; Chard, Kathleen M

2015-06-01

To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs (VA) has widely disseminated cognitive processing therapy (CPT) and prolonged exposure (PE) therapy to VA clinicians. However, there is a lack of research on veteran preferences when presented with a range of psychotherapy and medication options. This study uses a mixed-method approach to explore veteran satisfaction with a VA PTSD specialty clinic pre-treatment orientation group, which provides education about available PTSD treatment options. This study also tested differences in treatment preference in response to the group. Participants were 183 US veterans. Most were White, male, and referred to the clinic by a VA provider. Results indicated high satisfaction with the group in providing an overview of services and helping to inform treatment choice. Most preferred psychotherapy plus medications (63.4%) or psychotherapy only (30.1%). Participants endorsed a significantly stronger preference for CPT versus other psychotherapies. PE was significantly preferred over nightmare resolution therapy and present-centered therapy, and both PE and cognitive-behavioral conjoint therapy were preferred over virtual reality exposure therapy. Results suggest that by informing consumers about evidence-based treatments for PTSD, pre-treatment educational approaches may increase consumer demand for these treatment options. Published by Elsevier Ltd.

Team Clinic: An Innovative Group Care Model for Youth with Type 1 Diabetes-Engaging Patients and Meeting Educational Needs.

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Berget, Cari; Lindwall, Jennifer; Shea, Jacqueline J; Klingensmith, Georgeanna J; Anderson, Barbara J; Cain, Cindy; Raymond, Jennifer K

2017-06-01

The purpose of this pilot was to implement an innovative group care model, "Team Clinic", for adolescents with type 1 diabetes and assess patient and provider perspectives. Ninety-one intervention patients and 87 controls were enrolled. Ninety-six percent of intervention adolescents endorsed increased support and perceived connecting with peers as important. The medical providers and staff also provided positive feedback stating Team Clinic allowed more creativity in education and higher quality of care. Team Clinic may be a promising model to engage adolescents and incorporate education and support into clinic visits in a format valued by patients and providers.

Feminist Principles in Survivor's Groups: Out-of-Group Contact.

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Rittenhouse, JoAn

1997-01-01

Illustrates the value of theoretical concepts from Feminist Therapy in the group treatment of women survivors. Theoretical underpinnings are supported using data taken from clinical experience and by examining group themes and out-of-group contact developed from the case sample. Principles regarding feminist groups are proposed. (RJM)

Clinical Value of High Mobility Group Box 1 and the Receptor for Advanced Glycation End-products in Head and Neck Cancer: A Systematic Review

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Nguyen, Austin

2016-04-01

Full Text Available Introduction High mobility group box 1 is a versatile protein involved in gene transcription, extracellular signaling, and response to inflammation. Extracellularly, high mobility group box 1 binds to several receptors, notably the receptor for advanced glycation end-products. Expression of high mobility group box 1 and the receptor for advanced glycation end-products has been described in many cancers. Objectives To systematically review the available literature using PubMed and Web of Science to evaluate the clinical value of high mobility group box 1 and the receptor for advanced glycation end-products in head and neck squamous cell carcinomas. Data synthesis A total of eleven studies were included in this review. High mobility group box 1 overexpression is associated with poor prognosis and many clinical and pathological characteristics of head and neck squamous cell carcinomas patients. Additionally, the receptor for advanced glycation end-products demonstrates potential value as a clinical indicator of tumor angiogenesis and advanced staging. In diagnosis, high mobility group box 1 demonstrates low sensitivity. Conclusion High mobility group box 1 and the receptor for advanced glycation end-products are associated with clinical and pathological characteristics of head and neck squamous cell carcinomas. Further investigation of the prognostic and diagnostic value of these molecules is warranted.

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance.

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Campbell, S M; Sheaff, R; Sibbald, B; Marshall, M N; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M O

2002-03-01

To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Qualitative case studies using semi-structured interviews and documentation review. Twelve purposively sampled PCG/Ts in England. Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Participants' perceptions of the role of clinical governance in PCG/Ts. PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.

Ajuste social y escolar de jóvenes víctimas de maltrato infantil en situación de acogimiento residencial

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Alexander Muela

2013-01-01

Full Text Available El objetivo del presente trabajo consistió en examinar el ajuste social y escolar de jóvenes que habían sufrido maltrato en la infancia y se encontraban en situación de acogimiento residencial. Además, pretendíamos comprobar si existían diferencias entre los sujetos sometidos a distintas situaciones de desprotección infantil. En el estudio participaron 318 jóvenes residentes en la Comunidad Autónoma del País Vasco de edades comprendidas entre los 13 y los 18 años (M = 15.35, DT = 1.68 pertenecientes a tres colectivos. El primero de ellos estaba constituido por 69 jóvenes (31 mujeres y 38 varones víctimas de maltrato infantil que se hallaban bajo una medida de protección de acogimiento residencial. El segundo grupo estaba formado por 75 jóvenes (29 mujeres y 46 varones víctimas de maltrato infantil que se encontraban en situación de riesgo de desamparo. Por último, el tercer grupo estaba constituido por 174 jóvenes (95 mujeres y 79 varones que no habían sufrido maltrato. Los resultados pusieron de manifiesto que, independientemente de la situación de desprotección infantil en la que se encontrasen, los jóvenes víctimas de maltrato infantil mostraban mayores dificultades de adaptación social y escolar que los jóvenes que no habían sufrido maltrato en la infancia.

Mining approximate temporal functional dependencies with pure temporal grouping in clinical databases.

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Combi, Carlo; Mantovani, Matteo; Sabaini, Alberto; Sala, Pietro; Amaddeo, Francesco; Moretti, Ugo; Pozzi, Giuseppe

2015-07-01

Functional dependencies (FDs) typically represent associations over facts stored by a database, such as "patients with the same symptom get the same therapy." In more recent years, some extensions have been introduced to represent both temporal constraints (temporal functional dependencies - TFDs), as "for any given month, patients with the same symptom must have the same therapy, but their therapy may change from one month to the next one," and approximate properties (approximate functional dependencies - AFDs), as "patients with the same symptomgenerallyhave the same therapy." An AFD holds most of the facts stored by the database, enabling some data to deviate from the defined property: the percentage of data which violate the given property is user-defined. According to this scenario, in this paper we introduce approximate temporal functional dependencies (ATFDs) and use them to mine clinical data. Specifically, we considered the need for deriving new knowledge from psychiatric and pharmacovigilance data. ATFDs may be defined and measured either on temporal granules (e.g.grouping data by day, week, month, year) or on sliding windows (e.g.a fixed-length time interval which moves over the time axis): in this regard, we propose and discuss some specific and efficient data mining techniques for ATFDs. We also developed two running prototypes and showed the feasibility of our proposal by mining two real-world clinical data sets. The clinical interest of the dependencies derived considering the psychiatry and pharmacovigilance domains confirms the soundness and the usefulness of the proposed techniques. Copyright © 2014 Elsevier Ltd. All rights reserved.

Clinical investigation of proximate exposed group. 1. A study for prevalence rate of diabetes mellitus

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Ito, Chikako; Hasegawa, Kazuyo; Kato, Masafumi; Kumasawa, Toshihiko

1984-11-01

In order to investigate effects of the A-bombing on prevalence of diabetes mellitus, follow-up studies were made on 5907 A-bomb survivors who received glucose tolerance test (GTT) during 20 years between 1963 and 1983. The A-bomb survivors were divided into the group A (1899 men and 1165 women exposed within 1.9 km from the hypocenter) and the group B (1725 men and 1118 women exposed 3.0 km or farther from it). Among non-obese survivors, 21.9% and 21.8% were being treated for diabetes mellitus or were evaluated as having diabetic type on GTT in the group A and the group B, respectively; while this was seen in 52.1% of obese survivors in the group A and 49.9% in the group B. There was no difference between the groups. In non-obese survivors, the annual development rate from the normal type to the diabetic type was 0.89% in the group A and 0.65% in the group B; the annual development rate from the borderline type to the diabetic type was 5.73% in the group A and 5.49% in the group B, showing no differences between the groups. The annual development rate from the normal or borderline type to the diabetic type was two times or higher in obese survivors than in non-obese survivors irrespective of exposure status. Regarding the number of diabetic survivors who became non-diabetic type in spite of having no treatment, and prevalence of diabetic complications, no difference was seen between the groups. These results suggest that the A-bombing has scarcely influenced the prevalence of diabetes mellitus and clinical course.

Risk Factors, Clinical Presentation, and Outcomes in Overdose With Acetaminophen Alone or With Combination Products: Results From the Acute Liver Failure Study Group.

Science.gov (United States)

Serper, Marina; Wolf, Michael S; Parikh, Nikhil A; Tillman, Holly; Lee, William M; Ganger, Daniel R

2016-01-01

Acetaminophen (APAP) is the most common cause of acute liver failure (ALF) in the west. It is unknown if APAP overdose in combination with diphenhydramine or opioids confers a different clinical presentation or prognosis. Study objectives were to compare (1) baseline patient characteristics; (2) initial clinical presentation; and (3) clinical outcomes among patients with ALF due to APAP alone or in combination with diphenhydramine or opioids. We analyzed 666 cases of APAP-related liver failure using the Acute Liver Failure Study Group database from 1998 to 2012. The database contains detailed demographic, laboratory, and clinical outcome data, including hemodialysis, transplantation, and death and in-hospital complications such as arrhythmia and infection. The final sample included 666 patients with APAP liver injury. A total 30.3% of patients were overdosed with APAP alone, 14.1% with APAP/diphenhydramine, and 56.6% with APAP/opioids. Patients taking APAP with opioids were older, had more comorbidities, and were more likely to have unintentional overdose (all Ppresentation, 58% in the APAP/opioid group had advanced encephalopathy as compared with 43% with APAP alone (P=0.001) The APAP/diphenhydramine group presented with the highest serum aminotransferase levels, no differences in laboratory values were noted at 3 days postenrollment. No significant differences were observed in clinical outcomes among the groups. Most patients with APAP-induced ALF were taking APAP combination products. There were significant differences in patient characteristics and clinical presentation based on the type of product ingested, however, there were no differences noted in delayed hepatotoxicity or clinical outcomes.

Group psychotherapy for eating disorders: A randomized clinical trial and a pre-treatment moderator and mediator analyses

DEFF Research Database (Denmark)

Davidsen, Annika Helgadóttir

disorders in group therapy. We conducted a randomized clinical trial and included 159 adult participants, 156 females and 3 males, diagnosed with bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified according to DSM-IV. Eighty participants were allocated to the experimental...

Azúcar y Yodopovidona en la disminución del riesgo de infección de herida operatoria en peritonitis generalizada por apendicitis aguda

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Gilmar Hurtado Guerrero

2003-04-01

Full Text Available Objetivo: Se realizó un estudio clínico, de asignación aleatoria, abierto (no ciego para comparar la eficacia, en la disminución del Riesgo de Infección, de la aplicación de Azúcar de caña granulado (ACG vs solución de yodopovidona al 10% (YP, de Herida operatoria en pacientes con Peritonitis Generalizada por Apendicitis Aguda (PGAA. Métodos: Entre 1991 y 1996 se incluyeron a estudio 135 sujetos con diagnóstico de PGAA, intervenidos quirúrgicamente en el Hospital Nacional Cayetano Heredia. Los pacientes fueron asignados aleatoriamente a recibir (ACG o (YP en la Herida Operatoria. Resultados: Ambos grupos fueron estadísticamente comparables en sus características basales como género, edad, promedio de volumen de exudado purulento libre en cavidad peritoneal aspirado, volumen de solución salina al 0.9% usado para el lavado de cavidad peritoneal y en el tiempo operatorio. La frecuencia de infección de herida al 5to día del Post-operatorio para el grupo YP fue de 39.39 % (26 / 66 y el grupo ACG de 28.99% (20/69 (p = 0.20. Se realizó Cierre primario retardo luego del 5to día de Post-operatorio en 89 pacientes, en estos se observó infección de herida en 40% (16/40 para el Grupo YP vs 20.41 % (10/49 para el Grupo ACG (p =0.04, OR: 2.6 IC95%= 0.92 a 7.42. El total de infección de Herida al final del seguimiento fue de 63.64% (42/66 para el grupo YP vs 43.48 % (30 / 69 pacientes para el Grupo ACG. (p= 0.02, OR: 2.28 , IC95% = 1.08 - 4.83. ( Rev Med Hered 2003; 14:74-80 .

Gaming for Health: Systematic Review and Meta-analysis of the Physical and Cognitive Effects of Active Computer Gaming in Older Adults.

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Howes, Sarah C; Charles, Darryl K; Marley, Joanne; Pedlow, Katy; McDonough, Suzanne M

2017-12-01

Active computer gaming (ACG) is a method of facilitating physical activity in older people to improve health outcomes. The purpose of this study was to update and extend a systematic review of the evidence for ACG to determine its effects on physical and cognitive health in older adults. MEDLINE, EMBASE, CENTRAL in the Cochrane Library, and PsycINFO databases were searched from the date of the previous review (2011) to May 2016. Eligible articles were randomized controlled trials (RCTs) investigating the effect of ACG in adults aged 65 and older. Thirty-five studies were eligible for inclusion. Two review authors independently conducted data extraction, risk-of-bias assessment, and coding of behavior change techniques. Outcomes of interest were analyzed as continuous data and pooled as standardized mean differences (SMD) and 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to determine the quality of the evidence. Behavior change techniques (N = 106) were coded in the included studies (mean = 3.02). Data were pooled for 5 main outcomes of interest. Significant moderate effects in favor of ACG were observed for balance (SMD = 0.52, 95% CI = 0.24 to 0.79; 17 studies; 743 participants), for functional exercise capacity when intervention delivery was >120 minutes per week (SMD = 0.53, 95% CI = 0.15 to 0.90; 5 studies; 116 participants), and for cognitive function (SMD = -0.48, 95% CI = -0.80 to 0.17; 8 studies; 459 participants). There was no significant effect observed for functional mobility or fear of falling. The quality of the evidence for all comparisons was graded low or very low. At present there is very little confidence that ACG improves physical and cognitive outcomes in older adults. © 2017 American Physical Therapy Association

Reading the complex skipper butterfly fauna of one tropical place.

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Daniel H Janzen

Full Text Available BACKGROUND: An intense, 30-year, ongoing biodiversity inventory of Lepidoptera, together with their food plants and parasitoids, is centered on the rearing of wild-caught caterpillars in the 120,000 terrestrial hectares of dry, rain, and cloud forest of Area de Conservacion Guanacaste (ACG in northwestern Costa Rica. Since 2003, DNA barcoding of all species has aided their identification and discovery. We summarize the process and results for a large set of the species of two speciose subfamilies of ACG skipper butterflies (Hesperiidae and emphasize the effectiveness of barcoding these species (which are often difficult and time-consuming to identify. METHODOLOGY/PRINCIPAL FINDINGS: Adults are DNA barcoded by the Biodiversity Institute of Ontario, Guelph, Canada; and they are identified by correlating the resulting COI barcode information with more traditional information such as food plant, facies, genitalia, microlocation within ACG, caterpillar traits, etc. This process has found about 303 morphologically defined species of eudamine and pyrgine Hesperiidae breeding in ACG (about 25% of the ACG butterfly fauna and another 44 units indicated by distinct barcodes (n = 9,094, which may be additional species and therefore may represent as much as a 13% increase. All but the members of one complex can be identified by their DNA barcodes. CONCLUSIONS/SIGNIFICANCE: Addition of DNA barcoding to the methodology greatly improved the inventory, both through faster (hence cheaper accurate identification of the species that are distinguishable without barcoding, as well as those that require it, and through the revelation of species "hidden" within what have long been viewed as single species. Barcoding increased the recognition of species-level specialization. It would be no more appropriate to ignore barcode data in a species inventory than it would be to ignore adult genitalia variation or caterpillar ecology.

The intersection of everyday life and group prenatal care for women in two urban clinics.

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Novick, Gina; Sadler, Lois S; Knafl, Kathleen A; Groce, Nora Ellen; Kennedy, Holly Powell

2012-05-01

Women from vulnerable populations encounter challenging circumstances that generate stress and may adversely affect their health. Group prenatal care (GPNC) incorporates features that address social stressors, and has been demonstrated to improve pregnancy outcomes and prenatal care experiences. In this qualitative study, we describe the complex circumstances in the lives of women receiving care in two urban clinics and how GPNC attenuated them. Stressors included problems with transportation and child care, demanding jobs, poverty, homelessness, difficult relationships with partners, limited family support, and frustrating health care experiences. Receiving prenatal care in groups allowed women to strengthen relationships with significant others, gain social support, and develop meaningful relationships with group leaders. By eliminating waits and providing the opportunity to participate in care, GPNC also offered sanctuary from frustrations encountered in receiving individual care. Reducing such stressors may help improve pregnancy outcomes; however, more evidence is needed on mechanisms underlying these effects.

A tecnologia da informação como suporte ao ajuste da previsão da demanda: um estudo de caso em uma empresa de bebidas carbonatadas

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Alexandre Pereira Salgado Junior

2010-08-01

Full Text Available A gestão da cadeia de suprimentos é um problema que sempre instigou gestores por todo o mundo, ademais os modelos de previsão da demanda tradicionais não mais satisfazem os novos desafios da gestão dos estoques e da ruptura. Assim, novas soluções foram desenvolvidas, buscando-se melhorar os níveis de serviço prestados ao consumidor final. Dentre elas, destaca-se a utilização da TI que, por disponibilizar a informação em tempo real, pode contribuir para o ajuste dos modelos tradicionais de previsão da demanda. Desta forma, o objetivo desta pesquisa é analisar como a TI pode ajudar o segmento de bebidas a ajustar sua previsão de demanda. O método de pesquisa utilizado foi o estudo de caso, analisando uma empresa de bebidas carbonatadas, escolhida por conveniência. Para análise dos dados, utilizou-se a técnica de análise de conteúdo. Como principais resultados destacam-se melhorias no nível dos estoques, na ruptura e no nível de serviço.

Anxiety management groups in clinical practice.

Science.gov (United States)

Childs-Clarke, A; Whitfield, W; Cadbury, S; Sandu, S

Anxiety symptoms are commonly reported both in patients and in the general population. There is also increasing concern being expressed over the widespread use of prescribed anxiolytics. This has encouraged the development of psychological interventions for both specific and generalised anxiety. In this paper, 29 patients, most of whom suffered from generalised or free-floating anxiety, were treated in small groups as part of a staff training programme. Their treatment was standardised, and consisted of progressive muscular relaxation, cognitive therapy and an educational input as to the nature of anxiety. Two measures, the Spielberger Trait Scale and an individualised problem rating scale were completed before and after the group and at three months follow-up. All but one of the results was statistically significant. The implications of these results are discussed.

Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group.

Science.gov (United States)

Frerichs, Inéz; Amato, Marcelo B P; van Kaam, Anton H; Tingay, David G; Zhao, Zhanqi; Grychtol, Bartłomiej; Bodenstein, Marc; Gagnon, Hervé; Böhm, Stephan H; Teschner, Eckhard; Stenqvist, Ola; Mauri, Tommaso; Torsani, Vinicius; Camporota, Luigi; Schibler, Andreas; Wolf, Gerhard K; Gommers, Diederik; Leonhardt, Steffen; Adler, Andy

2017-01-01

Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use. Recommendations of how EIT findings can be applied to generate diagnoses and impact clinical decision-making and therapy planning are required. This consensus paper was prepared by an international working group, collaborating on the clinical promotion of EIT called TRanslational EIT developmeNt stuDy group. It addresses the stated needs by providing (1) a new classification of core processes involved in chest EIT examinations and data analysis, (2) focus on clinical applications with structured reviews and outlooks (separately for adult and neonatal/paediatric patients), (3) a structured framework to categorise and understand the relationships among analysis approaches and their clinical roles, (4) consensus, unified terminology with clinical user-friendly definitions and explanations, (5) a review of all major work in thoracic EIT and (6) recommendations for future development (193 pages of online supplements systematically linked with the chief sections of the main document). We expect this information to be useful for clinicians and researchers working with EIT, as well as for industry producers of this technology. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A familial case of achondrogenesis type II caused by a dominant COL2A1 mutation and "patchy" expression in the mosaic father.

Science.gov (United States)

Forzano, F; Lituania, M; Viassolo, A; Superti-Furga, V; Wildhardt, G; Zabel, B; Faravelli, F

2007-12-01

Achondrogenesis type II (ACG2) is the most severe disorder that can be produced by dominant mutations in COL2A1. We report on four pregnancies of an apparently healthy, nonconsanguineous young couple. The father had scoliosis as a child, and has slight body disproportion with short trunk. The first child was born at 32 weeks and died neonatally. In the second pregnancy, short limbs and fetal hygroma were noted on ultrasound at 17 weeks' gestation. Similar findings were observed in the third fetus. Clinical, radiological, and histological evaluation of the fetuses after termination of the pregnancies showed findings consistent with ACG2. Molecular analysis of genomic DNA extracted from amniotic cells of the second and third fetuses revealed heterozygosity for a 10370G > T missense mutation (G346V) in the COL2A1 gene. This mutation was also found in the father, as a mosaic. The couple had a fourth pregnancy, and at 11 weeks fetal hydrops with a septated cystic hygroma were obvious. DNA from CVS demonstrated the same COL2A1 mutation. (c) 2007 Wiley-Liss, Inc.

Susceptibility of clinical isolates of Bacteroides fragilis group strains to cefoxitin, cefoperazone and ticarcillin/clavulanate

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PEIXOTO JÚNIOR Arnaldo Aires

2000-01-01

Full Text Available A total of 40 strains of the B. fragilis group was isolated from clinical specimens in two hospital centers in Fortaleza from 1993 to 1997. The most frequently isolated species was Bacteroides fragilis (19 strains and most isolates came from intra-abdominal and wound infections. The susceptibility profile was traced for cefoxitin, cefoperazone and ticarcillin-clavulanate by using the agar dilution reference method. All isolates were susceptible to ticarcillin-clavulanate (128/2mug/ml. Resistance rates of 15 and 70% were detected to cefoxitin (64mug/ml and cefoperazone (64mug/ml, respectively. Such regional results permit a better orientation in choosing this group of antibiotics for prophylaxis and therapy especially in relation to cefoxitin, which is frequently used in the hospital centers studied.

Student attitudes towards clinical teaching resources in complementary medicine: a focus group examination of Australian naturopathic medicine students.

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Wardle, Jonathan Lee; Sarris, Jerome

2014-06-01

Complementary medicine is forming an increasingly large part of health care in developed countries and is increasingly being formally taught in tertiary academic settings. An exploratory study of naturopathic student perceptions of, use of and attitudes towards teaching resources in naturopathic clinical training and education. Focus groups were conducted with current and recent students of 4-year naturopathic degree programmes in Brisbane and Sydney to ascertain how they interact with clinical teaching materials, and their perceptions and attitudes towards teaching materials in naturopathic education. Naturopathic students have a complex and critical relationship with their learning materials. Although naturopathic practice is often defined by traditional evidence, students want information that both supports and is critical of traditional naturopathic practices, and focuses heavily on evidence-based medicine. Students remain largely ambivalent about new teaching technologies and would prefer that these develop organically as an evolution from printed materials, rather than depart from dramatically and radically from these previously established materials. Findings from this study will assist publishers, librarians and academics develop clinical information sources that appropriately meet student expectations and support their learning requirements. © 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group.

Radiotherapy of esophageal cancer. Clinical usefulness of new grouping

International Nuclear Information System (INIS)

Hishinuma, Tamio

1997-01-01

A total of 188 cases of nonresected esophageal cancer were categorized into the following groups based on T category (1987 UICC) and radiological classification (Japanese Society of Esophageal Diseases): Group 1: superficial or early (T2 or less) tumorous type; Group 2: advanced tumorous type, early serrated or early spiral type; Group 3: others. The response to radiotherapy was significantly related to the group. According to the proportional hazard model, the important factors predicting long-term survival were T category, radiotherapy response at the end of treatment, and group. There was a tendency to obtain better local control in group 1 patients than in group 2 patients, but cause-specific survival was the same for both groups (mainly the appearance of distant metastases). Local control was poor in group 3. If the tumor response at 40 Gy was excellent in group 2 patients, the main cause of death was distant metastases, much the same as in group 1 patients. However, if response at 40 Gy was not excellent, the main cause of death was local failure even though final tumor response was excellent. It seemed that therapy that may improve local control is valuable for group 3 patient, and for group 2 patients whose tumor response at 40 Gy was not excellent. (author)

No effects of a combination of caregivers support group and memory training/music therapy in dementia patients from a memory clinic population.

Science.gov (United States)

Berger, Gabriele; Bernhardt, Tanja; Schramm, Uta; Müller, Ruth; Landsiedel-Anders, Susanne; Peters, Juergen; Kratzsch, Tilman; Frolich, Lutz

2004-03-01

To evaluate the impact of a combination of caregiver support group and memory training/music therapy in dementia patients on behavioural and psychological symptoms (BPSD) and caregiver burden compared to a control group. Eighteen patient-carer-dyads in the treatment group and 18 patient-carer-dyads as controls were studied in the setting of a memory clinic of a psychiatric university hospital over a period of 2 years. Controls were matched for age, gender, diagnosis, dementia severity, living arrangement and medication. The interventions were conducted once per week for 1 hour run by a clinical psychogeriatric team. Outcome measures were patients' cognitive and functional status as well as BPSD and caregivers subjective burden and depression measured by validated scales. Data were obtained 6, 12 and 24 months after baseline. There were no significant differences between the intervention and control group neither after 6, 12 nor after 24 months treatment. The lack of a positive impact in alleviating caregiver burden or BPSD after intensive psychological interventions may result from extensive care in the routine clinical management including individual counselling for patients and families. The effect of 'treatment as usual' needs to be taken into account when comparing an intervention and control group, as well as the dosage of the intervention. Copyright 2004 John Wiley & Sons, Ltd.

The group-as-a-whole-object relations model of group psychotherapy.

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Rosen, D; Stukenberg, K W; Saeks, S

2001-01-01

The authors review the theoretical basis of group psychotherapy performed at The Menninger Clinic and demonstrate how the theory has been put into practice on two different types of inpatient units. The fundamental elements of the theory and practice used can be traced to object relations theory as originally proposed by Melanie Klein. Her work with individuals was directly applied to working with groups by Ezriel and Bion, who focused on interpreting group tension. More modern approaches have reintegrated working with individual concerns while also attending to the group-as-a-whole. Historically, these principles have been applied to long-term group treatment. The authors apply the concepts from the group-as-a-whole literature to short- and medium-length inpatient groups with open membership. They offer clinical examples of the application of these principles in short-term inpatient settings in groups with open membership.

[Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure].

Science.gov (United States)

del Saz Moreno, Vicente; Alberquilla Menéndez-Asenjo, Ángel; Camacho Hernández, Ana M; Lora Pablos, David; Enríquez de Salamanca Lorente, Rafael; Magán Tapia, Purificación

2016-02-01

To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Health area of the region of Madrid (n=466.901). There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Clinical Trials

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Full Text Available ... protocol affect the trial's results. Comparison Groups In most clinical trials, researchers use comparison groups. This means ... study before you agree to take part. Randomization Most clinical trials that have comparison groups use randomization. ...

Sex Differences in Stress Response Circuitry Activation Dependent on Female Hormonal Cycle

Science.gov (United States)

Goldstein, Jill M.; Jerram, Matthew; Abbs, Brandon; Whitfield-Gabrieli, Susan; Makris, Nikos

2010-01-01

Understanding sex differences in stress regulation has important implications for understanding basic physiological differences in the male and female brain and their impact on vulnerability to sex differences in chronic medical disorders associated with stress response circuitry. In this fMRI study, we demonstrated that significant sex differences in brain activity in stress response circuitry were dependent on women's menstrual cycle phase. Twelve healthy Caucasian premenopausal women were compared to a group of healthy men from the same population, based on age, ethnicity, education, and right-handedness. Subjects were scanned using negative valence/high arousal versus neutral visual stimuli that we demonstrated activated stress response circuitry (amygdala, hypothalamus, hippocampus, brainstem, orbitofrontal and medial prefrontal cortices (OFC and mPFC), and anterior cingulate gyrus (ACG). Women were scanned twice based on normal variation in menstrual cycle hormones (i.e., early follicular (EF) compared with late follicular-midcycle menstrual phases (LF/MC)). Using SPM8b, there were few significant differences in BOLD signal changes in men compared to EF women, except ventromedial (VMN) and lateral (LHA) hypothalamus, left amygdala, and ACG. In contrast, men exhibited significantly greater BOLD signal changes compared to LF/MC women on bilateral ACG and OFC, mPFC, LHA, VMN, hippocampus, and periaqueductal gray, with largest effect sizes in mPFC and OFC. Findings suggest that sex differences in stress response circuitry are hormonally regulated via the impact of subcortical brain activity on the cortical control of arousal, and demonstrate that females have been endowed with a natural hormonal capacity to regulate the stress response that differs from males. PMID:20071507

Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: Recommendations of the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009)

International Nuclear Information System (INIS)

Polgar, Csaba; Limbergen, Erik Van; Poetter, Richard; Kovacs, Gyoergy; Polo, Alfredo; Lyczek, Jaroslaw; Hildebrandt, Guido; Niehoff, Peter; Guinot, Jose Luis; Guedea, Ferran; Johansson, Bengt; Ott, Oliver J.; Major, Tibor; Strnad, Vratislav

2010-01-01

Purpose: To give recommendations on patient selection criteria for the use of accelerated partial-breast irradiation (APBI) based on available clinical evidence complemented by expert opinion. Methods and materials: Overall, 340 articles were identified by a systematic search of the PubMed database using the keywords 'partial-breast irradiation' and 'APBI'. This search was complemented by searches of reference lists of articles and handsearching of relevant conference abstracts and book chapters. Of these, 3 randomized and 19 prospective non-randomized studies with a minimum median follow-up time of 4 years were identified. The authors reviewed the published clinical evidence on APBI, complemented by relevant clinical and pathological studies of standard breast-conserving therapy and, through a series of personal communications, formulated the recommendations presented in this article. Results: The GEC-ESTRO Breast Cancer Working Group recommends three categories guiding patient selection for APBI: (1) a low-risk group for whom APBI outside the context of a clinical trial is an acceptable treatment option; including patients ageing at least 50 years with unicentric, unifocal, pT1-2 (≤30 mm) pN0, non-lobular invasive breast cancer without the presence of an extensive intraductal component (EIC) and lympho-vascular invasion (LVI) and with negative surgical margins of at least 2 mm, (2) a high-risk group, for whom APBI is considered contraindicated; including patients ageing ≤40 years; having positive margins, and/or multicentric or large (>30 mm) tumours, and/or EIC positive or LVI positive tumours, and/or 4 or more positive lymph nodes or unknown axillary status (pNx), and (3) an intermediate-risk group, for whom APBI is considered acceptable only in the context of prospective clinical trials. Conclusions: These recommendations will provide a clinical guidance regarding the use of APBI outside the context of a clinical trial before large-scale randomized

Perspectives on clinical use of bioimpedance in hemodialysis: focus group interviews with renal care professionals.

Science.gov (United States)

Stenberg, Jenny; Henriksson, Catrin; Lindberg, Magnus; Furuland, Hans

2018-05-23

Inadequate volume control may be a main contributor to poor survival and high mortality in hemodialysis patients. Bioimpedance measurement has the potential to improve fluid management, but several dialysis centers lack an agreed fluid management policy, and the method has not yet been implemented. Our aim was to identify renal care professionals' perceived barriers and facilitators for use of bioimpedance in clinical practice. Qualitative data were collected through four focus group interviews with 24 renal care professionals: dieticians, nephrologists and nurses, recruited voluntarily from a nation-wide selection of hemodialysis centers, having access to a bioimpedance-device. The participants were connected to each other and a moderator via equipment for telemedicine and the sessions were recorded. The interviews were semi-structured, focusing on the participants' perceptions of use of bioimpedance in clinical practice. Thematic content analysis was performed in consecutive steps, and data were extracted by employing an inductive, interactive, comparative process. Several barriers and facilitators to the use of bioimpedance in clinical practice were identified, and a multilevel approach to examining barriers and incentives for change was found to be applicable to the ideas and categories that arose from the data. The determinants were categorized on five levels, and the different themes of the levels illustrated with quotations from the focus groups participants. Determinants for use of bioimpedance were identified on five levels: 1) the innovation itself, 2) the individual professional, 3) the patient, 4) the social context and 5) the organizational context. Barriers were identified in the areas of credibility, awareness, knowledge, self-efficacy, care processes, organizational structures and regulations. Facilitators were identified in the areas of the innovation's attractiveness, advantages in practice, and collaboration. Motivation, team processes and

Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study

Science.gov (United States)

2013-01-01

Background Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. Methods/design This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. Discussion This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries

Current technological clinical practice in breast radiotherapy; results of a survey in EORTC-Radiation Oncology Group affiliated institutions

NARCIS (Netherlands)

van der Laan, Hans Paul; Hurkmans, Coen W; Kuten, Abraham; Westenberg, Helen A

PURPOSE: To evaluate the current technological clinical practice of radiation therapy of the breast in institutions participating in the EORTC-Radiation Oncology Group (EORTC-ROG). MATERIALS AND METHODS: A survey was conducted between August 2008 and January 2009 on behalf of the Breast Working

Modernizing Clinical Trial Eligibility Criteria: Recommendations of the American Society of Clinical Oncology–Friends of Cancer Research HIV Working Group

Science.gov (United States)

Uldrick, Thomas S.; Ison, Gwynn; Rudek, Michelle A.; Noy, Ariela; Schwartz, Karl; Bruinooge, Suanna; Schenkel, Caroline; Miller, Barry; Dunleavy, Kieron; Wang, Judy; Zeldis, Jerome; Little, Richard F.

2018-01-01

Purpose People with HIV are living longer as a result of effective antiretroviral therapy. Cancer has become a leading cause of morbidity and mortality in this patient population. However, studies of novel cancer therapeutics have historically excluded patients with HIV. Critical review of eligibility criteria related to HIV is required to accelerate development of and access to effective therapeutics for HIV-infected patients with cancer and make studies more generalizable to this patient population. Methods From January through April 2016, the HIV Working Group conducted a series of teleconferences; a review of 46 New Drug Applications from registration studies of unique agents studied in adults with cancer that led to the initial US Food and Drug Administration approval of that agent from 2011 to 2015; and a review of HIV-related eligibility criteria from National Cancer Institute–sponsored studies. Results were discussed and refined at a multistakeholder workshop held May 12, 2016. The HIV Working Group developed recommendations for eligibility criteria that focus on pharmacologic and immunologic considerations in this patient population and that balance patient safety, access to appropriate investigational agents, and study integrity. Results Exclusion of patients with HIV remains common in most studies of novel cancer agents. Models for HIV-related eligibility criteria in National Cancer Institute–sponsored studies are instructive. HIV infection itself should no longer be an exclusion criterion for most studies. Eligibility criteria related to HIV infection that address concurrent antiretroviral therapy and immune status should be designed in a manner that is appropriate for a given cancer. Conclusion Expanding clinical trial eligibility to be more inclusive of patients with HIV is justified in most cases and may accelerate the development of effective therapies in this area of unmet clinical need. PMID:28968173

Modernizing Clinical Trial Eligibility Criteria: Recommendations of the American Society of Clinical Oncology-Friends of Cancer Research HIV Working Group.

Science.gov (United States)

Uldrick, Thomas S; Ison, Gwynn; Rudek, Michelle A; Noy, Ariela; Schwartz, Karl; Bruinooge, Suanna; Schenkel, Caroline; Miller, Barry; Dunleavy, Kieron; Wang, Judy; Zeldis, Jerome; Little, Richard F

2017-11-20

Purpose People with HIV are living longer as a result of effective antiretroviral therapy. Cancer has become a leading cause of morbidity and mortality in this patient population. However, studies of novel cancer therapeutics have historically excluded patients with HIV. Critical review of eligibility criteria related to HIV is required to accelerate development of and access to effective therapeutics for HIV-infected patients with cancer and make studies more generalizable to this patient population. Methods From January through April 2016, the HIV Working Group conducted a series of teleconferences; a review of 46 New Drug Applications from registration studies of unique agents studied in adults with cancer that led to the initial US Food and Drug Administration approval of that agent from 2011 to 2015; and a review of HIV-related eligibility criteria from National Cancer Institute-sponsored studies. Results were discussed and refined at a multistakeholder workshop held May 12, 2016. The HIV Working Group developed recommendations for eligibility criteria that focus on pharmacologic and immunologic considerations in this patient population and that balance patient safety, access to appropriate investigational agents, and study integrity. Results Exclusion of patients with HIV remains common in most studies of novel cancer agents. Models for HIV-related eligibility criteria in National Cancer Institute-sponsored studies are instructive. HIV infection itself should no longer be an exclusion criterion for most studies. Eligibility criteria related to HIV infection that address concurrent antiretroviral therapy and immune status should be designed in a manner that is appropriate for a given cancer. Conclusion Expanding clinical trial eligibility to be more inclusive of patients with HIV is justified in most cases and may accelerate the development of effective therapies in this area of unmet clinical need.

Counterbalancing patient demands with evidence: results from a pan-Canadian randomized clinical trial of brief supportive-expressive group psychotherapy for women with systemic lupus erythematosus.

Science.gov (United States)

Dobkin, Patricia L; Da Costa, Deborah; Joseph, Lawrence; Fortin, Paul R; Edworthy, Steven; Barr, Susan; Ensworth, Stephanie; Esdaile, John M; Beaulieu, André; Zummer, Michel; Senécal, Jean-Luc; Goulet, Jean-Richard; Choquette, Denis; Rich, Eric; Smith, Doug; Cividino, Alfred; Gladman, Dafna; St-Pierre, Yvan; Clarke, Ann E

2002-01-01

To evaluate the effect of Brief Supportive-Expressive Group Psychotherapy as an adjunct to standard medical care in reducing psychological distress, medical symptoms, and health care costs and improving quality of life in women with systemic lupus erythematosus (SLE). A randomized clinical trial was conducted with 133 SLE female patients from 9 clinics across Canada. Clinical and psychosocial measures were taken at baseline, posttreatment, and 6 and 12 months posttreatment. Outcomes assessed were psychological distress, quality of life, disease activity, health service utilization, and diminished productivity. Intention-to-treat analyses revealed that there were no clinically important group differences on any of the outcome measures. Although both groups improved over time on several measures (e.g., decreases in psychological distress, stress, and emotion-oriented coping), these changes could not be attributed to the psychotherapeutic intervention. Thus, evidence does not support the referral of these patients to this type of intervention.

Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.

Science.gov (United States)

Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven

2012-07-04

Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

ICU nurses and physicians dialogue regarding patients clinical status and care options-a focus group study.

Science.gov (United States)

Kvande, Monica; Lykkeslet, Else; Storli, Sissel Lisa

2017-12-01

Nurses and physicians work side-by-side in the intensive care unit (ICU). Effective exchanges of patient information are essential to safe patient care in the ICU. Nurses often rate nurse-physician communication lower than physicians and report that it is difficult to speak up, that disagreements are not resolved and that their input is not well received. Therefore, this study explored nurses' dialogue with physicians regarding patients' clinical status and the prerequisites for effective and accurate exchanges of information. We adopted a qualitative approach, conducting three focus group discussions with five to six nurses and physicians each (14 total). Two themes emerged. The first theme highlighted nurses' contributions to dialogues with physicians; nurses' ongoing observations of patients were essential to patient care discussions. The second theme addressed the prerequisites of accurate and effective dialogue regarding care options, comprising three subthemes: nurses' ability to speak up and present clinical changes, establishment of shared goal and clinical understanding, and open dialogue and willingness to listen to each other. Nurses should understand their essential role in conducting ongoing observations of patients and their right to be included in care-related decision-making processes. Physicians should be willing to listen to and include nurses' clinical observations and concerns.

Ajuste de parâmetros de transporte de solutos no solo utilizando Matlab 6.5 Adjustment of soil solute transport parameters with Matlab 6.5

Directory of Open Access Journals (Sweden)

Anderson L. de Souza

2011-12-01

Full Text Available O sucesso na utilização de modelos matemáticos no estudo do transporte de íons no solo está intimamente ligado à precisão com que os parâmetros de transporte envolvidos neste processo são estabelecidos. De maneira geral, tais parâmetros são determinados mediante a resolução de um problema de otimização não linear em que os dados experimentais, obtidos em ensaios de deslocamento miscível, são ajustados a um modelo teórico. Neste sentido, a utilização de softwares de alta performance no ajuste destes parâmetros mostra-se vantajosa, uma vez que, além da consistência e da disponibilidade de ferramentas numéricas preexistentes, possibilita a incorporação de novas rotinas de acordo com o fenômeno que se queira simular. Sendo assim, este trabalho teve como objetivo desenvolver, em ambiente MATLAB 6.5, uma rotina computacional para a otimização dos seguintes parâmetros de transporte: fator de retardamento (R e coeficiente de dispersão (D. A rotina desenvolvida foi aplicada a dados experimentais de três ensaios de deslocamento miscível do íon potássio em colunas preenchidas com um Latossolo Vermelho- -Amarelo, fase arenosa. A qualidade dos ajustes obtidos foi avaliada utilizando-se do coeficiente de exatidão. Concluiu-se que a rotina proposta apresentou ótimo desempenho, o que, além de reforçar a consistência do método numérico utilizado, indica que a rotina proposta neste trabalho pode contribuir com o avanço dos estudos teóricos da dinâmica da água e de solutos em meios porosos não saturados.The successful use of mathematical models in studies of solute transport in soil is dependent on the accuracy to which the transport parameters involved in this process can be specified. In general, these parameters are determined by using nonlinear optimization techniques to fit theoretical models to experimental data obtained in miscible displacement experiments. The use, therefore, of high-performance software to

A new class of infinite-dimensional Lie algebras: an analytical continuation of the arbitrary finite-dimensional semisimple Lie algebra

International Nuclear Information System (INIS)

Fradkin, E.S.; Linetsky, V.Ya.

1990-06-01

With any semisimple Lie algebra g we associate an infinite-dimensional Lie algebra AC(g) which is an analytic continuation of g from its root system to its root lattice. The manifest expressions for the structure constants of analytic continuations of the symplectic Lie algebras sp2 n are obtained by Poisson-bracket realizations method and AC(g) for g=sl n and so n are discussed. The representations, central extension, supersymmetric and higher spin generalizations are considered. The Virasoro theory is a particular case when g=sp 2 . (author). 9 refs

The clinical database and implementation of treatment guidelines by the Danish Breast Cancer Cooperative Group in 2007-2016

DEFF Research Database (Denmark)

Jensen, Maj-Britt; Laenkholm, Anne-Vibeke; Offersen, Birgitte V

2018-01-01

BACKGROUND: Since 40 years, Danish Breast Cancer Cooperative Group (DBCG) has provided comprehensive guidelines for diagnosis and treatment of breast cancer. This population-based analysis aimed to describe the plurality of modifications introduced over the past 10 years in the national Danish...... guidelines for the management of early breast cancer. By use of the clinical DBCG database we analyze the effectiveness of the implementation of guideline revisions in Denmark. METHODS: From the DBCG guidelines we extracted modifications introduced in 2007-2016 and selected examples regarding surgery......, radiotherapy (RT) and systemic treatment. We assessed introduction of modifications from release on the DBCG webpage to change in clinical practice using the DBCG clinical database. RESULTS: Over a 10-year period data from 48,772 patients newly diagnosed with malignant breast tumors were entered into DBCG...

A comparison of clinical communication skills between two groups of ...

African Journals Online (AJOL)

a comprehensive clinical model and a “golden thread” for communication skills in the ... sity, South Africa, based on the primary ..... Planning: shared decision making ... Explanation and planning. Incorporate clinical reasoning skills. Develop.

Genitourinary medicine/HIV services for persons with insecure immigration or seeking asylum in the United Kingdom: a British Co-operative Clinical Group survey.

Science.gov (United States)

Rajamanoharan, Sasikala; Monteiro, Eric F; Maw, Raymond; Carne, Christopher A; Robinson, Angela

2004-08-01

Over the past three years many genitourinary medicine (GUM) clinics have anecdotally reported large numbers of persons with insecure immigration or seeking asylum (PIISA) attending their facilities. We conducted a national survey to assess the prevalence and demographic background of PIISA who were attending GUM clinics in the UK during 2001 and 2002 and the effect on service provision. A questionnaire was circulated in April 2003 to 182 consultants in the UK of whom 128 (70%) responded. Amongst those centres that responded, 89 (69%) had provided GUM/HIV services for PIISA in 2002. One-third of clinics had accurate data collection systems and less than a quarter used computerized databases in order to identify the associated workload. Of the HIV-positive patients attending these clinics during 2002, 1140 (42%) were identified as PIISA. Eighty-two (95.3%) and 62 (48.8%) clinics had cared for PIISA from Africa and Europe respectively. Co-infection with HIV and tuberculosis was higher in patients from the PIISA group compared with the non-PIISA group (85% vs 15%, P = 0.001) for both 2001 and 2002. Clinics reported many problems associated with the service for PIISA. Forty-five percent of the clinics reported difficulties with funding for the increased workload associated with PIISA. The survey shows that GUM services have an important role in the management of PIISA and that the programme of dispersal is having a significant impact on the workload of clinics outside London. Services report that they are significantly overstretched and underfunded. An immediate investment in GUM services is necessary to improve the health of this client group. Any delay in diagnosis of sexually transmitted infections and HIV will have implications for public health and acute services.

The specificity of emotional switching in borderline personality disorder in comparison to other clinical groups.

Science.gov (United States)

Houben, Marlies; Bohus, Martin; Santangelo, Philip S; Ebner-Priemer, Ulrich; Trull, Timothy J; Kuppens, Peter

2016-04-01

In an attempt to better understand the nature of emotion dysregulation in the daily lives of persons with a borderline personality disorder (BPD), Houben et al. (2016) recently identified emotional switching, which refers to the tendency to make large changes between positive and negative emotional states over time, as a possible defining characteristic of the emotion dynamics observed in BPD. The goal of this study was to examine the specificity of these previous findings in 2 samples by comparing BPD patients (N = 43 in sample 1; N = 81 in sample 2) to patients with bulimia nervosa (N = 20), posttraumatic stress disorder (N = 28), or healthy controls (N = 28) in sample 1, and to patients with depressive disorder (N = 50) in sample 2, with respect to measures of emotional switching. Analyses of these 2 experience sampling datasets revealed that contrary to expectations, BPD patients did not differ from the clinical groups regarding their mere tendency to switch between positive and negative emotional states on consecutive moments over time and regarding the magnitude of such changes between positive and negative emotional states over time. However, all clinical groups did differ from healthy controls regarding all switch measures in dataset 1. These results indicate that emotional switching, similar to other more traditional indicators of overall changes in emotional intensity in daily life, might reflect a feature of emotional responding characterizing a range of disorders with mood disturbances. (c) 2016 APA, all rights reserved).

Theory of Mind intervention for outpatients with schizophrenia.

Science.gov (United States)

Bechi, Margherita; Spangaro, Marco; Bosia, Marta; Zanoletti, Andrea; Fresi, Francesco; Buonocore, Mariachiara; Cocchi, Federica; Guglielmino, Carmelo; Smeraldi, Enrico; Cavallaro, Roberto

2013-01-01

Social disability is one of the critical areas known to be a predictor of daily functioning in schizophrenia. Recent studies showed that impairments in Theory of Mind (ToM) contribute to real-world social functioning and are more strongly associated with community outcomes than other neuropsychological domains of cognition. Several experiments revealed an improving potential of social cognition targeted training, particularly through introduction of verbalisation and explicit manipulation of information about others' mental states. Based on these data, we evaluated longitudinally, with a controlled trial, the feasibility and efficacy of ToM training and the possible influences of daily functioning and IQ on the enhancement of ToM abilities. Thirty outpatients with schizophrenia were recruited and randomly allocated to two groups: ToM Intervention (ToMI), based on verbalisation of selected comic strips representing ToM scenarios, or active control group (ACG). Results showed a significant improvement of ToM abilities among subjects allocated to ToMI compared to ACG, confirming the hypothesis of the enhancing potential of training methods targeting ToM functions. Moreover, we observed no influences of neuropsychological and functional variables on ToM improvement. Development of future studies should take into account possible effects of ToM training on functional outcome, according to the strong associations between ToM abilities and real-world social functioning.

The governing body nurse as a clinical commissioning group nurse leader.

Science.gov (United States)

Dempsey, Angela; Minogue, Virginia

2017-02-22

Aim The aim of this study was to understand governing body nurses' perspective of their effect on, and leadership of, clinical commissioning groups (CCGs). Method Semi-structured face-to-face and telephone interviews were conducted with a sample of governing body nurses, CCG chairs and regional chief nurses. A total of 23 individuals were interviewed. Findings Governing body nurses were overwhelmingly positive about their role and believed they had a positive effect on the CCG governing body. Specifically, they provided leadership for the quality agenda and compassionate practice. Challenges experienced by some governing body nurses related to their capacity to undertake the role where this was on a part-time basis, time restraints and difficulties working with colleagues. Conclusion The role of the governing body nurse was not well defined when it was introduced, and as a result its development across CCGs has varied. Governing body nurses have used their leadership skills to advance important agendas for their profession, such as workforce redesign, new integrated care pathways and co-commissioned services.

Can historical controls be used in current clinical trials in osteosarcoma. Metastases and survival in a historical and a concurrent group

International Nuclear Information System (INIS)

Brostroem, L.A.; Aparisi, T.; Ingimarsson, S.; Lagergren, C.; Nilsonne, U.; Strander, H.; Soederberg, G.

1980-01-01

A historical group consisting of 35 patients with osteosarcoma was compared to a concurrent group of 23 patients. The treatment for the primary tumors differed only slghtly in the two groups. A more active approach was adopted for treatment of pulmonary metastases in the concurrent group. The percentage of patients not developing metastases and the survival rate in the historical group were approximately one half those for the concurrent group. An analysis of prognostic factors disclosed differences between the two groups as regards the size and histological type of the tumor. The results of the study cast doubt on the suitability of historical controls in current clinical trials conducted to ascertain the effectiveness of adjuvant therapy for osteosarcoma

Guidelines for the conduct of pharmacological clinical trials in hand osteoarthritis: Consensus of a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

Science.gov (United States)

Reginster, Jean-Yves L; Arden, Nigel K; Haugen, Ida K; Rannou, Francois; Cavalier, Etienne; Bruyère, Olivier; Branco, Jaime; Chapurlat, Roland; Collaud Basset, Sabine; Al-Daghri, Nasser M; Dennison, Elaine M; Herrero-Beaumont, Gabriel; Laslop, Andrea; Leeb, Burkhard F; Maggi, Stefania; Mkinsi, Ouafa; Povzun, Anton S; Prieto-Alhambra, Daniel; Thomas, Thierry; Uebelhart, Daniel; Veronese, Nicola; Cooper, Cyrus

2017-12-07

To gather expert opinion on the conduct of clinical trials that will facilitate regulatory review and approval of appropriate efficacious pharmacological treatments for hand osteoarthritis (OA), an area of high unmet clinical need. The European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) organized a working group under the auspices of the International Osteoporosis Foundation (IOF) and the World Health Organization (WHO). This consensus guideline is intended to provide a reference tool for practice, and should allow for better standardization of the conduct of clinical trials in hand OA. Hand OA is a heterogeneous disease affecting different, and often multiple, joints of the thumb and fingers. It was recognized that the various phenotypes and limitations of diagnostic criteria may make the results of hand OA trials difficult to interpret. Nonetheless, practical recommendations for the conduct of clinical trials of both symptom and structure modifying drugs are outlined in this consensus statement, including guidance on study design, execution, and analysis. While the working group acknowledges that the methodology for performing clinical trials in hand OA will evolve as knowledge of the disease increases, it is hoped that this guidance will support the development of new pharmacological treatments targeting hand OA. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Investigation of class 1 integrons in Klebsiella pneumoniae clinical and microbiota isolates belonging to different phylogenetic groups in Recife, State of Pernambuco

Directory of Open Access Journals (Sweden)

Alexsandra Maria Silva Lima

2014-04-01

Full Text Available Introduction The high prevalence of Klebsiella pneumoniae infections is related to the ability of K. pneumoniae to acquire and disseminate exogenous genes associated with mobile elements, such as R plasmids, transposons and integrons. This study investigated the presence of class 1 integrons in clinical and microbiota isolates of K. pneumoniae belonging to different phylogenetic groups and correlated these results with the antimicrobial resistance profiles of the studied isolates. Methods Of the 51 isolates of K. pneumoniae selected for this study, 29 were from multidrug-resistant clinical isolates, and 22 were from children's microbiota. The susceptibility profile was determined using the disk diffusion method, and class 1 integrons were detected through polymerase chain reaction (PCR. Results The results showed that none of the 22 microbiota isolates carried class 1 integrons. Among the 29 clinical isolates, 19 (65.5% contained class 1 integrons, and resistance to sulfamethoxazole/trimethoprim was identified in 18 of these isolates (94.7%. Among the K. pneumoniae isolates with class 1 integrons, 47% belonged to the KpI phylogenetic group, and one isolate (14.3% carrying these genetic elements belonged to the KpIII group. Conclusions The wide variety of detected class 1 integrons supports the presence of high rates of antimicrobial resistance, genetic variability, and rapid dissemination of beta-lactamase genes among K. pneumoniae clinical isolates in recent years in hospitals in Recife-PE, Brazil. The findings of this study indicate that the surveillance of K. pneumoniae integrons in clinical isolates could be useful for monitoring the spread of antibiotic resistance genes in the hospital environment.

Clinical Trials

Medline Plus

Full Text Available ... needed. For safety purposes, clinical trials start with small groups of patients to find out whether a ... phase I clinical trials test new treatments in small groups of people for safety and side effects. ...

Homogeneous group, research, institution

Directory of Open Access Journals (Sweden)

Francesca Natascia Vasta

2014-09-01

Full Text Available The work outlines the complex connection among empiric research, therapeutic programs and host institution. It is considered the current research state in Italy. Italian research field is analyzed and critic data are outlined: lack of results regarding both the therapeutic processes and the effectiveness of eating disorders group analytic treatment. The work investigates on an eating disorders homogeneous group, led into an eating disorder outpatient service. First we present the methodological steps the research is based on including the strong connection among theory and clinical tools. Secondly clinical tools are described and the results commented. Finally, our results suggest the necessity of validating some more specifical hypothesis: verifying the relationship between clinical improvement (sense of exclusion and painful emotions reduction and specific group therapeutic processes; verifying the relationship between depressive feelings, relapses and transition trough a more differentiated groupal field.Keywords: Homogeneous group; Eating disorders; Institutional field; Therapeutic outcome

Psychiatric nursing menbers' reflections on participating in group-based clinical supervision

DEFF Research Database (Denmark)

Buus, Niels; Angel, Sanne; Traynor, Michael

2011-01-01

This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision...... they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very...

Inhalation Exposure to Jet Fuel (JP8) Among U.S. Air Force Personnel

Science.gov (United States)

2010-10-01

are occupationally exposcd.(I) )nfonnation on the health consequences o f human exposure 10 JP8 is limited.(I·2) though there is some evidence that...JP8 may be toxic to the immune system. respirdtory trdCt, and nervous system at exposure concentrations ncar 350 mg/m·1.m The current ACG lH...Egeghy et al.(7) and to reflect a scheme that may be used in epidemiologic studies assessing exposure and hcalth outcomes . The high exposure group

Thermochemical Properties of Hydrophilic Polymers from Cashew and Khaya Exudates and Their Implications on Drug Delivery

Directory of Open Access Journals (Sweden)

Emmanuel O. Olorunsola

2016-01-01

Full Text Available Characterization of a polymer is essential for determining its suitability for a particular purpose. Thermochemical properties of cashew gum (CSG extracted from exudates of Anacardium occidentale L. and khaya gum (KYG extracted from exudates of Khaya senegalensis were determined and compared with those of acacia gum BP (ACG. The polymers were subjected to different thermal and chemical analyses. Exudates of CSG contained higher amount of hydrophilic polymer. The pH of 2% w/v gum dispersions was in the order KYG < CSG < ACG. Calcium was the predominant ion in CSG while potassium was predominant in KYG. The FTIR spectra of CSG and KYG were similar and slightly different from that of ACG. Acacia and khaya gums exhibited the same thermal behaviour which is different from that of CSG. X-ray diffraction revealed that the three gums are the same type of polymer, the major difference being the concentration of metal ions. This work suggests the application of cashew gum for formulation of basic and oxidizable drugs while using khaya gum for acidic drugs.

Parental presence on neonatal intensive care unit clinical bedside rounds: randomised trial and focus group discussion

Science.gov (United States)

Boswell, Danette; Broom, Margaret; Smith, Judith; Davis, Deborah

2015-01-01

Background There are limited data to inform the choice between parental presence at clinical bedside rounds (PPCBR) and non-PPCBR in neonatal intensive care units (NICUs). Methods We performed a single-centre, survey-based, crossed-over randomised trial involving parents of all infants who were admitted to NICU and anticipated to stay >11 days. Parents were randomly assigned using a computer-generated stratified block randomisation protocol to start with PPCBR or non-PPCBR and then crossed over to the other arm after a wash-out period. At the conclusion of each arm, parents completed the ‘NICU Parental Stressor Scale’ (a validated tool) and a satisfaction survey. After completion of the trial, we surveyed all healthcare providers who participated at least in one PPCBR rounding episode. We also offered all participating parents and healthcare providers the opportunity to partake in a focus group discussion regarding PPCBR. Results A total of 72 parents were enrolled in this study, with 63 parents (87%) partially or fully completing the trial. Of the parents who completed the trial, 95% agreed that parents should be allowed to attend clinical bedside rounds. A total of 39 healthcare providers’ surveys were returned and 35 (90%) agreed that parents should be allowed to attend rounds. Nine healthcare providers and 8 parents participated in an interview or focus group, augmenting our understanding of the ways in which PPCBR was beneficial. Conclusions Parents and healthcare providers strongly support PPCBR. NICUs should develop policies allowing PPCBR while mitigating the downsides and concerns of parents and healthcare providers such as decreased education opportunity and confidentiality concerns. Trial registration number Australia and New Zealand Clinical Trials Register number, ACTRN12612000506897. PMID:25711125

Clinical and genetic characteristics in a group of 45 patients with Turner syndrome (monocentric study

Directory of Open Access Journals (Sweden)

Bucerzan S

2017-05-01

chromosome sequences were found in only one patient, who subsequently underwent gonadectomy.Conclusion: The importance of this study resides, to the best of our knowledge, in the fact that the largest group of patients in Romania was analyzed and assessed. To draw firm conclusions on the most valuable clinical indicators for Turner syndrome diagnosis in clinical practice, studies on large groups of patients should be conducted. Keywords: Turner syndrome, diagnosis, phenotype, karyotype, GH treatment, Y chromosome sequences

Detecting Treatment Group Differences in Alzheimer's Disease Clinical Trials: A Comparison of Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog) and the Clinical Dementia Rating - Sum of Boxes (CDR-SB).

Science.gov (United States)

Wessels, A M; Dowsett, S A; Sims, J R

2018-01-01

The Alzheimer's Disease Assessment Scale's cognitive subscale (ADAS-Cog) has been widely used as an outcome measure in Alzheimer's Disease (AD) clinical trials. In its original form (ADAS-Cog11), the scale has been used successfully in mild-to-moderate AD dementia populations, but its use is more limited in the study of earlier disease (mild cognitive impairment [MCI] or mild dementia due to AD) owing to lack of appropriate sensitivity of some items. With recent focus on earlier treatment, efforts have focused on the development of more sensitive tools, including the Clinical Dementia Rating-Sum of Boxes (CDR-SB), a global assessment tool to evaluate both cognition and function. The ability of the ADAS-Cog and CDR-SB to detect treatment group differences in the clinical trial environment has not been systematically studied. The aim of this analysis was to compare the utility of these tools in detecting treatment group differences, by reviewing study findings identified through advanced searches of clinicaltrials.gov and Ovid, and press releases and scientific presentations. Findings from placebo-controlled studies of ≥ 6m duration and enrolling >100 participants were included; reporting of both the ADAS-Cog and CDR-SB at endpoint was also a requirement. Of the >300 records identified, 34 studies fulfilled the criteria. There were significant placebo versus active drug group differences based on findings from at least one measure for 14 studies. The ADAS-Cog detected treatment differences more frequently than the CDR-SB. Based on these and previously published findings, the ADAS-Cog appears more useful than the CDR-SB in detecting treatment group differences.

L’exposition contrôlée à la lumière et à l’obscurité ajuste le rythme du cortisol salivaire chez les travailleurs de nuit

Directory of Open Access Journals (Sweden)

Anny Casademont

2005-05-01

Full Text Available Dans cette étude réalisée sur le terrain et en laboratoire, nous avons testé l’efficacité d’une intervention consistant à contrôler l’exposition à la lumière/obscurité de façon à favoriser l’adaptation circadienne au travail de nuit. Six travailleurs permanents de nuit (moyenne d’âge 37,1 ± σ : 8,1 ans avaient comme consigne de s’exposer de façon intermittente à une lumière blanche vive plein spectre (~2 000 lux au cours des 6 premières heures de leur quart de travail de 8 heures. Il leur était demandé de se protéger de la lumière solaire du matin avec des verres teintés (densité gris neutre, transmission visuelle de la lumière 15 % et de maintenir des épisodes réguliers de sommeil/obscurité dans une pièce très sombre. Ces épisodes devaient commencer 2 heures après la fin de chaque quart de travail de nuit. Cinq travailleurs du groupe contrôle (41,1 ± σ : 9,9 ans ont été étudiés alors qu’ils devaient uniquement maintenir un horaire régulier de sommeil/obscurité. Des procédures de routine constante, réalisées avant et après une série d’environ 12 quarts de travail de nuit s’échelonnant sur 3 semaines, ont montré chez les travailleurs du groupe traitement une variation significative dans l’heure d’apparition du pic de cortisol ainsi qu’un ajustement de ce rythme à un horaire de travail de nuit. Un plus petit changement de phase a été observé dans le groupe contrôle, ce qui suggère une adaptation partielle à l’horaire de travail de nuit. Nos résultats démontrent l’efficacité d’une exposition judicieuse à la lumière et à l’obscurité pour favoriser l’adaptation des rythmes physiologiques au travail de nuit.The efficacy of a light/darkness intervention designed to promote circadian adaptation to night shift work was tested in this combined field and laboratory study. Six permanent night shift workers (mean age: 37.1 / s: 8.1 years were instructed to

[Development of clinical trial education program for pharmaceutical science students through small group discussion and role-playing using protocol].

Science.gov (United States)

Imakyure, Osamu; Shuto, Hideki; Nishikawa, Fumi; Hagiwara, Yoshifuka; Inoue, Sachiko; Koyanagi, Taeko; Hirakawa, Masaaki; Kataoka, Yasufumi

2010-08-01

The acquirement of basic knowledge of clinical trials and professional attitude in their practices is a general instructional objective in the Model Core Curriculum for Pharmaceutical Education. Unfortunately, the previous program of clinical trial education was not effective in the acquirement of a professional attitude in their practices. Then, we developed the new clinical trial education program using protocol through small group discussion (SGD) and roll-playing. Our program consists of 7 steps of practical training. In step 1, the students find some problems after presentation of the protocol including case and prescription. In step 2, they analyse the extracted problems and share the information obtained in SGD. In steps 3 and 5, five clinical case scenarios are presented to the students and they discuss which case is suitable for entry to the clinical trial or which case corresponds to the discontinuance criteria in the present designed protocol. In steps 4 and 6, the roll-playing is performed by teachers and students as doctors and clinical research coordinators (CRC) respectively. Further, we conducted a trial practice based on this program for the students. In the student's self-evaluation into five grades, the average score of the skill acquisition level in each step was 3.8-4.7 grade. Our clinical trial education program could be effective in educating the candidates for CRC or clinical pharmacists.

A randomized trial assessing the impact of written information on outpatients' knowledge about and attitude toward randomized clinical trials. The Info Trial Group

DEFF Research Database (Denmark)

Kruse, A Y; Kjaergard, L L; Krogsgaard, K

2000-01-01

To improve the patient education process in clinical research, three information materials describing general aspects of design and conduct of randomized clinical trials were developed. The materials varied in length, reading ability level, and reader appeal. Their influence on knowledge about...... and attitude toward randomized clinical trials was assessed in a randomized, parallel group, evaluator-blinded trial among 415 outpatients. The patients were randomized to the following groups: control (no intervention), leaflet, brochure, or booklet. Knowledge was assessed by a 17-item multiple......-choice questionnaire and attitude was assessed by a 32-item Likert questionnaire at entry and 2 weeks after the intervention. The interventions and the questionnaires were pilot tested and power calculations were performed. At entry, the mean knowledge score was 7.9 points. At follow-up, the knowledge scores increased...

Group-Based Preference Assessment for Children and Adolescents in a Residential Setting: Examining Developmental, Clinical, Gender, and Ethnic Differences

Science.gov (United States)

Volz, Jennifer L. Resetar; Cook, Clayton R.

2009-01-01

This study examines developmental, clinical, gender, and ethnic group differences in preference in residentially placed children and adolescents. In addition, this study considers whether residentially placed youth prefer stimuli currently being used as rewards as part of a campuswide token economy system and whether youth would identify preferred…

Collaborative translational research leading to multicenter clinical trials in Duchenne muscular dystrophy: the Cooperative International Neuromuscular Research Group (CINRG).

Science.gov (United States)

Escolar, Diana M; Henricson, Erik K; Pasquali, Livia; Gorni, Ksenija; Hoffman, Eric P

2002-10-01

Progress in the development of rationally based therapies for Duchenne muscular dystrophy has been accelerated by encouraging multidisciplinary, multi-institutional collaboration between basic science and clinical investigators in the Cooperative International Research Group. We combined existing research efforts in pathophysiology by a gene expression profiling laboratory with the efforts of animal facilities capable of conducting high-throughput drug screening and toxicity testing to identify safe and effective drug compounds that target different parts of the pathophysiologic cascade in a genome-wide drug discovery approach. Simultaneously, we developed a clinical trial coordinating center and an international network of collaborating physicians and clinics where those drugs could be tested in large-scale clinical trials. We hope that by bringing together investigators at these facilities and providing the infrastructure to support their research, we can rapidly move new bench discoveries through animal model screening and into therapeutic testing in humans in a safe, timely and cost-effective setting.

Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness.

Science.gov (United States)

Santer, Miriam; Ridd, Matthew J; Francis, Nick A; Stuart, Beth; Rumsby, Kate; Chorozoglou, Maria; Becque, Taeko; Roberts, Amanda; Liddiard, Lyn; Nollett, Claire; Hooper, Julie; Prude, Martina; Wood, Wendy; Thomas, Kim S; Thomas-Jones, Emma; Williams, Hywel C; Little, Paul

2018-05-03

To determine the clinical effectiveness and cost effectiveness of including emollient bath additives in the management of eczema in children. Pragmatic randomised open label superiority trial with two parallel groups. 96 general practices in Wales and western and southern England. 483 children aged 1 to 11 years, fulfilling UK diagnostic criteria for atopic dermatitis. Children with very mild eczema and children who bathed less than once weekly were excluded. Participants in the intervention group were prescribed emollient bath additives by their usual clinical team to be used regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued with standard eczema management, including leave-on emollients, and caregivers were given standardised advice on how to wash participants. The primary outcome was eczema control measured by the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe) weekly for 16 weeks. Secondary outcomes were eczema severity over one year (monthly POEM score from baseline to 52 weeks), number of eczema exacerbations resulting in primary healthcare consultation, disease specific quality of life (dermatitis family impact), generic quality of life (child health utility-9D), utilisation of resources, and type and quantity of topical corticosteroid or topical calcineurin inhibitors prescribed. 483 children were randomised and one child was withdrawn, leaving 482 children in the trial: 51% were girls (244/482), 84% were of white ethnicity (447/470), and the mean age was 5 years. 96% (461/482) of participants completed at least one post-baseline POEM, so were included in the analysis, and 77% (370/482) completed questionnaires for more than 80% of the time points for the primary outcome (12/16 weekly questionnaires to 16 weeks). The mean baseline POEM score was 9.5 (SD 5.7) in the bath additives group and 10.1 (SD 5.8) in the no bath additives group. The mean POEM score

Definitions, End Points, and Clinical Trial Designs for Non-Muscle-Invasive Bladder Cancer: Recommendations From the International Bladder Cancer Group

NARCIS (Netherlands)

Kamat, A.M.; Sylvester, R.J.; Bohle, A.; Palou, J.; Lamm, D.L.; Brausi, M.; Soloway, M.; Persad, R.; Buckley, R.; Colombel, M.; Witjes, J.A.

2016-01-01

PURPOSE: To provide recommendations on appropriate clinical trial designs in non-muscle-invasive bladder cancer (NMIBC) based on current literature and expert consensus of the International Bladder Cancer Group. METHODS: We reviewed published trials, guidelines, meta-analyses, and reviews and

Frequencies of Blood Group Systems MNS, Diego, and Duffy and Clinical Phases of Carrion’s Disease in Amazonas, Peru

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Oscar Acosta

2014-01-01

Full Text Available Carrion’s disease (CD, is a human bartonellosis, that is, endemic in the Andes of Peru, Ecuador, and Colombia. Bartonella bacilliformis, a native hemotrophic bacteria, is the causative agent of CD, and the interaction with the host could have produced changes in the gene frequencies of erythrocyte antigens. The goal here is to investigate the relationship between allele frequencies of blood group systems MNS, Diego, and Duffy and the clinical phases of CD, within a genetic context. In this associative and analytical study, 76 individuals from Bagua Grande, the province of Utcubamba, and the department of Amazonas in Peru, were enrolled. Forty of them resided in Tomocho-Collicate-Vista Hermosa area (high prevalence of cases in chronic phase, verrucous, or eruptive phase, without previous acute phase. Thirty-six individuals were from the area of Miraflores (high prevalence of cases in acute phase only and were evaluated for blood group systems MNS, Diego, and Duffy. This study constitutes one of the first attempts at evaluating the genetic factors and clinical phases of CD. No significant statistical differences (P>0.05 between allele frequencies of blood groups MNS, Diego, and Duffy and the prevalence of chronic and acute phases were detected in the two areas of Amazonas, Peru.

Comparison of the clinical features and outcomes in two age-groups of elderly patients with atrial fibrillation

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Shao XH

2014-08-01

Full Text Available Xing-Hui Shao,1 Yan-Min Yang,1 Jun Zhu,1 Han Zhang,1 Yao Liu,1 Xin Gao,1 Li-Tian Yu,1 Li-Sheng Liu,1 Li Zhao,2 Peng-Fei Yu,3 Hua Zhang,4 Qing He,5 Xiao-Dan Gu6 1Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 2Department of Emergency, Fu Xing Hospital, Capital Medical University, Beijing, 3Department of Cardiology, Pingdu People’s Hospital, Pingdu, 4Department of Emergency, Qingdao Municipal Hospital, Qingdao, 5Department of Emergency, West China Hospital, Sichuan University, Chengdu, 6Department of Emergency, Sixth People’s Hospital of Chengdu, Chengdu, People’s Republic of China Background: Atrial fibrillation (AF disproportionately affects older adults. However, direct comparison of clinical features, medical therapy, and outcomes in AF patients aged 65–74 and ≥75 years is rare. The objective of the present study was to evaluate the differences in clinical characteristics and prognosis in these two age-groups of geriatric patients with AF.Materials and methods: A total of 1,336 individuals aged ≥65 years from a Chinese AF registry were assessed in the present study: 570 were in the 65- to 74-year group, and 766 were in the ≥75-year group. Multivariable Cox hazards regression was performed to analyze the major adverse cardiac events (MACEs between groups.Results: In our population, the older group were more likely to have coronary artery disease, hypertension, previous stroke, cognitive disorder, or chronic obstructive pulmonary disease, and the 65- to 74-year group were more likely to have valvular heart disease, left ventricular systolic dysfunction, or sleep apnea. The older patients had 1.2-fold higher mean CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke scores, but less ­probability of being prescribed drugs. Compared with those aged 65–74 years, the older group had a higher risk of death (hazard ratio 2

Qu'en est-il de la transmission dans les groupes d'analyse de pratiques en formation ?

OpenAIRE

Vallet, Patricia

2012-01-01

Atelier 21 : Travail social et bénévolat; Ma recherche s'intéresse à la formation des professionnels de la relation, et à cette instance particulière qu'est l'analyse des pratiques : celle-ci suppose la transmission d'une capacité de problématisation des situations professionnelles, un regard critique ajusté, un certain rapport aux savoirs, une attitude herméneutique, et une posture particulière de l'animateur pour favoriser le cheminement des personnes en formation. Car au-delà d'une meilleu...

Clinical Trials

Medline Plus

Full Text Available ... medical strategy, treatment, or device is safe and effective for humans. What Are Clinical Trials? Clinical trials ... and Centers sponsor clinical trials. Many other groups, companies, and organizations also sponsor clinical trials. Examples include ...

Clinical Trials

Medline Plus

Full Text Available ... more screening tests to see which test produces the best results. Some companies and groups sponsor clinical trials that test the ... and Drug Administration (FDA) oversees these clinical trials. The NIH may partner with these companies or groups to help sponsor some trials. All ...

Exploratory study of the characteristics of feedback in the reflective dialogue group given to medical students in a clinical clerkship

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Chin-Chen Wen

2015-02-01

Full Text Available Purpose: Structured narrative reflective writing combined with guided feedback is an efficient teaching method for enhancing medical students’ reflective capacity. However, what kinds of feedback offered and reflection presented in a reflective group remain unclear. The aim of this study was to investigate the characteristics of feedback in a reflective dialogue group. Methods: Fifth-year medical students on a monthly interval rotation at the pediatric department of a medical center in eastern Taiwan during the 2012 academic year completed their reflective writing regarding patient and family psychosocial issues, and were subsequently debriefed in a 2-h group discussion session to receive feedback from a clinical tutor and peers. Content analysis was conducted to explore the characteristics of feedback and reflection presented in the reflective dialogue. The evaluative questionnaire regarding the benefits of reflection with others was administrated following the group session. Results: Forty students participated in five reflective groups and 108 psychosocial issues were discussed and identified. The tutor played an initiating role in the group discussion by providing six equal feedback types involving exploring new knowledge, initiating advanced discussion, highlighting the issues, and encouraging the students. The students provided eight types of feedback that involved a substantial deep discussion on psychosocial issues and action plans based on the complex interactive ecological network of clinical encounters. Each student attained 1.25 times the depth or breadth of reflection after receiving feedback and experienced the benefits of reflection with others. Conclusion: Through structured narrative reflective writing combined with pluralistic group discussion with a tutor and peers, the medical students had time to think deeply and broadly about psychosocial issues among patients and their family members. Facilitative feedback providing new

Overgeneral autobiographical memory bias in clinical and non-clinical voice hearers.

Science.gov (United States)

Jacobsen, Pamela; Peters, Emmanuelle; Ward, Thomas; Garety, Philippa A; Jackson, Mike; Chadwick, Paul

2018-03-14

Hearing voices can be a distressing and disabling experience for some, whilst it is a valued experience for others, so-called 'healthy voice-hearers'. Cognitive models of psychosis highlight the role of memory, appraisal and cognitive biases in determining emotional and behavioural responses to voices. A memory bias potentially associated with distressing voices is the overgeneral memory bias (OGM), namely the tendency to recall a summary of events rather than specific occasions. It may limit access to autobiographical information that could be helpful in re-appraising distressing experiences, including voices. We investigated the possible links between OGM and distressing voices in psychosis by comparing three groups: (1) clinical voice-hearers (N = 39), (2) non-clinical voice-hearers (N = 35) and (3) controls without voices (N = 77) on a standard version of the autobiographical memory test (AMT). Clinical and non-clinical voice-hearers also completed a newly adapted version of the task, designed to assess voices-related memories (vAMT). As hypothesised, the clinical group displayed an OGM bias by retrieving fewer specific autobiographical memories on the AMT compared with both the non-clinical and control groups, who did not differ from each other. The clinical group also showed an OGM bias in recall of voice-related memories on the vAMT, compared with the non-clinical group. Clinical voice-hearers display an OGM bias when compared with non-clinical voice-hearers on both general and voices-specific recall tasks. These findings have implications for the refinement and targeting of psychological interventions for psychosis.

Elasto-plastic hardening models adjustment to ferritic, austenitic and austenoferritic Rebar; Ajuste de los aceros corrugados ferríticos, austeníticos y austenoferríticos a los modelos de endurecimiento elastoplástico por deformación

Energy Technology Data Exchange (ETDEWEB)

Hortigóna, B.; Gallardo, J.M.; Nieto-García, E.J.; López, J.A.

2017-09-01

de Rasmussen presentando un exponente de valor 6 realizando un ajuste libre de la función correspondiente. Para los aceros inoxidables Dúplex se obtienen muy bajos ajustes para los dos modelos citados.

Risk adjustment models for interhospital comparison of CS rates using Robson's ten group classification system and other socio-demographic and clinical variables.

Science.gov (United States)

Colais, Paola; Fantini, Maria P; Fusco, Danilo; Carretta, Elisa; Stivanello, Elisa; Lenzi, Jacopo; Pieri, Giulia; Perucci, Carlo A

2012-06-21

Caesarean section (CS) rate is a quality of health care indicator frequently used at national and international level. The aim of this study was to assess whether adjustment for Robson's Ten Group Classification System (TGCS), and clinical and socio-demographic variables of the mother and the fetus is necessary for inter-hospital comparisons of CS rates. The study population includes 64,423 deliveries in Emilia-Romagna between January 1, 2003 and December 31, 2004, classified according to theTGCS. Poisson regression was used to estimate crude and adjusted hospital relative risks of CS compared to a reference category. Analyses were carried out in the overall population and separately according to the Robson groups (groups I, II, III, IV and V-X combined). Adjusted relative risks (RR) of CS were estimated using two risk-adjustment models; the first (M1) including the TGCS group as the only adjustment factor; the second (M2) including in addition demographic and clinical confounders identified using a stepwise selection procedure. Percentage variations between crude and adjusted RRs by hospital were calculated to evaluate the confounding effect of covariates. The percentage variations from crude to adjusted RR proved to be similar in M1 and M2 model. However, stratified analyses by Robson's classification groups showed that residual confounding for clinical and demographic variables was present in groups I (nulliparous, single, cephalic, ≥37 weeks, spontaneous labour) and III (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, spontaneous labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour) and to a minor extent in groups II (nulliparous, single, cephalic, ≥37 weeks, induced or CS before labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour). The TGCS classification is useful for inter-hospital comparison of CS section rates, but

The capsular group B meningococcal vaccine, 4CMenB : clinical experience and potential efficacy.

Science.gov (United States)

Rollier, Christine S; Dold, Christina; Marsay, Leanne; Sadarangani, Manish; Pollard, Andrew J

2015-01-01

Capsular group B meningococcal disease is a leading cause of childhood meningitis and septicaemia. Up to 10% of sufferers die, and sequelae remain in > 30% of survivors. A vaccine, four component meningococcal group B ( 4CMenB ), designed with the aim to induce broad coverage against this highly variable bacterium, has been licensed in countries including in the European Union, Canada and Australia. Immunogenicity and safety data, published in peer-reviewed literature between 2004 and 2014, are presented in the context of the recent recommendation for the use of the vaccine in infants in the UK. 4CMenB induces significant reactogenicity when administered with routine infant vaccines, in particular with respect to fever rates. Fevers can be somewhat reduced using paracetamol. The efficacy of the vaccine is unknown but has been extrapolated from effectiveness data obtained from use of one of its components in New Zealand, immunogenicity data from clinical trials and estimation of coverage from in vitro studies. These data suggest that the vaccine will prevent a proportion of invasive meningococcal disease cases in infants and young children. Implementation and well-planned post-marketing surveillance will address uncertainties over field effectiveness.

Descriptive analysis of the verbal behavior of a therapist: a known-group validity analysis of the putative behavioral functions involved in clinical interaction.

Science.gov (United States)

Virues-Ortega, Javier; Montaño-Fidalgo, Montserrat; Froján-Parga, María Xesús; Calero-Elvira, Ana

2011-12-01

This study analyzes the interobserver agreement and hypothesis-based known-group validity of the Therapist's Verbal Behavior Category System (SISC-INTER). The SISC-INTER is a behavioral observation protocol comprised of a set of verbal categories representing putative behavioral functions of the in-session verbal behavior of a therapist (e.g., discriminative, reinforcing, punishing, and motivational operations). The complete therapeutic process of a clinical case of an individual with marital problems was recorded (10 sessions, 8 hours), and data were arranged in a temporal sequence using 10-min periods. Hypotheses based on the expected performance of the putative behavioral functions portrayed by the SISC-INTER codes across prevalent clinical activities (i.e., assessing, explaining, Socratic method, providing clinical guidance) were tested using autoregressive integrated moving average (ARIMA) models. Known-group validity analyses provided support to all hypotheses. The SISC-INTER may be a useful tool to describe therapist-client interaction in operant terms. The utility of reliable and valid protocols for the descriptive analysis of clinical practice in terms of verbal behavior is discussed. Copyright © 2011. Published by Elsevier Ltd.

Fast Neutron Radiotherapy for Locally Advanced Prostate Cancer: Final Report of a Radiation Therapy Oncology Group Randomized Clinical Trial

Energy Technology Data Exchange (ETDEWEB)

Laramore, G. E.; Krall, J. M.; Thomas, F. J.; Russell, K. J.; Maor, M. H.; Hendrickson, F. R.; Martz, K. L.; Griffin, T. W.; Davis, L. W.

1993-01-01

Between June 1977 and April 1983 the Radiation Therapy Oncology Group (RTOG) sponsored a Phase III randomized trial investigating the use of fast neutron radiotherapy for patients with locally advanced (Stages C and D1) adenocarcinoma of the prostate gland. Patients were randomized to receive either conventional photon radiation or fast neutron radiation used in a mixed-beam (neutron/photon) treatment schedule. A total of 91 analyzable patients were entered into the study, and the two patient groups were balanced with respect to the major prognostic variables. Actuarial curves are presented for local/regional control and "overall" survival. Ten-year results for clinically assessed local control are 70% for the mixed-beam group versus 58% for the photon group (p = 0.03) and for survival are 46% for the mixed-beam group versus 29% for the photon group (p = 0.04). This study suggests that a regional method of treatment can influence both local tumor control and survival in patients with locally advanced adenocarcinoma of the prostate gland.

Large-scale STI services in Avahan improve utilization and treatment seeking behaviour amongst high-risk groups in India: an analysis of clinical records from six states

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Gurung Anup

2011-12-01

Full Text Available Abstract Background Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data. Methods The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed. Results A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p Conclusions The programme demonstrated that acceptable and accessible services with marginalised and often difficult–to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.

Modelos para ajuste da produção de gases em silagens de girassol e milho Models for fit of gas production in sunflower and corn silages

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Renius Mello

2008-02-01

Full Text Available O objetivo deste trabalho foi identificar entre os modelos Brody, Von Bertalanffy, Gompertz, France, Logístico, Logístico modificado e Logístico bicompartimental, aquele que apresenta maior qualidade de ajuste à curva de produção cumulativa de gases em silagens de girassol e milho. Os critérios adotados foram: coeficiente de determinação, quadrado médio do resíduo, análise gráfica das curvas observadas e estimadas, análise gráfica de dispersão dos resíduos estudentizados, erro percentual médio, eficiência relativa e número de iterações para atingir a convergência. Os modelos Brody, France e Logístico bicompartimental apresentaram os maiores valores de coeficiente de determinação em ambos os substratos, e a diferença entre eles pode ser considerada desprezível. Estes modelos apresentaram, também, os menores valores de quadrado médio do resíduo em silagens de girassol, e a diferença entre eles foi considerada desprezível. Os modelos Brody e France apresentaram menor quadrado médio do resíduo em silagens de milho. Todos os modelos apresentaram dispersão positiva dos resíduos em ambos os substratos após 144 horas de incubação. O modelo Brody apresentou menor erro percentual médio e número de iterações em ambos os substratos. Os modelos Logístico bicompartimental e France apresentaram maior eficiência relativa, respectivamente, em silagens de girassol e milho. Assim, o modelo Logístico bicompartimental apresenta maior qualidade de ajuste à curva de produção de gases em silagens de girassol e milho.The aim of this work was to identify among the Brody, Von Bertalanffy, Gompertz, France, Logistic, Modified logistic and Dual-pool logistic models, the one that presents the highest quality of fit for cumulative gas production curve in sunflower and corn silages. The quality of fit was evaluated by coefficient of determination, residual mean square, graphic analysis of the observed and estimated curves

A need to simplify informed consent documents in cancer clinical trials. A position paper of the ARCAD Group.

Science.gov (United States)

Bleiberg, H; Decoster, G; de Gramont, A; Rougier, P; Sobrero, A; Benson, A; Chibaudel, B; Douillard, J Y; Eng, C; Fuchs, C; Fujii, M; Labianca, R; Larsen, A K; Mitchell, E; Schmoll, H J; Sprumont, D; Zalcberg, J

2017-05-01

In respect of the principle of autonomy and the right of self-determination, obtaining an informed consent of potential participants before their inclusion in a study is a fundamental ethical obligation. The variations in national laws, regulations, and cultures contribute to complex informed consent documents for patients participating in clinical trials. Currently, only few ethics committees seem willing to address the complexity and the length of these documents and to request investigators and sponsors to revise them in a way to make them understandable for potential participants. The purpose of this work is to focus on the written information in the informed consent documentation for drug development clinical trials and suggests (i) to distinguish between necessary and not essential information, (ii) to define the optimal format allowing the best legibility of those documents. The Aide et Recherche en Cancérologie Digestive (ARCAD) Group, an international scientific committee involving oncologists from all over the world, addressed these issues and developed and uniformly accepted a simplified informed consent documentation for future clinical research. A simplified form of informed consent with the leading part of 1200-1800 words containing all of the key information necessary to meet ethical and regulatory requirements and 'relevant supportive information appendix' of 2000-3000 words is provided. This position paper, on the basis of the ARCAD Group experts discussions, proposes our informed consent model and the rationale for its content. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology.

Clinical, physical and lifestyle indicators and relationship with cognition and mood in aging: a cross-sectional analysis of distinct educational groups

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Nadine Correia Santos

2014-02-01

Full Text Available It is relevant to unravel the factors that may mediate the cognitive decline observed during aging. Previous reports indicate that education has a positive influence on cognitive performance, while age, female gender and, especially, depressed mood were associated with poorer performances across multiple cognitive dimensions (memory and general executive function. Herein, the present study aimed to characterize the cognitive performance of community-dwelling individuals within distinct educational groups categorized by the number of completed formal school years: less than 4, 4, completed primary education, and more than 4. Participants (n = 1051 were randomly selected from local health registries and representative of the Portuguese population for age and gender. Neurocognitive and clinical assessments were conducted in local health care centers. Structural equation modeling was used to derive a cognitive score, and hierarchical linear regressions were conducted for each educational group. Education, age and depressed mood were significant variables in directly explaining the obtained cognitive score, while gender was found to be an indirect variable. In all educational groups, mood was the most significant factor with effect on cognitive performance. Specifically, a depressed mood led to lower cognitive performance. The clinical disease indices cardiac and stroke associated with a more negative mood, while moderate increases in BMI, alcohol consumption and physical activity associated positively with improved mood and thus benefitted cognitive performance. Results warrant further research on the cause-effect (longitudinal relationship between clinical indices of disease and risk factors and mood and cognition throughout aging.

Therapeutic Change in Group Therapy For Interpersonal Trauma: A Relational Framework for Research and Clinical Practice.

Science.gov (United States)

Chouliara, Zoë; Karatzias, Thanos; Gullone, Angela; Ferguson, Sandra; Cosgrove, Katie; Burke Draucker, Claire

2017-04-01

Our understanding of therapeutic change processes in group therapy for complex interpersonal trauma has been limited. The present study aimed at addressing this gap by developing a framework of therapeutic change in this field from a survivor and therapist perspective. This is a qualitative study, which utilized semistructured individual interviews. Transcripts were analyzed using interpretative phenomenological analysis (IPA) to identify recurrent themes. A final sample of n = 16 patients and n = 5 facilitators completed the interview. Main change processes identified by survivors were as follows: self versus others, trust versus threat, confrontation versus avoidance, and "patching up" versus true healing. Therapeutic processes identified by therapist facilitators included managing group dynamics, unpredictability and uncertainty, and process versus content. The proposed framework explains therapeutic change in group therapy in relational terms, that is, therapeutic dissonance, the dynamic interaction of self and experience as well as building empathic trusting relations. The importance of managing dissonance to aid personally meaningful recovery was highlighted. These findings have implications for the usefulness of relational and person-centered approaches to clinical practice in the area of interpersonal and complex trauma, especially in the early identification, prevention, and management of dropouts.

MAAGs (Medical Audit Advisory Groups): the Eli Lilly National Clinical Audit Centre.

Science.gov (United States)

Baker, R; Fraser, R

1993-01-01

Outlines the framework for promoting audit in general practice, created as one part of the health service reforms. Medical Audit Advisory Groups (MAAGs) were set up in each district with the aim of participation in audit of all general practitioners by April 1992. The activities undertaken have included those recommended by the Department of Health; the most significant of these being the appointment of lay facilitators who are able to assist general practitioners and primary care teams co-operate over efforts to improve the quality of care, and may offer one means of introducing some of the methods of total quality management into general practice. Discusses the problems which remain: audit is not yet sufficiently systematic, interface audit with secondary care is at a very early stage, the ways to involve managers and patients in audit remain to be clarified, and there is little evidence of the consequences of audit in terms of improved care. The Eli Lilly National Clinical Audit Centre has been set up within the Department of General Practice, University of Leicester, in order to address these issues.

The Globalization of Cooperative Groups.

Science.gov (United States)

Valdivieso, Manuel; Corn, Benjamin W; Dancey, Janet E; Wickerham, D Lawrence; Horvath, L Elise; Perez, Edith A; Urton, Alison; Cronin, Walter M; Field, Erica; Lackey, Evonne; Blanke, Charles D

2015-10-01

The National Cancer Institute (NCI)-supported adult cooperative oncology research groups (now officially Network groups) have a longstanding history of participating in international collaborations throughout the world. Most frequently, the US-based cooperative groups work reciprocally with the Canadian national adult cancer clinical trial group, NCIC CTG (previously the National Cancer Institute of Canada Clinical Trials Group). Thus, Canada is the largest contributor to cooperative groups based in the United States, and vice versa. Although international collaborations have many benefits, they are most frequently utilized to enhance patient accrual to large phase III trials originating in the United States or Canada. Within the cooperative group setting, adequate attention has not been given to the study of cancers that are unique to countries outside the United States and Canada, such as those frequently associated with infections in Latin America, Asia, and Africa. Global collaborations are limited by a number of barriers, some of which are unique to the countries involved, while others are related to financial support and to US policies that restrict drug distribution outside the United States. This article serves to detail the cooperative group experience in international research and describe how international collaboration in cancer clinical trials is a promising and important area that requires greater consideration in the future. Copyright © 2015 Elsevier Inc. All rights reserved.

The Globalization of Cooperative Groups

Science.gov (United States)

Valdivieso, Manuel; Corn, Benjamin W.; Dancey, Janet E.; Wickerham, D. Lawrence; Horvath, L. Elise; Perez, Edith A.; Urton, Alison; Cronin, Walter M.; Field, Erica; Lackey, Evonne; Blanke, Charles D.

2015-01-01

The National Cancer Institute-supported adult cooperative oncology research groups (now officially Network groups) have a long-standing history of participating in international collaborations throughout the world. Most frequently, the U.S. based cooperative groups work reciprocally with the Canadian national adult cancer clinical trial group, NCIC CTG (previously the National Cancer Institute of Canada Clinical Trials Group). Thus, Canada is the largest contributor to cooperative groups based in the U.S., and vice versa. Although international collaborations have many benefits, they are most frequently utilized to enhance patient accrual to large phase III trials originating in the U.S. or Canada. Within the cooperative group setting, adequate attention has not been given to the study of cancers that are unique to countries outside the U.S. and Canada, such as those frequently associated with infections in Latin America, Asia and Africa. Global collaborations are limited by a number of barriers, some of which are unique to the countries involved, while others are related to financial support and to U.S. policies that restrict drug distribution outside the U.S. This manuscript serves to detail the cooperative group experience in international research and describe how international collaboration in cancer clinical trials is a promising and important area that requires greater consideration in the future. PMID:26433551

Outpatient Combined Group and Individual Cognitive-Behavioral Treatment for Patients With Migraine and Tension-Type Headache in a Routine Clinical Setting.

Science.gov (United States)

Christiansen, Sandra; Jürgens, Tim P; Klinger, Regine

2015-09-01

To test the long-term clinical effectiveness (follow-up at 3, 6 and 12 months) of an outpatient combined group and individual cognitive-behavioral treatment (CBT) for headache patients following standard medical care. A decrease in headache intensity, frequency, headache-specific impairment, depression, and change of pain-related cognitions was expected. The efficacy of CBT for primary headaches has been confirmed in research, yet the translation into clinical practice has remained untested thus far. In this single-group outcome study, 87 headache patients diagnosed with migraine and/or tension-type headache received (1) headache-specific medication for 10 weeks and (2) a subsequent CBT treatment made up of 13 individual and 12 group sessions consisting of psychoeducation, progressive muscle relaxation, coping strategies for pain and stress, and goal setting skills. Booster group sessions after 3 and 6 months were implemented to stimulate individual goal attainment, and follow-up measures were recorded up to 12 months. A significant decrease was found for all primary and secondary outcome criteria, ie, average headache intensity (prae M: 6.0, standard deviation [SD]: 1.5 vs follow-up [FU] 1 year M: 5.1, SD: 1.9), headache frequency (prae M: 16.0, SD: 9.5 vs FU 1 year M: 13.4, SD: 9.9), and catastrophizing (prae M: 3.4, SD: 1.0 vs FU 1 year M: 2.6, SD: 1.1). Coping strategies were increased (prae M: 3.4, SD: .9 vs FU 1 year M: 4.0, SD: 1.0). CBT treatment is a useful component within a routine clinical setting and can improve standard medical care thereby helping patients in managing their headache pain. © 2015 American Headache Society.

Propensity scores as a basis for equating groups: basic principles and application in clinical treatment outcome research.

Science.gov (United States)

West, Stephen G; Cham, Heining; Thoemmes, Felix; Renneberg, Babette; Schulze, Julian; Weiler, Matthias

2014-10-01

A propensity score is the probability that a participant is assigned to the treatment group based on a set of baseline covariates. Propensity scores provide an excellent basis for equating treatment groups on a large set of covariates when randomization is not possible. This article provides a nontechnical introduction to propensity scores for clinical researchers. If all important covariates are measured, then methods that equate on propensity scores can achieve balance on a large set of covariates that mimics that achieved by a randomized experiment. We present an illustration of the steps in the construction and checking of propensity scores in a study of the effectiveness of a health coach versus treatment as usual on the well-being of seriously ill individuals. We then consider alternative methods of equating groups on propensity scores and estimating treatment effects including matching, stratification, weighting, and analysis of covariance. We illustrate a sensitivity analysis that can probe for the potential effects of omitted covariates on the estimate of the causal effect. Finally, we briefly consider several practical and theoretical issues in the use of propensity scores in applied settings. Propensity score methods have advantages over alternative approaches to equating groups particularly when the treatment and control groups do not fully overlap, and there are nonlinear relationships between covariates and the outcome. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Heterosis y aptitud combinatoria en pimenton (Capsicum allnuum L.

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Echeverri A. Álvaro

1998-12-01

Full Text Available El objetivo del presente estudio fue estimar la heterosis, la aptitud combinatoria general (ACG y la aptitud combinatoria específica (ACE en un cruzamiento dialélico entre diez cultivares de pimentón usando las metodología propuesta por Griffing (1956b, método experimental 4, Modelo I (modificado por Hallauer y Miranda, 1988. Los parentales con valores más altos de heterosis relativa (HR y heterobelriosis (HB fueron LPUNAL (155,87% y 138,69%, Avelar (136,84% y 119,18%, y L363-46-672 (130,95% y 113,22%, los que participaron en la formación de cuatro de los diez cruzamientos más destacados por rendimiento. El análisis de varianza para aptitud combinatoria, mostró que en la transmisión y expresión de los caracteres evaluados, actúan en forma conjunta y altamente significativa tanto los efectos génicos aditivos (ACG como los 110 aditivos (A CE, pero con predominio de los primeros (Griffing, 1956. Los mayores valores de ACG para rendimiento fueron observados en LPUNAL-Palmira y Avelar (87.0 y 79.9, respectivamente.

Pain in Parkinson’s disease: analysis of 50 cases in a clinic of movement disorders Dor na doença de Parkinson: análise de 50 casos em uma clínica de transtornos do movimento

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Elton Gomes da Silva

2008-03-01

Full Text Available INTRODUCTION: Pain is a common symptom in Parkinson's disease (PD, and is often related to the illness itself. OBJECTIVE: To prospectively establish the ocurrence of pain in PD patients. METHOD: This study was conducted within a population composed of 50 patients with PD to evaluate the presence of pain. RESULTS: Twenty-eight patients reported pain; comparing the group with pain and the group without pain, there were no differences related to the beginning of the illness and the motor symptoms of PD. However, many patients related an improvement of pain when antiparkinsonian therapy was initiated or adjusted. CONCLUSION: The use of techniques for analgesia and the adjustment of PD medication contribute to improve the manifestations of pain and the life quality of patients with PD.INTRODUÇÃO: Dor é um sintoma comum na doença de Parkinson (DP e, às vezes, está relacionada à própria patologia de base. OBJETIVOS: Estabelecer prospectivamente a ocorrência de dor em pacientes com DP. MÉTODO: Foram avaliados consecutivamente 50 pacientes com DP, para comparação entre os que referiam e os que negavam quadro álgico. RESULTADOS: Entre os entrevistados, 28 referiam episódios dolorosos, não havendo diferenças quanto ao início da doença e os sintomas motores da DP, na comparação entre os dois grupos. Porém, muitos pacientes referiam melhora da dor com a introdução ou ajuste da terapia antiparkinsoniana. CONCLUSÃO: O uso de analgesia e ajuste da terapia para a DP ajudam na melhora do quadro álgico e na qualidade de vida dos pacientes.

A web-based clinical decision tool to support treatment decision-making in psychiatry: a pilot focus group study with clinicians, patients and carers.

Science.gov (United States)

Henshall, Catherine; Marzano, Lisa; Smith, Katharine; Attenburrow, Mary-Jane; Puntis, Stephen; Zlodre, Jakov; Kelly, Kathleen; Broome, Matthew R; Shaw, Susan; Barrera, Alvaro; Molodynski, Andrew; Reid, Alastair; Geddes, John R; Cipriani, Andrea

2017-07-21

Treatment decision tools have been developed in many fields of medicine, including psychiatry, however benefits for patients have not been sustained once the support is withdrawn. We have developed a web-based computerised clinical decision support tool (CDST), which can provide patients and clinicians with continuous, up-to-date, personalised information about the efficacy and tolerability of competing interventions. To test the feasibility and acceptability of the CDST we conducted a focus group study, aimed to explore the views of clinicians, patients and carers. The CDST was developed in Oxford. To tailor treatments at an individual level, the CDST combines the best available evidence from the scientific literature with patient preferences and values, and with patient medical profile to generate personalised clinical recommendations. We conducted three focus groups comprising of three different participant types: consultant psychiatrists, participants with a mental health diagnosis and/or experience of caring for someone with a mental health diagnosis, and primary care practitioners and nurses. Each 1-h focus group started with a short visual demonstration of the CDST. To standardise the discussion during the focus groups, we used the same topic guide that covered themes relating to the acceptability and usability of the CDST. Focus groups were recorded and any identifying participant details were anonymised. Data were analysed thematically and managed using the Framework method and the constant comparative method. The focus groups took place in Oxford between October 2016 and January 2017. Overall 31 participants attended (12 consultants, 11 primary care practitioners and 8 patients or carers). The main themes that emerged related to CDST applications in clinical practice, communication, conflicting priorities, record keeping and data management. CDST was considered a useful clinical decision support, with recognised value in promoting clinician

Clinical Trials

Medline Plus

Full Text Available ... comparison groups by chance, rather than choice. This method helps ensure that any differences observed during a ... to learn more about clinical research and to search for clinical trials: NHLBI Clinical Trials Browse a ...

Stemcell Information: SKIP000797 [SKIP Stemcell Database[Archive

Lifescience Database Archive (English)

Full Text Available pe II (ACG2) ... 200610 ... Fetus Female ... Yes No ACG II(GM07892)-specific iPS cells 軟骨無発症患者線維芽細胞(GM07892)由来iPS細胞...PS Cell Research and Application, Kyoto University 京都大学iPS細胞研究所 ... Information Only Center for iPS Cell Res...earch and Application,Kyoto University 京都大学iPS細胞研究所　CiRA https://www.cira.kyoto-u.ac.jp/e/index.html ... 251...irected conversion and induced pluripotent stem cells. Okada M, Ikegawa S, Morioka M, Yamashita A, Saito A,

Stemcell Information: SKIP000798 [SKIP Stemcell Database[Archive

Lifescience Database Archive (English)

Full Text Available II (ACG2) ... 200610 ... Fetus Female ... Yes No ACG II(GM07892)-specific iPS cells 軟骨無発生症患者線維芽細胞(GM07892)由来iPS細胞...S Cell Research and Application, Kyoto University 京都大学iPS細胞研究所 ... Information Only Center for iPS Cell Rese...arch and Application,Kyoto University 京都大学iPS細胞研究所　CiRA https://www.cira.kyoto-u.ac.jp/e/index.html ... 2518...rected conversion and induced pluripotent stem cells. Okada M, Ikegawa S, Morioka M, Yamashita A, Saito A, S

Group Patient Education: Effectiveness of a Brief Intervention in People with Type 2 Diabetes Mellitus in Primary Health Care in Greece: A Clinically Controlled Trial

Science.gov (United States)

Merakou, K.; Knithaki, A.; Karageorgos, G.; Theodoridis, D.; Barbouni, A.

2015-01-01

This study aims to assess the impact of a brief patient group education intervention in people with type 2 diabetes mellitus. The sample, 193 people with type 2 diabetes mellitus who were patients at the diabetic clinic of a primary health care setting in Attica, was assigned to two groups, intervention (138 individuals) and control group (55…

Successful Integration of Cooperative Groups: The Origin of the Children's Oncology Group.

Science.gov (United States)

Reaman, Gregory H

2012-01-01

In March 2000, the four legacy pediatric cooperative groups officially merged to become the Children's Oncology Group (COG). This was accomplished by the ratification of a new constitution by the respective executive committees and voting membership of the four legacy groups. The actual merger was preceded by a 12 to 18 month period of planning, negotiation, and transition, overseen by a Transition Committee of select executive leadership under the direction of the four current chairs of the existing pediatric groups. Despite the constant threat of budget reductions and questions related to the judicious use of National Cancer Institute (NCI) funds to support four pediatric groups when "children constitute only 3% of the US cancer problem," the decision to unify was initiated and driven internally. The merger was envisioned as an opportunity to create efficiency by reducing duplicative systems and processes, which was becoming increasingly apparent as more planned clinical trials required intergroup collaboration. It was also recognized that such intergroup efforts would become more of a reality as clinical trial paradigms were built on risk-adjusted approaches. Clinically, biologically, and molecularly defined homogeneous subgroups of patients were of insufficient sample size within each group to design and conduct studies within a reasonable time frame. In essence, this merger was motivated by an overwhelming sense of necessity to preserve our mission of defining and delivering compassionate and state-of-the-art care through scientific discovery. The merger process itself was challenging, time consuming, not supported by any supplemental funding, and at times painful. What has emerged as a result is the largest pediatric cancer research organization in the world. Accomplishments in epidemiology, biology, translational science, and improved clinical outcomes for some pediatric cancers would have never been achieved without the merger. The very fact that outcome

Effect of Objective Structured Clinical Examination on Nursing Students' Clinical Skills

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Seyedeh Narjes Mousavizadeh

2018-01-01

Full Text Available Considering the daily increasing changes in clinical training approaches, the necessity of using new evaluation methods in proportion with these approaches is also becoming more and more obvious for measuring all of the cognitive, emotional and psychomotor dimensions of students. The present study was designed and conducted for reviewing the effect of objective structured clinical examination method on the clinical skills of nursing students. In this quasi-experimental study, 48 nursing students have participated that were randomly assigned to two groups of intervention and control. The intervention group students were evaluated at the end of educational period of their clinical skills and principles course using objective structured clinical examination (OSCE. The OSCE included five core skills in this course: assessing and fulfilling patients’ basic needs, dressing up, injectable drug therapy, noninjectable drug therapy, infection control. The control group students were evaluated using the routine method. Both groups of students were followed up in the next semester and were compared in terms of learning enhancement in these five skills. Evaluation of procedures was based on valid and reliable check-lists made by the researcher. Results were analyzed using descriptive and inferential statistics (Chi-square, independent and paired T tests. The mean score of the final evaluation in the intervention group was significantly higher than that of the control group (P= 0.000. Final evaluation scores of the intervention group students showed a better performance than their previous semester (P= 0.000, while the final evaluation scores of the control group students showed a lack of progress in their skills (P<0.05. It seems that this evaluation method also is a support for students' learning and resulted in improvement of clinical skills among them. Accordingly, it is recommended that nursing education centers apply this method to assess students�

Impact of a workplace ‘sit less, move more’ program on efficiency-related outcomes of office employees

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Anna Puig-Ribera

2017-05-01

Full Text Available Abstract Background Few studies have examined the impact of ‘sit less, move more’ interventions on workplace performance. This study assessed the short and mid-term impacts of and patterns of change within, a 19-week workplace web-based intervention (Walk@WorkSpain; W@WS; 2010–11 on employees´ presenteeism, mental well-being and lost work performance. Methods A site randomised control trial recruited employees at six Spanish university campuses (n = 264; 42 ± 10 years; 171 female, assigned by worksite and campus to an Intervention (IG; used W@WS; n = 129; 87 female or an active Comparison group (A-CG; pedometer, paper diary and self-reported sitting time; n = 135; 84 female. A linear mixed model assessed changes between the baseline, ramping (8 weeks, maintenance (11 weeks and follow-up (two months phases for the IG versus A-CG on (i % of lost work productivity (Work Limitations Questionnaire; WLQ; (ii three scales for presenteeism (WLQ assessing difficulty meeting scheduling demands (Time, performing cognitive and inter-personal tasks (Mental-Interpersonal and decrements in meeting the quantity, quality and timeliness of completed work (Output; and (iii mental well-being (Warwick-Edinburgh Mental Well-being Scale. T-tests assessed differences between groups for changes on the main outcomes. In the IG, a multivariate logistic regression model identified patterns of response according to baseline socio-demographic variables, physical activity and sitting time. Results There was a significant 2 (group × 2 (program time points interaction for the Time (F [3]=8.69, p = 0.005, Mental-Interpersonal (F [3]=10.01, p = 0.0185, Output scales for presenteeism (F [3]=8.56, p = 0.0357, and for % of lost work performance (F [3]=10.31, p = 0.0161. Presenteeism and lost performance rose significantly in both groups across all study time points; after baseline performance was consistently better in the IG than in the A-CG. Better

[Clinical analysis and follow-up of neonatal purulent meningitis caused by group B streptococcus].

Science.gov (United States)

Zhu, Minli; Zhu, Jianghu; Li, Haijing; Liu, Peining; Lin, Zhenlang

2014-02-01

To study the clinical characteristics, antibiotics sensitivity and outcome of group B streptococcus (GBS) meningitis in neonates in order to provide the guide for early diagnosis and appropriate treatment. A retrospective review was performed and a total of 13 cases of neonatal purulent meningitis caused by GBS were identified in the Neonatal Intensive Care Unit of Yuying Children's Hospital of Wenzhou Medical University from January 1, 2005 to May 31, 2013. The clinical characteristics, antibiotics sensitivity test results and outcome were analyzed. Fever, poor feeding, seizure and lethargy were common clinical signs of neonatal purulent meningitis caused by GBS. Three cases of early onset GBS meningitis received prepartum antibiotics. All 13 cases had abnormal C-reactive protein (CRP) level, and 11 cases had increased CRP within hours after admission. Of the 13 patients, 7 were cured, 4 discharged with improvement, 2 patients died during hospitalization after being given up because of serious complication. The average length of stay for recovered patients was (47 ± 21)d. Acute complications mainly included hyponatremia (5 cases), intracranial hemorrhage (3 cases) , ventriculomegaly (3 cases) , subdural collection (2 cases) , hydrocephalus (2 cases), septic shock (2 cases), cerebral hernia (1 case), encephalomalacia (1 case). One preterm patient with early onset GBS meningitis died 1 month after hospital discharge. Among 7 survivors with 10-24 months follow-up, 3 were early onset GBS meningitis, 2 with normal results of neurologic examination, 1 with delayed motor development, 4 were late onset GBS meningitis, 1 with normal results of neurologic examination, 3 were neurologically impaired with manifestations including delayed motor development (2 cases) and seizures (1 case). All the GBS strains were sensitive to penicillin and linezolid (13/13, 10/10), the susceptibility to levofloxacin, ampicillin and vancomycin were 11/12, 9/10, 8/13 respectively. The clinical

Clinical and molecular profile of newborns with confirmed or suspicious congenital adrenal hyperplasia detected after a public screening program implementation.

Science.gov (United States)

Kopacek, Cristiane; Prado, Mayara J; da Silva, Claudia M D; de Castro, Simone M; Beltrão, Luciana A; Vargas, Paula R; Grandi, Tarciana; Rossetti, Maria L R; Spritzer, Poli Mara

2018-04-30

To describe the results obtained in a neonatal screening program after its implementation and to assess the clinical and molecular profiles of confirmed and suspicious congenital adrenal hyperplasia cases. A cross-sectional study was conducted. Newborns with suspected disease due to high 17-hydroxyprogesterone levels and adjusted for birth weight were selected. Classical congenital adrenal hyperplasia (salt-wasting and simple virilizing forms) was diagnosed by an increase in 17-hydroxyprogesterone levels as confirmed in the retest, clinical evaluation, and genotype determined by SNaPshot and multiplex ligation-dependent probe amplification. After 24 months, 15 classic congenital adrenal hyperplasia cases were diagnosed in a total of 217,965 newborns, with an estimated incidence of 1:14,531. From 132 patients, seven non-classical and 14 heterozygous patients were screened for CYP21A2 mutations, and 96 patients presented false positives with wild type CYP21A2. On retest, increased 17-hydroxyprogesterone levels were found in classical congenital adrenal hyperplasia patients and showed significant correlation with genotype-related classical genital adrenal hyperplasia. The most frequent mutations were IVS2-13A/C>G followed by gene deletion or rearrangement events in the classical form. In non-classical and heterozygous diseases, p.Val282Leu was the most common mutation. The results underscore the effectiveness of congenital adrenal hyperplasia neonatal screening in the public health system and indicate that the adopted strategy was appropriate. The second sample collection along with genotyping of suspected cases helped to properly diagnose both severe and milder cases and delineate them from false positive patients. Copyright © 2018. Published by Elsevier Editora Ltda.

Prevalence and clinical impact of anaplasia in childhood rhabdomyosarcoma : a report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group.

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Qualman, Stephen; Lynch, James; Bridge, Julia; Parham, David; Teot, Lisa; Meyer, William; Pappo, Alberto

2008-12-01

Anapalsia is rare in childhood rhabdomyosarcoma and has not been included in the International Classification of Rhabdomyosarcoma (ICR). A recent review of cases from the Soft Tissue Sarcoma Committee of the Children's Oncology Group (COG) suggests that anaplasia might be more common than previously reported and may impact clinical outcome. The prevalence of anaplasia (focal or diffuse) was prospectively assessed in 546 eligible cases who were registered in an Intergroup Rhabdomyosarcoma Study Group (IRSG) or COG therapeutic trial from 1995 through 1998. The incidence of anaplasia in tumor samples and its impact in predicting clinical outcome was assessed. Overall, 71 (13%) of all samples analyzed had anaplasia. Anaplasia was more common in patients with tumors in favorable sites and was less commonly observed in younger patients and in those with stage II, III, or clinical group III disease. Regardless of its distribution (focal or diffuse), on univariate analysis the presence of anaplasia negatively influenced the failure-free survival rate (63% vs 77% at 5 years) and overall survival (68% vs 82% at 5 years) rates in patients with embryonal rhabdomyosarcoma. This effect was most pronounced in children with intermediate-risk tumors. Anaplasia did not affect outcome in patients with alveolar tumors. The incidence of anaplasia in patients with rhabdomyosarcoma is higher than previously described and may be of prognostic significance in children with intermediate-risk embryonal rhabdomyosarcoma. (c) 2008 American Cancer Society

[Analysis of scientific production and bibliometric impact of a group of Spanish clinical researchers].

Science.gov (United States)

Miró, O; Burbano Santos, P; Trilla, A; Casademont, J; Fernandez Pérez, C; Martín-Sánchez, Fj

2016-01-01

To study the behaviour of several indicators of scientific production and repercussion in a group of Spanish clinical researchers and to evaluate their possible utility for interpreting individual or collective scientific pathways. We performed a unicentric, ecological pilot study involving a group of physicians with consolidated research experience. From the Science Citation Index Expanded (SCI-Expanded) database, we obtained the number of publications of each author (indicator of production) and the number of citations, impact factor and h index (indicators of repercussion). These indicators were calculated individually for each of the years of research experience and we assessed the relationship between the experience of the researcher and the value of the indicator achieved, the relationship between these indicators themselves, and their temporal evolution, both individually and for the entire group. We analysed 35 researchers with a research experience of 28.4 (9.6) years. The h index showed the lowest coefficient of variance. The relationship between the indicators and research experience was significant, albeit modest (R2 between 0.15-0.22). The 4 indicators showed good correlations. The temporal evolution of the indicators, both individual and collective, adjusted better to a second grade polynomial than a linear function: individually, all the authors obtained R2>0.90 in all the indicators; together the best adjustment was produced with the h index (R2=0.61). Based on the indicator used, substantial variations may be produced in the researchers' ranking. A model of the temporal evolution of the indicators of production and repercussion can be described in a relatively homogeneous sample of researchers and the h index seems to demonstrate certain advantages compared to the remaining indicators. This type of analysis could become a predictive tool of performance to be achieved not only for a particular researcher, but also for a homogeneous group of resear

Predictors of placebo group decline in the Alzheimer's disease Assessment Scale-cognitive subscale (ADAS-Cog) in 24 week clinical trials of Alzheimer's disease.

Science.gov (United States)

Irizarry, Michael C; Webb, David J; Bains, Chanchal; Barrett, Steven J; Lai, Robert Y; Laroche, Janette P; Hosford, David; Maher-Edwards, Gareth; Weil, John G

2008-07-01

One limitation of several recent 24 week Alzheimer's disease (AD) clinical trials was the lack of cognitive decline detected by the AD Assessment Scale-cognitive subscale (ADAS-cog) in the placebo groups, possibly obscuring true medication effects. Data from 733 individuals in the placebo arms of six AD clinical trials performed 1996-1997 were pooled to examine the relationship of clinical, demographic, and genetic characteristics with the 24 week change in ADAS-cog. Baseline cognitive and functional status and the screening-to-baseline change in ADAS-cog were the strongest independent predictors of the 24 week change in ADAS-cog. The ADAS-cog did not detect progression in patients with mild dementia (screening Mini-Mental State Exam, MMSE, >or=20). The change in ADAS-cog from screening to baseline was inversely correlated with the 24 week change score; it was more difficult to detect cognitive decline at 24 weeks if individuals markedly worsened from screening to baseline. The effects of baseline MMSE and screening-to-baseline change in ADAS-cog generalized to the placebo group (N=106) of another AD study performed in 2004-2005. Overcoming lack of placebo decline in AD clinical trials will require scales more sensitive to cognitive decline in mild AD and strategies to reduce within-person variability in outcome measures.

Applications of blood group genotyping

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Mariza A. Mota

2006-03-01

Full Text Available Introduction: The determination of blood group polymorphism atthe genomic level facilitates the resolution of clinical problemsthat cannot be addressed by hemagglutination. They are useful to(a determine antigen types for which currently available antibodiesare weakly reactive; (b type patients who have been recentlytransfused; (c identify fetuses at risk for hemolytic disease of thenewborn; and (d to increase the reliability of repositories of antigennegative RBCs for transfusion. Objectives: This review assessedthe current applications of blood group genotyping in transfusionmedicine and hemolytic disease of the newborn. Search strategy:Blood group genotyping studies and reviews were searched ingeneral database (MEDLINE and references were reviewed.Selection criteria: All published data and reviews were eligible forinclusion provided they reported results for molecular basis ofblood group antigens, DNA analysis for blood group polymorphisms,determination of fetal group status and applications of blood groupgenotyping in blood transfusion. Data collection: All data werecollected based on studies and reviews of blood grouppolymorphisms and their clinical applications.

Using focus groups and social marketing to strengthen promotion of group prenatal care.

Science.gov (United States)

Vonderheid, Susan C; Carrie, S Klima; Norr, Kathleen F; Grady, Mary Alice; Westdahl, Claire M

2013-01-01

Centering Pregnancy, an innovative group model of prenatal care, shows promise to reduce persistent adverse maternal-infant outcomes and contain costs. Because this innovation requires systemwide change, clinics reported needing support enrolling women into groups and obtaining organizational buy-in. This study used the 3-step social marketing communication strategy to help clinic staff identify key customers and customer-specific barriers to adopting or supporting Centering Pregnancy. They developed targeted information to reduce barriers and built skills in communicating with different customers through role-playing. Findings provide practical information for others to use this communication strategy to improve implementation of Centering Pregnancy.

Ajuste do modelo de Schumacher e Hall e aplicação de redes neurais artificiais para estimar volume de árvores de eucalipto Adjustment of the Schumacher and Hall model and application of artificial neural networks to estimate volume of eucalypt trees

Directory of Open Access Journals (Sweden)

Mayra Luiza Marques da Silva

2009-12-01

Full Text Available Objetivou-se, neste trabalho, avaliar o ajuste do modelo volumétrico de Schumacher e Hall por diferentes algoritmos, bem como a aplicação de redes neurais artificiais para estimação do volume de madeira de eucalipto em função do diâmetro a 1,30 m do solo (DAP, da altura total (Ht e do clone. Foram utilizadas 21 cubagens de povoamentos de clones de eucalipto com DAP variando de 4,5 a 28,3 cm e altura total de 6,6 a 33,8 m, num total de 862 árvores. O modelo volumétrico de Schumacher e Hall foi ajustado nas formas linear e não linear, com os seguintes algoritmos: Gauss-Newton, Quasi-Newton, Levenberg-Marquardt, Simplex, Hooke-Jeeves Pattern, Rosenbrock Pattern, Simplex, Hooke-Jeeves e Rosenbrock, utilizado simultaneamente com o método Quasi-Newton e com o princípio da Máxima Verossimilhança. Diferentes arquiteturas e modelos (Multilayer Perceptron MLP e Radial Basis Function RBF de redes neurais artificiais foram testados, sendo selecionadas as redes que melhor representaram os dados. As estimativas dos volumes foram avaliadas por gráficos de volume estimado em função do volume observado e pelo teste estatístico L&O. Assim, conclui-se que o ajuste do modelo de Schumacher e Hall pode ser usado na sua forma linear, com boa representatividade e sem apresentar tendenciosidade; os algoritmos Gauss-Newton, Quasi-Newton e Levenberg-Marquardt mostraram-se eficientes para o ajuste do modelo volumétrico de Schumacher e Hall, e as redes neurais artificiais apresentaram boa adequação ao problema, sendo elas altamente recomendadas para realizar prognose da produção de florestas plantadas.This research aimed at evaluating the adjustment of Schumacher and Hall volumetric model by different algorithms and the application of artificial neural networks to estimate the volume of wood of eucalyptus according to the diameter at breast height (DBH, total height (Ht of the clone. For such, 21 scalings of stands of eucalyptus clones were used with

A dance movement therapy group for depressed adult patients in psychiatric outpatient clinic: Effects of the treatment

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Päivi Maria Pylvänäinen

2015-07-01

Full Text Available AbstractWe were interested in investigating the effects of dance movement therapy (DMT in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms.All adult patients (n = 33 included in the study received treatment as usual (TAU. 21 patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES were medium in favor for the DMT group (d= 0.60-0.79. In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15 – 0.37. The results indicated that DMT is beneficial in the treatment of depressed patients.

The effect of a corticosteroid cream and a barrier-strengthening moisturizer in hand eczema. A double-blind, randomized, prospective, parallel group clinical trial.

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Lodén, M; Wirén, K; Smerud, K T; Meland, N; Hønnås, H; Mørk, G; Lützow-Holm, C; Funk, J; Meding, B

2012-05-01

Hand eczema is a common and persistent disease with a relapsing course. Clinical data suggest that once daily treatment with corticosteroids is just as effective as twice daily treatment. The aim of this study was to compare once and twice daily applications of a strong corticosteroid cream in addition to maintenance therapy with a moisturizer in patients with a recent relapse of hand eczema. The study was a parallel, double-blind, randomized, clinical trial on 44 patients. Twice daily application of a strong corticosteroid cream (betamethasone valerate 0.1%) was compared with once daily application, where a urea-containing moisturizer was substituted for the corticosteroid cream in the morning. The investigator scored the presence of eczema and the patients judged the health-related quality of life (HRQoL) using the Dermatology Life Quality Index (DLQI), which measures how much the patient's skin problem has affected his/her life over the past week. The patients also judged the severity of their eczema daily on a visual analogue scale. Both groups improved in terms of eczema and DLQI. However, the clinical scoring demonstrated that once daily application of corticosteroid was superior to twice daily application in diminishing eczema, especially in the group of patients with lower eczema scores at inclusion. Twice daily use of corticosteroids was not superior to once daily use in treating eczema. On the contrary, the clinical assessment showed a larger benefit from once daily treatment compared with twice daily, especially in the group of patients with a moderate eczema at inclusion. © 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.

Rain pH estimation based on the particulate matter pollutants and wet deposition study.

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Singh, Shweta; Elumalai, Suresh Pandian; Pal, Asim Kumar

2016-09-01

In forecasting of rain pH, the changes caused by particulate matter (PM) are generally neglected. In regions of high PM concentration like Dhanbad, the role of PM in deciding the rain pH becomes important. Present work takes into account theoretical prediction of rain pH by two methods. First method considers only acid causing gases (ACG) like CO2, SO2 and NOx in pH estimation, whereas, second method additionally accounts for effect of PM (ACG-PM). In order to predict the rain pH, site specific deposited dust that represents local PM was studied experimentally for its impact on pH of neutral water. After incorporation of PM correction factor, it was found that, rain pH values estimated were more representative of the observed ones. Fractional bias (FB) for the ACG-PM method reduced to values of the order of 10(-2) from those with order of 10(-1) for the ACG method. The study confirms neutralization of rain acidity by PM. On account of this, rain pH was found in the slightly acidic to near neutral range, despite of the high sulfate flux found in rain water. Although, the safer range of rain pH blurs the severity of acid rain from the picture, yet huge flux of acidic and other ions get transferred to water bodies, soil and ultimately to the ground water system. Simple use of rain pH for rain water quality fails to address the issues of its increased ionic composition due to the interfering pollutants and thus undermines severity of pollutants transferred from air to rain water and then to water bodies and soil. Copyright © 2016 Elsevier B.V. All rights reserved.

Group cognitive behavioural therapy for postnatal depression: a systematic review of clinical effectiveness, cost-effectiveness and value of information analyses.

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Stevenson, M D; Scope, A; Sutcliffe, P A; Booth, A; Slade, P; Parry, G; Saxon, D; Kalthenthaler, E

2010-09-01

Postnatal depression (PND) describes a wide range of distressing symptoms that can occur in women following childbirth. There is substantial evidence to support the use of cognitive behaviour therapy (CBT) in the treatment of depression, and psychological therapies are recommended by the National Institute for Health and Clinical Excellence as a first-line treatment for PND. However, access is limited owing to expense, waiting lists and availability of therapists. Group CBT may, therefore, offer a solution to these problems by reducing therapist time and increasing the number of available places for treatment. To evaluate the clinical effectiveness and cost-effectiveness of group CBT compared with currently used packages of care for women with PND. Seventeen electronic bibliographic databases were searched (for example MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, PsycINFO, etc.), covering biomedical, health-related, science, social science and grey literature (including current research). Databases were searched from 1950 to January 2008. In addition, the reference lists of relevant articles were checked and various health services' related resources were consulted via the internet. The study population included women in the postpartum period (up to 1 year), meeting the criteria of a standardised PND diagnosis using the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, or scoring above cut-off on the Edinburgh Postnatal Depression Scale (EPDS). No exclusion was made on the basis of the standardised depression screening/case finding instrument of standardised clinical assessment tool used to define PND. All full papers were read by two reviewers (AS and DS) who made independent decisions regarding inclusion or exclusion, and consensus, where possible, was obtained by meeting to compare decisions. In the event of disagreement, a third reviewer (EK) read the paper and made the decision. All data from included quantitative

Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS.

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McDermott, Imelda; Checkland, Kath; Coleman, Anna; Osipovič, Dorota; Petsoulas, Christina; Perkins, Neil

2017-01-01

Objectives To explore the 'added value' that general practitioners (GPs) bring to commissioning in the English NHS. We describe the experience of Clinical Commissioning Groups (CCGs) in the context of previous clinically led commissioning policy initiatives. Methods Realist evaluation. We identified the programme theories underlying the claims made about GP 'added value' in commissioning from interviews with key informants. We tested these theories against observational data from four case study sites to explore whether and how these claims were borne out in practice. Results The complexity of CCG structures means CCGs are quite different from one another with different distributions of responsibilities between the various committees. This makes it difficult to compare CCGs with one another. Greater GP involvement was important but it was not clear where and how GPs could add most value. We identified some of the mechanisms and conditions which enable CCGs to maximize the 'added value' that GPs bring to commissioning. Conclusion To maximize the value of clinical input, CCGs need to invest time and effort in preparing those involved, ensuring that they systematically gather evidence about service gaps and problems from their members, and engaging members in debate about the future shape of services.

Clinical outcomes of an early intervention program for preschool children with Autism Spectrum Disorder in a community group setting.

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Eapen, Valsamma; Crnčec, Rudi; Walter, Amelia

2013-01-07

Available evidence indicates that early intervention programs, such as the Early Start Denver Model (ESDM), can positively affect key outcomes for children with Autism Spectrum Disorder (ASD). However, programs involving resource intensive one-to-one clinical intervention are not readily available or deliverable in the community, resulting in many children with ASD missing out on evidence-based intervention during their early and most critical preschool years. This study evaluated the effectiveness of the ESDM for preschool-aged children with ASD using a predominantly group-based intervention in a community child care setting. Participants were 26 children (21 male) with ASD with a mean age of 49.6 months. The ESDM, a comprehensive early intervention program that integrates applied behaviour analysis with developmental and relationship-based approaches, was delivered by trained therapists during the child's attendance at a child care centre for preschool-aged children with ASD. Children received 15-20 hours of group-based, and one hour of one-to-one, ESDM intervention per week. The average intervention period was ten months. Outcome measures were administered pre- and post-intervention, and comprised a developmental assessment - the Mullen Scales of Early Learning (MSEL); and two parent-report questionnaires - the Social Communication Questionnaire (SCQ) and Vineland Adaptive Behaviours Scales-Second Edition (VABS-II). Statistically significant post-intervention improvements were found in children's performance on the visual reception, receptive language and expressive language domains of the MSEL in addition to their overall intellectual functioning, as assessed by standardised developmental quotients. Parents reported significant increases in their child's receptive communication and motor skills on the VABS-II, and a significant decrease in autism-specific features on the SCQ. These effects were of around medium size, and appeared to be in excess of what may

The Effect of Participation in Support Groups on Depression, Anxiety and Stress in Family Caregivers of People with Alzheimers: Randomized clinical trial

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Fahimeh Taati

2016-07-01

Full Text Available This study sought to determine the effect of participation in support groups on the depression, anxiety and stress level of caregivers of patients with Alzheimer. This study was a single blind randomized clinical controlled trial (RCT with 80 family caregivers of people with Alzheimer’s (per group=40. The intervention group participated in eight sessions 1.5- 2 hours in support groups. The tool used in this study was the DASS-21 questionnaire for measuring depression, anxiety and stress level of the caregivers, analysis of parametric data, using SPSS version 21. Findings showed, participation in support groups showed no significant difference on depression, anxiety and stress in family caregivers of Alzheimer patients in the control group and the intervention group. Given that caring for these patients by their family members are very sensitive and costly issues for policy makers and health service providers, community and families of these patients.

Reexamining the validity and reliability of the clinical version of the Iowa gambling task: Evidence from a normal subject group

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Ching-Hung eLin

2013-05-01

Full Text Available Over past decade, the Iowa gambling task (IGT has been utilized to test various decision deficits induced by neurological damage or psychiatric disorders. The IGT has recently been standardized for identifying 13 different neuropsychological disorders. Neuropsychological patients choose bad decks frequently, and normal subjects prefer good EV decks. However, the IGT has several validity and reliability problems. Some research groups have pointed out that the validity of IGT is influenced by the personality and emotional state of subjects. Additionally, several other studies have proposed that the prominent deck B phenomenon (PDB phenomenon – that is, normal subjects preferring bad deck B – may be the most serious problem confronting IGT validity. Specifically, deck B offers a high frequency of gains but negative EV. In the standard IGT administration, choice behavior can be understood with reference to gain-loss frequency (GLF rather than inferred future consequences (EV, the basic assumption of IGT. Furthermore, using two different criteria (basic assumption vs. professional norm results in significantly different classification results. Therefore, we recruited 72 normal subjects to test the validity and reliability of IGT. Each subject performed three runs of the computer-based clinical IGT version. The PDB phenomenon has been observed to a significant degree in the first and second stages of the clinical IGT version. Obviously, validity, reliability and the practice effect were unstable between two given stages. The present form of the clinical IGT version has only one stage, so its use should be reconsidered for examining normal decision makers; results from patient groups must also be interpreted with great care. GLF could be the main factor to be considered in establishing the constructional validity and reliability of the clinical IGT version.

Controlled low-temperature fabrication of ZnO nanopillars with a wet-chemical approach

Energy Technology Data Exchange (ETDEWEB)

Postels, B [Institute of Semiconductor Technology, Technical University of Braunschweig, Hans-Sommer-Strasse 66, D-38106 Braunschweig (Germany); Wehmann, H-H [Institute of Semiconductor Technology, Technical University of Braunschweig, Hans-Sommer-Strasse 66, D-38106 Braunschweig (Germany); Bakin, A [Institute of Semiconductor Technology, Technical University of Braunschweig, Hans-Sommer-Strasse 66, D-38106 Braunschweig (Germany); Kreye, M [Institute of Semiconductor Technology, Technical University of Braunschweig, Hans-Sommer-Strasse 66, D-38106 Braunschweig (Germany); Fuhrmann, D [Institute of Applied Physics, Technical University of Braunschweig, Mendelssohnstrasse 2, D-38106 Braunschweig (Germany); Blaesing, J [Institute of Experimental Physics, Otto-von-Guericke-University Magdeburg, Universitaetsplatz 1, 39016 Magdeburg (Germany); Hangleiter, A [Institute of Applied Physics, Technical University of Braunschweig, Mendelssohnstrasse 2, D-38106 Braunschweig (Germany); Krost, A [Institute of Experimental Physics, Otto-von-Guericke-University Magdeburg, Universitaetsplatz 1, 39016 Magdeburg (Germany); Waag, A [Institute of Semiconductor Technology, Technical University of Braunschweig, Hans-Sommer-Strasse 66, D-38106 Braunschweig (Germany)

2007-05-16

Aqueous chemical growth (ACG) is an efficient way to generate wafer-scale and densely packed arrays of ZnO nanopillars on various substrate materials. ACG is a low-temperature growth approach that is only weakly influenced by the substrate and even allows growth on flexible polymer substrates or on conducting materials. The advanced fabrication of wafer-scale and highly vertically aligned arrays of ZnO nanopillars on various substrate materials is demonstrated. Moreover, it is possible to control the morphology in diameter and length by changing the growth conditions. Photoluminescence characterization clearly shows a comparatively strong band-edge luminescence, even at room temperature, that is accompanied by a rather weak visible luminescence in the yellow/orange spectral range.

Stemcell Information: SKIP000802 [SKIP Stemcell Database[Archive

Lifescience Database Archive (English)

Full Text Available pe II (ACG2) ... 200610 ... 0-9 Male ... Yes No ACG II(S2011-46)-specific iPS cells. Ⅱ型コラーゲン異常症患者線維芽細胞(S2011-46)由来iPS細胞...or iPS Cell Research and Application, Kyoto University 京都大学iPS細胞研究所 ... Information Only Center for iPS Cell... Research and Application,Kyoto University 京都大学iPS細胞研究所　CiRA https://www.cira.kyoto-u.ac.jp/e/index.html ... ...by directed conversion and induced pluripotent stem cells. Okada M, Ikegawa S, Morioka M, Yamashita A, Saito

Clinical Trials

Medline Plus

Full Text Available ... part. Randomization Most clinical trials that have comparison groups use randomization. This involves assigning patients to different comparison groups by chance, rather than choice. This ...

Ajuste do modelo fototérmico de estimativa do desenvolvimento e do índice de área foliar de soja Adjustment of the photothermic model to estimate soybean development and leaf area index

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Neila T. Toledo

2010-03-01

Full Text Available Visou-se neste estudo, realizar o ajuste do modelo de estimativa do desenvolvimento de populações de soja e da variação do índice de área foliar para a variedade IAS 5. Como fonte de variação na velocidade de desenvolvimento, diferentes épocas de plantio foram utilizadas em experimentos nos anos agrícolas de 2004/2005 (três datas e 2005/2006 (quatro datas no IRDeR (Instituto Regional de Desenvolvimento Rural localizado em Augusto Pestana, RS (28º 27' 17" S e 53º 54' 50" W, nos quais foram identificadas as datas em que ocorreram as principais fases do desenvolvimento da cultura da soja, seguindo a Escala Fenológica de Fehr & Caviness e estimados o índice de área foliar em quatro momentos: no final do período de instalação da população vegetal (V6; no início do florescimento (R1; início do enchimento de grãos (R5; e no início da maturação (R7. As variáveis meteorológicas temperaturas mínima e máxima diárias foram coletadas. Após o ajuste dos coeficientes genéticos, o modelo foi formatado no programa Stella 5.0. O modelo de estimativa do desenvolvimento da soja teve desempenho satisfatório, apresentando estimativas precisas para os dados que o determinaram. O modelo de estimativa do índice de área foliar apresentou estimativas satisfatórias.The present study was carried out to adjust the soy population development model and the leaf area index model for the IAS 5 cultivar. Different sowing dates were used in two experiments as source of development variation during 2004/2005 (three dates and 2005/2006 (four dates in the IRDeR (Instituto Regional de Desenvolvimento Rural located in Augusto Pestana, in the State of Rio Grande do Sul (28º 27' 17" S and 53º 54' 50" W. The main crop development phases were identified according to the Feher & Caviness phenological scale, and the leaf area index was determined in four occasions: at the final period of plant population installation (V6; at the beginning of flowering

Effects of basic clinical skills training on objective structured clinical examination performance.

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Jünger, Jana; Schäfer, Sybille; Roth, Christiane; Schellberg, Dieter; Friedman Ben-David, Miriam; Nikendei, Christoph

2005-10-01

The aim of curriculum reform in medical education is to improve students' clinical and communication skills. However, there are contradicting results regarding the effectiveness of such reforms. A study of internal medicine students was carried out using a static group design. The experimental group consisted of 77 students participating in 7 sessions of communication training, 7 sessions of skills-laboratory training and 7 sessions of bedside-teaching, each lasting 1.5 hours. The control group of 66 students from the traditional curriculum participated in equally as many sessions but was offered only bedside teaching. Students' cognitive and practical skills performance was assessed using Multiple Choice Question (MCQ) testing and an objective structured clinical examination (OSCE), delivered by examiners blind to group membership. The experimental group performed significantly better on the OSCE than did the control group (P < 0.01), whereas the groups did not differ on the MCQ test (P < 0.15). This indicates that specific training in communication and basic clinical skills enabled students to perform better in an OSCE, whereas its effects on knowledge did not differ from those of the traditional curriculum. Curriculum reform promoting communication and basic clinical skills are effective and lead to an improved performance in history taking and physical examination skills.

[Group psychotherapy. Working team in community psychiatry].

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Quevedo, J S; Barrera, E H

1977-01-01

A Community Psychiatry program was begun, based on the needs and requests of a clinic (this approach is restricted because there are institutional factors that only the institution can change). The work was aimed at sensitizing the beneficiaries and change clinic factors modifiable through operative group technique. When a great deal of every day stereotypes appeared, role playing was used: as a result, people in the clinic realized how they acted and how they asked from others behaviors that they themselves found difficult to show. As results, it was found that when workers were confronted with reality, desertion from operative groups appeared, with projection of problems (them, not me), great fear of change (fantasized in different ways), group passivity and the image of the institution, that the group saw as a persecutor.

Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis

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Pavlovic Nada J

2007-07-01

Full Text Available Abstract Background To identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices. Methods Within-groups analysis of responses to semi-structured interviews. Interviews consisted of using prototypes in response to task-based scenarios. The prototypes were implemented on two different form factors: a tablet style PC and a pocketPC. Participants were from three user groups: general internists, family physicians and medicine residents, and from two different settings: urban and semi-urban. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts of the testing sessions. Statistical relationships were investigated between staff physicians' and residents' background variables, self-reported experiences with the interfaces, and verbal code frequencies. Results 47 physicians were recruited from general internal medicine, family practice clinics and a residency training program. The mean age of participants was 42.6 years. Physician specialty had a greater effect on device and information-presentation preferences than gender, age, setting or previous technical experience. Family physicians preferred the screen size of the tablet computer and were less concerned about its portability. Residents liked the screen size of the tablet, but preferred the portability of the pocketPC. Internists liked the portability of the pocketPC, but saw less advantage to the large screen of the tablet computer (F[2,44] = 4.94, p = .012. Conclusion Different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization.

Primary care-led commissioning: applying lessons from the past to the early development of clinical commissioning groups in England.

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Checkland, Kath; Coleman, Anna; McDermott, Imelda; Segar, Julia; Miller, Rosalind; Petsoulas, Christina; Wallace, Andrew; Harrison, Stephen; Peckham, Stephen

2013-09-01

The current reorganisation of the English NHS is one of the most comprehensive ever seen. This study reports early evidence from the development of clinical commissioning groups (CCGs), a key element in the new structures. To explore the development of CCGs in the context of what is known from previous studies of GP involvement in commissioning. Case study analysis from sites chosen to provide maximum variety across a number of dimensions, from September 2011 to June 2012. A case study analysis was conducted using eight detailed qualitative case studies supplemented by descriptive information from web surveys at two points in time. Data collection involved observation of a variety of meetings, and interviews with key participants. Previous research shows that clinical involvement in commissioning is most effective when GPs feel able to act autonomously. Complicated internal structures, alongside developing external accountability relationships mean that CCGs' freedom to act may be subject to considerable constraint. Effective GP engagement is also important in determining outcomes of clinical commissioning, and there are a number of outstanding issues for CCGs, including: who feels 'ownership' of the CCG; how internal communication is conceptualised and realised; and the role and remit of locality groups. Previous incarnations of GP-led commissioning have tended to focus on local and primary care services. CCGs are keen to act to improve quality in their constituent practices, using approaches that many developed under practice-based commissioning. Constrained managerial support and the need to maintain GP engagement may have an impact. CCGs are new organisations, faced with significant new responsibilities. This study provides early evidence of issues that CCGs and those responsible for CCG development may wish to address.

Intranasal Midazolam versus Rectal Diazepam for the Management of Canine Status Epilepticus: A Multicenter Randomized Parallel-Group Clinical Trial.

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Charalambous, M; Bhatti, S F M; Van Ham, L; Platt, S; Jeffery, N D; Tipold, A; Siedenburg, J; Volk, H A; Hasegawa, D; Gallucci, A; Gandini, G; Musteata, M; Ives, E; Vanhaesebrouck, A E

2017-07-01

Intranasal administration of benzodiazepines has shown superiority over rectal administration for terminating emergency epileptic seizures in human trials. No such clinical trials have been performed in dogs. To evaluate the clinical efficacy of intranasal midazolam (IN-MDZ), via a mucosal atomization device, as a first-line management option for canine status epilepticus and compare it to rectal administration of diazepam (R-DZP) for controlling status epilepticus before intravenous access is available. Client-owned dogs with idiopathic or structural epilepsy manifesting status epilepticus within a hospital environment were used. Dogs were randomly allocated to treatment with IN-MDZ (n = 20) or R-DZP (n = 15). Randomized parallel-group clinical trial. Seizure cessation time and adverse effects were recorded. For each dog, treatment was considered successful if the seizure ceased within 5 minutes and did not recur within 10 minutes after administration. The 95% confidence interval was used to detect the true population of dogs that were successfully treated. The Fisher's 2-tailed exact test was used to compare the 2 groups, and the results were considered statistically significant if P status epilepticus in 70% (14/20) and 20% (3/15) of cases, respectively (P = .0059). All dogs showed sedation and ataxia. IN-MDZ is a quick, safe and effective first-line medication for controlling status epilepticus in dogs and appears superior to R-DZP. IN-MDZ might be a valuable treatment option when intravenous access is not available and for treatment of status epilepticus in dogs at home. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents: Effects of Acceptance and Commitment Therapy on Functioning

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Marie Kanstrup

2016-11-01

Full Text Available Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions, including a parent support program (four sessions. Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12 or individual (n = 18 treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p < 0.01 improvements (medium to large effects in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01 improvements (large effects in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%–63% of the adolescents across the different outcome measures and in 54%–76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.

Sample size determinations for group-based randomized clinical trials with different levels of data hierarchy between experimental and control arms.

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Heo, Moonseong; Litwin, Alain H; Blackstock, Oni; Kim, Namhee; Arnsten, Julia H

2017-02-01

We derived sample size formulae for detecting main effects in group-based randomized clinical trials with different levels of data hierarchy between experimental and control arms. Such designs are necessary when experimental interventions need to be administered to groups of subjects whereas control conditions need to be administered to individual subjects. This type of trial, often referred to as a partially nested or partially clustered design, has been implemented for management of chronic diseases such as diabetes and is beginning to emerge more commonly in wider clinical settings. Depending on the research setting, the level of hierarchy of data structure for the experimental arm can be three or two, whereas that for the control arm is two or one. Such different levels of data hierarchy assume correlation structures of outcomes that are different between arms, regardless of whether research settings require two or three level data structure for the experimental arm. Therefore, the different correlations should be taken into account for statistical modeling and for sample size determinations. To this end, we considered mixed-effects linear models with different correlation structures between experimental and control arms to theoretically derive and empirically validate the sample size formulae with simulation studies.

Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills--a controlled study.

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Perrig, Martin; Berendonk, Christoph; Rogausch, Anja; Beyeler, Christine

2016-01-28

The discrepancy between the extensive impact of musculoskeletal complaints and the common deficiencies in musculoskeletal examination skills lead to increased emphasis on structured teaching and assessment. However, studies of single interventions are scarce and little is known about the time-dependent effect of assisted learning in addition to a standard curriculum. We therefore evaluated the immediate and long-term impact of a small group course on musculoskeletal examination skills. All 48 Year 4 medical students of a 6 year curriculum, attending their 8 week clerkship of internal medicine at one University department in Berne, participated in this controlled study. Twenty-seven students were assigned to the intervention of a 6×1 h practical course (4-7 students, interactive hands-on examination of real patients; systematic, detailed feedback to each student by teacher, peers and patients). Twenty-one students took part in the regular clerkship activities only and served as controls. In all students clinical skills (CS, 9 items) were assessed in an Objective Structured Clinical Examination (OSCE) station, including specific musculoskeletal examination skills (MSES, 7 items) and interpersonal skills (IPS, 2 items). Two raters assessed the skills on a 4-point Likert scale at the beginning (T0), the end (T1) and 4-12 months after (T2) the clerkship. Statistical analyses included Friedman test, Wilcoxon rank sum test and Mann-Whitney U test. At T0 there were no significant differences between the intervention and control group. At T1 and T2 the control group showed no significant changes of CS, MSES and IPS compared to T0. In contrast, the intervention group significantly improved CS, MSES and IPS at T1 (p skills during regular clinical clerkship activities. However, an additional small group, interactive clinical skills course with feedback from various sources, improved these essential examination skills immediately after the teaching and several months later

Integrated DNA methylation and copy-number profiling identify three clinically and biologically relevant groups of anaplastic glioma.

Science.gov (United States)

Wiestler, Benedikt; Capper, David; Sill, Martin; Jones, David T W; Hovestadt, Volker; Sturm, Dominik; Koelsche, Christian; Bertoni, Anna; Schweizer, Leonille; Korshunov, Andrey; Weiß, Elisa K; Schliesser, Maximilian G; Radbruch, Alexander; Herold-Mende, Christel; Roth, Patrick; Unterberg, Andreas; Hartmann, Christian; Pietsch, Torsten; Reifenberger, Guido; Lichter, Peter; Radlwimmer, Bernhard; Platten, Michael; Pfister, Stefan M; von Deimling, Andreas; Weller, Michael; Wick, Wolfgang

2014-10-01

The outcome of patients with anaplastic gliomas varies considerably. Whether a molecular classification of anaplastic gliomas based on large-scale genomic or epigenomic analyses is superior to histopathology for reflecting distinct biological groups, predicting outcomes and guiding therapy decisions has yet to be determined. Epigenome-wide DNA methylation analysis, using a platform which also allows the detection of copy-number aberrations, was performed in a cohort of 228 patients with anaplastic gliomas (astrocytomas, oligoastrocytomas, and oligodendrogliomas), including 115 patients of the NOA-04 trial. We further compared these tumors with a group of 55 glioblastomas. Unsupervised clustering of DNA methylation patterns revealed two main groups correlated with IDH status: CpG island methylator phenotype (CIMP) positive (77.5 %) or negative (22.5 %). CIMP(pos) (IDH mutant) tumors showed a further separation based on copy-number status of chromosome arms 1p and 19q. CIMP(neg) (IDH wild type) tumors showed hallmark copy-number alterations of glioblastomas, and clustered together with CIMP(neg) glioblastomas without forming separate groups based on WHO grade. Notably, there was no molecular evidence for a distinct biological entity representing anaplastic oligoastrocytoma. Tumor classification based on CIMP and 1p/19q status was significantly associated with survival, allowing a better prediction of outcome than the current histopathological classification: patients with CIMP(pos) tumors with 1p/19q codeletion (CIMP-codel) had the best prognosis, followed by patients with CIMP(pos) tumors but intact 1p/19q status (CIMP-non-codel). Patients with CIMP(neg) anaplastic gliomas (GBM-like) had the worst prognosis. Collectively, our data suggest that anaplastic gliomas can be grouped by IDH and 1p/19q status into three molecular groups that show clear links to underlying biology and a significant association with clinical outcome in a prospective trial cohort.

Cost justification of clinical pharmacy services on a general surgery team: focus on diagnosis-related group cases.

Science.gov (United States)

Bertch, K E; Hatoum, H T; Willett, M S; Witte, K W

1988-11-01

We used a novel approach to cost-justify clinical pharmacy services on a general surgery team in nine diagnosis-related group cases. The clinical pharmacist monitored nine patients longitudinally on a general surgery team from admission to discharge and intervened in their therapeutic management. Each recommendation was analyzed for rationale, acceptance, perceived impact on quality and/or cost of patient care, whether self-initiated or solicited, and impact on patient outcome. Types of recommendations and outcomes were categorized by process and outcome measurement criteria. Total cost avoidance per patient was calculated using costs of drug therapy, laboratory tests, and length of stay. Accounting for cost of clinical pharmacy services, net cost avoidance per patient was calculated. The clinical pharmacist made 101 recommendations on nine patients. Physicians accepted 82 percent of the recommendations; 77 percent of the recommendations were self-initiated and 23 percent were solicited. Recommendations had a perceived impact on cost, quality, or both at 13, 31, and 56 percent, respectively. Most recommendations (79 percent) brought patient therapy to a level of conformance with current standards of practice as documented in the medical literature. Recommendations that potentially preserved a major organ function by preventing drug-induced toxicity or the exacerbation of existing problems constituted 16 percent of the total. None of the accepted recommendations adversely affected patient outcome and 23 percent directly resulted in a measurable positive outcome in patient care. A total of four hospital days was potentially saved for two cases. Based on objective outcome criteria, a 1.9-day increase in therapeutic control was documented per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials

Medline Plus

Full Text Available ... Some companies and groups sponsor clinical trials that test the safety of products, such as medicines, and how well they work. The U.S. Food and Drug Administration (FDA) oversees these clinical trials. ...

Clinical Trials

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Full Text Available ... best data available for health care decisionmaking. The purpose of clinical trials is research, so the studies ... Thus, research in humans is needed. For safety purposes, clinical trials start with small groups of patients ...

Clinical Trials

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Full Text Available ... whether a new approach causes any harm. In later phases of clinical trials, researchers learn more about ... other National Institutes of Health (NIH) Institutes and Centers sponsor clinical trials. Many other groups, companies, and ...

Clinical Trials

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Full Text Available ... sponsor clinical trials. Many other groups, companies, and organizations also sponsor clinical trials. Examples include Government Agencies, ... and Veterans Affairs; private companies; universities; and nonprofit organizations. NIH Institutes and Centers (including the NHLBI) usually ...

Influence of a sampling review process for radiation oncology quality assurance in cooperative group clinical trials -- results of the Radiation Therapy Oncology Group (RTOG) analysis

International Nuclear Information System (INIS)

Martin, Linda A.; Krall, John M.; Curran, Walter J.; Leibel, Steven A.; Cox, James D.

1995-01-01

The Radiation Therapy Oncology Group (RTOG) designed a random sampling process and observed its influence upon radiotherapy review mechanisms in cooperative group clinical trials. The method of sampling cases for review was modeled from sampling techniques commonly used in pharmaceutical quality assurance programs, and applied to the initial (on-study) review of protocol cases. 'In control' (IC) status is defined for a given facility as the ability to meet minimum compliance standards. Upon achieving IC status, activation of the sampling process was linked to the rate of continued patient accrual for each participating institution in a given protocol. The sampling design specified that ≥ 30% cases not in compliance would be detected with 80% power. A total of 458 cases was analyzed for initial review findings in four RTOG Phase III protocols. Initial review findings were compared with retrospective (final) review results. Of the 458 cases analyzed, 370 underwent initial review at on-study, while 88 did not require review as they were enrolled from institutions that had demonstrated protocol compliance. In the group that had both initial and final review, (345(370)) (93%) were found to have followed the protocol or had a minor variation. Of the exempted cases, (79(88)) (90%) were found to be per protocol or a minor variant. The sampling process proved itself to be cost-effective and resulted in a noticeable reduction in the workload, thus providing an improved approach to resource allocation for the group. Continued evaluation of the sampling mechanism is appropriate as study designs and participants vary over time, and as more data become available to study. Further investigation of individual protocol compliance is appropriate to identify problems specific to new trial investigations

Clinical Trials

Medline Plus

Full Text Available ... and Centers sponsor clinical trials. Many other groups, companies, and organizations also sponsor clinical trials. Examples include ... U.S. Departments of Defense and Veterans Affairs; private companies; universities; and nonprofit organizations. NIH Institutes and Centers ( ...

Increasing antimicrobial resistance in clinical isolates of Staphylococcus intermedius group bacteria and emergence of MRSP in the UK.

Science.gov (United States)

Beever, L; Bond, R; Graham, P A; Jackson, B; Lloyd, D H; Loeffler, A

2015-02-14

Frequencies of antimicrobial resistance were determined amongst 14,555 clinical Staphylococcus intermedius group (SIG) isolates from UK dogs and cats to estimate resistance trends and quantify the occurrence of meticillin-resistant Staphylococcus pseudintermedius (MRSP). Reports from two diagnostic laboratories (13,313 general submissions, 1242 referral centre only submissions) were analysed retrospectively (2003/2006-2012). MRSP were defined by phenotypic resistance to meticillin and concurrent broad β-lactam resistance; a subset was confirmed genetically (SIG-specific nuc and mecA). Trends were analysed by Cochran-Armitage test. Resistance remained below 10 per cent for cefalexin, amoxicillin-clavulanic acid and the fluoroquinolones. Increasing resistance trends were seen in both laboratories for ampicillin/amoxicillin (both PResistance to cefalexin increased over time in referral hospital isolates (Presistance to important antimicrobials was identified overtime and the emergence of MRSP from UK clinical cases was confirmed. Attention to responsible use of antibacterial therapy in small animal practice is urgently needed. British Veterinary Association.

A Systematic Review of CPAP Adherence Across Age Groups: Clinical and Empiric Insights for Developing CPAP Adherence Interventions

Science.gov (United States)

Sawyer, A.M.; Gooneratne, N.; Marcus, C.L.; Ofer, D.; Richards, K.C.; Weaver, T.E.

2011-01-01

Continuous positive airway pressure (CPAP) is a highly efficacious treatment for obstructive sleep apnea (OSA) but adherence to the treatment limits its overall effectiveness across all age groups of patients. Factors that influence adherence to CPAP include disease and patient characteristics, treatment titration procedures, technological device factors and side effects, and psychological and social factors. These influential factors have guided the development of interventions to promote CPAP adherence. Various intervention strategies have been described and include educational, technological, psychosocial, pharmacological, and multi-dimensional approaches. Though evidence to date has led to innovative strategies that address adherence in CPAP-treated children, adults, and older adults, significant opportunities exist to develop and test interventions that are clinically applicable, specific to subgroups of patients likely to demonstrate poor adherence, and address the multifactorial nature of CPAP adherence. The translation of CPAP adherence promotion interventions to clinical practice is imperative to improve health and functional outcomes in all persons with CPAP-treated OSA. PMID:21652236

Diabetes mellitus and abnormal glucose tolerance development after gestational diabetes: A three-year, prospective, randomized, clinical-based, Mediterranean lifestyle interventional study with parallel groups.

Science.gov (United States)

Pérez-Ferre, Natalia; Del Valle, Laura; Torrejón, Maria José; Barca, Idoya; Calvo, María Isabel; Matía, Pilar; Rubio, Miguel A; Calle-Pascual, Alfonso L

2015-08-01

Women with prior gestational diabetes mellitus (GDM) have a high risk of developing type 2 diabetes mellitus (DM2) in later life. The study aim was to evaluate the efficacy of a lifestyle intervention for the prevention of glucose disorders (impaired fasting glucose, impaired glucose tolerance or DM2) in women with prior GDM. A total of 260 women with prior GDM who presented with normal fasting plasma glucose at six to twelve weeks postpartum were randomized into two groups: a Mediterranean lifestyle intervention group (n = 130) who underwent an educational program on nutrition and a monitored physical activity program and a control group (n = 130) with a conventional follow-up. A total of 237 women completed the three-year follow-up (126 in the intervention group and 111 in the control group). Their glucose disorders rates, clinical and metabolic changes and rates of adherence to the Mediterranean lifestyle were analyzed. Less women in the intervention group (42.8%) developed glucose disorders at the end of the three-year follow-up period compared with the control group (56.75%), p Lifestyle intervention was effective for the prevention of glucose disorders in women with prior GDM. Body weight gain and an unhealthy fat intake pattern were found to be the most predictive factors for the development of glucose disorders. Current Controlled trials: ISRCTN24165302. http://www.controlled-trials.com/isrctn/pf/24165302. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Ajuste teórico de las curvas PTCR de BaTiO3 dopado con niobio

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Castro, M. S.

2002-02-01

Full Text Available In this work, a theoretical fitting to the experimental PTCR effect in slightly Nb-doped BaTiO3 from the Heywang-Jonker model is simulated. Besides, a qualitative approach was used to evaluate the GBBL characteristics of strongly Nb - doped BaTiO3. In both cases, a link between the electrical properties and the defect profile developed in these based - BaTiO3 ceramics was established. From the results, good agreement between experimental and calculated results was obtained for the PTCR ceramics. Asmall increment in Nb2O5 concentration leads to an increasing in the concentration of occupied acceptor states, the energy of the surface state and also the barrier height. In these cases, microstructural observations shown an important grain growth with average grain size between 10 and 100μm. EPR results clearly indicate low concentration of cationic vacancies for these materials. This phenomenon is associated to a charge-compensation mechanism in slightly-doped BaTiO3, that result in a semiconducting behaviour. On the other hand, the electrical behaviour of strongly–doped BaTiO3 moves away from the PTCR effect, and the material becomes insulating with noticeable GBBL characteristics. In this case, microstructural observations along defect structure analysis encourage the hypothesis in which barium vacancies act as acceptor at grain boundaries and play and important role in restricting grain growth of Nb2O5-BaTiO3 ceramics.En este trabajo se determinó la influencia de la concentración de Nb2O5 sobre el comportamiento PTCR de cerámicos basados en BaTiO3. Por otra parte, se estudió el impacto de una gran concentración del dopante sobre el comportamiento GBBL del BaTiO3. En ambos casos, se estableció una relación entre las propiedades eléctricas observadas y la estructura de defectos iónicos desarrollada. La aplicación del modelo de Heywang-Jonker permite el ajuste teórico de las curvas de resistividad – temperatura de los cerámicos PTCR

[Pharmacokinetics and clinical studies on flomoxef in neonates and premature infants. A study of flomoxef in the perinatal collaboration research group].

Science.gov (United States)

Fujii, R; Fujita, K; Murono, K; Saijo, M; Kakuya, F; Yoshioka, H; Maruyama, S; Sakata, H; Hiramoto, A; Inyaku, F

1993-07-01

We investigated pharmacokinetics and clinical effects of flomoxef sodium (6315-S, FMOX) in neonates and premature infants. These results are summarized as follows: 1. Pharmacokinetics (1) Plasma concentration (Ct) and half-lives (T1/2) were determined upon after intravenous one-shot injection (i.v.) of FMOX to neonates of different day-age groups (0-3 (n = 25), 4-7 (n = 18), 8-28 (n = 32) days of birth). At a dose of 10 mg/kg. i.v., mean C30 (30 minutes concentration) values were 21.2, 21.8 and 21.3 micrograms/ml, respectively, in the different groups mentioned above, and the mean T1/2 values were 3.37, 1.85 and 1.63 hours. At 20 mg/kg i.v., mean C15 (15 minutes concentration) values were 54.4, 51.4 and 50.7 micrograms/ml, and mean T1/2's were 2.99, 2.32 and 1.79 hours, respectively. At a dose of 40 mg/kg i.v., mean C15 values were 104.0, 95.9 and 99.2 micrograms/ml, and the mean T1/2's were 3.40, 1.20 and 1.80 hours, respectively. (2) Plasma concentrations and T1/2 after intravenous one-shot injection of FMOX in premature infants in group (0-3 (n = 14), 4-7 (n = 10), 8-28 (n = 13) days of birth). Mean C15's at doses of 10, 20 and 40 mg/kg in the different groups of infants were 24.0, 28.6, 21.7 and 54.0, 54.6, 55.5 and 98.2, 93.0, 106.0 micrograms/ml, and T1/2's were 4.10, 2.53, 2.57 and 4.28, 2.27, 3.02 and 4.66, 2.86, 2.09 hours, respectively. Mean Cmax values were clearly dose dependent, and mean T1/2 values tended to be longer in premature infants compared to neonates. (3) Urinary recovery rate of FMOX after intravenous injection in neonates and premature infants. Mean urinary recovery rates of FMOX in the first 6 hours after i.v. (one-shot) at doses of 10, 20 and 40 mg/kg to neonates and premature infants were 38.9-62.8% in the neonates and 30.7-61.5% in the premature infants. (4) Plasma concentrations and urinary recovery rates upon 1 hour drip infusion of 20 mg/kg in the neonate groups (or the premature infant groups) as follows: Mean C50 values were 31

Informed consent in oncology clinical trials: A Brown University Oncology Research Group prospective cross-sectional pilot study.

Directory of Open Access Journals (Sweden)

Andrew Schumacher

Full Text Available Informed consent forms (ICFs for oncology clinical trials have grown increasingly longer and more complex. We evaluated objective understanding of critical components of informed consent among patients enrolling in contemporary trials of conventional or novel biologic/targeted therapies.We evaluated ICFs for cancer clinical trials for length and readability, and patients registered on those studies were asked to complete a validated 14-question survey assessing their understanding of key characteristics of the trial. Mean scores were compared in groups defined by trial and patient characteristics.Fifty patients, of whom half participated in trials of immunotherapy or biologic/targeted agents and half in trials of conventional therapy, completed the survey. On average, ICFs for industry-originated trials (N = 9 trials were significantly longer (P < .0001 and had lower Flesch ease-of-reading scores (P = .003 than investigator-initiated trials (N = 11. At least 80% of patients incorrectly responded to three key questions which addressed the experimental nature of their trial therapy, its purported efficacy and potential risks relative to alternative treatments. The mean objective understanding score was 76.9±8.8, but it was statistically significantly lower for patients who had not completed high school (P = .011. The scores did not differ significantly by type of cancer therapy (P = .12 or trial sponsor (P = .38.Many participants enrolled on cancer trials had poor understanding of essential elements of their trial. In order to ensure true informed consent, innovative approaches, such as expanded in-person counseling adapted to the patient's education level or cultural characteristics should be evaluated across socio-demographic groups.Clinicaltrials.gov NCT01772511.

[Group psychotherapy. Experience with a changing process at a clinic of the Instituto del Servicio de Seguridad Social de los Trabajadores del Estado (ISSSTE)].

Science.gov (United States)

Velasco de Ongay, M E

1977-01-01

The problems of an ISSSTE clinic were approached within the general systems theory and it was observed that within the group there existed forces to maintain the status-quo and forces towards change; to produce the latter the group was handled during 20 hours with a slightly directive technique. The goals were to improve interpersonal relationships, to increase communication, to make known to individuals their attitudes within a group and make them sensitive to problems they shared with others. The results were good, the status-quo was broken and change started occurring.

Desarrollo de un modelo de predicción de riesgo de hospitalizaciones no programadas en el País Vasco

Directory of Open Access Journals (Sweden)

Juan F. Orueta Mendia

2014-01-01

Full Text Available Fundamentos: La hospitalizaciones son eventos indeseables que en ocasiones pueden ser evitados mediante intervenciones proactivas. El objetivo del estudio es determinar la capacidad de modelos basados en Adjusted Clinical Groups (ACGs en nuestro medio para identificar a los pacientes que presentarán ingresos no programados en los meses siguientes a su clasificación, tanto en la población general como en subpoblaciones de enfermos crónicos (diabetes mellitus, enfermedad pulmonar obstructiva crónica e insuficiencia cardiaca. Métodos: Estudio transversal que analizó información de un periodo de 2 años, de todos los residentes en Euskadi mayores de 14 años de edad (n=1.964.337. Los datos del primer año (demográficos, índice de privación socioeconómica, diagnósticos, prescripciones, procedimientos, ingresos y otros contactos con el servicio de salud sirvieron para construir las variables independientes. Las hospitalizaciones del segundo año, las dependientes. Se empleó el área bajo la curva ROC (AUC para evaluar la capacidad de los modelos en discriminar a los pacientes con hospitalizaciones y se calculó el valor predictivo positivo y la sensibilidad en diferentes puntos de corte. Resultados: En la población general, los modelos para predecir ingresos a los 6 y 12 meses así como hospitalizaciones prolongadas mostraron un comportamiento bueno (AUC>0,8, mientras que fue aceptable (AUC 0,7-0,8 en los grupos de pacientes crónicos. Conclusiones: Un sistema de estratificación de riesgo de ingresos, basado enACGs resulta válido y aplicable en nuestro medio. Estos modelos permiten clasificar a los pacientes en una escala de mayor a menor riesgo, lo cual hace posible la aplicación de las intervenciones preventivas más costosas solamente a un pequeño subgrupo de pacientes, mientras que otras menos intensivas pueden proporcionarse a grupos más amplios.

Extending the multicultural orientation (MCO) framework to group psychotherapy: A clinical illustration.

Science.gov (United States)

Kivlighan, D Martin; Chapman, Norah A

2018-03-01

Multicultural group work has received growing attention over the past two decades; however, there is a lack of conceptual frameworks to guide therapists' cultural processes within group therapy at present. As such, we extend the multicultural orientation (MCO) to group therapy in an effort to provide a conceptual framework for group therapists to effectively engage multicultural group work. The MCO framework was developed in an effort to operationalize therapists' cultural processes of cultural humility, cultural comfort, and cultural opportunity. Although the MCO framework has been empirically tested within an individual psychotherapy context, application to alternative therapeutic modalities is needed. Given the inherent multicultural nature of group therapy and calls for group therapist to be culturally competent in the delivery of group-based services, we extend the MCO framework to the practice of group therapy. In this article, we provide a rationale for the application of the MCO framework to the practice of group therapy, and illustrate how group therapists' cultural humility, comfort, and opportunities can assist in establishing a multicultural group orientation throughout the development of the group. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Group therapy for selective mutism - a parents' and children's treatment group.

Science.gov (United States)

Sharkey, Louise; Mc Nicholas, Fiona; Barry, Edwina; Begley, Maire; Ahern, Sinead

2008-12-01

To evaluate the feasibility and effectiveness of group therapy for children with selective mutism and their parents. Five children (mean age 6.1 years) with a diagnosis of selective mutism were administered group therapy over an 8-week period. Parents simultaneously attended a second group, aimed at providing education and advice on managing selective mutism in everyday situations, and in the school environment. At post-treatment, all children increased their level of confident speaking in school, clinic and community settings. Parents indicated a reduction in their own anxiety levels, from pre- to post-treatment on self-rating scales. Findings support the feasibility and effectiveness of group therapy for children with selective mutism and their parents.

MIBG avidity correlates with clinical features, tumor biology, and outcomes in neuroblastoma: A report from the Children's Oncology Group.